Walls of Expression and Dark Murals Tourism

[EN] The west wall of the former St. George¿s town hall in London¿s East End is a giant vivid artwork. A riot of color to depict a protest turned violent public disorder: Blackshirts waving Union Jacks; people chanting from the barricades; milk bottles, tools, and fascist pamphlets flying through the air. Residents lean out of tenement windows. A man throws a punch at a policeman. A woman tips the contents of a chamber pot onto the marchers below. Mounted police maneuver horses, swing truncheons overhead. But, curiously, this mural is not seen as a symbol of violence, but as a symbol of solidarity and anti-fascism. Men, women, and children from different religions; immigrants from different nationalities; and even new faces fighting together against a potential enemy.This project has received funding from the Valencian Regional Government, Spain, during the visiting research period of professor De Miguel Molina at the University of Roehampton. Reference: BEST/2019/175. We would like to thank Julian Cole and David Rosenberg for their assistance and knowledge of the mural and its neighborhood. Our acknowledgement also to Natalie Konopinski for her support and advice during the process to reach an excellent result.De-Miguel-Molina, M.; Skinner, J. (2019). Walls of Expression and Dark Murals Tourism. Anthropology News. 60(6):3-6. https://doi.org/10.1111/AN.1310S3660

Training health care professionals in root cause analysis: a cross-sectional study of post-training experiences, benefits and attitudes

BACKGROUND: Root cause analysis (RCA) originated in the manufacturing engineering sector but has been adapted for routine use in healthcare to investigate patient safety incidents and facilitate organizational learning. Despite the limitations of the RCA evidence base, healthcare authorities and decision makers in NHS Scotland – similar to those internationally - have invested heavily in developing training programmes to build local capacity and capability, and this is a cornerstone of many organizational policies for investigating safety-critical issues. However, to our knowledge there has been no systematic attempt to follow-up and evaluate post-training experiences of RCA-trained staff in Scotland. Given the significant investment in people, time and funding we aimed to capture and learn from the reported experiences, benefits and attitudes of RCA-trained staff and the perceived impact on healthcare systems and safety. METHODS: We adapted a questionnaire used in a published Australian research study to undertake a cross sectional online survey of health care professionals (e.g. nursing & midwifery, medical doctors and pharmacists) formally trained in RCA by a single territorial health board region in NHS Scotland. RESULTS: A total of 228/469 of invited staff completed the survey (48%). A majority of respondents had yet to participate in a post-training RCA investigation (n=127, 55.7%). Of RCA-experience staff, 71 had assumed a lead investigator role (70.3%) on one or more occasions. A clear majority indicated that their improvement recommendations were generally or partly implemented (82%). The top three barriers to RCA success were cited as: lack of time (54.6%), unwilling colleagues (34%) and inter-professional differences (31%). Differences in agreement levels between RCA-experienced and inexperienced respondents were noted on whether a follow-up session would be beneficial after conducting RCA (65.3% v 39.4%) and if peer feedback on RCA reports would be of educational value (83.2% v 37.0%). Comparisons with the previous research highlighted significant differences such as less reported difficulties within RCA teams (P<0.001) and a greater proportion of respondents taking on RCA leadership roles in this study (P<0.001). CONCLUSION: This study adds to our knowledge and understanding of the need to improve the effectiveness of RCA training and frontline practices in healthcare settings. The overall evidence points to a potential organisational learning need to provide RCA-trained staff with continuous development opportunities and performance feedback. Healthcare authorities may wish to look more critically at whom they train in RCA, and how this is delivered and supported educationally to maximize cost-benefits, organizational learning and safer patient care

Hypoxaemia on arrival in a multidisciplinary intensive care unit

Background. Transport of the critically ill patient poses the risk of numerous complications. Hypoxaemia is one such serious adverse event and is associated with potential morbidity and mortality. It is, however, potentially preventable.Objective. To determine the incidence of hypoxaemia on arrival in a tertiary multidisciplinary intensive care unit (ICU) and to identify risk factors for this complication.Method. A retrospective observational study was conducted at King Edward VIII Hospital, Durban, South Africa, from May 2013 to February 2014.Results. Hypoxaemia occurred in 15.5% of admissions sampled. Statistically significant risk factors for hypoxaemia on univariate analysis (p&lt;0.05) included lack of peripheral capillary oxygen saturation (SpO2) monitoring, transfer by an intern as opposed to other medical/ paramedical staff, and transfer from internal medicine. Use of neuromuscular blockers and transfer from theatre were protective. Binary logistic regression analysis revealed lack of SpO2 monitoring to be the only significant independent predictor of hypoxaemia (odds ratio 6.1; 95% confidence interval 1.5 - 24.5; p=0.02).Conclusion. Hypoxaemia is common on admission to the ICU and may be prevented by simple interventions such as appropriate transport monitoring

