A relational approach to improving interprofessional teamwork in post-partum haemorrhage (PPH)

BACKGROUND: Post-partum haemorrhage (PPH) is an obstetric emergency that requires effective teamwork under complex conditions. We explored healthcare team performance for women who suffered a PPH, focusing on relationships and culture as critical influences on teamwork behaviours and outcomes. METHODS: In collaboration with clinical teams, we implemented structural, process and relational interventions to improve teamwork in PPH cases. We were guided by the conceptual framework of Relational Coordination and used a mixed methods approach to data collection and analysis. We employed translational simulation as a central, but not singular, technique for enabling exploration and improvement. Key themes were identified from surveys, focus groups, simulation sessions, interviews, and personal communications over a 12-month period. RESULTS: Four overarching themes were identified: 1) Teamwork, clear roles and identified leadership are critical. 2) Relational factors powerfully underpin teamwork behaviours—shared goals, shared knowledge, and mutual respect. 3) Conflict and poor relationships can and should be actively explored and addressed to improve performance. 4) Simulation supports improved team performance through multifaceted mechanisms. One year after the project commenced, significant progress had been made in relationships and systems. Clinical outcomes have improved; despite unprecedented increase in labour ward activity, there has not been any increase in large PPHs. CONCLUSIONS: Teamwork, relationships, and the context of care can be actively shaped in partnership with clinicians to support high performance in maternity care. We present our multifaceted approach as a guide for leaders and clinicians in maternity teams, and as an exemplar for others enacting quality improvement in healthcare

Isotropic-nematic phase transition in suspensions of filamentous virus and the neutral polymer Dextran

We present an experimental study of the isotropic-nematic phase transition in an aqueous mixture of charged semi-flexible rods (fd virus) and neutral polymer (Dextran). A complete phase diagram is measured as a function of ionic strength and polymer molecular weight. At high ionic strength we find that adding polymer widens the isotropic-nematic coexistence region with polymers preferentially partitioning into the isotropic phase, while at low ionic strength the added polymer has no effect on the phase transition. The nematic order parameter is determined from birefringence measurements and is found to be independent of polymer concentration (or equivalently the strength of attraction). The experimental results are compared with the existing theoretical predictions for the isotropic-nematic transition in rods with attractive interactions.Comment: 8 Figures. To be published in Phys. Rev. E. For more information see http://www.elsie.brandeis.ed

‘Monetarism’ in the UK and the Southern Cone: an overview

SUMMARY This article discusses common patterns—as well as differences—between the ‘new orthodoxy’ of monetarism applied in the United Kingdom and that of the Latin American Southern Cone. In both cases, it interprets this new orthodoxy as a conscious attempt to break out of the previous pattern of capitalist development, as well as the social and political framework which sustained it. This long?term objective accounts for the huge and, in purely technical terms seemingly unnecessary, scale of social cuts. The experience of the United Kingdom, Argentina and Chile are examined from this perspective; the historical background for each of these monetarist experiences is described in some detail. RESUMEN Monetarismo en Gran Bretaña y en el Cono Sur: una reseña Este artículo analiza tanto las pautas comunes como las diferencias de la ‘nueva ortodoxia’ monetarista aplicada en Gran Bretaña y el Cono Sur de América Latina. En ambos casos, esta nueva ortodoxia es interpretada como una tentativa consciente para abandonar el modelo previo de desarrollo capitalista, así como la estructura social y política sobre las que se sustentaba. Este objetivo de largo plazo justifica la escala y el enorme costo social, aparentemente innecesarios desde un punto de vista exclusivamente técnico. Las experiencias de Gran Bretaña, Argentina y Chile son analizadas desde esta perspectiva y se describe con algún grado de detalle el trasfondo histórico de cada una de estas experiencias monetaristas. RESUME Le monétarisme en Grande?Bretagne, en Argentine et au Chili Cet article présente les similarités ainsi que les différences entre la ‘nouvelle orthodoxie’ du monétarisme appliquée au Royaume?Uni et celle des pays du ‘cône’ latino?américain. Pour ces deux cas, il considère la nouvelle orthodoxie comme une tentative consciente de briser l'ancien moule du développement capitaliste, ainsi que le cadre socio?politique qui le supportait. Cet objectif à long terme explique les réductions énormes, et qui, en termes purement techniques, ne paraissent pas nécessaires, des dépenses sociales. L'expérience du Royaume?Uni, de l'Argentine et du Chili est étudiée dans cette perspective et leur historique donné de façon assez détaillée

