Mitigating risk in Norwegian psychiatric care:Identifying triggers of adverse events through Global Trigger Tool for psychiatric care

BACKGROUND: Patients treated in psychiatric care are exposed to the risk of adverse events, similar to patients treated in somatic health care. OBJECTIVES: In this article we report the findings of triggers associated with adverse events (AEs) identified by a version of the Global Trigger Tool - Psychiatry (GTT-P) adapted for Norwegian hospital-based psychiatric treatment. METHODS: The design was a retrospective analysis of a random sample of 240 patient records from a psychiatric clinic in one Norwegian hospital. Patient records were sampled from both inpatient and outpatient psychiatric clinics in hospitals serving the northern part of the county of Trøndelag, Norway. RESULTS: Our analysis was based on the identification of 32 potential triggers of adverse events. Eighteen of the triggers were significantly related to adverse events. No adverse events were identified in patient records that did not also contain triggers included in the Global Trigger Tool. CONCLUSIONS: There is a clear relationship between the presence of triggers in a patient record and the likelihood of adverse events. Particularly relevant for psychiatric patients is 'suffering' as a trigger and this may also be relevant to somatic care and has implications for inclusion in the GTT-P

Magnetic fields in the early universe in the string approach to MHD

There is a reformulation of magnetohydrodynamics in which the fundamental dynamical quantities are the positions and velocities of the lines of magnetic flux in the plasma, which turn out to obey equations of motion very much like ideal strings. We use this approach to study the evolution of a primordial magnetic field generated during the radiation-dominated era in the early Universe. Causality dictates that the field lines form a tangled random network, and the string-like equations of motion, plus the assumption of perfect reconnection, inevitably lead to a self-similar solution for the magnetic field power spectrum. We present the predicted form of the power spectrum, and discuss insights gained from the string approximation, in particular the implications for the existence or not of an inverse cascade.Comment: 12 pages, 2 figure

Mobile Medical Education (MoMEd) - how mobile information resources contribute to learning for undergraduate clinical students - a mixed methods study

BACKGROUND: Mobile technology is increasingly being used by clinicians to access up-to-date information for patient care. These offer learning opportunities in the clinical setting for medical students but the underlying pedagogic theories are not clear. A conceptual framework is needed to understand these further. Our initial questions were how the medical students used the technology, how it enabled them to learn and what theoretical underpinning supported the learning. METHODS: 387 medical students were provided with a personal digital assistant (PDA) loaded with medical resources for the duration of their clinical studies. Outcomes were assessed by a mixed-methods triangulation approach using qualitative and quantitative analysis of surveys, focus groups and usage tracking data. RESULTS: Learning occurred in context with timely access to key facts and through consolidation of knowledge via repetition. The PDA was an important addition to the learning ecology rather than a replacement. Contextual factors impacted on use both positively and negatively. Barriers included concerns of interrupting the clinical interaction and of negative responses from teachers and patients. Students preferred a future involving smartphone platforms. CONCLUSIONS: This is the first study to describe the learning ecology and pedagogic basis behind the use of mobile learning technologies in a large cohort of undergraduate medical students in the clinical environment. We have developed a model for mobile learning in the clinical setting that shows how different theories contribute to its use taking into account positive and negative contextual factors.The lessons from this study are transferable internationally, to other health care professions and to the development of similar initiatives with newer technology such as smartphones or tablet computer

Peak grain forecasts for the US High Plains amid withering waters

Irrigated agriculture contributes 40% of total global food production. In the US High Plains, which produces more than 50 million tons per year of grain, as much as 90% of irrigation originates from groundwater resources, including the Ogallala aquifer. In parts of the High Plains, groundwater resources are being depleted so rapidly that they are considered nonrenewable, compromising food security. When groundwater becomes scarce, groundwater withdrawals peak, causing a subsequent peak in crop production. Previous descriptions of finite natural resource depletion have utilized the Hubbert curve. By coupling the dynamics of groundwater pumping, recharge, and crop production, Hubbert-like curves emerge, responding to the linked variations in groundwater pumping and grain production. On a state level, this approach predicted when groundwater withdrawal and grain production peaked and the lag between them. The lags increased with the adoption of efficient irrigation practices and higher recharge rates. Results indicate that, in Texas, withdrawals peaked in 1966, followed by a peak in grain production 9 y later. After better irrigation technologies were adopted, the lag increased to 15 y from 1997 to 2012. In Kansas, where these technologies were employed concurrently with the rise of irrigated grain production, this lag was predicted to be 24 y starting in 1994. In Nebraska, grain production is projected to continue rising through 2050 because of high recharge rates. While Texas and Nebraska had equal irrigated output in 1975, by 2050, it is projected that Nebraska will have almost 10 times the groundwater-based production of Texas

