Precision Teaching in IV Fluid Prescribing and Patient Safety

OBJECTIVES: Precision Teaching (PT) has been shown to be an effective intervention to assess teaching method effectiveness and evaluate learning outcomes. SAFMEDS (Say All Fast Minute Every Day Shuffled) are a practice/assessment procedure within the PT framework to assist learning and fluency. We explored the effects of a brief intervention with PT, to impart high frequency performance in safe intravenous fluid prescription in a group of final year undergraduate medical students.
METHODS: 133 final year undergraduate medical students completed a multiple choice question (MCQ) test on safe IV fluid prescription at the beginning and end of the study. The control group (n= 76) of students were taught using a current standardized teaching method. Students allocated to the intervention arm of the study were additionally instructed on PT and the use of SAFMEDS. The study group (n = 57) received 50 SAFMEDS cards containing information on the principles of IV fluid prescription scenarios. These students were trained/tested twice per day for 1 minute.
RESULTS: Interim analysis showed that the study group displayed an improvement in fluency and accuracy as the study progressed. There was a statistically significant improvement in MCQ performance for the PT group compared with the control group between the beginning and end of the study (35% vs 15%).
CONCLUSION: These results suggest PT employing SAFMEDS is an effective method for improving fluency, accuracy and patient safety in intravenous fluid prescribing amongst undergraduate medical students.

Characterizing K2 Planet Discoveries: A super-Earth transiting the bright K-dwarf HIP 116454

We report the first planet discovery from the two-wheeled Kepler (K2) mission: HIP 116454 b. The host star HIP 116454 is a bright (V = 10.1, K = 8.0) K1 dwarf with high proper motion and a parallax-based distance of 55.2 +/- 5.4 pc. Based on high-resolution optical spectroscopy, we find that the host star is metal-poor with [Fe/H]= -0.16 +/- 0.08 and has a radius R-star = 0.716 +/- 0.024 R-circle dot and mass M-star = 0.775 +/- 0.027M(circle dot). The star was observed by the Kepler spacecraft during its Two-Wheeled Concept Engineering Test in 2014 February. During the 9 days of observations, K2 observed a single transit event. Using a new K2 photometric analysis technique, we are able to correct small telescope drifts and recover the observed transit at high confidence, corresponding to a planetary radius of R-p = 2.53 +/- 0.18 R-circle plus. Radial velocity observations with the HARPS-N spectrograph reveal a 11.82 +/- 1.33 M-circle plus planet in a 9.1 day orbit, consistent with the transit depth, duration, and ephemeris. Follow-up photometric measurements from the MOST satellite confirm the transit observed in the K2 photometry and provide a refined ephemeris, making HIP 116454 b amenable for future follow-up observations of this latest addition to the growing population of transiting super-Earths around nearby, bright stars.

Nonlinear hydrodynamic Langmuir waves in fully degenerate relativistic plasma

The combined effect of special relativity and electron degeneracy on Langmuir waves is analyzed by utilizing a rigorous fully relativistic hydrodynamic model. Assuming a traveling wave solution form, a set of conservation laws is identified, together with a pseudo-potential function depending on the relativistic parameter p<inf>F</inf>/(m c) (where p<inf>F</inf> is the Fermi momentum, m is the mass of the charge carriers and c the speed of light), as well as on the amplitude of the electrostatic energy perturbation.

Fluid balance, intradialytic hypotension, and outcomes in critically ill patients undergoing renal replacement therapy: a cohort study

Introduction: In this cohort study, we explored the relationship between fluid balance, intradialytic hypotension and outcomes in critically ill patients with acute kidney injury (AKI) who received renal replacement therapy (RRT).

Methods: We analysed prospectively collected registry data on patients older than 16 years who received RRT for at least two days in an intensive care unit at two university-affiliated hospitals. We used multivariable logistic regression to determine the relationship between mean daily fluid balance and intradialytic hypotension, both over seven days following RRT initiation, and the outcomes of hospital mortality and RRT dependence in survivors.

Results: In total, 492 patients were included (299 male (60.8%), mean (standard deviation (SD)) age 62.9 (16.3) years); 251 (51.0%) died in hospital. Independent risk factors for mortality were mean daily fluid balance (odds ratio (OR) 1.36 per 1000 mL positive (95% confidence interval (CI) 1.18 to 1.57), intradialytic hypotension (OR 1.14 per 10% increase in days with intradialytic hypotension (95% CI 1.06 to 1.23)), age (OR 1.15 per five-year increase (95% CI 1.07 to 1.25)), maximum sequential organ failure assessment score on days 1 to 7 (OR 1.21 (95% CI 1.13 to 1.29)), and Charlson comorbidity index (OR 1.28 (95% CI 1.14 to 1.44)); higher baseline creatinine (OR 0.98 per 10 mu mol/L (95% CI 0.97 to 0.996)) was associated with lower risk of death. Of 241 hospital survivors, 61 (25.3%) were RRT dependent at discharge. The only independent risk factor for RRT dependence was pre-existing heart failure (OR 3.13 (95% CI 1.46 to 6.74)). Neither mean daily fluid balance nor intradialytic hypotension was associated with RRT dependence in survivors. Associations between these exposures and mortality were similar in sensitivity analyses accounting for immortal time bias and dichotomising mean daily fluid balance as positive or negative. In the subgroup of patients with data on pre-RRT fluid balance, fluid overload at RRT initiation did not modify the association of mean daily fluid balance with mortality.

Conclusions: In this cohort of patients with AKI requiring RRT, a more positive mean daily fluid balance and intradialytic hypotension were associated with hospital mortality but not with RRT dependence at hospital discharge in survivors.

