Factors influencing student nurse decisions to report poor practice witnessed while on placement

Background: While it is commonly accepted that nursing care is generally of a good standard, it would be naïve to think that this is always the case. Over recent years concern about aspects of the quality of some nursing care has grown. In tandem with this, there is recognition that nurses do not always report poor practice. As future registrants, student nurses have a role to play in changing this culture. We know, however, relatively little about the factors that influence student decisions on whether or not to report. In the absence of a more nuanced understanding of this issue, we run the risk of assuming students will speak out simply because we say they should. Objectives: To explore influences on student decisions about whether or not to report poor clinical practice which is a result of deliberate action and which is witnessed while on placement. Methods: Qualitative interviews were conducted with thirteen pre-registration nursing students from the UK. Participants included both adult and mental health nurses with an age range from 20–47. Data were analysed to identify key themes. Category integrity and fit with data was confirmed by a team member following initial analysis. Results: Four themes emerged from the data. The first of these, ‘I had no choice’ described the personal and ethical drivers which influenced students to report. ‘Consequences for self’ and ‘Living with ambiguity’ provide an account of why some students struggle to report, while ‘Being prepared’ summarised arguments both for and against reporting concerns. Conclusion: While there is a drive to promote openness in health care settings and an expectation that staff will raise concerns about quality of care, the reality is that the decision to do this can be very difficult. This is certainly the case for some student nurses. Our results suggest ways in which educationalists might intervene to support students who witness poor practice to report

Complexing additives to reduce the immiscible phase formed in the hybrid ZnBr2 flow battery

The zinc-bromine redox flow battery (RFB) is one of a very few commercially viable RFB energy storage system capable of integration with intermittent renewable energy sources to deliver improved energy management. However, due to the volatility of the electrogenerated bromine and potential for its crossover from positive to negative electrolytes, this system requires the use of quaternary ammonium complexes (N-methyl-N-ethylpyrrolidinium, (MEP)) to capture this bromine. This produces an immiscible phase with the Br2 which requires a complex network of pipes, pumps and automated controls to ensure access to the electroactive material during discharge. In this work, the use of novel quaternary ammonium complexes to capture the electrogenerated bromine but to keep it in the aqueous phase is examined. Three compounds, 1-(carboxymethyl) pyridine-1-ium, 1-(2-carboxymethyl)-1-methylmorpholin-1-ium and 1-(2-carboxymethyl)-1-methylpyrrolidin-1-ium, were found to successfully reduce the volume of the immiscible phase formed on complexing with the polybromide (Brx-) whilst displaying similar enthalpy of vaporisation values as that of MEP. Electrochemical analysis also revealed that these compounds did not impact on the electrode kinetics of the Br-/Brx- reaction indicating that the resulting surface film formed with these compounds behaved as a chemically modified electrode, in contrast to the surface film formed with MEP

Experimental demonstration of a measurement-based realisation of a quantum channel

We introduce and experimentally demonstrate a method for realising a quantum channel using the measurement-based model. Using a photonic setup and modifying the bases of single-qubit measurements on a four-qubit entangled cluster state, representative channels are realised for the case of a single qubit in the form of amplitude and phase damping channels. The experimental results match the theoretical model well, demonstrating the successful performance of the channels. We also show how other types of quantum channels can be realised using our approach. This work highlights the potential of the measurement-based model for realising quantum channels which may serve as building blocks for simulations of realistic open quantum systems.Comment: 8 pages, 4 figure

The relationship between the insulin-like growth factor-1 axis, weight loss, an inflammation-based score and survival in patients with inoperable non-small cell lung cancer

