bluuebunny/crossref_metadata_2025 huggingface dataset:
An Evaluation of Convergence Criteria for Digital Image Correlation Using Inverse Compositional Gauss–Newton Algorithm
Authors: Pan B.
Published: October 2013

A fast, robust and accurate digital image correlation (DIC) method, which uses a robust zero‐mean normalized sum of squared difference correlation criterion, a sophisticated reliability‐guided displacement tracking strategy and an efficient inverse compositional Gauss–Newton (IC‐GN) algorithm, was recently proposed for full‐field deformation measurement. As an iterative local optimization algorithm, IC‐GN algorithm iteratively solves for the incremental warp assumed on the reference subset until the preset convergence criteria are satisfied. In the literature, different convergence criteria have been set for iterative optimization algorithms. However, on the one hand, stringent convergence criteria lead to increased number of iterations and lessen the computational efficiency. On the other hand, too loose convergence conditions enhance the computational efficiency but may decrease the registration accuracy. Understanding the impact of prescribed convergence criteria on DIC measurement and how to choose proper convergence criteria are therefore fundamental problems in realizing high‐efficiency yet high‐accuracy DIC analysis. In this paper, the convergence characteristics of IC‐GN algorithm are investigated in terms of convergence speed and radius of convergence using real experimental images. The effect of various convergence criteria on the efficiency and accuracy of IC‐GN algorithm are carefully examined. Recommendations are given to select proper convergence criteria for more efficient implement of IC‐GN algorithm.
Microbial properties and nitrogen contents of arable soils under different tillage regimes
Authors: Sun B. , Roberts D. M. , Dennis P. G. , Caul S. , Daniell T. J. , Hallett P. D. , Hopkins D. W.
Published: October 2013

Attention is being paid to the use of different tillage regimes as a means of retaining soil organic carbon (SOC) and sequestering more SOC. Alongside earlier measurements of total SOC stocks under different tillage regimes, we have examined the distribution of nitrogen (N), microbial activity and the structure of the soil bacterial community from differently tilled plots under continuous barley. The plots were established 5 yr before sampling and have been maintained annually under conventional tillage (CT; moldboard ploughing to 20 cm and disking), deep ploughing (DP; ploughing to 40 cm and disking), minimum tillage (MT; disking to 7 cm) or zero tillage (ZT). Our earlier work showed there was no difference in SOC contents down to 60‐cm depth between the treatments, but now we report that there were significant differences in the total N and active microbial biomass (substrate‐induced respiration) contents of the same soils. The N contents of the CT, DP and MT treatments were not significantly different, but the ZT contained significantly more N, indicating either greater N retention under the ZT treatment or preferential loss from the more intensively tilled treatments, or a combination of both. The microbial biomass content was greater for the CT and DP treatments than for the MT and ZT treatments, indicating greater sensitivity to treatment effects of the microbial biomass pool than the total C pool, consistent with its more dynamic nature. Terminal restriction fragment length polymorphism (T‐RFLP) analyses of the soil bacteria DNA (a method of assessing the bacterial community structure) enabled the samples to be distinguished both according to SOC content, which is to be expected, and to tillage regime with the greatest differences in community structure occurring in the ZT treatment and the least in DP and CT treatments, reflecting the degree of homogenization or disturbance resulting from tillage.
Disseminated Rhizopus microsporus infection following allogeneic hematopoietic stem cell transplantation in a child with severe aplastic anemia
Authors: Ye B. , Yu D. , Zhang X. , Shao K. , Chen D. , Wu D. , Zhang Y. , Zhou Y. , Shen Y. , Yu Q.
Published: October 2013

Disseminated Rhizopus microsporus infections are uncommon in children and are resistant to echinocandin and azole antifungal agents. We describe a child with severe aplastic anemia who developed disseminated R. microsporus infection following allogeneic hematopoietic stem cell transplantation. R. microsporus was identified microscopically in the hepatic drain culture and was confirmed on the basis of 18S rRNA and 28S rRNA sequence analyses. The patient was treated successfully with hepatic drainage and amphotericin B deoxycholate.
Phosphorylation of the N‐ and C‐terminal UPF1 domains plays a critical role in plant nonsense‐mediated mRNA decay
Authors: Kerényi Farkas , Wawer Izabela , Sikorski Pawel J. , Kufel Joanna , Silhavy Dániel
Published: October 2013

