Interdisciplinary communication in the intensive care unit

Background. Patient safety research has shown poor communication among intensive care unit (ICU) nurses and doctors to be a common causal factor underlying critical incidents in intensive care. This study examines whether ICU doctors and nurses have a shared perception of interdisciplinary communication in the UK ICU. Methods. Cross-sectional survey of ICU nurses and doctors in four UK hospitals using a previously established measure of ICU interdisciplinary collaboration. Results. A sample of 48 doctors and 136 nurses (47% response rate) from four ICUs responded to the survey. Nurses and doctors were found to have differing perceptions of interdisciplinary communication, with nurses reporting lower levels of communication openness between nurses and doctors. Compared with senior doctors, trainee doctors also reported lower levels of communication openness between doctors. A regression path analysis revealed that communication openness among ICU team members predicted the degree to which individuals reported understanding their patient care goals (adjR2 = 0.17). It also showed that perceptions of the quality of unit leadership predicted open communication. Conclusions. Members of ICU teams have divergent perceptions of their communication with one another. Communication openness among team members is also associated with the degree to which they understand patient care goals. It is necessary to create an atmosphere where team members feel they can communicate openly without fear of reprisal or embarrassment

On operad structures of moduli spaces and string theory

Recent algebraic structures of string theory, including homotopy Lie algebras, gravity algebras and Batalin-Vilkovisky algebras, are deduced from the topology of the moduli spaces of punctured Riemann spheres. The principal reason for these structures to appear is as simple as the following. A conformal field theory is an algebra over the operad of punctured Riemann surfaces, this operad gives rise to certain standard operads governing the three kinds of algebras, and that yields the structures of such algebras on the (physical) state space naturally.Comment: 33 pages (An elaboration of minimal area metrics and new references are added

Fermion scattering off electroweak phase transition kink walls with hypermagnetic fields

We study the scattering of fermions off a finite width kink wall during the electroweak phase transition in the presence of a background hypermagnetic field. We derive and solve the Dirac equation for such fermions and compute the reflection and transmission coefficients for the case when the fermions move from the symmetric to the broken symmetry phase. We show that the chiral nature of the fermion coupling with the background field in the symmetric phase generates an axial asymmetry in the scattering processes. We discuss possible implications of such axial charge segregation for baryon number generation.Comment: 9 pages, 3 Postscript figures, uses RevTeX4. Expanded discussion, published versio

Skills-based intervention to enhance collaborative decision-making: systematic adaptation and open trial protocol for veterans with psychosis

Background: Collaborative decision-making is an innovative decision-making approach that assigns equal power and responsibility to patients and providers. Most veterans with serious mental illnesses like schizophrenia want a greater role in treatment decisions, but there are no interventions targeted for this population. A skills-based intervention is promising because it is well-aligned with the recovery model, uses similar mechanisms as other evidence-based interventions in this population, and generalizes across decisional contexts while empowering veterans to decide when to initiate collaborative decision-making. Collaborative Decision Skills Training (CDST) was developed in a civilian serious mental illness sample and may fill this gap but needs to undergo a systematic adaptation process to ensure fit for veterans. Methods: In aim 1, the IM Adapt systematic process will be used to adapt CDST for veterans with serious mental illness. Veterans and Veteran’s Affairs (VA) staff will join an Adaptation Resource Team and complete qualitative interviews to identify how elements of CDST or service delivery may need to be adapted to optimize its effectiveness or viability for veterans and the VA context. During aim 2, an open trial will be conducted with veterans in a VA Psychosocial Rehabilitation and Recovery Center (PRRC) to assess additional adaptations, feasibility, and initial evidence of effectiveness. Discussion: This study will be the first to evaluate a collaborative decision-making intervention among veterans with serious mental illness. It will also contribute to the field’s understanding of perceptions of collaborative decision-making among veterans with serious mental illness and VA clinicians, and result in a service delivery manual that may be used to understand adaptation needs generally in VA PRRCs. Trial registration: ClinicalTrials.gov Identifier: NCT0432494

