Placement Settings Research Articles

“They already trusted us a lot”: Allied health students’ experiences of an innovative hospital, service-focussed placement model

Background A service-focussed placement model involves an innovative partnership between service and education providers to a) address service delivery needs and b) facilitate students’ competency development. Services are collaboratively redesigned such that students are positioned as collaborators in service delivery with their learning supported through evidence-informed educational design. This model was implemented in the hospital setting and was found to promote positive patient outcomes. Our study explored whether this model supports student learning. Methods Students’ perception of learning was explored using a multiple-case study design with data collected from 22 semi-structured focus groups and interviews with 64 senior year allied health students (physiotherapy n = 55; occupational therapy n = 9) across six placement settings. Inductive thematic analysis identified aspects of this placement model that facilitated and challenged students’ learning. Results A service-focussed placement model provides a quality student learning experience. Students identified the need to be prepared for independent learning. This placement model promoted their professional development and sense of autonomy through engaging them in early, active learning within a safe learning environment. Conclusions Students perceived that a service-focussed placement model equipped them for the ever-changing complexities and challenges of hospital services.

Commentary: 'I never knew it was so prevalent': experiences and perceptions of student health visitors recognising and responding to domestic abuse in practice placement settings.

Commentary: 'I never knew it was so prevalent': experiences and perceptions of student health visitors recognising and responding to domestic abuse in practice placement settings.

'I never knew it was so prevalent': Experiences and perceptions of student health visitors recognising and responding to domestic abuse in practice placement settings.

Health visitors have a key role in supporting and protecting adults and children affected by domestic abuse. The study aimed to examine the experiences and perceptions of student health visitors recognising and responding to domestic abuse in practice placement settings. Semi-structured interviews were conducted with five student health visitors in the United Kingdom. Interviews were transcribed and analysed using interpretive phenomenological analysis. Four superordinate themes were identified: 'part and parcel of health visiting practice'; 'challenges in identifying domestic abuse'; 'uncertainty and apprehension'; 'strengthening knowledge and confidence'. All participants had engaged in practice activities related to domestic abuse within SCPHN placements, commonly expressing a sense of disbelief at the scale of the issue in practice. Difficulties and unease regarding identification and management of domestic abuse were reported. Access to support and opportunities to reflect and 'talk things through' were found to be important for students regarding this sphere of practice. The findings contribute to the body of knowledge about domestic abuse-related practice within nursing. Recommendations made may contribute to practice development and help inform future teaching and educational strategies within SCPHN programmes.

‘I Can't See Myself Seeking Help’: The Influence of Clinical Placements on Nursing Students' Stigmatising Beliefs and Intentions to Seek Help for Their Own Mental Health Issues: A Prospective Cohort Study

ABSTRACTMental health conditions such as anxiety, depression and psychosis represent a global health challenge. Stigma surrounding mental health continues to hinder help‐seeking behaviours for people with mental illness and as this study demonstrates, nursing students as well. However, if student nurses are reluctant to seek help for mental health issues, how can others be expected to do so? This reluctance poses challenges in mental health nursing, impacting both care provision and nursing education. The present study seeks to explore the influence of traditional versus non‐traditional mental health clinical placements on second‐year nursing students' stigmatising beliefs and intentions to seek help for mental health issues. Employing a prospective cohort design using the TREND checklist, the study sampled second‐year nursing students assigned to either traditional hospital‐based or non‐traditional recovery‐focused mental health clinical placements. Using validated scales, stigmatising beliefs and help‐seeking intentions were measured before and after the placements. Statistical analyses were conducted to assess changes in these variables over time and across placement settings. A significant impact of placement setting on help‐seeking intentions was observed, with students in non‐traditional placements showing an increased willingness to seek help. Additionally, non‐traditional placements were found to significantly reduce stigmatising beliefs in all measured domains, suggesting that these settings may provide a more conducive environment for fostering positive attitudes towards mental health. Recovery‐focused placements appear to offer experiences that can diminish stigma and encourage more positive perceptions and intentions related to mental health support.

Drainage and irrigation on demand may decrease severe septic complications and mortality in pancreatic resections.