<b>Background & aims:</b> The involvement of a systemic inflammatory response, as evidenced by the Glasgow Prognostic Score (GPS), is associated with weight loss and poor outcome in patients with non-small cell lung cancer. There is good evidence that nutritional and functional decline in patients with advanced malignant disease is associated with catabolic changes in metabolism. However, defects in anabolism may also contribute towards nutritional decline in patients with cancer. The aim of the present study was to examine the relationship between IGF-1 and IGFBP-3, performance status, mGPS and survival in patients with inoperable NSCLC. <b>Methods:</b> 56 patients with inoperable NSCLC were studied. The plasma concentrations of IGF-1, IGFBP-3 and leptin were measured using ELISA and RIA. <b>Results:</b> The patients were predominantly male (61%), over 60 years old (80%), with advanced (stage III or IV) disease (98%), with a BMI≥20 (84%), an ECOG-ps of 0 or 1 (79%), a haemoglobin (59%) and white cell count (79%) in the reference range. On follow-up 43 patients died of their cancer. On univariate analysis, BMI (p<0.05), Stage (p<0.05), ECOG-ps (p<0.05), haemoglobin (p<0.05), white cell count (p<0.05) and mGPS (p<0.05) were associated with cancer specific survival. There was no association between age, sex, treatment, IGF-1, IGFBP-3, IGF-1:IGFBP-3 ratio, or leptin and cancer specific survival. With an increasing mGPS concentrations of haemoglobin (p<0.005) and IGFBP-3 (p<0.05) decreased. mGPS was not associated with either IGF-1(p>0.20), or leptin (p>0.20). <b>Conclusions:</b> In summary, the results of this study suggest that anabolism (IGF-1 axis) does not play a significant role in the relationship between nutritional and functional decline, systemic inflammation and poor survival in patients with inoperable NSCLC

Statistics of lowest excitations in two dimensional Gaussian spin glasses

A detailed investigation of lowest excitations in two-dimensional Gaussian spin glasses is presented. We show the existence of a new zero-temperature exponent lambda describing the relative number of finite-volume excitations with respect to large-scale ones. This exponent yields the standard thermal exponent of droplet theory theta through the relation, theta=d(lambda-1). Our work provides a new way to measure the thermal exponent theta without any assumption about the procedure to generate typical low-lying excitations. We find clear evidence that theta < theta_{DW} where theta_{DW} is the thermal exponent obtained in domain-wall theory showing that MacMillan excitations are not typical.Comment: 4 pages, 3 figures, (v2) revised version, (v3) corrected typo

Using Flow Specifications of Parameterized Cache Coherence Protocols for Verifying Deadlock Freedom

We consider the problem of verifying deadlock freedom for symmetric cache coherence protocols. In particular, we focus on a specific form of deadlock which is useful for the cache coherence protocol domain and consistent with the internal definition of deadlock in the Murphi model checker: we refer to this deadlock as a system- wide deadlock (s-deadlock). In s-deadlock, the entire system gets blocked and is unable to make any transition. Cache coherence protocols consist of N symmetric cache agents, where N is an unbounded parameter; thus the verification of s-deadlock freedom is naturally a parameterized verification problem. Parametrized verification techniques work by using sound abstractions to reduce the unbounded model to a bounded model. Efficient abstractions which work well for industrial scale protocols typically bound the model by replacing the state of most of the agents by an abstract environment, while keeping just one or two agents as is. However, leveraging such efficient abstractions becomes a challenge for s-deadlock: a violation of s-deadlock is a state in which the transitions of all of the unbounded number of agents cannot occur and so a simple abstraction like the one above will not preserve this violation. In this work we address this challenge by presenting a technique which leverages high-level information about the protocols, in the form of message sequence dia- grams referred to as flows, for constructing invariants that are collectively stronger than s-deadlock. Efficient abstractions can be constructed to verify these invariants. We successfully verify the German and Flash protocols using our technique

Ice Sheet Elevation Change in West Antarctica From Ka‐Band Satellite Radar Altimetry

