The InSight HP3 Penetrator (Mole) on Mars: Soil Properties Derived from the Penetration Attempts and Related Activities

The NASA InSight Lander on Mars includes the Heat Flow and Physical Properties Package HP³ to measure the surface heat flow of the planet. The package uses temperature sensors that would have been brought to the target depth of 3-5 m by a small penetrator, nicknamed the mole. The mole requiring friction on its hull to balance remaining recoil from its hammer mechanism did not penetrate to the targeted depth. Instead, by precessing about a point midway along its hull, it carved a 7 cm deep and 5-6 cm wide pit and reached a depth of initially 31 cm. The root cause of the failure - as was determined through an extensive, almost two years long campaign - was a lack of friction in an unexpectedly thick cohesive duricrust. During the campaign - described in detail in this paper - the mole penetrated further aided by friction applied using the scoop at the end of the robotic Instrument Deployment Arm and by direct support by the latter. The mole tip finally reached a depth of about 37 cm, bringing the mole back-end 1-2 cm below the surface. It reversed its downward motion twice during attempts to provide friction through pressure on the regolith instead of directly with the scoop to the mole hull. The penetration record of the mole was used to infer mechanical soil parameters such as the penetration resistance of the duricrust of 0.3-0.7 MPa and a penetration resistance of a deeper layer ( > 30 cm depth) of 4.9 ± 0.4 MPa . Using the mole's thermal sensors, thermal conductivity and diffusivity were measured. Applying cone penetration theory, the resistance of the duricrust was used to estimate a cohesion of the latter of 2-15 kPa depending on the internal friction angle of the duricrust. Pushing the scoop with its blade into the surface and chopping off a piece of duricrust provided another estimate of the cohesion of 5.8 kPa. The hammerings of the mole were recorded by the seismometer SEIS and the signals were used to derive P-wave and S-wave velocities representative of the topmost tens of cm of the regolith. Together with the density provided by a thermal conductivity and diffusivity measurement using the mole's thermal sensors, the elastic moduli were calculated from the seismic velocities. Using empirical correlations from terrestrial soil studies between the shear modulus and cohesion, the previous cohesion estimates were found to be consistent with the elastic moduli. The combined data were used to derive a model of the regolith that has an about 20 cm thick duricrust underneath a 1 cm thick unconsolidated layer of sand mixed with dust and above another 10 cm of unconsolidated sand. Underneath the latter, a layer more resistant to penetration and possibly containing debris from a small impact crater is inferred. The thermal conductivity increases from 14 mW/m K to 34 mW/m K through the 1 cm sand/dust layer, keeps the latter value in the duricrust and the sand layer underneath and then increases to 64 mW/m K in the sand/gravel layer below.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s11214-022-00941-z.

Inappropriate use of clinical practices in Canada: a systematic review

Background:

Inappropriate health care leads to negative patient experiences, poor health outcomes and inefficient use of resources. We aimed to conduct a systematic review of inappropriately used clinical practices in Canada.

Methods:

We searched multiple bibliometric databases and grey literature to identify inappropriately used clinical practices in Canada between 2007 and 2021. Two team members independently screened citations, extracted data and assessed methodological quality. Findings were synthesized in 2 categories: diagnostics and therapeutics. We reported ranges of proportions of inappropriate use for all practices. Medians and interquartile ranges (IQRs), based on the percentage of patients not receiving recommended practices (underuse) or receiving practices not recommended (overuse), were calculated. All statistics are at the study summary level.

Results:

We included 174 studies, representing 228 clinical practices and 28 900 762 patients. The median proportion of inappropriate care, as assessed in the studies, was 30.0% (IQR 12.0%–56.6%). Underuse (median 43.9%, IQR 23.8%–66.3%) was more frequent than overuse (median 13.6%, IQR 3.2%–30.7%). The most frequently investigated diagnostics were glycated hemoglobin (underused, range 18.0%–85.7%, n = 9) and thyroid-stimulating hormone (overused, range 3.0%–35.1%, n = 5). The most frequently investigated therapeutics were statin medications (underused, range 18.5%–71.0%, n = 6) and potentially inappropriate medications (overused, range 13.5%–97.3%, n = 9).

