Advanced level practice education: UK Critical Care Pharmacists’ opinions in 2015

National UK standards for critical care highlight the need for clinical pharmacists to practice at an advanced level and above. The aim of this research paper was to describe the views of UK critical care pharmacists on the current provision of Advanced Level Practice (ALP) education and accreditation. It sought to identify whether there is a need for a national or regional training programme. A questionnaire was delivered electronically targeting UK critical care pharmacists. Whilst the response rate was low at 40% (166/411); the views expressed were representative of UK practitioners with the majority of responders meeting the national specifications for clinical pharmacist staffing in critical care areas. The responses highlighted work-based learning as the main resource for developing ALP and a lack of suitable training packages. The vast majority of pharmacists identified that a national or regional training programme was required for ALP. The results also identified the main barriers to undertaking ALP accreditation were lack of time, uncertainty regarding the process and its professional benefits and a lack of education and training opportunities. In conclusion, the responses clearly indicated that, for the necessary progression of critical care pharmacists to ALP, a national or regional training programme is required

Geometric Quantization on the Super-Disc

In this article we discuss the geometric quantization on a certain type of infinite dimensional super-disc. Such systems are quite natural when we analyze coupled bosons and fermions. The large-N limit of a system like that corresponds to a certain super-homogeneous space. First, we define an example of a super-homogeneous manifold: a super-disc. We show that it has a natural symplectic form, it can be used to introduce classical dynamics once a Hamiltonian is chosen. Existence of moment maps provide a Poisson realization of the underlying symmetry super-group. These are the natural operators to quantize via methods of geometric quantization, and we show that this can be done.Comment: 17 pages, Latex file. Subject: Mathematical physics, geometric quantizatio

Remarks on the naturality of quantization

Hamiltonian quantization of an integral compact symplectic manifold M depends on a choice of compatible almost complex structure J. For open sets U in the set of compatible almost complex structures and small enough values of Planck's constant, the Hilbert spaces of the quantization form a bundle over U with a natural connection. In this paper we examine the dependence of the Hilbert spaces on the choice of J, by computing the semi-classical limit of the curvature of this connection. We also show that parallel transport provides a link between the action of the group Symp(M) of symplectomorphisms of M and the Schrodinger equation.Comment: 20 page

Do working practices of cancer nurse specialists improve clinical outcomes? Retrospective cohort analysis from the English National Lung Cancer Audit

Background Cancer nurse specialists are advanced practitioners who offer continuity of care and expert support for people diagnosed with specific cancers. Health Education England's Cancer Workforce Plan prioritises expansion of cancer nurse specialist numbers by 2021 as part of the Cancer Taskforce Strategy for England. Objective To assess whether working practices of advanced practice specialist nurses are associated with clinical outcomes for people with lung cancer. Methods Adults with non-small cell lung cancer followed from 30 days post-diagnosis in English secondary care were obtained from the English National Lung Cancer Audit, 2007 to 2011. A national survey of lung cancer nurse specialists provided information on self-reported working practices. Mortality and unplanned admissions from 30 days to 12 months post diagnosis were respectively analysed using Cox and Poisson regression. Outcomes were assessed according to patients’ receipt of initial assessments by a lung cancer nurse specialist and according to trust-level reported working practices. Regression models were adjusted for individual sociodemographic and clinical characteristics, error adjusted for intracorrelations within regional cancer networks, and presented separately according to patients’ treatment pathways (surgery, chemotherapy, radiotherapy, or no anti-cancer therapy). Results Data for 108,115 people with lung cancer were analysed and associations with mortality and unplanned admissions were infrequent. Among people receiving only radiotherapy, however, the hazard for death was 17% lower among those who received an assessment by a lung cancer nurse specialist, compared with no assessment (hazard ratio = 0.83, 95% confidence interval 0.73–0.94; p = 0.003). The hazard was also lower among those receiving surgery (hazard ratio = 0.91, 0.84–0.99; p = 0.028). Among those receiving radiotherapy, nurse specialists’ reported confidence within multidisciplinary team settings was associated with a lower risk of death (hazard ratio = 0.88, 0.78–1.00; p = 0.049) and a lower rate of unplanned cancer-related admissions (incidence rate ratio = 0.83, 0.73–0.95; p = 0.007). Lung cancer nurse specialist assessments before/at diagnosis, were associated with a 5% lower rate of unplanned admissions, compared to when assessments occurred after diagnosis. Conclusion The contribution of nurse specialist working practices was occasionally associated with better outcomes for people with lung cancer. These were not limited to a single treatment pathway, but do indicate discrete relationships within pathways. Our study provides initial measures of overall lung cancer nurse specialist working practices at trusts, however, more detailed studies with longitudinal measurement of lung cancer nurse specialist-patient interaction are needed to better ascertain impacts on long-term patient outcomes. The findings highlight opportunities for potential improvement in effectiveness of service and care management

Active and passive in-plane wall fluctuations in turbulent channel flows

The authors are grateful to AkzoNobel’s Marine Coatings business (International Paint Ltd) and the Energy Technology Partnership [ETP106] for financial support. DNS computations were carried out on the ARCHER UK National Supercomputing Service (http://www.archer.ac.uk).Peer reviewedPublisher PD

