Spatial-temporal clustering of companion animal enteric syndrome: detection and investigation through the use of electronic medical records from participating private practices

SUMMARY There is interest in the potential of companion animal surveillance to provide data to improve pet health and to provide early warning of environmental hazards to people. We implemented a companion animal surveillance system in Calgary, Alberta and the surrounding communities. Informatics technologies automatically extracted electronic medical records from participating veterinary practices and identified cases of enteric syndrome in the warehoused records. The data were analysed using time-series analyses and a retrospective space-time permutation scan statistic. We identified a seasonal pattern of reports of occurrences of enteric syndromes in companion animals and four statistically significant clusters of enteric syndrome cases. The cases within each cluster were examined and information about the animals involved (species, age, sex), their vaccination history, possible exposure or risk behaviour history, information about disease severity, and the aetiological diagnosis was collected. We then assessed whether the cases within the cluster were unusual and if they represented an animal or public health threat. There was often insufficient information recorded in the medical record to characterize the clusters by aetiology or exposures. Space-time analysis of companion animal enteric syndrome cases found evidence of clustering. Collection of more epidemiologically relevant data would enhance the utility of practice-based companion animal surveillance.

Milk fatty acids as possible biomarkers to early diagnose elevated concentrations of blood plasma nonesterified fatty acids in dairy cows

Most cows encounter a state of negative energy balance during the periparturient period, which may lead to metabolic disorders and impaired fertility. The aim of this study was to assess the potential of milk fatty acids as diagnostic tools of detrimental levels of blood plasma nonesterified fatty acids (NEFA), defined as NEFA concentrations beyond 0.6 mmol/L, in a data set of 92 early lactating cows fed a glucogenic or lipogenic diet and subjected to 0-, 30-, or 60-d dry period before parturition. Milk was collected in wk 2, 3, 4, and 8 (n = 368) and blood was sampled weekly from wk 2 to 8 after parturition. Milk was analyzed for milk fatty acids and blood plasma for NEFA. Data were classified as "at risk of detrimental blood plasma NEFA" (NEFA ≥ 0.6 mmol/L) and "not at risk of detrimental blood plasma NEFA" (NEFA <0.6 mmol/L). Concentrations of 45 milk fatty acids and milk fat C18:1 cis-9-to-C15:0 ratio were subjected to a discriminant analysis. Milk fat C18:1 cis-9 revealed the most discriminating variable to identify detrimental blood plasma NEFA. A false positive rate of 10% allowed us to diagnose 46% of the detrimental blood plasma NEFA cases based on a milk fat C18:1 cis-9 concentration of at least 230 g/kg of milk fatty acids. Additionally, it was assessed whether the milk fat C18:1 cis-9 concentrations of wk 2 could be used as an early warning for detrimental blood plasma NEFA risk during the first 8 wk in lactation. Cows with at least 240 g/kg of C18:1 cis-9 in milk fat had about 50% chance to encounter blood plasma NEFA values of 0.6 mmol/L or more during the first 8 wk of lactation, with a false positive rate of 11.4%. Profit simulations were based on costs for cows suffering from detrimental blood plasma NEFA, and costs for preventive treatment based on daily dosing of propylene glycol for 3 wk. Given the relatively low incidence rate (8% of all observations), continuous monitoring of milk fatty acids during the first 8 wk of lactation to diagnose detrimental blood plasma NEFA does not seem cost effective. On the contrary, milk fat C18:1 cis-9 of the second lactation week could be an early warning of cows at risk of detrimental blood NEFA. In this case, selective treatment may be cost effective.