The necessity of routine drain placement in pancreatic resections is controversial. Some randomized controlled trials have shown that the omission of drainage is safe for some patients, whereas reintervention rates and mortality rates are substantial for others. The present study aimed to assess fistula-associated outcomes in the setting of routine drain placement and drain irrigation on demand. Between 01/2017 and 12/2022, perioperative and outcome data from patients who underwent consecutive pancreatoduodenectomies (PD, n = 253) or distal pancreatectomies (DP, n = 72) were prospectively collected in the electronic StuDoQ database and analysed. All patients underwent intraoperative drain placement. Drains were removed starting at postoperative day 2 in PD or at day 5 in DP after testing for amylase concentration. In case of high amylase levels or macroscopically suspicious pancreatic fistulas, drain irrigation was started. Nondrained fluid collections underwent percutaneous radiologic or transluminal endoscopic evacuation. Clinically relevant pancreatic fistulas were detected in 53 of 325 patients (POPF grade B 16.3%, grade C 1.2%). 43.3% of those had drain irrigation. Additional interventional or endoscopic drainage was necessary in 14 and 5 patients, respectively (overall 5.8%), and were observed in 4.0% of patients with PD and in 12.5% with DP (p = 0.009). Delayed fistula-associated postpancreatectomy haemorrhage (PPH) was present in 1.2% (4/325) of patients. The fistula- and delayed PPH-associated reoperation rate was 1.5% (5/325). The 30-day and in-hospital mortality rates were both 1.5% (5/325), and the rate of fistula-associated mortality was 0.6% (2/325). The overall 90-day mortality rate was 4.5%. In pancreatectomies, a standardized drainage protocol including on-demand drain irrigation results in very low fistula-associated morbidity and mortality and an infrequent need for interventional or surgical reintervention as compared to previously published drainage studies.

Exploration of student nurse experiences of being mentored by practice supervisors/assessors in placement settings.

The Nursing and Midwifery Council changed its standards in 2018 regarding student learning and assessment on placements. Previously, students were allocated a mentor with whom they spent at least 40% of their time and who also assessed them; the new standards brought in the separate roles of practice supervisor and a practice assessor and abolished the 40% minimum, with the student being supported by a wider range of practitioners. While extensive literature examines the experiences of qualified staff supporting students, there is little evidence on the student experience. A qualitative approach using semi-structured interviews with student nurses from two universities in the south of England was used to explore their experiences. The students reported benefits of being supported by the wider healthcare team, said being taught and assessed by different people was beneficial and that they felt better prepared for assessments.

Characteristics of practica in early childhood education: variation in criteria for placements and mentor educators

ABSTRACT Practicum experiences, a critical feature in educator preparation programs, provide preservice educators opportunities to incorporate theory and practice in classrooms while under the supervision of a mentor educator. Although general descriptions of high-quality practicum experiences are provided by professional organizations and accrediting bodies, state licensing and differences across educator preparation programs contribute to variation in these experiences, which in turn have implications for the early childhood workforce. To provide a data-based understanding of program-level requirements for practicum experiences, the current study collected survey data from 227 early childhood higher education programs across 48 states in the U.S. The survey included questions about practicum placement settings, requirements and additional criteria for practicum placement sites, mentor educator requirements, age of children in the classroom, and intensity of practicum experiences. Results show that higher education programs allow several different types of placements with most programs using public school placements. Types of program and ages of children in the classroom were most frequently reported as required criteria and partnerships and feedback were most frequently reported as additional considerations in the determination of placement sites. Mentor educator education and license criteria varied by the age of the children for the practica. Higher education programs varied in the number and hours of practicum offered with more practicum hours in early elementary, kindergarten, and pre-k classrooms than in infant and toddler classrooms. The variations in characteristics and criteria for practicum placements across educator preparation programs are discussed, including implications for early childhood educator preparation programs and future research.

Non-traditional mental health clinical placements: An effective means for reducing self-stigma in pre-registration nursing students.

