Background: Informal coercion, that is, situations where caregivers use subtle coercive measures to impose their will on patients, is common in adult psychiatric inpatient care. It has been described as ‘a necessary evil’, confronting nurses with an ethical dilemma where they need to balance between a wish to do good, and the risk of violating patients’ dignity and autonomy. Aim: To describe nurses’ experiences of being involved in informal coercion in adult psychiatric inpatient care. Research design: The study has a qualitative, inductive design. Participants and research context: Semi-structured interviews with 10 Swedish psychiatric nurses were analysed with qualitative content analysis. Ethical considerations: The study was performed in accordance with the Declaration of Helsinki. In line with the Swedish Ethical Review Act, it was also subject to ethical procedures at the university. Findings: Four domains comprise informal coercion as a process over time. These domains contain 11 categories focusing on different experiences involved in the process: Striving to connect, involving others, adjusting to the caring culture, dealing with laws, justifying coercion, waiting for the patient, persuading the patient, negotiating with the patient, using professional power, scrutinizing one’s actions and learning together. Discussion: Informal coercion is associated with moral stress as nurses might find themselves torn between a wish to do good for the patient, general practices and ‘house rules’ in the caring culture. In addition, nurses need to be aware of the asymmetry of the caring relationship, in order to avoid compliance becoming a consequence of patients subordinating to nurse power, rather than a result of mutual understanding. Reflections are thus necessary through the process to promote mutual learning and to avoid violations of patients’ dignity and autonomy. Conclusion: If there is a need for coercion, that is, if the coercion is found to be an ‘unpleasant good’, rather than ‘necessary evil’ considering the consequences for the patient, it should be subject to reflecting and learning together with the patient.

The present paper describes new experimental data of thermal mixing in a T-junction compared with results from Large-Eddy Simulations (LES) and Detached Eddy Simulations (DES). The experimental setup was designed in order to provide data suitable for validation of CFD-calculations. The data is obtained from temperature measurements with thermocouples located near the pipe wall, velocity measurements with Laser Doppler Velocimetry (LDV) as well as single-point concentration measurements with Laser Induced Fluorescence (LIF). The LES showed good agreement with the experimental data also when fairly coarse computational meshes were used. However, grid refinement studies revealed a fairly strong sensitivity to the grid resolution, and a simulation using a fine mesh with nearly 10 million cells significantly improved the results in the entire flow domain. The sensitivity to different unsteady inlet boundary conditions was however small, which shows that the strong large-scale instabilities that are present in the mixing region are triggered independent of the applied inlet perturbations. A shortcoming in the performed simulations is insufficient near-wall resolution, which resulted in poor predictions of the near-wall mean velocity profiles and the wall-shear stress. Simulations using DES improved the near-wall velocity predictions, but failed to predict the temperature fluctuations due to high levels of modeled turbulent viscosity that restrained the formation of small scale turbulence.

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Experimental exploration of equipment for stereotactic functional neurosurgery based on heating induced by radio-frequency current is most often carried out prior to surgery in order to secure a correct function of the equipment. The experiments are normally conducted in an experimental model including an albumin solution in which the treatment electrode is submerged, followed by a heating session during which a protein clot is generated around the electrode tip. The clot is believed to reflect the lesion generated in the brain during treatment. It is thereby presupposed that both the thermal and electric properties of the model are similar to brain tissue. This study investigates the presence of convective movements in the albumin solution using laser Doppler velocimetry. The result clearly shows that convective movements that depend on the time dependent heating characteristics of the equipment arise in the solution upon heating. The convective movements detected show a clear discrepancy compared with the in vivo situation that the experimental model tries to mimic; both the velocity (maximum velocity of about 5 mms) and mass flux are greater in this experimental setting. Furthermore the flow geometry is completely different since only a small fraction of the tissue surrounding the electrode in vivo consists of moving blood, whereas the entire surrounding given by the albumin solution in the experimental model is moving. Earlier investigations by our group (Eriksson et al., 1999, Med. Biol. Eng. Comput. 37, pp. 737-741; Wren, 2001, Ph.D. thesis; and Wren et al., 2001, Med. Biol. Eng. Comput. 39, pp. 255-262) indicate that the heat flux is an essential parameter for the lesion growth and final size, and that presence of convective movements in the model might substantially increase the heat flux. Thus, convective movements of the magnitude presented here will very likely underestimate the size of the brain lesion, a finding that definitely should be taken into consideration when using the model prior to patient treatment.