Lower extremity vascular disease

Purpose: We performed a systematic review to assess (1) to what extent Incident Reporting Systems (IRS) on the adult ICU meet the criteria of the WHO Draft Guidelines for Adverse Event Reporting and Learning Systems, (2) to what extent the IRSs comply with the four aspects of the iterative quality loop and (3) whether IRSs have led to improvement measures in clinical practice. Data sources: The authors searched multiple electronic databases from 1966 until June 26th 2014. Study Selection: Studies were included if they reported incident reporting systems on the adult ICU. Data Extraction: Data on study design, characteristics of the incident reporting system, implementation, feedback and improvement measures were collected using structured data extraction forms. Results of data synthesis: A total of 2098 studies were identified and 36 studies reported IRSs on the adult ICU. Studies were divided into: ICU specific IRSs and general IRSs. Items of the WHO checklist were assessed and categorized into the four phases of the iterative quality loop. Conclusion: None of the IRSs completely fulfilled the WHO checklist criteria. With respect to the iterative loop, data input and data collection are well established but not much attention was given to analyzing incidents and to give feedback. This resulted in an administrative report system, rather than the much desired instrument for change of practice and increase of quality as an IRS can only effectively contribute to improve patient safety and quality of care if more attention is given to analyzing incidents and feedback.Perioperative Medicine: Efficacy, Safety and Outcom

Taking Morbidity and Mortality Conferences to a Next Level: The Resilience Engineering Concept

Objective: To explore possibilities to improve morbidity and mortalityconferences using advancing insights in safety science.Summary background data: Mortality and Morbidity conferences (M&M)are the golden practice for case-based learning. While learning from complicationsis useful, M&M does not meet expectations for system-wideimprovement. Resilience engineering principles may be used to improveM&M.Methods: After a review of the shortcomings of traditional M&M, resilienceengineering principles are explored as a new way to evaluate performance.This led to the development of a new M&M format that also reviewssuccessful outcomes, rather than only complications. This ‘‘quality assessmentmeeting’’ (QAM) is presented and the first experiences are evaluatedusing local observations and a survey.Results: During the QAM teams evaluate all discharged patients, addressingteam resilience in terms of surgeons’ ability to respond to irregularities and tomonitor and learn from experiences. The meeting was feasible to implementand well received by the surgical team. Observations reveal that reflection onboth complicated and uncomplicated cases strengthened team morale but alsotriggered reflection on the entire clinical course. The QAM serves as a tool toidentify how adapting behavior led to success despite challenging conditions,so that this resilient performance can be supported.Conclusions: The resilience engineering concept can be used to adjustM&M, in which learning is focused not only on complications but also onhow successful outcomes were achieved despite ever-present challenges. Thisreveals the actual ratio between successful and unsuccessful outcomes,allowing to learn from both to reinforce safety-enhancing behavior.Gynecolog

Photoemission spectra of Sr2CuO2Cl2{\rm Sr_2 Cu O_2 Cl_2}: a theoretical analysis

Recent angle resolved photoemission (ARPES) results for the insulating cuprate ${\rm Sr_2 Cu O_2 Cl_2}$ have provided the first experimental data which can be directly compared to the (theoretically) well--studied problem of a single hole propagating in an antiferromagnet. The ARPES results reported a small bandwidth, providing evidence for the existence of strong correlations in the cuprates. However, in the same experiment some discrepancies with the familiar 2D ${\rm t-J}$ model were also observed. Here we discuss a comparison between the ARPES results and the quasiparticle dispersion of both (i) the ${\rm t-t'-J}$ Hamiltonian and (ii) the three--band Hubbard model in the strong--coupling limit. Both model Hamiltonians show that the experimentally observed one--hole band structure can be approximately reproduced using reasonable values for ${\rm t'}$, or the direct oxygen hopping amplitude ${\rm t_{pp}}$.Comment: 11 pages, RevTex version 3.0, 3 postscript figures, LaTeX file and figures have been uuencoded

Regulation of haemopoietic stem‐cell proliferation in mice carrying the Slj allele

We investigated a haemopoietic stromal defect, in mice heterozygous for the Slj allele, during haemopoietic stress induced by treatment with bacterial lipopolysaccharides (LPS) or lethal total body irradiation (TBI) and bone‐marrow cell (BMC) reconstitution. Both treatments resulted in a comparable haemopoietic stem cell (CFU‐s) proliferation in Slj/+ and +/+ haemopoietic organs. There was no difference in committed haemopoietic progenitor cell (BFU‐e and CFU‐G/M) kinetics after TBI and +/+ bone‐marrow transplantation in Slj/+ and +/+ mice. the Slj/+ mice were deficient in their ability to support macroscopic spleen colony formation (65% of +/+ controls) as measured at 7 and 10 days after BMC transplantation. However, the Slj/+ spleen colonies contained the same number of BFU‐E and CFU‐G/M as colonies from +/+ spleens, while their CFU‐s content was increased. On day 10 post‐transplantation, the macroscopic ‘missing’ colonies could be detected at the microscopic level. These small colonies contained far fewer CFU‐s than the macroscopic detectable colonies. Analysis of CFU‐s proliferation‐inducing activities in control and post‐LPS sera revealed that Slj/+ mice are normal in their ability to produce and to respond to humoral stem‐cell regulators. We postulate that Slj/+ mice have a normal number of splenic stromal ‘niches’ for colony formation. However, 35% of these niches is defective in its proliferative support. Copyrigh

