The development and impact of an endoscopic non-technical skills (ENTS) behavioural marker system

Background: Non-technical skills (NTS) are crucial to effective team working in endoscopy. Training in NTS has been shown to improve team performance and patient outcomes. As such, NTS training and assessment are now considered essential components of the endoscopy quality assurance process. Across the literature, other specialties have achieved this through development of behavioural marker systems (BMS). BMS provide a framework for assessing, training and measuring the NTS relevant to healthcare individuals and team. This article describes the development and impact of a novel BMS for endoscopy: the endoscopic non-technical skills (ENTS) system. Methods: The initial NTS taxonomy for endoscopy was created through a combination of literature review, staff focus groups and semi-structured interviews, incorporating the critical decision method. Framework analysis was conducted with three individual coders and generated a skills list which formed the preliminary taxonomy. Video observation of Bowel Cancer Screening endoscopists was used to identify exemplar behaviours which were mapped to relevant skills in the NTS taxonomy. Behavioural descriptors, derived from video data, were added to form the basis of the ENTS system. Results: A taxonomy of 33 skills in 14 separate categories were identified through framework analysis. Following video analysis and behaviour mapping, 4 overarching categories and 13 behavioural elements were identified which formed the ENTS framework. The endoscopy (directly observed procedural skills) 4-point rating scale was added to create the final ENTS system. Since its development in 2010, the ENTS system has been validated in the assessment of endoscopy for trainees nationally. ENTS informs a number of training initiatives, including a national strategy to improve NTS for all endoscopists. Conclusions: The ENTS system is a clinically relevant tool, validated for use in trainee assessment. The use of ENTS will be important to the future of training and quality assurance in endoscopy

Reduced grapevine canopy size post-flowering via mechanical trimming alters ripening and yield of 'Pinot noir'

The degree and time of canopy trimming can alter phenology, rates of increase or decrease in berry components during grape ripening, and may influence yield and its components. The objective of this study was to investigate the extent to which reducing canopy size, by mechanical trimming post-flowering, changed Vitis vinifera L. 'Pinot noir' fruit yield and composition. Vines were mechanically trimmed to three different canopy heights at fruitset: 1000 mm (100 % canopy height), 600 mm (60 % canopy height relative to the control treatment) and 300 mm (30 % canopy height relative to the control treatment). Total soluble solids concentration and content, titratable acidity, pH and fresh berry mass were measured throughout ripening, and yield and leaf area were measured at harvest.Reduced canopy size via trimming to 30 and 60 % of the control treatment height slowed total soluble solids accumulation and in some cases increased titratable acidity and increased pH. The total soluble solids-titratable acidity ratio was therefore reduced throughout ripening by these trimming treatments relative to the full canopy height. Trimming to reduce canopy size had two effects on the source-sink ratio; it reduced the source (canopy) but increased fruit yield, an important sink. Therefore, the time of trimming is an important management consideration because it can delay and slow ripening due to reduced source leaves but could potentially accentuate the delay via increasing yield (sink). This technique may represent a way to offset the acceleration of phenology and grape ripening that has been observed to occur as a result of warmer seasons

Association between tumour somatic mutations and venous thromboembolism in the 100,000 Genomes Project cancer cohort:A study protocol

Venous thromboembolism (VTE) is a common cause of morbidity and mortality in patients with cancer, and there is evidence that specific aberrations in tumour biology contribute to the pathophysiology of this condition. We plan to examine the association between tumour somatic mutations and VTE in an existing cohort of patients with cancer, who were enrolled to the flagship Genomics England 100,000 Genomes Project. Here, we outline an a-priori analysis plan to address this objective, including details on study cohort selection, exposure and outcome definitions, annotation of genetic variants and planned statistical analyses. We will assess the effect of 1) deleterious somatic DNA variants in each gene; 2) tumour mutational burden and 3) tumour mutational signatures on the rate of VTE (outcome) in a pan-cancer cohort. Sensitivity analyses will be performed to examine the robustness of any associations, including adjustment for potentially correlated co-variates including tumour type, stage and systemic anti-cancer therapy. We hope that results from this study may help to identify key genes which are implicated in the development of cancer associated thrombosis, which may shed light on related mechanistic pathways and/or provide data which can be integrated into genetic risk prediction models for these patients

Measuring the Quantum State of a Large Angular Momentum

We demonstrate a general method to measure the quantum state of an angular momentum of arbitrary magnitude. The (2F+1) x (2F+1) density matrix is completely determined from a set of Stern-Gerlach measurements with (4F+1) different orientations of the quantization axis. We implement the protocol for laser cooled Cesium atoms in the 6S_{1/2}(F=4) hyperfine ground state and apply it to a variety of test states prepared by optical pumping and Larmor precession. A comparison of input and measured states shows typical reconstruction fidelities of about 0.95.Comment: 4 pages, 6 figures, submitted to PR

