Acute care nurses' perceptions of barriers to using research information in clinical decision-making

Aim. To examine the barriers that nurses feel prevent them from using research in the decisions they make. Background. A sizeable research literature focusing on research utilization in nursing has developed over the past 20 years. However, this literature is characterized by a number of weaknesses: self-reported utilization behaviour; poor response rates and small, nonrandom sampling strategies. Design. Cross-case analysis involving anonymised qualitative interviews, observation, documentary audit and Q methodological modelling of shared subjectivities amongst nurses. The case sites were three large acute hospitals in the north of England. One hundred and eight nurses were interviewed, 61 of whom were also observed for a total of 180 h, and 122 nurses were involved in the Q modelling exercise (response rate of 64%). Results. Four perspectives were isolated that encompassed the characteristics associated with barriers to research use. These related to the individual, organization, nature of research information itself and environment. Nurses clustered around four main perspectives on the barriers to research use: (1) Problems in interpreting and using research products, which were seen as too complex, 'academic' and overly statistical; (2) Nurses who felt confident with research-based information perceived a lack of organizational support as a significant block; (3) Many nurses felt that researchers and research products lack clinical credibility and that they fail to offer the desired level of clinical direction; (4) Some nurses lacked the skills and, to a lesser degree, the motivation to use research themselves. These individuals liked research messages passed on to them by a third party and sought to foster others' involvement in research-based practice, rather than becoming directly involved themselves. Conclusions. Rejection of research knowledge is not a barrier to its application. Rather, the presentation and management of research knowledge in the workplace represent significant challenges for clinicians, policy-makers and the research community

The accessibility of research-based knowledge for nurses in United Kingdom acute care settings

Background. The successful dissemination of the results of the National Health Service (NHS) research and development strategy and the development of evidence based approaches to health care rely on clinicians having access to the best available evidence; evidence fit for the purpose of reducing the uncertainties associated with clinical decisions. Aim. To reveal the accessibility of those sources of information actually used by nurses, as well as those which they say they use. Design. Mixed method case site, using interview, observational, Q sort and documentary audit data in medical, surgical and coronary care units (CCUs) in three acute hospitals. Results. Three perspectives on accessibility were identified: (a) the humanist-in which human sources of information were the most accessible; (b) local information for local needs-in which locally produced resources were seen as the most accessible and (c) moving towards technology-in which information technology begins to be seen as accessible. Nurses' experience in a clinical specialty is positively associated with a perception that human sources such clinical nurse specialists, link nurses, doctors and experienced clinical colleagues are more accessible than text based sources. Clinical specialization is associated with different approaches to accessing research knowledge. Coronary care unit nurses were more likely perceive local guidelines, protocols and on-line databases as more accessible than their counterparts in general medical and surgical wards. Only a third of text-based resources available to nurses oil the wards had any explicit research base. These, and the remainder were Out of date (mean age of textbooks 11 years), and authorship hard to ascertain. Conclusion. A strategy to increase the use of research evidence by nurses should harness the influence of clinical nurse specialists, link nurses and those engaged in practice development. These roles Could act as 'conduits' through which research-based messages for practice, and information for clinical decision making, could flow. This role should be explored and enhanced

The importance of planetary rotation period for ocean heat transport

The climate, and hence potential habitability, of a planet crucially depends on how its atmospheric and oceanic circulation transports heat from warmer to cooler regions. However, previous studies of planetary climate have concentrated on modelling the dynamics of their atmospheres whilst dramatically simplifying the treatment of the oceans, which neglects or misrepresents the effect of the ocean in the total heat transport. Even the majority of studies with a dynamic ocean have used a simple so-called aquaplanet having no continental barriers, which is a configuration which dramatically changes the oceanic dynamics. Here the significance of the response of poleward ocean heat transport to planetary rotation period is shown with a simple meridional barrier – the simplest representation of any continental configuration. The poleward ocean heat transport increases significantly as the planetary rotation period is increased. The peak heat transport more than doubles when the rotation period is increased by a factor of ten. There are also significant changes to ocean temperature at depth, with implications for the carbon cycle. There is strong agreement between the model results and a scale analysis of the governing equations. This result highlights the importance of both planetary rotation period and the ocean circulation when considering planetary habitability

Ordered and periodic chaos of the bounded one dimensinal multibarrier potential

Numerical analysis indicates that there exists an unexpected new ordered chaos for the bounded one-dimensional multibarrier potential. For certain values of the number of barriers, repeated identical forms (periods) of the wavepackets result upon passing through the multibarrier potential.Comment: 16 pages, 9 figures, 1 Table. Some former text removed and other introduce

What's the evidence that NICE guidance has been implemented? Results from a national evaluation using time series analysis, audit of patients' notes, and interviews

OBJECTIVES: To assess the extent and pattern of implementation of guidance issued by the National Institute for Clinical Excellence (NICE). DESIGN: Interrupted time series analysis, review of case notes, survey, and interviews. SETTING: Acute and primary care trusts in England and Wales. PARTICIPANTS: All primary care prescribing, hospital pharmacies; a random sample of 20 acute trusts, 17 mental health trusts, and 21 primary care trusts; and senior clinicians and managers from five acute trusts. MAIN OUTCOME MEASURES: Rates of prescribing and use of procedures and medical devices relative to evidence based guidance. RESULTS: 6308 usable patient audit forms were returned. Implementation of NICE guidance varied by trust and by topic. Prescribing of some taxanes for cancer (P <0.002) and orlistat for obesity (P <0.001) significantly increased in line with guidance. Prescribing of drugs for Alzheimer’s disease and prophylactic extraction of wisdom teeth showed trends consistent with, but not obviously a consequence of, the guidance. Prescribing practice often did not accord with the details of the guidance. No change was apparent in the use of hearing aids, hip prostheses, implantable cardioverter defibrillators, laparoscopic hernia repair, and laparoscopic colorectal cancer surgery after NICE guidance had been issued. CONCLUSIONS: Implementation of NICE guidance has been variable. Guidance seems more likely to be adopted when there is strong professional support, a stable and convincing evidence base, and no increased or unfunded costs, in organisations that have established good systems for tracking guidance implementation and where the professionals involved are not isolated. Guidance needs to be clear and reflect the clinical context

