A Review of Best Practices for Monitoring and Improving Inpatient Pediatric Patient Experiences.

ContextAchieving high-quality patient-centered care requires assessing patient and family experiences to identify opportunities for improvement. With the Child Hospital Consumer Assessment of Healthcare Providers and Systems Survey, hospitals can assess performance and make national comparisons of inpatient pediatric experiences. However, using patient and family experience data to improve care remains a challenge.ObjectiveWe reviewed the literature on best practices for monitoring performance and undertaking activities aimed at improving pediatric patient and family experiences of inpatient care.Data sourcesWe searched PubMed, Cumulative Index to Nursing and Allied Health Literature, and PsychINFO.Study selectionWe included (1) English-language peer-reviewed articles published from January 2000 to April 2019; (2) articles based in the United States, United Kingdom, or Canada; (3) articles focused on pediatric inpatient care; (4) articles describing pediatric patient and family experiences; and (5) articles including content on activities aimed at improving patient and family experiences. Our review included 25 articles.Data extractionTwo researchers reviewed the full article and abstracted specific information: country, study aims, setting, design, methods, results, Quality Improvement (QI) initiatives performed, internal reporting description, best practices, lessons learned, barriers, facilitators and study implications for clinical practice, patient-experience data collection, and QI activities. We noted themes across samples and care settings.ResultsWe identified 10 themes of best practice. The 4 most common were (1) use evidence-based approaches, (2) maintain an internal system that communicates information and performance on patient and family experiences to staff and hospital leadership, (3) use experience survey data to initiate and/or evaluate QI interventions, and (4) identify optimal times (eg, discharge) and modes (eg, print) for obtaining patient and family feedback. These correspond to adult inpatient best practices.ConclusionsBoth pediatric and adult inpatient best practices rely on common principles of culture change (such as evidence-based clinical practice), collaborative learning, multidisciplinary teamwork, and building and/or supporting a QI infrastructure that requires time, money, collaboration, data tracking, and monitoring. QI best practices in both pediatric and adult inpatient settings commonly rely on identifying drivers of overall ratings of care, rewarding staff for successful implementation, and creating easy-to-use and easy-to-access planning and QI tools for staff

Fluctuational susceptibility of ultracold bosons in the vicinity of condensation

We study the behaviour of ultracold bosonic gas in the critical region above the Bose-Einstein condensation in the presence of an artificial magnetic field, $B_\mathrm{art}$. We show that the condensate fluctuations above the critical temperature $T_c$ cause the fluctuational susceptibility, $\chi _\mathrm{fl}$, of a uniform gas to have a stronger power-law divergence than in an analogous superconducting system. Measuring such a divergence opens new ways of exploring critical properties of the ultracold gas and an opportunity of an accurate determination of $T_c$. We describe a method of measuring $\chi _\mathrm{fl}$ which requires a constant gradient in $B_\mathrm{art}$ and suggest a way of creating such a field in experiment.Comment: 5 pages, 3 figures, 5 pages of Supplement; the text is rewritten and rearranged, and the figures are modifie

Method of carbonizing polyacrylonitrile fibers

This invention relates to a method of carbonizing polyacrylonitrile fibers by exposing the fibers at an elevated temperature to an oxidizing atmosphere; then exposing the oxidized fibers to an atmosphere of an inert gas such as nitrogen containing a carbonaceous material such as acetylene. The fibers are preferably treated with an organic compound, for example benzoic acid, before the exposure to an oxidizing atmosphere. The invention also relates to the resulting fibers. The treated fibers have enhanced tensile strength

Low-Temperature Decoherence of Qubit Coupled to Background Charges

We have found an exact expression for the decoherence rate of a Josephson charge qubit coupled to fluctuating background charges. At low temperatures $T$ the decoherence rate ${\Gamma}$ is linear in $T$ while at high temperatures it saturates in agreement with a known classical solution which, however, reached at surprisingly high $T$. In contrast to the classical picture, impurity states spread in a wide interval of energies ($\gg T$) may essentially contribute to ${\Gamma}$.Comment: Both figures are changed to illustrate a more generic case of impurity states spread in wide interval of energies. Some changes have been made to the abstract and the introductio