SUPPLY RESPONSE UNDER THE 1996 FARM ACT AND IMPLICATIONS FOR THE U.S. FIELD CROPS SECTOR

The 1996 Farm Act gives farmers almost complete planting flexibility, allowing producers to respond to price changes to a greater extent than they had under previous legislation. This study measures supply responsiveness for major field crops to changes in their own prices and in prices for competing crops and indicates significant increases in responsiveness. Relative to 1986-90, the percentage increases in the responsiveness of U.S. plantings of major field crops to a 1-percent change in their own prices are wheat (1.2 percent), corn (41.6 percent), soybeans (13.5 percent), and cotton (7.9 percent). In percentage terms, the increases in the responsiveness generally become greater with respect to competing crops' price changes. The 1996 legislation has the least effect on U.S. wheat acreage, whereas the law may lead to an average increase of 2 million acres during 1996-2005 in soybean acreage, a decline of 1-2 million acres in corn acreage, and an increase of 0.7 million acres in cotton acreage. Overall, the effect of the farm legislation on regional production patterns of major field crops appears to be modest. Corn acreage expansion in the Central and Northern Plains, a long-term trend in this important wheat production region, will slow under the 1996 legislation, while soybean acreage expansion in this region will accelerate. The authors used the Policy Analysis System-Economic Research Service (POLYSYS-ERS) model that was jointly developed by USDA's Economic Research Service and the University of Tennessee's Agricultural Policy Analysis Center to estimate the effects of the 1996 legislation.Supply response, major field crops, acreage price elasticities, normal flex acreage (NFA), 1996 farm legislation., Agricultural and Food Policy, Crop Production/Industries,

Procalcitonin kinetics in the first 48 hours of ICU admission is associated with higher mortality in critically ill patients with community-acquired pneumonia in a setting of high HIV prevalence

Background: Severe community acquired pneumonia (CAP) commonly results in ICU admission and is associated with significant morbidity and mortality. Procalcitonin (PCT) may assist risk stratification and prediction of aetiology but is not well studied in critically ill patients with a high HIV prevalence.Methods: A retrospective observational study of patients admitted to ICU with a clinical diagnosis of CAP was undertaken. PCT on admission and at 48 hours was evaluated as a predictor of ICU outcome and pneumonia aetiology.Results: A total of 100 patients were included; 62% were HIV positive. Overall ICU mortality was 61%. PCT at admission and 48 hours was not associated with any outcome variables. A significant association was found between mortality and patients whose PCT levels increased or remained &gt;10 ng/ml at 48 hours, compared with those that remained unchanged or decreased (67% vs. 41% p = 0.018). The commonest aetiology identified was Mycobacterium tuberculosis (n = 18, 21.4%). Patients with admission PCT levels &gt;10 ng/ml were more likely to have positive bacterial cultures (OR = 3.14; 95% CI 1.11–9.73).Conclusions: Increasing or persistently elevated PCT predicts a higher mortality in critically ill patients with CAP. This suggests PCT kinetics may be useful in risk stratifying patients with CAP at 48 hours. While positive bacterial cultures are more likely in patients with high admission PCT, this assay does not allow for decisions to be made on antimicrobial management and is of limited clinical utility in critically ill patients with a high HIV prevalence and CAP.Keywords: critical care, procalcitonin, intensive care, prognosis, severe community acquired pneumoni

Early catecholamine dose as a predictor of outcome among patients in a multidisciplinary intensive care unit

Background. Vasoactive and/or inotropic agents are used in the management of patients with circulatory shock. It is a clinical perception that mortality in critically ill patients increases with increasing doses of inotropes and/or vasopressors; however, the clinical significance of catecholamine doses early in the management of critically ill patients has not been investigated well, especially in the South African (SA) context. Arbitrary ‘maximum’ doses of catecholamine therapy are used that are not evidence based. This study will help clinicians by either showing that there is no clear cut-off beyond which survival is unlikely or by identifying a dose of inotropic support above which survival is unlikely. This article provides clinicians with an evidence base against which to direct their therapy.Objectives. To describe the inotropic prescribing practices in a heterogeneous population of shocked critically ill patients in a tertiary intensive care unit (ICU) in SA, establish an association between inotropic dose and outcome and ascertain the nature of this association.Methods. This was a retrospective observational study of 189 patients admitted to a multidisciplinary academic ICU. The admission, 24-hour and maximum inotrope doses were collected and analysed, and these and other biochemical and clinical parameters were evaluated as predictors of mortality.Results. A total of 189 patients met the study inclusion criteria. The overwhelming majority of patients (99%) received adrenaline, with only 7% of those requiring inotropes receiving noradrenaline. Median inotrope dose at admission, 24-hour dose and maximum dose in the first 24 hours were all significantly higher in non-survivors than survivors. ICU mortality increased with increasing inotrope dose, and an inotrope dose ≥60 μg/min on admission was associated with an ICU mortality of 89%, with the same cut-off at 24 hours being associated with a mortality of 89%. Survivors at doses &gt;80 μg/min were only noted among trauma patients.Conclusions. High early inotrope doses are associated with increasing ICU mortality. The findings highlight the need for further research on the clinical use of inotrope dose in risk stratification in the critical care environment. The current results call into question the routine provision of high-dose inotropic support in non-trauma patients

