Low Fidelity Simulation as a Mechanism to Enhance Midwifery Students’ Confidence in Relation to Emergency Obstetric Training

Simulation offers a safe opportunity for students to practice clinical procedures without exposure and risk of harm to real patients (Partin et al, 2011). Simulation is recognised to increase students’ confidence in their ability to make critical decisions (McCaughey and Traynor, 2010). Within Queen’s University Belfast, simulation for obstetric emergency training based on the ethos of ‘Practical Obstetric Multi-Professional Training[PROMPT]’ (Draycott et al, 2008) has been developed for midwifery students and is now uniquely embedded within the pre-registration curriculum. An important aspect of the PROMPT training is the use of low fidelity simulation as opposed to high tech support (Crofts et al, 2008). Studies have reflected that low fidelity simulation can be an effective tool for promoting student confidence (Tosterud, 2013; Hughes et al, 2013). Students are given the opportunity to experience obstetric emergencies within a safe environment and evaluation has indicated that students feel safe and have an increase in confidence and self-efficacy. The immediacy of the feedback offered by simulated situations encourages an exploration of beliefs and attitudes, particularly with peers, promoting a deeper sense of learning (Stoneham and Feltham, 2009).This paper will discuss why low fidelity simulation can effectively enhance the student experience and promote self-efficacy.

Using low fidelity simulation in interactive workshops for undergraduate medical and midwifery students

There is recognition of the need to continuously improve inter-professional relationships within clinical practice. Mutual respect, effective communication and working together are factors which will contribute to higher standards of care (Miers et al, 2005; Begley, 2008). An inter-professional education initiative, using low-fidelity simulation has been piloted and subsequently embedded within a pre-registration midwifery curriculum. The aim of the collaboration is to enhance inter-professional learning by providing an opportunity for final year midwifery students and 4th year medical students within a non-threatening environment to interact and communicate prior to obstetric clinical placements. The midwifery students are provided with an outline agenda for the workshop, but are encouraged to use creative license with regard to workshop delivery. Preliminary evaluations have been positive from both midwifery and medical students. The teaching sessions have provided an opportunity to learn about and respect each other’s roles. The midwifery students have commented on the enjoyable aspects of team working during preparation and the confidence gained from teaching medical students. The medical students felt that the sessions lowered their anxiety levels going into the labour setting. This workshop will demonstrate how low-fidelity simulation can effectively enhance the students experience promoting team working and self-confidence.

Assessment of Intervention Fidelity and Recommendations for Researchers Conducting Studies on the Diagnosis and Treatment of Chronic Cough in the Adult: CHEST Guideline and Expert Panel Report

BACKGROUND: Successful management of chronic cough has varied in the primary research studies in the reported literature. One of the potential reasons relates to a lack of intervention fidelity to the core elements of the diagnostic and/or therapeutic interventions that were meant to be used by the investigators.

METHODS: We conducted a systematic review to summarize the evidence supporting intervention fidelity as an important methodologic consideration in assessing the effectiveness of clinical practice guidelines used for the diagnosis and management of chronic cough. We developed and used a tool to assess for five areas of intervention fidelity. Medline (PubMed), Scopus, and the Cochrane Database of Systematic Reviews were searched from January 1998 to May 2014. Guideline recommendations and suggestions for those conducting research using guidelines or protocols to diagnose and manage chronic cough in the adult were developed and voted upon using CHEST Organization methodology.

RESULTS: A total of 23 studies (17 uncontrolled prospective observational, two randomized controlled, and four retrospective observational) met our inclusion criteria. These articles included 3,636 patients. Data could not be pooled for meta-analysis because of heterogeneity. Findings related to the five areas of intervention fidelity included three areas primarily related to the provider and two primarily related to the patients. In the area of study design, 11 of 23 studies appeared to be underpinned by a single guideline/protocol; for training of providers, two of 23 studies reported training, and zero of 23 reported the use of an intervention manual; and for the area of delivery of treatment, when assessing the treatment of gastroesophageal reflux disease, three of 23 studies appeared consistent with the most recent guideline/protocol referenced by the authors. For receipt of treatment, zero of 23 studies mentioned measuring concordance of patient-interventionist understanding of the treatment recommended, and zero of 23 mentioned measuring enactment of treatment, with three of 23 measuring side effects and two of 23 measuring adherence. The overall average intervention fidelity score for all 23 studies was poor (20.74 out of 48).