Impurity Scattering in Luttinger Liquid with Electron-Phonon Coupling

We study the influence of electron-phonon coupling on electron transport through a Luttinger liquid with an embedded weak scatterer or weak link. We derive the renormalization group (RG) equations which indicate that the directions of RG flows can change upon varying either the relative strength of the electron-electron and electron-phonon coupling or the ratio of Fermi to sound velocities. This results in the rich phase diagram with up to three fixed points: an unstable one with a finite value of conductance and two stable ones, corresponding to an ideal metal or insulator.Comment: 4 pages, 2 figure

Superfluidity of "dirty" indirect excitons and magnetoexcitons in two-dimensional trap

The superfluid phase transition of bosons in a two-dimensional (2D) system with disorder and an external parabolic potential is studied. The theory is applied to experiments on indirect excitons in coupled quantum wells. The random field is allowed to be large compared to the dipole-dipole repulsion between excitons. The slope of the external parabolic trap is assumed to change slowly enough to apply the local density approximation (LDA) for the superfluid density, which allows us to calculate the Kosterlitz-Thouless temperature $T_{c}(n(r))$ at each local point $r$ of the trap. The superfluid phase occurs around the center of the trap ($\mathbf{r}=0$) with the normal phase outside this area. As temperature increases, the superfluid area shrinks and disappears at temperature $T_{c}(n(r=0))$. Disorder acts to deplete the condensate; the minimal total number of excitons for which superfluidity exists increases with disorder at fixed temperature. If the disorder is large enough, it can destroy the superfluid entirely. The effect of magnetic field is also calculated for the case of indirect excitons. In a strong magnetic field $H$, the superfluid component decreases, primarily due to the change of the exciton effective mass.Comment: 13 pages, 3 figure

Theory of non-equilibrium electronic Mach-Zehnder interferometer

We develop a theoretical description of interaction-induced phenomena in an electronic Mach-Zehnder interferometer formed by integer quantum Hall edge states (with \nu =1 and 2 channels) out of equilibrium. Using the non-equilibrium functional bosonization framework, we derive an effective action which contains all the physics of the problem. We apply the theory to the model of a short-range interaction and to a more realistic case of long-range Coulomb interaction. The theory takes into account interaction-induced effects of dispersion of plasmons, charging, and decoherence. In the case of long-range interaction we find a good agreement between our theoretical results for the visibility of Aharonov-Bohm oscillations and experimental data.Comment: 19 pages, 10 figure

Emission of volatile halogenated organic compounds over various Dead Sea landscapes

Volatile halogenated organic compounds (VHOCs), such as methyl halides (CH3X; X is Br, Cl and I) and very short-lived halogenated substances (VSLSs; bromoform-CHBr3, dibromomethane-CH2Br2, bromodichloromethane-CHBrCl2, trichloroethylene-C2HCl3, chloroform-CHCl3- A nd dibromochloromethane-CHBr2Cl) are well known for their significant influence on ozone concentrations and oxidation capacity of the troposphere and stratosphere and for their key role in aerosol formation. Insufficient characterization of the sources and the emission rate of VHOCs limits our ability to understand and assess their impact in both the troposphere and stratosphere. Over the last two decades, several natural terrestrial sources for VHOCs, including soil and vegetation, have been identified, but our knowledge of emission rates from these sources and their responses to changes in ambient conditions remains limited. Here we report measurements of the mixing ratios and fluxes of several chlorinated and brominated VHOCs from different landscapes and natural and agricultural vegetated sites at the Dead Sea during different seasons. Fluxes were generally positive (emission into the atmosphere), corresponding to elevated mixing ratios, but were highly variable. Fluxes (and mixing ratios) for the investigated VHOCs ranged as follows: CHBr3 from 79 to 187 nmolm2 d1 (1.9 to 22.6 pptv), CH2Br2 from 55 to 71 nmolm2 d1 (0.7 to 19 pptv), CHBr2Cl from 408 to 768 nmolm2 d1 (0.4 to 11 pptv), CHBrCl2 from 29 to 45 nmolm2 d1 (0.5 to 9.6 pptv), CHCl3 from 577 to 883 nmolm2 d1 (15 to 57 pptv), C2HCl3 from 74 to 884 nmolm2 d1 (0.4 to 11 pptv), methyl chloride (CH3Cl) from-5300 to 10,800 nmolm2 d1 (530 to 730 pptv), methyl bromide (CH3Br) from 111 to 118 nmolm2 d1 (7.5 to 14 pptv) and methyl iodide (CH3I) from 25 to 17 nmolm2 d1 (0.4 to 2.8 pptv). Taking into account statistical uncertainties, the coastal sites (particularly those where soil is mixed with salt deposits) were identified as sources of all VHOCs, but this was not statistically significant for CHCl3. Further away from the coastal area, the bare soil sites were sources for CHBrCl2, CHBr2Cl, CHCl3, and probably also for CH2Br2 and CH3I, and the agricultural sites were sources for CHBr3, CHBr2Cl and CHBrCl2. In contrast to previous reports, we also observed emissions of brominated trihalomethanes, with net molar fluxes ordered as follows: CHBr2Cl > CHCl3 > CHBr3 > CHBrCl2 and lowest positive flux incidence for CHCl3 among all trihalomethanes; this finding can be explained by the soil's enrichment with Br. Correlation analysis, in agreement with recent studies, indicated common controls for the emission of CHBr2Cl and CHBrCl2 and likely also for CHBr3. There were no indications for correlation of the brominated trihalomethanes with CHCl3. Also in line with previous reports, we observed elevated emissions of CHCl3 and C2HCl3 from mixtures of soil and different salt-deposited structures; the flux correlations between these compounds and methyl halides (particularly CH3I) suggested that at least CH3I is also emitted via similar mechanisms or is subjected to similar controls. Overall, our results indicate elevated emission of VHOCs from bare soil under semiarid conditions. Along with other recent studies, our findings point to the strong emission potential of a suite of VHOCs from saline soils and salt lakes and call for additional studies of emission rates and mechanisms of VHOCs from saline soils and salt lakes

