A quality improvement project using a problem based post take ward round proforma based on the SOAP acronym to improve documentation in acute surgical receiving

Objectives: Ward round documentation provides one of the most important means of communication between healthcare professionals. We aimed to establish if the use of a problem based standardised proforma can improve documentation in acute surgical receiving. Methods: Gold standards were established using the RCSE record keeping guidelines. We audited documentation for seven days using the following headings: patient name/identification number, subjective findings, objective findings, clinical impression/diagnosis, plan, diet status, discharge decision, discharge planning, signature, and grade. After the initial audit cycle, a ward round proforma was introduced using the above headings and re-audited over a seven day period. Results: The pre-intervention arm contained 50 patients and the post intervention arm contained 47. The following headings showed an improvement in documentation compliance to 100%: patient name/identification number vs 96%, subjective findings vs 84%, objective findings vs 48%, plan vs 98%, signature vs 96%, and grade vs 62%. Documentation of the clinical impression/diagnosis improved to 98% vs 30%, diet status rose to 83% vs 16%, discharge decision to 66% vs 16%, and discharge planning to 40% vs 20%. Conclusions: Standardised proformas improve the documentation of post-take ward round notes. This helps to clarify the onward management plan for all aspects of a patient's care and will help avoid adverse events and litigation. This should improve the quality and safety of Patient Care

The Web of Power: Elites, Social Movements, and Structural Change, A Method of Analysis

http://deepblue.lib.umich.edu/bitstream/2027.42/51095/1/327.pd

EPR Steering Inequalities from Entropic Uncertainty Relations

We use entropic uncertainty relations to formulate inequalities that witness Einstein-Podolsky-Rosen (EPR) steering correlations in diverse quantum systems. We then use these inequalities to formulate symmetric EPR-steering inequalities using the mutual information. We explore the differing natures of the correlations captured by one-way and symmetric steering inequalities, and examine the possibility of exclusive one-way steerability in two-qubit states. Furthermore, we show that steering inequalities can be extended to generalized positive operator valued measures (POVMs), and we also derive hybrid-steering inequalities between alternate degrees of freedom.Comment: 10 pages, 2 figure

Quality of life in patients with intermittent claudication

© 2017, The Author(s). Background: Intermittent claudication (IC) is a common condition that causes pain in the lower limbs when walking and has been shown to severely impact the quality of life (QoL) of patients. The QoL is therefore often regarded as an important measure in clinical trials investigating intermittent claudication. To date, no consensus exits on the type of life questionnaire to be used. This review aims to examine the QoL questionnaires used in trials investigating peripheral arterial disease (PAD). Material and methods: A systematic review of randomised clinical trials including a primary analysis of QoL via questionnaire was performed. Trials involving patients with diagnosed PAD were included (either clinically or by questionnaire). Any trial which had QoL as the primary outcome data was included with no limit being placed on the type of questionnaire used. Results: The search yielded a total of 1845 articles of which 31 were deemed appropriate for inclusion in the review. In total, 14 different QoL questionnaires were used across 31 studies. Of the questionnaires 24.06% were missing at least one domain when reported in the results of the study. Mean standard deviation varied widely based on the domain reported, particularly within the SF36. Discussion: Despite previous recommendations for Europewide standardisation of quality of life assessment, to date no such tool exists. This review demonstrated that a number of different questionnaires remain in use, that their completion is often inadequate and that further evidence-based guidelines on QoL assessment are required to guide future research

British research in accounting and finance (2001–2007): the 2008 research assessment exercise

No abstract available

Rotational 3D Printing of Sensor Devices using Reactive Ink Chemistries

This paper charts progress in three key areas of a project supported by both UK government and UK industry to manufacture novel sensor devices using rotary 3D printing technology and innovative ink chemistries; (1) the development of an STL file slicing algorithm that returns constant Z height 2D contour data at a resolution that matches the given print head setup, allowing digital images to be generated of the correct size without the need for scaling; (2) the development of image transformation algorithms which allow images to be printed at higher resolutions using tilted print heads and; (3) the formulation of multi part reaction inks which combine and react on the substrate to form solid material layers with a finite thickness. A Direct Light Projection (DLP) technique demonstrated the robustness of the slice data by constructing fine detailed three dimensional test pieces which were comparable to identical parts built in an identical way from slice data obtained using commercial software. Material systems currently under investigation include plaster, stiff polyamides and epoxy polymers and conductive metallic’s. Early experimental results show conductivities of silver approaching 1.42x105 Siemens/m.Mechanical Engineerin

Irreconcilably past and present; The representation of the archaeological fabric of post-1989 Berlin in six narrative texts.