Satellite altimetry has been used to track changes in ice sheet elevation using a series of Ku‐band radars in orbit since the late 1970s. Here, we produce an assessment of higher‐frequency Ka‐band satellite radar altimetry for the same purpose, using SARAL/AltiKa measurements recorded over West Antarctica. AltiKa elevations are 3.8 ± 0.5 and 2.5 ± 0.1 m higher than those determined from airborne laser altimetry and CryoSat‐2, respectively, likely due to the instruments' coarser footprint in the sloping coastal margins. However, AltiKa rates of elevation change computed between 2013 and 2019 are within 0.6 ± 2.4 and 0.1 ± 0.1 cm/year of airborne laser and CryoSat‐2, respectively, indicating that trends in radar penetration are negligible. The fast‐flowing trunks of the Pine Island and Thwaites Glaciers thinned by 117 ± 10 and 100 ± 20 cm/year, respectively, amounting to a 9% reduction and a 43% increase relative to the 2000s

DEveloping a Complex Intervention for DEteriorating Patients using Theoretical Modelling (DECIDE study): study protocol

AIM: To develop a theory-based complex intervention (targeting nursing staff), to enhance enablers and overcome barriers to enacting expected behaviour when monitoring patients and responding to abnormal vital signs that signal deterioration. DESIGN: A mixed method design including structured observations on hospital wards, field notes, brief, un-recorded interviews and semi-structured interviews to inform the development of an intervention to enhance practice. METHODS: Semi-structured interviews will be conducted with nursing staff using a topic guide informed by the Theoretical Domains Framework. Semi-structured interviews will be transcribed verbatim and coded deductively into the 14 Theoretical Domains Framework domains and then inductively into 'belief statements'. Priority domains will be identified and mapped to appropriate behaviour change techniques. Intervention content and mode of delivery (how behaviour change techniques are operationalised) will be developed using nominal groups, during which participants (clinicians) will rank behaviour change techniques /mode of delivery combinations according to acceptability and feasibility. Findings will be synthesised to develop an intervention manual. DISCUSSION: Despite being a priority for clinicians, researchers and policymakers for two decades, 'sub-optimal care' of the deteriorating ward patient persists. Existing interventions have been largely educational (i.e., targeting assumed knowledge deficits) with limited evidence that they change staff behaviour. Staff behaviour when monitoring and responding to abnormal vital signs is likely influenced by a range of mediators that includes barriers and enablers. IMPACT: Systematically applying theory and evidence-based methods, will result in the specification of an intervention which is more likely to result in behaviour change and can be tested empirically in future research. This article is protected by copyright. All rights reserved

Experimentally exploring compressed sensing quantum tomography

In the light of the progress in quantum technologies, the task of verifying the correct functioning of processes and obtaining accurate tomographic information about quantum states becomes increasingly important. Compressed sensing, a machinery derived from the theory of signal processing, has emerged as a feasible tool to perform robust and significantly more resource-economical quantum state tomography for intermediate-sized quantum systems. In this work, we provide a comprehensive analysis of compressed sensing tomography in the regime in which tomographically complete data is available with reliable statistics from experimental observations of a multi-mode photonic architecture. Due to the fact that the data is known with high statistical significance, we are in a position to systematically explore the quality of reconstruction depending on the number of employed measurement settings, randomly selected from the complete set of data, and on different model assumptions. We present and test a complete prescription to perform efficient compressed sensing and are able to reliably use notions of model selection and cross-validation to account for experimental imperfections and finite counting statistics. Thus, we establish compressed sensing as an effective tool for quantum state tomography, specifically suited for photonic systems.Comment: 12 pages, 5 figure

On the Use of Finite-Size Scaling to Measure Spin-Glass Exponents

Finite-size scaling (FSS) is a standard technique for measuring scaling exponents in spin glasses. Here we present a critique of this approach, emphasizing the need for all length scales to be large compared to microscopic scales. In particular we show that the replacement, in FSS analyses, of the correlation length by its asymptotic scaling form can lead to apparently good scaling collapses with the wrong values of the scaling exponents.Comment: RevTeX, 5 page