A mixed-methods study of challenges experienced by clinical teams in measuring improvement.

OBJECTIVE: Measurement is an indispensable element of most quality improvement (QI) projects, but it is undertaken to variable standards. We aimed to characterise challenges faced by clinical teams in undertaking measurement in the context of a safety QI programme that encouraged local selection of measures. METHODS: Drawing on an independent evaluation of a multisite improvement programme (Safer Clinical Systems), we combined a qualitative study of participating teams' experiences and perceptions of measurement with expert review of measurement plans and analysis of data collected for the programme. Multidisciplinary teams of frontline clinicians at nine UK NHS sites took part across the two phases of the programme between 2011 and 2016. RESULTS: Developing and implementing a measurement plan against which to assess their improvement goals was an arduous task for participating sites. The operational definitions of the measures that they selected were often imprecise or missed important details. Some measures used by the teams were not logically linked to the improvement actions they implemented. Regardless of the specific type of data used (routinely collected or selected ex novo), the burdensome nature of data collection was underestimated. Problems also emerged in identifying and using suitable analytical approaches. CONCLUSION: Measurement is a highly technical task requiring a degree of expertise. Simply leveraging individual clinicians' motivation is unlikely to defeat the persistent difficulties experienced by clinical teams when attempting to measure their improvement efforts. We suggest that more structural initiatives and broader capability-building programmes should be pursued by the professional community. Improving access to, and ability to use repositories of validated measures, and increasing transparency in reporting measurement attempts, is likely to be helpful.This study was funded by the Health Foundation, charity number 286967. This work was also supported by MDW’s Wellcome Trust Investigator award WT09789. MDW is a National Institute for Health Research (NIHR) Senior Investigator. MDW and EL are supported by the Health Foundation’s grant to the University of Cambridge for The Healthcare Improvement Studies (THIS) Institute. THIS Institute is supported by the Health Foundation – an independent charity committed to bringing about better health and health care for people in the UK. TW was supported by the National Institute for Health Research (NIHR) Collaborations for Leadership in Applied Health Research and Care (CLAHRC) programme for North West London, and through an Improvement Science Fellowship from the Health Foundation. The views expressed in this publication are those of the authors and not necessarily those of the Health Foundation, the NHS, the NIHR, or the Department of Health and Social Care

Subarctic Records and Range Extensions of Two Species of Tiger Beetles (Coleoptera: Cicindelidae) in Churchill and Wapusk National Park, Manitoba

Two species of tiger beetle (Coleoptera: Cicindelidae) were collected in the vicinity of Churchill, Manitoba and Wapusk National Park. Habitats were dry, sandy areas typically preferred by this family. No tiger beetle has been recorded from this region previously. Cicindela longilabris longilabris was collected in two localities, one south of Churchill and another on a relict beach ridge in Wapusk National Park. Cicindela limbata hyperborea was collected only on the beach ridge, where adults co-occurred with C. longilabris longilabris. These localities represent significant range extensions for both species. Erratum included

Anomalous Nernst effect in perpendicularly magnetised {\tau}-MnAl thin films

$\tau$-MnAl is interesting for spintronic applications as a ferromagnet with perpendicular magnetic anisotropy due to its high uniaxial magnetocrystalline anisotropy. Here we report on the anomalous Nernst effect of sputter deposited $\tau$-MnAl thin films. We demonstrate a robust anomalous Nernst effect at temperatures of 200 K and 300 K with a hysteresis similar to the anomalous Hall effect and the magnetisation of the material. The anomalous Nernst coefficient of (0.6$\pm$0.24) $\mu$V/K at 300 K is comparable to other perpendicular magnetic anisotropy thin films. Therefore $\tau$-MnAl is a promising candidate for spin-caloritronic research

The impact of chemical short-range order on the thermophysical properties of medium- and high-entropy alloys

