Background Mental health service users report that staff empathy is key to developing positive therapeutic relationships but promoting empathy in staff training is challenging. Staff may struggle to maintain their compassion, particularly in challenging settings, and have limited clinical confidence when treating conditions of which they lack subjective understanding. Novel interventions are required to address these needs. Main body of the text Virtual reality-based simulation training has been shown to be an effective training modality for healthcare professionals; it has the potential to deliver crucial empathy-building learning for frontline mental health staff due to its capacity to increase staff understanding of service users’ experiences. Virtual reality and simulation technology take interactivity and experiential learning to a level beyond which we have seen in teaching and training before. Subjective understanding is elicited because this is a technology for enhanced experiential learning, which in turn fosters greater empathy and compassion. Increased empathy in the workforce is likely to yield significant benefits for service users. Greater empathy in nursing is linked with reduced restrictive practices and reduced conflict between staff and service users. Restrictive practices, including restraint and seclusion, are widely used in mental health settings within the UK, and are an aspect of mental health nursing that is at odds with the therapeutic role of nursing. Despite these innovative developments, there are challenges ahead. Many nurses feel that complete eradication of restrictive practices is impossible and that barriers include a limitation of resources, communication, management, and lack of education. There is a need to make simulation training economically viable so that it can be upscaled and widely available. Therefore, greater investment and resources are needed to bring this innovative training to the wider workforce to support staff and to realise the benefits for service users. Short conclusion Virtual reality-based training has great potential for mental health staff, which could have important consequences in terms of improved staff empathy and reductions in harmful restrictive practices. Further research and funding for such training is necessary so that it can be more widely available.
Use of heterojunctions between two materials having favorable optical and electronic properties can lead to increased photon absorption and charge separation resulting in enhanced photo-electro-chemical energy conversion. In the present study, graphene monolayer nano-flakes are mixed with TiO2 nanoparticles to form nanocomposites having different weight percentages of graphene. The microstructural, morphological and structural properties of the composite samples are investigated using X-ray diffraction, Raman spectroscopy and transmission electron microscopy techniques. Raman studies carried out on samples annealed at different temperatures show the interfacial interaction between TiO2 and graphene, although Anatase TiO2 and graphene maintain their phase integrity. PEC measurements show higher photo-electro-chemical activity in TiO2-graphene nanocomposite at an optimized concentration (2.0 weight percent) due to increased surface area, higher optical absorption in the visible part of the solar spectrum and favorable carrier transport due to increased concentration of defect states and graphene acting as a charge carrier medium.
Introduction: The Radiography Research Ethics Standards for Europe (RRESFE) project aimed to provide a cross-sectional view of the current state of radiography research ethics across Europe. This included investigating education and training in research ethics, and identifying the key challenges and potential improvements associated with using existing research ethics frameworks. Methods: This cross-sectional online survey targeting radiography researchers in Europe was conducted between April 26 and July 12, 2021. Descriptive and analytical statistics were used to identify research ethics education and training trends. Content analysis of qualitative responses was employed to identify significant challenges and proposed improvements in research ethics frameworks of practice. Results: There were 232 responses received across 33 European countries. Most (n ¼ 132; 57%) respondents had received some research ethics training; however, fewer participants had received training on safeguarding vulnerable patients (n ¼ 72; 38%), diversity and inclusivity (n ¼ 62; 33%), or research with healthy volunteers (n ¼ 60; 32%). Training was associated with a greater perceived importance of the need for research ethics review (p ¼ 0.031) and with the establishment of EQF Level 6 training (p ¼ 0.038). The proportion of formally trained researchers also varied by region (p ¼ <0.001). Time-toethics-approval was noted as the biggest challenge for professionals making research ethics applications. Conclusion: Early and universal integration of research-oriented teaching within the radiography education framework which emphasises research ethics is recommended. Additionally, study findings suggest research ethics committee application and approval processes could be further simplified and streamlined. Implications for practice: The survey contributes to a growing body of knowledge surrounding the importance of education and training in research ethics for assuring a high standard of research outputs