LSQ14bdq: a type Ic Super-luminous Supernova with a double-peaked light curve

We present data for LSQ14bdq, a hydrogen-poor super-luminous supernova (SLSN) discovered by the La Silla QUEST survey and classified by the Public ESO Spectroscopic Survey of Transient Objects. The spectrum and light curve are very similar to slow-declining SLSNe such as PTF12dam. However, detections within ∼1 day after explosion show a bright and relatively fast initial peak, lasting for ∼15 days, prior to the usual slow rise to maximum light. The broader, main peak can be fit with either central engine or circumstellar interaction models. We discuss the implications of the precursor peak in the context of these models. It is too bright and narrow to be explained as a normal ⁵⁶Ni-powered SN, and we suggest that interaction models may struggle to fit the two peaks simultaneously. We propose that the initial peak may arise from the post-shock cooling of extended stellar material, and reheating by a central engine drives the second peak. In this picture, we show that an explosion energy of ∼2 × 10⁵² erg and a progenitor radius of a few hundred solar radii would be required to power the early emission. The competing engine models involve rapidly spinning magnetars (neutron stars) or fallback onto a central black hole. The prompt energy required may favor the black hole scenario. The bright initial peak may be difficult to reconcile with a compact Wolf-Rayet star as a progenitor since the inferred energies and ejected masses become unphysical.

Super suburbia: developing resilience by closing resource cycles in North Belfast

Sustainability can be described as having three interlinked strands, known as the ‘trias energetica’, without which resilience is difficult to achieve. These strands are environmental, social and economic: and if taken as indicators, the suburbs of North Belfast are very poorly performing indeed. Places such as Ligoneal and Glen Cairn have poor housing stock energetically, and also little economic activity. This paper describes propositional work completed by Queens University and Belfast City Council as part of the UK’s Technology Strategy Board’s Future Cities Programme, which aimed to develop new synergies in these neighbourhoods by the insertion of closed cycle economies.

By utilising a research by design methodology, the paper develops a process-based and phased design to develop a new emergent form to these neighbourhoods, one in which new productive systems are embedded into the city, at a small-scales. These include a peak-load hydro-electric project in Ligoneal; a productive landscape in Glen Cairn and a city-wide energy refurbishment utilising neighbourhood waste streams.

These designs allow for a roadmap for development to be created that could change the modus operandi of an area over a relatively short period of time, and show that even modest investments of productive technologies at a local scale could fundamentally change the form and the economic and environmental operation of the city in the future, and create a new resilient city, one that can be less externally dependent and more socially just.

Evaluation of La1−xSrxMnO3 (0 ≤ x < 0.4) synthesised via a modified sol–gel method as mediators for magnetic fluid hyperthermia

A range of lanthanum strontium manganates (La1−xSrxMnO3–LSMO) where 0 ≤ x < 0.4 were prepared using a modified peroxide sol–gel synthesis method. The magnetic nanoparticle (MNP) clusters obtained for each of the materials were characterised using scanning electron microscopy (SEM), X-ray powder diffraction (XRD) and infra-red (IR) spectroscopy in order to confirm the crystalline phases, crystallite size and cluster morphology. The magnetic properties of the materials were assessed using the Superconducting quantum interference device (SQUID) to evaluate the magnetic susceptibility, Curie temperature (Tc) and static hysteretic losses. Induction heating experiments also provided an insight into the magnetocaloric effect for each material. The specific absorption rate (SAR) of the materials was evaluated experimentally and via numerical simulations. The magnetic properties and heating data were linked with the crystalline structure to make predictions with respect to the best LSMO composition for mild hyperthermia (41 °C ≤ T ≤ 46 °C). La0.65Sr0.35MnO3, with crystallite diameter of 82.4 nm, (agglomerate size of ∼10 μm), Tc of 89 °C and SAR of 56 W gMn−1 at a concentration 10 mg mL−1 gave the optimal induction heating results (Tmax of 46.7 °C) and was therefore deemed as most suitable for the purposes of mild hyperthermia, vide infra.

The high-energy environment in the super-Earth system CoRoT-7

High-energy irradiation of exoplanets has been identified to be a key influence on the stability of these planets' atmospheres. So far, irradiation-driven mass-loss has been observed only in two Hot Jupiters, and the observational data remain even more sparse in the super-Earth regime. We present an investigation of the high-energy emission in the CoRoT-7 system, which hosts the first known transiting super-Earth. To characterize the high-energy XUV radiation field into which the rocky planets CoRoT-7b and CoRoT-7c are immersed, we analyzed a 25 ks XMM-Newton observation of the host star. Our analysis yields the first clear (3.5σ) X-ray detection of CoRoT-7. We determine a coronal temperature of ≈ 3 MK and an X-ray luminosity of 3 × 1028 erg s-1. The level of XUV irradiation on CoRoT-7b amounts to ≈37 000 erg cm-2 s-1. Current theories for planetary evaporation can only provide an order-of-magnitude estimate for the planetary mass loss; assuming that CoRoT-7b has formed as a rocky planet, we estimate that CoRoT-7b evaporates at a rate of about 1.3 × 1011 g s-1 and has lost ≈4-10 earth masses in total.

X-Ray Emission from the Super-Earth Host GJ 1214

Stellar activity can produce large amounts of high-energy radiation, which is absorbed by the planetary atmosphere leading to irradiation-driven mass loss. We present the detection and an investigation of high-energy emission in a transiting super-Earth host system, GJ 1214, based on XMM-Newton observations. We derive an X-ray luminosity of LX = 7.4 × 1025 erg s-1 and a corresponding activity level of log (LX /L bol) ~ -5.3. Further, we determine a coronal temperature of about ~3.5 MK, which is typical for coronal emission of moderately active low-mass stars. We estimate that GJ 1214 b evaporates at a rate of 1.3× 1010 g s-1 and has lost a total of ≈2-5.6 M ⊕.