Acute care nurses' perceptions of barriers to using research information in clinical decision-making

Aim. To examine the barriers that nurses feel prevent them from using research in the decisions they make. Background. A sizeable research literature focusing on research utilization in nursing has developed over the past 20 years. However, this literature is characterized by a number of weaknesses: self-reported utilization behaviour; poor response rates and small, nonrandom sampling strategies. Design. Cross-case analysis involving anonymised qualitative interviews, observation, documentary audit and Q methodological modelling of shared subjectivities amongst nurses. The case sites were three large acute hospitals in the north of England. One hundred and eight nurses were interviewed, 61 of whom were also observed for a total of 180 h, and 122 nurses were involved in the Q modelling exercise (response rate of 64%). Results. Four perspectives were isolated that encompassed the characteristics associated with barriers to research use. These related to the individual, organization, nature of research information itself and environment. Nurses clustered around four main perspectives on the barriers to research use: (1) Problems in interpreting and using research products, which were seen as too complex, 'academic' and overly statistical; (2) Nurses who felt confident with research-based information perceived a lack of organizational support as a significant block; (3) Many nurses felt that researchers and research products lack clinical credibility and that they fail to offer the desired level of clinical direction; (4) Some nurses lacked the skills and, to a lesser degree, the motivation to use research themselves. These individuals liked research messages passed on to them by a third party and sought to foster others' involvement in research-based practice, rather than becoming directly involved themselves. Conclusions. Rejection of research knowledge is not a barrier to its application. Rather, the presentation and management of research knowledge in the workplace represent significant challenges for clinicians, policy-makers and the research community

The accessibility of research-based knowledge for nurses in United Kingdom acute care settings

Background. The successful dissemination of the results of the National Health Service (NHS) research and development strategy and the development of evidence based approaches to health care rely on clinicians having access to the best available evidence; evidence fit for the purpose of reducing the uncertainties associated with clinical decisions. Aim. To reveal the accessibility of those sources of information actually used by nurses, as well as those which they say they use. Design. Mixed method case site, using interview, observational, Q sort and documentary audit data in medical, surgical and coronary care units (CCUs) in three acute hospitals. Results. Three perspectives on accessibility were identified: (a) the humanist-in which human sources of information were the most accessible; (b) local information for local needs-in which locally produced resources were seen as the most accessible and (c) moving towards technology-in which information technology begins to be seen as accessible. Nurses' experience in a clinical specialty is positively associated with a perception that human sources such clinical nurse specialists, link nurses, doctors and experienced clinical colleagues are more accessible than text based sources. Clinical specialization is associated with different approaches to accessing research knowledge. Coronary care unit nurses were more likely perceive local guidelines, protocols and on-line databases as more accessible than their counterparts in general medical and surgical wards. Only a third of text-based resources available to nurses oil the wards had any explicit research base. These, and the remainder were Out of date (mean age of textbooks 11 years), and authorship hard to ascertain. Conclusion. A strategy to increase the use of research evidence by nurses should harness the influence of clinical nurse specialists, link nurses and those engaged in practice development. These roles Could act as 'conduits' through which research-based messages for practice, and information for clinical decision making, could flow. This role should be explored and enhanced

Polo like kinase 2 tumour suppressor and cancer biomarker: new perspectives on drug sensitivity/resistance in ovarian cancer

The polo-like kinase PLK2 has recently been identified as a potential theranostic marker in the management of chemotherapy sensitive cancers. The methylation status of the PLK2 CpG island varies with sensitivity to paclitaxel and platinum in ovarian cancer cell lines. Importantly, extrapolation of these in vitro data to the clinical setting confirms that the methylation status of the PLK2 CpG island predicts outcomes in patients treated with carboplatin and paclitaxel chemotherapy. A second cell cycle regulator, p57Kip2, is also subject to epigenetic silencing in carboplatin resistance in vitro and in vivo, emphasising that cell cycle regulators are important determinants of sensitivity to chemotherapeutic agents and providing insights into the phenomenon of collateral drug sensitivity in oncology. Understanding the mechanistic basis and identification of robust biomarkers to predict collateral sensitivity may inform optimal use of chemotherapy in patients receiving multiple lines of treatment

