A quality improvement project using a problem based post take ward round proforma based on the SOAP acronym to improve documentation in acute surgical receiving

Objectives: Ward round documentation provides one of the most important means of communication between healthcare professionals. We aimed to establish if the use of a problem based standardised proforma can improve documentation in acute surgical receiving. Methods: Gold standards were established using the RCSE record keeping guidelines. We audited documentation for seven days using the following headings: patient name/identification number, subjective findings, objective findings, clinical impression/diagnosis, plan, diet status, discharge decision, discharge planning, signature, and grade. After the initial audit cycle, a ward round proforma was introduced using the above headings and re-audited over a seven day period. Results: The pre-intervention arm contained 50 patients and the post intervention arm contained 47. The following headings showed an improvement in documentation compliance to 100%: patient name/identification number vs 96%, subjective findings vs 84%, objective findings vs 48%, plan vs 98%, signature vs 96%, and grade vs 62%. Documentation of the clinical impression/diagnosis improved to 98% vs 30%, diet status rose to 83% vs 16%, discharge decision to 66% vs 16%, and discharge planning to 40% vs 20%. Conclusions: Standardised proformas improve the documentation of post-take ward round notes. This helps to clarify the onward management plan for all aspects of a patient's care and will help avoid adverse events and litigation. This should improve the quality and safety of Patient Care

Exact bond percolation thresholds in two dimensions

Recent work in percolation has led to exact solutions for the site and bond critical thresholds of many new lattices. Here we show how these results can be extended to other classes of graphs, significantly increasing the number and variety of solved problems. Any graph that can be decomposed into a certain arrangement of triangles, which we call self-dual, gives a class of lattices whose percolation thresholds can be found exactly by a recently introduced triangle-triangle transformation. We use this method to generalize Wierman's solution of the bow-tie lattice to yield several new solutions. We also give another example of a self-dual arrangement of triangles that leads to a further class of solvable problems. There are certainly many more such classes.Comment: Accepted for publication in J. Phys

Does Botulinum Toxin A Injections Into The Pelvic Floor Muscles of Women with Chronic Genitopelvic Pain and Vaginal Spasm Improve Pain and Sexual Functioning?

OBJECTIVE: The objective of this evidenced based medicine review is to determine whether or not botulinum toxin A injections into the pelvic floor muscles of women with chronic genitopelvic pain and vaginal spasm improve pain and sexual functioning. STUDY DESIGN: Review of two double blind randomized controlled trials and one case series from peer reviewed journals published between 2006-2011. DATA SOURCES: Two randomized controlled trials and one case series were found using PubMed, Google Scholar, and Cochrane Library. OUTCOMES MEASURED: All three studies measured pain and sexual functioning using selfreported surveys including the visual analog scale for pain, Female Sexual Functioning Index, and Sexual Activity Questionnaire. RESULTS: Petersen et al. determined that botulinum toxin injections into the vulva did not improve pain or sexual functioning in vestibulodynia patients when compared to the control group. Similarly, Abbott et al. found that botulinum toxin injections into the pelvic muscles for chronic pelvic pain did not improve pain or sexual functioning when compared to the control group. In the case series conducted by Pelletier et al., botulinum toxin injections into the vulva reduced pain and improved sexual functioning for vestibulodynia patients. CONCLUSION: Botulinum toxin type A injections into the pelvic floor muscles are not an effective form of treatment for chronic pelvic pain or vestibulodynia. Both randomized controlled trials contributed the improvement in the control group to the placebo effect, among other theories. In the future, randomized controlled trials should use a larger sample size and include a nocebo group to further elaborate on the above results

Genetics and applications of nisin production in Lactococcus lactis subsp. lactis and conjugal exchange of this trait

Chapter I reviews current literature on gene transfer systems in lactic acid bacteria, how genetically altered microorganisms for food are presently regulated, and how nisin is used as a food preservative. Chapter II investigates previous reports which linked genes for nisin biosynthesis and sucrose utilization (Nip+Suc+) to plasmid DNA in two well characterized L· lactis subsp. lactis strains. Plasmid curing studies, conjugations, and DNA-DNA hybridizations indicated that these genes were encoded by chromosomal loci in all Nip+Suc+ strains examined. Similar results were noted in nisin-sucrose transconjugants of L. lactis subsp. cremoris and S. salivarius subsp. thermophilus in Chapters III and IV. Chapter III describes the use of conjugation to construct nisin-producing Lactococcus lactis subsp. cremoris strains. The direct-plate conjugation method was developed to facilitate transfer of Nip+Suc+ to L. lactis subsp. cremoris recipients. DNA-DNA hybridizations to transconjugant DNAs with an oligonucleotide that detected the nisin structural gene, nisA, demonstrated that this gene was transferred during conjugation. Lactococcus lactis subsp. cremoris Nip+Suc+ transconjugants retained the recipient strain phenotype with respect to bacteriophage resistance and acid production in milk. These results indicated that it would be feasible to construct nisin-producing L. lactis subsp. cremoris strains for mixed and multiple starter systems. Chapter IV investigates features of Nip+Suc+ transfer using a Lactococcus lactis subsp. lactis model system. Intergeneric transfer of nisin-sucrose genes was also achieved between lactococcal Nip+Suc+ donors and Streptococcus salivarius subsp. thermophilus recipients. Streptococcal transconjugants acquired Suc+ and nisin immunity but did not produce nisin. DNA-DNA hybridizations, however, demonstrated that nisA was present in these transconjugants. To investigate whether nisA was involved in nisin immunity, this gene was cloned and electro-transformed into Lactococcus lactis subsp. lactis LM0230. Electro-transformants did not express nisin immunity or any other trait linked to nisin production in lactococci. Results presented in Chapter V indicate that nisin may have application for control or prevention of bovine mastitis. Gram-positive pathogens which cause bovine mastitis were examined for their susceptibility to nisin. Disc diffusion assays indicated that minimum inhibitory concentrations of nisin ranged from 10 to 250 ug per ml. In addition, 50 ug of nisin per ml in milk inhibited all gram-positive pathogens tested