Nonsense‐mediated mRNA decay (NMD) is an essential quality control system that degrades aberrant transcripts containing premature termination codons and regulates the expression of several normal transcripts. Targets for NMD are selected during translational termination. If termination is slow, the UPF1 NMD factor binds the eRF3 protein of the termination complex and then recruits UPF2 and UPF3. Consequently, the UPF1‐2‐3 NMD complex induces SMG7‐mediated degradation of the target mRNA. It is unknown how formation of the NMD complex and transcript degradation are linked in plants. Previously we have shown that the N‐ and C‐terminal domains of UPF1 act redundantly and that the N‐terminal domain is phosphorylated. To clarify the role of UPF1 phosphorylation in plant NMD, we generated UPF1 mutants and analyzed their phosphorylation status and the NMD competency of the mutants. We show that although several residues in the N‐terminal domain of UPF1 are phosphorylated, only three phosphorylated amino acids, S3, S13 and T29, play a role in NMD. Moreover, we found that the C‐terminal domain consists of redundant S/TQ‐rich segments and that S1076 is involved in NMD. All NMD‐relevant phosphorylation sites were in the S/TQ context. Co‐localization and fluorescence resonance energy transfer–fluorescence lifetime imaging assays suggest that N‐terminal and probably also C‐terminal phosphorylated S/TQ residues are the binding platform for SMG7. Our data support the hypothesis that phosphorylation of UPF1 connects NMD complex formation and the SMG7‐mediated target transcript degradation steps of NMD. SMG7 binds the phosphorylated S/TQ sites of the UPF1 component of the NMD complex, and then it induces the degradation of the NMD target.
MAG2 and three MAG2‐INTERACTING PROTEINs form an ER‐localized complex to facilitate storage protein transport in Arabidopsis thaliana
Authors: Li Lixin , Shimada Tomoo , Takahashi Hideyuki , Koumoto Yasuko , Shirakawa Makoto , Takagi Junpei , Zhao Xiaonan , Tu Baoyu , Jin Hongmin , Shen Zhe , Han Baoda , Jia Meihui , Kondo Maki , Nishimura Mikio , Hara‐Nishimura Ikuko
Published: October 2013

In Arabidopsis thaliana, MAIGO 2 (MAG2) is involved in protein transport between the endoplasmic reticulum (ER) and the Golgi apparatus via its association with the ER‐localized t‐SNARE components SYP81/AtUfe1 and SEC20. To characterize the molecular machinery of MAG2‐mediated protein transport, we explored MAG2‐interacting proteins using transgenic A. thaliana plants expressing TAP‐tagged MAG2. We identified three proteins, which were designated as MAG2‐INTERACTING PROTEIN 1–3 [MIP1 (At2g32900), MIP2 (At5g24350) and MIP3 (At2g42700)]. Both MIP1 and MAG2 localized to the ER membrane. All of the mag2, mip1, mip2 and mip3 mutants exhibited a defect in storage protein maturation, and developed abnormal storage protein body (MAG body) structures in the ER of seed cells. These observations suggest that MIPs are closely associated with MAG2 and function in protein transport between the ER and Golgi apparatus. MIP1 and MIP2 contain a Zeste–White 10 (ZW10) domain and a Sec39 domain, respectively, but have low sequence identities (21% and 23%) with respective human orthologs. These results suggest that the plant MAG2–MIP1–MIP2 complex is a counterpart of the triple‐subunit tethering complexes in yeast (Tip20p–Dsl1p–Sec39p) and humans (RINT1–ZW10–NAG). Surprisingly, the plant complex also contained a fourth member (MIP3) with a Sec1 domain. There have been no previous reports showing that a Sec1‐containing protein is a subunit of ER‐localized tethering complexes. Our results suggest that MAG2 and the three MIP proteins form a unique complex on the ER that is responsible for efficient transport of seed storage proteins.
The First Review ofEuropeanUnion Antidumping Reviews
Authors: Nita Andreea C. , Zanardi Maurizio
Published: October 2013

The literature on antidumping (AD) has documented various aspects of this protectionist tool. However, a peculiar feature ofADhas not received much attention: these measures are endogenous to the behaviour of the exporting firms, which can adjust the dumping margin by changing their export price and ask the authority to amend theADmeasures accordingly. The objective of this paper is to fill part of this gap in the literature by analysing theADreviews conducted by theEuropeanUnion for affirmative petitions initiated in 1980–2009. To this end, a novel data set of all such reviews has been assembled. Summary statistics reveal that more than a third of all petitions concluded with the imposition ofADmeasures are reviewed at least once before their expiration, and most reviews lead to lowerADduties (although, almost 20 per cent of the firms investigated through interim reviews see their duties increase). There are significant differences in the outcome of the reviews depending on the party requesting them (i.e. reviews lodged byEuropean producers are less likely to lead to lower duties). These conclusions are confirmed by the econometric analysis, which also shows thatChinese firms see their duties reduced significantly less than those of firms from other countries.
A case of vesicular cutaneous lupus erythematosus in a Border collie successfully treated with topical tacrolimus and nicotinamide–tetracycline
Authors: Lehner Georg M. , Linek Monika
Published: October 2013

Background

Canine vesicular cutaneous lupus erythematosus (VCLE) is an autoimmune skin disease of the Shetland sheepdog and rough collie, which manifests as an erosive dermatitis of sparsely haired skin of the ventrum and concave pinnae. Reported treatment consists of immunosuppression with glucocorticoids alone or in combination with azathioprine, but successful treatment is unpredictable.

Objectives

To report on the treatment ofVCLEin a Border collie dog with topical 0.1% tacrolimus and nicotinamide in combination with tetracycline.

