Anticipatory vigilance: A classic grounded theory of risk reduction and management in the perioperative setting

This research aimed to investigate the main concern facing nurses in minimising risk within the perioperative setting and to generate an explanatory substantive theory of how they resolve this through anticipatory vigilance. In the context of the perioperative setting, nurses encounter challenges in minimising risks for their patients on a continuous basis. Current explanations of minimising risk in the perioperative setting offers insights into how perioperative nurses undertake their work. Currently research in minimising risk is broadly related to dealing with errors as opposed to preventing them. To date, little is known about how perioperative nurses practice and maintain safety. This study was guided by the principles of classic grounded theory as described by Glaser (1978, 1998, 2001). Data was collected through individual unstructured interviews with thirty seven perioperative nurses (with varying lengths of experiences of working in the area) and thirty three hours of non-participant observation within eight different perioperative settings in the Republic of Ireland. Data was simultaneously collected and analysed. The theory of anticipatory vigilance emerged as the pattern of behaviour through which nurse’s deal with their main concern of minimising risk in a high risk setting. Anticipatory vigilance is enacted through orchestrating, routinising and momentary adapting within a spirit of trusting relations within the substantive area of the perioperative setting. This theory of offers an explanation on how nurses resolve their main concern of minimising risk within the perioperative setting. The theory of anticipatory vigilance will be useful to nurses in providing a comprehensive framework of explanation and understanding on how nurses deal with minimising risk in the perioperative setting. The theory links perioperative nursing, risk and vigilance together. Clinical improvements through understanding and awareness of the theory of anticipatory vigilance will result in an improved quality environment, leading to safe patient outcomes.

Clinical and economic impact of contaminated blood cultures within the hospital setting

Blood cultures have an important role in the diagnosis of serious infections, although contamination of blood cultures (i.e. false-positive blood cultures) is a common problem within the hospital setting. The objective of the present investigation was to determine the impact of the false-positive blood culture results on the following outcomes: length of stay, hotel costs, antimicrobial costs, and costs of laboratory and radiological investigation. A retrospective case-control study design was used in which 142 false-positive blood culture cases were matched with suitable controls (patients for whom cultures were reported as true negatives). The matching criteria included age, comorbidity score and month of admission to the hospital. The research covered a 13-month period (July 2007 to July 2008). The findings indicated that differences in means, between cases and controls, for the length of hospital stay and the total costs were 5.4 days [95% CI (confidence interval): 2.8-8.1 days; P

Realizing a high magnetic moment in Gd/Cr/FeCo: The role of the rare earth

The search for materials or systems exhibiting a high magnetic saturation has been of longstanding importance. It has been suggested that increased saturation could be achieved by coupling a transition metal via a spacer to a rare earth. We report Gd/Cr/Fe₇₀Co₃₀ multilayer stacks and find reduced yet modulating magnetic moment as a function of Cr thickness. Through a micro structural analysis the lowered moment is indicated by the nucleation of the ultrathin Gd films into an fcc phase. We discuss the possible solution in terms of quasi-perfect lattice match seed material to promote growth of hcp Gd.

General Nurses’ Experiences of End-Of-Life Care in the Acute Hospital Setting

Approximately 90% of the UK population spend some time in hospital in their final year of life, and more than half of the population die in hospital. This review aims to explore the experiences of general nurses when providing end-of-life care to patients in the acute hospital setting. Nine studies were identified through a literature search, and each was then analysed and evaluated until themes emerged. Six themes were drawn from the literature: lack of education and knowledge, lack of time with patients, barriers arising in the culture of the health-care setting, communication barriers, symptom management, and nurses' personal issues. The themes cause concern about the quality of end-of-life care being provided in the acute care setting. The literature appears to be consistent in the view that terminally ill patients are best cared for in specialised care settings, such as palliative care units and hospices. However, increasing demands on health services will result in greater numbers of dying patients being admitted to the acute hospital setting. It is therefore paramount that general nurses' educational needs are met to ensure they develop clinical competence to provide high-quality holistic end-of-life care.

