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Introduction: Identification of latent safety threats (LSTs) in the emergency department is an important aspect of quality improvement that can lead to improved patient care. In situ simulation (ISS) takes place in the real clinical environment and multidisciplinary teams can participate in diverse high acuity scenarios to identify LSTs. The purpose of this study is to examine the influence that the profession of the participant (i.e. physician, registered nurse, or respiratory therapist) has on the identification of LSTs during ISS. Methods: Six resuscitation- based adult and pediatric simulated scenarios were developed and delivered to multidisciplinary teams in the Kingston General Hospital ED. Each ISS session consisted of a 10- minute scenario, followed by 3-minutes of individual survey completion and a 7- minute group debrief led by ISS facilitators. An objective assessor recorded LSTs identified during each debrief. Surveys were completed prior to debrief to reduce response bias. Data was collected on participant demographics and perceived LSTs classified in the following categories: medication; equipment; resources and staffing; teamwork and communication; or other. Two reviewers evaluated survey responses and debrief notes to formulate a list of unique LSTs across scenarios and professions. The overall number and type of LSTs from surveys was identified and stratified by health care provider. Results: Thirteen ISS sessions were conducted with a total of 59 participants. Thirty- four unique LSTs (8 medication, 15 equipment, 5 resource, 4 communication, and 2 miscellaneous issues) were identified from surveys and debrief notes. Overall, MDs (n = 12) reported 19 LSTss (n = 41) reported 77 LSTs, and RTs (n = 6) reported 4 LSTs based on individual survey data. The most commonly identified category of LSTs reported by MDs (36.8%) and RTs (75%) was equipment issues while RNs most commonly identified medication issues (36.4%). Participants with □5 years of experience in their profession, on average identified more LSTs in surveys than participants with >5 years experience (1.9 LSTs vs 1.5 LSTs respectively). Conclusion: Nursing staff identified the highest number of LSTs across all categories. There was fairly unanimous identification of major LSTs across professions, however each profession did identify unique perspectives on LSTs in survey responses. ISS programs with the purpose of LST identification would benefit from multidisciplinary participation.
We have analyzed FUSE, COS, GHRS, and Keck/HIRES spectra of the UV-bright star Barnard 29 in M13. Fits to the star’s optical spectrum yield Teff = 20,000 ± 100 K and log g = 3.00 ± 0.01. Using modern stellar-atmosphere models, we are able to reproduce the complex shape of the Balmer H.. feature. We derive photospheric abundances of He, C, N, O, Mg, Al, Si, P, S, Cl, Ar, Ti, Cr, Fe, Ni, and Ge. Barnard 29 exhibits an abundance pattern typical of the first-generation stars in M13, enhanced in oxygen and depleted in aluminum. We see no evidence of significant chemical evolution since the star left the RGB; in particular, it did not undergo third dredge-up. Previous workers found that the star’s FUV spectra yield an iron abundance about 0.5 dex lower than its optical spectrum, but the iron abundances derived from all of our spectra are consistent with one another and with the cluster value. We attribute this difference to our use of model atmospheres without microturbulence. By comparing our best-fit model with the star’s optical magnitudes, we derive a mass M*/M=0.40 − 0.49 and luminosity log L*/L⊙=3.20 − 3.29, depending on the cluster distance. Comparison with stellar-evolution models suggests that Barnard 29 evolved from a ZAHB star of mass M*/M⊙∼0.50, placing it near the boundary between the extreme and blue horizontal branches.
Metal–insulator–metal (MIM) resonant absorbers comprise a conducting ground plane, a thin dielectric, and thin separated metal top-surface structures. The dielectric SiO2 strongly absorbs near 9 µm wavelength and has correspondingly strong long-wave-infrared (LWIR) dispersion for the refractive index. This dispersion results in multiple absorption resonances spanning the LWIR, which can enhance broad-band sensitivity for LWIR bolometers. Similar considerations apply to silicon nitride Si3N4. TiO2 and AlN have comparatively low dispersion and give simple single LWIR resonances. These dispersion-dependent features for infrared MIM devices are demonstrated by experiment, electrodynamic simulation, and an analytic model based on standing waves.
To identify predominant dietary patterns in four African populations and examine their association with obesity.
We used data from the Africa/Harvard School of Public Health Partnership for Cohort Research and Training (PaCT) pilot study established to investigate the feasibility of a multi-country longitudinal study of non-communicable chronic disease in sub-Saharan Africa. We applied principal component analysis to dietary intake data collected from an FFQ developed for PaCT to ascertain dietary patterns in Tanzania, South Africa, and peri-urban and rural Uganda. The sample consisted of 444 women and 294 men.
We identified two dietary patterns: the Mixed Diet pattern characterized by high intakes of unprocessed foods such as vegetables and fresh fish, but also cold cuts and refined grains; and the Processed Diet pattern characterized by high intakes of salad dressing, cold cuts and sweets. Women in the highest tertile of the Processed Diet pattern score were 3·00 times more likely to be overweight (95 % CI 1·66, 5·45; prevalence=74 %) and 4·24 times more likely to be obese (95 % CI 2·23, 8·05; prevalence=44 %) than women in this pattern’s lowest tertile (both P<0·0001; prevalence=47 and 14 %, respectively). We found similarly strong associations in men. There was no association between the Mixed Diet pattern and overweight or obesity.