Pre-registration nursing students report high rates of stigma, leading to low help-seeking attitudes when seeking help for mental health issues. Traditional mental health clinical placements can improve stigma related to attitudes and social distance for pre-registration nursing students. There are nil recorded clinical placement interventions that have decreased self-stigma for pre-registration nursing students, with this study highlighting a clinical placement model that is effective in significantly decreasing self-stigma. The knowledge around the mental health struggles experienced by pre-registration nursing students, and the effect of a non-traditional mental health placement in decreasing self-stigmatizing attitudes in this population, is important for the future of retaining mental health nurses. There is an opportunity to use the clinical placement model presented, and design interventions for nursing students that aims to promote help-seeking behaviours. INTRODUCTION: Traditional mental health clinical placements can improve pre-registration nurse stigma toward mental illness, particularly in measures of attitudes and social distance. However, they have not yet been shown to improve self-stigma, which affects mental health disclosure and help-seeking behaviour. The present study investigates nursing students' stigma following a non-traditional mental health placement immersed alongside people living with mental illness. Three stigma subtypes were measured using the Opening Minds Scale for Healthcare Providers: Attitudes, Social Distance, and Disclosure/Help-seeking. Pre-registration nurses (N = 848) completed the instrument pre- and post-placement. A multivariate analysis of variance (MANOVA) identified a large effect of placement on stigma (p < .001, = .101). Post hoc pairwise comparisons revealed all three types of stigma decreased after the non-traditional placement (Attitudes: p < .001, = 0.09, Social Distance: p < .001, = 0.07, Disclosure/Help-seeking: p < .001, = 0.04). These findings emphasize that attending a non-traditional mental health clinical placement can effectively reduce multiple types of nursing student stigma. Further research in this area could focus on which attributes of the clinical placement setting foster positive help-seeking. These results are noteworthy for stigma surrounding disclosure/help-seeking, as traditional (i.e. hospital-based) mental-health clinical placements have been found ineffective in reducing nursing student stigma in this domain. Further research into the effectiveness of non-traditional clinical placements in reducing nursing students' stigma regarding mental health disclosure and help-seeking, is required.

High stress during clinical practicum placement is associated with bullying among nursing students: A mixed-method study

BackgroundNursing students are often subjected to bullying during their clinical practices, but few study has examined associations of bullying with psychological status among these groups, and how they cope with the bullying. ObjectivesThis study aimed to evaluate the experience and psychological status of clinical placement setting bullying among nursing students attending clinical practices, and explore students' coping strategies when bullied. DesignA mixed methods. SettingsSix tertiary hospitals in Northwest China. ParticipantsA total of 687 nursing students completed the questionnaire survey, of which 18 nursing students participated in the qualitative interview. MethodsA two-phase hybrid study was produced. During first phase, data were collected by using the Bullying Behavior Scale in Nursing Education (BNEQ) and the Depression, Anxiety and Stress Scale (DASS-21). Subsequently, those who have experienced bullying in the workplace were invited to participate in a face-to-face interview (second phase) which focused on exploring students' deeper insights. ResultsOf the 687 students involved, 72.19 % had experienced various types of bullying. Of them, 92.11 % experienced implicit violence. Those with higher education levels and from rural were more likely to experience bullying. Students were prone to greater psychological stress when exposed to bullying. “Pretending not to see” (33.16 %), “reporting to superiors” (30.10 %), and “doing nothing” were the most common ways students responded. Four themes were obtained from the qualitative interviews: (a) impaired self-esteem; (b) career rejection; (c) psychological stress; and (d) the decline of humanistic care. ConclusionOur findings suggest that senior nursing students experience multiple types of bullying during the clinical practices, leading to a high level of psychological stress, which further effect students' professional approval and self-esteem. To prevent such incidents, we need to call on university and hospitals' support to help students successfully cope with bullying.

VARIPULSE: A step-by-step guide to pulmonary vein isolation.

The VARIPULSE™ variable-loop circular catheter (VLCC) is a bidirectional, multielectrode catheter that can perform electrophysiological mapping and deliver pulsed field energy through the TRUPULSE™ Generator for the treatment of atrial fibrillation. This ablation system, including the CARTO 3™ three-dimensional electroanatomical mapping system, represents a fully integrated system. Pulsed field ablation (PFA) is a novel, primarily cardiac tissue-selective ablation technology with a minimal thermal effect, potentially eliminating the collateral tissue damage associated with radiofrequency ablation or cryoablation. Integration of a mapping system may lead to shorter fluoroscopy times and improve the usability of the system, allowing tracking of energy density and placement to confirm no areas around the vein are left untreated. This step-by-step review covers patient selection, mapping, the step-by-step ablation workflow, details on catheter repositioning and ensuring contact, considerations for ablation of specific anatomical variations, and discussion of ablation without fluoroscopy based on our initial clinical experience. The VLCC is part of the fully integrated PFA system designed for pulmonary vein isolation, using mapping to guide catheter placement and lesion set creation. The current workflow, which is based on our initial clinical experience, may be further refined as the PFA system is used in real-world settings.

