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.

The implausibility of ‘usual care’ in an open system: sedation and weaning practices in Paediatric Intensive Care Units (PICUs) in the United Kingdom (UK).

Background
The power of the randomised controlled trial depends upon its capacity to operate in a closed system whereby the intervention is the only causal force acting upon the experimental group and absent in the control group, permitting a valid assessment of intervention efficacy. Conversely, clinical arenas are open systems where factors relating to context, resources, interpretation and actions of individuals will affect implementation and effectiveness of interventions. Consequently, the comparator (usual care) can be difficult to define and variable in multi-centre trials. Hence outcomes cannot be understood without considering usual care and factors that may affect implementation and impact on the intervention.

Methods
Using a fieldwork approach, we describe PICU context, ‘usual’ practice in sedation and weaning from mechanical ventilation, and factors affecting implementation prior to designing a trial involving a sedation and ventilation weaning intervention. We collected data from 23 UK PICUs between June and November 2014 using observation, individual and multi-disciplinary group interviews with staff.

Results
Pain and sedation practices were broadly similar in terms of drug usage and assessment tools. Sedation protocols linking assessment to appropriate titration of sedatives and sedation holds were rarely used (9 % and 4 % of PICUs respectively). Ventilator weaning was primarily a medical-led process with 39 % of PICUs engaging senior nurses in the process: weaning protocols were rarely used (9 % of PICUs). Weaning methods were variably based on clinician preference. No formal criteria or use of spontaneous breathing trials were used to test weaning readiness. Seventeen PICUs (74 %) had prior engagement in multi-centre trials, but limited research nurse availability. Barriers to previous trial implementation were intervention complexity, lack of belief in the evidence and inadequate training. Facilitating factors were senior staff buy-in and dedicated research nurse provision.

Conclusions
We examined and identified contextual and organisational factors that may impact on the implementation of our intervention. We found usual practice relating to sedation, analgesia and ventilator weaning broadly similar, yet distinctively different from our proposed intervention, providing assurance in our ability to evaluate intervention effects. The data will enable us to develop an implementation plan; considering these factors we can more fully understand their impact on study outcomes.

I can hear once more: The role of the Anaesthetic Nurse specialist in Cochlear implantation for people with long term deafness

This paper examines the role of the Anaesthetic Nuse Specialist(ANS) in the context of innovative cochlear implant surgery which restores hearing to those with long term deafness. The specific focus is patient centered care during the long surgery under local anaestha when the patient is awake.
It is crucial during this surgery that the patient remains still, relaxed and calm, the ANS has been particularly creative using communication cards and tablets to allow patients to write questions and the nurse to answer. The writers capture the unique moment when someone with long term hearing can hear, and the ensuing emotion from the patient and theatre team.

Robust bimodal person identification using face and speech with limited training data and corruption of both modalities

This paper presents a novel method of audio-visual fusion for person identification where both the speech and facial modalities may be corrupted, and there is a lack of prior knowledge about the corruption. Furthermore, we assume there is a limited amount of training data for each modality (e.g., a short training speech segment and a single training facial image for each person). A new representation and a modified cosine similarity are introduced for combining and comparing bimodal features with limited training data as well as vastly differing data rates and feature sizes. Optimal feature selection and multicondition training are used to reduce the mismatch between training and testing, thereby making the system robust to unknown bimodal corruption. Experiments have been carried out on a bimodal data set created from the SPIDRE and AR databases with variable noise corruption of speech and occlusion in the face images. The new method has demonstrated improved recognition accuracy.