CONCLUSIONS: Only low-quality evidence supports that intervention fidelity strategies were used when conducting primary research in diagnosing and managing chronic cough in adults. This supports the contention that some of the variability in the reporting of patients with unexplained or unresolved chronic cough may be due to lack of intervention fidelity. By following the recommendations and suggestions in this article, researchers will likely be better able to incorporate strategies to address intervention fidelity, thereby strengthening the validity and generalizability of their results that provide the basis for the development of trustworthy guidelines.

Undergraduate interprofessional education using high-fidelity paediatric simulation

BACKGROUND: High-fidelity simulation is becoming increasingly important in the delivery of teaching and learning to health care professionals within a safe environment. Its use in an interprofessional context and at undergraduate level has the potential to facilitate the learning of good communication and teamworking, in addition to clinical knowledge and skills.

METHODS: Interprofessional teaching and learning workshops using high-fidelity paediatric simulation were developed and delivered to undergraduate medical and nursing students at Queen's University Belfast. Learning outcomes common to both professions, and essential in the clinical management of sick children, included basic competencies, communication and teamworking skills. Quantitative and qualitative evaluation was undertaken using published questionnaires.

RESULTS: Quantitative results - the 32-item questionnaire was analysed for reliability using spss. Responses were positive for both groups of students across four domains - acquisition of knowledge and skills, communication and teamworking, professional identity and role awareness, and attitudes to shared learning. Qualitative results - thematic content analysis was used to analyse open-ended responses. Students from both groups commented that an interprofessional education (IPE) approach to paediatric simulation improved clinical and practice-based skills, and provided a safe learning environment. Students commented that there should be more interprofessional and simulation learning opportunities.

DISCUSSION: High-fidelity paediatric simulation, used in an interprofessional context, has the potential to meet the requirements of undergraduate medical and nursing curricula. Further research is needed into the long-term benefits for patient care, and its generalisability to other areas within health care teaching and learning.

Optimising power take-off of an oscillating wave surge converter using high fidelity numerical simulations

Oscillating wave surge converters are a promising technology to harvest ocean wave energy in the near shore region. Although research has been going on for many years, the characteristics of the wave action on the structure and especially the phase relation between the driving force and wave quantities like velocity or surface elevation have not been investigated in detail. The main reason for this is the lack of suitable methods. Experimental investigations using tank tests do not give direct access to overall hydrodynamic loads, only damping torque of a power take off system can be measured directly. Non-linear computational fluid dynamics methods have only recently been applied in the research of this type of devices. This paper presents a new metric named wave torque, which is the total hydrodynamic torque minus the still water pitch stiffness at any given angle of rotation. Changes in characteristics of that metric over a wave cycle and for different power take off settings are investigated using computational fluid dynamics methods. Firstly, it is shown that linearised methods cannot predict optimum damping in typical operating states of OWSCs. We then present phase relationships between main kinetic parameters for different damping levels. Although the flap seems to operate close to resonance, as predicted by linear theory, no obvious condition defining optimum damping is found.

Graded Relative Evidence

Relative Evidential Supports (RES) was developed and justified several years ago as a non-numeric apparatus that allows us to compare evidential supports for alternative conclusions when making a decision. An extension called Graded Relative Evidence (GRE) of the RES concept of pairwise balancing and trading-off of evidence is reported here which keeps its basic features of simplicity and perspicacity but enriches its modelling fidelity by permitting very modest and intuitive variations in degrees of outweighing (which the essentially binary RES does not). The formal justification is very simply based on linkages to RES and to the Dempster - Shafer theory of evidence. The use of the simple extension is illustrated and to a small degree further justified empirically by application to a topical scientific debate about what is called the Congo Crossover Conjecture here. This decision-making instance is chosen because of the wealth of evidence that has been accumulated on both sides of the debate and the range of evidence strengths manifested in it. The conjecture is that the advent of Aids was in the late 1950s in the Congo when a vaccine for polio was allegedly cultivated in the kidneys of chimpanzees which allowed the Aids infection to cross over to humans from primates. © 2005 Springer.

Quantum-information processing for a coherent superposition state via a mixed entangled coherent channel

An entangled two-mode coherent state is studied within the framework of 2 x 2-dimensional Hilbert space. An entanglement concentration scheme based on joint Bell-state measurements is worked out. When the entangled coherent state is embedded in vacuum environment, its entanglement is degraded but not totally lost. It is found that the larger the initial coherent amplitude, the faster entanglement decreases. We investigate a scheme to teleport a coherent superposition state while considering a mixed quantum channel. We find that the decohered entangled coherent state may be useless for quantum teleportation as it gives the optimal fidelity of teleportation less than the classical limit 2/3.