Mechanisms and Observations of Coronal Dimming for the 2010 August 7 Event

Coronal dimming of extreme ultraviolet (EUV) emission has the potential to be a useful forecaster of coronal mass ejections (CMEs). As emitting material leaves the corona, a temporary void is left behind which can be observed in spectral images and irradiance measurements. The velocity and mass of the CMEs should impact the character of those observations. However, other physical processes can confuse the observations. We describe these processes and the expected observational signature, with special emphasis placed on the differences. We then apply this understanding to a coronal dimming event with an associated CME that occurred on 2010 August 7. Data from the Solar Dynamics Observatory's (SDO) Atmospheric Imaging Assembly (AIA) and EUV Variability Experiment (EVE) are used for observations of the dimming, while the Solar and Heliospheric Observatory's (SOHO) Large Angle and Spectrometric Coronagraph (LASCO) and the Solar Terrestrial Relations Observatory's (STEREO) COR1 and COR2 are used to obtain velocity and mass estimates for the associated CME. We develop a technique for mitigating temperature effects in coronal dimming from full-disk irradiance measurements taken by EVE. We find that for this event, nearly 100% of the dimming is due to mass loss in the corona

Optical constraints of kerogen from 0.15 to 40 microns: Comparison with meteoritic organics

Kerogens are dark, complex organic materials produced on the Earth primarily by geologic processing of biologic materials, but kerogens have chemical and spectral similarities to some classes of highly processed extraterrestrial organic materials. Kerogen-like solids were proposed as constitutents of the very dark reddish surfaces of some asteroids and are also spectrally similar to some carbonaceous organic residues and the Iapetus dark material. Kerogen can thus serve as a useful laboratory analog to very dark, spectrally red extraterrestrial materials; its optical constants can be used to investigate the effects of particle size, void space and mixing of bright and dark components in models of scattering by dark asteroidal, cometary, and satellite surfaces. Measurements of the optical constants of both Type 2 kerogen and of macromolecular organic residue from the Murchison carbonaceous chondrite via transmission and reflection measurements on thin films are reported. The real part of the refractive index, n, is determined by variable incidence-angle reflectance to be 1.60 + or - 0.05 from 0.4 to 2.0 micrometers wavelength. Work extending the measurement of n to longer wavelengths is in progress. The imaginary part of the refractive index, k, shows substantial structure from 0.15 to 40 micrometers. The values are accurate to + or - 20 percent in the UV and IR regions and to + or - 30 percent in the visible. The k values of organic residues were also measured from the Murchison meteorite. Comparison of the kerogen and Murchison data reveals that between 0.15 and 40 microns, Murchison has a similar structure but no bands as sharp as in kerogen, and that the k values for Murchison are significantly higher than those of kerogen

Pattern formation in crystal growth under parabolic shear flow

Morphological instability of the solid-liquid interface occuring in a crystal growing from an undercooled thin liquid being bounded on one side by a free surface and flowing down inclined plane is investigated by a linear stability analysis under shear flow. It is found that restoring forces due to gravity and surface tension is important factor for stabilization of the solid-liquid interface on long length scales. This is a new stabilizing effect different from the Gibbs-Thomson effect. A particular long wavelength mode of about 1 cm of wavy pattern observed on the surface of icicles covered with thin layer of flowing water is obtained from the dispersion relation including the effect of flow and restoring forces.Comment: 30 pages, 4 figure

A predictive standard model for heavy electron systems

We propose a predictive standard model for heavy electron systems based on a detailed phenomenological two-fluid description of existing experimental data. It leads to a new phase diagram that replaces the Doniach picture, describes the emergent anomalous scaling behavior of the heavy electron (Kondo) liquid measured below the lattice coherence temperature, T*, seen by many different experimental probes, that marks the onset of collective hybridization, and enables one to obtain important information on quantum criticality and the superconducting/antiferromagnetic states at low temperatures. Because T* is ~J^2\rho/2, the nearest neighbor RKKY interaction, a knowledge of the single-ion Kondo coupling, J, to the background conduction electron density of states, \rho, makes it possible to predict Kondo liquid behavior, and to estimate its maximum superconducting transition temperature in both existing and newly discovered heavy electron families.Comment: 4 pages, 2 figures, submitted to J. Phys.: Conf. Ser. for SCES 201

Efficient fiber-optical interface for nanophotonic devices

We demonstrate a method for efficient coupling of guided light from a single mode optical fiber to nanophotonic devices. Our approach makes use of single-sided conical tapered optical fibers that are evanescently coupled over the last ~10 um to a nanophotonic waveguide. By means of adiabatic mode transfer using a properly chosen taper, single-mode fiber-waveguide coupling efficiencies as high as 97(1)% are achieved. Efficient coupling is obtained for a wide range of device geometries which are either singly-clamped on a chip or attached to the fiber, demonstrating a promising approach for integrated nanophotonic circuits, quantum optical and nanoscale sensing applications.Comment: 7 pages, 4 figures, includes supplementary informatio