The development of a nursing subset of patient problems to support interoperability

Since the emergence of electronic health records, nursing information is increasingly being recorded and stored digitally. Several studies have shown that a wide range of nursing information is not interoperable and cannot be re-used in different health contexts. Difficulties arise when nurses share information with others involved in the delivery of nursing care. The aim of this study is to develop a nursing subset of patient problems that are prevalent in nursing practice, based on the SNOMED CT terminology to assist in the exchange and comparability of nursing information. Explorative qualitative focus groups were used to collect data. Mixed focus groups were defined. Additionally, a nursing researcher and a nursing expert with knowledge of terminologies and a terminologist participated in each focus group. The participants, who work in a range of practical contexts, discussed and reviewed patient problems from various perspectives. Sixty-seven participants divided over seven focus groups selected and defined 119 patient problems. Each patient problem could be documented and coded with a current status or an at-risk status. Sixty-six percent of the patient problems included are covered by the definitions established by the International Classification of Nursing Practice, the reference terminology for nursing practice. For the remainder, definitions from either an official national guideline or a classification were used. Each of the 119 patient problems has a unique SNOMED CT identifier. To support the interoperability of nursing information, a national nursing subset of patient problems based on a terminology (SNOMED CT) has been developed. Using unambiguously defined patient problems is beneficial for clinical nursing practice, because nurses can then compare and exchange information from different settings. A key strength of this study is that nurses were extensively involved in the development process. Further research is required to link or associate nursing patient problems to concepts from a nursing classification with the same meaning

Rapid Late Pleistocene climate change reconstructed from a lacustrine ostracod record in central Italy (Lake Trasimeno, Umbria)

© 2020 Collegium Boreas. Published by John Wiley & Sons Ltd This study presents, for the first time, a detailed quantitative reconstruction of winter (January) and summer (July) palaeotemperatures from the Late Pleistocene to Holocene transition in central Italy based on ostracod assemblages in an 8.59-m-long sediment core retrieved in Lake Trasimeno. Of 19 ostracod species recovered, 13 were calibrated according to their living temperature ranges, enabling us to reconstruct mean January and July temperature ranges using the mutual ostracod temperature range (MOTR) method. The occurrences of Cytheromorpha fuscata and Limnocythere suessenbornensis from 44 000 to 25 500 cal. a BP showed mean January temperatures at least 7 °C colder and mean July temperature at least 1 °C cooler in some intervals compared to present-day temperatures. Comparison of the MOTR-derived January minima curve with a Greenland oxygen isotope record (NGRIP) shows a remarkable correlation of warmer Greenland Interstadial and the colder Greenland Stadial events with clear peaks and troughs in the MOTR signal. These correlations were tested successfully by tuning the MOTR curve to the NGRIP record, resulting in an improved age-depth model combining radiocarbon ages with MOTR tie points. The results demonstrate that a record of rapid climate change in the North Atlantic region is archived in lacustrine ostracod assemblages in central Italy

Implementing complete smokefree policies in mental health inpatient settings Results from a before and after mixed-methods evaluation : results from a before and after mixed-methods evaluation

Abstract Background Tobacco smoking is extremely prevalent in people with severe mental illness (SMI) and has been recognised as the main contributor to widening health inequalities in this population. Historically, smoking has been deeply entrenched in the culture of mental health settings in the UK, and until recently, smokefree policies tended to be only partially implemented. However, recent national guidance and the government’s tobacco control plan now call for the implementation of complete smokefree policies. Many mental health Trusts across the UK are currently in the process of implementing the new guidance, but little is known about the impact of and experience with policy implementation. Methods This paper reports findings from a mixed-methods evaluation of policy implementation across 12 wards in a large mental health Trust in England. Quantitative data were collected and compared before and after implementation of NICE guidance PH48 and referred to 1) identification and treatment of tobacco dependence, 2) smoking-related incident reporting, and 3) prescribing of psychotropic medication. A qualitative exploration of the experience of inpatients was also carried out. Descriptive statistical analyses were performed, and the feasibility of collecting relevant and complete data for each quantitative component was assessed. Qualitative data were analysed using thematic framework analysis. Results Following implementation of the complete smokefree policy, increases in the numbers of patients offered smoking cessation advice (72% compared to 38%) were identified. While incident reports demonstrated a decrease in challenging behaviour during the post-PH48 period (6% compared to 23%), incidents relating to the concealment of smoking materials increased (10% compared to 2%). Patients reported encouraging changes in smoking behaviour and motivation to maintain change after discharge. However, implementation issues challenging full policy implementation, including covert facilitation of smoking by staff, were reported, and difficulties in collecting relevant and complete data for comprehensive evaluation purposes identified. Conclusions Overall, the implementation of complete smokefree policies in mental health settings may currently be undermined by partial support. Strategies to enhance support and the establishment of suitable data collection pathways to monitor progress are required