Asymmetric quantum channel for quantum teleportation

We propose an optimal strategy for continuous-variable teleportation in a realistic situation. We show that the typical imperfect quantum operation can be described as a combination of an asymmetrically decohered quantum channel and perfect apparatuses for other operations. For the asymmetrically decohered quantum channel, we find some counterintuitive results: teleportation does not necessarily get better as the channel is initially squeezed more. We show that decoherence-assisted measurement and transformation may enhance fidelity for an asymmetrically mixed quantum channel.

Experimentally realizable characterizations of continuous- variable Gaussian states

Measures of entanglement, fidelity, and purity are basic yardsticks in quantum-information processing. We propose how to implement these measures using linear devices and homodyne detectors for continuous-variable Gaussian states. In particular, the test of entanglement becomes simple with some prior knowledge that is relevant to current experiments.

Conditional production of superpositions of coherent states with inefficient photon detection

It is shown that a linear superposition of two macroscopically distinguishable optical coherent states can be generated using a single photon source and simple all-optical operations. Weak squeezing on a single photon, beam mixing with an auxiliary coherent state, and photon detecting with imperfect threshold detectors are enough to generate a coherent state superposition in a free propagating optical field with a large coherent amplitude (alpha>2) and high fidelity (F>0.99). In contrast to all previous schemes to generate such a state, our scheme does not need photon number resolving measurements nor Kerr-type nonlinear interactions. Furthermore, it is robust to detection inefficiency and exhibits some resilience to photon production inefficiency.

Quantum-state transfer in imperfect artificial spin networks

High-fidelity quantum computation and quantum state transfer are possible in short spin chains. We exploit a system based on a dispersive qubit-boson interaction to mimic XY coupling. In this model, the usually assumed nearest-neighbor coupling is no longer valid: all the qubits are mutually coupled. We analyze the performances of our model for quantum state transfer showing how preengineered coupling rates allow for nearly optimal state transfer. We address a setup of superconducting qubits coupled to a microstrip cavity in which our analysis may be applied.

Conclusive teleportation of a d-dimensional unknown state

We formulate a conclusive teleportation protocol for a system in d-dimensional Hilbert space utilizing the positive operator- valued measurement. The conclusive teleportation protocol ensures some perfect teleportation events when the channel is only partially entangled. at the expense of lowering the overall average fidelity. We discuss how much information remains in the inconclusive parts of the teleportation.

Nidovirales: evolving the largest RNA virus genome.

This review focuses on the monophyletic group of animal RNA viruses united in the order Nidovirales. The order includes the distantly related coronaviruses, toroviruses, and roniviruses, which possess the largest known RNA genomes (from 26 to 32 kb) and will therefore be called ‘large’ nidoviruses in this review. They are compared with their arterivirus cousins, which also belong to the Nidovirales despite having a much smaller genome (13–16 kb). Common and unique features that have been identified for either large or all nidoviruses are outlined. These include the nidovirus genetic plan and genome diversity, the composition of the replicase machinery and virus particles, virus-specific accessory genes, the mechanisms of RNA and protein synthesis, and the origin and evolution of nidoviruses with small and large genomes. Nidoviruses employ single-stranded, polycistronic RNA genomes of positive polarity that direct the synthesis of the subunits of the replicative complex, including the RNA-dependent RNA polymerase and helicase. Replicase gene expression is under the principal control of a ribosomal frameshifting signal and a chymotrypsin-like protease, which is assisted by one or more papain-like proteases. A nested set of subgenomic RNAs is synthesized to express the 3'-proximal ORFs that encode most conserved structural proteins and, in some large nidoviruses, also diverse accessory proteins that may promote virus adaptation to specific hosts. The replicase machinery includes a set of RNA-processing enzymes some of which are unique for either all or large nidoviruses. The acquisition of these enzymes may have improved the low fidelity of RNA replication to allow genome expansion and give rise to the ancestors of small and, subsequently, large nidoviruses.

Surrogate-Based Optimization Using Multifidelity Models with Variable Parameterization and Corrected Space Mapping

Surrogate-based-optimization methods provide a means to achieve high-fidelity design optimization at reduced computational cost by using a high-fidelity model in combination with lower-fidelity models that are less expensive to evaluate. This paper presents a provably convergent trust-region model-management methodology for variableparameterization design models: that is, models for which the design parameters are defined over different spaces. Corrected space mapping is introduced as a method to map between the variable-parameterization design spaces. It is then used with a sequential-quadratic-programming-like trust-region method for two aerospace-related design optimization problems. Results for a wing design problem and a flapping-flight problem show that the method outperforms direct optimization in the high-fidelity space. On the wing design problem, the new method achieves 76% savings in high-fidelity function calls. On a bat-flight design problem, it achieves approximately 45% time savings, although it converges to a different local minimum than did the benchmark.