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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.
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.
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 initiated a project with the VLBA to measure directly the distance to the Galactic Center, R0, via a trigonometric parallax. Here we describe the observing program and the first results–direct imaging of the effects of the Sun’s orbit about the Galactic Center.
A review of the MOA (Microlensing Observations in Astrophysics) project is presented. MOA is a collaboration of approximately 30 astronomers from New Zealand and Japan established with the aim of finding and detecting microlensing events towards the Magellanic Clouds and the Galactic bulge, which may be indicative of either dark matter or of planetary companions. The observing program commenced in 1995, using very wide band blue and red filters and a nine-chip mosaic CCD camera.
As a by-product of these observations a large database of CCD photometry for 1.4 million stars towards both LMC and SMC has been established. In one preliminary analysis 576 bright variable stars were confirmed, nearly half of them being Cepheids. Another analysis has identified large numbers of blue variables, and 205 eclipsing binaries are included in this sample. In addition 351 red variables (AGB stars) have been found. Light curves have been obtained for all these stars. The observations are carried out on a 61-cm f/6.25 telescope at Mt John University Observatory where a new larger CCD camera was installed in 1998 July. From this latitude (44° S) the Magellanic Clouds can be monitored throughout the year.
The red variables whose amplitude is larger than 1.3 mag in the MOA database are studied for the LMC. Among 3 196 such stars, 532 stars are likely to be Miras or red semiregular variables. The period–colour relation of these stars is shown.
A large database of CCD photometry for 1.4 million stars towards both the LMC and the SMC, which has been established by the MOA project, is a useful resource to study variable stars. In our preliminary study, variables identified as β Lyrae type stars and Herbig Ae/Be stars have been found amongst blue stars.
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.
On 1980 February 20 we conducted an 8-station intercontental VLBI experiment in order to study the nucleus and jet of M87 at 1666.6 MHz in right circular polarization. Our array was sensitive to structures from 0.001 to 0.1 arcsec. We made a hybrid map of the nucleus of M87, and also searched for compact structures within the knots of the jet. The map (Figure 1) shows that the nucleus of M87 contains a one-sided jet. This morphology is similar to that observed in many compact extragalactic sources. The position angle of the nuclear jet is 290.5 (±1) degrees, which precisely matches that of the 20 arcsec jet. No bending of the jet through an angle greater than about 2 degrees is observed. The nucleus also contains a large component (>0.1 arcsec) which is elongated along the same position angle as the jet and has a flux density of roughly 1 Jy. This component is fully resolved by the vast majority of our (u, v) points, and we could not map it with standard techniques.
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.
The effects of the growth temperature and exposure time to TMGa for ALE of gallium arsenide was studied using TMGa and AsH3 in a modified, vertical, atmospheric, MOCVD reactor with a rotating susceptor. It was found that the temperature range for ALE growth could -be extended from 450°C to 700°C by adjustment of the exposure time to TMGa. The maximum exposure time to TMGa was found to decrease as growth temperature increased with high temperature growth limited to exposures of only fractions of a second. Beyond a critical exposure time to TMGa, gallium droplets form on the surface. It is known that premature decomposition of TMGa in the heated gaseous boundary layer causes the formation of the gallium droplets and the consequent loss of ALE growth.
A process for forming thin (1-3 μm) stacks of Si/SiO2 or SiO2/Si/SiO2 layers into spherical shells 0.5-3.0 mm in diameter is demonstrated as the baseline for realizing sub-mm3 micro-robots. The fabrication process combines bulk and thin-film micromachining, design of novel masks, and multistage wet and dry etching to release the layers from the substrate. The released layers curl up, self assembling into a spherical shell. The radius of curvature of the released stack is a function of the type, thickness, and residual stresses in the layers. The diameter of the resulting shells is calculated using a mechanical model of the multi-layer stacks. This calculation is compared with measurements of fabricated spheres. The fabrication process is compatible with CMOS circuitry, and future work will focus on realizing spheres with embedded solar cell as a power source and a capacitor for energy storage, which will result in a functional micro-robot.
From July 2008 until May 2009, 240 client-owned pet dogs from seven veterinary clinics in the Region of Waterloo, Ontario, Canada participated in a study to determine pet-related management factors that may be associated with the presence of Campylobacter spp. in dogs. The prevalence of Campylobacter spp. carriage in our study population of pet dogs was 22%, with 19% of the dogs positive for C. upsaliensis, and 3% positive for C. jejuni. A significant risk factor from multivariable logistic regression models for both Campylobacter spp. and C. upsaliensis carriage was having homemade cooked food as the dog's diet or added to its diet, and a significant sparing factor for both models was treatment with antibiotics in the previous month. Increasing age of the dog decreased the odds of Campylobacter spp. and C. upsaliensis carriage. Based on the high prevalence of Campylobacter, and specifically C. upsaliensis, further research concerning pet dogs as a risk factor for campylobacteriosis in humans is warranted.
During a 15-month period in Scotland a small but important number of human Campylobacter cases (3·2%) arose from 91 putative household outbreaks. Of the 26 outbreaks with known strain composition, 89% were composed of the same MLST which supports the potential use of MLST in public health epidemiology. The number of cases associated with household outbreaks is much larger than general outbreaks and there is some evidence to indicate that there may be secondary transmission, although this is relatively rare.
Clostridium difficile may be an emerging community-associated pathogen but little is known about its sources of exposure. This study evaluated C. difficile contamination in households and colonization of pets. C. difficile was isolated from 44/836 (5·3%) sites in 26/84 (31%) households. Ribotype 027 was the most common (25%) environmental strain. C. difficile was isolated from 14/139 (10%) dogs. Living with an immunocompromised individual was associated with C. difficile colonization in dogs. All toxigenic strains identified in pets have been isolated from humans in Ontario. C. difficile was isolated concurrently from dogs and the environment in four households, but in all cases canine and environmental ribotypes were different. C. difficile was relatively common in households, suggesting that exposure to this pathogen may be a regular event. There was no evidence that dogs are a significant source of household C. difficile contamination.