The Australian Incident Monitoring Study in Intensive Care: AIMS-ICU. The development and evaluation of an incident reporting system in intensive care

Publisher's copy made available with the permission of the publisher © 1996 Australian Society of AnaesthetistsIntensive care units are complex, dynamic patient management environments. Incidents and accidents can be caused by human error, by problems inherent in complex systems, or by a combination of these. Study objectives were to develop and evaluate an incident reporting system. A report form was designed eliciting a description of the incident, contextual information and contributing factors. Staff group sessions using open-ended questions, observations in the workplace and a review of earlier narratives were used to develop the report form. Three intensive care units participated in a two-month evaluation study. Feedback questionnaires were used to assess staff attitudes and understanding, project design and organization. These demonstrated a positive attitude and good understanding by more than 90% participants. Errors in communication, technique, problem recognition and charting were the predisposing factors most commonly chosen in the 128 incidents reported. It was concluded that incident monitoring may be a suitable technique for improving patient safety in intensive care.U. Beckman, L.F. West, G.J. Groombridge, I. Baldwin, G.K. Hart, D.G. Clayton, R.K. Webb, W.B. Runcima

Diffusive electron acceleration at SNR shock fronts and the observed SNR radio spectral indices

The radio synchrotron emission from relativistic electrons in shell supernova remnants (SNRs) provides a unique opportunity to probe the energy distribution of energetic electrons at their acceleration site (SNR shock fronts). This information provides insight into the acceleration mechanism(s). The implications of these observations for the diffusive (first-order Fermi) acceleration of electrons at the SNR shock fronts are discussed

The Density Spike in Cosmic-Ray-Modified Shocks: Formation, Evolution, and Instability

We examine the formation and evolution of the density enhancement (density spike) that appears downstream of strong, cosmic-ray-modified shocks. This feature results from temporary overcompression of the flow by the combined cosmic-ray shock precursor/gas subshock. Formation of the density spike is expected whenever shock modification by cosmic-ray pressure increases strongly. That occurence may be anticipated for newly generated strong shocks or for cosmic-ray-modified shocks encountering a region of higher external density, for example. The predicted mass density within the spike increases with the shock Mach number and with shocks more dominated by cosmic-ray pressure. We find this spike to be linearly unstable under a modified Rayleigh-Taylor instability criterion at the early stage of its formation. We confirm this instability numerically using two independent codes based on the two-fluid model for cosmic-ray transport. These two-dimensional simulations show that the instability grows impulsively at early stages and then slows down as the gradients of total pressure and gas density decrease. Observational discovery of this unstable density spike behind shocks, possibly through radio emission enhanced by the amplified magnetic fields would provide evidence for the existence of strongly cosmic-ray modified shock structures.Comment: 26 pages in Latex and 6 figures. Accepted to Ap

Fabrication and properties of gallium phosphide variable colour displays

The unique properties of single-junction gallium phosphide devices incorporating both red and green radiative recombination centers were investigated in application to the fabrication of monolithic 5 x 7 displays capable of displaying symbolic and alphanumeric information in a multicolor format. A number of potentially suitable material preparation techniques were evaluated in terms of both material properties and device performance. Optimum results were obtained for double liquid-phase-epitaxial process in which an open-tube dipping technique was used for n-layer growth and a sealed tipping procedure for subsequent p-layer growth. It was demonstrated that to prepare devices exhibiting a satisfactory range of dominant wavelengths which can be perceived as distinct emission colors extending from the red through green region of the visible spectrum involves a compromise between the material properties necessary for efficient red emission and those considered optimum for efficient green emission

Group classification of the two-dimensional magnetogasdynamics equations in Lagrangian coordinates

The present paper is devoted to the group classification of magnetogasdynamics equations in which dependent variables in Euler coordinates depend on time and two spatial coordinates. It is assumed that the continuum is inviscid and nonthermal polytropic gas with infinite electrical conductivity. The equations are considered in mass Lagrangian coordinates. Use of Lagrangian coordinates allows reducing number of dependent variables. The analysis presented in this article gives complete group classification of the studied equations. This analysis is necessary for constructing invariant solutions and conservation laws on the base of Noether's theorem

HST and Spitzer imaging of red and blue galaxies at z~2.5: A correlation between size and star formation activity from compact quiescent galaxies to extended star forming galaxies

We present HST NICMOS+ACS and Spitzer IRAC+MIPS observations of 41 galaxies at 2<z<3.5 in the FIRES MS1054 field with red and blue rest-frame optical colors. About half of the galaxies are very compact (effective radii r_e < 1 kpc) at rest-frame optical wavelengths, the others are extended (1< r_e < 10 kpc). For reference, 1 kpc corresponds to 0.12 arcsec at z=2.5 in the adopted cosmology. We separate actively star forming galaxies from quiescent galaxies by modeling their rest-frame UV-NIR SEDs. The star forming galaxies span the full range of sizes, while the quiescent galaxies all have r_e<2kpc. In the redshift range where MIPS 24 micron imaging is a sensitive probe of re-radiated dust emission (z<2.5), the 24 micron fluxes confirm that the light of the small quiescent galaxies is dominated by old stars, rather than dust-enshrouded star formation or AGN activity. The inferred surface mass densities and velocity dispersions for the quiescent galaxies are very high compared to those in local galaxies. The galaxies follow a Kormendy relation (between surface brightness and size) with approximately the same slope as locally, but shifted to brighter surface brightnesses, consistent with a mean stellar formation redshift of z_f~5. This paper demonstrates a direct relation between star formation activity and size at z~2.5, and the existence of a significant population of massive, extremely dense, old stellar systems without readily identifiable counterparts in the local universe.Comment: Accepted for publication in Ap