“This should be a compulsory placement for all nursing students”: An evaluation of pre-registration nursing students’ perceptions of learning on a mental health clinical placement

AimTo conduct a longitudinal exploration of pre-registration nursing students’ perceptions of their learning on an immersive mental health clinical placement grounded in learning from people with a lived experience of mental illness (otherwise known as consumers). BackgroundEnriching mental health clinical learning environments are crucial for positive mental health nursing outcomes. Though non-traditional clinical placement (i.e. non-hospital-based) models effectively increase student learning in a range of domains, little is known about the specific features of contemporary non-traditional placement settings that may be supporting student learning over time. DesignA survey design in the form of a standardised evaluation tool with additional qualitative response questions was used to examine nursing students’ perceptions of learning whilst on a non-traditional clinical placement over a 5-year period. Non-traditional placement settings are alternative placement options to traditional inpatient/community mental health settings. The TREND Statement Checklist was adhered to. MethodsSecond- and third-year students studying a Bachelor of Nursing (N = 753) from eight Australian Universities completed a Student Placement Feedback Survey between 2019 and 2023. Data were collected via an evaluation survey including 7-items (rated on a 5-point agreement scale) and three free-response questions. Quantitative and qualitative responses were analysed over all observations and compared between the five years of student evaluations. ResultsAcross five years, the immersive mental health placement was consistently rated by students as a highly valuable learning experience. Utilizing a Multivariate Analysis-of-variance (MANOVA) for the quantitative component revealed that student ‘learning from lived experience’ remained uniformly high and steady throughout 2020–2023. This was despite disrupted learning that ceased face-to-face tuition caused by the COVID-19 pandemic. An increase in ‘student enthusiasm for nursing’ was identified after the return to face-to-face learning. Qualitative analysis identified a greater need for preparedness prior to attending the placement and wellbeing support amongst students. ConclusionsOver the five years, pre-registration nursing students report clinical skill improvement and enhanced knowledge following the immersive mental health placement alongside an increased desire for further skill development. Learning from people’s lived experience of mental illness and specialised facilitators was valuable for student learning outcomes. Increased support is needed for student mental health vulnerabilities and wellbeing ahead of clinical placements. Further research is recommended on the aspects of non-traditional clinical placements that may be protective for student learning.

Learning and achieving basic mental health competence in placement studies with the support of a tool: A qualitative study of student nurses’ experiences

BackgroundLearning basic mental health care competence is often challenging for the bachelor of science student nurses, and many lack basic mental health care competence to ensure safe and confident mental health care practice. Mental health assessment is an integrated part of this competence. ObjectiveThe objective of this study was to explore and describe in depth how student nurses experience learning and achieving basic mental health competence while on mental health placement with the support of a learning tool. DesignAn explorative and descriptive qualitative design was conducted to gain insight on how student nurses experienced learning basic mental health competence when on placement. SettingA diversity of mental health placement settings in which student nurses were involved with patient care or welfare were approached; general psychiatric wards (n = 2), psychiatric ward for elderly people (n = 1), community mental health in-patient facilities (n = 2) and unconventional placements in the community (n = 9). Unconventional placements are a diversity of non-clinical service contexts. ParticipantsThe participants comprised student nurses in their 3rd and final year while on mental health placement. Potential participants received information from course coordinators, the online learning platform, and from teachers in plenary. Using purposive sampling, 14 student nurses were recruited. MethodsIndividual semi-structured interviews were conducted online and in person at two campuses of one university in Norway between August 2020 and December 2021. The interviews were transcribed and thematically analysed as described by Braun and Clarke. ResultsStudents expressed insecurity in a new clinical context. They engaged in new learning situations and realized the diversity of nursing practice. Unconventional placements were described as challenging contexts for learning basic mental health care competence. ConclusionsThis qualitative study provided insight into how student nurses experience learning mental health assessment, and gaining relational, communicative, and ethical competence while on placement. Students revealed their insecurities and challenges in learning in a new context. Awareness of clinical learning opportunities on placement when preparing student nurses to learn basic mental health competence may help improve their confidence.

