The ABC of handover: a qualitative study to develop a new tool for handover in the emergency department.

Objectives This study identifies best practice for shift handover and introduces a new tool used to hand over clinical and operational issues at the end of a shift in the emergency department (ED). Methods Literature review, semi-structured interviews and observations of handover were used to develop a standardised process for handover. Participants were ED middle grades, consultants and senior nurses. Interviews were used to identify agreed best practice and derive a tool to classify the information into relevant sections. Results Interviews identified a variety of perceived current deficits in handover including a lack of standardised practice and structure. Participants provided examples of poor handover that were thought to have led to adverse events; these included delay in investigations and treatment for patients who were handed over with brief or inaccurate information. There was wide variation in the understanding of the meaning and purpose of shift handover, and differences were apparent according to the level of experience of the middle grades interviewed. The experts' responses were used to reach a unifying ‘best practice’ for the content of handover. This was then grouped under ABCDE headings to develop the ABC of handover tool. Conclusions A simple tool was developed to provide the basis for medical shift handover, which includes clinical and operational information necessary for efficiency and organisation of the next shift. The ABC of handover classifies shift information to be handed over under the ABCDE headings, which are easy to remember and highly relevant to emergency medicine

Gestational Age at Delivery and Doppler Waveforms in Very Preterm Intrauterine Growth‐Restricted Fetuses as Predictors of Perinatal Mortality

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/135288/1/jum2007265555.pd

Fitting the Phenomenological MSSM

We perform a global Bayesian fit of the phenomenological minimal supersymmetric standard model (pMSSM) to current indirect collider and dark matter data. The pMSSM contains the most relevant 25 weak-scale MSSM parameters, which are simultaneously fit using `nested sampling' Monte Carlo techniques in more than 15 years of CPU time. We calculate the Bayesian evidence for the pMSSM and constrain its parameters and observables in the context of two widely different, but reasonable, priors to determine which inferences are robust. We make inferences about sparticle masses, the sign of the $\mu$ parameter, the amount of fine tuning, dark matter properties and the prospects for direct dark matter detection without assuming a restrictive high-scale supersymmetry breaking model. We find the inferred lightest CP-even Higgs boson mass as an example of an approximately prior independent observable. This analysis constitutes the first statistically convergent pMSSM global fit to all current data.Comment: Added references, paragraph on fine-tunin

Effect of energy spectrum law on clustering patterns for inertial particles subjected to gravity in Kinematic Simulation

We study the clustering of inertial particles using a periodic kinematic simulation. Particles clustering is observed for different pairs of Stokes number and Froude number and different spectral power laws (1.4 6 p 6 2.1). The main focus is to identify and then quantify the effect of p on the clustering attractor - by attractor we mean the set of points in the physical space where the particles settle when time tends to infinity. It is observed that spectral power laws can have a dramatic effect on the attractor shape. In particular, we observed a new attractor type which was not present in previous studies for Kolmogorov spectra (p = 5/3)

Anisotropic Dirac fermions in a Bi square net of SrMnBi2

We report the highly anisotropic Dirac fermions in a Bi square net of SrMnBi2, based on a first principle calculation, angle resolved photoemission spectroscopy, and quantum oscillations for high-quality single crystals. We found that the Dirac dispersion is generally induced in the (SrBi)+ layer containing a double-sized Bi square net. In contrast to the commonly observed isotropic Dirac cone, the Dirac cone in SrMnBi2 is highly anisotropic with a large momentum-dependent disparity of Fermi velocities of ~ 8. These findings demonstrate that a Bi square net, a common building block of various layered pnictides, provide a new platform that hosts highly anisotropic Dirac fermions.Comment: 5 pages, 4 figure

