Performing an aseptic technique in a community setting : fact or fiction?

Background - Maintaining the principles of asepsis when performing wound care and other invasive procedures is one of the fundamental approaches of preventing healthcare-acquired infection. Such an approach has been advocated for community practitioners. Literature - The performance of an aseptic technique is an under-researched area. The few studies that have been conducted have identified how strict adherence to the technique is difficult and contamination of hands/gloves is common and that community nurses often have a fatalistic view about whether asepsis is possible in a community setting. Aim - The overall aim of this research project was to examine how experienced practitioners have adapted the aseptic technique within a community setting and to what extent the changed procedure still adhered to the principles of asepsis. Methods - This study used a mixture of non-participant observation and individual semi-structured interviews to examine adherence to the principles of the aseptic technique among the district nurses. Data were collected from one Trust in England with a total of 10 district nurses taking part and 30 aseptic procedures been observed. Results - The results show that almost all of the staff understood the principles of asepsis and had adapted the standard procedure for use in a patient’s home. Common challenges included wound cleaning using a single nurse procedure, the contents of the pack and the home environment. The research also identified misconceptions about clean versus aseptic procedures and a lack of training for staff. Conclusions - This study highlights the challenges of maintaining the principles of asepsis in a home environment and the fact that district nurses are often relied upon to find creative solutions to such challenges. The study also highlights issues around the implementation of evidence-based practice and the need for clearer guidance about how evidence should be used alongside existing procedures

Cyber Infrastructure for the Humanities and Social Sciences

In January 2003, a blue ribbon panel appointed by the National Science Foundation and led by Dan Atkins, of the University of Michigan, completed a report called ‘Revolutionising Science and Engineering through Cyberinfrastructure’.2 This report is a kind of provocation for the American Council of Learned Societies (ACLS) Commission on Cyberinfrastructure for the Humanities and Social Sciences, and there is a lot of other activity of this sort, going on right now —for example: Digital Archiving and the National Archives and Records Administration;3 NSF ‘Post Digital Library Futures’ report;4 NRC ‘Beyond Productivity’ report (2003);5 The United Nations World Summit on the Information Society.

University 2.0

The major challenge facing universities in the next decade is to reinvent themselves as information organizations. Universities are, at their core, organizations that cultivate knowledge, seeking both to create new knowledge and to preserve and convey existing knowledge, but they are remarkably inefficient and therefore ineffective in the way that they leverage their own information resources to advance that core activity. This talk will explore ways that the university could learn from what is now widely called "Web 2.0" -- a term that is meant to identify a shift in emphasis from the computer as platform to the network as platform, from hardware to data, from the wisdom of the expert to the wisdom of crowds, and from fixity to remixability

Pharmacotherapeutics targeting the hedgehog pathway: emerging treatments for metastatic basal cell carcinoma

Basal Cell Carcinoma (BCC) is one of the most commonly diagnosed nonmelanoma skin cancers (NMSC) in the world. While BCC is usually readily treatable with surgical excision of the tumor, its metastatic form (mBCC) is far deadlier, with an average patient survival of eight months following diagnosis. A majority of mBCC cases is tied to mutations causing dysfunction in the Hedgehog Pathway (HHP), a pathway that induces basal cells in the skin to divide rapidly and repeatedly. For this reason, there has been an emphasis over the last thirty years on developing novel drug-based therapeutics for the treatment of mBCC that specifically target the HHP. This paper will examine the body of published research investigating current and developing mBCC treatments, with a focus on the therapeutic modalities of the two current treatments for mBCC, Vismodegib and Sonidegib, and one potential treatment currently under investigation, Itraconazole/ATO. A review of the clinical research will detail the mechanism of action for each drug with regard to the HHP and its components, the efficacy of the treatment, and adverse effects seen in patients during treatment

Where from and by whom? Tracing academic and practitioner visions of energy systems change related to lower income countries