Hybrid Approach-Based Placement of Micro-Phasor Measurement Units in Active Distribution Networks

The placement of monitoring devices like micro-Phasor Measurement Unit (μPMU), which works 24 hours, at all nodes in the distribution system, is contributing to temperature rise. This temperature rise can be reduced by placing the μPMUs at selected nodes. Therefore, this paper depicted a hybrid approach for μPMUs optimal placement in the distribution system. Optimal placement recognises the placement set containing the least number of μPMUs with optimum redundancy with which the phasors of voltage, as well as the current, can be calculated at each bus of the system. Constraints such as communication link unavailability, zero injection buses, and network reconfiguration are considered in the optimal μPMU placement formulation. The proposed approach overcomes the downside of Integer Linear Programming (ILP) which provides a single optimal location set. The proposed approach automatically assigned μPMUs to buses connected to radial buses, established by the degree of each bus, and reduces the computational concern. Provided algorithm efficiency is checked out with IEEE 40 bus feeder and IEEE 85 bus feeder system under Matlab/Simulink environment.

Is it time to consider a “time-out” before primary prevention implantable cardioverter-defibrillator placement in currently or recently hospitalized older patients with heart failure?

BackgroundTrajectories of mortality after primary prevention implantable cardioverter-defibrillator (ICD) placement for older patients with heart failure during or soon after acute hospitalization have not been assessed. ObjectiveThe purpose of this study was to compare trajectories of mortality after primary prevention ICD placement during or soon after acute cardiac or non-cardiac hospitalization. MethodsWe identified older patients with heart failure undergoing primary prevention ICD placement using 20% Medicare data (2008–2018). Placement settings were as follows: (1) Current-H—during current hospitalization, (2) Recent-H—within 90 days of hospitalization, or (3) Chronic stable. Hospitalization was categorized as cardiac vs non-cardiac. Interval mortality rates and hazard ratios (HRs) using Cox regression were estimated at 0–30, 31–90, and 91–365 days after ICD placement. ResultsOf the 61,710 patients (mean age 76 years; 35% female; 85% white), 19% (11,947), 25% (15,147), and 56% (34,616) had ICDs in Current-H, Recent-H, and Chronic stable settings. Mortality rates (per 100 person-years) were highest during 0–30 days, with 38 (34–42) and 22 (19–24) for Current-H and Recent-H, which declined to 21 (20–22) and 16 (15–17) during 91–365 days, respectively. Compared to Chronic stable, HRs were highest during 0–30 days post–ICD placement (5.5 [4.5–6.8] for Current-H and 3.4 [2.8–4.2] for Recent-H) and decreased during 91–365 days (2.0 [1.8–2.1] for Current-H and 1.6 [1.5–1.7] for Recent-H). HR pattens were similar for cardiac and non-cardiac hospitalizations. ConclusionPrimary prevention ICD placement during or soon after hospitalization for any reason was associated with worse mortality with diminishing risks after 90 days. Hospitalization likely identifies a sicker population in whom early mortality with or without ICD may be higher. Our results support careful consideration regarding ICD placement during the 90 days after hospitalization.

Model based data-driven optimisation of automated fibre placement set up

The composites manufacturing industry relies heavily on manual hand layup, unsuitable for increasing demands. Automated Fiber Placement (AFP) offers a solution, but setup complexity and extensive trials inflate costs. Digital tools promise to expedite development, but CPU-intensive simulations limit large-scale parameter optimisation. This paper introduces Gaussian Process (GP) models for understanding AFP parameters’ relationship with nip-point temperature. The GP emulator streamlines optimisation, offering accurate power curves with minimal simulations. An efficient method to enhance emulator performance through sequential design is also proposed, providing a cost-effective decision tool for AFP optimisation.

The influence of educational reform on the self-perceived readiness to practice of newly registered pharmacists in Ireland

