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.

Nuclei of Nearby Active Galaxies: NIR and Sub-mm Views and Finalizing the LINC-NIRVANA Fringe and Flexure Tracking System: Flexure and Temperature Behavior

The work presented in my thesis addresses the two cornerstones of modern astronomy: Observation and Instrumentation. Part I deals with the observation of two nearby active galaxies, the Seyfert 2 galaxy NGC 1433 and the Seyfert 1 galaxy NGC 1566, both at a distance of $\sim10$ Mpc, which are part of the Nuclei of Galaxies (NUGA) sample. It is well established that every galaxy harbors a super massive black hole (SMBH) at its center. Furthermore, there seems to be a fundamental correlation between the stellar bulge and SMBH masses. Simulations show that massive feedback, e.g., powerful outflows, in Quasi Stellar Objects (QSOs) has an impact on the mutual growth of bulge and SMBH. Nearby galaxies follow this relation but accrete mass at much lower rates. This gives rise to the following questions: Which mechanisms allow feeding of nearby Active Galactic Nuclei (AGN)? Is this feeding triggered by events, e.g., star formation, nuclear spirals, outflows, on $\sim500$ pc scales around the AGN? Does feedback on these scales play a role in quenching the feeding process? Does it have an effect on the star formation close to the nucleus? To answer these questions I have carried out observations with the Spectrograph for INtegral Field Observation in the Near Infrared (SINFONI) at the Very Large Telescope (VLT) situated on Cerro Paranal in Chile. I have reduced and analyzed the recorded data, which contain spatial and spectral information in the H-band ($1.45 \mic-1.85 \mic$) and K-band ($1.95 \mic-2.45 \mic$) on the central $10\arcsec\times10\arcsec$ of the observed galaxies. Additionally, Atacama Large Millimeter/Sub-millimeter Array (ALMA) data at $350$ GHz ($\sim0.87$ mm) as well as optical high resolution Hubble Space Telescope (HST) images are used for the analysis. For NGC 1433 I deduce from comparison of the distributions of gas, dust, and intensity of highly ionized emission lines that the galaxy center lies $\sim70$ pc north-northwest of the prior estimate. A velocity gradient is observed at the new center, which I interpret as a bipolar outflow, a circum nuclear disk, or a combination of both. At least one dust and gas arm leads from a $r\sim200$ pc ring towards the nucleus and might feed the SMBH. Two bright warm H$_2$ gas spots are detected that indicate hidden star formation or a spiral arm-arm interaction. From the stellar velocity dispersion (SVD) I estimate a SMBH mass of $\sim1.74\times10^7$ \msol. For NGC 1566 I observe a nuclear gas disk of $\sim150$ pc in radius with a spiral structure. I estimate the total mass of this disk to be $\sim5.4\times10^7$ \msol. What mechanisms excite the gas in the disk is not clear. Neither can the existence of outflows be proven nor is star formation detected over the whole disk. On one side of the spiral structure I detect a star forming region with an estimated star formation rate of $\sim2.6\times10^{-3}$ \msol\ yr$^{-1}$. From broad Br$\gamma$ emission and SVD I estimate a mean SMBH mass of $\sim5.3\times10^6$ \msol\ with an Eddington ratio of $\sim2\times10^{-3}$. Part II deals with the final tests of the Fringe and Flexure Tracker (FFTS) for LBT INterferometric Camera and the NIR/Visible Adaptive iNterferometer for Astronomy (LINC-NIRVANA) at the Large Binocular Telescope (LBT) in Arizona, USA, which I conducted. The FFTS is the subsystem that combines the two separate beams of the LBT and enables near-infrared interferometry with a significantly large field of view. The FFTS has a cryogenic system and an ambient temperature system which are separated by the baffle system. I redesigned this baffle to guarantee the functionality of the system after the final tests in the Cologne cryostat. The redesign did not affect any scientific performance of LINC-NIRVANA. I show in the final cooldown tests that the baffle fulfills the temperature requirement and stays $<110$ K whereas the moving stages in the ambient system stay $>273$ K, which was not given for the old baffle design. Additionally, I test the tilting flexure of the whole FFTS and show that accurate positioning of the detector and the tracking during observation can be guaranteed.

