Medication communication between nurses and doctors for paediatric acute care: An ethnographic study

AIMS AND OBJECTIVES: To examine how communication between nurses and doctors occurred for managing medications in inpatient paediatric settings. BACKGROUND: Communication between health professionals influences medication incidents' occurrence and safe care. DESIGN: An ethnographic study was undertaken. METHODS: Semi-structured interviews, observations and focus groups were conducted in three clinical areas of an Australian tertiary paediatric hospital. Data were transcribed verbatim and thematically analysed using the Medication Communication Model. RESULTS: The actual communication act revealed professionals' commitment to effective medication management and the influence of professional identities on medication communication. Nurses and doctors were dedicated to providing safe, effective medication therapy for children, within their scope of practice and perceived role responsibilities. Most nurses and junior doctors used tentative language in their communication while senior doctors tended to use direct language. Irrespective of language style, nurses actively engaged with doctors to promote patients' needs. Yet, the medical hierarchical structure, staffing and attendant expectations influenced communication for medication management, causing frustration among nurses and doctors. Doctors' lack of verbal communication of documented changes to medication orders particularly troubled nurses. Nurses persisted in their efforts to acquire appropriate orders for safe medication administration to paediatric patients. CONCLUSIONS: Collaborative practice between nurses and doctors involved complex, symbiotic relationships. Their dedication to providing safe medication therapy to paediatric patients facilitated effective medication management. At times, shortcomings in inter-disciplinary communication impacted on potential and actual medication incidents. RELEVANCE TO CLINICAL PRACTICE: Understanding of the complexities affecting medication communication between nurses and doctors helps to ensure inter-professional respect for each other's roles and inherent demands. Interdisciplinary education delivered in health care organisations would facilitate greater clarity in communication related to medications. Encouraging the use of concise, clear words in communication would help to promote improved understanding between parties, and accuracy and efficacy of medication management. This article is protected by copyright. All rights reserved

Pterodactyl: Thermal Protection System for Integrated Control Design of a Mechanically Deployed Entry Vehicle

The need for precision landing of high mass payloads on Mars and the return of sensitive samples from other planetary bodies to specific locations on Earth is driving the development of an innovative NASA technology referred to as the Deployable Entry Vehicle (DEV). A DEV has the potential to deliver an equivalent science payload with a stowed diameter 3 to 4 times smaller than a traditional rigid capsule configuration. However, the DEV design does not easily lend itself to traditional methods of directional control. The NASA Space Technology Mission Directorate (STMD)s Pterodactyl project is currently investigating the effectiveness of three different Guidance and Control (G&C) systems actuated flaps, Center of Gravity (CG) or mass movement, and Reaction Control System (RCS) for use with a DEV using the Adaptable, Deployable, Entry, and Placement Technology (ADEPT) design. This paper details the Thermal Protection System (TPS) design and associated mass estimation efforts for each of the G&C systems. TPS is needed for the nose cap of the DEV and the flaps of the actuated flap control system. The development of a TPS selection, sizing, and mass estimation method designed to deal with the varying requirements for the G&C options throughout the trajectory is presented. The paper discusses the methods used to i) obtain heating environments throughout the trajectory with respect to the chosen control system and resulting geometry; ii) determine a suitable TPS material; iii) produce TPS thickness estimations; and, iv) determine the final TPS mass estimation based on TPS thickness, vehicle control system, vehicle structure, and vehicle payload

Effects of circadian rhythm phase alteration on physiological and psychological variables: Implications to pilot performance (including a partially annotated bibliography)

The effects of environmental synchronizers upon circadian rhythmic stability in man and the deleterious alterations in performance and which result from changes in this stability are points of interest in a review of selected literature published between 1972 and 1980. A total of 2,084 references relevant to pilot performance and circadian phase alteration are cited and arranged in the following categories: (1) human performance, with focus on the effects of sleep loss or disturbance and fatigue; (2) phase shift in which ground based light/dark alteration and transmeridian flight studies are discussed; (3) shiftwork; (4)internal desynchronization which includes the effect of evironmental factors on rhythmic stability, and of rhythm disturbances on sleep and psychopathology; (5) chronotherapy, the application of methods to ameliorate desynchronization symptomatology; and (6) biorythm theory, in which the birthdate based biorythm method for predicting aircraft accident susceptability is critically analyzed. Annotations are provided for most citations

The inverse cascade and nonlinear alpha-effect in simulations of isotropic helical hydromagnetic turbulence