Introduction Advances in Radiotherapy (RT) technology and increase of complexity in cancer care have enabled the implementation of new treatment techniques. Subsequently, a greater level of autonomy, responsibility, and accountability in the practice of Therapeutic Radiographers/Radiation Therapists (TR/RTTs) has led to Advanced Practice (AP) roles. The published evidence of this role is scattered with confusing terminology and divergence regarding the perception of whether a specific role represents AP internationally. This study aims to establish an international baseline of evidence on AP roles in RT to identify roles and activities performed by TR/RTTs at advanced level practice and to summarise the impact. Methods A systematic PRISMA review of the literature was undertaken. Thematic analysis was used to synthesise the roles and associated activities. Six RT external experts validated the list. The impact was scrutinised in terms of clinical, organisational, and professional outcomes. Results Studies (n = 87) were included and categorised into four groups. AP roles were listed by clinical area, site-specific, and scope of practice, and advanced activities were organised into seven dimensions and 27 sub-dimensions. Three most-reported outcomes were: enhanced service capacity, higher patient satisfaction, and safety maintenance. Conclusion Evidence-based AP amongst TR/RTTs show how AP roles were conceptualised, implemented, and evaluated. Congruence studies have shown that TR/RTTs are at par with the gold-standard across the various AP roles. Implications for practice This is the first systematic literature review synthetisising AP roles and activities of TR/RTTs. This study also identified the main areas of AP that can be used to develop professional frameworks and education guiding policy by professional bodies, educators and other stakeholders.
In mountainous or hilly areas, the slope aspect affects the amount of solar radiation, with direct consequences on species distribution and tree growth. However, little is known on how the tree shape and volume allometry may be affected by contrasting environmental conditions driven by the slope aspect. This study aims to investigate whether the slope aspect affects the aboveground tree shape and volume allometry of European beech (Fagus sylvatica L.) trees. We used the data of scanned trees from two plots located on south- and respectively north-facing slopes and, additionally, an inventory dataset containing measurements of diameter at breast height (D) and tree height (H). To investigate the differences in tree shape, we used analysis of covariance. However, to assess the differences in volume allometry, we first predicted the volume of each individual tree within the inventory dataset using either the south- or the north-facing slope volume model, and then performed a paired t-test on the plot estimates based on the two volume models. Since the uncertainty originating from allometric volume model predictions was likely to affect the results of the paired t-test, we performed a Monte-Carlo simulation to assess the rate of null hypothesis acceptance with the paired t-test. The results showed that trees growing on the north-facing slope were significantly thinner (p < 0.001), with a significantly longer branching system (p < 0.001) compared to those on the south- facing slope. Correspondingly, the volume estimates per unit of forest area based on the south- vs. north-facing slope allometric volume models were significantly different (p < 0.001). The estimates of total aboveground volume per unit of forest area based on the north-facing slope allometric models were significantly larger compared to those based on the south-facing slope volume models, a difference driven by the significantly larger branch and stem volume for the north-facing slope. These differences in estimates per unit of forest area were larger when based on allometric models that only used D as a predictor of aboveground tree volume. The rates of null hypothesis acceptance within the paired t-test were generally low. For total aboveground volume estimated by D and H, the acceptance rate was 1.79%. Nevertheless, only using D to predict tree volume, the rates of null hypothesis acceptance were lower (i.e., 0.1%), suggesting that addition of H as a predictor of tree volume partly explains the differences caused by the slope aspect on volume allometry, but not enough to offset the differences entirely. In conclusion, slope aspect has significantly affected the tree shape and volume allometry of European beech trees.