Case report

An 8‐year‐old male neutered Border collie was presented with multiple coalescing erosions on the ventral abdomen, groin and axillae and ulceration on the oral commissures. Clinical presentation, routine diagnostics, histology and immunohistochemistry were consistent withVCLE. Remission was achieved with topical 0.1% tacrolimus and combination therapy of nicotinamide and tetracycline.

Conclusion and clinical importance

This dog responded well to treatment with topical 0.1% tacrolimus, nicotinamide–tetracycline and sun avoidance. Complete remission was achieved after 2.5 months, and the dog was lesion free during a 1 year follow‐up period.
Intraocular and periocular lymphoma in dogs and cats: a retrospective review of 21 cases (2001–2012)
Authors: Ota‐Kuroki Juri , Ragsdale John M. , Bawa Bhupinder , Wakamatsu Nobuko , Kuroki Keiichi
Published: October 2013

Objective

To immunologically phenotype and histologically classify canine and feline intraocular and periocular lymphomas.

Methods

The databases of four veterinary medical diagnostic laboratories were searched to identify cases of intraocular or periocular lymphoma in dogs and cats between 2001 and 2012. Hematoxylin and eosin (H&E) stained slides were reviewed for confirmation and classification of lymphoma, and immunohistochemistry for CD3 (T‐cell marker) and CD79a and/or CD20 (B‐cell markers) was examined to determine the lineage of the neoplastic lymphocytes.

Results

Six canine and 15 feline cases of ocular lymphoma were identified. In the canine cases, there were three intraocular and three periocular lymphomas where two intraocular and one periocular lymphomas were B‐cell, one of each intraocular and periocular lymphomas were T‐cell and one periocular lymphoma was nonreactive with CD3, CD79a or CD20. In the feline cases, there were six intraocular and nine periocular lymphomas where five intraocular and six periocular lymphomas were B‐cell, and one intraocular and three periocular lymphomas were T‐cell. Only one canine case had concurrent generalized lymphadenopathy, only one canine conjunctival lymphoma had simultaneous cutaneous lymphoma, and only one feline case had bilateral ocular involvement when they were diagnosed.

Conclusion

Canine and feline intraocular and periocular lymphomas are often of B‐cell phenotype. Although in general terms lymphoma is not considered a primary tumor when it occurs in or adjacent to the globe, these tumors frequently first become evident in the globe and/or periocular area. An accurate early diagnostic approach is crucial for the patient's quality of life because B‐cell lymphomas are generally more amenable to chemotherapy than T‐cell lymphomas.
Distichiasis in a ferret (Mustela putorius furo)
Authors: Verboven Chantal A.P.M. , Djajadiningrat‐Laanen Sylvia C. , Kitslaar Willem‐Jan P. , Grinwis Guy C.M. , Schoemaker Nico J. , Boevé Michael H.
Published: October 2013

A 4‐year‐old intact male ferret was presented to the Ophthalmology Service of the Department of Clinical Sciences of Companion Animals of Utrecht University with chronic blepharospasm, epiphora, and conjunctivitis of the right eye. Examination of the eye revealed mild conjunctivitis and three hairs protruding from the openings of meibomian glands in the upper eyelid, providing the clinical diagnosis of distichiasis. The distichia were removed by transconjunctival unipolar electrocautery. Recovery was uneventful, but the original signs recurred 10 weeks after surgery. Ophthalmic examination revealed another distichia at a different location in the same eyelid and it was removed by full‐thickness wedge excision. Histopathological examination failed to reveal the exact origin of the distichia. To our knowledge, this is the first reported case of distichiasis in a ferret.
Evaluation of accelerated collagen cross‐linking for the treatment of melting keratitis in ten cats
Authors: Famose Frank
Published: October 2013

Objectives

Melting keratitis is a serious condition presenting a high risk of permanent blindness and is caused by infectious or noninfectious factors. In humans, the clinical efficacy of collagen cross‐linking (CXL) has been described in the treatment of refractory infectious keratitis by arresting keratomalacia. The aim of this study was to evaluate the efficacy of acceleratedCXLfor the treatment of melting keratitis in cats.

Animals studied

Ten cats were treated for unilateral melting keratitis by acceleratedCXL.

Procedure

Corneas were irradiated byUVA(370 nm) at 30 mW/cm² irradiance for 3 min after soaking with 0.1% riboflavin in 20% dextran for 30 min (D1). Follow‐up was conducted 3, 7, 14, and 30 days after treatment.

Results

Pain improvement was noted for all cases atD4 examination. Epithelial healing was observed atD8 for 9 of 10 cases and atD15 for 1 of 10 cases. Resolution of cellular infiltration was observed for all cases atD8 examination. The corneal vascularization was reduced for 9 of 10 cats byD31. AtD31, all cases presented a variable degree of corneal fibrosis, but all eyes had visual function. No recurrent infection was observed.