Local electronic nematicity in the one-band Hubbard model

Nematicity is a well known property of liquid crystals and has been recently discussed in the context of strongly interacting electrons. An electronic nematic phase has been seen by many experiments in certain strongly correlated materials, in particular, in the pseudogap phase generic to many hole-doped cuprate superconductors. Recent measurements in high $T_c$ superconductors has shown even if the lattice is perfectly rotationally symmetric, the ground state can still have strongly nematic local properties. Our study of the two-dimensional Hubbard model provides strong support of the recent experimental results on local rotational $C_4$ symmetry breaking. The variational cluster approach is used here to show the possibility of an electronic nematic state and the proximity of the underlying symmetry-breaking ground state within the Hubbard model. We identify this nematic phase in the overdoped region and show that the local nematicity decreases with increasing electron filling. Our results also indicate that strong Coulomb interaction may drive the nematic phase into a phase similar to the stripe structure. The calculated spin (magnetic) correlation function in momentum space shows the effects resulting from real-space nematicity

Interaction effects and quantum phase transitions in topological insulators

We study strong correlation effects in topological insulators via the Lanczos algorithm, which we utilize to calculate the exact many-particle ground-state wave function and its topological properties. We analyze the simple, noninteracting Haldane model on a honeycomb lattice with known topological properties and demonstrate that these properties are already evident in small clusters. Next, we consider interacting fermions by introducing repulsive nearest-neighbor interactions. A first-order quantum phase transition was discovered at finite interaction strength between the topological band insulator and a topologically trivial Mott insulating phase by use of the fidelity metric and the charge-density-wave structure factor. We construct the phase diagram at $T = 0$ as a function of the interaction strength and the complex phase for the next-nearest-neighbor hoppings. Finally, we consider the Haldane model with interacting hard-core bosons, where no evidence for a topological phase is observed. An important general conclusion of our work is that despite the intrinsic nonlocality of topological phases their key topological properties manifest themselves already in small systems and therefore can be studied numerically via exact diagonalization and observed experimentally, e.g., with trapped ions and cold atoms in optical lattices.Comment: 13 pages, 12 figures. Published versio

Electronic structure of and Quantum size effect in III-V and II-VI semiconducting nanocrystals using a realistic tight binding approach

We analyze the electronic structure of group III-V semiconductors obtained within full potential linearized augmented plane wave (FP-LAPW) method and arrive at a realistic and minimal tight-binding model, parameterized to provide an accurate description of both valence and conduction bands. It is shown that cation sp3 - anion sp3d5 basis along with the next nearest neighbor model for hopping interactions is sufficient to describe the electronic structure of these systems over a wide energy range, obviating the use of any fictitious s* orbital, employed previously. Similar analyses were also performed for the II-VI semiconductors, using the more accurate FP-LAPW method compared to previous approaches, in order to enhance reliability of the parameter values. Using these parameters, we calculate the electronic structure of III-V and II-VI nanocrystals in real space with sizes ranging upto about 7 nm in diameter, establishing a quantitatively accurate description of the band-gap variation with sizes for the various nanocrystals by comparing with available experimental results from the literature.Comment: 28 pages, 8 figures, Accepted for publication in Phys. Rev.

Inelastic effects in electron transport studied with wave packet propagation

A time-dependent approach is used to explore inelastic effects during electron transport through few-level systems. We study a tight-binding chain with one and two sites connected to vibrations. This simple but transparent model gives insight about inelastic effects, their meaning and the approximations currently used to treat them. Our time-dependent approach allows us to trace back the time sequence of vibrational excitation and electronic interference, the ibrationally introduced time delay and the electronic phase shift. We explore a full range of parameters going from weak to strong electron-vibration coupling, from tunneling to contact, from one-vibration description to the need of including all vibrations for a correct description of inelastic effects in transport. We explore the validity of single-site resonant models as well as its extension to more sites via molecular orbitals and the conditions under which multi-orbital, multi-vibrational descriptions cannot be simplified. We explain the physical meaning of the spectral features in the second derivative of the electron current with respect to the bias voltage. This permits us to nuance the meaning of the energy value of dips and peaks. Finally, we show that finite-band effects lead to electron back-scattering off the molecular vibrations in the regime of high-conductance, although the drop in conductance at the vibrational threshold is rather due to the rapid variation of the vibronic density of states.Comment: 38 pages, 14 figure

Intensified biochip system using chemiluminescence for the detection of Bacillus globigii spores

This paper reports the first intensified biochip system for chemiluminescence detection and the feasibility of using this system for the analysis of biological warfare agents is demonstrated. An enzyme-linked immunosorbent assay targeting Bacillus globigii spores, a surrogate species for Bacillus anthracis, using a chemiluminescent alkaline phosphatase substrate is combined with a compact intensified biochip detection system. The enzymatic amplification was found to be an attractive method for detection of low spore concentrations when combined with the intensified biochip device. This system was capable of detecting approximately 1 × 105Bacillus globigii spores. Moreover, the chemiluminescence method, combined with the self-contained biochip design, allows for a simple, compact system that does not require laser excitation and is readily adaptable to field use