Post Mortem Computed Tomography: An innovative tool for teaching anatomy within pre-registration nursing curricula

The file attached to this record is the author's final peer reviewed version. The Publisher's final version can be found by following the DOI link.Background There is significant change throughout the world regarding Post Mortem Computed Tomography (PMCT) as an adjunct or a replacement to the traditional invasive autopsy. Of interest, is the ability to demonstrate visually two and three dimensional normal soft tissue, organ and skeletal anatomy, as well as natural disease and trauma pathology. Objectives The objective was to compare formal traditional methods of teaching anatomy and pathology (pictures and diagrams) to pre-registration student nurses with supplementary PMCT 2/3D generated images, videos and printed anatomical models. The specific objective was to determine if these tools would increase the students’ perception of their understanding and learning experience of the subject area. Design A quasi-experimental within-subject design was chosen. Setting A School of Nursing and Midwifery within a Higher Education Institution in the UK. Participants Purposeful sampling of 57 voluntary informed consented pre-registration student nurses. Method Students were initially exposed to teaching of normal anatomy and common fractures using traditional methods. Data was then collected following the teaching session using a questionnaire entailing both quantitative and qualitative elements. The teaching session was then repeated with the same students but with the inclusion of PMCT of all the same normal anatomy and fractures. Data was then collected again using the same questionnaire. Both questionnaires were then compared. Results The quantitative findings proved highly significantly proved (P = < 0.01) that the inclusion of Post Mortem Computed Tomography when teaching normal anatomy and pathology increases preregistration nursing students’ perception of their understanding and learning experience. The qualitative results revealed three positive themes concerning visual learning, realism and patient empathy. Conclusion Including Post Mortem Computed Tomography imagery enables nurse academics to provide students with a virtual tour of the human body and a rich, authentic learning experience of a real individual who experienced a relevant clinical scenario that nurses are likely to encounter in their careers

Philosophy & quality? TAPUPASM as an approach to rigour in critical realist research

Aims This article discusses an approach to ensuring scientific rigour in post-positivist critical realist research using an enhanced model of TAPUPAS: transferability, accessibility, propriety, utility, purposivity, accuracy and specificity, with the additional criterion, modified objectivity (TAPUPASM). Background Philosophical principles should guide the manner in which research is designed, conducted and appraised. Therefore, the more traditional and commonly employed approaches to positivist (validity and generalisability) or interpretivist (trustworthiness) research do not necessarily complement the philosophical principles of post-positivist critical realism. Methods This is a methodological discussion paper illustrating the strategies for rigorous research using TAPUPASM in a critical realist ethnographic study in nurse education. Results This paper presents examples of strategies to ensure TAPUPASM in the planning, design, conduct and dissemination of a realist research study. These include choices about data collection and analysis and also, the role of a dissemination strategy outside of traditional academic methods. Conclusion This article proposes an enhanced version of the quality criteria framework TAPUPAS(M) for the design of critical realist research. It provides a practical example of how TAPUPASM was used to ensure rigour in a critical realist ethnographic study in pre-registration nurse education. For nurse researchers, this article provides a framework for quality in post-positivist critical realist research. It provides examples of the strategies that can be employed for nurse researchers planning, designing, conducting and disseminating critical realist research

Decision-making in an emergency department: A nursing accountability model

The file attached to this record is the author's final peer reviewed version. The Publisher's final version can be found by following the DOI link.Introduction Nurses that work in an emergency department regularly care for acute patients in a fast-paced environment, being at risk of suffering high levels of burnout. This situation makes them especially vulnerable to be accountable for decisions they did not have time to consider or have been pressured into. Research objective The objective of this study was to find which factors influence ethical, legal and professional accountability in nursing practice in an emergency department. Research design Data were analysed, codified and triangulated using qualitative ethnographic content analysis. Participants and research context This research is set in a large emergency department in the Midlands area of England. Data was collected from 186 nurses using participant observation, 34 semi-structured interviews with nurses and ethical analysis of 54 applicable clinical policies Ethical considerations Ethical approval was granted by two research ethics committees and the National Health Service Health Research Authority. Results The main result was the clinical nursing accountability cycle model, which showed accountability as a subjective concept that flows between the nurse and the healthcare institution. Moreover, the relations amongst the clinical nursing accountability factors are also analysed to understand which factors affect decision-making. Discussion The retrospective understanding of the factors that regulate nursing accountability is essential to promote that both the nurse and the healthcare institution take responsibility not only for the direct consequences of their actions but also for the indirect consequences derived from previous decisions. Conclusion The decision-making process and the accountability linked to it are affected by several factors that represent the holistic nature of both entities, which are organised and interconnected in a complex grid. This pragmatic interpretation of nursing accountability allows the nurse to comprehend how their decisions are affected, while the healthcare institution could act proactively to avoid any problems before they happen