A local families index formula for d-bar operators on punctured Riemann surfaces

Using heat kernel methods developed by Vaillant, a local index formula is obtained for families of d-bar operators on the Teichmuller universal curve of Riemann surfaces of genus g with n punctures. The formula also holds on the moduli space M{g,n} in the sense of orbifolds where it can be written in terms of Mumford-Morita-Miller classes. The degree two part of the formula gives the curvature of the corresponding determinant line bundle equipped with the Quillen connection, a result originally obtained by Takhtajan and Zograf.Comment: 47 page

Nanostructured Channel for Improving Emission Efficiency of Hybrid Light-Emitting Field-Effect Transistors

We report on the mechanism of enhancing the luminance and external quantum efficiency (EQE) by developing nanostructured channels in hybrid (organic/inorganic) light-emitting transistors (HLETs) that combine a solution-processed oxide and a polymer heterostructure. The heterostructure comprised two parts: (i) the zinc tin oxide/zinc oxide (ZTO/ZnO), with and without ZnO nanowires (NWs) grown on the top of the ZTO/ZnO stack, as the charge transport layer and (ii) a polymer Super Yellow (SY, also known as PDY-132) layer as the light-emitting layer. Device characterization shows that using NWs significantly improves luminance and EQE (≈1.1% @ 5000 cd m–2) compared to previously reported similar HLET devices that show EQE < 1%. The size and shape of the NWs were controlled through solution concentration and growth time, which also render NWs to have higher crystallinity. Notably, the size of the NWs was found to provide higher escape efficiency for emitted photons while offering lower contact resistance for charge injection, which resulted in the improved optical performance of HLETs. These results represent a significant step forward in enabling efficient and all-solution-processed HLET technology for lighting and display applications

Are working practices of lung cancer nurse specialists associated with variation in peoples' receipt of anticancer therapy?

OBJECTIVES: Treatment choices for people with lung cancer may be influenced by contact and engagement with lung cancer nurse specialists (LCNSs). We investigated how service factors, LCNS workload, and LCNS working practices may influence the receipt of anticancer treatment. MATERIALS AND METHODS: English National Lung Cancer Audit data and inpatient Hospital Episode Statistics for 109,079 people with lung cancer surviving 30 days from diagnosis were linked along with LCNS workforce census data and a bespoke nationwide LCNS survey. Multinomial logistic regression was used to determine adjusted relative risk ratios (RRRs) for receipt of anticancer therapies associated with LCNS assessment, LCNS workforce composition, caseload, LCNS reported working practices, treatment facilities at the patients' attending hospitals, and the size of the lung cancer service. RESULTS: Assessment by an LCNS was the strongest independent predictor for receipt of anticancer therapy, with early LCNS assessments being particularly associated with greater receipt of surgery (RRR 1.85, 95%CI 1.63-2.11). For people we considered clinically suitable for surgery, receipt was 55%. Large LCNS caseloads were associated with decreased receipt of surgery among suitable patients (RRR 0.71, 95%CI 0.51-0.97) for caseloads >250 compared to ≤150. Reported LCNS working practices were associated with receipt of surgery, particularly provision of psychological support (RRR 1.60, 95%CI 1.02-2.51) and social support (RRR 1.56, 95%CI 1.07-2.28). CONCLUSION: LCNS assessment, workload, and working practices are associated with the likelihood of patients receiving anticancer therapy. Enabling and supporting LCNSs to undertake key case management interventions offers an opportunity to improve treatment uptake and reduce the apparent gap in receipt of surgery for those suitable

Klebsiella pneumoniae is able to trigger epithelial-mesenchymal transition process in cultured airway epithelial cells

The ability of some bacterial pathogens to activate Epithelial-Mesenchymal Transition normally is a consequence of the persistence of a local chronic inflammatory response or depends on a direct interaction of the pathogens with the host epithelial cells. In this study we monitored the abilities of the K. pneumoniae to activate the expression of genes related to EMT-like processes and the occurrence of phenotypic changes in airway epithelial cells during the early steps of cell infection. We describe changes in the production of intracellular reactive oxygen species and increased HIF-1α mRNA expression in cells exposed to K. pneumoniae infection. We also describe the upregulation of a set of transcription factors implicated in the EMT processes, such as Twist, Snail and ZEB, indicating that the morphological changes of epithelial cells already appreciable after few hours from the K. pneumoniae infection are tightly regulated by the activation of transcriptional pathways, driving epithelial cells to EMT. These effects appear to be effectively counteracted by resveratrol, an antioxidant that is able to exert a sustained scavenging of the intracellular ROS. This is the first report indicating that strains of K. pneumoniae may promote EMT-like programs through direct interaction with epithelial cells without the involvement of inflammatory cells

Almost holomorphic embeddings in Grassmannians with applications to singular symplectic submanifolds

In this paper we use Donaldson's approximately holomorphic techniques to build embeddings of a closed symplectic manifold with symplectic form of integer class in the Grassmannians Gr(r, N). We assure that these embeddings are asymptotically holomorphic in a precise sense. We study first the particular case of CPN obtaining control on N and we improve in a sense a classical result about symplectic embeddings. The main reason of our Study is the construction of singular determinantal submanifolds as the intersection of the embedding with certain "generalized Schubert cycles" defined on a product of Grassmannians. It is shown that the symplectic type of these submanifolds is quite more general that the ones obtained by Donaldson and Auroux,as zeroes of "very ample" vector bundles