Poetic Inquiry, Consumer Vulnerability: Realities of Quadriplegia

Alternative forms of research interpretation have been utilised within the social sciences. Poetic inquiry, an area of growing interest influences readership affectively as well as intelligently. Incorporating interview data as a poetic submission, this paper intends to reflexively capture, emotional intensity, hopelessness, liminality, voicelessness and self-transformative realities attendant to those experiencing vulnerability. The unintelligible language that can appropriate the poetic form, supports the elucidation of hidden narratives of more vulnerable inscapes. Consumer vulnerability lends itself to the power of poetry for legitimacy of the moment, where sensory imagery and nonce words attend hiatuses common in scientific discourse. The poetic inquiry, Vulnerability in Parts, is elicited from wider research with homebound consumers conducted over a two-year period, which draws on one homebound consumer’s experience of quadriplegia.

Moment of stasis: the successful failure of a constitution for Europe

The 2005 French and Dutch negative votes on the Constitution open up a space of conceptualisation, not only of Europe's relation to its demos, but significantly to its failures. Through a critical analysis of mainly Niklas Luhmann's systems theory, the article proposes taking a distance from traditional constitutional dogmatics that are no longer capable of dealing with the paradox of contemporary society, and more specifically with the eventual resurgence of the European project as one of absence and stasis: the two terms are used to explain the need, on the one hand, to maintain the 'absent community' of Europe, and, on the other, to start realising that any conceptualisation of the European project will now have to take place in that space of instability and contingency revealed by the constitutional failure. The relation between law and politics, the location of a constitution, the distinction between social and normative legitimacy, the connection between European identity and demos, and the concept of continuity between constitutional text and context are revisited in an attempt to trace the constitutional failure as the constitutional moment par excellence.

Determination of the vibrational transition moment ratio for the Coriolis interacting v9 and v10 fundamentals of allene

Comparison between observed and calculated infrared band contours has been made to determine the vibrational transition moment ratio |M10/M9| for the Coriolis interacting ν9 and ν10 perpendicular fundamentals of allene-h4. The ratio obtained is appreciably lower than that of a previous estimate and the result obtained by integrated band intensity measurements of Overend and Crawford. From the best estimate of the ratio, the dipole moment derivatives of the two bands are determined; the value for the weaker band ν9 is subject to a large uncertainty.

The use of drama to teach social skills in a special school setting for students with autism.

For children with autism, social challenges may be both part of the disability and a barrier to accessing education. This paper reports on a project which used drama to address such challenges by drawing on the social skills of non-autistic peers in a special school setting. The paper demonstrates how drama’s flexibility may be harnessed in order to help students support each other’s development of creative and communicative skills. Focusing on two children in particular, specific examples are given to illustrate how they participated in group work, made imaginative contributions to verbal and physical representations, and engaged with abstract ideas. The project’s outcomes suggest, given a concrete structure and an invitation to collaborate, drama can be a powerful learning medium for children with ASD. The conclusion reflects on the diverse meaning of inclusive practice which can be achieved within specialist settings.

Application of Narrative Pedagogy to Promote Excellence in the Clinical Setting

The clinical setting has become increasingly complex in recent years. Nurse educators have recognized the limitations of traditional pedagogies in the clinical setting. The need for innovative, student-centered learning is essential in order to transfer knowledge to practical situations and discover new ways of thinking about clinical situations. Narrative pedagogy which emphasizes how students learn and experience learning is an effective evidence-based approach to clinical education.

Catching gender-Identity production in flight : making the commonplace visible

The purpose of this article is to develop and illustrate an approach for making the commonplace visible in a natural, as opposed to manipulated, social setting. The key research task was to find a way of capturing the ongoing production or enactment of the self that provides some insight into the way in which it is produced in a routine, matter of fact way. The article takes a number of steps to develop a research approach to the task. First, gender-identity was selected as a more specific aspect of self-production. Second, the concept of “flashpoints” was used to refer to a particular moment in the routine which achieves some significance or salience as a result of the participants seizing upon some otherwise unremarkable action or statement and twisting it to their purpose. In this study, the purpose was gender-identity creation. Primary school children in the classroom and their teachers were the participants of the study. Through the use of flashpoints, the article demonstrates how gender-identity production of these children can be caught in flight. The article concludes that this approach can be added to the researcher’s toolkit.

‘Retrieving the Bandung Conference … moment by moment’

This review article discusses two publications: Bandung 1955: Little histories (2010) and Making a world after empire: The Bandung moment and its political afterlives (2010). It concludes that, though thesee two texts offer many prisms through which the conference might be understood, the history of the Bandung Conference remains somewhat fragmented.