Can Consent Training End Sexual Violence On Campus?: Students, Consent and Sexual Ethics

The ongoing, potentially worsening problem of sexual violence and harassment on university campuses has emerged in the last few years as an area of concern. Female students have been identified as one of the most likely groups to experience sexual violence and this violence is exacerbated by contemporary student cultures around alcohol consumption and gendered and sexual norms. University campuses have also become central to prevention efforts in many countries due to their relatively accessible populations and an ability to implement social policies at an institutional level.
Many of these measures are based around promoting or educating students about sexual consent, and particularly notions of affirmative consent, expressed as ‘Yes means Yes’. However, there exists little research around sexual ethics with students exploring whether consent is in fact the best way to tackle cultural problems of sexual violence on campus. This paper makes use of existing literature on sexual ethics and focus group research undertaken with Australian university students to argue for an approach to the problem of sexual ethics on campus that is broader than simply focusing on training programs in sexual consent. It identifies a number of limitations to the consent framework and argues that prevention efforts need to more seriously engage with broader cultural norms around heterosexuality and gendered relationships.

Vision and deaf awareness training is it app.ropriate?

Title
Visual and deaf awareness training is it app.ropriate
Purpose
Some of our most vulnerable patients have a sensory deficit. An app which focused on patients with a vision and/or hearing loss was developed for healthcare students. The intent was to embed the core values necessary for students to provide appropriate care for patients with a sensory deficit.
Setting
Queen’s University Belfast, School of Nursing and Midwifery.
Methods
Stage 1
A review of current sensory awareness training in the United Kingdom
Stage 2
Application for funding
Stage 3
Development of a teaching tool template with the essential aspects required for sensory awareness training
Stage 4
Collaboration with others: Royal National Institute for the Blind, Action on Hearing Loss, Computer technician.
Stage 5
Production and transfer of multimedia outputs onto a software application system.
Stage 6
App Piloted with a sample of lecturers (n=5), undergraduate nursing students (n=20), service users (n=5)
Stage 7
Editing
Stage 8
App made available to all undergraduate nursing students
Stage 9
App evaluation (n=300)



Results
Overall nursing students positively evaluated the app, 100% of students rated the app between good and excellent. Qualitative evidence from service users and practice partnerships was extremely positive:
"At last I feel listened too in respect to my hearing loss and empowered. I don't feel like I am complaining I am actually helping to create something which should benefit staff and all of us with a hearing or vision loss". Patient
“Very insightful into the lives of those with a disability will be so useful in practice as an aid to jog my memory". 1st year nursing student
Conclusion
It is hoped that further evaluation and implementation of the app will show an improved quality to the care delivered to those with a sensory deficit. We believe that by working in partnership with service users we have helped to create an innovative tool that benefits both staff and patients.
Financial disclosure Yes
Funding of £2700 was awarded in 2014 through the Martha McMenamin Memorial Northern Ireland Scholarship.

Impact of Residual Transmit RF Impairments on Training-Based MIMO Systems

Radio-frequency (RF) impairments, which intimately exist in wireless communication systems, can severely limit the performance of multiple-input-multiple-output (MIMO) systems. Although we can resort to compensation schemes to mitigate some of these impairments, a certain amount of residual impairments always persists. In this paper, we consider a training-based point-to-point MIMO system with residual transmit RF impairments (RTRI) using spatial multiplexing transmission. Specifically, we derive a new linear channel estimator for the proposed model, and show that RTRI create an estimation error floor in the high signal-to-noise ratio (SNR) regime. Moreover, we derive closed-form expressions for the signal-to-noise-plus-interference ratio (SINR) distributions, along with analytical expressions for the ergodic achievable rates of zero-forcing, maximum ratio combining, and minimum mean-squared error receivers, respectively. In addition, we optimize the ergodic achievable rates with respect to the training sequence length and demonstrate that finite dimensional systems with RTRI generally require more training at high SNRs than those with ideal hardware. Finally, we extend our analysis to large-scale MIMO configurations, and derive deterministic equivalents of the ergodic achievable rates. It is shown that, by deploying large receive antenna arrays, the extra training requirements due to RTRI can be eliminated. In fact, with a sufficiently large number of receive antennas, systems with RTRI may even need less training than systems with ideal hardware.