Emergency nurse practitioners and doctors consulting with patients in an emergency department : a comparison of communication skills and satisfaction

Background: Emergency nurse practitioners (ENPs) play an increasingly important role in UK emergency departments (EDs), but there is limited evidence about how this affects patient care and outcome. A study was undertaken to compare the content of, and satisfaction with, consultations made with patients presenting with problems of low acuity to an ED. Methods: Patients presenting with "primary care" problems were allocated to senior house officers (SHOs, n = 10), specialist registrars/staff grades (n = 7), sessionally-employed general practitioners (GPs, n = 12) or ENPs (n = 6) randomly rostered to work in a consulting room that had a wall-mounted video camera. At the end of each consultation the doctor/ENP and the patient were asked to complete the Physician/Patient Satisfaction Questionnaire. A stratified sample of videotaped consultations (n = 296) was analysed in depth using the Roter Interaction Analysis System. The main outcome measures were length of consultation; numbers of utterances of doctor/ENP and patient talk related to building a relationship, data gathering, activating/partnering, and patient education/counselling; doctor/ENP and patient consultation satisfaction scores. Results: ENPs and GPs focused more on patient education and counselling about the medical condition or therapeutic regimen than did ED doctors. There were no significant differences in consultation length. ENPs had higher levels of overall self-satisfaction with their consultations than ED doctors. Patient satisfaction with how actively they participated in the consultation was significantly associated with the amount of talk relating to building a relationship and activating and partnering, and patient satisfaction with information giving in the consultation was significantly associated with the amount of talk relating to building a relationship. Conclusion: These findings suggest differences between ENP and ED doctor consultations which are associated with some aspects of patient satisfaction. In contrast to previous reports, consultation length was not greater for ENPs than for doctors. There is a need for further research to test the generalisability of these findings and their impact on clinical outcome

Seasonal Variability In The Ionosphere Of Uranus

Infrared ground-based observations using IRTF, UKIRT, and Keck II of Uranus have been analyzed as to identify the long-term behavior of the H-3(+) ionosphere. Between 1992 and 2008 there are 11 individual observing runs, each recording emission from the H-3(+) Q branch emission around 4 mu m through the telluric L' atmospheric window. The column-averaged rotational H-3(+) temperature ranges between 715 K in 1992 and 534 K in 2008, with the linear fit to all the run-averaged temperatures decreasing by 8 K year(-1). The temperature follows the fractional illumination curve of the planet, declining from solstice (1985) to equinox (2007). Variations in H-3(+) column density do not appear to be correlated to either solar cycle phase or season. The radiative cooling by H-3(+) is similar to 10 times larger than the ultraviolet solar energy being injected to the atmosphere. Despite the fact that the solar flux alone is incapable of heating the atmosphere to the observed temperatures, the geometry with respect to the Sun remains an important driver in determining the thermospheric temperature. Therefore, the energy source that heats the thermosphere must be linked to solar mechanisms. We suggest that this may be in the form of conductivity created by solar ionization of atmospheric neutrals and/or seasonally dependent magnetospherically driven current systems.STFC PP/E/000983/1, ST/G0022223/1RCUKGemini ObservatoryNational Aeronautics and Space Administration (NASA) NXX08A043G, NNX08AE38AAstronom

Adaptive clinical trials incorporating treatment selection and evaluation: methodology and application in progressive multiple sclerosis

In progressive multiple sclerosis (MS) irreversible disability often takes many years to accumulate as a result prolonged trials are required to assess the benefits of therapies. There is a need to understand the relationship between short-term outcome measures such as MRI endpoints and long-term clinical outcomes in progression to determine the evolution of the disease early on. Thus, the common phase I-II-III paradigm for clinical trial design with separate trials for each phase may not be appropriate

