Situation Background Assessment Recommendation (SBAR): Undergraduate Perspectives

Situation Background Assessment and Recommendation (SBAR): Undergraduate Perspectives C Morgan, L Adams, J Murray, R Dunlop, IK Walsh. Ian K Walsh, Centre for Medical Education, Queen’s University Belfast, Mulhouse Building, Royal Victoria Hospital, Grosvenor Road, Belfast BT12 6DP Background and Purpose: Structured communication tools are used to improve team communication quality.1,2 The Situation Background Assessment and Recommendation (SBAR) tool is widely adopted within patient safety.3 SBAR effectiveness is reportedly equivocal, suggesting use is not sustained beyond initial training.4-6 Understanding perspectives of those using SBAR may further improve clinical communication. We investigated senior medical undergraduate perspectives on SBAR, particularly when communicating with senior colleagues. Methodology: Mixed methods data collection was used. A previously piloted questionnaire with 12 five point Lickert scale questions and 3 open questions was given to all final year medical students. A subgroup also participated in 10 focus groups, deploying strictly structured audio-recorded questions. Selection was by convenience sampling, data gathered by open text questions and comments transcribed verbatim. In-vivo coding (iterative, towards data saturation) preceded thematic analysis. Results: 233 of 255 students (91%) completed the survey. 1. There were clearly contradictory viewpoints on SBAR usage. A recurrent theme was a desire for formal feedback and a relative lack of practice/experience with SBAR. 2. Students reported SBAR as having variable interpretation between individuals; limiting use as a shared mental model. 3. Brief training sessions are insufficient to embed the tool. 4. Most students reported SBAR helping effective communication, especially by providing structure in stressful situations. 5. Only 18.5% of students felt an alternative resource might be needed. Sub analysis of the themes highlighted: A. Lack of clarity regarding what information to include and information placement within the acronym, B. Senior colleague negative response to SBAR C. Lack of conciseness with the tool. Discussion and Conclusions: Despite a wide range of contradictory interpretation of SBAR utility, most students wish to retain the resource. More practice opportunities/feedback may enhance user confidence and understanding. References: (1) Leonard M, Graham S, Bonacum D. The human factor: the critical importance of effective teamwork and communication in providing safe care. Quality & Safety in Health Care 2004 Oct;13(Suppl 1):85-90. (2) d'Agincourt-Canning LG, Kissoon N, Singal M, Pitfield AF. Culture, communication and safety: lessons from the airline industry. Indian J Pediatr 2011 Jun;78(6):703-708. (3) Dunsford J. Structured communication: improving patient safety with SBAR. Nurs Womens Health 2009 Oct;13(5):384-390. (4) Compton J, Copeland K, Flanders S, Cassity C, Spetman M, Xiao Y, et al. Implementing SBAR across a large multihospital health system. Jt Comm J Qual Patient Saf 2012 Jun;38(6):261-268. (5) Ludikhuize J, de Jonge E, Goossens A. Measuring adherence among nurses one year after training in applying the Modified Early Warning Score and Situation-Background-Assessment-Recommendation instruments. Resuscitation 2011 Nov;82(11):1428-1433. (6) Cunningham NJ, Weiland TJ, van Dijk J, Paddle P, Shilkofski N, Cunningham NY. Telephone referrals by junior doctors: a randomised controlled trial assessing the impact of SBAR in a simulated setting. Postgrad Med J 2012 Nov;88(1045):619-626.

Investigation of the effects of flow conditions at rotor inlet on mixed flow turbine performance for automotive applications