Gene identification for the cblD defect of vitamin B12 metabolism

Background Vitamin B12 (cobalamin) is an essential cofactor in several metabolic pathways. Intracellular conversion of cobalamin to its two coenzymes, adenosylcobalamin in mitochondria and methylcobalamin in the cytoplasm, is necessary for the homeostasis of methylmalonic acid and homocysteine. Nine defects of intracellular cobalamin metabolism have been defined by means of somatic complementation analysis. One of these defects, the cblD defect, can cause isolated methylmalonic aciduria, isolated homocystinuria, or both. Affected persons present with multisystem clinical abnormalities, including developmental, hematologic, neurologic, and metabolic findings. The gene responsible for the cblD defect has not been identified. Methods We studied seven patients with the cblD defect, and skin fibroblasts from each were investigated in cell culture. Microcell-mediated chromosome transfer and refined genetic mapping were used to localize the responsible gene. This gene was transfected into cblD fibroblasts to test for the rescue of adenosylcobalamin and methylcobalamin synthesis. Results The cblD gene was localized to human chromosome 2q23.2, and a candidate gene, designated MMADHC (methylmalonic aciduria, cblD type, and homocystinuria), was identified in this region. Transfection of wild-type MMADHC rescued the cellular phenotype, and the functional importance of mutant alleles was shown by means of transfection with mutant constructs. The predicted MMADHC protein has sequence homology with a bacterial ATP-binding cassette transporter and contains a putative cobalamin binding motif and a putative mitochondrial targeting sequence. Conclusions Mutations in a gene we designated MMADHC are responsible for the cblD defect in vitamin B12 metabolism. Various mutations are associated with each of the three biochemical phenotypes of the disorder

Algorithm Based Fault Tolerance in Massively Parallel Systems

An A complex computer system consists of billions of transistors, miles of wires, and many interactions with an unpredictable environment. Correct results must be produced despite faults that dynamically occur in some of these components. Many techniques have been developed for fault tolerant computation. General purpose methods are independent of the application, yet incur an overhead cost which may be unacceptable for massively parallel systems. Algorithm-specific methods, which can operate at lower cost, are a developing alternative [1, 72]. This paper first reviews the general-purpose approach and then focuses on the algorithm-specific method, with an eye toward massively parallel processors. Algorithm-based fault tolerance has the attraction of low overhead; furthermore it addresses both the detection and also the correction problems. The principle is to build low-cost checking and correcting mechanism based exclusively on the redundancies inherent in the system