The Cosmic-Ray Proton and Helium Spectra measured with the CAPRICE98 balloon experiment

A new measurement of the primary cosmic-ray proton and helium fluxes from 3 to 350 GeV was carried out by the balloon-borne CAPRICE experiment in 1998. This experimental setup combines different detector techniques and has excellent particle discrimination capabilities allowing clear particle identification. Our experiment has the capability to determine accurately detector selection efficiencies and systematic errors associated with them. Furthermore, it can check for the first time the energy determined by the magnet spectrometer by using the Cherenkov angle measured by the RICH detector well above 20 GeV/n. The analysis of the primary proton and helium components is described here and the results are compared with other recent measurements using other magnet spectrometers. The observed energy spectra at the top of the atmosphere can be represented by (1.27+-0.09)x10^4 E^(-2.75+-0.02) particles (m^2 GeV sr s)^-1, where E is the kinetic energy, for protons between 20 and 350 GeV and (4.8+-0.8)x10^2 E^(-2.67+-0.06) particles (m^2 GeV nucleon^-1 sr s)^-1, where E is the kinetic energy per nucleon, for helium nuclei between 15 and 150 GeV nucleon^-1.Comment: To be published on Astroparticle Physics (44 pages, 13 figures, 5 tables

Clustering and descendants of MUSYC galaxies at z<1.5

We measure the evolution of galaxy clustering out to a redshift of z~1.5 using data from two MUSYC fields, the Extended Hubble Deep Field South (EHDF-S) and the Extended Chandra Deep Field South (ECDF-S). We use photometric redshift information to calculate the projected-angular correlation function, omega(sigma), from which we infer the projected correlation function Xi(sigma). We demonstrate that this technique delivers accurate measurements of clustering even when large redshift measurement errors affect the data. To this aim we use two mock MUSYC fields extracted from a LambdaCDM simulation populated with GALFORM semi-analytic galaxies which allow us to assess the degree of accuracy of our estimates of Xi(sigma) and to identify and correct for systematic effects in our measurements. We study the evolution of clustering for volume limited subsamples of galaxies selected using their photometric redshifts and rest-frame r-band absolute magnitudes. We find that the real-space correlation length r_0 of bright galaxies, M_r<-21 (rest-frame) can be accurately recovered out to z~1.5, particularly for ECDF-S given its near-infrared photometric coverage. There is mild evidence for a luminosity dependent clustering in both fields at the low redshift samples (up to =0.57), where the correlation length is higher for brighter galaxies by up to 1Mpc/h between median rest-frame r-band absolute magnitudes of -18 to -21.5. As a result of the photometric redshift measurement, each galaxy is assigned a best-fit template; we restrict to E and E+20%Sbc types to construct subsamples of early type galaxies (ETGs). Our ETG samples show a strong increase in r_0 as the redshift increases, making it unlikely (95% level) that ETGs at median redshift z_med=1.15 are the direct progenitors of ETGs at z_med=0.37 with equivalent passively evolved luminosities. (ABRIDGED)Comment: 16 pages, 12 figures, 2 tables, accepted for publication in MNRA

ALMA Long Baseline Observations of the Strongly Lensed Submillimeter Galaxy HATLAS J090311.6+003906 at z=3.042

