Clinical decision-making: midwifery students' recognition of, and response to, post partum haemorrhage in the simulation environment

<p>Abstract</p> <p>Background</p> <p>This paper reports the findings of a study of how midwifery students responded to a simulated post partum haemorrhage (PPH). Internationally, 25% of maternal deaths are attributed to severe haemorrhage. Although this figure is far higher in developing countries, the risk to maternal wellbeing and child health problem means that all midwives need to remain vigilant and respond appropriately to early signs of maternal deterioration.</p> <p>Methods</p> <p>Simulation using a patient actress enabled the research team to investigate the way in which 35 midwifery students made decisions in a dynamic high fidelity PPH scenario. The actress wore a birthing suit that simulated blood loss and a flaccid uterus on palpation. The scenario provided low levels of uncertainty and high levels of relevant information. The student's response to the scenario was videoed. Immediately after, they were invited to review the video, reflect on their performance and give a commentary as to what affected their decisions. The data were analysed using Dimensional Analysis.</p> <p>Results</p> <p>The students' clinical management of the situation varied considerably. Students struggled to prioritise their actions where more than one response was required to a clinical cue and did not necessarily use mnemonics as heuristic devices to guide their actions. Driven by a response to single cues they also showed a reluctance to formulate a diagnosis based on inductive and deductive reasoning cycles. This meant they did not necessarily introduce new hypothetical ideas against which they might refute or confirm a diagnosis and thereby eliminate fixation error.</p> <p>Conclusions</p> <p>The students response demonstrated that a number of clinical skills require updating on a regular basis including: fundal massage technique, the use of emergency standing order drugs, communication and delegation of tasks to others in an emergency and working independently until help arrives. Heuristic devices helped the students to evaluate their interventions to illuminate what else could be done whilst they awaited the emergency team. They did not necessarily serve to prompt the students' or help them plan care prospectively. The limitations of the study are critically explored along with the pedagogic implications for initial training and continuing professional development.</p

Pollination and dispersal trait spectra recover faster than the growth form spectrum during spontaneous succession in sandy old‐fields

Question: Spontaneous succession is the most natural and cost‐effective solution for grassland restoration. However, little is known about the time required for the recovery of grassland functionality, i.e., for the recovery of reproductive and vegetative processes typical of pristine grasslands. Since these processes operate at different scales, we addressed the question: do reproductive and vegetative processes require different recovery times during spontaneous succession? Location: Kiskunság sand region (Central Hungary). Methods: As combinations of plant traits can be used to highlight general patterns in ecological processes, we compared reproductive (pollination‐ and dispersal‐related) and vegetative (growth form) traits between recovered grasslands of different age (&lt;10 years old; 10–20 years old; 20–40 years old) and pristine grasslands. Results: During spontaneous succession, the reproductive trait spectra became similar to those of pristine grasslands earlier than the vegetative ones. In arable land abandoned for 10 years, pollination‐ and dispersal‐related trait spectra did not show significant difference to those of pristine grasslands; anemophily and anemochory were the prevailing strategies. Contrarily, significant differences in the growth form spectrum could be observed even after 40 years of abandonment; in recovered grasslands erect leafy species prevailed, while the fraction of dwarf shrubs and tussock‐forming species was significantly lower than in pristine grasslands. Conclusions: The recovery of the ecological processes of pristine grasslands might require different amounts of time, depending on the spatial scale at which they operate. The reproductive trait spectra recovered earlier than the vegetative one, since reproductive attributes first determine plant species sorting at the regional level towards their respective habitats. The recovery of the vegetative trait spectrum needs more time as vegetative‐based interactions operate on a smaller spatial scale. Thus, vegetative traits might be more effective in the long‐term assessment of restoration success than the reproductive ones

Hohlraum Designs for High Velocity Implosions on NIF Hohlraum Designs for High Velocity Implosions on NIF

Abstract. In this paper, we compare experimental shock and capsule trajectories to design calculations using the radiation-hydrodynamics code hydra. The measured trajectories from surrogate ignition targets are consistent with reducing the x-ray flux on the capsule by about 85 %. A new method of extracting the radiation temperature as seen by the capsule from x-ray intensity and image data shows that about half of the apparent 15 % flux deficit in the data with respect to the simulations can be explained by hydra overestimating the x-ray flux on the capsule

Reading characteristics of Chinese-English adolescents: Knowledge and application of strategic reading

[[abstract]]Integrating both quantitative and qualitative approaches, this study examined the knowledge and application of strategic reading among Taiwanese adolescents learning to read English as a foreign language. A total of 144 Grade 11 students participated in this study. Correlational analysis and t-tests were applied to analyzing quantitative data, including an English reading comprehension test and two sets of reading strategy questionnaires; the constant comparative method (Glaser and Strauss 1967) was used for analyzing qualitative data, comprising semi-structured interviews and think-aloud protocols. Results from quantitative analysis show a relatively strong link between the perceived use of first language (L1, Chinese) and second language (L2, English) strategies. Nonetheless, metacognitive and cognitive strategies were reportedly used more frequently for L1 reading, whereas support strategies were more often used for L2 reading. One salient theme that emerged from the qualitative analysis is that the reading of the English texts more closely resembled the reading of the texts written in the classic literary style of Chinese than the reading of the texts written in contemporary Chinese. These findings to some extent support the reading universals hypothesis (Goodman in Journal of Typographic Reseach, 103–110, 1970); yet, skills transfer is not uniformly automatic (Bell in TESOL Quarterly, 687–704, 1995; Urquhart and Weir 1998).[[incitationindex]]SSC