Sedimentary rocks of the Internal Hellenides, Greece: age, source, and depositional setting

Ziel der vorliegenden Dissertation war die Untersuchung der Liefergebiete und Ablagerungsräume sedimentärer Gesteine aus ausgewählten Gebieten der inneren Helleniden Griechenlands. Die untersuchten Sedimente Nordgriechenlands gehören zu den Pirgadikia und Vertiskos Einheiten des Serbo-Makedonische Massifs, zu den Examili, Melissochori und Prinochori Formationen der östlichen Vardar Zone und zur Makri Einheit und Melia Formation des östlichen Zirkum-Rhodope-Gürtels in Thrakien. In der östlichen Ägäis lag der Schwerpunkt bei den Sedimenten der Insel Chios. Der Metamorphosegrad der untersuchten Gesteine variiert von der untersten Grünschieferfazies bis hin zur Amphibolitfazies. Das stratigraphische Alter reicht vom Ordovizium bis zur Kreide. Zur Charakterisierung der Gesteine und ihrer Liefgebiete wurden Haupt- und Spurenelementgehalte der Gesamtgesteine bestimmt, mineralchemische Analysen durchgeführt und detritische Zirkone mit U–Pb datiert. An ausgewählten Proben wurden außerdem biostratigraphische Untersuchungen zur Bestimmung des Sedimentationsalters durchgeführt. Die Untersuchungsergebnisse dieser Arbeit sind von großer Bedeutung für paläogeographische Rekonstruktionen der Tethys. Die wichtigsten Ergebnisse lassen sich wie folgt zusammenfassen: Die ältesten Sedimente Nordgriechenlands gehören zur Pirgadikia Einheit des Serbo-Makedonischen Massifs. Es sind sehr reife, quarzreiche, siliziklastische Metasedimente, die auf Grund ihrer Maturität und ihrer detritischen Zirkone mit ordovizischen overlap-Sequenzen vom Nordrand Gondwanas korreliert werden können. Die Metasedimente der Vertiskos Einheit besitzen ein ähnliches stratigraphisches Alter, haben aber einen anderen Ablagerungsraum. Das Altersspektrum detritischer Zirkone lässt auf ein Liefergebiet im Raum NW Afrikas (Hun Superterrane) schließen. Die Gesteinsassoziation der Vertiskos Einheit wird als Teil einer aktiven Kontinentalrandabfolge gesehen. Die ältesten biostratigraphisch datierten Sedimente Griechenlands sind silurische bis karbonische Olistolithe aus einer spätpaläozoischen Turbidit-Olistostrom Einheit auf der Insel Chios. Die Alter detritischer Zirkone und die Liefergebietsanalyse der fossilführenden Olistolithe lassen den Schluss zu, dass die klastischen Sedimente von Chios Material vom Sakarya Mikrokontinent in der West-Türkei und faziellen Äquivalenten zu paläozoischen Gesteinen der Istanbul Zone in der Nord-Türkei und der Balkan Region erhalten haben. Während der Permotrias wurde die Examili Formation der östlichen Vardar Zone in einem intrakontinentalen, sedimentären Becken, nahe der Vertiskos Einheit abgelagert. Untergeordnet wurde auch karbonisches Grundgebirgsmaterial eingetragen. Im frühen bis mittleren Jura wurde die Melissochori Formation der östlichen Vardar Zone am Abhang eines karbonatführenden Kontinentalrandes abgelagert. Der Großteil des detritischen Materials kam von permokarbonischem Grundgebirge vulkanischen Ursprungs, vermutlich von der Pelagonischen Zone und/oder der unteren tektonischen Einheit des Rhodope Massifs. Die Makri Einheit in Thrakien besitzt vermutlich ein ähnliches Alter wie die Melissochori Formation. Beide sedimentären Abfolgen ähneln sich sehr. Der Großteil des detritischen Materials für die Makri Einheit kam vom Grundgebirge der Pelagonischen Zone oder äquivalenten Gesteinen. Während der frühen Kreide wurde die Prinochori Formation der östlichen Vardar Zone im Vorfeld eines heterogenen Deckenstapels abgelagert, der ophiolitisches Material sowie Grundgebirge ähnlich zu dem der Vertiskos Einheit enthielt. Ebenfalls während der Kreidezeit wurde in Thrakien, vermutlich im Vorfeld eines metamorphen Deckenstapels mit Affinitäten zum Grundgebirge der Rhodopen die Melia Formation abgelagert. Zusammenfassend kann festgehalten werden, dass die Subduktion eines Teiles der Paläotethys und die anschließende Akkretion vom Nordrand Gondwanas stammender Mikrokontinente (Terranes) nahe dem südlichen aktiven Kontinentalrand Eurasiens den geodynamischen Rahmen für die Schüttung des detritischen Materials der Sedimente der inneren Helleniden im späten Paläozoikum bildeten. Die darauf folgenden frühmesozoischen Riftprozesse leiteten die Bildung von Ozeanbecken der Neotethys ein. Intraozeanische Subduktion und die Obduzierung von Ophioliten prägten die Zeit des Jura. Die spätjurassische und frühkretazische tektonische Phase wurde durch die Ablagerung von mittelkretazischen Kalksteinen besiegelt. Die endgültige Schließung von Ozeanbecken der Neotethys im Bereich der inneren Helleniden erfolgte schließlich in der späten Kreide und im Tertiär.

