Nurses' views of using computerized decision support software in NHS Direct

Background. Nurses working in NHS Direct, the 24-hour telephone advice line in England, use computerized decision support software to recommend to callers the most appropriate service to contact, or to advise on self-care. Aims. To explore nurses' views of their roles and the computerized decision support software in NHS Direct. Methods. Qualitative analysis of semi-structured interviews with 24 NHS Direct nurses in 12 sites. Findings. Nurses described both the software and themselves as essential to the clinical decision-making process. The software acted as safety net, provider of consistency, and provider of script, and was relied upon more when nurses did not have clinical knowledge relevant to the call. The nurse handled problems not covered by the software, probed patients for the appropriate information to enter into the software, and interpreted software recommendations in the light of contextual information which the software was unable to use. Nurses described a dual process of decision-making, with the nurse as active decision maker looking for consensus with the software recommendation and ready to override recommendations made by the software if necessary. However, nurses' accounts of the software as a guide, prompt or support did not fully acknowledge the power of the software, which they are required to use, and the recommendation of which they are required to follow under some management policies. Over time, the influence of nurse and software merges as nurses internalize the software script as their own knowledge, and navigate the software to produce recommendations that they feel are most appropriate. Conclusions. The nurse and the software have distinct roles in NHS Direct, although the effect of each on the clinical decision-making process may be difficult to determine in practice

Production of alkenes and novel secondary products by P450 OleT JE using novel H2O2-generating fusion protein systems

Jeotgalicoccus sp. 8456 OleTJE (CYP152L1) is a fatty acid decarboxylase cytochrome P450 that uses hydrogen peroxide (H2O2) to catalyse production of terminal alkenes, which are industrially important chemicals with biofuel applications. We report enzyme fusion systems in which Streptomyces coelicolor alditol oxidase (AldO) is linked to OleTJE. AldO oxidizes polyols (including glycerol), generating H2O2 as a co-product and facilitating its use for efficient OleTJE-dependent fatty acid decarboxylation. AldO activity is regulatable by polyol substrate titration, enabling control over H2O2 supply to minimise oxidative inactivation of OleTJE and prolong activity for increased alkene production. We also use these fusion systems to generate novel products from secondary turnover of 2-OH and 3-OH myristic acid primary products, expanding the catalytic repertoire of OleTJE

Urban and rural differences in older drivers' failure to stop at stop signs

Our purpose was to determine visual and cognitive predictors for older drivers' failure to stop at stop signs. 1425 drivers aged between ages 67 and 87 residing in Salisbury Maryland were enrolled in a longitudinal study of driving. At baseline, the participants were administered a battery of vision and cognition tests, and demographic and health questionnaires. Five days of driving data were collected with a Driving Monitoring System (DMS), which obtained data on stop signs encountered and failure to stop at stop signs. Driving data were also collected 1 year later (round two). The outcome, number of times a participant failed to stop at a stop sign at round two, was modeled using vision and cognitive variables as predictors. A negative binomial regression model was used to model the failure rate. Of the 1241 who returned for round two, 1167 drivers had adequate driving data for analyses and 52 did not encounter a stop sign. In the remaining 1115, 15.8% failed at least once to stop at stop signs, and 7.1% failed to stop more than once. Rural drivers had 1.7 times the likelihood of not stopping compared to urban drivers. Amongst the urban participants, the number of points missing in the bilateral visual field was significantly associated with a lower failure rate. In this cohort, older drivers residing in rural areas were less likely to stop at stop-sign intersections than those in urban areas. It is possible that rural drivers frequent areas with less traffic and better visibility, and may be more likely to take the calculated risk of not stopping. In this cohort failure to stop at stop signs was not explained by poor vision or cognition. Conversely in urban areas, those who have visual field loss appear to be more cautious at stop signs

Generation of entangled coherent states via cross phase modulation in a double electromagnetically induced transparency regime

The generation of an entangled coherent state is one of the most important ingredients of quantum information processing using coherent states. Recently, numerous schemes to achieve this task have been proposed. In order to generate travelling-wave entangled coherent states, cross phase modulation, optimized by optical Kerr effect enhancement in a dense medium in an electromagnetically induced transparency (EIT) regime, seems to be very promising. In this scenario, we propose a fully quantized model of a double-EIT scheme recently proposed [D. Petrosyan and G. Kurizki, {\sl Phys. Rev. A} {\bf 65}, 33833 (2002)]: the quantization step is performed adopting a fully Hamiltonian approach. This allows us to write effective equations of motion for two interacting quantum fields of light that show how the dynamics of one field depends on the photon-number operator of the other. The preparation of a Schr\"odinger cat state, which is a superposition of two distinct coherent states, is briefly exposed. This is based on non-linear interaction via double-EIT of two light fields (initially prepared in coherent states) and on a detection step performed using a $50:50$ beam splitter and two photodetectors. In order to show the entanglement of a generated entangled coherent state, we suggest to measure the joint quadrature variance of the field. We show that the entangled coherent states satisfy the sufficient condition for entanglement based on quadrature variance measurement. We also show how robust our scheme is against a low detection efficiency of homodyne detectors.Comment: 15 pages, 9 figures; extensively revised version; added Section

Analysis of the modes of energy consumption of the complex of an incoherent scattering of the institute of ionosphere of national academy of sciences and the ministry of education and science of Ukraine