Pop-Up Structures and the Fracture Pattern in the Balsam Lake Area, Southern Ontario

An examination of topographic lineaments detectable in Landsat TM images and measurement of joints in outcrop in the Balsam Lake area reveals a systematic bedrock fracture pattern with three principal sets oriented 091°, 027°, and 152°. The 027° trend is parallel to a major aeromagnetic anomaly, the Niagara-Pickering Linear Zone (NPLZ), which underlies the Balsam Lake area and is thought to mark the sub-Paleozoic continuation of the Proterozoic Central Metasedimentary Belt Boundary Zone (CMBBZ). Possible origins of the main joint sets due to Acadian (091° set), Alleghanian (152° set) and St. Lawrence rift system tectonics (091° and 027° sets) are discussed. En-echelon pop-up structures have a mean principal trend of 118°. They displace Lake Algonquin paleobeaches, suggesting formation less than 12,500 years ago. The orientation of the pop-up structures is subnormal to the current in situ maximum horizontal stress direction, SHmax (020°), and is parallel to members of the 091° joint set, indicating possible nuclea-tion on favourably-oriented pre-existing joints. These pop-ups are the only features in the Balsam Lake area with strong evidence for a neotectonic age.L'examen des linéaments topographiques repérables sur les images Landsat (TM) et la mesure des diaclases dans un affleurement de la région de Balsam Lake révèle la présence d'un réseau de fractures dont l'orientation des trois principaux ensembles est 091°, 027° et 152°. La direction 027° est parallèle à une anomalie aéromagnétique majeure, la zone linéaire Niagara-Pickering, présente sous la région de Balsam Lake; on croit qu'elle identifie le prolongement sub-paléozoïque de l'aire limite de la zone méta-sédimentaire centrale protérozoïque. On traite des origines possibles des principaux ensembles de fractures attribuables aux systèmes acadien (091°), alléghanien (152°) et du rift du Saint-Laurent (091 °et 027°). La direction des structures de soulèvement en échelon est de 118°. Elles ont déplacé des paléo-plages du Lac Algonquin, indiquant ainsi une formation postérieure à 12 500 ans. L'orientation des structures de soulèvement est subnormale à la direction de la contrainte horizontale maximale actuelle, SHmax(020°), et est parallèle à des éléments de l'ensemble des fractures de direction 091°, montrant ainsi leur formation possible dans des fractures existantes bien orientées. Ces structures de soulèvement sont les seuls éléments de la région démontrant un âge néotectonique.Eine Untersuchung der topographischen Lineamente die in Landsat TM-Bildern nachweisbar sind und Messungen der Fugen in den Aufschlùssen des Balsam Lake-Gebiets lassen ein systematisches Bruchmuster des anstehenden Gesteins erkennen mit drei nach 091°, 027° und 152° ausgerichteten Haupteinheiten. Die Ausrichtung nach 027° ist parallel zu einer wichtigen aeromagnetischen Anomalie, der linearen Zone von Niagara-Pickering, die unter dem Balsam Lake-Gebiet liegt; man halt sie fur eine subpalàozoische Fortfùhrung des Grenz-bereichs der proterozoischen zentralen metasedimentàren Gùrtel-zone. Man diskutiert môgliche Ursprùnge der Hauptfugen-systeme, die auf die akadische (091° System), alleghanische (152° System) und Sankt-Lorenz-Spaltensystem Tektonik (091° und 027° System) zurùckgefùhrt werden. Die gestaffelten Hebungsstrukturen haben eine durchschnittliche Hauptrichtung von 118°. Sie haben Palào-Strànde vom Lake Algonquin versetzt, und weisen so auf eine Bildung vor weniger als 12,500 Jahren. Die Orientierung der Hebungsstrukturen ist subnormal zu der gegenwàrtigen maximalen horizontalen Stressrichtung, S"m" (020°) und parallel zu Elementen des 091° Fugen-systems, was auf ihre môgliche Bildung auf gùnstig orientierten schon vorhandenen Fugen weist. Dièse Hebungen sind die einzi-gen Strukturen im Balsm Lake-Gebiet, welche deutlich ein neotektonisches Alter belegen