Olfactory Proxy Detection of Dietary Antioxidants in Drosophila

SummaryBackgroundDietary antioxidants play an important role in preventing oxidative stress. Whether animals in search of food or brood sites are able to judge the antioxidant content, and if so actively seek out resources with enriched antioxidant content, remains unclear.ResultsWe show here that the vinegar fly Drosophila melanogaster detects the presence of hydroxycinnamic acids (HCAs)—potent dietary antioxidants abundant in fruit—via olfactory cues. Flies are unable to smell HCAs directly but are equipped with dedicated olfactory sensory neurons detecting yeast-produced ethylphenols that are exclusively derived from HCAs. These neurons are housed on the maxillary palps, express the odorant receptor Or71a, and are necessary and sufficient for proxy detection of HCAs. Activation of these neurons in adult flies induces positive chemotaxis, oviposition, and increased feeding. We further demonstrate that fly larvae also seek out yeast enriched with HCAs and that larvae use the same ethylphenol cues as the adults but rely for detection upon a larval unique odorant receptor (Or94b), which is co-expressed with a receptor (Or94a) detecting a general yeast volatile. We also show that the ethylphenols act as reliable cues for the presence of dietary antioxidants, as these volatiles are produced—upon supplementation of HCAs—by a wide range of yeasts known to be consumed by flies.ConclusionsFor flies, dietary antioxidants are presumably important to counteract acute oxidative stress induced by consumption or by infection by entomopathogenic microorganisms. The ethylphenol pathway described here adds another layer to the fly’s defensive arsenal against toxic microbes

The importance of the weak: Interaction modifiers in artificial spin ices

The modification of geometry and interactions in two-dimensional magnetic nanosystems has enabled a range of studies addressing the magnetic order, collective low-energy dynamics, and emergent magnetic properties, in e.g. artificial spin ice structures. The common denominator of all these investigations is the use of Ising-like mesospins as building blocks, in the form of elongated magnetic islands. Here we introduce a new approach: single interaction modifiers, using slave-mesospins in the form of discs, within which the mesospin is free to rotate in the disc plane. We show that by placing these on the vertices of square artificial spin ice arrays and varying their diameter, it is possible to tailor the strength and the ratio of the interaction energies. We demonstrate the existence of degenerate ice-rule obeying states in square artificial spin ice structures, enabling the exploration of thermal dynamics in a spin liquid manifold. Furthermore, we even observe the emergence of flux lattices on larger length-scales, when the energy landscape of the vertices is reversed. The work highlights the potential of a design strategy for two-dimensional magnetic nano-architectures, through which mixed dimensionality of mesospins can be used to promote thermally emergent mesoscale magnetic states.Comment: 17 pages, including methods, 4 figures. Supplementary information contains 16 pages and 15 figure

A unique bacteriohopanetetrol stereoisomer of marine anammox

Anaerobic ammonium oxidation (anammox) is a major process of bioavailable nitrogen removal from marine systems. Previously, a bacteriohopanetetrol (BHT) isomer, with unknown stereochemistry, eluting later than BHT using high performance liquid chromatography (HPLC), was detected in ‘Ca. Scalindua profunda’ and proposed as a biomarker for anammox in marine paleo-environments. However, the utility of this BHT isomer as an anammox biomarker is hindered by the fact that four other, non-anammox bacteria are also known to produce a late-eluting BHT stereoisomer. The stereochemistry in Acetobacter pasteurianus, Komagataeibacter xylinus and Frankia sp. was known to be 17β, 21β(H), 22R, 32R, 33R, 34R (BHT-34R). The stereochemistry of the late-eluting BHT in Methylocella palustris was unknown. To determine if marine anammox bacteria produce a unique BHT isomer, we studied the BHT distributions and stereochemistry of known BHT isomer producers and of previously unscreened marine (‘Ca. Scalindua brodeae’) and freshwater (‘Ca. Brocadia sp.’) anammox bacteria using HPLC and gas chromatographic (GC) analysis of acetylated BHTs and ultra high performance liquid chromatography (UHPLC)-high resolution mass spectrometry (HRMS) analysis of non-acetylated BHTs. The 34R stereochemistry was confirmed for the BHT isomers in Ca. Brocadia sp. and Methylocella palustris. However, ‘Ca. Scalindua sp.’ synthesise a stereochemically distinct BHT isomer, with still unconfirmed stereochemistry (BHT-x). Only GC analysis of acetylated BHT and UHPLC analysis of non-acetylated BHT distinguished between late-eluting BHT isomers. Acetylated BHT-x and BHT-34R co-elute by HPLC. As BHT-x is currently only known to be produced by ‘Ca. Scalindua spp.’, it may be a biomarker for marine anammox