Current trends in the automotive industry have placed increased importance on engine downsizing for passenger vehicles. Engine downsizing often results in reduced power output and turbochargers have been relied upon to restore the power output and maintain drivability. As improved power output is required across a wide range of engine operating conditions, it is necessary for the turbocharger to operate effectively at both design and off-design conditions. One off-design condition of considerable importance for turbocharger turbines is low velocity ratio operation, which refers to the combination of high exhaust gas velocity and low turbine rotational speed. Conventional radial flow turbines are constrained to achieve peak efficiency at the relatively high velocity ratio of 0.7, due the requirement to maintain a zero inlet blade angle for structural reasons. Several methods exist to potentially shift turbine peak efficiency to lower velocity ratios. One method is to utilize a mixed flow turbine as an alternative to a radial flow turbine. In addition to radial and circumferential components, the flow entering a mixed flow turbine also has an axial component. This allows the flow to experience a non-zero inlet blade angle, potentially shifting peak efficiency to a lower velocity ratio when compared to an equivalent radial flow turbine.
This study examined the effects of varying the flow conditions at the inlet to a mixed flow turbine and evaluated the subsequent impact on performance. The primary parameters examined were average inlet flow angle, the spanwise distribution of flow angle across the inlet and inlet flow cone angle. The results have indicated that the inlet flow angle significantly influenced the degree of reaction across the rotor and the turbine efficiency. The rotor studied was a custom in-house design based on a state-of-the-art radial flow turbine design. A numerical approach was used as the basis for this investigation and the numerical model has been validated against experimental data obtained from the cold flow turbine test rig at Queen’s University Belfast. The results of the study have provided a useful insight into how the flow conditions at rotor inlet influence the performance of a mixed flow turbine.

Stratégies reproductives et sex-ratio chez le termite Cavitermes tuberosus (Emerson, 1925) -- Biologie des Organismes et Ecologie

Recently shown in some termites, Asexual Queen Succession (AQS) is a reproductive strategy in which the primary queen is replaced by numerous parthenogenetically-produced neotenic queens that mate with the primary king. In contrast, the workforce and alate dispersers are produced sexually. If the primary king is replaced by a sexually-produced neotenic son, the matings between neotenic male and females beget asymmetries in the reproductive value of alates, promoting a female-biased alate sex-ratio. Cavitermes tuberosus (Termitidae: Termitinae) is a soil-feeding tropical species, which shows parthenogenetically-produced neotenics and an AQS syndrome. Our work aims to characterize the reproductive strategies in this species by determining (i) the developmental scheme, (ii) the genetic origin of sexuals, (iii) the level of genetic structure (analysis of 65 nests distributed in 14 sites) and (iv) the alate sex-ratio.Our results show that (i) neotenic females develop from the third or fourth nymphal instar; (ii) the majority of neotenic females (82%) are parthenogenetically-produced while only 2% of female alates are so; (iii) nests are differentiated within sites, indicating that the foundation of new nests mainly occurs by nuptial flights; (iv) numerical sex-ratio of alate-destined sexuals is balanced (SRN=0.509, IC95%=0.497-0.522) while investment sex-ratio is slightly female-biased (SRE=0.529, IC95%=0.517-0.542). Altogether, our results demonstrate AQS and its implications in C. tuberosus, and reveal particularities compared to other species in which AQS has been demonstrated: neotenic-headed nests are less frequent than primary-headed ones and neotenic females never become physogastric. AQS is found in various ecological contexts and seems phylogenetically more widespread than previously thought. This strategy shows some evolutionary advantages but these seem to differ depending on species.

Efeito de agentes de controle sobre a qualidade reprodutiva de rainhas de Apis mellifera L. (Hymenoptera: Apidae) africanizadas

The agriculture with the use of products with less environmental impact is expanding. In it, the producers offer their products without the use of synthetic chemical inputs, solving the phytosanitary problems with the use of biological or alternative control agents such as parasites, predators, entomopathogenic, alternative products, plant extracts and essential oils. These products can be considered safe to non-target organisms, but studies are needed to find these features on natural enemies and on the beneficial insects such as bees, common frequenter of cultures. In this sense, this study aims to evaluate the effects of control over reproductive quality queens of Apis mellifera L. (Hymenoptera: Apidae) Africanized. For this, it tested the action of control products on the production of A. mellifera queens, using the commercial entomopathogenic fungus Boveril® 1,0x108 (Beauveria bassiana) and aqueous extract of pomegranate (Punica granatum) at a concentration of 5% sterile distilled water with Tween (0.01%) and sterile distilled water (controls). The treatments were incorporated into a tissue type gauze, wrapped in an acrylic plate and packed inside minirrecrias type colonies for the production of queens on the day before the transfer of larvae. The next day were introduced battens with 30 domes with larvae to produce queens, so the workers have contacted the agent tested. From the emergence of all the queens, they were monitored to determine the measures of body weight (mg), length and width of wing and abdomen, length, width and height of the chest (mm) as well as the time of emergence of queens. The next step was evaluated the influence of the control agents in production creates, performing measurements of creating areas in cm2 for six straight weeks. It was found that the area creates Queens did not differ among the treatments. Histological analysis of hipofaringeanas of workers glands that came into contact with the control agents and the midgut of virgin queens were also held. Histological analysis differences were observed in the tissues when the treatments were compared with the respective controls.