Timely Reporting and Interactive Visualization of Animal Health and Slaughterhouse Surveillance Data in Switzerland

The reporting of outputs from health surveillance systems should be done in a near real-time and interactive manner in order to provide decision makers with powerful means to identify, assess, and manage health hazards as early and efficiently as possible. While this is currently rarely the case in veterinary public health surveillance, reporting tools do exist for the visual exploration and interactive interrogation of health data. In this work, we used tools freely available from the Google Maps and Charts library to develop a web application reporting health-related data derived from slaughterhouse surveillance and from a newly established web-based equine surveillance system in Switzerland. Both sets of tools allowed entry-level usage without or with minimal programing skills while being flexible enough to cater for more complex scenarios for users with greater programing skills. In particular, interfaces linking statistical softwares and Google tools provide additional analytical functionality (such as algorithms for the detection of unusually high case occurrences) for inclusion in the reporting process. We show that such powerful approaches could improve timely dissemination and communication of technical information to decision makers and other stakeholders and could foster the early-warning capacity of animal health surveillance systems.

Desarrollo e implementación de un sistema robótico aéreo con programación tridimensional orientado al recorrido de rutas

En la actualidad se estudia en numerosos campos cómo automatizar distintas tareas ejecutadas por aeronaves con tripulación humana. Estas tareas son en todos los casos muy costosos, debido al gran consumo de combustible, gran coste de adquisición y mantenimiento de la propia aeronave, todo ello sin contar el riesgo para los mismos tripulantes. Como ejemplo de estas tareas se puede incluir la vigilancia policial y fronteriza, revisiones de tendidos de alta tensión, la alerta temprana de incendios forestales y la medición de parámetros contaminantes. El objetivo de este proyecto es el diseño y la construcción de un prototipo electrónico empotrado basado en microcontrolador con núcleo C8051 de Silicon labs, que sea capaz de gobernar una aeronave de radiocontrol de forma transparente, de manera que en un futuro se pueda sustituir el propio aeromodelo, con la modificación de algunos parámetros, para poder incorporar sistemas de video o distintos medios de detección de variables. El prototipo seguirá una ruta confeccionada y transferida como un archivo de texto con un formato determinado que contendrá los datos necesarios para poder navegar mediante GPS. El trabajo con los modelos de motorización térmica (motores de combustión interna tipo glow, en este caso) resulta peligroso debido a la gran energía que son capaces de alcanzar. A fin de mantener la máxima seguridad durante la evolución del proyecto, se ha diseñado un proceso de tres partes independientes que permitan la correcta familiarización de los distintos componentes que se emplearán. Las fases son las siguientes: 1. Test y modelado de todos los componentes mediante pequeños montajes con protoboard de inserción y programas individuales. Se realizará mediante una tarjeta multipropósito que contendrá un microcontrolador similar en características, aunque de menor complejidad, al del prototipo final. 2. Integración de todos los componentes mediante una tarjeta especialmente diseñada que servirá de interfaz entre la tarjeta multipropósito y todo el hardware necesario para el control de un vehículo terrestre de iguales características (actuadores y motorización) al aeromodelo. 3. Diseño de un sistema embebido que concentre todos los subsistemas desarrollados en las fases anteriores y que integre todos los componentes necesarios para el gobierno de una aeronave de ala fija. ABSTRACT. Nowadays, the way of automating different tasks done by manned vehicles is studied. These tasks are any case very expensive, due to large fuel consumption, costs of aircraft buying, without taking into account the risk for human crew. As an example of these tasks, we can include policing or border surveillance, maintenance of high voltage lines, early warning of forest fire and measuring of pollution parameters. The target of this project is the design and construction of an embedded electronic prototype, based on a microcontroller with C8051 core from Silicon labs, and it will be able to controlling an aircraft transparently, in order that in the future the flying model could be changed with the modification of some parameters, and video or any variables detection systems could be added. The prototype will follow a designed and transferred path as an plain text file with a given format, that will contain all the necessary data for GPS navigation. Working with heat engine models (internal combustion engine, glow type, in this case) becomes dangerous due to the large energy that can be able to acquire. In order to keep the maximum safety level during the project evolution a three independent stages process have been designed, this allows familiarizing properly with the parts that will be used. The stages are as follows: 1. Test and modeling of all of the parts by little assemblies with through-hole protoboard and stand alone programs. It will be done with a multipurpose card which contains a microcontroller of similar characteristics, although less complex, of the final prototype. 2. Integrating of all of parts through a dedicated design card that will serve as interface between multipurpose card and all the necessary hardware for controlling a ground vehicle with the same characteristics (actuators and engine) of the flying model. 3. Embedded system designing that contains all the developed subsystems in the previous stages and integrates all the necessary parts for controlling a fixed-wing aircraft.