Quantum nondemolition measurement of mechanical motion quanta

The fields of opto- and electromechanics have facilitated numerous advances in the areas of precision measurement and sensing, ultimately driving the studies of mechanical systems into the quantum regime. To date, however, the quantization of the mechanical motion and the associated quantum jumps between phonon states remains elusive. For optomechanical systems, the coupling to the environment was shown to preclude the detection of the mechanical mode occupation, unless strong single photon optomechanical coupling is achieved. Here, we propose and analyse an electromechanical setup, which allows to overcome this limitation and resolve the energy levels of a mechanical oscillator. We find that the heating of the membrane, caused by the interaction with the environment and unwanted couplings, can be suppressed for carefully designed electromechanical systems. The results suggest that phonon number measurement is within reach for modern electromechanical setups.Comment: 8 pages, 5 figures plus 24 pages, 11 figures supplemental materia

Direct enzymatic esterification of cotton and Avicel with wild-type and engineered cutinases

In this work, the surface of cellulose, either Avicel or cotton fabric, was modified using cutinases without any previous treatment to swell or to solubilise the polymer. Aiming further improvement of cutinase ester synthase activity on cellulose, an engineered cutinase was investigated. Wild-type cutinase from Fusarium solani and its fusion with the carbohydrate-binding module N1 from Cellulomonas fimi were able to esterify the hydroxyl groups of cellulose with distinct efficiencies depending on the acid substrate/solvent system used, as shown by titration and by ATR-FTIR. The carbonyl stretching peak area increased significantly after enzymatic treatment during 72 h at 30 °C. Cutinase treatment resulted in relative increases of 31 and 9 % when octanoic acid and vegetable oil were used as substrates, respectively. Cutinase-N1 treatment resulted in relative increases of 11 and 29 % in the peak area when octanoic acid and vegetable oil were used as substrates, respectively. The production and application of cutinase fused with the domain N1 as a cellulose ester synthase, here reported for the first time, is therefore an interesting strategy to pursuit.This work was co-funded by the European Social Fund through the management authority POPH and FCT, Postdoctoral fellowship reference: SFRH/BPD/47555/2008. The authors also want to thank Doctor Raul Machado for his valuable help on FTIR spectral data treatment

Nematic phase transitions in mixtures of thin and thick colloidal rods

Published versio

Coupling ultracold atoms to mechanical oscillators

In this article we discuss and compare different ways to engineer an interface between ultracold atoms and micro- and nanomechanical oscillators. We start by analyzing a direct mechanical coupling of a single atom or ion to a mechanical oscillator and show that the very different masses of the two systems place a limit on the achievable coupling constant in this scheme. We then discuss several promising strategies for enhancing the coupling: collective enhancement by using a large number of atoms in an optical lattice in free space, coupling schemes based on high-finesse optical cavities, and coupling to atomic internal states. Throughout the manuscript we discuss both theoretical proposals and first experimental implementations.Comment: 19 pages, 9 figure

Dual Career of the U-23 Spanish Canoeing Team

We would like to thank the Royal Spanish Canoeing Federation, their coaches and paddlers for the time they have dedicated to making this study a success. In particular, to María Corbera Muñoz. We would also like to thank Maria Repice for her help with the English version of this manuscript.Canoeing is one of the sport disciplines that brings great success to Spain in international competitions and Olympic Games (of the 17 medals won in Rio in 2016, four were in this sport, including three gold). However, the journey to become an elite athlete coincides in time with the challenge of pursuing an academic education, which often involves making difficult choices in the training-university dichotomy. The aim of this research was to ascertain how the Spanish under-23 calm water canoeing team perceives their athletic and academic careers. The present study was carried out with the Spanish under-23 flat water canoeing team, the step prior to competition at the highest level. The study sample comprised the whole population, namely the entire national team, made up of 21 athletes (11 women and 10 men) with a mean age of 20.57 ± 2.64 years and 10.00 ± 3.49 years of experience. These athletes are usually based at La Cartuja High Performance Center (Seville) and combine their sports activity with studying toward a university degree. A double qualitative and quantitative methodology was used. For the first of these, an interview script was elaborated based on the theoretical model by Wylleman et al. (2013). Applicable consents were requested from the Spanish Royal Canoeing Federation, coaches and paddlers. Interviews were carried out with each athlete twice: at the beginning and at the end of the season/academic year, which were recorded and subsequently tabulated and analyzed. Concerning quantitative methodology, the ESTPORT dual career questionnaire validated by Sánchez-Pato et al. (2016) was used. The results show that for all the paddlers canoeing is very important. It is typically complicated for them to attend classes, and subject planning is usually based on their training schedules. In the second/last part of the course, it is stressful for these athletes to combine both activities and some drop out of school. During the course, though, they appreciate having another activity that allows them to escape from the training routine. In addition, they miss not having an academic tutor to guide and advise them. These student-athletes are aware that their sport causes them to miss out on many moments with family and friends due to training or competing. However, at present this is offset, largely because of their high level of performance, which makes it easier for them to obtain scholarships that provide economic support