Failure of an Educational Intervention to Improve Consultation and Implications for Healthcare Consultation.

INTRODUCTION: Consultation of another physician for his or her specialized expertise regarding a patient's care is a common occurrence in most physicians' daily practice, especially in the emergency department (ED). Therefore, the ability to communicate effectively with another physician during a patient consultation is an essential skill. However, there has been limited research on a standardized method for a physician to physician consultation with little guidance on teaching consultations to physicians in training. The objective of our study was to measure the effect of a structured consultation intervention on both content standardization and quality of medical student consultations. METHODS: Senior medical students were assessed on a required emergency medicine rotation with a physician phone consultation during a standardized, simulated chest pain case. The intervention groups received a standard consult checklist as part of their orientation to the rotation, followed by a video recording of a good consult call and a bad consult call with commentary from an emergency physician. The intervention was given to students every other month, alternating with a control group who received no additional education. Recordings were reviewed by three second-year internal medicine residents pursuing a fellowship in cardiology. Each recording was evaluated by two of the three reviewers and scored using a standardized checklist. RESULTS: Providing a standardized consultation intervention did not improve students' ability to communicate with consultants. In addition, there was variability between evaluators in regards to how they received the same information and how they perceived the quality of the same recorded consultation calls. Evaluator inter-rater reliability (IRR) was poor on the questions of 1) would you have any other questions of the student calling the consult and 2) did the student calling the consult provide an accurate account of information and case detail. The IRR was also poor on objective data such as whether the student stated their name. CONCLUSIONS: A brief intervention may not be enough to change complex behavior such as a physician to physician consultant communication. Importantly, despite consultants listening to the same audio recordings, the information was processed differently. Future investigations should focus on both those delivering as well as those receiving a consultation

Geometry of bend : singular lines and defects in twist-bend nematics

We describe the geometry of bend distortions in liquid crystals and their fundamental degeneracies, which we call β lines; these represent a new class of linelike topological defect in twist-bend nematics. We present constructions for smecticlike textures containing screw and edge dislocations and also for vortexlike structures of double twist and Skyrmions. We analyze their local geometry and global structure, showing that their intersection with any surface is twice the Skyrmion number. Finally, we demonstrate how arbitrary knots and links can be created and describe them in terms of merons, giving a geometric perspective on the fractionalization of Skyrmions

The topology and geometry of liquid crystals

Liquid crystals are materials that exhibit a number of fascinating properties, many of which have a geometric and topological flavour. Our understanding of liquid crystals often comes through the study of their topological defects, which has inspired new concepts of structural organization in soft matter. Topological and geometric methods have been fundamental to these developments. Today it is impossible to imagine any direction of the science of liquid crystals that does not actively use the concepts of topological defects: they play an essential role in fundamental theory and descriptions of such materials, and also underpin the promising new applications. Varieties of liquid crystal with additional geometric structure are at the forefront of new applications. These materials include the chiral nematics, or cholesterics, and also the more recently discovered twist-bend nematics. It is known that chirality especially brings enormous richness, allowing for a wealth of new metastable states and textures. The defects in these classes of material have more structure than those in standard nematics, and include not just defects in the director, but defects in other directions associated to the director which nonetheless have a fundamental structural importance; these are the familiar lambda lines of cholesterics, and the beta lines in twist-bend materials which I describe for the first time. Despite their importance, defects in cholesteric materials are still poorly understood. In this thesis I develop a theory of point and line defects in cholesterics using the mathematics of contact topology. I classify the structure of point defects by using singularity theory and contact topology; the classification shows a very good correspondence with experimental observations. Hedgehog point defects, ubiquitous in standard nematics, are energetically disfavoured in cholesterics due to being incompatibile with a single handedness. The same constraint applies to the boundary of a droplet with normal anchoring, which results in topologically-protected regions of reversed handedness in the boundary region. These ‘twist solitons’ are a novel type of topological defect in cholesterics, identified and studied here for the first time. This theory is applied to recent experiments to explain the stability of the novel structures observed in spherical cholesteric droplets. Additional textures with complex layered structures are examined from the perspective of contact topology. Convex surface theory aids visualisation of layered structures as well as helping to describe their properties. I give an overview of the structures that may occur based on their layer topology, achieving a good correspondence with experiment. Disclinations in cholesterics are studied using contact topology, and a full classification up to homotopy is obtained. The dichotomy between tight and overtwisted structures manifests itself in an interesting way for disclinations: the tight disclinations are exactly those not attached to positive strength lambda lines. While the overtwisted lines admit no new invariants, for these tight lines I identify a novel topological invariant, which has the form of a self-linking number. Orientable singular lines can be removed in a standard nematic, but the classification shows obstructions to doing this in a cholesteric which I use to explain certain experimentally-observed textures. This observation also leads to an experimentally accessible method for generating metastable twist solitons in the bulk, as well as suggesting a novel method for generating Hopf solitons. The topological invariants of nematics can be related to the zeros of a vector field orthogonal to the director. Using this approach, I study Hopf solitons in cholesteric droplets using the lambda lines, a novel perspective. The bend distortion of the director is a vector field that is always orthogonal to it; its zeros, the beta lines, have fundamental importance in the twist-bend nematic phase. I produce the first topological and geometric study of this phase, identifying various textures and defects, including Skyrmions, screw dislocations, and focal conics, by the structure of their beta lines. Hopf solitons in twist-bend materials appear not be stable; fundamental results in contact topological give insight into their process of removal, as well demonstrating that they are replaced with a twist soliton. Finally, I develop a geometric theory of directors using Cartan’s method of moving frames. As well as giving new insight into the director distortions and the relationships between them, this allows us to study the problem of reconstructing a director from its gradients, which has previously been solved in two dimensions but not three dimensions. This approach demonstrates the connection between directors and Lie theory, and suggests a description of directors in terms of their local symmetry groups