A numerical model of isotropic homogeneous turbulence with helical forcing is investigated. The resulting flow, which is essentially the prototype of the alpha^2 dynamo of mean-field dynamo theory, produces strong dynamo action with an additional large scale field on the scale of the box (at wavenumber k=1; forcing is at k=5). This large scale field is nearly force-free and exceeds the equipartition value. As the magnetic Reynolds number R_m increases, the saturation field strength and the growth rate of the dynamo increase. However, the time it takes to built up the large scale field from equipartition to its final super-equipartition value increases with magnetic Reynolds number. The large scale field generation can be identified as being due to nonlocal interactions originating from the forcing scale, which is characteristic of the alpha-effect. Both alpha and turbulent magnetic diffusivity eta_t are determined simultaneously using numerical experiments where the mean-field is modified artificially. Both quantities are quenched in a R_m-dependent fashion. The evolution of the energy of the mean field matches that predicted by an alpha^2 dynamo model with similar alpha and eta_t quenchings. For this model an analytic solution is given which matches the results of the simulations. The simulations are numerically robust in that the shape of the spectrum at large scales is unchanged when changing the resolution from 30^3 to 120^3 meshpoints, or when increasing the magnetic Prandtl number (viscosity/magnetic diffusivity) from 1 to 100. Increasing the forcing wavenumber to 30 (i.e. increasing the scale separation) makes the inverse cascade effect more pronounced, although it remains otherwise qualitatively unchanged.Comment: 21 pages, 26 figures, ApJ (accepted

Evolution of Second-Order Cosmological Perturbations and Non-Gaussianity

We present a second-order gauge-invariant formalism to study the evolution of curvature perturbations in a Friedmann-Robertson-Walker universe filled by multiple interacting fluids. We apply such a general formalism to describe the evolution of the second-order curvature perturbations in the standard one-single field inflation, in the curvaton and in the inhomogeneous reheating scenarios for the generation of the cosmological perturbations. Moreover, we provide the exact expression for the second-order temperature anisotropies on large scales, including second-order gravitational effects and extend the well-known formula for the Sachs-Wolfe effect at linear order. Our findings clarify what is the exact non-linearity parameter f_NL entering in the determination of higher-order statistics such as the bispectrum of Cosmic Microwave Background temperature anisotropies. Finally, we compute the level of non-Gaussianity in each scenario for the creation of cosmological perturbations.Comment: 14 pages, LaTeX file. Further comments adde

Completing Natural Inflation

If the inflaton is a pseudo-scalar axion, the axion shift symmetry can protect the flatness of its potential from too large radiative corrections. This possibility, known as natural inflation, requires an axion scale which is greater than the (reduced) Planck scale. It is unclear whether such a high value is compatible with an effective field theoretical description, and if the global axionic symmetry survives quantum gravity effects. We propose a mechanism which provides an effective large axion scale, although the original one is sub-Planckian. The mechanism is based on the presence of two axions, with a potential provided by two anomalous gauge groups. The effective large axion scale is due to an almost exact symmetry between the couplings of the axions to the anomalous groups. We also comment on a possible implementation in heterotic string theory.Comment: 9 pages, 1 figur

Evidence for universal structure in galactic halos

The late infall of dark matter onto a galaxy produces structure (such as caustics) in the distribution of dark matter in the halo. We argue that such structure is likely to occur generically on length scales proportional to $l \sim t_0 v_{rot}$, where $t_0$ is the age of the universe and $v_{rot}$ is the rotation velocity of the galaxy. A set of 32 extended galactic rotation curves is analyzed. For each curve, the radial coordinate is rescaled according to $r\to \tilde r \equiv r (v_0 / v_{rot})$, where we choose $v_0 = 220 km/s$. A linear fit to each rescaled rotation curve is subtracted, and the residuals are binned and averaged. The sample shows significant features near $\tilde r = 40 kpc$ and $\tilde r = 20 kpc$. This is consistent with the predictions of the self-similar caustic ring model of galactic halos.Comment: 4 pages, LaTeX, 1 epsf figur

An E7 Surprise

We explore some curious implications of Seiberg duality for an SU(2) four-dimensional gauge theory with eight chiral doublets. We argue that two copies of the theory can be deformed by an exactly marginal quartic superpotential so that they acquire an enhanced E7 flavor symmetry. We argue that a single copy of the theory can be used to define an E7-invariant superconformal boundary condition for a theory of 28 five-dimensional free hypermultiplets. Finally, we derive similar statements for three-dimensional gauge theories such as an SU(2) gauge theory with six chiral doublets or Nf=4 SQED.Comment: 27 page

Brany Liouville Inflation

We present a specific model for cosmological inflation driven by the Liouville field in a non-critical supersymmetric string framework, in which the departure from criticality is due to open strings stretched between the two moving Type-II 5-branes. We use WMAP and other data on fluctuations in the cosmic microwave background to fix parameters of the model, such as the relative separation and velocity of the 5-branes, respecting also the constraints imposed by data on light propagation from distant gamma-ray bursters. The model also suggests a small, relaxing component in the present vacuum energy that may accommodate the breaking of supersymmetry.Comment: 23 pages LATEX, two eps figures incorporated; version accepted for publication in NJ