The activities of hospital nursing unit managers and quality of patient care in South African hospitals: a paradox?

PKBackground: Improving the quality of health care is central to the proposed health care reforms in South Africa. Nursing unit managers play a key role in coordinating patient care activities and in ensuring quality care in hospitals. Objective: This paper examines whether the activities of nursing unit managers facilitate the provision of quality patient care in South African hospitals. Methods: During 2011, a cross-sectional, descriptive study was conducted in nine randomly selected hospitals (six public, three private) in two South African provinces. In each hospital, one of each of the medical, surgical, paediatric, and maternity units was selected (n 36). Following informed consent, each unit manager was observed for a period of 2 hours on the survey day and the activities recorded on a minute-by-minute basis. The activities were entered into Microsoft Excel, coded into categories, and analysed according to the time spent on activities in each category. The observation data were complemented by semi-structured interviews with the unit managers who were asked to recall their activities on the day preceding the interview. The interviews were analysed using thematic content analysis. Results: The study found that nursing unit managers spent 25.8% of their time on direct patient care, 16% on hospital administration, 14% on patient administration, 3.6% on education, 13.4% on support and communication, 3.9% on managing stock and equipment, 11.5% on staff management, and 11.8% on miscellaneous activities. There were also numerous interruptions and distractions. The semi-structured interviews revealed concordance between unit managers’ recall of the time spent on patient care, but a marked inflation of their perceived time spent on hospital administration. Conclusion: The creation of an enabling practice environment, supportive executive management, and continuing professional development are needed to enable nursing managers to lead the provision of consistent and high-quality patient care

Educational aspirations in inner city schools

The research aimed to assess the nature and level of pupils’ educational aspirations and to elucidate the factors that influence these aspirations. A sample of five inner city comprehensive secondary schools were selected by their Local Authority because of poor pupil attendance, below average examination results and low rates of continuing in full-time education after the age of 16. Schools were all ethnically mixed and co-educational. Over 800 pupils aged 12-14 completed a questionnaire assessing pupils’ experience of home, school and their peers. A sub-sample of 48 pupils selected by teachers to reflect ethnicity and ability levels in individual schools also participated in detailed focus group interviews. There were no significant differences in aspirations by gender or year group, but differences between ethnic groups were marked. Black African, Asian Other and Pakistani groups had significantly higher educational aspirations than the White British group, who had the lowest aspirations. The results suggest the high aspirations of Black African, Asian Other and Pakistani pupils are mediated through strong academic self-concept, positive peer support, a commitment to schooling and high educational aspirations in the home. They also suggest that low educational aspirations may have different mediating influences in different ethnic groups. The low aspirations of White British pupils seem to relate most strongly to poor academic self-concept and low educational aspirations in the home, while for Black Caribbean pupils disaffection, negative peers and low commitment to schooling appear more relevant. Interviews with pupils corroborated the above findings and further illuminated the factors students described as important in their educational aspirations. The results are discussed in relation to theories of aspiration which stress its nature as a cultural capacity

Effect of heat treatment on mechanical dissipation in Ta2_2O5_5 coatings

Thermal noise arising from mechanical dissipation in dielectric reflective coatings is expected to critically limit the sensitivity of precision measurement systems such as high-resolution optical spectroscopy, optical frequency standards and future generations of interferometric gravitational wave detectors. We present measurements of the effect of post-deposition heat treatment on the temperature dependence of the mechanical dissipation in ion-beam sputtered tantalum pentoxide between 11\,K and 300\,K. We find the temperature dependence of the dissipation is strongly dependent on the temperature at which the heat treatment was carried out, and we have identified three dissipation peaks occurring at different heat treatment temperatures. At temperatures below 200\,K, the magnitude of the loss was found to increase with higher heat treatment temperatures, indicating that heat treatment is a significant factor in determining the level of coating thermal noise.Comment: accepted Classical and Quantum Gravity 201

UNITED STATES-LATIN AMERICAN TRADE RELATIONS: IMPORTANCE TO U.S. AGRICULTURAL POLICY DECISIONS

International Relations/Trade,

Characterising sand and gravel deposits using electrical resistivity tomography (ERT) : case histories from England and Wales

Electrical Resistivity Tomography (ERT) is a rapidly developing geophysical imaging technique that is now widely used to visualise subsurface geological structure, groundwater and lithological variations. It is being increasingly used in environmental and engineering site investigations, but despite its suitability and potential benefits, ERT has yet to be routinely applied by the minerals industry to sand and gravel deposit assessment and quarry planning. The principal advantages of ERT for this application are that it is a cost-effective non-invasive method, which can provide 2D or 3D spatial models of the subsurface throughout the full region of interest. This complements intrusive sampling methods, which typically provide information only at discrete locations. Provided that suitable resistivity contrasts are present, ERT has the potential to reveal mineral and overburden thickness and quality variations within the body of the deposit. Here we present a number of case studies from the UK illustrating the use of 2D and 3D ERT for sand and gravel deposit investigation in a variety of geological settings. We use these case studies to evaluate the performance of ERT, and to illustrate good practice in the application of ERT to deposit investigation. We propose an integrated approach to site investigation and quarry planning incorporating both conventional intrusive methods and ERT

Synthetic microplastic abundance and composition along a longitudinal gradient traversing the subtropical gyre in the North Atlantic Ocean.

Plastic pollution has been reported in the North Atlantic Ocean since the 1970s, yet limited data over subsequent decades pose challenges when assessing spatio-temporal trends in relation to global leakages and intervention strategies. This study quantified microplastics within the upper ocean along a longitudinal transect of the North Atlantic and its subtropical gyre. Microplastics were sampled from surface and subsurface (-25 m) water using a manta trawl and NIKSIN bottle respectively. The surface water polymer community varied significantly between geographic positions ('inshore', 'gyre', 'open ocean'), and was significantly influenced by fragment quantity. Compared to other positions, the North Atlantic gyre was associated with high concentrations of polyethylene, polypropylene, acrylic and polyamide fragments. Subsurface water was dominated by polyamide and polyester fibres. Backtracked 2-year Lagrangian simulations illustrated connectivity patterns. Continued monitoring of microplastics throughout the water column of the North Atlantic Ocean is required to address knowledge gaps and assess spatio-temporal trends

On Metal-Insulator Transitions due to Self-Doping

We investigate the influence of an unoccupied band on the transport properties of a strongly correlated electron system. For that purpose, additional orbitals are coupled to a Hubbard model via hybridization. The filling is one electron per site. Depending on the position of the additional band, both, a metal--to--insulator and an insulator--to--metal transition occur with increasing hybridization. The latter transition from a Mott insulator into a metal via ``self--doping'' was recently proposed to explain the low carrier concentration in $\rm Yb_4As_3$. We suggest a restrictive parameter regime for this transition making use of exact results in various limits. The predicted absence of the self--doping transition for nested Fermi surfaces is confirmed by means of an unrestricted Hartree--Fock approximation and an exact diagonalization study in one dimension. In the general case metal--insulator phase diagrams are obtained within the slave--boson mean--field and the alloy--analog approximation.Comment: 9 pages, Revtex, 6 postscript figure