Aim To explore nurses' and midwives' experiences, views, perceptions and impact on their responses to out of work emergencies where first aid may be required. Design A constructivist grounded theory study was conducted between 2012 and 2019. Methodology In-depth, semi-structured interviews were undertaken with 16 nurses and midwives. Participants were recruited via a participant referral process with registered nurses and midwives being accessed from three NHS organizations. Data were analysed and coded using constant comparative analysis with the support of Nvivo 10 software leading to the construction of a substantive grounded theory. Results A core enduring in vivo theme, ‘The Right Thing to Do’, emerged as a central conceptual reality constructed via three key in vivo themes; ‘Something I've Heard’, ‘Am I Covered?’ and ‘Just Who I Am’, each with several sub-themes. A pervading anxiety about responding at off-duty situations requiring first aid was persistently evident across these themes. Conclusion The study showed a strong sense of moral agency among nurses and midwives, despite a powerful underlying feeling of anxiety surrounding broader issues of urban myth, protection and personal and professional identity. The substantive theory emerged as ‘doing "The Right Thing" in a climate of anxiety’. Impact The study illuminates an area that has previously been the subject of anecdotal debate. The substantive theory, ‘doing "The Right Thing" in a climate of anxiety’ illustrates the issues and tensions that exist surrounding the off-duty response. Implications and recommendations for practice and education focus on the fostering of knowledge and understanding of professional identity, position in law and scope of practice, together with potential future research directions. This work provides the first in-depth qualitative study contributing a significant new perspective both nationally and globally.
Background/Aims Anxiety is a common characteristic for people who live with an autistic spectrum condition and while studies on anxiety in this population are commonplace and case studies correlate anxiety with mental health service experience, little is known about the actual triggers of anxiety and its manifestations, particularly during the discharge process. This aim of this study was to explore how mental health inpatients with autistic spectrum conditions experienced and coped with discharge from a UK acute mental health inpatient facility. Methods Between 2018 and 2019, audio-recorded semi-structured interviews captured the experiences of 20 adults from the east of England, who were former psychiatric inpatients with an established diagnosis of an autistic spectrum condition. Results Themes were identified through interpretative phenomenological data analysis, which explained participants' reflections regarding the situations and events within the acute care mental health facility that triggered their anxiety, behavioural manifestations of anxiety and responses to the discussion of discharge. Broad behavioural patterns were established that could be associated with their anxiety, such as self-harming or exhibiting aggressive and violent behaviours. Conclusions The anxiety caused by the discussion of the discharge process appears to be overlooked by mental health practitioners, so attention to potentially anxiety-inducing dialogue is needed when planning discharge from acute care mental health services. The nature of patient–practitioner interactions and dialogue leading up to discharge needs to be handled with sensitivity to the unique needs of the patient so that the experience of discharge becomes less daunting. Transformative research is required to clearly understand the experiences of this vulnerable group and to act as a vehicle to enhance pre-discharge dialogue and support.
The Canary Islands have a maritime position, and there are many ports along their coasts, including commercial, passenger transport and marinas, which is the case studied here. This document aims to determine the impact of marinas on the environment. To achieve this, carbon and water footprint calculation tools were used. A survey was developed and sent to the managers of the marinas, with questions that addressed three areas of the carbon footprint and the blue water in the water footprint calculation. Once the completed surveys were received, the data were processed and converted into tons of CO2 equivalent, using emission factors published in official Spanish sources. The amount of greenhouse gases produced by the marinas studied was obtained. One of the most remarkable findings is that companies working for the marinas (scope 3) have an important effect on the calculation, since not only the marina’s own activities generate emissions but also the movement of vehicles of companies related to this facility.
This qualitative, systematic review explored the influence of gender on children's and young people's caring roles. However, there was very limited research in this area. Eight studies were included and the synthesis yielded seven global themes. The meta‐ethnography produced a higher‐order concept—the gendered reproduction of children's and young people's caring. The review shows that children and young people are relied on as a caring resource in the global North and South. We emphasise that gender equality in caring, particularly among adults, is necessary to enhance the lifechances of girls and young women.
The Lesser Antilles volcanic arc is known for its magmatic diversity and unusually abundant plutonic xenoliths. Xenoliths from Petit St. Vincent (Grenadines archipelago) are particularly interesting because of their textural and petrogenetic range. Here we combine petrographic observations, Electron Backscatter Diffraction (EBSD) analysis, major and trace element chemistry of xenoliths and lavas, and geochemical and thermal modelling to explore the construction of arc crust beneath Petit St. Vincent. Petit St. Vincent xenoliths are dominated by calcic plagioclase, clinopyroxene and amphibole, and can be divided into two main categories, igneous and meta-igneous. Igneous xenoliths typically have cumulate textures; meta-igneous xenoliths range texturally from those that preserve vestiges of primary magmatic fabrics to intensely deformed varieties characterised by grain-size reduction and foliation development. Meta-igneous xenoliths also contain the most calcic plagioclase (An98-100).