Transport properties of dense fluid argon

We calculate using molecular dynamics simulations the transport properties of realistically modeled fluid argon at pressures up to $\simeq 50GPa$ and temperatures up to $3000K$. In this context we provide a critique of some newer theoretical predictions for the diffusion coefficients of liquids and a discussion of the Enskog theory relevance under two different adaptations: modified Enskog theory (MET) and effective diameter Enskog theory. We also analyze a number of experimental data for the thermal conductivity of monoatomic and small diatomic dense fluids.Comment: 8 pages, 6 figure

An Exact Diagonalization Demonstration of Incommensurability and Rigid Band Filling for N Holes in the t-J Model

We have calculated S(q) and the single particle distribution function for N holes in the t - J model on a non--square sqrt{8} X sqrt{32} 16--site lattice with periodic boundary conditions; we justify the use of this lattice in compariosn to those of having the full square symmetry of the bulk. This new cluster has a high density of vec k points along the diagonal of reciprocal space, viz. along k = (k,k). The results clearly demonstrate that when the single hole problem has a ground state with a system momentum of vec k = (pi/2,pi/2), the resulting ground state for N holes involves a shift of the peak of the system's structure factor away from the antiferromagnetic state. This shift effectively increases continuously with N. When the single hole problem has a ground state with a momentum that is not equal to k = (pi/2,pi/2), then the above--mentioned incommensurability for N holes is not found. The results for the incommensurate ground states can be understood in terms of rigid--band filling: the effective occupation of the single hole k = (pi/2,pi/2) states is demonstrated by the evaluation of the single particle momentum distribution function . Unlike many previous studies, we show that for the many hole ground state the occupied momentum states are indeed k = (+/- pi/2,+/- pi/2) states.Comment: Revtex 3.0; 23 pages, 1 table, and 13 figures, all include

Spin polaron damping in the spin-fermion model for cuprate superconductors

A self-consistent, spin rotational invariant Green's function procedure has been developed to calculate the spectral function of carrier excitations in the spin-fermion model for the CuO2 plane. We start from the mean field description of a spin polaron in the Mori-Zwanzig projection method. In order to determine the spin polaron lifetime in the self-consistent Born approximation, the self-energy is expressed by an irreducible Green's function. Both, spin polaron and bare hole spectral functions are calculated. The numerical results show a well pronounced quasiparticle peak near the bottom of the dispersion at (pi/2,pi/2), the absence of the quasiparticle at the Gamma-point, a rather large damping away from the minimum and an asymmetry of the spectral function with respect to the antiferromagnetic Brillouin zone. These findings are in qualitative agreement with photoemission data for undoped cuprates. The direct oxygen-oxygen hopping is responsible for a more isotropic minimum at (pi/2,pi/2).Comment: 18 pages, 13 figure

Implementation considerations for a point-of-care Neisseria gonorrhoeae rapid diagnostic test at primary healthcare level in South Africa : a qualitative study

ADDITIONAL FILE 1 : IDI protocols. Interview protocols used in this study during the pre-implementation, initial use, 3-month (mid-assessment) and 6-month (post-evaluation) implementation phase.ADDITIONAL TABLE 1 : Consolidated criteria for reporting qualitative studies (COREQ): 32-item checklist for interviews and focus groups.ADDITIONAL TABLE 2 : NPT Constructs as defined for the implementation of the NG-LFA.BACKGROUND : South Africa maintains an integrated health system where syndromic management of sexually transmitted infections (STI) is the standard of care. An estimated 2 million cases of Neisseria gonorrhoeae (N. gonorrhoeae) occur in South Africa every year. Point-of-care diagnostic tests (POCT) may address existing STI control limitations such as overtreatment and missed cases. Subsequently, a rapid lateral flow assay with fluorescence-based detection (NG-LFA) with a prototype reader was developed for N. gonorrhoeae detection showing excellent performance and high usability; however, a better understanding is needed for device implementation and integration into clinics. METHODS : A qualitative, time-series assessment using 66 in-depth interviews was conducted among 25 trained healthcare workers involved in the implementation of the NG-LFA. Findings were informed by the Normalization Process Theory (NPT) as per relevant contextual (strategic intentions, adaptive execution, and negotiation capacity) and procedural constructs (coherence, cognitive participation, collective action, reflexive monitoring) to examine device implementation within primary healthcare levels. Interviews were audio-recorded, transcribed, and then analyzed using a thematic approach guided by NPT to interpret results. RESULTS : Overall, healthcare workers agreed that STI POCT could guide better STI clinical decision-making, with consideration for clinic integration such as space constraints, patient flow, and workload. Perceived NG-LFA benefits included enhanced patient receptivity and STI knowledge. Further, healthcare workers reflected on the suitability of the NG-LFA given current limitations with integrated primary care. Recommendations included sufficient STI education, and appropriate departments for first points of entry for STI screening. CONCLUSIONS : The collective action and participation by healthcare workers in the implementation of the NG-LFA revealed adaptive execution within the current facility environment including team compositions, facility-staff receptivity, and STI management experiences. User experiences support future clinic service integration, highlighting the importance of further assessing patient-provider communication for STI care, organizational readiness, and identification of relevant departments for STI screening.Sub-award via FIND (primary recipient Cecilia Ferreyra), from the Global Antimicrobial Resistance Innovation Fund (GAMRIF) (https://www.gov.uk/government/groups/theglobal-amr-innovation-fund).https://bmchealthservres.biomedcentral.comhj2024Medical MicrobiologySDG-03:Good heatlh and well-bein

Search for DCC in 158A GeV Pb+Pb Collisions

A detailed analysis of the phase space distributions of charged particles and photons have been carried out using two independent methods. The results indicate the presence of nonstatistical fluctuations in localized regions of phase space.Comment: Talk at the PANIC99 Conference, June 9-16, 199