On Modeling an Innovative Monitoring Network for Protecting and Managing Cultural Heritage from Risk Events

In this paper the model of an Innovative Monitoring Network involving properly connected nodes to develop an Information and Communication Technology (ICT) solution for preventive maintenance of historical centres from early warnings is proposed. It is well known that the protection of historical centres generally goes from a large-scale monitoring to a local one and it could be supported by a unique ICT solution. More in detail, the models of a virtually organized monitoring system could enable the implementation of automated analyses by presenting various alert levels. An adequate ICT solution tool would allow to define a monitoring network for a shared processing of data and results. Thus, a possible retrofit solution could be planned for pilot cases shared among the nodes of the network on the basis of a suitable procedure utilizing a retrofit catalogue. The final objective would consist in providing a model of an innovative tool to identify hazards, damages and possible retrofit solutions for historical centres, assuring an easy early warning support for stakeholders. The action could proactively target the needs and requirements of users, such as decision makers responsible for damage mitigation and safeguarding of cultural heritage assets.

Identificação do risco de deterioração fisiológica no pré-hospitalar

Enquadramento – A Early Warning Scores é uma escala de alerta, baseada num sistema de atribuição de pontos (scores) aos parâmetros vitais e deterioração do SNC, sendo a sua principal finalidade a identificação precoce do risco de deterioração fisiológica do doente. Objetivos – Determinar os parâmetros da escala que foram avaliados; identificar a periodicidade de avaliação dos parâmetros da escala; determinar as situações identificadas como risco de deterioração fisiológica; avaliar as propriedades psicométricas da escala Early Warning Scores (validade e fiabilidade). Material e Método – Estudo quantitativo e descritivo-correlacional, cuja população alvo consistiu nos doentes vítimas de acidente ou doença súbita, submetidos a atendimentos por parte de enfermeiros afetos ao INEM, nomeadamente nas ambulâncias de Suporte Imediato de Vida, mediante ativação via 112. O instrumento de avaliação utilizado consiste na Escala Early Warning Scores. Resultados – Verificou-se que o índice de fiabilidade se traduziu num valor de alfa de Cronbach, para a globalidade da escala, fraco (α=0.462). Concluiu-se que houve uma redução progressiva dos scores, em termos de risco, indicando a ocorrência de uma deteção precoce da degradação clínica dos 214 doentes, o que se traduziu numa atuação mais eficaz no pré-hospitalar. Conclusão - A redução progressiva dos scores, em termos de risco ao longo dos três momentos de avaliação com a Early Warning Scores, sugere que houve uma deteção precoce da degradação clínica dos doentes, resultando numa atuação mais eficaz no pré-hospitalar. Palavras-chave: Pré-hospitalar; Risco de deterioração fisiológica; Early Warning Scores.

A COMUNICAÇÃO PODE SALVAR VIDAS: ALERTAS ANTECIPADOS DE EMERGÊNCIAS CLIMÁTICAS PELA TELEVISÃO DIGITAL INTERATIVA BRASILEIRA