Conclusion

AcceleratedCXLappears to be a valuable option for the treatment of melting keratitis in cats. All the cases have reached a satisfactory outcome despite the individual differences in the conditions prior to theCXLtreatment and the variable presence of infectious agents.
Optimising the production of energy from coblended food waste and biosolids using batch reactor studies
Authors: Siddiqui Zuhaib , Horan Nigel. J , Sahito Abdul R , Abdulkadir Jamila , Memon Sheeraz A
Published: October 2013

Energy production from a coblended mixture of biosolids and food waste was optimised for hydrogen and methane production. Four different blends were prepared by varying the carbohydrate : protein (carb : pro) ratios. The biosolids contained a low carbohydrate fraction and so was not suitable for hydrogen production when used alone. However coblending this waste with a carbohydrate‐enriched food waste produced a greater hydrogen yield, making this option viable. Batch studies showed that the optimised mix had a biosolids concentration of 25.7% (w/w). The largest hydrogen yield of 198.5 mL/gVSremoved was observed when the carb : pro was 2.78, and this was threefold higher than the other carb : pro ratios evaluated in this study. The digestate recovered after hydrogen recovery had a C : N of 17.5, which is in the ideal range for methane production. The biochemical methane potential test showed a methane yield of 239 mL/gVSremoved, and the total volatile solids destruction following two‐phase hydrogen and methane production was 93%.
Natural Convection of Viscoplastic Fluids in a Square Enclosure
Authors: Hassan M. A. , Pathak Manabendra , Khan Mohd. Kaleem
Published: October 2013

Viscoplastic fluids are special kind of non-Newtonian materials which deform or flow only when applied stresses are more than a critical value known as yield stress. In this work, a numerical investigation of natural convection in a square enclosure filled with viscoplastic fluids has been reported. The enclosure has been partially heated from the bottom wall by a heating source and symmetrically cooled from both the side walls. The rheology of the viscoplastic fluids has been modeled with Bingham fluid model. A scaling analysis has been presented to establish the gross dependence of heat transfer on different values of operating parameters of the problem. The effects of yield stress of the fluid on heat and fluid transport inside the enclosure have been investigated for different values of temperature difference, across the hot and cold surfaces and also for different fluids. The effects of different lengths of heated zone on the flow phenomena and heat transfer characteristics have been investigated for three different values of the heated zones. All the important results have been expressed in terms of Bingham number (Bn), Rayleigh number (Ra), and Prandtl number (Pr). It has been observed that with the increase in Bingham number, the buoyancy induced fluid circulation and convection effect decreases inside the enclosure. For each Rayleigh number, there correspond a critical Bingham number for which the heat transfer inside the enclosure takes place solely by conduction mode. This critical value increases with the increase in Rayleigh number. For fixed value of Bingham number, i.e., fixed value of yield stress, the effects of Rayleigh number and heated length on heat transfer have been observed similar to the case of natural convection in Newtonian fluid. It has been also observed that at high Bingham number the effect of increase in Rayleigh number on average Nusselt number is lesser compared to the effect of increasing Rayleigh number at low Bingham number. Using the present numerical results, a correlation of average Nusselt number as a function of other nondimensional numbers has been established.
Effect of Morphology on Spectral Radiative Properties of Three-Dimensionally Ordered Macroporous Ceria Packed Bed
Authors: Ganesan Krithiga , Randrianalisoa Jaona , Lipiński Wojciech
Published: October 2013

In this paper, radiative characterization of a packed bed of novel three-dimensionally ordered macroporous (3DOM) ceria particles is performed in the spectral range relevant to solar thermochemical processes, 0.35–2.2 μm. Normal–hemispherical transmittance and reflectance of three samples of various thicknesses are measured. Monte Carlo ray-tracing (MCRT) and discrete ordinate methods are employed to identify transport scattering albedo and transport extinction coefficient in the spectral range corresponding to weak absorption in the semi-transparency band of ceria. 3DOM ceria particles are characterized by weaker scattering in comparison to sintered ceria ceramics, and increased transparency in the near-infrared spectral range 0.7–2 μm. The ordered pore-morphology of the 3DOM ceria after thermochemical redox cycling between temperatures 1373 K and 1073 K is altered due to sintering of walls of the 3DOM structure. The absorption coefficient of the packed bed is found to be practically independent of morphology. Radiative characterization of 3DOM ceria ceramics before and after thermochemical cycling suggests that preserving the 3DOM structure can lead to scattering characteristics that permit longer attenuation path lengths of incident concentrated solar radiation in the material, as well as be favorable for confinement of the near-infrared radiation during thermochemical cycling leading to favorable thermochemical conditions for fuel production.
Nonlinear Rayleigh–Bénard Convection With Variable Heat Source
Authors: Siddheshwar P. G. , Stephen Titus P.
Published: October 2013

Linear and nonlinear Rayleigh–Bénard convections with variable heat source (sink) are studied analytically using the Fourier series. The strength of the heat source is characterized by an internal Rayleigh number, RI, whose effect is to decrease the critical external Rayleigh number. Linear theory involving an autonomous system (linearized Lorenz model) further reveals that the critical point at pre-onset can only be a saddle point. In the postonset nonlinear study, analysis of the generalized Lorenz model leads us to two other critical points that take over from the critical point of the pre-onset regime. Classical analysis of the Lorenz model points to the possibility of chaos. The effect of RI is shown to delay or advance the appearance of chaos depending on whether RI is negative or positive. This aspect is also reflected in its effect on the Nusselt number. The Lyapunov exponents provide useful information on the closing in and opening out of the trajectories of the solution of the Lorenz model in the cases of heat sink and heat source, respectively. The Ginzburg-Landau models for the problem are obtained via the 3-mode and 5-mode Lorenz models of the paper.
Canine olfactory detection of malignant melanoma
Authors: Campbell Leon Frederick , Farmery Luke , George Susannah Mary Creighton , Farrant Paul B J
Published: October 2013