The unusual behavior observed in the coefficient of thermal expansion and specific heat capacity of CrFeNi, CoCrNi, and CoCrFeNi medium/high-entropy alloys is commonly referred to as the K-state effect. It is shown to be independent of the Curie temperature, as demonstrated by temperature-dependent magnetic moment measurements. CoCrFeNi alloy is chosen for detailed characterization; potential reasons for the K-state effect such as texture, recrystallization, and second-phase precipitation are ruled out. An examination of the electronic structure indicates the formation of a pseudo-gap in the Density of States, which suggests a specific chemical interaction between Ni and Cr atoms upon alloying. Hybrid Monte Carlo/Molecular Dynamic (MC/MD) simulations indicate the presence of non-negligible chemical short-range order (CSRO). Local lattice distortions are shown to be negligible, although deviations around Cr and Ni elements from those expected in a fully disordered structure are experimentally observed by X-ray absorption spectroscopy. The determined bonding distances are in good agreement with MC/MD calculations. A mechanism is proposed to explain the anomalies and calorimetric experiments and their results are used to validate the mechanism

The Global Landsat Archive: Status, Consolidation, and Direction

New and previously unimaginable Landsat applications have been fostered by a policy change in 2008 that made analysis-ready Landsat data free and open access. Since 1972, Landsat has been collecting images of the Earth, with the early years of the program constrained by onboard satellite and ground systems, as well as limitations across the range of required computing, networking, and storage capabilities. Rather than robust on-satellite storage for transmission via high bandwidth downlink to a centralized storage and distribution facility as with Landsat-8, a network of receiving stations, one operated by the U.S. government, the other operated by a community of International Cooperators (ICs), were utilized. ICs paid a fee for the right to receive and distribute Landsat data and over time, more Landsat data was held outside the archive of the United State Geological Survey (USGS) than was held inside, much of it unique. Recognizing the critical value of these data, the USGS began a Landsat Global Archive Consolidation (LGAC) initiative in 2010 to bring these data into a single, universally accessible, centralized global archive, housed at the Earth Resources Observation and Science (EROS) Center in Sioux Falls, South Dakota. The primary LGAC goals are to inventory the data held by ICs, acquire the data, and ingest and apply standard ground station processing to generate an L1T analysis-ready product. As of January 1, 2015 there were 5,532,454 images in the USGS archive. LGAC has contributed approximately 3.2 million of those images, more than doubling the original USGS archive holdings. Moreover, an additional 2.3 million images have been identified to date through the LGAC initiative and are in the process of being added to the archive. The impact of LGAC is significant and, in terms of images in the collection, analogous to that of having had twoadditional Landsat-5 missions. As a result of LGAC, there are regions of the globe that now have markedly improved Landsat data coverage, resulting in an enhanced capacity for mapping, monitoring change, and capturing historic conditions. Although future missions can be planned and implemented, the past cannot be revisited, underscoring the value and enhanced significance of historical Landsat data and the LGAC initiative. The aim of this paper is to report the current status of the global USGS Landsat archive, document the existing and anticipated contributions of LGAC to the archive, and characterize the current acquisitions of Landsat-7 and Landsat-8. Landsat-8 is adding data to the archive at an unprecedented rate as nearly all terrestrial images are now collected. We also offer key lessons learned so far from the LGAC initiative, plus insights regarding other critical elements of the Landsat program looking forward, such as acquisition, continuity, temporal revisit, and the importance of continuing to operationalize the Landsat program

Systematic review and meta-analysis of reduction in all-cause mortality from walking and cycling and shape of dose response relationship