The Case for a Heat-Pipe Phase of Planet Evolution on the Moon

The prevalence of anorthosite in the lunar highlands is generally attributed to the flotation of less dense plagioclase in the late stages of the solidification of the lunar magma ocean. It is not clear, however, that these models are capable of producing the extremely high plagioclase contents (near 100%) observed in both Apollo samples and remote sensing data, since a mostly solid lithosphere forms (at 60-70% solidification) before plagioclase feldspar reaches saturation (at approximately 80% solidification). Formation as a floating cumulate is made even more problematic by the near uniformity of the alkali composition of the plagioclase, even as the mafic phases record significant variations in Mg/(Mg+Fe) ratios. These problems can be resolved for the Moon if the plagioclase-rich crust is produced and refined through a widespread episode of heat-pipe magmatism rather than a process dominated by density-driven plagioclase flotation. Heat-pipes are an important feature of terrestrial planets at high heat flow, as illustrated by Io's present activity. Evidence for their operation early in Earth's history suggests that all terrestrial bodies should experience an early episode of heat-pipe cooling. As the Moon likely represents the most wellpreserved example of early planetary thermal evolution in our solar system, studies of the lunar surface and of lunar materials provide useful data to test the idea of a universal model of the way terrestrial bodies transition from a magma ocean state into subsequent single-plate, rigid-lid convection or plate tectonic phases

A Forward-Design Approach to Increase the Production of Poly-3-Hydroxybutyrate in Genetically Engineered Escherichia coli

Biopolymers, such as poly-3-hydroxybutyrate (P(3HB)) are produced as a carbon store in an array of organisms and exhibit characteristics which are similar to oil-derived plastics, yet have the added advantages of biodegradability and biocompatibility. Despite these advantages, P(3HB) production is currently more expensive than the production of oil-derived plastics, and therefore, more efficient P(3HB) production processes would be desirable. In this study, we describe the model-guided design and experimental validation of several engineered P(3HB) producing operons. In particular, we describe the characterization of a hybrid phaCAB operon that consists of a dual promoter (native and J23104) and RBS (native and B0034) design. P(3HB) production at 24 h was around six-fold higher in hybrid phaCAB engineered Escherichia coli in comparison to E. coli engineered with the native phaCAB operon from Ralstonia eutropha H16. Additionally, we describe the utilization of non-recyclable waste as a low-cost carbon source for the production of P(3HB)

Enhanced Safety Surveillance of Influenza Vaccines in General Practice, Winter 2015-16: Feasibility Study

BACKGROUND: The European Medicines Agency (EMA) requires vaccine manufacturers to conduct enhanced real-time surveillance of seasonal influenza vaccination. The EMA has specified a list of adverse events of interest to be monitored. The EMA sets out 3 different ways to conduct such surveillance: (1) active surveillance, (2) enhanced passive surveillance, or (3) electronic health record data mining (EHR-DM). English general practice (GP) is a suitable setting to implement enhanced passive surveillance and EHR-DM. OBJECTIVE: This study aimed to test the feasibility of conducting enhanced passive surveillance in GP using the yellow card scheme (adverse events of interest reporting cards) to determine if it has any advantages over EHR-DM alone. METHODS: A total of 9 GPs in England participated, of which 3 tested the feasibility of enhanced passive surveillance and the other 6 EHR-DM alone. The 3 that tested EPS provided patients with yellow (adverse events) cards for patients to report any adverse events. Data were extracted from all 9 GPs' EHRs between weeks 35 and 49 (08/24/2015 to 12/06/2015), the main period of influenza vaccination. We conducted weekly analysis and end-of-study analyses. RESULTS: Our GPs were largely distributed across England with a registered population of 81,040. In the week 49 report, 15,863/81,040 people (19.57% of the registered practice population) were vaccinated. In the EPS practices, staff managed to hand out the cards to 61.25% (4150/6776) of the vaccinees, and of these cards, 1.98% (82/4150) were returned to the GP offices. Adverse events of interests were reported by 113 /7223 people (1.56%) in the enhanced passive surveillance practices, compared with 322/8640 people (3.73%) in the EHR-DM practices. CONCLUSIONS: Overall, we demonstrated that GPs EHR-DM was an appropriate method of enhanced surveillance. However, the use of yellow cards, in enhanced passive surveillance practices, did not enhance the collection of adverse events of interests as demonstrated in this study. Their return rate was poor, data entry from them was not straightforward, and there were issues with data reconciliation. We concluded that customized cards prespecifying the EMA's adverse events of interests, combined with EHR-DM, were needed to maximize data collection. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1136/bmjopen-2016-015469