Kilometre-sized flows (KSFs) have been observed in many regions on Mars and have been typically interpreted as lava flows. However, sedimentary volcanism has been proposed as an alternative origin for some KSFs. Remarkable examples of such hypothesized sedimentary KSFs are located at the southern margin of Chryse Planitia. There, the flows are associated with conical and dome-shaped edifices; however their formation mechanism remains enigmatic due to the absence of ground truth. Previous studies revealed that these KSFs consist of three morphological elements: a central depression, leveed central channels, and a distal portion of the fading channel(s). Here, we present new morphological results obtained on these KSFs using seven newly available Digital Elevation Models computed from HiRISE stereo pairs. Our investigation confirms that these features are aggradational and formed by the transport of a liquid. This material emerged from identified depressions and the presence of subtle mounds inside them is interpreted to mark the position of feeder vents. We also observe that the margins surrounding the central large channels are not continuous. They are cut by meter-sized troughs linking the central channels to units which have distinctive albedo and roughness compared to their surroundings. These bright units do not have a clear topographical expression, suggesting that the effused material originally flowing away from the central channel was easily removed after its emplacement. Such surface features are unlikely to be related to igneous deposits, since once lava is released from a main channel, it would rapidly solidify due to the heat loss and hence result in topographically distinct features. In contrast, such morphological expressions are more likely related to sedimentary volcanism and the emplacement of low viscosity water-rich mud. Sublimation, evaporation, infiltration or a combination of these processes should lead to water loss from the flows without leaving a detectable topographic expression but changing the roughness and hence albedo of the surface. The southern part of Chryse Planitia is a region on Mars where subsurface sediment mobilization could have operated in the past and hence represents a promising site for future exploration where deeper-sourced sedimentary deposits are exposed at the surface.
Fused Deposition Modelling (FDM), is an additive manufacturing technology where polymers are extruded using appropriate processing parameters to achieve suitable bonding while ensuring that overheating does not occur. Among processing parameters, polymer inlet temperature, nozzle size, extrusion speed, and air cooling speed are significantly effect on the extrusion process at the distance between the build plate and the nozzle tip (standoff region). This study aims to evaluate the influences of the processing parameters on the thermal behavior and phase change zone of Polyamide 12 (PA12) and Acrylonitrile Butadiene Styrene (ABS) polymers at standoff region. A nonlinear three-dimensional (3D) finite element (FE) model was developed by implementing an apparent heat capacity model using the Heat Transfer Module in COMSOL® Multiphysics software. FE results in the standoff region were validated by experimental tests, concerning various nozzle sizes and extrusion speed. The validated numerical results demonstrated that there is a complex correlation between processing parameters and thermal behaviors such as phase change and temperature distribution in the standoff region. The FE results were then employed in training an artificial neural network (ANN). A well-established compromise between the trained ANN and the FE results demonstrates that the trained ANN can be employed in the prediction of further thermal and glass transition behavior using subsequent processing parameters.
This study examines the perspectives and experiences of older lifelong participants in outdoor education/recreation. 32 participants, women (11) and men (21), aged 60-84 provided narratives of their lifelong engagements in the outdoors in nature-based activities. They were invited to write freely on their early experiences and their current engagements in the outdoors. The purpose was to explore and understand why and how serious lifelong older participants continued with their outdoor activities. This paper considers participants’ current embodied engagements. The evidence suggests that as they age, their bodies become less able to deal with discomfort. Yet, the participants, as a consequence of their lifelong knowledge and experience, manage injuries and ill-health, choosing to adapt in various ways to enable their continued engagement/enjoyment in being active in nature. The study stresses the significance of lifelong engagement in the outdoors and the necessity for opportunities for outdoor nature -based experiences throughout the lifespan.