Resolved-sideband Raman cooling to the ground state of an optical lattice

We trap neutral Cs atoms in a two-dimensional optical lattice and cool them close to the zero-point of motion by resolved-sideband Raman cooling. Sideband cooling occurs via transitions between the vibrational manifolds associated with a pair of magnetic sublevels and the required Raman coupling is provided by the lattice potential itself. We obtain mean vibrational excitations \bar{n}_x \approx \bar{n}_y \approx 0.01, corresponding to a population \sim 98% in the vibrational ground state. Atoms in the ground state of an optical lattice provide a new system in which to explore quantum state control and subrecoil laser coolingComment: PDF file, 13 pages including 3 figure

Phase Control of Nonadiabaticity-induced Quantum Chaos in An Optical Lattice

The qualitative nature (i.e. integrable vs. chaotic) of the translational dynamics of a three-level atom in an optical lattice is shown to be controllable by varying the relative laser phase of two standing wave lasers. Control is explained in terms of the nonadiabatic transition between optical potentials and the corresponding regular to chaotic transition in mixed classical-quantum dynamics. The results are of interest to both areas of coherent control and quantum chaos.Comment: 3 figures, 4 pages, to appear in Physical Review Letter

Evaluating the Impact of a Virtual Reality Workstation in an Academic Library: Methodology and Preliminary Findings

Collections of 3D models and the analytic affordances of virtual reality (VR) systems can be integrated to form a “3D digital heritage ecosystem” (Limp, et al., 2011), providing a potentially richer and more intuitive learning environment that enables students to interact with models of artifacts and spaces that are too rare, fragile, or distant to access directly. This paper describes efforts to evaluate the impact of virtual reality on undergraduate instruction in varied disciplines, hosted within an academic library context. Existing research on VR and learning has focused primarily on domain -specific tasks carried out in controlled lab settings or the social aspects of immersive virtual worlds. This paper describes the methodology and preliminary findings of a mixed-methods research project currently underway (running from September 2017 to August 2018) that is evaluating how use of virtual reality impacts undergraduate students’ self-efficacy, and seeks to understand students’ embodied experiences. The strengths and weaknesses of the methodology, initial findings drawn from the early stages of data analysis, and directions for further research are discussed.YesDouble-blind review

State determination in continuous measurement

The possibility of determining the state of a quantum system after a continuous measurement of position is discussed in the framework of quantum trajectory theory. Initial lack of knowledge of the system and external noises are accounted for by considering the evolution of conditioned density matrices under a stochastic master equation. It is shown that after a finite time the state of the system is a pure state and can be inferred from the measurement record alone. The relation to emerging possibilities for the continuous experimental observation of single quanta, as for example in cavity quantum electrodynamics, is discussed.Comment: 12 pages, 4 figures, Revte

Dichotomy of Tyrosine Hydroxylase and Dopamine Regulation between Somatodendritic and Terminal Field Areas of Nigrostriatal and Mesoaccumbens Pathways

Measures of dopamine-regulating proteins in somatodendritic regions are often used only as static indicators of neuron viability, overlooking the possible impact of somatodendritic dopamine (DA) signaling on behavior and the potential autonomy of DA regulation between somatodendritic and terminal field compartments. DA reuptake capacity is less in somatodendritic regions, possibly placing a greater burden on de novo DA biosynthesis within this compartment to maintain DA signaling. Therefore, regulation of tyrosine hydroxylase (TH) activity may be particularly critical for somatodendritic DA signaling. Phosphorylation of TH at ser31 or ser40 can increase activity, but their impact on L-DOPA biosynthesis in vivo is unknown. Thus, determining their relationship with L-DOPA tissue content could reveal a mechanism by which DA signaling is normally maintained. In Brown-Norway Fischer 344 F1 hybrid rats, we quantified TH phosphorylation versus L-DOPA accumulation. After inhibition of aromatic acid decarboxylase, L-DOPA tissue content per recovered TH protein was greatest in NAc, matched by differences in ser31, but not ser40, phosphorylation. The L-DOPA per catecholamine and DA turnover ratios were significantly greater in SN and VTA, suggesting greater reliance on de novo DA biosynthesis therein. These compartmental differences reflected an overall autonomy of DA regulation, as seen by decreased DA content in SN and VTA, but not in striatum or NAc, following short-term DA biosynthesis inhibition from local infusion of the TH inhibitor α-methyl-p-tyrosine, as well as in the long-term process of aging. Such data suggest ser31 phosphorylation plays a significant role in regulating TH activity in vivo, particularly in somatodendritic regions, which may have a greater reliance on de novo DA biosynthesis. Thus, to the extent that somatodendritic DA release affects behavior, TH regulation in the midbrain may be critical for DA bioavailability to influence behavior