Epidemiology and Immune Pathogenesis of Viral Sepsis

Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. Sepsis can be caused by a broad range of pathogens; however, bacterial infections represent the majority of sepsis cases. Up to 42% of sepsis presentations are culture negative, suggesting a non-bacterial cause. Despite this, diagnosis of viral sepsis remains very rare. Almost any virus can cause sepsis in vulnerable patients (e.g., neonates, infants, and other immunosuppressed groups). The prevalence of viral sepsis is not known, nor is there enough information to make an accurate estimate. The initial standard of care for all cases of sepsis, even those that are subsequently proven to be culture negative, is the immediate use of broad-spectrum antibiotics. In the absence of definite diagnostic criteria for viral sepsis, or at least to exclude bacterial sepsis, this inevitably leads to unnecessary antimicrobial use, with associated consequences for antimicrobial resistance, effects on the host microbiome and excess healthcare costs. It is important to understand non-bacterial causes of sepsis so that inappropriate treatment can be minimised, and appropriate treatments can be developed to improve outcomes. In this review, we summarise what is known about viral sepsis, its most common causes, and how the immune responses to severe viral infections can contribute to sepsis. We also discuss strategies to improve our understanding of viral sepsis, and ways we can integrate this new information into effective treatment

Ka-Band Radar Terminal Descent Sensor

The terminal descent sensor (TDS) is a radar altimeter/velocimeter that improves the accuracy of velocity sensing by more than an order of magnitude when compared to existing sensors. The TDS is designed for the safe planetary landing of payloads, and may be used in helicopters and fixed-wing aircraft requiring high-accuracy velocity sensin

Improving quality of life in patients with end-stage age-related macular degeneration: focus on miniature ocular implants

Low vision devices in the past have been mainly extraocular. There are now four new devices in different stages of development and implementation that are currently available. Three of them, the Implantable Miniature Telescope (IMT, VisionCare Ophthalmic Technologies, Saratoga, CA), Intraocular Lens for Visually Impaired People (IOL-VIP, IOL-VIP System, Soleko, Pontecorvo, Italy), and Lipschitz Mirror Implant (LMI, Optolight Vision Technology, Herzlia, Israel) are implanted into the anterior segment while the Argus II (Second Sight Medical Products, Sylmar, CA) is implanted into the posterior segment. The goal of these devices is to increase the patient quality of life which has been measured by Visual Functioning Questionnaire (VFQ) scales. The IMT is the only device that has been shown to increase the VFQ score by seven points at 6 months compared to baseline. It is the only FDA-approved device in the US while the Argus has been approved in Europe. Each of these prosthetics has potential benefits for patients