Our patient is a 75-year-old man who presented after his pet dog licked persistently at an asymptomatic lesion behind his right ear. Examination revealed a nodular lesion in the postauricular sulcus. Histology confirmed malignant melanoma, which was subsequently excised. Canine olfactory detection of human malignancy is a well-documented phenomenon. Advanced olfaction is hypothesised to explain canine detection of bladder, breast, colorectal, lung, ovarian, prostate and skin cancers. Further research in this area may facilitate the development of a highly accurate aid to diagnosis for many malignancies, including melanoma.
Febrile ulceronecrotic Mucha-Habermann disease
Authors: Lejuste F-X , Michaux C , Lehners C , Calteux N
Published: October 2013

The Mucha-Habermann disease is an inflammatory disease of the skin and is a variant of pityriasis lichenoides et varioliformis acuta. We describe the case of a 64-years-old woman who was admitted for erysipelas of the face. Despite treatment, evolution was marked by the appearance of a necrotising ulcerative area in the centre of the erysipelas associated with local oedema and headache. A skin biopsy revealed a pityriasis lichenoides et varioliformis acuta. Corticosteroids led to a rapid stabilisation of lesions, and after 6 months the patient shows only a small area of frontal hypopigmentation. The aetiology remains uncertain. There is no established standard treatment. We would like to draw attention of the medical and surgical specialists to this rare disease. The diagnosis should be considered in a necrotic lesion associated with rapid expansion of systemic and peripheral cutaneous signs. Diagnosis must be considered to avoid unnecessary debridement and extensive scars.
Shortness of breath, fever and abdominal pain in a 21-year-old student
Authors: Whalley Hugh James , Remoundos Dionysios-Dennis , Webster Jonathan , Silva Michael Anthony
Published: October 2013

A 21-year-old patient presented with a 3-day history of shortness of breath, productive cough, fatigue, fevers and night sweats, associated with right upper quadrant pain. He had an appendicectomy 3 months previously. The CT images showed a right subphrenic collection, which was indenting the right lobe of the liver, with an appendicolith in the middle. He underwent laparoscopic surgery where the abscess was drained and the appendicolith was retrieved. The patient had an uncomplicated postoperative period and was discharged soon afterwards. Complications from spilled appendicoliths have been reported previously. Retained appendicoliths and gallstones can act as niduses for infection, and thus cause symptoms at a later stage. Surgical notes should include the findings of appendicoliths, and in the event where retrieval is not possible, a clear record of this must be made, and the patient along with the general practitioner need to be informed.
Inhaled β-agonist therapy and respiratory muscle fatigue as under-recognised causes of lactic acidosis
Authors: Lau Emily , Mazer Jeffrey , Carino Gerardo
Published: October 2013

A 49-year-old man with chronic obstructive pulmonary disease (COPD) presented with significant tachypnoea, fevers, productive cough and increased work of breathing for the previous 4 days. Laboratory data showed elevated lactate of 3.2 mEq/L. Continuous inhaled ipratropium and albuterol nebuliser treatments were administered. Lactate levels increased to 5.5 and 3.9 mEq/L, at 6 and 12 h, respectively. No infectious source was found and the lactic acidosis cleared as the patient improved. The lactic acidosis was determined to be secondary to respiratory muscle fatigue and inhaled β-agonist therapy, two under-recognised causes of lactic acidosis in patients presenting with respiratory distress. Lactic acidosis is commonly used as a clinical marker for sepsis and shock, but in the absence of tissue hypoperfusion and severe hypoxia, alternative aetiologies for elevated levels should be sought to avoid unnecessary and potentially harmful medical interventions.
Reducing time spent by junior doctors on call performing routine tasks at weekends
Authors: Ibrahim Wadah , Lin Simeng
Published: October 2013

At the Northern General Hospital, there are sixteen medical wards, spread over approximately half a mile. Weekend care for inpatients on these wards is provided by a team of four junior doctors, of different levels of training. We undertook a quality improvement project to reduce the amount of time junior doctors spent performing routine tasks at weekends. This may increase their available time for direct patient care.

The study was performed over a period of nine weeks on two medical wards - Diabetes & Endocrine (W1) and Care of the Elderly Rehabilitation (W2). We monitored the bleeps received by the covering junior doctors during the weekend daytime shifts from the two study wards. We noted that a proportion of bleeps were routine tasks that could have been performed during weekday working hours. We also noted that W2 recorded fewer bleeps than W1 ward. This seemed to be because W2 batched junior doctors' jobs together. Firstly, we attempted to reduce the amount of routine work left undone each weekend. We provided a poster to remind Junior Doctors to complete such work during the week. Secondly, on W1 we replicated the job-batching system already in place on W2. A Doctors' Book was introduced in which nursing staff recorded the tasks that needed doing. This saved them from having to bleep the doctor repeatedly. The two changes resulted in a reduction in the number of bleeps generated by each ward and the number of visits required by the Junior Doctors to W1.

