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

A uniform analysis of HD209458b Spitzer/IRAC lightcurves with Gaussian process models

We present an analysis of Spitzer/IRAC primary transit and secondary eclipse lightcurves measured for HD209458b, using Gaussian process models to marginalise over the intrapixel sensitivity variations in the 3.6 micron and 4.5 micron channels and the ramp effect in the 5.8 micron and 8.0 micron channels. The main advantage of this approach is that we can account for a broad range of degeneracies between the planet signal and systematics without actually having to specify a deterministic functional form for the latter. Our results do not confirm a previous claim of water absorption in transmission. Instead, our results are more consistent with a featureless transmission spectrum, possibly due to a cloud deck obscuring molecular absorption bands. For the emission data, our values are not consistent with the thermal inversion in the dayside atmosphere that was originally inferred from these data. Instead, we agree with another re-analysis of these same data, which concluded a non-inverted atmosphere provides a better fit. We find that a solar-abundance clear-atmosphere model without a thermal inversion underpredicts the measured emission in the 4.5 micron channel, which may suggest the atmosphere is depleted in carbon monoxide. An acceptable fit to the emission data can be achieved by assuming that the planet radiates as an isothermal blackbody with a temperature of $1484\pm 18$ K.Comment: 18 pages, 5 figures, 6 tables. Accepted by MNRA

An interprofessional nurse-led mental health promotion intervention for older home care clients with depressive symptoms.

BackgroundDepressive symptoms in older home care clients are common but poorly recognized and treated, resulting in adverse health outcomes, premature institutionalization, and costly use of health services. The objectives of this study were to examine the feasibility and acceptability of a new six-month interprofessional (IP) nurse-led mental health promotion intervention, and to explore its effects on reducing depressive symptoms in older home care clients (≥ 70 years) using personal support services.MethodsA prospective one-group pre-test/post-test study design was used. The intervention was a six-month evidence-based depression care management strategy led by a registered nurse that used an IP approach. Of 142 eligible consenting participants, 98 (69%) completed the six-month and 87 (61%) completed the one-year follow-up. Outcomes included depressive symptoms, anxiety, health-related quality of life (HRQoL), and the costs of use of all types of health services at baseline and six-month and one-year follow-up. An interpretive descriptive design was used to explore clients', nurses', and personal support workers' perceptions about the intervention's appropriateness, benefits, and barriers and facilitators to implementation.ResultsOf the 142 participants, 56% had clinically significant depressive symptoms, with 38% having moderate to severe symptoms. The intervention was feasible and acceptable to older home care clients with depressive symptoms. It was effective in reducing depressive symptoms and improving HRQoL at six-month follow-up, with small additional improvements six months after the intervention. The intervention also reduced anxiety at one year follow-up. Significant reductions were observed in the use of hospitalization, ambulance services, and emergency room visits over the study period.ConclusionsOur findings provide initial evidence for the feasibility, acceptability, and sustained effects of the nurse-led mental health promotion intervention in improving client outcomes, reducing use of expensive health services, and improving clinical practice behaviours of home care providers. Future research should evaluate its efficacy using a randomized clinical trial design, in different settings, with an adequate sample of older home care recipients with depressive symptoms.Trial registrationClinicaltrials.gov identifier: NCT01407926

Observation and analysis of in situ carbonaceous matter in Nakhla: Part I

New analyses of indigenous secondary material in the martian meteorite Nakhla reveal amorphous carbon-rich veins and dendrites. The texture and chemistry of this material resembles that of biogenically altered sub-ocean basaltic glasses

Observation and analysis of in situ carbonaceous matter in Nakhla: part II

Analysis of in situ carbonaceous matter in the Nakhla SNC meteorite has been carried out using a variety of techniques. Laser raman data shows the carbonaceous matter to be highly complex and static mass spectrometry has shown it to have an isotopic composition of '18 to '20' C

Organic Carbon Exists in Mars Meteorites: Where is it on the Martian Surface?

The search for organic carbon on Mars has been a major challenge. The first attempt was the Viking GC-MS in situ experiment which gave inconclusive results at two sites oil. After the discovery that the SNC meteorites were from Mars, reported C isotopic compositional information which suggested a reduced C component present in the Martian meteorites reported the presence of reduced C components (i.e., polycyclic aromatic hydrocarbons) associated with the carbonate globules in ALH84001. Jull et al. noted in Nakhla there was acid insoluble C component present with more than 75% of its C lacking any C-14, which is modern-day terrestrial carbon. This C fraction was believed to be either indigenous martian or ancient meteoritic carbon. Fisk et al. have shown textural evidence along with C-enriched areas within fractures in Nakhla and ALH84001. Westall et al. have shown the presence of a large irregular fragment of organic material completely embedded within a chip of ALH84001. Interior samples from the Naklnla SNC made available by the British Museum of Natural History, were analyzed. Petrographic examination of Nakhla showed evidence of fractures (approx.0.5 microns wide) filled with dark brown to black dendritic material with characteristics similar to those observed by. Iddingsite is also present along fractures in olivine. Fracture filling and dendritic material was examined by SEM-EDX, TEM-EDX, Focused Electron Beam microscopy, Laser Raman Spectroscopy, Nano-SIMS Ion Micro-probe, and Stepped-Combustion Static Mass Spectrometry. Observations from the first three techniques are discussed

