Ward redesign project: Improving admission processes and flow

Background: With changing ACGME work-hour restrictions, residency programs across the country have continued to work on optimizing admission and workflow processes. Prior to our institutions new inpatient service structure, nighttime medicine admissions were handled by one upper-level resident (post-graduate year 2 or 3) on a night-float rotation, and one intern who was from one of the inpatient ward teams. Day call responsibilities in the old structure included performing daytime admissions as well as medical intensive care unit (MICU) transfers. To improve workflow, our residency program instituted two major ward structure modifications. The first change involved the creation of a two-resident night-float team, with the rotating intern returning to daytime coverage only. The second change was the uncoupling of daytime admissions and MICU transfers into two separate call days. Purpose: The major goals in modifying our inpatient ward structure were to improve throughput from the Emergency Department (ED) to inpatient wards services, decrease the number of hand-offs of patients between admitting teams, and create a more even distribution of patients on inpatient ward teams. Description: Data was collected before and after implementation of the above interventions. When compared to the previous system, the new system was associated with decreased numbers of daily patient hand-offs between admitting teams (5.60 vs. 3.07 patients, p = 0.021) and decreased ED-to-admission times (historical average 5.5 hours vs. new system average 2.9 hours). There was a moderate increase in number of daily admission evaluations (15.50 vs. 16.56 patients, p = 0.56) and number of daily admissions performed (10.75 vs. 12.62 patients, p = 0.18). There was a minimal change in the daily distribution of patients on medicine ward team censuses over the two study periods (11.23 +/- 2.29 vs. 10.21 +/- 3.11 patients). Average inpatient ward censuses were not different over the two study periods (old system 81.46 patients vs. new system 81.7 patients, p = 0.917). Conclusions: Creation of a two-resident night-float team and separating daytime admission and MICU-transfer responsibilities over two teams was associated with improved overall workflow in our resident medicine ward system.\u2

Complete microtubule–kinetochore occupancy favours the segregation of merotelic attachments

Kinetochores are multi-protein complexes that power chromosome movements by tracking microtubules plus-ends in the mitotic spindle. Human kinetochores bind up to 20 microtubules, even though single microtubules can generate sufficient force to move chromosomes. Here, we show that high microtubule occupancy at kinetochores ensures robust chromosome segregation by providing a strong mechanical force that favours segregation of merotelic attachments during anaphase. Using low doses of the microtubules-targeting agent BAL27862 we reduce microtubule occupancy and observe that spindle morphology is unaffected and bi-oriented kinetochores can still oscillate with normal intra-kinetochore distances. Inter-kinetochore stretching is, however, dramatically reduced. The reduction in microtubule occupancy and inter-kinetochore stretching does not delay satisfaction of the spindle assembly checkpoint or induce microtubule detachment via Aurora-B kinase, which was so far thought to release microtubules from kinetochores under low stretching. Rather, partial microtubule occupancy slows down anaphase A and increases incidences of lagging chromosomes due to merotelically attached kinetochores

SN2013fs and SN2013fr: Exploring the circumstellar-material diversity in Type II supernovae

We present photometry and spectroscopy of SN2013fs and SN2013fr in the first 100 days post-explosion. Both objects showed transient, relatively narrow H$\alpha$ emission lines characteristic of SNeIIn, but later resembled normal SNeII-P or SNeII-L, indicative of fleeting interaction with circumstellar material (CSM). SN2013fs was discovered within 8hr of explosion. Its light curve exhibits a plateau, with spectra revealing strong CSM interaction at early times. It is a less luminous version of the transitional SNIIn PTF11iqb, further demonstrating a continuum of CSM interaction intensity between SNeII-P and IIn. It requires dense CSM within 6.5$\times$10$^{14}$~cm of the progenitor, from a phase of advanced pre-SN mass loss shortly before explosion. Spectropolarimetry of SN2013fs shows little continuum polarization, but noticeable line polarization during the plateau phase. SN2013fr morphed from a SNIIn at early times to a SNII-L. After the first epoch its narrow lines probably arose from host-galaxy emission, but the bright, narrow H$\alpha$ emission at early times may be intrinsic. As for SN2013fs, this would point to a short-lived phase of strong CSM interaction if proven to be intrinsic, suggesting a continuum between SNeIIn and II-L. It is a low-velocity SNII-L, like SN2009kr but more luminous. SN2013fr also developed an IR excess at later times, due to warm CSM dust that require a more sustained phase of strong pre-SN mass loss.Comment: MNRAS accepted. 28 pages, 23 figures, 8 table

Measurement of refractive index by nanoparticle tracking analysis reveals heterogeneity in extracellular vesicles