Simple changes can reduce the amount of time junior doctors spend performing routine work at weekends. We implemented two such changes and achieved a reduction in the number of bleeps experienced by junior doctors and the number of times they had to return to one ward.
Acute Kidney Injury: It’s as easy as ABCDE
Authors: Forde Caroline , McCaughan Jennifer , Leonard Niall
Published: October 2013

Acute kidney injury (AKI) is a common, serious problem which has been found to be poorly managed. Early recognition and action is critical in potentially slowing or reversing its course and facilitating timely referral to specialist services. In this quality improvement project, multidisciplinary education sessions and a simple 'ABCDE' checklist to aid AKI management were introduced in a district general hospital. The incidence of AKI (defined as 26umol/l rise in creatinine), its recognition and management were measured hospital wide. AKI recognition was improved by educating the entire multidisciplinary team to identify three key early warning signs: a rise in serum creatinine, urine output of <500mls in 24 hours and systolic blood pressure of <90mmHg. The 'ABCDE' checklist (Address drugs, Boost blood pressure, Calculate fluid balance, Dip urine, Exclude obstruction) was introduced to prompt AKI management. A four week educational programme was delivered, initially on a pilot ward, to doctors, nurses, nursing assistants and pharmacists. AKI recognition and implementation of the 'ABCDE' checklist were measured. Prior to project introduction 16% of patients developed AKI, but were recognised within 24 hours in only 31% of cases, with 80% of 'ABCDE' steps implemented in only 20%. Following multidisciplinary education, AKI recognition improved to 100%, with 80% of 'ABCDE' steps implemented in 67% of cases. These results were replicated when the project was rolled out across the surgical directorate (120 beds) and in the 40 bed medical admission unit. Prevention and treatment of AKI should be a core competency of all clinical staff. Educating and empowering the multidisciplinary team to implement simple interventions improves standards and should be the foundation of strategies targeting AKI. Through this study significant improvements have been demonstrated in AKI recognition and management, positively impacting on patient safety, quality of care and patients' and staff experience.
Improving Medication Reconciliation on the Surgical Wards of a District General Hospital
Authors: Hughes Erika , Hegarty Paul , Mahon Andrew
Published: October 2013

During a routine audit it was noted that the surgical wards were consistently underperforming in their rate of medicines reconciliation in comparison to other specialities. The process of medication reconciliation is usually performed by junior doctors during the admission process and can be a complex task which is usually undertaken in the midst of several other jobs. The aim of this project was to review this process and identify methods of improving patient safety. This led to the design of a surgical admissions proforma which incorporated a 'medications on admission' section, to be used for reconciliation. Over a six month period from its introduction into a pilot ward it was noted to improve medication reconciliation from 60% to 85%. The benefits were discussed with members of the trust and a standardised version of the admissions proforma has since been rolled out to all hospitals within the trust.
Competence in confirming correct placement of nasogastric feeding tubes amongst FY1 doctors
Authors: Lee Sindy , Mason Eleanor
Published: October 2013

Foundation year one (FY1) doctors are required to confirm correct placement of nasogastric (NG) feeding tubes on chest radiography on a regular basis. Many FY1s do not receive formal training during medical school or during the FY1 year. Multiple incidents of harm to patients, including death, resulting from incorrect placement of an NG feeding tube have been reported to the National Patient Safety Agency (NPSA) since 2005. Our audit assessed the confidence and knowledge of FY1 doctors in correctly confirming NG placement using a qualitative questionnaire. The results showed that both confidence and knowledge on the topic were remarkably poor. Our intervention consisted of a teaching session to the FY1 cohort, which included information on NPSA guidelines for identifying correct NG placement. A post-teaching questionnaire was attained from the same group of FY1s. Confidence and knowledge of the criteria had significantly improved. We concluded that there is clearly a need for teaching on this subject at an undergraduate and post-graduate level. The interactive peer-led style of our teaching session was shown to be highly effective. The addition of handouts and posters in the clinical workplace acted as helpful reminders for junior doctors to use at the point of need. Our project has highlighted a gap in training which poses a serious potential risk to patient safety. We have created a simple solution which, if adopted on a local and national scale, will facilitate a reduction in avoidable harm to patients.
The Effect of ‘On-Line’ POCT on Patient waiting times in an Accident and Emergency Department
Authors: Gilkar Ashfaq , Fink Richard , Eardley Philip , Barron Catriona
Published: October 2013

This POCT (point of care testing) team was constructed at the start of 2012 to implement the POCT project aiming to define and test the hypothesis that interfacing POCT devices to a clinical electronic order communications system reduces patient waiting times in an NHS Accident and Emergency Department (A&E). The devices selected for evaluation initially comprised the Sysmex XS 1000i haematology analyser and the Abbott i-Stat chemistry analyser.