Dominant agendas of global sustainable development broadly emphasise the urgency of a transition towards an environmentally, socially and economically preferable future. Critical scholars have raised concerns that this transition either produces new environmental, social and economic problems or reproduces those problems of the present system. They call instead for more radical transformations, encapsulating both material change and epistemic pluralism in research related to this. Energy systems are a key domain in which these different conceptualisations of change are discussed. One critical area in which perspectives diverge regards the spatial aspects of how energy systems change is designed and implemented within and between countries. Where do, will or could the drivers of sociotechnical change stem from? Which places are expected to be more beneficiaries than generators of change, and what are the implications of this for ambitions of “sustainability”?The answers to these questions, I argue, depend on how, and from where, these processes of change are envisioned. This licentiate thesis advances this inquiry by exploring how, from where, by whom and for whom energy systems change is envisioned related to lower income countries, with Rwanda as the principal country of focus. This broad landscape is explored through a synthesis of three articles which approach these questions using different theoretical approaches. These articles analyse processes of knowledge production at a global level. They also explore how energy systems change is envisioned by academics from diverse research traditions. They additionally examine actors seeking to facilitate or implement energy systems change at a national and subnational level. Together, my analysis shows that actors who are from, or based in, higher income countries are often envisioned as the principal architects of energy systems change. Common kinds of actors invoked include scientists, donors or private sector companies with an international footprint. Additionally, similar ideas are often articulated by actors who describe themselves as being from lower income countries. A prerequisite for the latter is however that they either are: (1) practitioners working for organisations headquartered in higher income countries, or (2) academics working with theory developed in higher income countries.Alternatives to these visions exist. Such alternatives place a greater emphasis on the role of users as coproducers of change originating from whichever place is envisioned to benefit from change. This licentiate thesis therefore illustrates the need for both academics and practitioners – particularly those based in or from higher income countries and working in relation to lower income countries – to reflect carefully on how they envision the energy systems change which they participate in. This is to avoid locking in assumptions regarding who or what drives change, particularly when change is urgently demanded. I argue that such assumptions risk locking lower income countries such as Rwanda into global circuits of capital on an imbalanced footing. This may reproduce relationships of economic dependence and capital accumulation in higher income countries. The thesis concludes by reflecting where else this thesis may speak to, noting my own analytical focus on the geographic situatedness of knowledge making. I argue that this thesis may be relevant to other locations besides Rwanda (and perhaps even locations in higher income countries) which host encounters between globalised agendas of change emphasising urgency and scale and other possibilities which are more rooted in localised framings of problems and solutions

A Pleistocene legacy structures variation in modern seagrass ecosystems

Distribution of Earth’s biomes is structured by the match between climate and plant traits, which in turn shape associated communities and ecosystem processes and services. However, that climate–trait match can be disrupted by historical events, with lasting ecosystem impacts. As Earth’s environment changes faster than at any time in human history, critical questions are whether and how organismal traits and ecosystems can adjust to altered conditions. We quantified the relative importance of current environmental forcing versus evolutionary history in shaping the growth form (stature and biomass) and associated community of eelgrass (Zostera marina), a widespread foundation plant of marine ecosystems along Northern Hemisphere coastlines, which experienced major shifts in distribution and genetic composition during the Pleistocene. We found that eelgrass stature and biomass retain a legacy of the Pleistocene colonization of the Atlantic from the ancestral Pacific range and of more recent within-basin bottlenecks and genetic differentiation. This evolutionary legacy in turn influences the biomass of associated algae and invertebrates that fuel coastal food webs, with effects comparable to or stronger than effects of current environmental forcing. Such historical lags in phenotypic acclimatization may constrain ecosystem adjustments to rapid anthropogenic climate change, thus altering predictions about the future functioning of ecosystems

Man versus Machine: the importance of manual blood pressure measurement skills amongst registered nurses

