Accounting for actions and omissions:a discourse analysis of student nurse accounts of responding to instances of poor care

Aims: To explore how nursing students account for decisions to report or not report poor care witnessed on placement and to examine the implications of findings for educators. Background: Concern has been raised about the extent to which cases of poor care go unreported. Failure to report cases may have serious consequences for patient safety. Design: Semi structured interviews were conducted with 13 under graduate students at a UK university during 2013. They were asked to consider their response to episodes of poor practice witnessed on placement. Methods: Data were transcribed verbatim and categorized according to whether or not students reported concerns. Cases were analysed in accordance with Potter and Wetherall’s version of discourse analysis to identify the discursive strategies used to account for decisions to report or not report poor practice. Results: Participants took care to present themselves in a positive light regardless of whether or not they had reported an episode of concern. Those who had reported tended to attribute their actions to internal factors such as moral strength and a commitment to a professional code. Those who had not or would not report concerns provided accounts which referred to external influences that prevented them from doing so or made reporting pointless. Conclusion: This study provides information about how students account for their actions and omissions in relation to the reporting of poor care. Findings suggest ways educators might increase reporting of concerns

Studies on the mythological commentaries attributed to a certain Nonnos on four sermons by Gregory of Nazianzus with a representative text and apparatus criticus of the Commentaries on Sermons 4 and 5

The thesis consists of five chapters and eight Appendices. The first four chapters contain studies on the text and manuscript tradition of the Pseudo-Nonnos Commentaries; the last, Chapter V, provides a representative text of, and apparatus criticus to Commentaries IV and V, 1 - 35.Chapter I supplies an analysis of the literary and religious background of the Commentaries, their relationship with the sermons of Gregory of Nazianzus, their origins and those of their author, and the links between them and other literature of the same type. They are shown to have been composed as an entity, and it is suggested that they derive from the methods of exegesis followed in the schools.In Chapter II the original list of 134 manuscripts of the Commentaries printed by J. Sajdak in 191U is revised, and the loss or misidentification of some witnesses noted. This is followed by a supplementary list of other manuscripts of the Commentaries, which have either been discussed by other scholars after 1914 or have been noted in the catalogues and other publications by the present writerChapter III gives an account of the previous work on the text and tradition of the Commentaries. All modern studies of this are based on the conclusions of E. Patzig, published in 1869/90.In 1922, Th. Sinko printed a series of notes on various aspects of the contents of the Commentaries and on some of the manuscripts in which they appeared. Although an edition of the Armenian Version of the Commentaries was published in 1903 by A. Manandian, this was not translated into English until 1971. Then S.P. Brock added a collation of this to his translation and edition of the Syriac Versions of the Commentaries. The Greek tradition of the Commentaries is also given prominence in the last-mentioned publication, which includes an edition of the Greek text of Commentary XXXIX. Finally, J.H. Declerck has, since 1976, written a series of articles on the tradition of the Commentaries in text and translation, and provided editions of the texts of Commentaries XLIII and V, 36 - 40.Section 1 of Chapter IV analyses the 154 extant manuscripts of the Commentaries by their dates, and lists the Commentaries found in each. Of the 88 which contain a substantial portion of the text, over half date from the fifteenth century onwards. Host of the remainder are pre-thirteenth century, and copies of these have been obtained by the writer. Section 2 gives a survey of their contents. Section 3 employs the information so provided (and that obtained by a comparison of it with the translations of the Syriac and Armenian Versions and the use made by Cosmas of Jerusalem of the Commentaries) to give a more detailed account of the parts of the Greek tradition than has previously been attempted. The long-established division of the tradition into two parts (here denoted m and n) is redefined, and a hitherto unnoted sub-division within m identified. It is also argued that the Syriac (and Armenian) Versions may depend on Greek text(s) that have been subject to interpolation. A discussion of the manuscripts involved in the production of the representative text and apparatus criticus in Chapter V completes this chapter.In Chapter V the text is based on that of a witness in n. Below the text is placed one apparatus criticus containing the readings of witnesses in m and those of the translation of the Syriac and Armenian Versions, and a second apparatus with the variants in n.The Appendices include a full list of the manuscripts of the Commentaries, their contents as they are found in both parts of the Greek tradition and in the works of Cosmas of Jerusalem, and an account of the editions of the Commentaries from 1569 until 1977