The Enigma of the Highest Energy Particles of Nature

Historically cosmic rays have always been at the intersection of astrophysics with particle physics. This is still and especially true in current days where experimenters routinely observe atmospheric showers from particles whose energies reach macroscopic values up to about 50 Joules. This dwarfs energies achieved in the laboratory by about eight orders of magnitude in the detector frame and three orders of magnitude in the center of mass. While the existence of these highest energy cosmic rays does not necessarily testify physics not yet discovered, their macroscopic energies likely links their origin to the most energetic processes in the Universe. Explanations range from conventional shock acceleration to particle physics beyond the Standard Model and processes taking place at the earliest moments of our Universe. While motivation for some of the more exotic scenarios may have diminished by newest data, conventional shock acceleration scenarios remain to be challenged by the apparent isotropy of cosmic ray arrival directions which may not be easy to reconcile with a highly structured and magnetized Universe. Fortunately, many new experimental activities promise a strong increase of statistics at the highest energies and a combination with gamma-ray and neutrino astrophysics will put strong constraints on all these theoretical models. This short review is far from complete and instead presents a selection of aspects regarded by the author as interesting and/or promising for the future.Comment: 31 latex pages, 7 ps figures; draft of a review for Annals of Physics, Comments, suggestions for improvements are highly appreciate

Level Set Method for the Evolution of Defect and Brane Networks

A theory for studying the dynamic scaling properties of branes and relativistic topological defect networks is presented. The theory, based on a relativistic version of the level set method, well-known in other contexts, possesses self-similar ``scaling'' solutions, for which one can calculate many quantities of interest. Here, the length and area densities of cosmic strings and domain walls are calculated in Minkowski space, and radiation, matter, and curvature-dominated FRW cosmologies with 2 and 3 space dimensions. The scaling exponents agree the naive ones based on dimensional analysis, except for cosmic strings in 3-dimensional Minkowski space, which are predicted to have a logarithmic correction to the naive scaling form. The scaling amplitudes of the length and area densities are a factor of approximately 2 lower than results from numerical simulations of classical field theories. An expression for the length density of strings in the condensed matter literature is corrected.Comment: 46pp LaTeX, revtex4(preprint), 1 eps figure, revised for publication. Note title chang

Atlas of the clinical genetics of human dilated cardiomyopathy

[Abstract] Aim. Numerous genes are known to cause dilated cardiomyopathy (DCM). However, until now technological limitations have hindered elucidation of the contribution of all clinically relevant disease genes to DCM phenotypes in larger cohorts. We now utilized next-generation sequencing to overcome these limitations and screened all DCM disease genes in a large cohort. Methods and results. In this multi-centre, multi-national study, we have enrolled 639 patients with sporadic or familial DCM. To all samples, we applied a standardized protocol for ultra-high coverage next-generation sequencing of 84 genes, leading to 99.1% coverage of the target region with at least 50-fold and a mean read depth of 2415. In this well characterized cohort, we find the highest number of known cardiomyopathy mutations in plakophilin-2, myosin-binding protein C-3, and desmoplakin. When we include yet unknown but predicted disease variants, we find titin, plakophilin-2, myosin-binding protein-C 3, desmoplakin, ryanodine receptor 2, desmocollin-2, desmoglein-2, and SCN5A variants among the most commonly mutated genes. The overlap between DCM, hypertrophic cardiomyopathy (HCM), and channelopathy causing mutations is considerably high. Of note, we find that >38% of patients have compound or combined mutations and 12.8% have three or even more mutations. When comparing patients recruited in the eight participating European countries we find remarkably little differences in mutation frequencies and affected genes. Conclusion. This is to our knowledge, the first study that comprehensively investigated the genetics of DCM in a large-scale cohort and across a broad gene panel of the known DCM genes. Our results underline the high analytical quality and feasibility of Next-Generation Sequencing in clinical genetic diagnostics and provide a sound database of the genetic causes of DCM.Hôpitaux de Paris; PHRC AOM0414