Alertas Antecipados de Emergência são elementos importantes na redução de riscos de desastres, evitando a perda de vidas e reduzindo seu impacto econômico e material. Dentre os meios de comunicação mais eficazes para geração de alertas antecipados, a televisão digital com sua capacidade de emissão de um para muitos e ainda com suas possibilidades de gerar informações reativas com dados enviados pelo mesmo sinal de TV é, no momento, o estado da arte para ajudar a população em situações de risco, comprovado através de estudos comparativos entre os sistemas de alerta de emergência existentes hoje em todo o mundo. Neste trabalho são comparados os sistemas japonês e norte-americano, sendo que os referenciais teóricos apresentados focalizam o processo comunicacional de uma informação de emergência, a partir de diversas teorias que fundamentam o processo de comunicação em situações de crise, com os quais chegou-se à conclusão de que a tecnologia de televisão Digital Brasileira, juntamente com a infraestrutura essencial para detecção de riscos e confiabilidade para a geração de alertas antecipados já existente, dispõe de todo o ferramental necessário para a criação de um sistema nacional. Por fim são apresentadas as indicações iniciais para a criação de um modelo para uma comunicação eficaz e efetiva de informações de emergência destinado à população brasileira.

Goal-based modeling of dynamically adaptive system requirements

Self-adaptation is emerging as an increasingly important capability for many applications, particularly those deployed in dynamically changing environments, such as ecosystem monitoring and disaster management. One key challenge posed by Dynamically Adaptive Systems (DASs) is the need to handle changes to the requirements and corresponding behavior of a DAS in response to varying environmental conditions. Berry et al. previously identified four levels of RE that should be performed for a DAS. In this paper, we propose the Levels of RE for Modeling that reify the original levels to describe RE modeling work done by DAS developers. Specifically, we identify four types of developers: the system developer, the adaptation scenario developer, the adaptation infrastructure developer, and the DAS research community. Each level corresponds to the work of a different type of developer to construct goal model(s) specifying their requirements. We then leverage the Levels of RE for Modeling to propose two complementary processes for performing RE for a DAS. We describe our experiences with applying this approach to GridStix, an adaptive flood warning system, deployed to monitor the River Ribble in Yorkshire, England.

Measuring water activity of aviation fuel using a polymer optical fiber Bragg grating

Poly(methyl methacrylate) (PMMA) based polymer optical fiber Bragg gratings have been used for measuring water activity of aviation fuel. Jet A-1 samples with water content ranging from 100% ERH (wet fuel) to 10 ppm (dried fuel), have been conditioned and calibrated for measurement. The PMMA based optical fiber grating exhibits consistent response and a good sensitivity of 59±3pm/ppm (water content in mass). This water activity measurement allows PMMA based optical fiber gratings to detect very tiny amounts of water in fuels that have a low water saturation point, potentially giving early warning of unsafe operation of a fuel system. © 2014 SPIE.

Early warnings of heart rate deterioration

Hospitals can experience difficulty in detecting and responding to early signs of patient deterioration leading to late intensive care referrals, excess mortality and morbidity, and increased hospital costs. Our study aims to explore potential indicators of physiological deterioration by the analysis of vital-signs. The dataset used comprises heart rate (HR) measurements from MIMIC II waveform database, taken from six patients admitted to the Intensive Care Unit (ICU) and diagnosed with severe sepsis. Different indicators were considered: 1) generic early warning indicators used in ecosystems analysis (autocorrelation at-1-lag (ACF1), standard deviation (SD), skewness, kurtosis and heteroskedasticity) and 2) entropy analysis (kernel entropy and multi scale entropy). Our preliminary findings suggest that when a critical transition is approaching, the equilibrium state changes what is visible in the ACF1 and SD values, but also by the analysis of the entropy. Entropy allows to characterize the complexity of the time series during the hospital stay and can be used as an indicator of regime shifts in a patient’s condition. One of the main problems is its dependency of the scale used. Our results demonstrate that different entropy scales should be used depending of the level of entropy verified.

