Labour ward incidents and potential claims - Lessons learned from research

This paper provides an insight into the underlying factors involved in potential cerebral palsy and/or shoulder dystocia claims. The research was undertaken to identify the root causes of 37 cases of birth asphyxia in term infants severe enough to warrant admission to neonatal care units in the north-west of England between 2001 and 2002. All available staff (n ¼ 93) providing care during critical periods were interviewed by the author using the cognitive interviewing technique. These included 81 midwives, two consultant obstetricians, eight registrars and two senior house officers. An expert panel consisting of consultant obstetricians, midwives, a consultant neonatologist and the researcher applied the Bolam test to identify instances where care had been substandard and injury caused as a result. Although the cases were often complex, covering more than one shift and over more than one stage of labour, the most dangerous time appeared to be during the night shift (19 cases, 51%), followed by the evening shift (13 cases, 35%) and then the day shift (five cases, 14%). The main problems include: failure to respond appropriately to signs of fetal hypoxia (26 cases, 70%); undiagnosed obstruction (22 cases, 59%), which was broken down into failure to identify cephalopelvic disproportion (13 cases, 35%); and shoulder dystocia (nine cases, 24%). Delayed resuscitation of the infant occurred in 26 cases (80%), and in 18 cases (49%) there was excessive and inappropriate use of Syntocinon. All cases involved human error, either through a delay or failure to take action, or taking inappropriate action. However, these were all underpinned and perpetuated by system and cultural errors present in the labour wards, such as allowing unsupported and inexperienced personnel to work in a position for which they lacked the necessary skill and experience. This was perpetuated by the customary practice of using unsupervised junior medical staff in a first on-call position for complications, and also of failing to sustain safe midwifery staffing levels. This in turn prevented support for more inexperienced staff. Consequently, when inexperienced midwives and obstetricians were left unsupervised in charge of complicated cases, it created accidents waiting to happen. When unsupervised and inexperienced paediatricians attended the birth of an asphyxiated infant, the child’s condition deteriorated further when they were unable to resuscitate it. If such system and cultural errors as these are not rectified, the current high rate of damaged babies is likely to continue

Failures in childbirth care

The study, first published in 2003, looks at the root causes of adverse events and near misses in obstetrics at seven hospital maternity units by interviewing 93 members of staff, identifying the areas of mismanagement in each case and thematically analysing them

Amplitude-mode dynamics of polariton condensates

We study the stability of collective amplitude excitations in non-equilibrium polariton condensates. These excitations correspond to renormalized upper polaritons and to the collective amplitude modes of atomic gases and superconductors. They would be present following a quantum quench or could be created directly by resonant excitation. We show that uniform amplitude excitations are unstable to the production of excitations at finite wavevectors, leading to the formation of density-modulated phases. The physical processes causing the instabilities can be understood by analogy to optical parametric oscillators and the atomic Bose supernova.Comment: 4 pages, 2 figure

Crystalline free energies of micelles of diblock copolymer solutions

We report a characterization of the relative stability and structural behavior of various micellar crystals of an athermal model of AB-diblock copolymers in solution. We adopt a previously devel- oped coarse-graining representation of the chains which maps each copolymer on a soft dumbbell. Thanks to this strong reduction of degrees of freedom, we are able to investigate large aggregated systems, and for a specific length ratio of the blocks f = MA/(MA + MB) = 0.6, to locate the order-disorder transition of the system of micelles. Above the transition, mechanical and thermal properties are found to depend on the number of particles per lattice site in the simulation box, and the application of a recent methodology for multiple occupancy crystals (B.M. Mladek et al., Phys. Rev. Lett. 99, 235702 (2007)) is necessary to correctly define the equilibrium state. Within this scheme we have performed free energy calculations at two reduced density {\rho}/{\rho}\ast = 4,5 and for several cubic structures as FCC,BCC,A15. At both densities, the BCC symmetry is found to correspond to the minimum of the unconstrained free energy, that is to the stable symmetry among the few considered, while the A15 structure is almost degenerate, indicating that the present sys- tem prefers to crystallize in less packed structures. At {\rho}/{\rho}\ast = 4 close to melting, the Lindemann ratio is fairly high (~ 0.29) and the concentration of vacancies is roughly 6%. At {\rho}/{\rho}\ast = 5 the mechanical stability of the stable BCC structure increases and the concentration of vacancies ac- cordingly decreases. The ratio of the corona layer thickness to the core radius is found to be in good agreement with experimental data for poly(styrene-b-isoprene)(22-12) in isoprene selective solvent which is also reported to crystallize in the BCC structure