X-Ray Emission from Young Stars in the Massive Star Forming Region IRAS 20126+4104

We present a $40\,$ks Chandra observation of the IRAS$\,$20126+4104 core region. In the inner $6^{\prime\prime}$ two X-ray sources were detected, which are coincident with the radio jet source I20S and the variable radio source I20Var. No X-ray emission was detected from the nearby massive protostar I20N. The spectra of both detected sources are hard and highly absorbed, with no emission below $3\,$keV. For I20S, the measured $0.5-8\,$keV count rate was $4.3\,$cts$\,$ks$^{-1}$. The X-ray spectrum was fit with an absorbed 1T APEC model with an energy of kT$\,=10\,$keV and an absorbing column of N$_H = 1.2\times 10^{23}\,$cm$^{-2}$. An unabsorbed X-ray luminosity of about $1.4\times 10^{32}\,$erg$\,$s$^{-1}$ was estimated. The spectrum shows broad line emission between 6.4 and 6.7\, keV, indicative of emission from both neutral and highly ionized iron. The X-ray lightcurve indicates that I20S is marginally variable; however, no flare emission was observed. The variable radio source I20Var was detected with a count rate of $0.9\,$cts$\,$ks$^{-1}$ but there was no evidence of X-ray variability. The best fit spectral model is a 1T APEC model with an absorbing hydrogen column of N$_H = 1.1\times 10^{23}\,$cm$^{-2}$ and a plasma energy of kT = 6.0$\,$keV. The unabsorbed X-ray luminosity is about $3\times 10^{31}\,$erg$\,$s$^{-1}$.Comment: 17pages, 4 figures to appear in Astronomical Journa

Application of Optimal Control to CPMG Refocusing Pulse Design

We apply optimal control theory (OCT) to the design of refocusing pulses suitable for the CPMG sequence that are robust over a wide range of B0 and B1 offsets. We also introduce a model, based on recent progress in the analysis of unitary dynamics in the field of quantum information processing (QIP), that describes the multiple refocusing dynamics of the CPMG sequence as a dephasing Pauli channel. This model provides a compact characterization of the consequences and severity of residual pulse errors. We illustrate the methods by considering a specific example of designing and analyzing broadband OCT refocusing pulses of length 10 t180 that are constrained by the maximum instantaneous pulse power. We show that with this refocusing pulse, the CPMG sequence can refocus over 98% of magnetization for resonance offsets up to 3.2 times the maximum RF amplitude, even in the presence of +/- 10% RF inhomogeneity.Comment: 23 pages, 10 figures; Revised and reformatted version with new title and significant changes to Introduction and Conclusions section

X-rays from Colliding Stellar Winds: the case of close WR+O binary systems

We have analysed the X-ray emission from a sample of close WR+O binaries using data from the public Chandra and XMM-Newton archives. Global spectral fits show that two-temperature plasma is needed to match the X-ray emission from these objects as the hot component (kT > 2 keV) is an important ingredient of the spectral models. In close WR+O binaries, X-rays likely originate in colliding stellar wind (CSW) shocks driven by the massive winds of the binary components. CSW shocks in these objects are expected to be radiative due to the high density of the plasma in the interaction region. Opposite to this, our analysis shows that the CSW shocks in the sample of close WR+O binaries are adiabatic. This is possible only if the mass-loss rates of the stellar components in the binary are at least one order of magnitude smaller than the values currently accepted. The most likely explanation for the X-ray properties of close WR+O binaries could be that their winds are two-component flows. The more massive component (dense clumps) play role for the optical/UV emission from these objects, while the smooth rarefied component is a key factor for their X-ray emission.Comment: MNRAS, accepted for publication (Feb 6, 2012); 13 pages, 6 figures, 3 table

Evidence for water-mediated mechanisms in coral-algal interactions

Although many coral reefs have shifted from coral-to-algal dominance, the consequence of such a transition for coral algal interactions and their underlying mechanisms remain poorly understood. At the microscale, it is unclear how diffusive boundary layers (DBLs) and surface oxygen concentrations at the coral algal interface vary with algal competitors and competitiveness. Using field observations and microsensor measurements in a flow chamber, we show that coral (massive Porites) interfaces with thick turf algae, macro algae, and cyanobacteria, which are successful competitors against coral in the field, are characterized by a thick DBL and hypoxia at night. In contrast, coral interfaces with crustose coralline algae, conspecifics, and thin turf algae, which are poorer competitors, have a thin DBL and low hypoxia at night. Furthermore, DBL thickness and hypoxia at the interface with turf decreased with increasing flow speed, but not when thick turf was upstream. Our results support the importance of water-mediated transport mechanisms in coral algal interactions. Shifts towards algal dominance, particularly dense assemblages, may lead to thicker DBLs, higher hypoxia, and higher concentrations of harmful metabolites and pathogens along coral borders, which in turn may facilitate algal overgrowth of live corals. These effects may be mediated by flow speed and orientation