In the political and cultural discourses of the post-Wende period Berlin was widely seen as the symbolic force of the new united Germany. Between 1989 and 1999 much of East Berlin's urban fabric was radically altered to confirm this image. Memories of the GDR and of National Socialism were erased from the recently unified city - hence the renaming of prominent public sites, of street names and buildings and the demolition of others, mostly in East Berlin. This thesis analyses in six narrative texts a link between the unification and the erasure of Berlin's divided pasts. Both Thomas Hettche's Nox and Thomas Brussig's Helden wie wir focus on the night of November 9 1989 in Berlin and proffer conflicting readings of the event as well as its importance. In Gunter Grass's Ein weites Feld Berlin is represented as a site informed by an omnipresent past covering the last 150 years of German history. For the protagonist of Cees Nooteboom's Allerseelen, Berlin is understood as an archaeological site that invites the critical purchase of a modern, non-German flaneur to uncover the historic. For the paranoid protagonist of Friedrich Christian Delius's Die Flatterzunge, Berlin is experienced as a suffocating and an inescapably constant reminder of an assumed inherited National Socialist guilt. Whereas Tanja Duckers's novel, Spielzone, illustrates a potential liberation from the historic thematised in the previous texts by portraying Berlin as an uninscribed blank urban space inhabited by a historically carefree younger generation. The six texts studied in this thesis constantly debate the function of Berlin as a site of remembering and forgetting

The effect of task load, information reliability and interdependency on anticipation performance

In sport, coaches often explicitly provide athletes with stable contextual information related to opponent action preferences to enhance anticipation performance. This information can be dependent on, or independent of, dynamic contextual information that only emerges during the sequence of play (e.g. opponent positioning). The interdependency between contextual information sources, and the associated cognitive demands of integrating information sources during anticipation, has not yet been systematically examined. We used a temporal occlusion paradigm to alter the reliability of contextual and kinematic information during the early, mid- and final phases of a two-versus-two soccer anticipation task. A dual-task paradigm was incorporated to investigate the impact of task load on skilled soccer players' ability to integrate information and update their judgements in each phase. Across conditions, participants received no contextual information (control) or stable contextual information (opponent preferences) that was dependent on, or independent of, dynamic contextual information (opponent positioning). As predicted, participants used reliable contextual and kinematic information to enhance anticipation. Further exploratory analysis suggested that increased task load detrimentally affected anticipation accuracy but only when both reliable contextual and kinematic information were available for integration in the final phase. This effect was observed irrespective of whether the stable contextual information was dependent on, or independent of, dynamic contextual information. Findings suggest that updating anticipatory judgements in the final phase of a sequence of play based on the integration of reliable contextual and kinematic information requires cognitive resources.</p

Reachability in Higher-Order-Counters

Higher-order counter automata (\HOCS) can be either seen as a restriction of higher-order pushdown automata (\HOPS) to a unary stack alphabet, or as an extension of counter automata to higher levels. We distinguish two principal kinds of \HOCS: those that can test whether the topmost counter value is zero and those which cannot. We show that control-state reachability for level $k$ \HOCS with $0$-test is complete for \mbox{$(k-2)$}-fold exponential space; leaving out the $0$-test leads to completeness for \mbox{$(k-2)$}-fold exponential time. Restricting \HOCS (without $0$-test) to level $2$, we prove that global (forward or backward) reachability analysis is \PTIME-complete. This enhances the known result for pushdown systems which are subsumed by level $2$ \HOCS without $0$-test. We transfer our results to the formal language setting. Assuming that \PTIME \subsetneq \PSPACE \subsetneq \mathbf{EXPTIME}, we apply proof ideas of Engelfriet and conclude that the hierarchies of languages of \HOPS and of \HOCS form strictly interleaving hierarchies. Interestingly, Engelfriet's constructions also allow to conclude immediately that the hierarchy of collapsible pushdown languages is strict level-by-level due to the existing complexity results for reachability on collapsible pushdown graphs. This answers an open question independently asked by Parys and by Kobayashi.Comment: Version with Full Proofs of a paper that appears at MFCS 201