Heat pumping in nanomechanical systems

We propose using a phonon pumping mechanism to transfer heat from a cold to a hot body using a propagating modulation of the medium connecting the two bodies. This phonon pump can cool nanomechanical systems without the need for active feedback. We compute the lowest temperature that this refrigerator can achieve.Comment: 4 pages, 1 figure, published versio

NaAlSi: a self-doped semimetallic superconductor with free electrons and covalent holes

The layered ternary sp conductor NaAlSi, possessing the iron-pnictide "111" crystal structure, superconducts at 7 K. Using density functional methods, we show that this compound is an intrinsic (self-doped) low-carrier-density semimetal with a number of unusual features. Covalent Al-Si valence bands provide the holes, and free-electron-like Al 3s bands, which propagate in the channel between the neighboring Si layers, dip just below the Fermi level to create the electron carriers. The Fermi level (and therefore the superconducting carriers) lies in a narrow and sharp peak within a pseudogap in the density of states. The small peak arises from valence bands which are nearly of pure Si, quasi-two-dimensional, flat, and coupled to Al conduction bands. Isostructural NaAlGe, which is not superconducting above 1.6 K, has almost exactly the same band structure except for one missing piece of small Fermi surface. Certain deformation potentials induced by Si and Na displacements along the c-axis are calculated and discussed. It seems likely that the mechanism of pairing is related to that of several other lightly doped two-dimensional nonmagnetic semiconductors (TiNCl, ZrNCl, HfNCl), which is not well understood but apparently not of phonon origin.Comment: 9 pages, 7 figures, 1 tabl

Intraband Optical Spectral Weight in the presence of a van Hove singularity: application to Bi2_2Sr2_2CaCu2_2O8+δ_{8+\delta}

The Kubo single band sum rule is used to determine the optical spectral weight of a tight binding band with further than nearest neighbour hopping. We find for a wide range of parameters and doping concentrations that the change due to superconductivity at low temperature can be either negative or positive. In contrast, the kinetic energy change is always negative. We use an ARPES determined tight binding parametrization of Bi$_2$Sr$_2$CaCu$_2$O$_{8+\delta}$ to investigate whether this can account for recent observations of a positive change in the spectral weight due to the onset of superconductivity. With this band structure we find that in the relevant doping regime a straightforward BCS calculation of the optical spectral weight cannot account for the experimental observations.Comment: 10 page 9 figure

Weighted-density approximation for general nonuniform fluid mixtures

In order to construct a general density-functional theory for nonuniform fluid mixtures, we propose an extension to multicomponent systems of the weighted-density approximation (WDA) of Curtin and Ashcroft [Phys. Rev. A 32, 2909 (1985)]. This extension corrects a deficiency in a similar extension proposed earlier by Denton and Ashcroft [Phys. Rev. A 42, 7312 (1990)], in that that functional cannot be applied to the multi-component nonuniform fluid systems with spatially varying composition, such as solid-fluid interfaces. As a test of the accuracy of our new functional, we apply it to the calculation of the freezing phase diagram of a binary hard-sphere fluid, and compare the results to simulation and the Denton-Ashcroft extension.Comment: 4 pages, 4 figures, to appear in Phys. Rev. E as Brief Repor

Real space first-principles derived semiempirical pseudopotentials applied to tunneling magnetoresistance

In this letter we present a real space density functional theory (DFT) localized basis set semi-empirical pseudopotential (SEP) approach. The method is applied to iron and magnesium oxide, where bulk SEP and local spin density approximation (LSDA) band structure calculations are shown to agree within approximately 0.1 eV. Subsequently we investigate the qualitative transferability of bulk derived SEPs to Fe/MgO/Fe tunnel junctions. We find that the SEP method is particularly well suited to address the tight binding transferability problem because the transferability error at the interface can be characterized not only in orbital space (via the interface local density of states) but also in real space (via the system potential). To achieve a quantitative parameterization, we introduce the notion of ghost semi-empirical pseudopotentials extracted from the first-principles calculated Fe/MgO bonding interface. Such interface corrections are shown to be particularly necessary for barrier widths in the range of 1 nm, where interface states on opposite sides of the barrier couple effectively and play a important role in the transmission characteristics. In general the results underscore the need for separate tight binding interface and bulk parameter sets when modeling conduction through thin heterojunctions on the nanoscale.Comment: Submitted to Journal of Applied Physic