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Introduction: In the emergency department (ED), high-acuity presentations encountered at low frequencies are associated with reduced staff comfort. Previous studies have shown that simulation can improve provider confidence with practical skills and management of presentations in various fields of medicine. The present study examined the effect of in situ simulation on interprofessional provider comfort with the identification and management of high-acuity low-frequency events in the ED. It further assessed the feasibility of implementing weekly simulation as an interprofessional education initiative in a high-volume ED. Methods: This was a retrospective pre-test post-test quasi-experimental design. Weekly in situ simulation events were facilitated by an interdisciplinary team in a high-volume ED in Hamilton, Ontario that sees an average of 185 patients per day. To date, 34 simulation events were held between January 18, 2019 and November 22, 2019, and included neonatal, paediatric and obstetric emergencies, and adult codes. There was an average of 20 patients presenting to the ED during these events. Events included a debrief, and typically lasted 60 minutes in total. Participants included individuals from various disciplines working on shift at the time of the event. Questionnaires were administered via email following the event, in which participants were asked to rank their comfort with emergency codes before and after the simulation using two 5-point Likert scales. The data from 39 questionnaires was analyzed. T-tests were used to analyze differences in self-reported comfort scores. Results: Questionnaire responders included nurses (41%), respiratory therapists (26%), resident physicians (10%), paramedics (3%), attending physicians (3%), students of various disciplines (10%) and other (7%). 38% of participants reported increases in comfort following simulation when compared to prior. Using the 5-point scale, the average reported score for comfort pre-simulation was 3.59 (95% CI 3.30–3.88), and the average post-simulation score was 3.97 (95% CI 3.76–4.19, p = 0.03). Conclusion: Our results demonstrate that weekly interprofessional in situ simulation is feasible in a high-volume ED, and significantly improves self-reported provider comfort with the identification and management of high-acuity, low-frequency events. This warrants the implementation of this simulation design to improve staff confidence and has implications for its potential role in improving team dynamics and patient safety.
Despite spending more on health care than every other industrialized country, the U.S. ranks 37th in health outcomes. These differences cannot be explained away with differences in age and income, or even with quality of care. And, the rate of growth in health care spending in the U.S. continues to increase. The share of the Gross Domestic Product (GDP) attributable to health care grew from 9% in 1980 to more than 17% in 2011. Health care costs are projected to account for more than one-fifth of our economy by 2021. Despite spending more and more, the U.S. does not have better health outcomes than other countries. Worse, our increasing spending is largely attributable to preventable conditions. More than 85 cents of every dollar spent on health in the U.S. are spent on the treatment and management of chronic diseases, such as those caused by preventable conditions related to obesity and tobacco use.
A survey for leprosy among 565 armadillos from Louisiana and Texas found IgM antibodies to the phenolic glycolipid-l antigen of Mycobacterium leprae in 16% of the animals. There were no geographic trends in the distribution of prevalence rates between the sites and the disease probably has a much greater range. Repeat observations in one location showed significant seasonal variations in the observable antibody prevalence rate, but the yearly average remained similar. Infected armadillos tended to be heavier, and the females usually had plasma progesterone concentrations indicative of sexual maturity. Using these characteristics to stratify the populations into adult and sub-adult cohorts, variations in the observable leprosy prevalence rate were seen to be proportional to changes in the age structure of the populations. Leprosy appears to be maintained in steady state within some regions, and nearly a third of the adult armadillos in Louisiana and Texas harbour M. leprae.
Klebsiella aerogenes V9A carrying a lac plasmid in addition to its chromosomal operon showed strongly positive fermentation of lactose on MacConkey lactose agar plates, and was found to transport the lactose analogue thiomethyl-β-galactoside (TMG) at a rapid rate. The strain that had been freed of the plasmid showed moderate transport due to the chromosomal lac operon. When a plasmid bearing a mutation in lac Y was inserted into a strain with a normal Y gene, the resulting diploid became lactose-negative in phenotype. The presence of E. coli F′lac factors that carried lac Y mutations, whether deletions or missense or nonsense mutations, also rendered lac Y+Klebsiella lactose-negative. Such diploids, after growth in 1% lactose, transported TMG at a much lower rate than the corresponding plasmid-free lac Y+Klebsiella. However, this interference by lac Y− plasmids with the expression of the chromosomal lac Y gene was not seen when cells were induced with IPTG or when the chromosomal and plasmid lac operons were both constitutive. It was found that this effect of the plasmids was dependent on their possessing an intact lacZ gene.
Theoretical quantification of viscous effects in fluid flows is difficult, even if turbulence is absent, except when it is legitimate to simplify the Navier-Stokes equations in some way; for example by invoking the boundary-layer approximation in appropriate cases of interacting viscous and inviscid flow. The technical importance of viscous effects was thought sufficient incentive to re-examine a very simple flow configuration — namely plane, uniform and steady flow of an incompressible, viscous fluid toward a vanishingly-thin flat plate aligned with the undisturbed stream — in search of fresh insights into the general theory for viscous-inviscid interactions.
