A burden of knowledge: A qualitative study of experiences of neonatal intensive care nurses’ concerns when keeping information from parents

© 2014, © The Author(s) 2014. Improved life-sustaining technology in the neonatal intensive care has resulted in an increased probability of survival for extremely premature babies. In the neonatal intensive care, the condition of a baby can deteriorate rapidly. Nurses and parents are together for long periods at the bedside and so form close and trusting relationships. Neonatal nurses as the constant caregivers may be presented with contradictory demands in attempting to meet the baby’s needs and being a patient and family advocate. This article aims to explore the issues arising for neonatal nurses when holding information about changes to a condition of a baby that they are unable to share with parents. Data were collected via interviews with 24 neonatal nurses in New South Wales, Australia. A qualitative approach was used to analyse the data. The theme ‘keeping secrets’ was identified and comprised of three sub-themes ‘coping with potentially catastrophic news’, ‘fear of inadvertent disclosure’ and ‘a burden that could damage trust’. Keeping secrets and withholding information creates internal conflict in the nurses as they balance the principle of confidentiality with the parent’s right to know information. The neonatal nurses experienced guilt and shame when they were felt forced by circumstances to keep secrets or withhold information from the parents of extremely premature babies

The Hudson Bay Lithospheric Experiment (HuBLE) : Insights into Precambrian Plate Tectonics and the Development of Mantle Keels

The UK component of HuBLE was supported by Natural Environment Research Council (NERC) grant NE/F007337/1, with financial and logistical support from the Geological Survey of Canada, Canada–Nunavut Geoscience Office, SEIS-UK (the seismic node of NERC), and First Nations communities of Nunavut. J. Beauchesne and J. Kendall provided invaluable assistance in the field. Discussions with M. St-Onge, T. Skulski, D. Corrigan and M. Sanborne-Barrie were helpful for interpretation of the data. D. Eaton and F. A. Darbyshire acknowledge the Natural Sciences and Engineering Research Council. Four stations on the Belcher Islands and northern Quebec were installed by the University of Western Ontario and funded through a grant to D. Eaton (UWO Academic Development Fund). I. Bastow is funded by the Leverhulme Trust. This is Natural Resources Canada Contribution 20130084 to its Geomapping for Energy and Minerals Program. This work has received funding from the European Research Council under the European Unions Seventh Framework Programme (FP7/2007-2013)/ERC Grant agreement no. 240473 ‘CoMITAC’.Peer reviewedPublisher PD

Seismological structure of the 1.8 Ga Trans-Hudson Orogen of North America

Precambrian tectonic processes are debated: what was the nature and scale of orogenic events on the younger, hotter, and more ductile Earth? Northern Hudson Bay records the Paleoproterozoic collision between the Western Churchill and Superior plates—the ∼1.8 Ga Trans-Hudson Orogeny (THO)—and is an ideal locality to study Precambrian tectonic structure. Integrated field, geochronological, and thermobarometric studies suggest that the THO was comparable to the present-day Himalayan-Karakoram-Tibet Orogen (HKTO). However, detailed understanding of the deep crustal architecture of the THO, and how it compares to that of the evolving HKTO, is lacking. The joint inversion of receiver functions and surface wave data provides new Moho depth estimates and shear velocity models for the crust and uppermost mantle of the THO. Most of the Archean crust is relatively thin (∼39 km) and structurally simple, with a sharp Moho; upper-crustal wave speed variations are attributed to postformation events. However, the Quebec-Baffin segment of the THO has a deeper Moho (∼45 km) and a more complex crustal structure. Observations show some similarity to recent models, computed using the same methods, of the HKTO crust. Based on Moho character, present-day crustal thickness, and metamorphic grade, we support the view that southern Baffin Island experienced thickening during the THO of a similar magnitude and width to present-day Tibet. Fast seismic velocities at >10 km below southern Baffin Island may be the result of partial eclogitization of the lower crust during the THO, as is currently thought to be happening in Tibet

Biomimetic heterogenous elastic tissue development

There is an unmet need for artificial tissue to address current limitations with donor organs and problems with donor site morbidity. Despite the success with sophisticated tissue engineering endeavours, which employ cells as building blocks, they are limited to dedicated labs suitable for cell culture, with associated high costs and long tissue maturation times before available for clinical use. Direct 3D printing presents rapid, bespoke, acellular solutions for skull and bone repair or replacement, and can potentially address the need for elastic tissue, which is a major constituent of smooth muscle, cartilage, ligaments and connective tissue that support organs. Thermoplastic polyurethanes are one of the most versatile elastomeric polymers. Their segmented block copolymeric nature, comprising of hard and soft segments allows for an almost limitless potential to control physical properties and mechanical behaviour. Here we show direct 3D printing of biocompatible thermoplastic polyurethanes with Fused Deposition Modelling, with a view to presenting cell independent in-situ tissue substitutes. This method can expeditiously and economically produce heterogenous, biomimetic elastic tissue substitutes with controlled porosity to potentially facilitate vascularisation. The flexibility of this application is shown here with tubular constructs as exemplars. We demonstrate how these 3D printed constructs can be post-processed to incorporate bioactive molecules. This efficacious strategy, when combined with the privileges of digital healthcare, can be used to produce bespoke elastic tissue substitutes in-situ, independent of extensive cell culture and may be developed as a point-of-care therapy approach

