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

Unique equilibrium states for Bonatti-Viana diffeomorphisms

We show that the robustly transitive diffeomorphisms constructed by Bonatti and Viana have unique equilibrium states for natural classes of potentials. In particular, we characterize the SRB measure as the unique equilibrium state for a suitable geometric potential. The techniques developed are applicable to a wide class of DA diffeomorphisms, and persist under $C^1$ perturbations of the map. These results are an application of general machinery developed by the first and last named authors.Comment: 46 pages, 2 figures. In response to referee reports, we added an appendix on the regularity of the geometric potential, and made other suggested minor changes. Accepted for publication in Nonlinearit

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

Absorption of pyrimidines, purines, and nucleosides by Co, Ni, Cu and Fe /III-montmorillonite /clay-organic studies XIII/

Absorption of pyrimidines, purines, and nucleosides by copper, nickel, cobalt, and iron montmorillonit

New Civil Orders to contain Sexually Harmful Behaviour in the Community

This article presents an overview of the new civil orders brought in by the Anti-social Behaviour, Crime and Policing Act 2014 to combat sexually harmful behaviour in the community in the United Kingdom. The two new orders – the Sexual Risk Order and the Sexual Harm Prevention Order – will replace earlier orders available in the Sexual Offences Act 2003. The new orders with their lower evidential thresholds should be easier to obtain and involve less work for the police. They may also present a number of difficulties in terms of human rights and have already been described as 'sweeping' powers and 'tougher' powers. The article looks at the origins of the new law and their subsequent development and seeks to examine these contesting viewpoints of balancing public protection with human rights

Heat-Capacity Measurements of Energy-Gap Nodes of the Heavy-Fermion Superconductor CeIrIn5 Deep inside the Pressure-Dependent Dome Structure of its Superconducting Phase Diagram

We use heat capacity measurements as a function of field rotation to identify the nodal gap structure of CeIrIn5 at pressures to 2.05 GPa, deep inside its superconducting dome. A four-fold oscillation in the heat capacity at 0.3 K is observed for all pressures but with its sign reversed between 1.50 and 0.90 GPa. On the basis of recent theoretical models for the field-angle dependent specific heat, all data, including the sign reversal, imply a d{x^2-y^2} order parameter with nodes along [110], which constrains theoretical models of the pairing mechanism in CeIrIn5.Comment: To appear in Phys. Rev. Let