Development of a programme to facilitate interprofessional simulation-based training for final year undergraduate healthcare students

Original report can be found at: http://www.health.heacademy.ac.uk/publications/miniproject/alinier260109.pdfIntroduction: Students have few opportunities to practise alongside students from other disciplines. Simulation offers an ideal context to provide them with concrete experience in a safe and controlled environment. This project was about the development of a programme to facilitate interprofessional scenario-based simulation training for final year undergraduate healthcare students and explored whether simulation improved trainees’ knowledge of other healthcare discipline’s roles and skills. Methods: A multidisciplinary academic project team was created and trained for the development and facilitation of this project. The team worked on the development of appropriate multiprofessional scenarios and a strategy to recruit the final year students on a volunteer basis to the project. By the end of the project 95 students were involved in small groups to one of fifteen 3-hour interprofessional simulation sessions. Staff role played the relatives, doctor on call, and patient when it was more appropriate than using a patient simulator (Laerdal SimMan/SimBaby) in the simulated community setting and paediatric or adult emergency department. Each session had 3 to 4 of the following disciplines represented (Adult/Children/Learning Disability Nursing, Paramedic, Radiography, Physiotherapy) and each student observed and took part in one long and relevant high-fidelity scenario. Half the students were randomly selected to fill in a 40-item questionnaire testing their knowledge of other disciplines before the simulation (control group) and the others after (experimental group). Students were assessed on the questions relating to the disciplines represented in their session. Results: By the end of the project 95 questionnaires were collected of which 45 were control group students (Questionnaire before simulation) and 50 experimental group students (Questionnaire after simulation). Both groups were comparable in terms of gender, discipline and age representation. Participants were: Adult nurses (n=46), Children’s nurses (n=4), Learning Disability nurses (n=7), Nurses, Paramedics (n=8), Radiographers (n=20), Physiotherapists (n=8). 15 sessions were run with an average of around 7 participants and at least 3 disciplines represented. The knowledge test results about the disciplines represented was significantly different between the control and experimental groups (Control 73.80%, 95% CI 70.95-76.65; and Experimental 78.81%, 95% CI 75.76-81.87, p=0.02). In addition, there were sometimes reliable differences between the groups in their view of multidisciplinary training; confidence about working as part of a multidisciplinary team was 3.33 (SD=0.80, Control) and 3.79 (SD=0.90, Experimental), p=0.011; their anticipation that working as part of a multidisciplinary team would make them feel anxious was 2.67 (SD=1.17, Control) and 2.25 (SD=1.04, Experimental), p=0.073; their perception of their knowledge of what other healthcare professionals can or cannot do was 3.00 (SD=0.91, Control) and 3.35 (SD=0.93, Experimental), p=0.066; their view that learning with other healthcare students before qualification will improve their relationship after qualification was 3.93 (SD=1.14, Control) and 4.33 (SD=0.81, Experimental), p=0.055; their opinion about interprofessional learning helping them to become better team workers before qualification was 3.96 (SD=1.24, Control) and 4.42 (SD=0.77, Experimental), p=0.036. Conclusions: Although the difference is relatively small (~5%), the results demonstrate that students gained confidence and knowledge about the skills and role of other disciplines involved in their session. Through simulation, the positivism of students about different aspects of learning or working with other healthcare disciplines has significantly improved. Students gained knowledge of other disciplines simply by being given the opportunity to take part in a multiprofessional scenario and observe another one. The results of the test and their reported perception about multidisciplinary team working suggest that they are better prepared to enter the healthcare workforce. Discussions during the debriefings highlighted the fact that multidisciplinary training is important. The main challenges identified have been the voluntary student attendance and timetabling issues forcing us to run the session late in the day due to the number of disciplines involved in each session and their different placement rota. The aim is now to timetable formally this session within their curriculum. Introducing simulation in the undergraduate curriculum should facilitate its implementation as Continuing Professional Development once these students become qualified healthcare professionals

On Representations of Conformal Field Theories and the Construction of Orbifolds

We consider representations of meromorphic bosonic chiral conformal field theories, and demonstrate that such a representation is completely specified by a state within the theory. The necessary and sufficient conditions upon this state are derived, and, because of their form, we show that we may extend the representation to a representation of a suitable larger conformal field theory. In particular, we apply this procedure to the lattice (FKS) conformal field theories, and deduce that Dong's proof of the uniqueness of the twisted representation for the reflection-twisted projection of the Leech lattice conformal field theory generalises to an arbitrary even (self-dual) lattice. As a consequence, we see that the reflection-twisted lattice theories of Dolan et al are truly self-dual, extending the analogies with the theories of lattices and codes which were being pursued. Some comments are also made on the general concept of the definition of an orbifold of a conformal field theory in relation to this point of view.Comment: 11 pages, LaTeX. Updated references and added preprint n