Introduction: Optical techniques are routinely used to size and count extracellular vesicles (EV). For comparison of data from different methods and laboratories, suitable calibrators are essential. A suitable calibrator must have a refractive index (RI) as close to that of EV as possible but the RI of EV is currently unknown. To measure EV, RI requires accurate knowledge of size and light scattering. These are difficult to measure as most EVs cannot be resolved by light microscopy and their diameter is smaller than the wavelength of visible light. However, nanoparticle tracking analysis (NTA) provides both size and relative light scattering intensity (rLSI) values. We therefore sought to determine whether it was possible to use NTA to measure the RI of individual EVs. Methods: NTA was used to measure the rLSI and size of polystyrene and silica microspheres of known size and RI (1.470 and 1.633, respectively) and of EV isolated from a wide range of cells. We developed software, based on Mie scattering code, to calculate particle RI from the rLSI data. This modelled theoretical scattering intensities for polystyrene and silica microspheres of known size (100 and 200 nm) and RI. The model was verified using data from the polystyrene and silica microspheres. Size and rLSI data for each vesicle were processed by the software to generate RI values. Results: The following modal RI measurements were obtained: fresh urinary EV 1.374, lyophilised urinary EV 1.367, neuroblastoma EV 1.393, blood EV 1.398, EV from activated platelets 1.390, small placental EV 1.364–1.375 and 1.398–1.414 for large placental EV (>200 nm). Large placental EV had a significantly higher RI than small placental EV (p<0.0001). The spread of RI values was narrower for small EV than for the more heterogeneous large EV. Discussion: Using NTA and Mie scattering theory, we have demonstrated that it is possible to estimate the RI of sub-micron EV using NTA data. EV typically had a modal RI of 1.37–1.39, whereas values of >1.40 were observed for some large (>200 nm) microvesicles. Conclusion: This method for measuring EV RI will be useful for developing appropriate calibrators for EV measurement

Rofecoxib and cardiovascular adverse events in adjuvant treatment of colorectal cancer

Background Selective cyclooxygenase inhibitors may retard the progression of cancer, but they have enhanced thrombotic potential. We report on cardiovascular adverse events in patients receiving rofecoxib to reduce rates of recurrence of colorectal cancer. Methods All serious adverse events that were cardiovascular thrombotic events were reviewed in 2434 patients with stage II or III colorectal cancer participating in a randomized, placebo-controlled trial of rofecoxib, 25 mg daily, started after potentially curative tumor resection and chemotherapy or radiotherapy as indicated. The trial was terminated prematurely owing to worldwide withdrawal of rofecoxib. To examine possible persistent risks, we examined cardiovascular thrombotic events reported up to 24 months after the trial was closed. Results The median duration of active treatment was 7.4 months. The 1167 patients receiving rofecoxib and the 1160 patients receiving placebo were well matched, with a median follow-up period of 33.0 months (interquartile range, 27.6 to 40.1) and 33.4 months (27.7 to 40.4), respectively. Of the 23 confirmed cardiovascular thrombotic events, 16 occurred in the rofecoxib group during or within 14 days after the treatment period, with an estimated relative risk of 2.66 (from the Cox proportional-hazards model; 95% confidence interval [CI], 1.03 to 6.86; P = 0.04). Analysis of the Antiplatelet Trialists’ Collaboration end point (the combined incidence of death from cardiovascular, hemorrhagic, and unknown causes; of nonfatal myocardial infarction; and of nonfatal ischemic and hemorrhagic stroke) gave an unadjusted relative risk of 1.60 (95% CI, 0.57 to 4.51; P = 0.37). Fourteen more cardiovascular thrombotic events, six in the rofecoxib group, were reported within the 2 years after trial closure, with an overall unadjusted relative risk of 1.50 (95% CI, 0.76 to 2.94; P = 0.24). Four patients in the rofecoxib group and two in the placebo group died from thrombotic causes during or within 14 days after the treatment period, and during the follow-up period, one patient in the rofecoxib group and five patients in the placebo group died from cardiovascular causes. Conclusions Rofecoxib therapy was associated with an increased frequency of adverse cardiovascular events among patients with a median study treatment of 7.4 months’ duration. (Current Controlled Trials number, ISRCTN98278138.

War on video: Combat footage, vernacular video analysis and military culture from within

open access articleIn this article we present an ethnomethodological study of a controversial case of ‘friendly fire’ from the Iraq War in which leaked video footage, war on video, acquired particular significance. We examine testimony given during a United States Air Force (USAF) investigation of the incident alongside transcribed excerpts from the video to make visible the methods employed by the investigators to assess the propriety of the actions of the pilots involved. With a focus on the way in which the USAF investigators pursued their own analysis of language-in-use in their discussions with the pilots about what had been captured on the video, we turn attention to the background expectancies that analytical work was grounded in. These ‘vernacular’ forms of video analysis and the expectancies which inform them constitute, we suggest, an inquiry into military culture from within that culture. As such, attending to them provides insights into that culture

Metrology system for measuring mast motions on the NuSTAR mission

A metrology system designed and built for the NuSTAR mission is described. The NuSTAR mission is an orbiting X-ray telescope with a 10 meter focal length. The system consists of two laser pointers mounted rigidly together with a star tracker and the X-ray optics. The focused laser beams illuminates two metrology detectors mounted rigidly with the X-ray detectors. The detectors and optics/lasers are separated by a ∼10 meter deployable (and somewhat flexible) carbon fiber mast. Details about the implementation of the metrology system is discussed in this paper

Experimental Investigation of Elastomer Docking Seal Compression Set, Adhesion, and Leakage

A universal docking and berthing system is being developed by the National Aeronautics and Space Administration (NASA) to support all future space exploration missions to low-Earth orbit (LEO), to the Moon, and to Mars. An investigation of the compression set of two seals mated in a seal-on-seal configuration and the force required to separate the two seals after periods of mating was conducted. The leakage rates of seals made from two silicone elastomer compounds, S0383-70 and S0899-50, configured in seal-on-seal mating were quantified. The test specimens were sub-scale seals with representative cross-sections and a 12 inch outside diameter. The leakage rate of the seals manufactured from S0899-50 was higher than that of the seals made from S0383-70 by a factor of 1.8. Similarly, the adhesion of the 50 durometer elastomer was significantly higher than that of the 70 durometer compound. However, the compression set values of the S0899-50 material were observed to be significantly lower than those for the S0383-70