The POCT devices were interfaced to a server (Midlynx) which in turn was connected via the hospital internal network, to the ICE system (Integrated Clinical Environment). Test orders entered on the ICE system produced a bar code label read by the individual POCT devices. Once required tests were assayed, the results were transmitted back to the ICE system, where they could be viewed by users across the hospital site. The quality of POCT analytical performance was assessed by running quality control checks as recommended by the manufacturers and by exchanging samples daily with the clinical laboratory. The I-Stat (a Chemistry analyser manufactured by 'Abbott plc') was also tested against material obtained from a national external quality assurance scheme (NEQAS).

The time taken to produce POCT tests was calculated as the time elapsed (TE) between requesting tests, and the time at which completed results were returned to the ICE system. Patient waiting times were derived from the patient administration system (Symphony) used in the A&E department. To assess the true effect of POCT on patient waiting times the analysis was confined to cases associated with POCT tests only (n = 217). A control population (n=229) was randomly selected from the clinical laboratory database. The time interval between requesting a test and receiving the results for the POCT tests was 23 minutes and for the laboratory tests, 60 minutes. The patient waiting times (time of discharge â time of arrival) was 167 minutes for the POCT group and 208 for the clinical laboratory group, a difference of 31 minutes. The project confirmed that interfaced (on-line) POCT has many advantages with respect to the quality and safety of data management. The benefits include reliable identification of the requesting clinician and patient and the assurance that the right result is allocated to the right patient. The study also showed that the quality of results produced by the POCT devices met the requirements of the clinical environment.
Professional Support, London: the professional development unit supporting practitioner well-being, refreshment, remediation and revalidation
Authors: Whiteman Julia , Morris Penny , Halpern Helen
Published: October 2013

London's Professional Support Unit (PSU) was launched in April 2012 at a time when changes and financial pressures across the health service were placing considerable demand on the medical and dental workforce. At the same time the infrastructure to support medical revalidation was established. The PSU provides developmental support to clinicians across London in all career grades and specialities, to sustain and restore them to contribute effectively to health service delivery across the capital. The costs of medical training are high. Maintaining doctors at work has to be cost effective. Clinicians in multicultural London require diverse resources, as increasing numbers have trained abroad.

The PSU offers a holistic, tailor-made approach to professional and personal development with a range of resources and approaches. It provides proven high quality educational interventions, creating a linked and integrated service, providing clinicians with new opportunities. Access is by self-referral with resources targeted at those going through transitions in their professional lives, as well as those who have specific developmental needs.

A collaborative approach across the PSU and its education and governance communities ensured the provision of personal support to over 1300 clinicians in its first year, together with interdisciplinary group learning opportunities. Online materials were created to assist individuals, workplace groups and a broad network of support and expertise. To maximise the effectiveness of the service, learning events were also held for those working within the PSU.

In commending the PSU and its positive impact, the General Medical Council has recommended the model be shared nationally. At the same time the Londonâs three Local Education Training Boards have recommended that the PSU expand to encompass a more diverse range of professional groups. Our challenge is how to extend such flexible, responsive and values-based support across the workforce, given stringent financial pressures.
Successful implementation of strategies to transform Emergency Department transfusion practice.
Authors: Reed Matthew J , Kelly Sarah-Louise , Beckwith Hannah , Innes Catherine J , Manson Lynn
Published: October 2013

Blood component transfusion is an important and lifesaving Emergency Department (ED) procedure. It is not however risk-free and careful consideration of its clinical benefit for each individual patient is therefore essential. In 2008, we audited the patterns of blood component usage in 2007 within our ED. This work revealed that whilst 3209 units of blood component were ordered only 39.5% were transfused, and 9.5% were unaccounted for. This was the first and only published detailed look at ED blood transfusion practices. We had to address our poor traceability (i.e. unaccounted for units), our high blood usage, and our ordering of units which were then not transfused as this can lead to wastage. Firstly, better links between the ED and the Scottish National Blood Transfusion Service (SNBTS) were established. A set of improvement measures were then implemented including better ED medical and nursing staff education, monthly traceability reports sent to the ED clinical management teams, the introduction of an ED transfusion guideline, moving our blood fridge into the resuscitation room, having a named ED transfusion consultant and ED transfusion link nurse, ED consultant representation on the Hospital Transfusion Group and finally increasing awareness of ED emergency transfusion with a rotational thromboelastometry (ROTEM) research programme. In 2012, we re-audited our practice looking at our blood component usage in 2011. There was a 64% reduction in blood component ordering (3209 vs. 1034 units), a 39% reduction in blood component transfusion (1131 vs. 687 units), a 68% increase in the proportion of ordered units that were transfused and a 96% reduction in unaccounted units (289 vs. 9 units) between 2007 and 2011. In attempting to cost the savings resulting from our changes we showed that SNBTS spent £306,437 less in 2011 compared to 2007 on handling and issuing ED transfusion requests. Our improvements are immediately generalizable across the UK and the potential savings to the NHS are enormous.
Oxfordshire Childrens Diabetes - The Primary Schools Intervention Programme
Authors: Pal Rani , Edge Julie
Published: October 2013

Poorly controlled diabetes adversely affects a child's education, with concentration difficulties, alterations in mood, behaviour and fatigue associated with high or low blood glucose levels. Between years 2004-6 we started all toddlers and children on intensive insulin regimens (multiple dose injection or pump) making it imperative that they received support during the school day. This required close monitoring of blood glucose levels and counting carbohydrate intake to adjust rapid-acting insulin dose or pump bolus at every meal. We report our experience of formulating a sustainable structure of support in primary schools based on trained volunteers who partake in the daily 'Individualised Care Plan (ICP)'.

