A review of clinical decision-making: Models and current research

Aims and objectives: The aim of this paper was to review the current literature with respect to clinical decision-making models and the educational application of models to clinical practice. This was achieved by exploring the function and related research of the three available models of clinical decision making: information processing model, the intuitive-humanist model and the clinical decision making model. Background: Clinical decision-making is a unique process that involves the interplay between knowledge of pre-existing pathological conditions, explicit patient information, nursing care and experiential learning. Historically, two models of clinical decision making are recognised from the literature; the information processing model and the intuitive-humanist model. The usefulness and application of both models has been examined in relation the provision of nursing care and care related outcomes. More recently a third model of clinical decision making has been proposed. This new multidimensional model contains elements of the information processing model but also examines patient specific elements that are necessary for cue and pattern recognition. Design: Literature review Methods: Evaluation of the literature generated from MEDLINE, CINAHL, OVID, PUBMED and EBESCO systems and the Internet from 1980 – November 2005

Think globally, measure locally: The MIREN standardized protocol for monitoring plant species distributions along elevation gradients

Climate change and other global change drivers threaten plant diversity in mountains worldwide. A widely documented response to such environmental modifications is for plant species to change their elevational ranges. Range shifts are often idiosyncratic and difficult to generalize, partly due to variation in sampling methods. There is thus a need for a standardized monitoring strategy that can be applied across mountain regions to assess distribution changes and community turnover of native and non-native plant species over space and time. Here, we present a conceptually intuitive and standardized protocol developed by the Mountain Invasion Research Network (MIREN) to systematically quantify global patterns of native and non-native species distributions along elevation gradients and shifts arising from interactive effects of climate change and human disturbance. Usually repeated every five years, surveys consist of 20 sample sites located at equal elevation increments along three replicate roads per sampling region. At each site, three plots extend from the side of a mountain road into surrounding natural vegetation. The protocol has been successfully used in 18 regions worldwide from 2007 to present. Analyses of one point in time already generated some salient results, and revealed region-specific elevational patterns of native plant species richness, but a globally consistent elevational decline in non-native species richness. Non-native plants were also more abundant directly adjacent to road edges, suggesting that disturbed roadsides serve as a vector for invasions into mountains. From the upcoming analyses of time series, even more exciting results can be expected, especially about range shifts. Implementing the protocol in more mountain regions globally would help to generate a more complete picture of how global change alters species distributions. This would inform conservation policy in mountain ecosystems, where some conservation policies remain poorly implemented.EEA BarilocheFil: Haider, Sylvia. German Centre for Integrative Biodiversity Research; AlemaniaFil: Haider, Sylvia. Martin Luther University. Institute of Biology. Geobotany and Botanical Garden; AlemaniaFil: Lembrechts, Jonas Johan. University of Antwerp. Centre of Excellence Plants and Ecosystems (PLECO); BélgicaFil: McDougall, Keith. Department of Planning, Industry and Environment; AustraliaFil: Pauchard, Aníbal. Universidad de Concepción. Facultad de Ciencias Forestales. Laboratorio de Invasiones Biológicas; ChileFil: Pauchard, Aníbal. Institute of Ecology and Biodiversity (IEB); ChileFil: Alexander, Jake M. Institute of Integrative Biology; SuizaFil: Barros, Agustina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico. Instituto Argentino de Nivología y Glaciología y Ciencias Ambientales (IANIGLA); ArgentinaFil: Cavieres, Lohengrin A. Universidad de Concepción. Facultad de Ciencias Naturales y Oceanográficas. Departamento de Botánica; ChileFil: Cavieres, Lohengrin A. Institute of Ecology and Biodiversity (IEB); ChileFil: Rashid, Irfan. University of Kashmir. Department of Botany; IndiaFil: Rew, Lisa J. Montana State University. Department of Land Resource and Environmental Sciences; Estados UnidosFil: Aleksanyan, Alla. Institute of Botany aft. A.L. Takhtajyan NAS RA. Department of Geobotany and Plant Ecophysiology; ArmeniaFil: Aleksanyan, Alla. Armenian National Agrarian University. Chair of Biology and Biotechnologies; ArmeniaFil: Dimarco, Romina Daniela. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria Bariloche. Instituto de Investigaciones Forestales y Agropecuarias Bariloche. Grupo de Ecología de Poblaciones de Insectos; ArgentinaFil: Dimarco, Romina Daniela. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Investigaciones Forestales y Agropecuarias Bariloche. Grupo de Ecología de Poblaciones de Insectos; ArgentinaFil: Dimarco, Romina Daniela. University of Houston. Department of Biology and Biochemistry; Estados UnidosFil: Seipel, Tim. Montana State University. Department of Land Resource and Environmental Sciences; Estados Unido