The romances of Alexandre Dumas.

4. The count of Monte Cristo / illustrated by Edmund H. Garrett -- 5. Agénor de Mauléon : a romance of the reign of Charles V. of France / illustrated by J. Wagrez -- 6. Agénor de Mauléon : a romance of the reign of Charles V. of France / illustrated by J. Wagrez -- 7. The Brigand : a romance of the reign of Don Carlos and Black the story of a dog / illustrated by Eugéne Grivaz -- 8. Ascanio : a romance of the reign of Francis First / illustrated by Evert Van Muyden -- 9. The two Dianas : a romance of the reign of Henry ll. / illustrated by Evert Van Muyden -- 10. The two Dianas : a romance of the reign of Henry ll. / illustrated by Evert Van Muyden -- 11. The page of the Duke of Savoy : a romance of the reign of Henry ll. / illustrated by Frank T. Merrill -- 12. The horoscope : a romance of the reign of Francois ll. and tales of the caucasus / illustrated by Eugéne Grivaz -- 13. Marguerite de Valois : a romance of the reign of Charles lX. / illustrated by Félix Oudart -- 14. La Dame de Monsoreau : a romance of the reign of Henry lll. / illustrated by Eugéne Courboin -- 15. The fourty-five : a romance of the reign of Henri lll. / illustrated by Eugéne Courboin -- 16. The Three Musketeers : a romance of the reign of Louis Xlll. / illustrated by E. Abot, Gustave Doré, Félix Oudart and Edmund H. Garrett -- 17. The Three Musketeers : a romance of the reign of Louis Xlll. / illustrated by E. Abot, Gustave Doré, Félix Oudart and Edmund H. Garrett -- 20. The Vicomte de Bragelonne or, Ten years later : a romance of the reign of Louis XlV. in which are included the stories of "Louise de La Valliére" and "The Iron Mask" / illustrated by Evert Van Muyden, Félix Oudart and Edmund H. Garrett -- 21. The Vicomte de Bragelonne or, Ten years later : a romance of the reign of Louis XlV. in which are included the stories of "Louise de La Valliére" and "The Iron Mask" / illustrated by Evert Van Muyden, Félix Oudart and Edmund H. Garrett -- 22. The Vicomte de Bragelonne or, Ten years later : a romance of the reign of Louis XlV. in which are included the stories of "Louise de La Valliére" and "The Iron Mask" / illustrated by Félix Oudart and Edmund H. Garrett --23. The Vicomte de Bragelonne or, Ten years later : a romance of the reign of Louis XlV. in which are included the stories of "Louise de La Valliére" and "The Iron Mask" / illustrated by Evert Van Muyden, Félix Oudart and Edmund H. Garrett -- 24. Sylvandire : a romance of the time of Louis XlV. and The Woman with the Velvet Necklace : a romance of the Revolution / illustrated by J. Wagrez -- 25. The war of women : a romance of the Fronde / illustrated by Eugéne Grivaz -- 26. Le Chevalier D'Harmental : a romance of the regency of Philippe, Duc D'Orléans / illustrated by Evert Van Muyden -- 27. The Regents daughter and the black tulip / illustrated by Evert Van Muyden, Félix Oudart and Edmund H. Garrett -- 28. Olympe de Cléves and Chauvelin's will : romances of the reign of Louis XV. / illustrated by Evert Van Muyden -- 29. Olympe de Cléves and Chauvelin's will : romances of the reign of Louis XV. illustrated by Evert Van Muyden -- 30. Memoirs of a physician : a romance of the reign of Louis XV. / illustrated by Félix Oudart, Evert Van Muyden and Eugéne Courbion -- 31. Memoirs of a physician : a romance of the reign of Louis XV. / illustrated by Félix Oudart, Evert Van Muyden and Eugéne Courbion -- 32. Memoirs of a physician : a romance of the reign of Louis XV. / illustrated by Félix Oudart, Evert Van Muyden and Eugéne Courbion -- 33. The Queens necklace : a romance of the reign of Louis XVl. / illustrated by Eugéne Courbion, Félix Oudart and Evert Van Muyden -- 34. The Queens necklace : a romance of the reign of Louis XVl. / illustrated by Eugéne Courbion, Félix Oudart and Evert Van Muyden -- 35. Ange Pitou and Blanche de Beaulieu : romances of the French Revolution / illustrated by Eugéne Courbion and Evert Van Muyden -- 36. Ange Pitou and Blanche de Beaulieu : romances of the French Revolution / illustrated by Eugéne Courbion and Evert Van Muyden -- 37. La Comtesse de Charny : a romance of the French Revolution / illustrated by Félix Oudart, Eugéne Courbion and Evert Van Muyden -- 38. La Comtesse de Charny : a romance of the French Revolution / illustrated by Félix Oudart, Eugéne Courbion and Evert Van Muyden -- 39. La Comtesse de Charny : a romance of the French Revolution / illustrated by Félix Oudart, Eugéne Courbion and Evert Van Muyden -- 40. The Chevalier de Maison-Rouge : a romance of the French Revolution / illustrated by E. Abot -- 41. The companions of Jehu : a romance of the consulate under Napoleon / illustrated by Evert Van Muyden and F. T. Merrill -- 42. The whites and the blues : a romance of the directory / illustrated by Félix Oudart, Eugéne Courbion and Evert Van Muyden -- 43.The whites and the blues : a romance of the directory / illustrated by Félix Oudart, Eugéne Courbion and Evert Van Muyden -- 44. The She-Wolves of Machecoul : a romance of the Last Vendée to which are added The Corsican Brothers / illustrated by Evert Van Muyden, Félix Oudart and Edmund H. Garrett -- 45. The She-Wolves of Machecoul : a romance of the Last Vendée to which are added The Corsican Brothers / illustrated by Evert Van Muyden, Félix Oudart and Edmund H. Garrett.