Weather and Climate for Coastal Tourism

Weather and climate serve as an important travel motivator, influencing destination choice, the timing of travel, travel expenditures and overall trip satisfaction. Climatic resources are a defining factor in destination attractiveness and are a key element of the natural resource base of a destination that can be classified along a spectrum from ideal to unacceptable. A growing literature has sought to measure, evaluate and assess climate resources for tourism, both generally and for specific tourism market segments. A direct impact of climate change on tourism will be the global redistribution of climatic resources. This would change the length and quality of climate-sensitive tourism seasons, affecting both the temporal and spatial distribution of domestic and international tourism flows and spending. Studies have revealed a generally consistent temporal and geographical pattern of climate change impacts on global tourism. As the 21st century progresses, there is anticipated to be a pronounced shift in thermal comfort (and thereby tourism demand) towards higher latitudes and away from sub-tropical and tropical destinations. This would have a substantial impact on the tourism-intensive economy of the Caribbean, as the vast majority of the region’s attractions are based on weather- and climate-dependent 3S (sun, sea, sand) tourism. However, the assertion that major coastal tourism destinations, such as the Caribbean, will become seasonally ‘too hot’ for tourism has been questioned because the literature has not established what tourists to these regions perceive to be thermally unacceptable for coastal tourism activities. In addition, existing climate and tourism assessments do not account for the microclimatic conditions where tourism activities take place. With the inextricable dependency between 3S tourism and favourable weather conditions in the coastal zone, it is important to understand both how tourists perceive and evaluate climatic resources, particularly those conditions that are most preferred or avoided (i.e., trigger behavioural responses), as well as examine the adaptive climatic range tourists’ can experience within a coastal setting. Such information is a prerequisite if accurate projections are to be made about changes in tourism demand as a result of climate variability or future climate change. This dissertation proposes a conceptual framework that integrates the multiple facets known to influence tourists’ evaluation of climatic resources, as well as tourists’ responses to holiday weather conditions. The research advances weather and climate resource assessments for tourism by improving our understanding of the complex relationship between personal and meteorological parameters that influence tourists’ climatic preferences and thresholds for coastal tourism. This was achieved through concurrent meteorological measurements and in situ surveys with 472 beach tourists in the Caribbean islands of Barbados, Saint Lucia and Tobago. The results from this study reveal that tourists’ optimal and unacceptable climatic conditions are dependent on several interpersonal factors, with statistically significant differences (p < 0.05) found based on gender, age, and climatic region of origin. Thermal comfort expectations and perceived thermal control were also found to be key contextual considerations that enable beach tourists’ to not only be exposed to, but to prefer, thermal conditions that elicit strong to very strong heat stress. This indicates that conventional evaluation systems of thermal comfort (e.g., PET, UTCI) cannot be applied to 3S tourists without modification. This research also highlights the importance of microclimatic conditions when evaluating weather and climate for tourism, with thermo-physiological comfort varying up to 4°C within a coastal resort setting. The results from this research can be incorporated into existing climate indices and climate change assessments to allow for more robust projections of tourism demand, as well as used in various decision-making contexts by both tourists (e.g., plan best time/place to travel, plan appropriate accommodation, attire, transportation and activity schedule) and the tourism industry (e.g., marketing strategies, risk assessment, operational decision making, infrastructure planning and development)

Will the Mediterranean Become "Too Hot" for Tourists?: A Reassessment

Numerous studies emphasize that climate, particularly temperature, is one of the most important resources of a tourist destination. With the onset of climate change, this climatic parameter of tourist destinations may change, leading some scientists and the media to claim that some destinations, including the Mediterranean, will become “too hot” for tourist comfort by as early as 2020 or 2030. This study examines tourists’ perceived and stated ideal and unacceptable conditions for multiple climate variables (temperature, rain, wind and sky conditions) for two popular Mediterranean tourism segments; beach/3S and urban sightseeing holidays. A survey instrument was administered to university students (n=866) in five countries that represent source markets for the Mediterranean (Austria, Germany, The Netherlands, Sweden and Switzerland). The survey results were applied to a baseline climate (1961-1990) and a minimum and maximum climate change scenario (A1B emission scenario for 2080-2099). With the exception of Athens, Greece, the results suggest that the media’s claims are erroneous, with only one urban destination incurring “unacceptably hot” conditions by mid-century and only a few destinations becoming “unacceptably hot” by the end of the 21st century. A more imminent threat could be the influence the media claims may have on tourists’ perception of the climate in the Mediterranean region. It is anticipated that these findings will hold important implications for critically assessing the potential impact of climate change in the study area and other destinations more broadly, and can be used to refine models intended to predict tourism demand and international tourism flows under climate change