Implications of the reduction of cutting fluid in drilling AISI P20 steel with carbide tools

The machining of hardened steel is becoming increasingly important in manufacturing processes. Machined parts made with hardened steel are often subjected to high service demands, which require great resistance and quality. The machining of this material submits the tools to high mechanical and thermal loads, which increases the tool wear and affects the surface integrity of the part. In that context, this work presents a study of drilling of AISI P20 steel with carbide tools, analyzing the effects on the process caused by the reduction of cutting fluid supply and its relation with the tool wear and the surface integrity of the piece. The major problem observed in the tests was a difficulty for chips to flow through the drill flute, compromising their expulsion from the hole. After a careful analysis, a different machining strategy was adopted to solve the problem

Princesses et duchesses bibliophiles à la cour de René d'Anjou

De nombreuses dames de la cour d'Anjou ont exercé un mécénat littéraire et bibliophilique important à la cour d'Anjou. Parmi elles se trouvent Marie de Blois (v. 1340-1404), Yolande d'Aragon (1381-1442), Isabelle de Lorraine (v. 1400-1453), Jeanne de Laval (1433-1498) et Marie de Clèves (1426-1487). Le mécénat de ces femmes, parentes, épouses ou amies de René d'Anjou, est ici abordé à travers les documents d'archives et les manuscrits conservés qui attestent d'un intérêtréel et constant pour l'art du livre et de l'enluminure et pour la littérature en vogue à la cour. Une attention toute particulière est réservée au Pèlerinage de Vie humaine de Guillaume de Digulleville dont la version rimée, et plus tard la version en prose commandée par Jeanne de Laval, n'a cessé de captiver le lectorat féminin et notamment Marguerite d'Anjou, Blanche d'Anjou et Guyonne de Beauvau

A música na socialização de crianças com perturbação do espectro do autismo: perspetivas de educadores e professores

Projeto de Investigação realizado no âmbito da Unidade Curricular de Seminário de Projeto – Problemas Cognitivos e Motores

An Amidinohydrolase Provides the Missing Link in the Biosynthesis of Amino Marginolactone Antibiotics

Desertomycin A is an aminopolyol polyketide containing a macrolactone ring. We have proposed that desertomycin A and similar compounds (marginolactones) are formed by polyketide synthases primed not with gamma-aminobutanoyl-CoA but with 4-guanidinylbutanoyl-CoA, to avoid facile cyclization of the starter unit. This hypothesis requires that there be a final-stage de-amidination of the corresponding guanidino-substituted natural product, but no enzyme for such a process has been described. We have now identified candidate amidinohydrolase genes within the desertomycin and primycin clusters. Deletion of the putative desertomycin amidinohydrolase gene dstH in Streptomyces macronensis led to the accumulation of desertomycin B, the guanidino form of the antibiotic. Also, purified DstH efficiently catalyzed the in vitro conversion of desertomycin B into the A form. Hence this amidinohydrolase furnishes the missing link in this proposed naturally evolved example of protective-group chemistry.

Taxonomy of rare congenital metabolic bone disorders

International audience

Double incretin receptor knock-out (DIRKO) mice present with alterations of trabecular and cortical micromorphology and bone strength.

International audience

Desempenho produtivo de oleaginosas no Município de Jaguariúna/SP.

RESUMO: O trabalho analisa a experiência de cultivo de três espécies oleaginosas, amendoim, girassol e mamona, com potencial de uso para a produção de biodiesel, no município de Jaguariúna-SP. O trabalho foi conduzido em campo experimental da Embrapa Meio Ambiente, Jaguariúna-SP, no período entre novembro de 2008 a maio de 2009, utilizando quatro cultivares comerciais: uma de amendoim (IAC8116), duas de girassol (Embrapa 122 e M734) e uma de mamona (IAC2028) e foram avaliados: a) período para emergência de plântulas; b) início do florescimento; c) ciclo total da cultura; d) rendimento final de grãos; e) peso de 100 grãos. Os dados levantados foram analisados pela estatística descritiva e os resultados apontaram para o desempenho satisfatório das três oleaginosas. O rendimento do amendoim foi de 2998 kg ha-1, com ciclo total de 129 dias; para girassol as médias foram superiores a 2100 kg ha-1 e o ciclo entre 90-106 dias; para mamona a produtividade foi de 1260 kg ha-1 aos 187 dias. Conclui-se que as cultivares de amendoim (IAC8116), girassol (Embrapa 122 e M734) e mamona (IAC2028) possuem rendimentos satisfatórios no município de Jaguariúna-SP. O amendoim e o girassol podem ser importantes alternativas para maiores estudos em sucessão à cana-de-açúcar, enquanto a mamona se mostra mais viável como cultura principal para pequenos produtores, tendo em vista o ciclo longo.