The Brooklyn Hills Improvement Co.'s plat no. 1 : property at Woodhaven, L.I. ; Brooklyn Hills Improvement Co.'s map showing relative position of property to prominent points in cities of New York & Brooklyn /

Woodside map is black-and-white cadastral map with lot lines/dimensions, lot/block numbers, and street widths.

Politics and protestant Lordship in North East Scotland during the reign of James VI: The life of George Keith, fourth Earl Marischal, 1554-1623

George Keith, fourth Earl Marischal is a case study of long-term, quietly successful and stable lordship through the reign of James VI. Marischal’s life provides a wholly underrepresented perspective on this era, where the study of rebellious and notorious characters has dominated. He is also a counter-example to the notion of a general crisis among the European nobility, at least in the Scottish context, as well as to the notion of a ‘conservative’ or ‘Catholic’ north east. In 1580 George inherited the richest earldom in Scotland, with a geographical extent stretching along the east coast from Caithness to East Lothian. His family came to be this wealthy as a long term consequence of the Battle of Flodden (1513) where a branch of the family, the Inverugie Keiths had been killed. The heiress of this branch was married to the third earl and this had concentrated a large number of lands, and consequently wealth, in the hands of the earls. This had, however, also significantly decreased the number of members and hence power of the Keith kindred. The third earl’s conversion to Protestantism in 1544 and later his adherence to the King’s Party during the Marian Civil War forced the Keiths into direct confrontation with their neighbours in the north east, the Gordons (led by the Earls of Huntly), a Catholic family and supporters of the Queen’s Party. Although this feud was settled for a time at the end of the war, the political turmoil caused by a succession of short-lived factional regimes in the early part of the personal reign of James VI (c.1578-1585) led the new (fourth) Earl Marischal into direct confrontation with the new (sixth) Earl of Huntly. Marischal was outclassed, outmanoeuvred and outgunned at both court and in the locality in this feud, suffering considerably. However, Huntly’s over-ambition in wider court politics meant that Marischal was able to join various coalitions against his rival, until Huntly was exiled in 1595. Marischal also came into conflict briefly with Chancellor John Maitland of Thirlestane as a consequence of Marischal’s diplomatic mission to Denmark in 1589-1590, but was again outmatched politically and briefly imprisoned. Both of these feuds reveal Marischal to be relatively cautious and reactionary, and both reveal the limitations of his power. Elsewhere, the study of Marischal’s activities in the centre of Scottish politics reveal him to be unambitious. He was ready to serve King James, the two men having a healthy working relationship, but Marischal showed no ambition as a courtier, to woo the king’s favour or patronage, instead delegating interaction with the monarch to his kinsmen. Likewise, in government, Marischal rarely attended any of the committees he was entitled to attend, such as the Privy Council, although he did keep a keen eye on the land market and the business conducted under the Great Seal. Although personally devout and a committed Protestant, the study of Marischal’s interaction with the national Kirk and the parishes of which he was patron reveal that he was at times a negligent patron and exercised his right of ministerial presentation as lordly, not godly patronage. The notion of a ‘conservative North East’ is, however, rejected. Where Marischal was politically weak at court and weak in terms of force in