Transition to turbulence in particulate pipe flow

We investigate experimentally the influence of suspended particles on the transition to turbulence. The particles are monodisperse and neutrally-buoyant with the liquid. The role of the particles on the transition depends both upon the pipe to particle diameter ratios and the concentration. For large pipe-to-particle diameter ratios the transition is delayed while it is lowered for small ratios. A scaling is proposed to collapse the departure from the critical Reynolds number for pure fluid as a function of concentration into a single master curve.Comment: 4 pages, 4 figure

Valuing seasonal climate forecasts in the northern Australia beef industry

Seasonal climate forecasts (SCFs) provide opportunities for pastoralists to align production decisions to climatic conditions, as SCFs offer economic value by increasing certainty about future climatic states at decision-making time. Insufficient evidence about the economic value of SCFs was identified as a major factor limiting adoption of SCFs in Australia and abroad. This study examines the value of SCFs to beef production system management in northern Australia by adopting a theoretical probabilistic climate forecast system. Stocking rate decisions in October, before the onset of the wet season, were identified by industry as a key climate sensitive decision. The analysis considered SCF value across economic drivers (steer price in October) and environmental drivers (October pasture availability). A range in forecast value was found (0-$14/head) dependent on pasture availability, beef price and SCF skill. Skilful forecasts of future climate conditions offered little value with medium or high pasture availability, as in these circumstances, pastures were rarely over-utilised. In contrast, low pasture availability provided conditions for alternative optimal stocking rates and for SCFs to be valuable. Optimal stocking rates under low pasture availability varied the most with climate state (i.e. wet or dry), indicating that producers have more to gain from a skilful SCF at these times. Although the level of pasture availability in October was the major determinant of stocking rate decisions, beef price settings were also found to be important. This analysis provides insights into the potential value of SCFs to extensive beef enterprises and can be used by pastoralists to evaluate the cost-benefit of using a SCF in annual management

The UK register of HIV seroconverters: Methods and analytical issues

A Register of HIV-infected persons who have had a negative antibody test within 3 years of their first antibody positive test (seroconverters) is being set up in the UK to monitor the distribution of times from HIV seroconversion to AIDS (the incubation period) and to death. It will also provide a national resource for use by those designing studies in this group of individuals. Clinicians caring for HIV-positive persons in Genito-Urinary Medicine, Infectious Disease and other departments throughout the UK were asked to participate by providing information on eligible subjects. Most laboratories undertaking HIV antibody testing were also contacted and asked to provide the name of the attending clinician for all seroconverters identified through the HIV laboratory reporting systems of the PHLS Communicable Disease Surveillance Centre (CDSC) and the Scottish Centre for Infection and Environmental Health (SCIEH) and for any other seroconverters known to them but not identified by CDSC or SCIEH. Data items sought for the Register include: sex, ethnic group, probable route of HIV transmission, annual CD4 counts, details of therapy and prophylaxis prescribed, AIDS-defining events and vital status. Follow up information is collected annually. Wherever possible, all seroconverters known to a clinic have been identified, whether currently alive or dead, either from clinic records or laboratory reporting or both. The objective is to establish and update a complete register of seroconverters on a long-term basis to provide reliable estimates of the incubation period on which future projections of AIDS cases in the UK can be made

Subduction beneath Laurentia modified the eastern North American cratonic edge : Evidence from P wave and S wave tomography

Funding Information: NERC Doctoral Training Partnership: Science and Solutions for a Changing Planet and Leverhulme Trust Acknowledgments A.B. is funded by the NERC Doctoral Training Partnership: Science and Solutions for a Changing Planet. I.B. is funded by the Leverhulme Trust. F.D. acknowledges funding from NSERC through their Discovery grants and Canada Research Chairs program. We thank J. VanDecar for use of his tomographic inversion and MCCC codes. SAC [Helffrich et al., 2013] and GMT [Wessel and Smith, 1995] software were also used to process seismic data obtained from the IRIS DMC and from the Canadian National Data Centre (Natural Resources Canada). A digital supplement is also available to download containing models and the processed relative arrival‐time data set, additional information is available from A.B. (email: [email protected]). Discussing the implications of our tomographic results with S. Goes and A. Hynes provided great motivation for this manuscript. Two anonymous reviewers helped clarify our interpretations.Peer reviewedPublisher PD

An experimental model to measure the ability of headphones with active noise control to reduce patient's exposure to noise in an intensive care unit.