Abstract Introduction Newly registered pharmacists serve important roles in our healthcare system. Investigation of their readiness to practice confirms whether their education has furnished them with the knowledge, skills and competencies to be practice-ready. In 2015, a five-year integrated master’s programme in Pharmacy replaced a 4 + 1 model and included integrated learning with dispersed experiential learning placements. Factors known to influence self-perceived readiness to practice are prior experiential learning, education, placement environment and preceptor relationship. Aim This study examined the self-perceived readiness to practice of newly registered pharmacists in their first year of qualification and the influence of educational reform. Methods The participants were newly registered pharmacists who had completed the undergraduate Pharmacy programme within the State. Participants were identified using the Pharmaceutical Society of Ireland’s database of newly qualified registrants. An email was circulated to registrants inviting them to participate in a cross-sectional online survey consisting of 25 items. Variables were self-perceived abilities to perform practice-related competencies (on a five-point Likert scale), relationship with preceptor, placement experience, and demographic information. Three cohorts were surveyed. The first cohort (2020) were graduates from the last year of the 4 + 1 programme. The second (2021) and third (2022) cohorts were graduates from the new five-year integrated programme. All analyses were performed using SPSS 24.0 (SPSS Inc, Chicago, IL, USA) and Microsoft Excel. Results Of 458 registrants, 71 completed the survey (response rate=15%). A greater proportion of females (65%, n=46) than males (31%, n=22) responded to this survey, with 4% (n=3) not disclosing a gender. Most respondents (83%, n=59) had undertaken a community pharmacy placement, while others had either a hospital placement (11%, n=8) or a mixed setting placement (5%, n=4). Participants perceived that they were adept at performing practice-related competencies. Participants agreed that they developed fruitful relationships with preceptors and had positive experiences on placement; when asked about preceptor feedback, there was a positive response: 55% for (n=17), 83% for 2021 (n=15), and 95% for 2022 (n=21). A curriculum effect was observed, as graduates from the post-reform cohort declared readiness to practice in more areas than pre-reform graduates, e.g. in leadership: (58% for 2020 [n=18], 61% for 2021 [n=11], and 73% for 2022 [n=16]), communication (58% for 2020 [n=27], 61% for 2021 [n=16], and 73% for 2022 [n=21]), and recommending drug therapies (77% for 2020 [n=24], 72% for 2021 [n=13], and 95% for 2022 [n=21]). Conclusion This study found that most respondents self-perceived themselves as ready for autonomous practice. Whilst this study found that the pharmacists surveyed were ready to practice, they may still lack practical skills. This study suggests adopting an integrated curriculum that incorporates experiential learning is supportive of readiness to practice and has a positive impact on self-perceived readiness to practice, placement setting, and preceptor relationships. The repeated cross-sectional nature of the study is a strength, but a limitation is the low response rate and there may be response bias by participants. This research seeks to contribute to curriculum development to support students in their transition to professional practice.

The concept of optimal planning of a linearly oriented segment of the 5G network.

In the article, the extreme problem of finding the optimal placement plan of 5G base stations at certain points within a linear area of finite length is set. A fundamental feature of the author's formulation of the extreme problem is that it takes into account not only the points of potential placement of base stations but also the possibility of selecting instances of stations to be placed at a specific point from a defined excess set, as well as the aspect of inseparable interaction of placed 5G base stations within the framework of SON. The formulation of this extreme problem is brought to the form of a specific combinatorial model. The article proposes an adapted branch-and-bounds method, which allows the process of synthesis of the architecture of a linearly oriented segment of a 5G network to select the best options for the placement of base stations for further evaluation of the received placement plans in the metric of defined performance indicators. As the final stage of the synthesis of the optimal plan of a linearly oriented wireless network segment based on the sequence of the best placements, it is proposed to expand the parametric space of the design task due to the specific technical parameters characteristic of the 5G platform. The article presents a numerical example of solving an instance of the corresponding extremal problem. It is shown that the presented mathematical apparatus allows for the formation of a set of optimal placements taking into account the size of the non-coverage of the target area. To calculate this characteristic parameter, both exact and two approximate approaches are formalized. The results of the experiment showed that for high-dimensional problems, the approximate approach allows for reducing the computational complexity of implementing the adapted branch-and-bounds method by more than six times, with a slight loss of accuracy of the optimal solution. The structure of the article includes Section 1 (introduction and state-of-the-art), Section 2 (statement of the research, proposed models and methods devoted to the research topic), Section 3 (numerical experiment and analysis of results), and Section 4 (conclusions and further research).

Aerosol Delivery to Simulated Spontaneously Breathing Tracheostomized Adult Model With and Without Humidification.

