Bridge number and integral Dehn surgery

In a 3-manifold M, let K be a knot and R be an annulus which meets K transversely. We define the notion of the pair (R,K) being caught by a surface Q in the exterior of the link given by K and the boundary curves of R. For a caught pair (R,K), we consider the knot K^n gotten by twisting K n times along R and give a lower bound on the bridge number of K^n with respect to Heegaard splittings of M -- as a function of n, the genus of the splitting, and the catching surface Q. As a result, the bridge number of K^n tends to infinity with n. In application, we look at a family of knots K^n found by Teragaito that live in a small Seifert fiber space M and where each K^n admits a Dehn surgery giving the 3-sphere. We show that the bridge number of K^n with respect to any genus 2 Heegaard splitting of M tends to infinity with n. This contrasts with other work of the authors as well as with the conjectured picture for knots in lens spaces that admit Dehn surgeries giving the 3-sphere

Bridge number, Heegaard genus and non-integral Dehn surgery

We show there exists a linear function w: N->N with the following property. Let K be a hyperbolic knot in a hyperbolic 3-manifold M admitting a non-longitudinal S^3 surgery. If K is put into thin position with respect to a strongly irreducible, genus g Heegaard splitting of M then K intersects a thick level at most 2w(g) times. Typically, this shows that the bridge number of K with respect to this Heegaard splitting is at most w(g), and the tunnel number of K is at most w(g) + g-1.Comment: 76 page, 48 figures; referee comments incorporated and typos fixed; accepted at TAM

Physicians' Practice of Dispensing Medicines: A Qualitative Study

Objectives: The physical act of giving medication to patients to administer away from a health care setting, dispensing, is normally performed by pharmacists. Dispensing of medication by physicians is a neglected patient safety issue, and having observed considerable variation in practice, the lead author sought to explore this issue further. A literature review yielded zero articles pertaining to this, so an exploratory study was commenced. The qualitative arm, relating to junior physicians' experience of, and training in, dispensing, is reported here. Methods: Focus groups were conducted to explore the beliefs, ideas, and experiences of physicians-in-training pertaining to dispensing of medication. These were recorded and transcribed. The transcriptions were thematically analyzed using the grounded theory. Results: The emergency department was the most common site of dispensing. No formal training in dispensing had been received. Informal training was variable in content and utility. The physicians felt that dispensing was part of their role. Conclusions: Despite being expected to dispense, and the patient safety issues involved in giving drugs to patients to use at home, physicians do not feel that they have been trained to undertake this task. These findings from 1 hospital raise questions about thewider quality and safety of this practic

Devising a consensus definition and framework for non-technical skills in healthcare to support educational design: A modified Delphi study

Background Non-technical skills are a subset of human factors that focus on the individual and promote safety through teamwork and awareness. There is no widely adopted competency or outcome based framework for non-technical skills training in healthcare outside the surgical environment. The authors set out to devise such a framework and reach a consensus on a definition using a modified Delphi approach. Methods An exhaustive list of published and team suggested items was presented to the expert panel for ranking and to propose a definition. In the second round, a focused list was presented, as well as the proposed definition elements. The finalised framework was sent to the panel for review. Summary of results 16 experts participated (58% response rate). A total of 36 items of 105 ranked highly enough to present in round two. The final framework consists of 16 competencies for all and 8 specific competencies for team leaders. The consensus definition describes non-technical skills as ‘a set of social (communication and team work) and cognitive (analytical and personal behaviour) skills that support high quality, safe, effective and efficient inter-professional care within the complex healthcare system’. Conclusions The authors have produced a new competency framework, through the works of an international expert panel, which is not discipline specific. This consensus competency framework can be used by curriculum developers, educational innovators and clinical teachers to support developments in the field

You’re a Trustee -- Now What?

The article talks about the public library trustees appointed by local funding agencies of the library system in the U.S. The funding agencies in Henry County, Georgia are the Board of Commissioners and the Board of Education. Trustees have a library director who has an advanced degree in library science and who has participated in ongoing staff development activities to learn new tricks and trends. They also have fellow board members and a state library agency, which is the Georgia Public Library Service. Important factors to remember about the responsibilities of trustees are mentioned

A study of dental disease in the horse

Summary avaiilable; p. iii-iv