Projet Seine-Aval 6 PHARESEE « Productivité microphytobenthique des HAbitats intertidaux en lien avec la dynamique sédimentaire, biogéochimique et les ingénieurs d'écosystème de la faune benthique : implication pour des enjeux de modélisation et de REhabilitation des vasières de la SEine Estuarienne »

L'estuaire de la Seine est soumis à divers stress anthropiques et hydro-climatiques. Cet écosystème côtier perd son caractère estuarien à cause d'aménagements qui ont eu comme conséquence de voir disparaître de vastes surfaces de vasières intertidales. Ces habitats fonctionnels jouent un rôle majeur dans le fonctionnement écologique des estuaires, car ils abritent des communautés méio- et macro-benthiques très diversifiées et représentent la principale zone d’alimentation de nombreux vertébrés dont certains d’intérêt écologique ou commercial majeur (e.g. poissons, oiseaux). La dynamique des vasières intertidales est fortement influencée par les processus hydro-sédimentaires estuariens, étant tantôt source, tantôt puits de sédiment. Elles constituent ainsi un élément essentiel des cycles biogéochimiques se déroulant au sein des estuaires. Les caractéristiques morphologiques et biogéochimiques de ces zones vont directement influencer les échanges de matière et d’énergie qui s’y déroulent. Il est donc impératif d'avoir une approche pluridisciplinaire pour comprendre leur fonctionnement. Le projet PHARE-SEE avait pour objectif (i) de mieux comprendre le rôle des bioturbateurs et leur effet sur le microphytobenthos, les paramètres hydrosédimentaires et biogéochimiques dans les vasières de l’estuaire de Seine et (ii) de développer un modèle de production primaire microphytobenthique couplant l’ensemble des paramètres susmentionnés. Le premier objectif du projet a été réalisé en couplant expériences sur le terrain et en laboratoire. Ainsi, des expériences d’exclusion/ensemencement de faune ont été menées sur la vasière Nord, à l’aval de l’estuaire de Seine, et sur 2 faciès sédimentaires contrastés, avec un suivi de la dynamique saisonnière du microphytobenthos et de l’ensemble des paramètres biogéochimiques et hydrosédimentaires. De plus, des expériences en laboratoire ont été réalisées, avec une évaluation des flux diffusifs de nutriments à 2 saisons contrastées (hiver/été) en fonction du mélange sablo-vaseux et de l’intensité de la bioturbation par la macrofaune benthique dominante de la vasière (le ver Hediste diversicolor et le bivalve Scrobicularia plana). Les expériences de terrain ont montré que l’effet saisonnier était plus prononcé que celui des bioturbateurs sur l’ensemble des paramètres biogéochimiques dans le sédiment (matière organique sédimentaire, processus et biomasse microbiens). Contrairement à la matière organique sédimentaire, principalement d’origine terrigène, la matière organique dissoute présente dans les eaux interstitielles, majoritairement d’origine autochtone, est réactive et influencée par l’activité des bioturbateurs. Ces derniers ont une influence prononcée sur l’érodabilité, avec un rôle biostabilisateur efficace pour Hediste diversicolor en été comme en hiver et un rôle déstabilisateur pour Scrobicularia plana exclusivement en été. Malgré des processus de consommations primaires très élevés et des pertes par érosion, le niveau de production primaire microphytobenthique reste par ailleurs très important sur la vasière. Les analyses réalisées ont également révélé le rôle majeur du microphytobenthos dans le réseau trophique pour H. diversicolor, S. plana et la méiofaune (analyses isotopes stables, collaboration projet SA6 SENTINELLES). Les expériences en mésocosme, complémentaires de celles réalisées sur le terrain, ont montré que l’activité de bioturbation des deux ingénieurs d’écosystème diffère quelle que soit la saison. Ainsi, le processus de transport d’eau et des composés dissous (bioirrigation) domine chez H. diversicolor, alors que l’activité de S. plana est dominée par le remaniement sédimentaire. Les flux biogéochimiques à l’interface eau-sédiment sont principalement influencés par la bioirrigation. Enfin, il a été observé que S. plana consomme très activement les biofilms microphytobenthiques et limite fortement leur capacité de développement, alors que la biomasse microphytobenthique n’est pas affectée par les activités de Hediste. Cela démontre que la consommation herbivore est totalement compensée par des effets positifs liés probablement à la bioirrigation, activée de manière générale plus de 40 fois par Hediste. Dans un second temps, ce projet proposait de modéliser la production primaire microphytobenthique en relation avec la dynamique sédimentaire et les processus biogéochimiques. Les données acquises via expériences en laboratoire et sur le terrain ont servi à développer ce modèle. Ainsi, le modèle MARS3D en version Cross-shore 2DV a été implémenté sur la vasière intertidale étudiée avec une très bonne qualité des simulations des processus hydrosédimentaires et des variations altimétriques. L’intégration de l’effet de la bioturbation et de la régulation de l’érodabilité des sédiments a permis d’améliorer encore la qualité des simulations. Un modèle de diffusion thermique a été intégré, testé et amélioré en termes d’interaction avec la composition sédimentaire. Le modèle biogéochimique BLOOM a été intégré également dans le modèle MARS3D avec une dynamique biogéochimique saisonnière bien représentée. Le modèle prend en compte le rôle des bioturbateurs sur les flux diffusifs, mais une perspective d’amélioration doit être envisagée pour mieux reproduire les flux à l’interface eau-sédiment et l’assimilation du NH4 + par le microphytobenthos en surface. Enfin, le modèle de la production primaire microphytobenthique a été implémenté dans le code MARS3D et fournit des simulations de la dynamique spatio-temporelle des biomasses microphytobenthiques intéressantes, même si les flux sont encore sous-estimés dans le modèle et les interactions avec la faune doivent encore être améliorées. Au final, les très nombreuses données issues du projet PHARESEE et le modèle associé serviront à comprendre et relier les nombreux facteurs influençant le fonctionnement des vasières et leurs rôles écosystémiques essentiels – rôle physique, de régulation sur les cycles biogéochimiques et rôle de productivité biologique et soutien au réseau trophique. Des travaux de synthèse ont été engagés en particulier pour tenter d’expliquer le haut niveau de productivité actuel du système en lien avec la bonne santé des espèces sentinelles (ingénieurs d’écosystèmes) de la macrofaune benthique