BACKGROUND AND OBJECTIVE: Walking and cycling have shown beneficial effects on population risk of all-cause mortality (ACM). This paper aims to review the evidence and quantify these effects, adjusted for other physical activity (PA). DATA SOURCES: We conducted a systematic review to identify relevant studies. Searches were conducted in November 2013 using the following health databases of publications: Embase (OvidSP); Medline (OvidSP); Web of Knowledge; CINAHL; SCOPUS; SPORTDiscus. We also searched reference lists of relevant texts and reviews. STUDY ELIGIBILITY CRITERIA AND PARTICIPANTS: Eligible studies were prospective cohort design and reporting walking or cycling exposure and mortality as an outcome. Only cohorts of individuals healthy at baseline were considered eligible. STUDY APPRAISAL AND SYNTHESIS METHODS: Extracted data included study population and location, sample size, population characteristics (age and sex), follow-up in years, walking or cycling exposure, mortality outcome, and adjustment for other co-variables. We used random-effects meta-analyses to investigate the beneficial effects of regular walking and cycling. RESULTS: Walking (18 results from 14 studies) and cycling (8 results from 7 studies) were shown to reduce the risk of all-cause mortality, adjusted for other PA. For a standardised dose of 11.25 MET.hours per week (or 675 MET.minutes per week), the reduction in risk for ACM was 11% (95% CI = 4 to 17%) for walking and 10% (95% CI = 6 to 13%) for cycling. The estimates for walking are based on 280,000 participants and 2.6 million person-years and for cycling they are based on 187,000 individuals and 2.1 million person-years. The shape of the dose-response relationship was modelled through meta-analysis of pooled relative risks within three exposure intervals. The dose-response analysis showed that walking or cycling had the greatest effect on risk for ACM in the first (lowest) exposure interval. CONCLUSIONS AND IMPLICATIONS: The analysis shows that walking and cycling have population-level health benefits even after adjustment for other PA. Public health approaches would have the biggest impact if they are able to increase walking and cycling levels in the groups that have the lowest levels of these activities. REVIEW REGISTRATION: The review protocol was registered with PROSPERO (International database of prospectively registered systematic reviews in health and social care) PROSPERO 2013: CRD42013004266

Bacterial rotary export ATPases are allosterically regulated by the nucleotide second messenger cyclic-di-GMP

The widespread second messenger molecule cyclic di-GMP (cdG) regulates the transition from motile and virulent lifestyles to sessile, biofilm-forming ones in a wide range of bacteria. Many pathogenic and commensal bacterial-host interactions are known to be controlled by cdG signaling. Although the biochemistry of cyclic dinucleotide metabolism is well understood, much remains to be discovered about the downstream signaling pathways that induce bacterial responses upon cdG binding. As part of our ongoing research into the role of cdG signaling in plant-associated Pseudomonas species, we carried out an affinity capture screen for cdG binding proteins in the model organism Pseudomonas fluorescens SBW25. The flagella export AAA+ ATPase FliI was identified as a result of this screen and subsequently shown to bind specifically to the cdG molecule, with a KD in the low micromolar range. The interaction between FliI and cdG appears to be very widespread. In addition to FliI homologs from diverse bacterial species, high affinity binding was also observed for the type III secretion system homolog HrcN and the type VI ATPase ClpB2. The addition of cdG was shown to inhibit FliI and HrcN ATPase activity in vitro. Finally, a combination of site-specific mutagenesis, mass spectrometry, and in silico analysis was used to predict that cdG binds to FliI in a pocket of highly conserved residues at the interface between two FliI subunits. Our results suggest a novel, fundamental role for cdG in controlling the function of multiple important bacterial export pathways, through direct allosteric control of export ATPase proteins

Chromatin: a tunable spring at work inside chromosomes

This paper focuses on mechanical aspects of chromatin biological functioning. Within a basic geometric modeling of the chromatin assembly, we give for the first time the complete set of elastic constants (twist and bend persistence lengths, stretch modulus and twist-stretch coupling constant) of the so-called 30-nm chromatin fiber, in terms of DNA elastic properties and geometric properties of the fiber assembly. The computation naturally embeds the fiber within a current analytical model known as the ``extensible worm-like rope'', allowing a straightforward prediction of the force-extension curves. We show that these elastic constants are strongly sensitive to the linker length, up to 1 bp, or equivalently to its twist, and might locally reach very low values, yielding a highly flexible and extensible domain in the fiber. In particular, the twist-stretch coupling constant, reflecting the chirality of the chromatin fiber, exhibits steep variations and sign changes when the linker length is varied. We argue that this tunable elasticity might be a key feature for chromatin function, for instance in the initiation and regulation of transcription.Comment: 38 pages 15 figure

Uniform electron gases

We show that the traditional concept of the uniform electron gas (UEG) --- a homogeneous system of finite density, consisting of an infinite number of electrons in an infinite volume --- is inadequate to model the UEGs that arise in finite systems. We argue that, in general, a UEG is characterized by at least two parameters, \textit{viz.} the usual one-electron density parameter $\rho$ and a new two-electron parameter $\eta$. We outline a systematic strategy to determine a new density functional $E(\rho,\eta)$ across the spectrum of possible $\rho$ and $\eta$ values.Comment: 8 pages, 2 figures, 5 table