We identified two major dietary patterns in several African populations, a Mixed Diet pattern and a Processed Diet pattern. The Processed Diet pattern was associated with obesity.
We present observational results of the submillimeter H2O and SiO lines toward a candidate high-mass young stellar object Orion Source I using ALMA. The spatial structures of the high excitation lines at lower-state energies of >2500 K show compact structures consistent with the circumstellar disk and/or base of the northeast-southwest bipolar outflow with a 100 au scale. The highest excitation transition, the SiO (v=4) line at band 8, has the most compact structure. In contrast, lower-excitation transitions are more extended than 200 au tracing the outflow. Almost all the line show velocity gradients perpendicular to the outflow axis suggesting rotation motions of the circumstellar disk and outflow. While some of the detected lines show broad line profiles and spatially extended emission components indicative of thermal excitation, the strong H2O lines at 321 GHz, 474 GHz, and 658 GHz with brightness temperatures of >1000 K show clear signatures of maser action.
Observations of the masers in the course of RadioAstron mission yielded detections of fringes for a number of sources in both water and hydroxyl maser transitions. Several sources display numerous ultra-compact details. This proves that implementation of the space VLBI technique for maser studies is possible technically and is not always prevented by the interstellar scattering, maser beaming and other effects related to formation, transfer, and detection of the cosmic maser emission. For the first time, cosmic water maser emission was detected with projected baselines exceeding Earth Diameter. It was detected in a number of star-forming regions in the Galaxy and two megamaser galaxies NGC 4258 and NGC 3079. RadioAstron observations provided the absolute record of the angular resolution in astronomy. Fringes from the NGC 4258 megamaser were detected on baseline exceeding 25 Earth Diameters. This means that the angular resolution sufficient to measure the parallax of the water maser source in the nearby galaxy LMC was directly achieved in the cosmic maser observations. Very compact features with angular sizes about 20\muas\, have been detected in star-forming regions of our Galaxy. Corresponding linear sizes are about 5-10 million kilometers. So, the major step from milli- to micro-arcsecond resolution in maser studies is achieved by the RadioAstron mission. The existence of the features with extremely small angular sizes is established. Further implementations of the space–VLBI maser instrument for studies of the nature of cosmic objects, studies of the interaction of extremely high radiation field with molecular material and studies of the matter on the line of sight are planned.
We initiated a long-term and highly frequent monitoring project toward 442 methanol masers at 6.7 GHz (Dec >−30 deg) using the Hitachi 32-m radio telescope in December 2012. The observations have been carried out daily, monitoring a spectrum of each source with intervals of 9–10 days. In September 2015, the number of the target sources and intervals were redesigned into 143 and 4–5 days, respectively. This monitoring provides us complete information on how many sources show periodic flux variations in high-mass star-forming regions, which have been detected in 20 sources with periods of 29.5–668 days so far (e.g., Goedhart et al. 2004). We have already obtained new detections of periodic flux variations in 31 methanol sources with periods of 22–409 days. These periodic flux variations must be a unique tool to investigate high-mass protostars themselves and their circumstellar structure on a very tiny spatial scale of 0.1–1 au.
The interferometric and single-dish observations of the Extended Green Objects sample have been carried out in order to check the possible common pumping mechanism of class I methanol maser (cIMM) and OH(1720 MHz) maser and their identification with a front of bipolar outflow as a source of interstellar shock stimulating collisional pumping of the molecules. High spatial and spectral resolution observations of OH masers allow us to investigate structure, kinematics, and magnetic field configuration of the inner region of the source, i.e., the outflow ejection region. Analysis of magnetic field strength in a disk area is crucial to understanding of the outflow origin.
W49 A is a star-forming region (SFR) found in the constellation of Aquila. It contains 3 active regions: W49 North (W49 N), W49 South West (W49 SW) and W49 South (W49 S). We present preliminary results from two epochs (e-)MERLIN observations of all ground-state OH masers towards the star-forming region (SFR) complex W49 A. The first epoch of observations was done in full-polarization mode with MERLIN in 2005 while the second epoch was obtained only in dual circular polarization during the test observations of the upgraded e-MERLIN in 2013. The overall maser spatial distributions in both epochs are in good agreement. We found several new high velocity maser features up to +34 km s−1 and −28 km s−1. The magnetic field strengths are between 1.1 to 10.8 mG. All three sources show evidence of magnetic field reversal.
We present estimates of brightness temperature for 5 galactic masers in star-forming regions detected at space baselines. Very compact features with angular sizes of ~23-60 μas were detected in these regions with corresponding linear sizes of ~4-10×106 km. Brightness temperatures range from 1014 up to 1016 K.