A multi-site pilot test study to measure safety climate in the university work setting

Next to leisure, sport, and household activities, the most common activity resulting in medically consulted injuries and poisonings in the United States is work, with an estimated 4 million workplace related episodes reported in 2008 (U.S. Department of Health and Human Services, 2009). To address the risks inherent to various occupations, risk management programs are typically put in place that include worker training, engineering controls, and personal protective equipment. Recent studies have shown that such interventions alone are insufficient to adequately manage workplace risks, and that the climate in which the workers and safety program exist (known as the "safety climate") is an equally important consideration. The organizational safety climate is so important that many studies have focused on developing means of measuring it in various work settings. While safety climate studies have been reported for several industrial settings, published studies on assessing safety climate in the university work setting are largely absent. Universities are particularly unique workplaces because of the potential exposure to a diversity of agents representing both acute and chronic risks. Universities are also unique because readily detectable health and safety outcomes are relatively rare. The ability to measure safety climate in a work setting with rarely observed systemic outcome measures could serve as a powerful means of measure for the evaluation of safety risk management programs. ^ The goal of this research study was the development of a survey tool to measure safety climate specifically in the university work setting. The use of a standardized tool also allows for comparisons among universities throughout the United States. A specific study objective was accomplished to quantitatively assess safety climate at five universities across the United States. At five universities, 971 participants completed an online questionnaire to measure the safety climate. The average safety climate score across the five universities was 3.92 on a scale of 1 to 5, with 5 indicating very high perceptions of safety at these universities. The two lowest overall dimensions of university safety climate were "acknowledgement of safety performance" and "department and supervisor's safety commitment". The results underscore how the perception of safety climate is significantly influenced at the local level. A second study objective regarding evaluating the reliability and validity of the safety climate questionnaire was accomplished. A third objective fulfilled was to provide executive summaries resulting from the questionnaire to the participating universities' health & safety professionals and collect feedback on usefulness, relevance and perceived accuracy. Overall, the professionals found the survey and results to be very useful, relevant and accurate. Finally, the safety climate questionnaire will be offered to other universities for benchmarking purposes at the annual meeting of a nationally recognized university health and safety organization. The ultimate goal of the project was accomplished and was the creation of a standardized tool that can be used for measuring safety climate in the university work setting and can facilitate meaningful comparisons amongst institutions.^

The influence of the section shape of box-girder decks on the steady aerodynamic yawing moment of double cantilever bridges under construction

The yawing moment acting on the box-girder deck of reinforced concrete bridges constructed using the balanced cantilever method during the erection stage has been experimentally analyzed by testing different types of bridge cross-sections. Experimental results show that the yawing moment coefficient decreases as the bridge decks become streamlined, and that the yawing moment coefficient reaches a maximum when the bridge deck length is nearly twice the deck width.

The Role of Corals on Tsunami Dynamics in an Island Setting: A Case Study of Tutuila Island

Thesis (Ph.D.)--University of Washington, 2016-07