the locality, we see him pursuing sideways approaches to dealing with this. Thus he was keen to build up his general influence in the north and in particular with the burgh of Aberdeen (one result of this being the creation of Marischal College in 1593), pursued disputes through increasing use of legal methods rather than bloodfeud (thus exploiting his wealth and compensating for his relative lack of force) and developed a sophisticated system of maritime infrastructure, ultimately expressed through the creating of the burghs of Peterhead and Stonehaven. Although his close family caused him a number of problems over his lifetime, he was able to pass on a stable and enlarged lordship to his son in 1623.

[Rapid transit map of Manhattan and adjacent districts of New York City].

Covers Manhattan, South Bronx, and small adjacent parts of Queens, Brooklyn, and Jersey City.

Ana Istarú en tono mayor

Pocas veces se ha oído un tono tan enérgico en la poesía femenina hispanoamericana como el que surge de Poesía escogida1 de Ana Istarú. La suya es voz que remonta los vientos cargados de fluoruro de carbono y choca contra el agujero abierto por nuestra salvaje civilización en la capa de ozono.

An exploration of students’ perceptions and attitudes towards creativity in engineering education

Thesis (Master, Mechanical and Materials Engineering) -- Queen's University, 2016-09-29 17:45:16.051

FABRICATION, CHARACTERIZATION, AND IRRADIATION OF AN AUSTENITIC OXIDE DISPERSION STRENGTHENED STEEL SUITED FOR NEXT GENERATION NUCLEAR APPLICATIONS

As nuclear energy systems become more advanced, the materials encompassing them need to perform at higher temperatures for longer periods of time. In this Master’s thesis we experiment with an oxide dispersion strengthened (ODS) austenitic steel that has been recently developed. ODS materials have a small concentration of nano oxide particles dispersed in their matrix, and typically have higher strength and better extreme temperature creep resistance characteristics than ordinary steels. However, no ODS materials have ever been installed in a commercial power reactor to date. Being a newer research material, there are many unanswered phenomena that need to be addressed regarding the performance under irradiation. Furthermore, due to the ODS material traditionally needing to follow a powder metallurgy fabrication route, there are many processing parameters that need to be optimized before achieving a nuclear grade material specification. In this Master’s thesis we explore the development of a novel ODS processing technology conducted in Beijing, China, to produce solutionized bulk ODS samples with ~97% theoretical density. This is done using relatively low temperatures and ultra high pressure (UHP) equipment, to compact the mechanically alloyed (MA) steel powder into bulk samples without any thermal phase change influence or oxide precipitation. By having solutionized bulk ODS samples, transmission electron microscopy (TEM) observation of nano oxide precipitation within the steel material can be studied by applying post heat treatments. These types of samples will be very useful to the science and engineering community, to answer questions regarding material powder compacting, oxide synthesis, and performance. Subsequent analysis performed at Queen’s University included X-ray diffraction (XRD) and inductively coupled plasma optical emission spectrometry (ICP-OES). Additional TEM in-situ 1MeV Kr2+ irradiation experiments coupled with energy dispersive X-ray (EDX) techniques, were also performed on large (200nm+) non-stoichiometric oxides embedded within the austenite steel grains, in an attempt to quantify the elemental compositional changes during high temperature (520oC) heavy ion irradiation.