Disaster Risk Management Disparity in the Caribbean: Evidence from Barbados, Dominican Republic, Jamaica and Trinidad and Tobago

This study on risk and disaster management capacities of four Caribbean countries: Barbados, the Dominican Republic, Jamaica, and Trinidad and Tobago, examines three main dimensions: 1) the impact of natural disasters from 1900 to 2010 (number of events, number of people killed, total number affected, and damage in US$); 2) institutional assessments of disaster risk management disparity; and 3) the 2010 Inter-American Bank for Development (IADB) Disaster Risk and Risk Management indicators for the countries under study. The results show high consistency among the different sources examined, pointing out the need to extend the IADB measurements to the rest of the Caribbean countries. Indexes and indicators constitute a comparison measure vis-à-vis existing benchmarks in order to anticipate a capacity to deal with adverse events and their consequences; however, the indexes and indicators could only be tested against the occurrence of a real event. Therefore, the need exists to establish a sustainable and comprehensive evaluation system after important disasters to assess a country‘s performance, verify the indicators, and gain feedback on measurement systems and methodologies. There is diversity in emergency and preparedness for disasters in the four countries under study. The nature of the event (hurricanes, earthquakes, floods, and seismic activity), especially its frequency and the intensity of the damage experienced, is related to how each has designed its risk and disaster management policies and programs to face natural disasters. Vulnerabilities to disaster risks have been increasing, among other factors, because of uncontrolled urbanization, demographic density and poverty increase, social and economic marginalization, and lack of building code enforcement. The four countries under study have shown improvements in risk management capabilities, yet they are far from being completed prepared. Barbados‘ risk management performance is superior, in comparison, to the majority of the countries of the region. However, is still far in achieving high performance levels and sustainability in risk management, primarily when it has the highest gap between potential macroeconomic and financial losses and the ability to face them. The Dominican Republic has shown steady risk performance up to 2008, but two remaining areas for improvement are hazard monitoring and early warning systems. Jamaica has made uneven advances between 1990 and 2008, requiring significant improvements to achieve high performance levels and sustainability in risk management, as well as macroeconomic mitigation infrastructure. Trinidad and Tobago has the lowest risk management score of the 15 countries in the Latin American and Caribbean region as assessed by the IADB study in 2010, yet it has experienced an important vulnerability reduction. In sum, the results confirmed the high disaster risk management disparity in the Caribbean region.

Disater Risk Management Disparity in the Caribbean: Evidence from Barbados, Dominican Republic, Jamaica and Trinidad and Tobago

This study on risk and disaster management capacities of four Caribbean countries: Barbados, the Dominican Republic, Jamaica, and Trinidad and Tobago, examines three main dimensions: 1) the impact of natural disasters from 1900 to 2010 (number of events, number of people killed, total number affected, and damage in US$); 2) institutional assessments of disaster risk management disparity; and 3) the 2010 Inter-American Bank for Development (IADB) Disaster Risk and Risk Management indicators for the countries under study. The results show high consistency among the different sources examined, pointing out the need to extend the IADB measurements to the rest of the Caribbean countries. Indexes and indicators constitute a comparison measure vis-à-vis existing benchmarks in order to anticipate a capacity to deal with adverse events and their consequences; however, the indexes and indicators could only be tested against the occurrence of a real event. Therefore, the need exists to establish a sustainable and comprehensive evaluation system after important disasters to assess a country’s performance, verify the indicators, and gain feedback on measurement systems and methodologies. There is diversity in emergency and preparedness for disasters in the four countries under study. The nature of the event (hurricanes, earthquakes, floods, and seismic activity), especially its frequency and the intensity of the damage experienced, is related to how each has designed its risk and disaster management policies and programs to face natural disasters. Vulnerabilities to disaster risks have been increasing, among other factors, because of uncontrolled urbanization, demographic density and poverty increase, social and economic marginalization, and lack of building code enforcement. The four countries under study have shown improvements in risk management capabilities, yet they are far from being completed prepared. Barbados’ risk management performance is superior, in comparison, to the majority of the countries of the region. However, is still far in achieving high performance levels and sustainability in risk management, primarily when it has the highest gap between potential macroeconomic and financial losses and the ability to face them. The Dominican Republic has shown steady risk performance up to 2008, but two remaining areas for improvement are hazard monitoring and early warning systems. Jamaica has made uneven advances between 1990 and 2008, requiring significant improvements to achieve high performance levels and sustainability in risk management, as well as macroeconomic mitigation infrastructure. Trinidad and Tobago has the lowest risk management score of the 15 countries in the Latin American and Caribbean region as assessed by the IADB study in 2010, yet it has experienced an important vulnerability reduction. In sum, the results confirmed the high disaster risk management disparity in the Caribbean region.