Experience Feedback Committee: a management tool to improve patient safety in mental health

BACKGROUND: A management tool, called the Experience Feedback Committee, has been applied for patient safety and successfully used in medical departments. The purpose of this study was to analyse the functioning of an Experience Feedback Committee in a psychiatric department and to explore its contribution to the particular issues of patient safety in mental health. METHODS: We conducted a descriptive study based on all the written documents produced by the Experience Feedback Committee between March 2010 and January 2013. The study was conducted in Grenoble University Hospital in France. We analysed all reported incidents, reports of meetings and event analysis reports. Adverse events were classified according to the Conceptual Framework for the International Classification for Patient Safety. RESULTS: A total of 30 meetings were attended by 22 professionals including seven physicians and 12 paramedical practitioners. We identified 475 incidents reported to the Experience Feedback Committee. Most of them (92 %) had no medical consequence for the patient. Eleven incidents were investigated with an analysis method inspired by civil aviation security systems. Twenty-one corrective actions were set up, including eight responses to the specific problems of a mental health unit, such as training to respond to situations of violence or management of suicide attempts. CONCLUSIONS: The Experience Feedback Committee makes it possible to involve mental healthcare professionals directly in safety management. This tool seems appropriate to manage specific patient safety issues in mental health. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12991-015-0062-2) contains supplementary material, which is available to authorized users