Design and simulation of losses in Ge/SiGe terahertz quantum cascade laser waveguides

The waveguide losses from a range of surface plasmon and double metal waveguides for Ge/Si1-xGex THz quantum cascade laser gain media are investigated at 4.79 THz (62.6 µm wavelength). Double metal waveguides demonstrate lower losses than surface plasmonic guiding with minimum losses for a 10 µm thick active gain region with silver metal of 21 cm-1 at 300 K reducing to 14.5 cm-1 at 10 K. Losses for silicon foundry compatible metals including Al and Cu are also provided for comparison and to provide a guide for gain requirements to enable lasers to be fabricated in commercial silicon foundries. To allow these losses to be calculated for a range of designs, the complex refractive index of a range of nominally undoped Si1-xGex with x = 0.7, 0.8 and 0.9 and doped Ge heterolayers were extracted from Fourier transform infrared spectroscopy measurements between 0.1 and 10 THz and from 300 K down to 10 K. The results demonstrate losses comparable to similar designs of GaAs/AlGaAs quantum cascade laser plasmon waveguides indicating that a gain threshold of 15.1 cm-1 and 23.8 cm-1 are required to produce a 4.79 THz Ge/SiGe THz laser at 10 K and 300 K, respectively, for 2 mm long double metal waveguide quantum cascade lasers with facet coatings. © 2020 OSA - The Optical Society. All rights reserved

What are school leavers' priorities for festival preparation?

Published: 20 November 2013This paper reports on the findings from a qualitative research study that explored how young people prepared to minimise and/or avoid alcohol-related harm while attending a Schoolies Festival (SF). SFs are mass gatherings at which young people (schoolies) celebrate their graduation from high school. The attendance of schoolies, in various Australian communities, ranges between 10 000 and 30 000 individuals during the event. The literature suggests that schoolies are at higher than normal risk of harm at SF from misuse of alcohol, unsafe sex, aggressive behaviour, and other risk-taking factors. As a result of these concerns, SF organisers developed an infrastructure that treats alcohol-related harm, and provides on-site care (first aid stations) by St John Ambulance staff. This study used focus groups to identify strategies used by schoolies to avoid alcohol-related harm during SFs. Data revealed that schoolies did not actively seek health information before attending the event and did not display an interest in doing so. It is important to note that schoolies planned to use alcohol to celebrate and have a good time. Therefore a harm minimisation approach with a focus on providing the necessary infrastructure at SFs to minimise the dangers associated with excess alcohol use is important. Schoolies indicated that they had no desire for information about the hazards of alcohol ingestion. If any health messages were to be used by health authorities, it would be far more appropriate to promote the message of ‘take care of your mate’, to contribute to building a supportive environment at the event. This may be of more benefit to minimise harm at SFs than funding other health messages.Alison Hutton, Lynette Cusack, Lana Zannettino, Sarah J. M. Shaefer, Naomi Verdonk and Paul Arbo

Design and simulation of losses in Ge/SiGe terahertz quantum cascade laser waveguides

The waveguide losses from a range of surface plasmon and double metal waveguides for Ge/Si1−xGex THz quantum cascade laser gain media are investigated at 4.79 THz (62.6 μm wavelength). Double metal waveguides demonstrate lower losses than surface plasmonic guiding with minimum losses for a 10 μm thick active gain region with silver metal of 21 cm−1 at 300 K reducing to 14.5 cm−1 at 10 K. Losses for silicon foundry compatible metals including Al and Cu are also provided for comparison and to provide a guide for gain requirements to enable lasers to be fabricated in commercial silicon foundries. To allow these losses to be calculated for a range of designs, the complex refractive index of a range of nominally undoped Si1−xGex with x = 0.7, 0.8 and 0.9 and doped Ge heterolayers were extracted from Fourier transform infrared spectroscopy measurements between 0.1 and 10 THz and from 300 K down to 10 K. The results demonstrate losses comparable to similar designs of GaAs/AlGaAs quantum cascade laser plasmon waveguides indicating that a gain threshold of 15.1 cm−1 and 23.8 cm−1 are required to produce a 4.79 THz Ge/SiGe THz laser at 10 K and 300 K, respectively, for 2 mm long double metal waveguide quantum cascade lasers with facet coatings

Importance of Appropriate Medication Administration in Patients with Nasogastric Feeding Tube