Quasiperiodic spin-orbit motion and spin tunes in storage rings

We present an in-depth analysis of the concept of spin precession frequency for integrable orbital motion in storage rings. Spin motion on the periodic closed orbit of a storage ring can be analyzed in terms of the Floquet theorem for equations of motion with periodic parameters and a spin precession frequency emerges in a Floquet exponent as an additional frequency of the system. To define a spin precession frequency on nonperiodic synchro-betatron orbits we exploit the important concept of quasiperiodicity. This allows a generalization of the Floquet theorem so that a spin precession frequency can be defined in this case too. This frequency appears in a Floquet-like exponent as an additional frequency in the system in analogy with the case of motion on the closed orbit. These circumstances lead naturally to the definition of the uniform precession rate and a definition of spin tune. A spin tune is a uniform precession rate obtained when certain conditions are fulfilled. Having defined spin tune we define spin-orbit resonance on synchro--betatron orbits and examine its consequences. We give conditions for the existence of uniform precession rates and spin tunes (e.g. where small divisors are controlled by applying a Diophantine condition) and illustrate the various aspects of our description with several examples. The formalism also suggests the use of spectral analysis to ``measure'' spin tune during computer simulations of spin motion on synchro-betatron orbits.Comment: 62 pages, 1 figure. A slight extension of the published versio

IDE spatio-temporal impact fluxes and high time-resolution studies of multi-impact events and long-lived debris clouds

The purpose of the Interplanetary Dust Experiment (IDE) on the Long Duration Exposure Facility (LDEF) was to sample the cosmic dust environment and to use the spatio-temporal aspect of the experiment to distinguish between the various components of the environment: zodiacal cloud, beta meteoroids, meteor streams, interstellar dust, and orbital debris. It was found that the introduction of precise time and even rudimentary directionality as co-lateral observables in sampling the particulate environment in near-Earth space produces an enormous qualitative improvement in the information content of the impact data. The orbital debris population is extremely clumpy, being dominated by persistent clouds in which the fluxes may rise orders of magnitude above the background. The IDE data suggest a strategy to minimize the damage to sensitive spacecraft components, using the observed characteristics of cloud encounters

Implications of Synchronous IVR Radio on Syrian Refugee Health and Community Dynamics

With 1,033,513 Syrian refugees adding a strain on the Lebanese healthcare system, innovation is key to improving access to healthcare. Our previous work identified the potential for technology to improve access to antenatal care services and increase refugee agency. Using (1) paper mock ups and a mobile based prototype, (2) process mapping, (3) focus groups and interviews and (4) key informant meetings, we explored the concept of refugee led community radio shows to deliver peer-led healthcare. We observed the influence of community radio shows on Syrian refugee health education, community dynamics and community agency in relationships between healthcare providers and refugees. Refugees were positively impacted through situating the technology within the community. We highlight issues around trust, agency, understanding, sel-forganization and privacy that resulted from running the shows through mock ups and a mobile based prototype. Our findings inform future work in community run radio shows

Evidence for surprise minimization over value maximization in choice behavior

Classical economic models are predicated on the idea that the ultimate aim of choice is to maximize utility or reward. In contrast, an alternative perspective highlights the fact that adaptive behavior requires agents' to model their environment and minimize surprise about the states they frequent. We propose that choice behavior can be more accurately accounted for by surprise minimization compared to reward or utility maximization alone. Minimizing surprise makes a prediction at variance with expected utility models; namely, that in addition to attaining valuable states, agents attempt to maximize the entropy over outcomes and thus 'keep their options open'. We tested this prediction using a simple binary choice paradigm and show that human decision-making is better explained by surprise minimization compared to utility maximization. Furthermore, we replicated this entropy-seeking behavior in a control task with no explicit utilities. These findings highlight a limitation of purely economic motivations in explaining choice behavior and instead emphasize the importance of belief-based motivations

Changing knowledge, attitudes and behaviours towards cytomegalovirus in pregnancy through film-based antenatal education: a feasibility randomised controlled trial of a digital educational intervention

Background Congenital cytomegalovirus (CMV) is the most common congenital infection globally, however information about CMV is not routinely included in antenatal education in the United Kingdom. This feasibility study aimed to gather the essential data needed to design and power a large randomised controlled trial (RCT) to investigate the efficacy of a digital intervention in reducing the risk of CMV acquisition in pregnancy. In order to do this, we carried out a single-centre RCT, which explored the knowledge, attitudes and risk reduction behaviours in women in the intervention and treatment as usual groups, pre- and post-intervention. Methods CMV seronegative women living with a child less than four years old, receiving antenatal care at a single UK tertiary centre, were randomised to the digital intervention or ‘treatment as usual’ groups. Participants completed questionnaires before the digital intervention and after and at 34 gestational weeks, and responses within groups and between groups were compared using tailored randomisation tests. CMV serology was tested in the first trimester and at the end of pregnancy. Results Of the 878 women screened, 865 samples were analysed with 43% (n = 372) being CMV seronegative and therefore eligible to take part in the RCT; of these, 103 (27.7%) women were enrolled and 87 (84%) of these completed the study. Most participants (n = 66; 64%) were unfamiliar with CMV at enrolment, however at 34 gestational weeks, women in the intervention group (n = 51) were more knowledgeable about CMV compared to the treatment as usual group (n = 52) and reported engaging in activities that may increase the risk of CMV transmission less frequently. The digital intervention was highly acceptable to pregnant women. Overall, four participants seroconverted over the course of the study: two from each study group. Conclusions A large multi-centre RCT investigating the efficacy of a CMV digital intervention is feasible in the United Kingdom; this study has generated essential data upon which to power such a study. This single-centre feasibility RCT demonstrates that a digital educational intervention is associated with increase in knowledge about CMV and can result in behaviour change which may reduce the risk of CMV acquisition in pregnancy