After overcoming multiple barriers, an acceptable system was negotiated with our Primary Care Trust (PCT) and Local Education Authority (LEA). In 2009, the PCT confirmed 3 years funding for a Paediatric Diabetes specialist nurse (PDSN) for schools. In 2010, the first full school year with agreed protocols was in place. By July 2012, our nurses had trained a total of 342 volunteers who provide care for 132 children.

The Oxfordshire Schools Intervention Programme ensures that legal obligations are met. A risk assessment allows the LEA to provide indemnity to their school staff to give injections and do blood tests, after training and competency sign-off by a PDSN. Parents, volunteers and PDSN jointly agree a comprehensive 'ICP' and utilise a hand-held communication record book. Diabetes control improved (age 4-11 years cohort from 2004 onwards: Mean (SD) HbA1c in 2001-4 = 8.38 (1.09)%; in 2005-8 = 7.74 (0.81)%; in 2009-12 = 7.58 (0.69)%; ANOVA p<0.001). This requires 500-1000 hours of DSN time to train/retrain/problem-solve annually (approximately 5-10days per month). The cost-benefits are discussed. We advocate that our programme supports each child's ICP, use of intensive insulin regimes in school-day and reassures parents that schools can deliver this safely.
Training the Trainers of Tomorrow Today - driving excellence in medical education
Authors: Fellow-Smith Elizabeth , Beveridge Ed , Hogben Katy , Wilson Graeme , Lowe John , Abraham Rachel , Ingle Digby , Bennett Danielle , Hernandez Carol
Published: October 2013

Training the Trainers of Tomorrow Today (T4) is a new way to deliver "Training for Trainers". Responding to local dissatisfaction with existing arrangements, T4 builds on 3 essential requirements for a future shape of training:

1. Clinical Leadership and a Collaborative Approach

2. Cross-Specialty Design and Participation

3. Local Delivery and Governance Networks

Design principles also included: 3 levels of training to reflect differing needs of clinical supervisors, educational supervisors and medical education leader, mapping to GMC requirements and the London Deanery's Professional Development Framework; alignment of service, educational theory and research; recognition of challenges in delivering and ensuring attendance in busy acute and mental health settings, and the development of a faculty network.

The delivery plan took into account census of professional development uptake and GMC Trainee Surveys. Strong engagement and uptake from the 11 Trusts in NW London has been achieved, with powerful penetration into all specialties. Attendance has exceeded expectations. Against an initial 12 month target of 350 attendances, 693 were achieved in the first 8 months.

Evaluation of content demonstrates modules are pitched appropriately to attendees needs, with positive feedback from trainers new to the role. Delivery style has attracted high ratings of satisfaction: 87% attendees rating delivery as "good\excellent". External evaluation of impact demonstrated improved training experiences through changes in supervision, the learning environment and understanding of learning styles.

We have addressed sustainability of the programme by advertising and recruiting Local Faculty Development Trainers. Volunteer consultants and higher trainees are trained to deliver the programme on a cascade model, supported by the Specialty Tutors, individual coaching and educational bursaries. The Trainers are local champions for excellence in training, provide a communication between the programme and local providers, are a repository of expertise in their service, and trouble shoot local barriers to engagement.
Implementing a Patient Safety Team to reduce serious incidents
Authors: Dowell Louise
Published: October 2013

The Division were experiencing a high number of serious incidents, and the Team felt that a good safety strategy would improve the quality of care given. Through multidisciplinary engagement they wanted to learn from these, encourage reporting and focus on a fair blame culture. The ultimate aim was to increase incident reporting, decrease serious incidents and improve quality. The key aim of the project was to improve the quality of care for the woman and their babies, we reduced the incidence of serious incidents and increased the incident reporting of less serious incidents, this was based on the theory of the Heinrich Ratio which theorises that for every serious incident there will be 300 less serious / near miss incidents. The Team wanted to ensure that the multidisciplinary team were engaged and felt confident to report incidents, and would receive the appropriate feedback and support. In addition all staff involved in the incident would be involved in the investigation and be at the heart of the decision making. The key measure for improvement was the increase in incident reporting (44% increase 2011 â 2012) and the decrease in serious incidents. The figures support the theory that the increase in minor incidents being reported and managed has reduced the incidence of serious incidents. Staff engagement in the process was paramount, and this was driven by a passion to ensure the woman was at the centre of every decision or safety improvement that was made. Women and their families would be involved in the quality improvement process.