Distribution, occurrence and biotoxin composition of the main shellfish toxin producing microalgae within European waters: A comparison of methods of analysis.

Harmful algal blooms (HABs) are a natural global phenomena emerging in severity and extent. Incidents have many economic, ecological and human health impacts. Monitoring and providing early warning of toxic HABs are critical for protecting public health. Current monitoring programmes include measuring the number of toxic phytoplankton cells in the water and biotoxin levels in shellfish tissue. As these efforts are demanding and labour intensive, methods which improve the efficiency are essential. This study compares the utilisation of a multitoxin surface plasmon resonance (multitoxin SPR) biosensor with enzyme-linked immunosorbent assay (ELISA) and analytical methods such as high performance liquid chromatography with fluorescence detection (HPLC-FLD) and liquid chromatography–tandem mass spectrometry (LC–MS/MS) for toxic HAB monitoring efforts in Europe. Seawater samples (n = 256) from European waters, collected 2009–2011, were analysed for biotoxins: saxitoxin and analogues, okadaic acid and dinophysistoxins 1/2 (DTX1/DTX2) and domoic acid responsible for paralytic shellfish poisoning (PSP), diarrheic shellfish poisoning (DSP) and amnesic shellfish poisoning (ASP), respectively. Biotoxins were detected mainly in samples from Spain and Ireland. France and Norway appeared to have the lowest number of toxic samples. Both the multitoxin SPR biosensor and the RNA microarray were more sensitive at detecting toxic HABs than standard light microscopy phytoplankton monitoring. Correlations between each of the detection methods were performed with the overall agreement, based on statistical 2 × 2 comparison tables, between each testing platform ranging between 32% and 74% for all three toxin families illustrating that one individual testing method may not be an ideal solution. An efficient early warning monitoring system for the detection of toxic HABs could therefore be achieved by combining both the multitoxin SPR biosensor and RNA microarray.

Distribution, occurrence and biotoxin composition of the main shellfish toxin producing microalgae within European waters: A comparison of methods of analysis.

Harmful algal blooms (HABs) are a natural global phenomena emerging in severity and extent. Incidents have many economic, ecological and human health impacts. Monitoring and providing early warning of toxic HABs are critical for protecting public health. Current monitoring programmes include measuring the number of toxic phytoplankton cells in the water and biotoxin levels in shellfish tissue. As these efforts are demanding and labour intensive, methods which improve the efficiency are essential. This study compares the utilisation of a multitoxin surface plasmon resonance (multitoxin SPR) biosensor with enzyme-linked immunosorbent assay (ELISA) and analytical methods such as high performance liquid chromatography with fluorescence detection (HPLC-FLD) and liquid chromatography–tandem mass spectrometry (LC–MS/MS) for toxic HAB monitoring efforts in Europe. Seawater samples (n = 256) from European waters, collected 2009–2011, were analysed for biotoxins: saxitoxin and analogues, okadaic acid and dinophysistoxins 1/2 (DTX1/DTX2) and domoic acid responsible for paralytic shellfish poisoning (PSP), diarrheic shellfish poisoning (DSP) and amnesic shellfish poisoning (ASP), respectively. Biotoxins were detected mainly in samples from Spain and Ireland. France and Norway appeared to have the lowest number of toxic samples. Both the multitoxin SPR biosensor and the RNA microarray were more sensitive at detecting toxic HABs than standard light microscopy phytoplankton monitoring. Correlations between each of the detection methods were performed with the overall agreement, based on statistical 2 × 2 comparison tables, between each testing platform ranging between 32% and 74% for all three toxin families illustrating that one individual testing method may not be an ideal solution. An efficient early warning monitoring system for the detection of toxic HABs could therefore be achieved by combining both the multitoxin SPR biosensor and RNA microarray.

