The Differences in Antibiotic Decision-making Between Acute Surgical and Acute Medical Teams: An Ethnographic Study of Culture and Team Dynamics

Background Cultural and social determinants influence antibiotic decision-making in hospitals. We investigated and compared cultural determinants of antibiotic decision-making in acute medical and surgical specialties. Methods An ethnographic observational study of antibiotic decision-making in acute medical and surgical teams at a London teaching hospital was conducted (August 2015–May 2017). Data collection included 500 hours of direct observations, and face-to-face interviews with 23 key informants. A grounded theory approach, aided by Nvivo 11 software, analyzed the emerging themes. An iterative and recursive process of analysis ensured saturation of the themes. The multiple modes of enquiry enabled cross-validation and triangulation of the findings. Results In medicine, accepted norms of the decision-making process are characterized as collectivist (input from pharmacists, infectious disease, and medical microbiology teams), rationalized, and policy-informed, with emphasis on de-escalation of therapy. The gaps in antibiotic decision-making in acute medicine occur chiefly in the transition between the emergency department and inpatient teams, where ownership of the antibiotic prescription is lost. In surgery, team priorities are split between 3 settings: operating room, outpatient clinic, and ward. Senior surgeons are often absent from the ward, leaving junior staff to make complex medical decisions. This results in defensive antibiotic decision-making, leading to prolonged and inappropriate antibiotic use. Conclusions In medicine, the legacy of infection diagnosis made in the emergency department determines antibiotic decision-making. In surgery, antibiotic decision-making is perceived as a nonsurgical intervention that can be delegated to junior staff or other specialties. Different, bespoke approaches to optimize antibiotic prescribing are therefore needed to address these specific challenges

Interaction of gases with lunar materials

The surface chemistry of Apollo 17 lunar fines samples 74220 (the orange soil) and 74241 (the gray control soil) has been studied by measuring the adsorption of nitrogen, argon, and oxygen (all at 77 K) and also water vapor (at 20 or 22 C). In agreement with results for samples from other missions, both samples had low initial specific surface areas, consisted of nonporous particles, and were attacked by water vapor at high relative pressure to give an increased specific surface area and create a pore system which gave rise to a capillary condensation hysteresis loop in the adsorption isotherms. In contrast to previous samples, both of the Apollo 17 soils were partially hydrophobic in their initial interaction with water vapor (both samples were completely hydrophilic after the reaction with water). The results are consistent with formation at high temperatures without subsequent exposure to significant amounts of water

Interaction of gases with lunar materials

Quantitative efforts to assess the surface properties of lunar fines, particularly water induced porosity are discussed. Data show that: (1) changes induced in lunar fines are not visible in high energy electron micrographs, (2) scanning micrographs show no change in particle size distribution as a result of reaction with water, (3) water induced changes are internal to the particles themselves, (4) normal laboratory atmosphere blocks alteration reaction with water, and (5) surface properties of mature lunar soils appear to be almost independent of chemical composition and mineralogy, but there are some variations in their reactivity toward water

Data mining in bioinformatics using Weka

The Weka machine learning workbench provides a general purpose environment for automatic classification, regression, clustering and feature selection-common data mining problems in bioinformatics research. It contains an extensive collection of machine learning algorithms and data exploration and the experimental comparison of different machine learning techniques on the same problem. Weka can process data given in the form of a single relational table. Its main objectives are to (a) assist users in extracting useful information from data and (b) enable them to easily identify a suitable algorithm for generating an accurate predictive model from it

Quantifying Spatiotemporal Chaos in Rayleigh-B\'enard Convection

Using large-scale parallel numerical simulations we explore spatiotemporal chaos in Rayleigh-B\'enard convection in a cylindrical domain with experimentally relevant boundary conditions. We use the variation of the spectrum of Lyapunov exponents and the leading order Lyapunov vector with system parameters to quantify states of high-dimensional chaos in fluid convection. We explore the relationship between the time dynamics of the spectrum of Lyapunov exponents and the pattern dynamics. For chaotic dynamics we find that all of the Lyapunov exponents are positively correlated with the leading order Lyapunov exponent and we quantify the details of their response to the dynamics of defects. The leading order Lyapunov vector is used to identify topological features of the fluid patterns that contribute significantly to the chaotic dynamics. Our results show a transition from boundary dominated dynamics to bulk dominated dynamics as the system size is increased. The spectrum of Lyapunov exponents is used to compute the variation of the fractal dimension with system parameters to quantify how the underlying high-dimensional strange attractor accommodates a range of different chaotic dynamics

Resonance Zones and Lobe Volumes for Volume-Preserving Maps

We study exact, volume-preserving diffeomorphisms that have heteroclinic connections between a pair of normally hyperbolic invariant manifolds. We develop a general theory of lobes, showing that the lobe volume is given by an integral of a generating form over the primary intersection, a subset of the heteroclinic orbits. Our definition reproduces the classical action formula in the planar, twist map case. For perturbations from a heteroclinic connection, the lobe volume is shown to reduce, to lowest order, to a suitable integral of a Melnikov function.Comment: ams laTeX, 8 figure

Pacific Hake, Merluccius productus, Autecology: A Timely Review

Pacific hake, Merluccius productus, the most abundant groundfish in the California Current Large Marine Ecosystem (CCLME), is a species of both commercial significance, supporting a large international fishery, and ecological importance, connecting other species as both predator and prey. Coastal Pacific hake migrations are characterized by movements between northern summer feeding areas and southern winter spawning areas, with variations in annual abundance, distribution, and the extent of these movements associated with varying climate-ocean conditions. In general, warm (cool) years with enhanced (reduced) stratification and poleward (equatorward) transport are often related to good (poor) recruitment, increased (decreased) northward distribution, and reduced (enhanced) growth. However, the classic periodic pattern of annual migration and distribution may no longer be fully representative. Based on recent advances in the understanding of climate-ocean variability off the U.S. west coast, we hypothesize that the annual movements of Pacific hake are more responsive to climate-ocean variability than previously thought, and further, that changes observed in Pacific hake distributions may reflect long-term changes in climate-ocean conditions in the CCLME. Therefore, an updated model of these relations is key to effective monitoring and management of this stock, as well as to devising scenarios of future change in the CCLME as a result of climate variations. The current state of knowledge of the relationship between the Pacific hake and its environment is reviewed, highlighting emerging ideas compared to those of the past, and priorities for future research are suggested

The Effects of Manufacturing Tolerances on the Vibration of Aero-engine Rotor-damper Assemblies

A range of rotor assemblies incorporating one and two squeeze film dampers with various static misalignments is investigated. Waterfall diagrams are constructed which demonstrate the effects of such misalignment and damper support flexibility on the nature and severity of subsynchronous resonance and jump phenomena. Vibration signatures of similar rotor-bearing assemblies are shown to contrast strongly due to different accumulations of tolerances during manufacture, fitting, and operation