Indigenous Carbonaceous Matter and Boron Associated with Halite Crystals in Nakhla

We report here the observation of indigenous organic matter spatially associated with, and in several cases embedded within, halite crystals located in alteration veins inside the Martian meteorite Nakhla. Further-more, we have also detected enrichments of boron (B) in these halites far in excess of those previously reported in bulk Martian meteorites. Boron in Martian halites has not been detected previously

Nature of Reduced Carbon in Martian Meteorites

Martian meteorites provide important information on the nature of reduced carbon components present on Mars throughout its history. The first in situ analyses for carbon on the surface of Mars by the Viking landers yielded disappointing results. With the recognition of Martian meteorites on Earth, investigations have shown carbon-bearing phases exist on Mars. Studies have yielded presence of reduced carbon, carbonates and inferred graphitic carbon phases. Samples ranging in age from the first approximately 4 Ga of Mars history [e.g. ALH84001] to nakhlites with a crystallization age of 1.3 Ga [e.g. Nakhla] with aqueous alteration processes occurring 0.5-0.7 Ga after crystallizaton. Shergottites demonstrate formation ages around 165-500 Ma with younger aqueous alterations events. Only a limited number of the Martian meteorites do not show evidence of significance terrestrial alterations. Selected areas within ALH84001, Nakhla, Yamato 000593 and possibly Tissint are suitable for study of their indigenous reduced carbon bearing phases. Nakhla possesses discrete, well-defined carbonaceous phases present within iddingsite alteration zones. Based upon both isotopic measurements and analysis of Nakhla's organic phases the presence of pre-terrestrial organics is now recognized. The reduced carbon-bearing phases appear to have been deposited during preterrestrial aqueous alteration events that produced clays. In addition, the microcrystalline layers of Nakhla's iddingsite have discrete units of salt crystals suggestive of evaporation processes. While we can only speculate on the origin of these unique carbonaceous structures, we note that the significance of such observations is that it may allow us to understand the role of Martian carbon as seen in the Martian meteorites with obvious implications for astrobiology and the pre-biotic evolution of Mars. In any case, our observations strongly suggest that reduced organic carbon exists as micrometer- size, discrete structures on Mars associated with clay and salt minerals. The Mars Science Laboratory s investigators should be aware of reduced organic carbon components within clay-bearing phases

Characterization of Spitsbergen Disks by Transmission Electron Microscopy and Raman Spectroscopy

'Carbonate disks' found in the fractures and pores spaces of peridotite xenoliths and basalts from the island of Spitsbergen in the Norwegian Svalbard archipelago have been suggested to be "The best (and best documented) terrestrial analogs for the [Martian meteorite] ALH84001 carbonate globules ..." Previous studies have indicated that Spitsbergen carbonates show broadly comparable internal layering and mineral compositions to ALH84001 carbonate-magnetite disks. We report here for the first time, the detailed mineral characterization of Spitsbergen carbonates and their spatial relationship to the host mineral assemblages in the xenolith, using high resolution TEM (as used previously for ALH84001 carbonate disks). These studies were conducted in concert with complementary Raman and SEM analysis of the same samples. Our results indicate that there are significant chemical and physical differences between the disks in Spitsbergen and the carbonates present in ALH84001

The Origin of Magnetite Crystals in ALH84001 Carbonate Disks

Martian meteorite ALH84001 preserves evidence of interaction with aqueous fluids while on Mars in the form of microscopic carbonate disks believed to have formed approx 3.9 Ga ago at beginning of the Noachian epoch. Intimately associated within and throughout these carbonate disks are nanocrystal magnetites (Fe3O4) with unusual chemical and physical properties, whose origins have become the source of considerable debate. One group of hypotheses argues that these magnetites are the product of partial thermal decomposition of the host carbonate. Alternatively, the origins of magnetite and carbonate may be unrelated; that is, from the perspective of the carbonate the magnetite is allochthonous. We have sought to resolve between these hypotheses through the detailed characterized of the compositional and structural relationships between the carbonate disks, their associated magnetites and the orthopyroxene matrix in which they are embedded. Comparison of these results with experimental thermal decomposition studies of sideritic carbonates conducted under a range of heating scenarios suggests that the magnetite nanocrystals in the ALH84001 carbonate disks are not the products of thermal decomposition