This study aimed to identify the factors affecting consumer behavior and customer loyalty toward organic food. Whether consumers seek organic food for a healthy body or more as food for thought continues to be debated. However, since consumers’ purchase habits are based on their honest life experiences, which shape the building of a brand, this study reviewed the extant literature to understand the factors influencing the purchasing behavior for organic food. The follow-up problems highlighted in the research are related to organic business marketing strategy. Based on our methodology, we conducted semi-structured interviews to gain themes for qualitative research. The study found that availability, variety, and taste were the top three factors affecting consumers’ purchase decisions; surprisingly, neither price nor health-consciousness was the first concern. Using market-led innovation as an innovative lens to understand customer loyalty, this research highlights sustainable and advantageous business practices in the organic food market to enrich the literature on organic food purchasing behavior from multiple stakeholders.
Aim/Objective The aim of this pilot study was to establish the impact of a virtual, short-term, Enquiry-Based Learning (EBL) intervention on students’ ability to accurately decode medical terms and determine students’ perspectives on the value of learning medical terminology to their academic success and professional practice. Background Undergraduate Nursing Associate Apprenticeship (NAA) students are required to learn a range of medical terminology to orient them for practice. Dedicating time to teaching students skills to comprehend and gain confidence with medical terms is central to their success. Design The pilot study used a non-experimental before and after design, alongside a cross-sectional survey. Undergraduate NAA students were included in this pilot study. The pilot study was conducted at a UK-based, Widening Participation university in the School of Nursing, Midwifery and Allied Health. Methods Pre- and post-assessments were completed by all participants and quantitative analysis was performed using SPSS to assess impact. An anonymous, online questionnaire was shared with all participants to understand their perspectives on the value of learning medical terminology and the instructional tools and materials used in the intervention. Setting The pilot study was conducted at a UK-based, Widening Participation university in the School of Nursing, Midwifery and Allied Health. Results Following the teaching intervention, a paired samples t-test showed that participants’ post-assessment results were significantly higher (p < 0.001) than those obtained in the pre-assessment, with a mean difference in results of 5 marks, specifically a 20% gain. The questionnaire responses indicated that participants value the opportunity to learn medical terminology, and perceive a benefit in doing so. Overall, participants agreed that the EBL intervention increased knowledge and skills in decoding medical terminology. Conclusions The findings suggest that the virtual EBL intervention had a beneficial impact, and students perceive value in learning medical terminology for application to both academic study and professional practice.
Background There is limited empirical evidence in Ethiopia on the determinants of treatment outcomes of patients with multidrug-resistant tuberculosis (MDR-TB) who were enrolled to second-line anti-tuberculosis drugs. Thus, this study investigated the determinants of treatment outcomes in patients with MDR-TB at referral hospitals in Ethiopia. Design and methods This study was underpinned by a cross-sectional quantitative research design that guided both data collection and analysis. Data is collected using structured questionnaire and data analyses was performed using the Statistical Package for Social Sciences. Multi-variable logistic regression was used to control for confounders in determining the association between treatment outcomes of patients with MDR-TB and selected predictor variables, such as co-morbidity with MDR-TB and body mass index. Results From the total of 136 patients with MDR-TB included in this study, 31% had some co-morbidity with MDR-TB at baseline, and 64% of the patients had a body mass index of less than 18.5 kg/m ² . At 24 months after commencing treatment, 76 (69%), n = 110), of the patients had successfully completed treatment, while 30 (27%) died of the disease. The odds of death was significantly higher among patients with low body mass index (AOR = 2.734, 95% CI: 1.01–7.395; P<0.048) and those with some co-morbidity at baseline (AOR = 4.260, 95%CI: 1.607–11.29; p<0.004). Conclusion The higher proportion of mortality among patients treated for MDR-TB at Adama and Nekemte Hospitals, central Ethiopia, is attributable to co-morbidities with MDR-TB, including HIV/AIDS and malnutrition. Improving socio-economic and nutritional support and provision of integrated care for MDR-TB and HIV/AIDS is recommended to mitigate the higher level of death among patients treated for MDR-TB.
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