We present initial results of very high resolution Atacama Large Millimeter/submillimeter Array (ALMA) observations of the $z$=3.042 gravitationally lensed galaxy HATLAS J090311.6+003906 (SDP.81). These observations were carried out using a very extended configuration as part of Science Verification for the 2014 ALMA Long Baseline Campaign, with baselines of up to 15 km. We present continuum imaging at 151, 236 and 290 GHz, at unprecedented angular resolutions as fine as 23 milliarcseconds (mas), corresponding to an un-magnified spatial scale of ~180 pc at z=3.042. The ALMA images clearly show two main gravitational arc components of an Einstein ring, with emission tracing a radius of ~1.5". We also present imaging of CO(10-9), CO(8-7), CO(5-4) and H2O line emission. The CO emission, at an angular resolution of ~170 mas, is found to broadly trace the gravitational arc structures but with differing morphologies between the CO transitions and compared to the dust continuum. Our detection of H2O line emission, using only the shortest baselines, provides the most resolved detection to date of thermal H2O emission in an extragalactic source. The ALMA continuum and spectral line fluxes are consistent with previous Plateau de Bure Interferometer and Submillimeter Array observations despite the impressive increase in angular resolution. Finally, we detect weak unresolved continuum emission from a position that is spatially coincident with the center of the lens, with a spectral index that is consistent with emission from the core of the foreground lensing galaxy.Comment: 9 pages, 5 figures and 3 tables, accepted for publication in the Astrophysical Journal Letter

Systems analysis of bioenergetics and growth of the extreme halophile Halobacterium salinarum

Halobacterium salinarum is a bioenergetically flexible, halophilic microorganism that can generate energy by respiration, photosynthesis, and the fermentation of arginine. In a previous study, using a genome-scale metabolic model, we have shown that the archaeon unexpectedly degrades essential amino acids under aerobic conditions, a behavior that can lead to the termination of growth earlier than necessary. Here, we further integratively investigate energy generation, nutrient utilization, and biomass production using an extended methodology that accounts for dynamically changing transport patterns, including those that arise from interactions among the supplied metabolites. Moreover, we widen the scope of our analysis to include phototrophic conditions to explore the interplay between different bioenergetic modes. Surprisingly, we found that cells also degrade essential amino acids even during phototropy, when energy should already be abundant. We also found that under both conditions considerable amounts of nutrients that were taken up were neither incorporated into the biomass nor used as respiratory substrates, implying the considerable production and accumulation of several metabolites in the medium. Some of these are likely the products of forms of overflow metabolism. In addition, our results also show that arginine fermentation, contrary to what is typically assumed, occurs simultaneously with respiration and photosynthesis and can contribute energy in levels that are comparable to the primary bioenergetic modes, if not more. These findings portray a picture that the organism takes an approach toward growth that favors the here and now, even at the cost of longer-term concerns. We believe that the seemingly "greedy" behavior exhibited actually consists of adaptations by the organism to its natural environments, where nutrients are not only irregularly available but may altogether be absent for extended periods that may span several years. Such a setting probably predisposed the cells to grow as much as possible when the conditions become favorable

ALMA Observations of Asteroid 3 Juno at 60 Kilometer Resolution

We present Atacama Large Millimeter/submillimeter Array (ALMA) 1.3 mm continuum images of the asteroid 3 Juno obtained with an angular resolution of 0.042 arcseconds (60 km at 1.97 AU). The data were obtained over a single 4.4 hr interval, which covers 60% of the 7.2 hr rotation period, approximately centered on local transit. A sequence of ten consecutive images reveals continuous changes in the asteroid's profile and apparent shape, in good agreement with the sky projection of the three-dimensional model of the Database of Asteroid Models from Inversion Techniques. We measure a geometric mean diameter of 259pm4 km, in good agreement with past estimates from a variety of techniques and wavelengths. Due to the viewing angle and inclination of the rotational pole, the southern hemisphere dominates all of the images. The median peak brightness temperature is 215pm13 K, while the median over the whole surface is 197pm15 K. With the unprecedented resolution of ALMA, we find that the brightness temperature varies across the surface with higher values correlated to the subsolar point and afternoon areas, and lower values beyond the evening terminator. The dominance of the subsolar point is accentuated in the final four images, suggesting a reduction in the thermal inertia of the regolith at the corresponding longitudes, which are possibly correlated to the location of the putative large impact crater. These results demonstrate ALMA's potential to resolve thermal emission from the surface of main belt asteroids, and to measure accurately their position, geometric shape, rotational period, and soil characteristics.Comment: 8 pages, 3 figures, 2 tables, accepted for publication in the Astrophysical Journal Letter