Forces generated in stabbing attacks:an evaluation of the utility of the mild, moderate and severe scale

The commonest way of killing in the UK is by asharp instrument. Knight reported in 1975 that it is impossibleto discern with any degree of certainty the degree of force usedto create a stab wound. Despite this, expert witnesses continueto approximate the degree of force used for their reports andevidence in court. It is usually subjectively categorized as mild,moderate or severe, based solely on the examination of thewound. We undertook a study considering forces generated ina range of blunt trauma actions, using a novel force plate dy-namometer to measure the peak forces obtained by adult maleand female volunteers. We then studied forces generated bystabbing skin simulants and porcine samples with knives andscrewdrivers. Men generated more force than women duringstabbings which was found to be equivalent to somewherebetween the blunt trauma actions of pushing a button to asingle-handed push. When asked to stab using what theythought was mild, moderate and severe force, although volun-teers were able to actively decide the force used, the actualforce was found to be influenced by the weapon, sex of theindividual, hand used and biological/anatomical sitepenetrated. This study shows that the forces generated by vol-unteers in mild, moderate and severe stabbing tests in almost allcases were significantly greater than the forces required for skinpenetration. We suggest that the use of subjective force scales isinappropriate. Rather than use of a subjective scale, we suggestthat the force required in any stabbing requires investigation infour areas: the tip radius of the weapon, minimal force requiredfor penetration, the sex of the assailant and whether the forcerequired for penetration is greater than that that can be gener-ated by a person stabbing. This allows for the use of anevidence-based two-tier scale to suggest the force required Forces generated in stabbing attacks: an evaluation of the utility of the mild, moderate and severe scale (PDF Download Available). Available from: https://www.researchgate.net/publication/320429308_Forces_generated_in_stabbing_attacks_an_evaluation_of_the_utility_of_the_mild_moderate_and_severe_scale [accessed Oct 20 2017]

The meaning of Being as a nurse involved in the work of death investigation. A North American view and its implications to practice in England.

This research study explored the meaning of ¿Being¿ (i.e. Heidegger¿s four philosophical concepts of Being-in the-world, fore-structures, time and space) as a nurse involved in the work of death investigation in the USA. The objectives were to: reveal the hidden meaning of Being; transfer the findings into an English context by examining what nurses could offer beyond their current role boundaries in an area not currently practised to the extent that nurses make to other medical specialities; and finally put forward developments that would need to take place to ensure such proposals were successful in making an effective difference to health care. In the USA there are two systems of death investigation, the Coronial and Medical Examiner system. The Coroner is an elected county or state position with varied educational and professional requirements. Some Coroner positions have been filled by registered nurses as they have put themselves forward successfully for election. In contrast, the Medical Examiner is an appointed county or state position who must be a licensed physician and a qualified pathologist or forensic pathologist in most cases. Within the Medical Examiner systems death investigators may also be appointed of which some have been filled by registered nurses. It was under the interpretive paradigm that a Heideggerian hermeneutic study was undertaken. Snowball sampling was instigated to reach a hidden population and collect qualitative data by means of unstructured interviews, non-participant observations, interrogation of historical records and the keeping of a personal reflective diary. The seven phase analysis process underpinned by the hermeneutic circle was developed to enable a synopsis of the shared meaning of Being to be revealed through the presentation of paradigm cases that encompass stories and themes. Of the 22 nurses found to be working as either death investigators or Coroners in the USA who fulfilled the inclusion criteria, 17 nurses from 11 States in the USA consented to take part. Fore-structures concerning age (average 37), gender (82% were women) and professional experience (majority came from an adult nursing background with emergency department or critical care experience) are discussed. Overall participants were interviewed for a total of 78 hours in 11 States, five of which were also observed in practice for a total of 142 hours in 3 States, giving a total of 220 hours of interview and observational data. The interpretive analysis revealed the three major paradigms of: the authentic and inauthentic reality of Being (the death investigator nurse in action); the everydayness and averageness of Being (community outreach) and the publicness of Being (mass fatality care). This study reveals knowledge concerning the meaning of Being as a nurse involved in the work of death investigation in the USA. Aspects of this illuminated landscape have propositioned for the advancement of nursing clinical practice to replace and further develop the current coroner¿s officer and soon to be implemented medical examiner officer role in England and Wales. Hence recommendations are made for practice development and further research in England