Optimal aerosol delivery methods for spontaneously breathing patients with a tracheostomy remain unclear. Thus, we aimed to assess the impact of nebulizer placement, flow settings, and interfaces on aerosol delivery by using a vibrating mesh nebulizer and a jet nebulizer in line with unheated humidification. An 8.0-mm tracheostomy tube was connected to the lung model that simulates adult breathing parameters via a collecting filter. Albuterol sulfate (2.5 mg/3 mL) was administered via a vibrating mesh nebulizer and a jet nebulizer, which was placed in line with unheated humidification provided by a large-volume nebulizer, with FIO2 set at 0.28, with gas flows of 2 L/min versus 6 L/min. Nebulizers were placed in line distal and proximal to the lung model by using a tracheostomy collar and a T-piece. Conventional nebulization was tested using a vibrating mesh nebulizer and a jet nebulizer directly connected to the tracheostomy tube bypassing the humidification device. The drug was eluted from the collecting filter and assayed with ultraviolet spectrophotometry (276 nm). During in-line nebulizer placement with unheated humidification, the inhaled dose was 2-4 times higher with a gas flow of 2 L/min than 6 L/min, regardless of nebulizer type, placement, or interface (all P < .05). At 6 L/min, the inhaled dose was higher with proximal than distal placement when using both interfaces, but, at 2 L/min, the inhaled dose was lower with proximal placement. With a jet nebulizer, the tracheostomy collar generated a higher inhaled dose at proximal placement compared with the T-piece, whereas the T-piece resulted in a higher inhaled dose than the tracheostomy collar with distal placement, regardless of the flow settings. Compared with conventional nebulization using a vibrating mesh nebulizer, an in-line vibrating mesh nebulizer with a large-volume nebulizer at 2 L/min had a similar inhaled dose, regardless of nebulizer placement and interface. In contrast, the in-line jet nebulizer was influenced by both placement and interface. Aerosol delivery with an in-line vibrating mesh nebulizer and jet nebulizer with unheated humidification was affected by nebulizer placement, interface, and gas flow settings.

Discrimination in Multiphase Systems: Evidence from Child Protection

Abstract We develop empirical tools for studying discrimination in multiphase systems and apply them to the setting of foster care placement by child protective services. Leveraging the quasi-random assignment of two sets of decision-makers—initial hotline call screeners and subsequent investigators—we study how unwarranted racial disparities arise and propagate through this system. Using a sample of over 200,000 maltreatment allegations, we find that calls involving Black children are 55% more likely to result in foster care placement than calls involving white children with the same potential for future maltreatment in the home. Call screeners account for up to 19% of this unwarranted disparity, with the remainder due to investigators. Unwarranted disparity is concentrated in cases with potential for future maltreatment, suggesting that white children may be harmed by “underplacement” in high-risk situations.

Mapping interaction quality for nursing and medical students in primary care placement in municipal emergency care units: a systematic observational study.

Primary care placement for nursing and medical students is vital for developing the competence to accommodate the increasing number of patients with multimorbid and complex conditions. Prior studies have suggested that interaction quality in primary care placement empowers learning. However, research mapping interaction quality in primary care placements in municipal emergency care units is lacking. This study aimed to systematically map interaction quality for nursing and medical students in primary care placement in two municipal emergency care units. This study adopted a systematic descriptive observational design. Systematic observations (n = 201 cycles) of eight nursing students (n = 103 cycles) and six medical students (n = 98 cycles) were used to map interaction quality across six learning situations between March and May 2019. Observations were coded using the Classroom Assessment Scoring System-Secondary (CLASS-S). Data were analyzed using descriptive statistics and Spearman correlations. Interaction quality is described in three domains: (I) emotional support, (II) framework for learning, and (III) instructional support, and the overall measure, student engagement. The results indicated middle-quality interactions in the emotional and instructional support domains and high quality in the framework for learning domain and student engagement. Correlations exhibited similar patterns and ranged from non-significant to strong correlations. The interaction qualities indicated a generally positive and supportive learning environment contributing to nursing and medical students' learning and active participation in work tasks related to their professional roles. Thus, this new form for primary care placement for nursing and medical students in the municipal emergency care units was found to be a positive learning arena. These results may enhance nursing and medical education programs in countries with similar health services and education. Health education, supervisors, peers, and others contributing to students' learning should recognize which interaction qualities may affect learning and how to improve quality, thus affecting supervisors' approach to training students. While the CLASS-S showed potential for mapping interaction qualities for nursing and medical students in primary care placement in municipal emergency care units, further studies are needed to validate the CLASS-S for use in clinical placement settings.