Background: The manual recording of blood pressure is widely accepted to be more accurate than the recording of blood pressure using an automated device. Despite this many western healthcare systems have moved almost entirely to the automated recording of this important vital sign using oscillometric devices. Such devices may either fail to record the patient’s blood pressure in persistent hypotension or may give inaccurate readings in people with arteriosclerotic or atherosclerotic changes. This paper explores the importance of manual blood pressure recording, the availability of aneroid sphygmomanometers in UK hospitals and the maintenance of the skills of the workforce following initial nurse education. Methods: Using a survey of nursing students to explore what opportunities they have to practice manual blood pressures in the clinical setting, the paper explores the maintenance of skills following initial nurse education. The paper also describes the results of data collection, using unobtrusive methods, regarding the availability of aneroid sphygmomanometers in general and specialist hospital facilities in Northern England (UK). Data using both methods were collected in the spring of 2014. Results: The results suggest that despite most hospitals having some aneriod sphygmomanometers available (mean was 1 device for every 6 beds in acute, 1 device for every 3 beds in specialist hospitals and 1 device for every 12 beds in mental health) they were rarely used in clinical practice with only 35% of students reporting that they had undertaken a manual blood pressure in a clinical setting during the first year of their course. In addition, some hospitals had no aneroid devices and several others had no central record of location and regular calibration of such devices. Conclusions: The suggested infrequent use of aneroid devices raises a concern that nurses skills in manual blood pressure recording may be subject to decay over time. Given the importance of these skills in patient safety and, in ensuring accurate and effective care, failure to ensure adequate equipment and opportunities for skill maintenance could result in practitioners and hospitals being open to negligence claims

First do no harm: Teaching and assessing the recognition and rescue of deteriorating patients to nursing students

Failure to recognise and appropriately rescue the deteriorating patient is a global issue which has the potential to cause serious harm to patients. Such recognition and rescue of a deteriorating patient requires both technical and non-technical skills and there are multiple points for potential failure. The taking and recording of vital observations is one of the cornerstones of recognising deterioration. However, such observations are often delegated to students and the least experienced staff. This paper explores the teaching and assessment of under-graduate nursing students to recognise and arrange the rescue of a deteriorating patient within the first 16 weeks of their course. The paper describes the development of an integrated Objective Structured Clinical Examination (OSCE) and the subsequent evaluation of this using survey data, student performance results and unobtrusive methods. The results suggest that it is possible to use an integrated OSCE to assess students even at such an early stage in their course. Although data from other Higher Education Institutions in the UK suggests that integrated OSCEs at such an early stage are rare. The appropriate teaching of vital observations, structured hand off and reporting enable students to contribute to safer care and to adhere to the maxim “First Do No Harm”

Computational Work with Very Large Text Collections

This essay will address the challenges and possibilities presented to the Text Encoding Initiative, particularly in the area of interoperability, by the very large text collections (on the order of millions of volumes) being made available for computational work in environments where the texts can be reprocessed into new representations, in order to be manipulated with analytical tools. It will also consider TEI’s potential role in the design of these environments, these representations, and these tools. The argument of the piece is that interoperability is a process as well as a state, that it requires mechanisms that would sustain it, and that TEI is one of those mechanisms

Make or break: factors influencing the development of nursing practice within the UK National Health Service.

The development of nursing practice has become a central feature of modern healthcare. The advent of clinical governance has resulted in the development of an organisational climate where practitioners are encouraged to develop direct care and health services. Despite the desire of many professional groups to develop practice within the NHS, there has been a shortage of research which has specifically examined the processes of practice development in such a way as to identify the factors which facilitate or hinder developments. This study examines the nature of practice development and how this process is influenced by organisational, structural, individual and contextual factors. Using techniques developed by Walker and Avant (1995), the critical attributes of practice development were identified and it was contended and accepted that practice development was a specialist form of innovation. The study identified positive and negative factors which were shown to influence practice development using two principal methodologies. Firstly, a UK-wide Delphi survey was carried out with 139 Directors of Nursing in order to identify their perceptions of key influences on practice development. A total of 24 positive and 23 negative categorisations was identified from the surveys; these were grouped using principal component analysis into 8 components. Following on from this a series of case studies was carried out to examine which factors influenced the development of practice, and how this influence manifested itself. Findings from the case studies highlighted that there was some congruence between the perceptions of Directors of Nursing and the factors which were found to influence development. Several factors were identified as having a positive influence including championship, participation, ownership and flat management structures; whereas factors such as leader dependence, pressures and inter-professional tensions had a negative influence in some developments. In addition the study identified that the influence of other factors such as personal interest, merger and organisational transition are often underestimated