BACKGROUND: Defining the association between excessive noise in intensive care units, sleep disturbance and morbidity, including delirium, is confounded by the difficulty of implementing successful strategies to reduce patient's exposure to noise. Active noise control devices may prove to be useful adjuncts but there is currently little to quantify their ability to reduce noise in this complex environment. METHODS: Sound meters were embedded in the auditory meatus of three polystyrene model heads with no headphones (control), with headphones alone and with headphones using active noise control and placed in patient bays in a cardiac ICU. Ten days of recording sound levels at a frequency of 1 Hz were performed, and the noise levels in each group were compared using repeated measures MANOVA and subsequent pairwise testing. RESULTS: Multivariate testing demonstrated that there is a significant difference in the mean noise exposure levels between the three groups (p < 0.001). Subsequent pairwise testing between the three groups shows that the reduction in noise is greatest with headphones and active noise control. The mean reduction in noise exposure between the control and this group over 24 h is 6.8 (0.66) dB. The use of active noise control was also associated with a reduction in the exposure to high-intensity sound events over the course of the day. CONCLUSIONS: The use of active noise cancellation, as delivered by noise-cancelling headphones, is associated with a significant reduction in noise exposure in our model of noise exposure in a cardiac ICU. This is the first study to look at the potential effectiveness of active noise control in adult patients in an intensive care environment and shows that active noise control is a candidate technology to reduce noise exposure levels the patients experience during stays on intensive care

Biogenic cloud nuclei in the central Amazon during the transition from wet to dry season

© Author(s) 2016. This work is distributed under the Creative Commons Attribution 3.0 License. Whitehead, J. D., Darbyshire, E., Brito, J., Barbosa, H. M. J., Crawford, I., Stern, R., Gallagher, M. W., Kaye, P. H., Allan, J. D., Coe, H., Artaxo, P., and McFiggans, G.: Biogenic cloud nuclei in the central Amazon during the transition from wet to dry season, Atmos. Chem. Phys., 16, 9727-9743, doi:10.5194/acp-16-9727-2016, 2016.The Amazon basin is a vast continental area in which atmospheric composition is relatively unaffected by anthropogenic aerosol particles. Understanding the proper- ties of the natural biogenic aerosol particles over the Ama- zon rainforest is key to understanding their influence on re- gional and global climate. While there have been a number of studies during the wet season, and of biomass burning par- ticles in the dry season, there has been relatively little work on the transition period – the start of the dry season in the absence of biomass burning. As part of the Brazil–UK Net- work for Investigation of Amazonian Atmospheric Composi- tion and Impacts on Climate (BUNIAACIC) project, aerosol measurements, focussing on unpolluted biogenic air masses, were conducted at a remote rainforest site in the central Ama- zon during the transition from wet to dry season in July 2013. This period marks the start of the dry season but before sig- nificant biomass burning occurs in the region. Median particle number concentrations were 266 cm−3, with size distributions dominated by an accumulation mode of 130–150 nm. During periods of low particle counts, a smaller Aitken mode could also be seen around 80 nm. While the concentrations were similar in magnitude to those seen during the wet season, the size distributions suggest an en- hancement in the accumulation mode compared to the wet season, but not yet to the extent seen later in the dry sea- son, when significant biomass burning takes place. Submi- cron nonrefractory aerosol composition, as measured by an aerosol chemical speciation monitor (ACSM), was domi- nated by organic material (around 81 %). Aerosol hygro- scopicity was probed using measurements from a hygro- scopicity tandem differential mobility analyser (HTDMA), and a quasi-monodisperse cloud condensation nuclei counter (CCNc). The hygroscopicity parameter, κ , was found to be low, ranging from 0.12 for Aitken-mode particles to 0.18 for accumulation-mode particles. This was consistent with pre- vious studies in the region, but lower than similar measure- ments conducted in Borneo, where κ ranged 0.17–0.37. A wide issue bioaerosol sensor (WIBS-3M) was deployed at ground level to probe the coarse mode, detecting pri- mary biological aerosol by fluorescence (fluorescent biolog- ical aerosol particles, or FBAPs). The mean FBAP number concentration was 400 ± 242 L−1; however, this ranged from around 200 L−1 during the day to as much as 1200 L−1 at night. FBAPs dominated the coarse-mode particles, compris- ing between 55 and 75 % of particles during the day to more than 90 % at night. Non-FBAPs did not show a strong diur- nal pattern. Comparison with previous FBAP measurements above canopy at the same location suggests there is a strong vertical gradient in FBAP concentrations through the canopy. Cluster analysis of the data suggests that FBAPs were dom- inated (around 70 %) by fungal spores. Further, long-term measurements will be required in order to fully examine the seasonal variability and distribution of primary biological aerosol particles through the canopy. This is the first time that such a suite of measurements has been deployed at this site to investigate the chemical compo- sition and properties of the biogenic contributions to Ama- zonian aerosol during the transition period from the wet to the dry season, and thus provides a unique comparison to the aerosol properties observed during the wet season in previ- ous similar campaigns. This was also the first deployment of a WIBS in the Amazon rainforest to study coarse-mode parti- cles, particularly primary biological aerosol particles, which are likely to play an important role as ice nuclei in the region.Peer reviewe