Curvature, singularities and projections of smooth maps

This work is an initial attempt to extend to many-parameter families of smooth functions on a smooth manifold, and projections of smooth maps into subspaces of higher dimension, the well-known inter relations, between the space of Morse function on a smooth manifold and the space of immersions of the manifold in a cartesian space, which are given by the Gauss-maps of the immersions, and the orthogonal projections of the immersions onto lines in the Cartesian spaces. Results, both local and global, are obtained

Factors influencing student nurse decisions to report poor practice witnessed while on placement

Background: While it is commonly accepted that nursing care is generally of a good standard, it would be naïve to think that this is always the case. Over recent years concern about aspects of the quality of some nursing care has grown. In tandem with this, there is recognition that nurses do not always report poor practice. As future registrants, student nurses have a role to play in changing this culture. We know, however, relatively little about the factors that influence student decisions on whether or not to report. In the absence of a more nuanced understanding of this issue, we run the risk of assuming students will speak out simply because we say they should. Objectives: To explore influences on student decisions about whether or not to report poor clinical practice which is a result of deliberate action and which is witnessed while on placement. Methods: Qualitative interviews were conducted with thirteen pre-registration nursing students from the UK. Participants included both adult and mental health nurses with an age range from 20–47. Data were analysed to identify key themes. Category integrity and fit with data was confirmed by a team member following initial analysis. Results: Four themes emerged from the data. The first of these, ‘I had no choice’ described the personal and ethical drivers which influenced students to report. ‘Consequences for self’ and ‘Living with ambiguity’ provide an account of why some students struggle to report, while ‘Being prepared’ summarised arguments both for and against reporting concerns. Conclusion: While there is a drive to promote openness in health care settings and an expectation that staff will raise concerns about quality of care, the reality is that the decision to do this can be very difficult. This is certainly the case for some student nurses. Our results suggest ways in which educationalists might intervene to support students who witness poor practice to report

Direct measurement of hairpin-like vortices in the bottom boundary layer of the coastal ocean

Laboratory measurements and numerical modeling at low Reynolds numbers (Reθ<7700) indicate the energy-containing turbulence of boundary layer flows comprises coherent packets of hairpin vortices. Here direct measurements in the bottom boundary layer of the coastal ocean at higher Reynolds numbers (Reθ = 266,150) show tidal flows also contain packets of large vortices separated by periods of more quiescent conditions. The 1452 vortices recorded within a 20 min period are typically aligned along stream (∼8.0° from the mean flow direction) and inclined to the horizontal (∼27.0° from the seabed), with a mean period of occurrence of 4.3 s. These results lend three-dimensional, in situ support to an interpretation of the coastal ocean bottom boundary layer as comprising coherent packets of hairpin vortices. This demonstrates a direct linkage from low Reynolds number experiments to higher Reynolds number flows, permitting fine-scale details of particle transport and pollutant dispersion to be inferred from lower Reynolds number data

Simulated recovery of Europa's global shape and tidal Love numbers from altimetry and radio tracking during a dedicated flyby tour

The fundamental scientific objectives for future spacecraft exploration of Jupiter's moon Europa include confirmation of the existence of subsurface ocean beneath the surface ice shell and constraints on the physical properties of the ocean. Here we conduct a comprehensive simulation of a multiple-flyby mission. We demonstrate that radio tracking data can provide an estimate of the gravitational tidal Love number k2 with sufficient precision to confirm the presence of a liquid layer. We further show that a capable long-range laser altimeter can improve determination of the spacecraft position, improve the k2 determination (2 (3-4% error), which is directly related to the amplitude of the surface tidal deformation. These measurements, in addition to the global shape accurately constrained by the long altimetric profiles, can yield further constraints on the interior structure of Europa. Key Points A multiple-flyby mission to Europa can recover key geophysical parameters Laser altimetry can uniquely and accurately recover the global shape of Europa Laser altimetry enables the recovery of h2 to constrain the ice shell thicknes