The surface waters of the Southern Ocean play a key role in the global climate and carbon cycles by promoting growth of some of the world’s largest phytoplankton blooms. Several studies have emphasized the importance of glacial and sediment inputs of Fe that fuel the primary production of the Fe-limited Southern Ocean. Although the fertile surface waters along the shelf of the western Antarctic Peninsula (WAP) are influenced by large inputs of freshwater, this freshwater may take multiple pathways (e.g. calving, streams, groundwater discharge) with different degrees of water-rock interactions leading to variable Fe flux to coastal waters. During the summers of 2012–13 and 2013–14, seawater samples were collected along the WAP, near Anvers Island, to observe water column dynamics in nearshore and offshore waters. Tracers (223,224Ra, 222Rn, 18O, 2H) were used to evaluate the source and transport of water and nutrients in coastal fjords and across the shelf. Coastal waters are compared across two field seasons, with increased freshwater observed during 2014. Horizontal mixing rates of water masses along the WAP ranged from 110–3600 m2 s-1. These mixing rates suggest a rapid transport mechanism for moving meltwater offshore.
Fetal alcohol spectrum disorder (FASD) is increasingly recognized as a growing public health issue worldwide. Although more research is needed on both the diagnosis and treatment of FASD, and a broader and more culturally diverse range of services are needed to support those who suffer from FASD and their families, both research and practice for FASD raise significant ethical issues. In response, from the point of view of both research and clinical neuroethics, we provide a framework that emphasizes the need to maximize benefits and minimize harm, promote justice, and foster respect for persons within a global context.
A number of sophisticated modelling approaches are available to investigate potential associations between antimicrobial use (AMU) and resistance (AMR) in animal health settings. All have their advantages and disadvantages, making it unclear as to which model is most appropriate. We used advanced regression modelling to investigate AMU-AMR associations in faecal non-type-specific Escherichia coli (NTSEC) isolates recovered from 275 pens of feedlot cattle. Ten modelling strategies were employed to investigate AMU associations with resistance to chloramphenicol, ampicillin, sulfisoxazole, tetracycline and streptomycin. Goodness-of-fit statistics did not show a consistent advantage for any one model type. Three AMU-AMR associations were significant in all models. Recent parenteral tetracycline use increased the odds of finding tetracycline-resistant NTSEC [odds ratios (OR) 1·1–3·2]; recent parenteral sulfonamide use increased the odds of finding sulfisoxazole-resistant NTSEC (OR 1·4–2·5); and recent parenteral macrolide use decreased the odds of recovering ampicillin-resistant NTSEC (OR 0·03–0·2). Other results varied markedly depending on the modelling approach, emphasizing the importance of exploring and reporting multiple modelling methods based on a balanced consideration of important factors such as study design, mathematical appropriateness, research question and target audience.
The crystal structure of solifenacin hydrogen succinate [C23H27N2O2(HC4H4O4)] has been solved and refined using synchrotron X-ray powder diffraction data, and optimized using density functional techniques. Solifenacin hydrogen succinate crystallizes in space group P21 (#4) with a = 6.477 03(2), b = 7.830 95(2), c = 23.848 72(7) Å, β = 90.2373(3)°, V = 1209.63(1) Å3, and Z = 2. The hydrogen succinate anions form a chain linked by strong hydrogen bonds parallel to the a-axis. Discrete N–H···O hydrogen bonds lie on the sides of this chain, resulting in a layer parallel to the ab-plane rich in hydrogen bonds. Halfway between these layers the molecules meet in a herringbone packing of aromatic rings. The powder pattern has been submitted to ICDD for inclusion in future releases of the Powder Diffraction File™.
Human campylobacteriosis exhibits a distinctive seasonality in temperate regions. This paper aims to identify the origins of this seasonality. Clinical isolates [typed by multi-locus sequence typing (MLST)] and epidemiological data were collected from Scotland. Young rural children were found to have an increased burden of disease in the late spring due to strains of non-chicken origin (e.g. ruminant and wild bird strains from environmental sources). In contrast the adult population had an extended summer peak associated with chicken strains. Travel abroad and UK mainland travel were associated with up to 17% and 18% of cases, respectively. International strains were associated with chicken, had a higher diversity than indigenous strains and a different spectrum of MLST types representative of these countries. Integrating empirical epidemiology and molecular subtyping can successfully elucidate the seasonal components of human campylobacteriosis. The findings will enable public health officials to focus strategies to reduce the disease burden.
Accurate measurements of seed rain are important for understanding tree reproduction (Greene & Johnson 1994), forest regeneration (Cole et al. 2010, Cubiña & Aide 2001, Howe et al. 2010, Zahawi & Augspurger 2006), forest ecology (Muller-Landau et al. 2008, Terborgh et al. 2011) and maintenance of community diversity (Harms et al. 2000). Seed traps generally consist of a bucket or net of a fixed area suspended 0.3–1 m above the ground, and seeds are typically collected once or twice per month. An implicit assumption of all seed-rain studies is that traps do not influence seed dispersal. Should birds perch on and defecate seeds into seed traps, seed abundance will be overestimated. This behaviour could produce a directional bias if birds perch on seed traps in one habitat more than others. To our knowledge, no study has considered this potential bias.