The strategy was to exploit the analogy between vorticity transport in a viscous fluid and heat conduction in a moving solid. The key to doing so was the realization that, if the perturbation of the undisturbed flow by the plate might be represented as the sum of a series of successive approximations, then the stream function of the viscous part of the flow field — not merely the vorticity which resulted from its existence — might be expressible at every stage as the solution of an analogous heat conduction problem.
This article reports on the planning, development, and implementation of a large national Internet-based panel study of how Americans are coping with the terrorist attacks of September 11, 2001. The study was designed to determine predictors and correlates of risk and resilience, both cross-sectionally and longitudinally. In order to acquire timely and meaningful data, we developed/adapted an extensive set of measures, obtained human subjects approval, and posted a research Web site just 17 days after the attacks. This article describes the major hurdles we confronted and the guidelines we recommend regarding these topics, including the methodological trade-offs inherent in Internet-based research, information technology requirements and tribulations, human subjects issues, selection of measures and securing permission for their use, and the challenges of participant recruitment. We also discuss issues that we did not anticipate, including the survey intervention. We focus not on findings, but on the concrete procedural, administrative, technical, and scientific challenges we encountered and the solutions we devised under considerable time and resource pressures.
A recent paper of Ockendon et al. discusses the Fanno model for quasi-one-dimensional flow of gas in a tube, in situations where the flow is turbulent and the tube is long enough for wall drag to be important. Based on appropriate scalings and with associated boundary conditions they derive equations for similarity solutions and make predictions about travelling and evolving waves. In this paper the existence, uniqueness and asymptotic behaviour of these wave forms is proved rigorously. Techniques include shooting methods (both one- and two-parameter), appropriate changes of variables, and comparison techniques.
Demographers predict that world population will double to around twelve billion people during the first half of the twenty-first century and then begin to level off. Based on this scenario, Sustainable Development: The Challenge of Transition examines what societal changes must occur over the next generation to ensure a successful transition to sustainability within the constraints of the natural environment. An array of prominent authors present a broad discussion of the dimensions of sustainable development: not just economic and environmental, but also spiritual and religious, corporate and social, scientific and political. Unlike other books on the subject, this volume provides insightful policy recommendations about how business, government, and individuals must change their values, priorities, and behaviour to meet these challenges. This volume will appeal to scholars and decision makers interested in global change, environmental policy, population growth, and sustainable development, and also to corporate environmental managers.
The meanings of abstract concepts depend on context. Perceptual
symbol systems (PSS) provide a powerful framework for representing such
context. Whereas a few expected difficulties for simulations are
consistent with empirical findings, the theory does not clearly predict
simulations of specific abstract concepts in a testable way and does not
appear to distinguish abstract noun concepts (like truth) from
their stem concepts (such as true).
Positron emission tomography (PET) scanning has recently been introduced into clinical practice but its usefulness in the management of head and neck cancer is not well defined. The aim of this prospective preliminary study was to examine the clinical value of fluorodeoxyglucose (FDG) – PET in patients with head and neck cancer treated by radiotherapy with surgery in reserve by (i) relating quantitative uptake of isotope to tumour type and histological grade and (ii) comparing the imaging findings of PET and magnetic resonance imaging (MRI) in post-radiotherapy assessment of tumour response. Twenty-one patients had pre-treatment PET and MRI scans and these were repeated four and eight months after treatment if there was no clinical relapse. Pre-treatment uptake of FDG using tumour to cerebellar ratio parameters was significantly related to the histological grade of squamous cancer (p = 0.04) but not to tumour type. Discordance of post-treatment PET/MRI findings in one case indicates a possible role for PET in the early detection of tumour recurrence. Other potential uses of PET scanning in the management of head and neck cancer are discussed.
The development of micro- and nanofabrication, their applications, and their dependent industries has progressed to a point where a bifurcation of technology development will likely occur. On the one hand, the semiconductor industry (at least in the USA) has decided to develop EUV and SCALPEL to meet its future needs. Even if the semiconductor industry is successful in this (which is by no means certain) such tools will not be useful in most other segments of industry and research that will employ nanolithography. As examples, MEMS, integrated optics, biological research, magnetic information storage, quantum-effect research, and multiple applications not yet envisioned will not employ the lithography tools of the semiconductor industry, either because they are too expensive, insufficiently flexible, or lacking in accuracy and spatial-phase coherence. Of course, direct-write electron-beam lithography can meet many of these non-semiconductor-industry needs, but in other cases a technique of higher throughput or broader process-latitude is necessary. Our experience at MIT in applying low-cost proximity x-ray nanolithography to a wide variety of applications leads us to conclude that this technology can provide an alternative path of a bifurcation. A new projection lithography technique, zone-plate-array lithography (ZPAL), does not require a mask, can operate from UV to EUV to x-rays, and has the potential to reach the limits of the lithographic process.