Relating Ediacaran Fronds

Ediacaran fronds are key components of terminal-Proterozoic ecosystems. They represent one of the most widespread and common body forms ranging across all major faunal localities and time slices postdating the Gaskiers glaciation, but uncertainty over their phylogenetic affinities has led to uncertainty over issues of homology and functional morphology between, and within, organisms displaying this ecomorphology. Here we present the first large scale, multi-group cladistic analysis of Ediacaran organisms sampling 20 ingroup taxa with previously asserted affinities to the Arboreomorpha, Erniettomorpha and Rangeomorpha. Using a newly derived morphological character matrix that incorporates multiple axes of potential phylogenetically informative data, including architectural, developmental, and structural qualities, we seek to illuminate the evolutionary history of these organisms. We find strong support for existing classification schema and devise apomorphy-based definitions for each of the three frondose clades examined here. Through a rigorous cladistics framework it is possible to discern the pattern of evolution within, and between, these clades, including the identification of homoplasies and functional constraints. This work both validates earlier studies of Ediacaran groups and accentuates instances where previous assumptions of their natural history are uninformative.

Preservation of Honey Bee (Apis mellifera L.) Semen

L’abeille domestique (Apis mellifera Linnaeus) joue un rôle crucial comme pollinisateur dans l’industrie de l’agriculture. Cependant, durant les dernières décennies, une mortalité des colonies d’abeilles a été observée partout à travers le monde. La conservation du sperme d’abeille est un outil efficace pour sauvegarder la diversité génétique. Sa conservation est possible à température pièce, mais la cryoconservation serait une meilleure méthode pour la conservation à long terme. Notre objectif général est de développer une méthode de cryoconservation de la semence d’abeille. L’hypothèse no.1 était que la cryoconservation de la semence d’abeille est plus efficace à long terme que les températures au-dessus de 0 °C. Nous avons évalué l’efficacité, basé sur la viabilité des spermatozoïdes, de deux températures de conservation: -196 °C et 16 °C. Après un an de conservation, la semence congelée avait une meilleure viabilité comparée à 16°C (76% ± 5% vs 0%; p < 0,05). Par la suite, la spermathèque des reines inséminées avec la semence cryoconservée a été évaluée par la migration des spermatozoïdes ainsi que la viabilité des spermatozoïdes. Il y avait beaucoup de variabilités dans nos résultats. Nous n’avons pas été en mesure de vérifier si l’ajout de la centrifugation après la conservation améliore la fertilité des reines après insémination. Toutefois, nos résultats confirment que la cryoconservation est une technique efficace pour conserver la semence d’abeille à long terme.

Applied genomics to monitor the genetic diversity and integrity of honey bee (Apis mellifera) populations and define sustainable strategies to benefit the beekeeping sector

Honey bees are considered keystone species in ecosystem, the effect of harmful pesticides for the honey bees, the action of extreme climatic waves and their consequence on honey bees health can cause the loss of many colonies which could contribute to the reduction of the effective population size and incentive the use of non-autochthonous queens to replace dead colonies. Over the last decades, the use of non-ligustica bee subspecies in Italy has increased and together with the mentioned phenomena exposed native honey bees to hybridization, laeding to a dramatic loss of genetic erosion and admixture. Healthy genetic diversity within honey bee populations is critical to provide tolerance and resistance to current and future threatening. Nowadays it is urgent to design strategies for the conservation of local subspecies and their valorisation on a productive scale. In this Thesis we applied genomics tool for the analysis of the genetic diversity and the genomic integrity of honey bee populations in Italy are described. In this work mtDNA based methods are presented using honey bee DNA or honey eDNA as source of information of the genetic diversity of A. mellifera at different level. Taken together, the results derived from these studies should enlarge the knowledge of the genetic diversity and integrity of the honey bee populations in Italy, filling the gap of information necessary to design efficient conservation programmes. Furthermore, the methods presented in these works will provide a tool for the honey authentication to sustain and valorise beekeeping products and sector against frauds.