Shell-model calculations of neutrino scattering from 12C

Neutrino reaction cross-sections, $(\nu_\mu,\mu^-)$, $(\nu_e,e^-)$, $\mu$-capture and photoabsorption rates on $^{12}$C are computed within a large-basis shell-model framework, which included excitations up to $4\hbar\omega$. When ground-state correlations are included with an open $p$-shell the predictions of the calculations are in reasonable agreement with most of the experimental results for these reactions. Woods-Saxon radial wave functions are used, with their asymptotic forms matched to the experimental separation energies for bound states, and matched to a binding energy of 0.01 MeV for unbound states. For comparison purposes, some results are given for harmonic oscillator radial functions. Closest agreement between theory and experiment is achieved with unrestricted shell-model configurations and Woods-Saxon radial functions. We obtain for the neutrino-absorption inclusive cross sections: $\bar{\sigma} = 13.8 \times 10^{-40}$ cm$^2$ for the $(\nu_{\mu},\mu^{-})$ decay-in-flight flux in agreement with the LSND datum of $(12.4 \pm 1.8) \times 10^{-40}$ cm$^2$; and $\bar{\sigma} = 12.5 \times 10^{-42}$ cm$^2$ for the $(\nu_{e},e^{-})$ decay-at-rest flux, less than the experimental result of $(14.4 \pm 1.2) \times 10^{-42}$ cm$^2$.Comment: 19 pages. ReVTeX. No figure

Large-space shell-model calculations for light nuclei

An effective two-body interaction is constructed from a new Reid-like $NN$ potential for a large no-core space consisting of six major shells and is used to generate the shell-model properties for light nuclei from $A$=2 to 6. (For practical reasons, the model space is partially truncated for $A$=6.) Binding energies and other physical observables are calculated and compare favorably with experiment.Comment: prepared using LaTex, 21 manuscript pages, no figure

On the Open-Closed B-Model

We study the coupling of the closed string to the open string in the topological B-model. These couplings can be viewed as gauge invariant observables in the open string field theory, or as deformations of the differential graded algebra describing the OSFT. This is interpreted as an intertwining map from the closed string sector to the deformation (Hochschild) complex of the open string algebra. By an explicit calculation we show that this map induces an isomorphism of Gerstenhaber algebras on the level of cohomology. Reversely, this can be used to derive the closed string from the open string. We shortly comment on generalizations to other models, such as the A-model.Comment: LaTeX, 48 pages. Citation adde

First-order cosmological phase transitions in the radiation dominated era

We consider first-order phase transitions of the Universe in the radiation-dominated era. We argue that in general the velocity of interfaces is non-relativistic due to the interaction with the plasma and the release of latent heat. We study the general evolution of such slow phase transitions, which comprise essentially a short reheating stage and a longer phase equilibrium stage. We perform a completely analytical description of both stages. Some rough approximations are needed for the first stage, due to the non-trivial relations between the quantities that determine the variation of temperature with time. The second stage, instead, is considerably simplified by the fact that it develops at a constant temperature, close to the critical one. Indeed, in this case the equations can be solved exactly, including back-reaction on the expansion of the Universe. This treatment also applies to phase transitions mediated by impurities. We also investigate the relations between the different parameters that govern the characteristics of the phase transition and its cosmological consequences, and discuss the dependence of these parameters with the particle content of the theory.Comment: 38 pages, 3 figures; v2: Minor changes, references added; v3: several typos correcte

Organic nitrate aerosol formation via NO³ + biogenic volatile organic compounds in the southeastern United States

Gas- and aerosol-phase measurements of oxidants, biogenic volatile organic compounds (BVOCs) and organic nitrates made during the Southern Oxidant and Aerosol Study (SOAS campaign, Summer 2013) in central Alabama show that a nitrate radical (NO₃) reaction with monoterpenes leads to significant secondary aerosol formation. Cumulative losses of NO₃ to terpenes are correlated with increase in gasand aerosol-organic nitrate concentrations made during the campaign. Correlation of NO₃ radical consumption to organic nitrate aerosol formation as measured by aerosol mass spectrometry and thermal dissociation laser-induced fluorescence suggests a molar yield of aerosol-phase monoterpene nitrates of 23–44 %. Compounds observed via chemical ionization mass spectrometry (CIMS) are correlated to predicted nitrate loss to BVOCs and show C₁₀H₁₇NO₅, likely a hydroperoxy nitrate, is a major nitrate-oxidized terpene product being incorporated into aerosols. The comparable isoprene product C₅H₉NO₅ was observed to contribute less than 1% of the total organic nitrate in the aerosol phase and correlations show that it is principally a gas-phase product from nitrate oxidation of isoprene. Organic nitrates comprise between 30 and 45% of the NOy budget during SOAS. Inorganic nitrates were also monitored and showed that during incidents of increased coarse-mode mineral dust, HNO₃ uptake produced nitrate aerosol mass loading at a rate comparable to that of organic nitrate produced via NO₃ CBVOCs