У даній статті представлені результати аналізу режимів енергоспоживання комплексу некогерентного розсіяння Інституту іоносфери НАН і МОН України з метою вирішення проблеми підвищення енергоефективності науково-дослідного комплексу та створення енергоефективної системи електропостачання, яка забезпечить стійку роботу наукового обладнання для виконання дослідницьких програм НАН України. Описана система електроживлення комплексу та режими енергоспоживання комплексу. Описано пристрої радарної системи, а також найбільш потужні споживачі електроенергії, які споживають електроенергію на експериментальні і господарські потреби. Проаналізовано енергоспоживання комплексу некогерентного розсіяння за 2013 р. Отримано і представлено графіки середньої споживаної потужності (середньодобовий показник) і середньої споживаної потужності в режимі вимірювань. Описана доцільність проведення робіт з оптимізації енергопостачання науково-дослідного комплексу Інституту іоносфери. Запропоновано можливі заходи для зниження економічної вартості проведення експериментів з дослідження іоносфери науково-дослідного комплексу некогерентного розсіяння. Проведено аналіз робіт сучасних авторів з метою показати, що підвищення ефективності функціонування систем електропостачання є актуальною проблемою сучасних досліджень.This article presents the results of the analysis of the energy consumption modes of the incoherent scattering complex of the Institute of Ionosphere of the National Academy of Sciences and the Ministry of Education and Science of Ukraine to solve the problem of increasing the energy efficiency of a research complex and creating an energy efficient power supply system that will ensure the sustainability of scientific equipment for research programs of the National Academy of Sciences of Ukraine. The system of power supply of the complex and modes of power consumption of the complex are described. The devices of the radar system are described, as well as the most powerful consumers of electricity, which consume electricity for experimental and economic needs. The energy consumption of the incoherent scattering complex in 2013 is analyzed. Graphs of the average power consumption (daily average) and average power consumption in measurement modes were obtained and presented. The feasibility of work to optimize the energy supply of the research complex of the institute of the ionosphere is described. Possible measures are proposed to reduce the economic cost of conducting experiments on the study of the ionosphere of an incoherent scattering research complex. The analysis of the works of modern authors i s carried out in order to show that increasing the efficiency of the power supply systems is an actual problem of modern research

Narrative inquiry into (re)imagining alternative schools: a case study of Kevin Gonzales.

Although there are many alternative schools that strive for the successful education for their students, negative images of alternative schools persist. While some alternative schools are viewed as “idealistic havens,” many are viewed as “dumping grounds,” or “juvenile detention centers.” Employing narrative inquiry, this article interrogates how a student, Kevin Gonzales, experiences his alternative education and raises questions about the role of alternative schools. Kevin Gonzales’s story is presented in a literary form of biographical journal to provide a “metaphoric loft” that helps us imagine other students like Kevin. This, in turn, provokes us to examine our current educational practice, and to (re)imagine ways in which alternative education can provide the best possible educational experiences for disenfranchised students who are increasingly underserved by the public education system

Mineral deficiency and the presence of Pinus sylvestris on mires during the mid- to late Holocene: Palaeoecological data from Cadogan's Bog, Mizen Peninsula, Co. Cork, southwest Ireland

Pollen records across parts of Ireland, England and northern Scotland show a dramatic collapse in Pinus pollen percentages at approximately 4000 radiocarbon years BP. This phenomenon has attracted much palaeoecological interest and several hypotheses have been put forward to account for this often synchronous and rapid reduction in pine from mid-Holocene woodland. Explanations for the 'pine decline' include prehistoric human activity, climatic change, in particular a substantial increase in precipitation resulting in increased mire wetness, and airborne pollution associated with the deposition of tephra. Hitherto, one largely untested hypothesis is that mineral deficiency could adversely affect pine growth and regeneration on mire surfaces. The discovery of pine-tree remains (wood pieces, stumps and trunks) within a peat located at Cadogan's Bog on the Mizen Peninsula, southwest Ireland, provided an opportunity to investigate the history of Pinus sylvestris and also to assess the importance of mineral nutrition in maintaining pine growth on mires. Pollen, plant macrofossils, microscopic charcoal and geochemical data are presented from a radiocarbon dated monolith extracted from this peat together with tree ring-width data and radiocarbon dated age estimates from subfossil wood. Analyses of these data suggest that peat accumulation commenced at the site around 6000 years BP when pine was the dominant local tree. Thereafter Pinus pollen percentages diminish in two stages, with the second decline taking place around 4160 ± 50 years BP. Concomitant with this decline in Pinus pollen, there is a noticeable, short-lived increase in wet-loving mire taxa and a decrease in the concentration of phosphorus, potassium, magnesium, calcium, sodium, iron and zinc. These results suggest that increased mire surface wetness, possibly the result of a change in climate, created conditions unsuitable for pine growth c. 4000 years BP. Mire surface wetness, coupled with a period of associated nutrient deficiency, appears to be a possible explanation for a lack of subsequent pine-seedling establishment for most of the later Holocene

Mapping local patterns of childhood overweight and wasting in low- and middle-income countries between 2000 and 2017

A double burden of malnutrition occurs when individuals, household members or communities experience both undernutrition and overweight. Here, we show geospatial estimates of overweight and wasting prevalence among children under 5 years of age in 105 low- and middle-income countries (LMICs) from 2000 to 2017 and aggregate these to policy-relevant administrative units. Wasting decreased overall across LMICs between 2000 and 2017, from 8.4 (62.3 (55.1�70.8) million) to 6.4 (58.3 (47.6�70.7) million), but is predicted to remain above the World Health Organization�s Global Nutrition Target of <5 in over half of LMICs by 2025. Prevalence of overweight increased from 5.2 (30 (22.8�38.5) million) in 2000 to 6.0 (55.5 (44.8�67.9) million) children aged under 5 years in 2017. Areas most affected by double burden of malnutrition were located in Indonesia, Thailand, southeastern China, Botswana, Cameroon and central Nigeria. Our estimates provide a new perspective to researchers, policy makers and public health agencies in their efforts to address this global childhood syndemic. © 2020, The Author(s)