Operational loads on a tidal turbine due to environmental conditions

Accurate assessment of the fatigue life of tidal stream turbines and components requires prediction of the unsteady loading of turbine components over a wide range of frequencies. This study focuses on the influence of ambient turbulence, velocity shear and the approach taken to model wave kinematics, on the variation of thrust load imposed on the rotor shaft and supporting tower. Load cycles are assessed based on sea-state occurrence data taken over a five month period for a case study site. The influence of each environmental parameter on component loading is evaluated and the impact on material design parameters assessed. Alternative approaches are considered for modelling turbulent loading and wave loading. The frequency variation of loads due to turbulence are scaled from experimental data from trials of a three-bladed horizontal axis turbine of 1.2 m diameter on a bed-mounted supporting structure. Frequency dependent wave loading is estimated by a relative form of the drag term of the widely used equation of Morison et al. (1950), with the depth decay of kinematics modelled by linear wave theory. Over the five month interval considered a ten year design life can be obtained with a lower design load by accounting for variation of turbulence intensity that occurs during each tidal cycle. This is expected to vary further with the approach taken to model the onset turbulence. A component can also be designed for lower loads over the same time period if irregular waves are modelled instead of regular

Only connect: addressing the emotional needs of Scotland's children and young people

A report on the SNAP (Scottish Needs Assessment Programme) Child and Adolescent Mental Health Phase Two survey. It describes a survey of a wide range of professionals working with children and young people in Scotland, and deals with professional perspectives on emotional, behavioural and psychological problems. Conclusions and recommendations are presented

Escape rate and Hausdorff measure for entire functions

The escaping set of an entire function is the set of points that tend to infinity under iteration. We consider subsets of the escaping set defined in terms of escape rates and obtain upper and lower bounds for the Hausdorff measure of these sets with respect to certain gauge functions.Comment: 24 pages; some errors corrected, proof of Theorem 2 shortene

Designing Digital Content to Support Science Journalism

Journalists need to become more effective at communicating science and countering post-truth activities that seek to undermine scientific processes and evidence. Digital support for journalists when investigating and writing about sciencerelated topics is one means of improving this science communication. However, little bespoke digital support is available. This paper reports the research and development of one new form of such digital support. During a participatory design process, experienced science journalists and other professionals were interviewed about their challenges experienced and understanding of good practices in science journalism. These challenges and good practices informed the development of a prototype of a new form of digital tool that was evaluated by journalists without specialist science training. A new version of the prototype, called INQUEST, was implemented to automate some parts of good practices in order to augment journalists’ capabilities. These practices included the retrieval of science information from diverse sources, targeting different science audiences, and providing different forms of guidance for explaining science to the target audience. This prototype is presented, and an early evaluation of it is reported

Less Traditional – More Conceptual: Enhancing Student Learning in First-Year Biology

Over the last two decades, a number of influential reports have called for fundamental changes to undergraduate science education. Most importantly, these reports advocate a shift from traditional lecture-based teaching formats to ones that use student-focused pedagogies to encourage deep student learning about key conceptual ideas in science. Based on these reports, and the underlying research, the University of Calgary completed an extensive redesign of its first-year biology courses in 2011, resulting in two courses: Energy Flow in Biological Systems and DNA, Inheritance and Evolution. These courses focus student learning on two foundational concepts and use student-centered pedagogies to encourage the development of critical-thinking and problem-solving skills. Pre/post data collected from one year of the previous introductory courses and two years of the redesigned courses were used to determine the impact of the transition to a conceptual-based curriculum and the incorporation of active learning strategies including clickers and in-class group assignments on student learning gains measured via normalized change using questions from Biological Concept Inventory, Respiration and Photosynthesis Diagnostic Question Clusters and the Conceptual Inventory of Natural Selection. Student motivations and approaches for learning (e.g. deep versus surface approaches) using the published Approaches and Study Skills Inventory for Students (ASSIST) survey and the Experiences of Teaching and Learning Questionnaire (ETLQ). Data show significantly higher learning gains during the two consecutive years of implementation of the redesigned courses than those achieved in the previous format. Additionally, students reported that lecture activities allowed them being more engaged with course content. We are currently analyzing student written responses, which will provide further insight into the impact of course redesign on content knowledge and critical reasoning skills on student success