Solid dosage forms like modified release and enteric coated formulations are considered inappropriate for nasogastric feeding tube (NGFT) administration due to varying pharmacokinetics which could lead to inadequate therapeutic responses or toxicity. An analysis was conducted to assess the appropriateness of prescribed medicines for NGFT administration in hospital inpatients so that physicians can be sensitized to the importance of this. In this cross-sectional study conducted in a large tertiary care centre, prescription data of in-patients with nasogastric feeding tube (NGFT) were retrieved through electronic pharmacy transactions. Adult patients who were admitted in the hospital for more than one day and were dispensed a NGFT were included. The appropriateness of medicines administered through NGFT was assessed using standard published literature. Details of medicines that were categorized as inappropriate were collated and analysed. In case of inappropriate prescribing, availability of appropriate dosage forms was also determined. A total of 510 patients were found eligible for analyses. Majority of the patients were dispensed at least one inappropriate dosage form. Among the dispensed oral solid dosage forms, 16.38% were found to be inappropriate for NGFT administration. Of these, 21.41% were dispensed on same day as the NGFT, 34.67% were dispensed before the NGFT and were continued throughout the hospital stay and 43.92% were dispensed within or after 24 hours of NGFT dispensation. These findings will improve awareness among healthcare professionals about the need for appropriate administration of oral formulations in patients intubated with NGFT. Keywords: Inappropriate Dosage Forms, Nasogastric Feeding Tube, Appropriate Dosage Forms, Modified Release Formulation

AIMES: advanced computation and I/O methods for earth-system simulations

Dealing with extreme scale Earth-system models is challenging from the computer science perspective, as the required computing power and storage capacity are steadily increasing. Scientists perform runs with growing resolution or aggregate results from many similar smaller-scale runs with slightly different initial conditions (the so-called ensemble runs). In the fifth Coupled Model Intercomparison Project (CMIP5), the produced datasets require more than three Petabytes of storage and the compute and storage requirements are increasing significantly for CMIP6. Climate scientists across the globe are developing next-generation models based on improved numerical formulation leading to grids that are discretized in alternative forms such as an icosahedral (geodesic) grid. The developers of these models face similar problems in scaling, maintaining and optimizing code. Performance portability and the maintainability of code are key concerns of scientists as, compared to industry projects, model code is continuously revised and extended to incorporate further levels of detail. This leads to a rapidly growing code base that is rarely refactored. However, code modernization is important to maintain productivity of the scientist working with the code and for utilizing performance provided by modern and future architectures. The need for performance optimization is motivated by the evolution of the parallel architecture landscape from homogeneous flat machines to heterogeneous combinations of processors with deep memory hierarchy. Notably, the rise of many-core, throughput-oriented accelerators, such as GPUs, requires non-trivial code changes at minimum and, even worse, may necessitate a substantial rewrite of the existing codebase. At the same time, the code complexity increases the difficulty for computer scientists and vendors to understand and optimize the code for a given system. Storing the products of climate predictions requires a large storage and archival system which is expensive. Often, scientists restrict the number of scientific variables and write interval to keep the costs balanced. Compression algorithms can reduce the costs significantly but can also increase the scientific yield of simulation runs. In the AIMES project, we addressed the key issues of programmability, computational efficiency and I/O limitations that are common in next-generation icosahedral earth-system models. The project focused on the separation of concerns between domain scientist, computational scientists, and computer scientists

The Bio-Politics of Population Control and Sex Selective Abortion in China and India

China and India, two countries with skewed sex ratios in favor of males, have introduced a wide range of policies over the past few decades to prevent couples from deselecting daughters, including criminalizing sex-selective abortion through legal jurisdiction. This article aims to analyze how such policies are situated within the bio-politics of population control and how some of the outcomes reflect each government’s inadequacy in addressing the social dynamics around abortion decision making and the social, physical, and psychological effects on women’s wellbeing in the face of criminalization of sex-selective abortion. The analysis finds that overall, the criminalization of sex selection has not been successful in these two countries. Further, the broader economic, social, and cultural dynamics which produce bias against females must be a part of the strategy to combat sex selection, rather than a narrow criminalization of abortion which endangers women’s access to safe reproductive health services and their social, physical, and psychological wellbeing

Compassion Stress and the Qualitative Researcher

Human subjects are carefully protected in the research process. However, the same consideration is not currently being given to the qualitative researcher, even those investigating topics that are likely to elicit powerful emotions. The role of researcher’s emotional responses and the self-care strategies that, in some circumstances, are appropriate for the researcher and other research support personnel have not received the attention they deserve in qualitative research literature. Based on experience in conducting research on the topic of self-directed learning and breast cancer, and on the limited literature available, the author makes the case for the use of strategies such as counseling, peer debriefing, and journal writing as means of dealing with the potential for “compassion stress” as experienced by the researcher and other research support personnel. She also suggests that the preparation of social science researchers should include information on appropriate self-care strategies.Yeshttps://us.sagepub.com/en-us/nam/manuscript-submission-guideline