Situation Background Assessment Recommendation (SBAR): Undergraduate Perspectives

Situation Background Assessment and Recommendation (SBAR): Undergraduate Perspectives C Morgan, L Adams, J Murray, R Dunlop, IK Walsh. Ian K Walsh, Centre for Medical Education, Queen’s University Belfast, Mulhouse Building, Royal Victoria Hospital, Grosvenor Road, Belfast BT12 6DP Background and Purpose: Structured communication tools are used to improve team communication quality.1,2 The Situation Background Assessment and Recommendation (SBAR) tool is widely adopted within patient safety.3 SBAR effectiveness is reportedly equivocal, suggesting use is not sustained beyond initial training.4-6 Understanding perspectives of those using SBAR may further improve clinical communication. We investigated senior medical undergraduate perspectives on SBAR, particularly when communicating with senior colleagues. Methodology: Mixed methods data collection was used. A previously piloted questionnaire with 12 five point Lickert scale questions and 3 open questions was given to all final year medical students. A subgroup also participated in 10 focus groups, deploying strictly structured audio-recorded questions. Selection was by convenience sampling, data gathered by open text questions and comments transcribed verbatim. In-vivo coding (iterative, towards data saturation) preceded thematic analysis. Results: 233 of 255 students (91%) completed the survey. 1. There were clearly contradictory viewpoints on SBAR usage. A recurrent theme was a desire for formal feedback and a relative lack of practice/experience with SBAR. 2. Students reported SBAR as having variable interpretation between individuals; limiting use as a shared mental model. 3. Brief training sessions are insufficient to embed the tool. 4. Most students reported SBAR helping effective communication, especially by providing structure in stressful situations. 5. Only 18.5% of students felt an alternative resource might be needed. Sub analysis of the themes highlighted: A. Lack of clarity regarding what information to include and information placement within the acronym, B. Senior colleague negative response to SBAR C. Lack of conciseness with the tool. Discussion and Conclusions: Despite a wide range of contradictory interpretation of SBAR utility, most students wish to retain the resource. More practice opportunities/feedback may enhance user confidence and understanding. References: (1) Leonard M, Graham S, Bonacum D. The human factor: the critical importance of effective teamwork and communication in providing safe care. Quality & Safety in Health Care 2004 Oct;13(Suppl 1):85-90. (2) d'Agincourt-Canning LG, Kissoon N, Singal M, Pitfield AF. Culture, communication and safety: lessons from the airline industry. Indian J Pediatr 2011 Jun;78(6):703-708. (3) Dunsford J. Structured communication: improving patient safety with SBAR. Nurs Womens Health 2009 Oct;13(5):384-390. (4) Compton J, Copeland K, Flanders S, Cassity C, Spetman M, Xiao Y, et al. Implementing SBAR across a large multihospital health system. Jt Comm J Qual Patient Saf 2012 Jun;38(6):261-268. (5) Ludikhuize J, de Jonge E, Goossens A. Measuring adherence among nurses one year after training in applying the Modified Early Warning Score and Situation-Background-Assessment-Recommendation instruments. Resuscitation 2011 Nov;82(11):1428-1433. (6) Cunningham NJ, Weiland TJ, van Dijk J, Paddle P, Shilkofski N, Cunningham NY. Telephone referrals by junior doctors: a randomised controlled trial assessing the impact of SBAR in a simulated setting. Postgrad Med J 2012 Nov;88(1045):619-626.