Unconditionally verifiable blind computation

Blind Quantum Computing (BQC) allows a client to have a server carry out a quantum computation for them such that the client's input, output and computation remain private. A desirable property for any BQC protocol is verification, whereby the client can verify with high probability whether the server has followed the instructions of the protocol, or if there has been some deviation resulting in a corrupted output state. A verifiable BQC protocol can be viewed as an interactive proof system leading to consequences for complexity theory. The authors, together with Broadbent, previously proposed a universal and unconditionally secure BQC scheme where the client only needs to be able to prepare single qubits in separable states randomly chosen from a finite set and send them to the server, who has the balance of the required quantum computational resources. In this paper we extend that protocol with new functionality allowing blind computational basis measurements, which we use to construct a new verifiable BQC protocol based on a new class of resource states. We rigorously prove that the probability of failing to detect an incorrect output is exponentially small in a security parameter, while resource overhead remains polynomial in this parameter. The new resource state allows entangling gates to be performed between arbitrary pairs of logical qubits with only constant overhead. This is a significant improvement on the original scheme, which required that all computations to be performed must first be put into a nearest neighbour form, incurring linear overhead in the number of qubits. Such an improvement has important consequences for efficiency and fault-tolerance thresholds.Comment: 46 pages, 10 figures. Additional protocol added which allows arbitrary circuits to be verified with polynomial securit

A fresh start for screening under the Habitats Regulations: Case c-323/17 People Over Wind, Peter Sweetman v Coillte Teoranta [2018] Ecr I-244

This is the author accepted manuscript. The final version is available from SAGE Publications via the DOI in this recordFor over twenty-five years, the courts have been delivering judgments that shape and refine the requirements of the Habitats Directive. The recent CJEU judgment of People Over Wind, Peter Sweetman v Coillte Teoranta [2018] ECR I-244 provides further clarification that will keep developers and decision-makers on their toes. In the judgment delivered in April 2018, the sole question for the court was whether, or in what circumstances, mitigation measures can be considered when carrying out screening for appropriate assessment under Article 6(3) of the Habitats Directive? The court’s response to this question is significant. In a confident judgment, it was held that mitigation measures cannot be considered when carrying out screening for appropriate assessment. This case note provides a detailed overview of the judgment, followed by an analysis of the extent to which the decision is consistent with existing case law authority in England. Finally, this commentary concludes with a consideration of the potential implications that the ruling may have on developers and decision-makers

Lunar navigation study, volume 2 Final report, Jan. - Dec. 1966

Performance data utilization in mission phase, lunar exploration phase, and navigational phase of lunar roving vehicle mission

Correlated Spectral and Recurrence Variations of Cygnus X-1

We present results of recurrence analysis of the black hole X-ray binary Cygnus X-1 using combined observations from the Rossi X-ray Timing Explorer All-sky Monitor and the Japanese Monitor of All-sky X-ray Image aboard the ISS. From the time-dependent windowed recurrence plot (RP), we compute ten recurrence quantities that describe the dynamical behavior of the source and compare them to the spectral state at each point in time. We identify epochs of state changes corresponding to transitions into highly deterministic or highly stochastic dynamical regimes and their correlation to specific spectral states. We compare k-Nearest Neighbors and Random Forest models for various sizes of the time-dependent RP. The spectral state in Cygnus X-1 can be predicted with greater than 95 per cent accuracy for both types of models explored across a range of RP sizes based solely on the recurrence properties. The primary features from the RP that distinguish between spectral states are the determinism, Shannon entropy, and average line length, all of which are systematically higher in the hard state compared to the soft state. Our results suggest that the hard and soft states of Cygnus X-1 exhibit distinct dynamical variability and the time domain alone can be used for spectral state classification.Comment: 17 pages, 10 figures, 7 tables; Accepted for publication in Monthly Notices of the Royal Astronomical Societ

Quantum computing on encrypted data

The ability to perform computations on encrypted data is a powerful tool for protecting privacy. Recently, protocols to achieve this on classical computing systems have been found. Here we present an efficient solution to the quantum analogue of this problem that enables arbitrary quantum computations to be carried out on encrypted quantum data. We prove that an untrusted server can implement a universal set of quantum gates on encrypted quantum bits (qubits) without learning any information about the inputs, while the client, knowing the decryption key, can easily decrypt the results of the computation. We experimentally demonstrate, using single photons and linear optics, the encryption and decryption scheme on a set of gates sufficient for arbitrary quantum computations. Because our protocol requires few extra resources compared to other schemes it can be easily incorporated into the design of future quantum servers. These results will play a key role in enabling the development of secure distributed quantum systems

Critical surfaces for general bond percolation problems

We present a general method for predicting bond percolation thresholds and critical surfaces for a broad class of two-dimensional periodic lattices, reproducing many known exact results and providing excellent approximations for several unsolved lattices. For the checkerboard and inhomogeneous bow-tie lattices, the method yields predictions that agree with numerical measurements to more than six figures, and are possibly exact