DEMANDA TRIMESTRAL POR EMISIÓN MONETARIA: ESTIMACIÓN MEDIANTE TRES TÉCNICAS ESTADÍSTICAS

Este documento presenta la estimación de la demanda trimestral por emisión monetaria mediante tres técnicas estadísticas, a saber: mínimos cuadrados ordinarios, corrección de errores y vectores autorregresivos. La estimación de la demanda se realizó para el periodo 1987–1997. En general las ecuaciones estimadas presentaron resultados satisfactorios en términos económicos y estadísticos. La capacidad de predicción se verificó con los bajos errores de pronóstico, inferiores al 3% para 1997. Se comprobó la estabilidad de la demanda de corto y largo plazo mediante los estadísticos Cusum y Cusum-Cuadrado, así como con la prueba de cointegración de Johansen.

Estratégias para o aumento do rendimento em biomassa e lípidos na levedura Rhodosporidium toruloides

Dissertação de Mestrado, Engenharia Biológica, Faculdade de Ciências e Tecnologia, Universidade do Algarve, 2015

Avoiding staff removal stage in optical music recognition: application to scores written in white mensural notation

Staff detection and removal is one of the most important issues in optical music recognition (OMR) tasks since common approaches for symbol detection and classification are based on this process. Due to its complexity, staff detection and removal is often inaccurate, leading to a great number of errors in posterior stages. For this reason, a new approach that avoids this stage is proposed in this paper, which is expected to overcome these drawbacks. Our approach is put into practice in a case of study focused on scores written in white mensural notation. Symbol detection is performed by using the vertical projection of the staves. The cross-correlation operator for template matching is used at the classification stage. The goodness of our proposal is shown in an experiment in which our proposal attains an extraction rate of 96 % and a classification rate of 92 %, on average. The results found have reinforced the idea of pursuing a new research line in OMR systems without the need of the removal of staff lines.

SARASOM: a supervised architecture based on the recurrent associative SOM

We present and evaluate a novel supervised recurrent neural network architecture, the SARASOM, based on the associative self-organizing map. The performance of the SARASOM is evaluated and compared with the Elman network as well as with a hidden Markov model (HMM) in a number of prediction tasks using sequences of letters, including some experiments with a reduced lexicon of 15 words. The results were very encouraging with the SARASOM learning better and performing with better accuracy than both the Elman network and the HMM.

Determination of acrylamide levels in selected commercial and traditional foods in Syria

Purpose: To determine acrylamide (AA) levels in different brands of commercial and traditional foodstuffs available in Syria by ultra-performance liquid chromatography-mass spectrometery (UPLCMS). Methods: A total of 63 samples were analyzed. Food samples were defatted by hexane and then extracted with methanol 98 % in a vortex mixer. Thereafter, Carrez I and Carrez II were added to precipitate proteins from the co-extractives and then centrifuged to obtain a clear aqueous extract that was evaporated to dryness. The extract was dissolved in 1 mL of water, eluted through a preconditioned Oasis HLB cartridge and then filtered. The filtrate was analyzed by UPLC-MS/MS to determine AA content. Results: Among the commercial foods tested, the highest acrylamide quantity was found in potato products (396 ± 3.59 – 1844 ± 5.29 μg kg−1) and the lowest in corn products (183 ± 2.64 – 366 ± 4.58 μg kg−1). This was followed by biscuits (57 ± 2.64 – 1433 ± 2.51 μg kg−1), breakfast cereals (121 ± 8.73 – 245 ± 3.60 μg kg−1), bread (119 ± 1.73 – 263 ± 3.60 μg kg−1) and then coffee (113 ± 2.64 - 64 ± 3.05 μg kg−1). Regarding traditional foods, the highest level of AA was found in AL- Mshabak (481 ± 2.08 μg kg−1) and AL-Awamat (421 ± 2.64 μg kg−1) followed by AL-Namora (282 ± 4.35 μg kg−1) and AL-Kenafa (242 ± 2.64 μg kg−1). It was also observed that the lowest amount of AA was in fried bread (230 μg kg−1), AL-Fatayer (192 ± 3.51 μg kg−1) and AL-Baqlawa (172 ± 4.35 μg kg−1) while Eid Aqras (130 ± 4.58 μg kg−1) and AL-Brazeq (167 ± 3.78 μg kg−1) contained the least amount of AA. Conclusion: The results indicate that the highest levels of AA are found in the most commonly consumed foods. There was significant difference (p < 0.05) in AA levels among different food items and within different brands of the same product.