Evaluating unsupervised methods to size and classify suspended particles using digital in-line holography

Substantial information can be gained from digital in-line holography of marine particles, eliminating depth-of-field and focusing errors associated with standard lens-based imagingmethods.However, for the technique to reach its full potential in oceanographic research, fully unsupervised (automated) methods are required for focusing, segmentation, sizing, and classification of particles. These computational challenges are the subject of this paper, in which the authors draw upon data collected using a variety of holographic systems developed at Plymouth University, United Kingdom, from a significant range of particle types, sizes, and shapes. A new method for noise reduction in reconstructed planes is found to be successful in aiding particle segmentation and sizing. The performance of an automated routine for deriving particle characteristics (and subsequent size distributions) is evaluated against equivalent size metrics obtained by a trained operative measuring grain axes on screen. The unsupervised method is found to be reliable, despite some errors resulting from oversegmentation of particles. A simple unsupervised particle classification system is developed and is capable of successfully differentiating sand grains, bubbles, and diatoms from within the surfzone. Avoiding miscounting bubbles and biological particles as sand grains enables more accurate estimates of sand concentrations and is especially important in deployments of particle monitoring instrumentation in aerated water. Perhaps the greatest potential for further development in the computational aspects of particle holography is in the area of unsupervised particle classification. The simple method proposed here provides a foundation upon which further development could lead to reliable identification of more complex particle populations, such as those containing phytoplankton, zooplankton, flocculated cohesive sediments, and oil droplets

The dispersal of phytoplankton populations by enhanced turbulent mixing in a shallow coastal sea

A single tidal cycle survey in a Lagrangian reference frame was conducted in autumn 2010 to evaluate the impact of short-term, episodic and enhanced turbulent mixing on large chain-forming phytoplankton. Observations of turbulence using a free-falling microstructure profiler were undertaken, along with near-simultaneous profiles with an in-line digital holographic camera at station L4 (50° 15' N 4° 13' W, depth 50 m) in theWestern English Channel. Profiles fromeach instrumentwere collected hourly whilst following a drogued drifter. Results from an ADCP attached to the drifter showed pronounced vertical shear, indicating that the water column structure consisted of two layers, restricting interpretation of the Lagrangian experiment to the upper ̃25 m. Atmospheric conditions deteriorated during the mid-point of the survey, resulting in values of turbulent dissipation reaching a maximum of 10-4Wkg-1 toward the surface in the upper 10 m. Chain-forming phytoplankton >200 μm were counted using the data from the holographic camera for the two periods, before and after the enhanced mixing event. As mixing increased phytoplankton underwent chain breakage,were dispersed by advection through their removal from the upper to lower layer and subjected to aggregation with other suspended material. Depth averaged counts of phytoplankton were reduced from a maximum of around 2050 L-1 before the increased turbulence, to 1070 L-1 after, with each of these mechanisms contributing to this reduction. These results demonstrate the sensitivity of phytoplantkon populations to moderate increases in turbulent activity, yielding consequences for accurate forecasting of the role played by phytoplankton in climate studies and also for the ecosystem in general in their role as primary producers. © 2014 Elsevier B.V. All rights reserved

Representational gestures in Developmental Coordination Disorder and specific language impairment: Error-types and the reliability of ratings

Gesture production was studied in children with developmental coordination disorder (DCD) and specific language impairment (SLI) in comparison to normally developing age-matched and younger control children. The pattern of error production was investigated to characterize the praxis skills seen in these two developmental disorders as well as to inform understanding of the aetiology of both DCD and SLI. Given the subjective nature of the categorization of errors, a separate study was conducted to investigate inter-rater reliability. Independent adult raters consistently used four out of fourteen error-types and for these four, inter-rater reliability was found to be good. The type of errors made by children with DCD, SLI and the younger controls were very similar. The only difference between the groups was in the frequency with which errors were displayed, suggesting that the performance of the clinical children might be an indicator of immature praxis development. It is suggested that the inclusion of a younger control (similar to a ''motor match'') group is an important methodological device for investigating the underlying nature of disorders such as DCD and SL