Interpretation:

We have provided a summary of inappropriately used clinical practices in Canadian health care systems. Our findings can be used to support health care professionals and quality agencies to improve patient care and safety in Canada.

Cost-effectiveness of a Province-wide Quality Improvement Initiative for Reducing Potentially Inappropriate Use of Antipsychotics in Long-Term Care in British Columbia, Canada

BACKGROUND

Potentially inappropriate use of antipsychotics (PIUA) raises serious concerns about safety, quality, and cost of care for residents in long-term care (LTC).

OBJECTIVE

This study aimed to estimate the cost-effectiveness of the Call for Less Antipsychotics in Long-Term Care (Clear) initiative compared with the status quo (pre-Clear, baseline).

METHODS

A model-based cost-utility analysis, from a public-payer perspective in British Columbia, was conducted using secondary data of residents in LTC homes from 2013 to 2019. Residents' health resource utilization and quality-adjusted life-year (QALY) measures were extracted from multiple administrative databases. Six Markov states were modelled for post-antipsychotic progression representing PIUA, appropriate use of antipsychotic, complete withdrawal, and death. The primary outcome was the incremental cost per QALY gained.

RESULTS

A cohort of 35,669 residents was included in the primary analysis. The Clear initiative, over 10 years, was estimated to have an incremental cost-effectiveness ratio (ICER) of CA$26,055 (2020 Canadian dollars) per QALY gained at an incremental cost of CA$5211 per resident and a QALY gain of 0.20. In the subgroup analyses, our findings were even more favourable for Clear wave 2 (ICER of CA$24,447 per QALY gained) and Clear wave 3 (ICER of CA$25,933 per QALY gained). At a willingness-to-pay of CA$50,000 per QALY gained, the probabilities of Clear waves 2 and 3 were 82% cost-effective.

CONCLUSION

This study demonstrated incremental costs and yielded favourable ICERs for Clear compared with the baseline. More research is needed to understand the level of support for individual care homes to sustain the Clear initiative in the long run.

Dual-mode auto-calibrating resistance thermometer: A novel approach with Johnson noise thermometry

A dual-mode auto-calibrating resistance thermometer (DART) is presented. The novel DART concept combines in one instrument the fast and accurate resistance thermometry with the primary method of Johnson noise thermometry. Unlike previous approaches, the new thermometer measures the spectral density of the thermal noise in the sensing resistor directly in a sequential measurement procedure without using correlation techniques. A sophisticated data analysis corrects the thermometer output for both the parasitic effects of the sensor wiring and the amplifier current noise. The instrument features a highly linear low-noise DC coupled amplifier with negative feedback as well as an accurate voltage reference and reference resistor to improve the gain stability over time and ambient temperature. Therefore, the system needs only infrequent calibrations with electrical quantum standards and can be operated over long intervals and a wide temperature range without recalibration. A first prototype is designed for the industrially relevant temperature range of the IEC 60751 (-200 °C to +850 °C); a later extension of the measurement range is being considered. A proof-of-principle measurement with a calibrated Pt100 sensor at room temperature yielded an uncertainty of about 100 µK/K. The final device is expected to reach uncertainties of below 10 µK/K, suitable for accurate measurements of the difference between thermodynamic temperatures and temperatures traceable to the International Temperature Scale of 1990 (ITS-90).

Complex molecular dynamics of a symmetric model discotic liquid crystal revealed by broadband dielectric, thermal and neutron spectroscopy

The molecular dynamics of the triphenylene-based discotic liquid crystal HAT6 is investigated by broadband dielectric spectroscopy, advanced dynamical calorimetry and neutron scattering. Differential scanning calorimetry in combination with X-ray scattering reveals that HAT6 has a plastic crystalline phase at low temperatures, a hexagonally ordered liquid crystalline phase at higher temperatures and undergoes a clearing transition at even higher temperatures. The dielectric spectra show several relaxation processes: a localized γ-relaxation at lower temperatures and a so called α2-relaxation at higher temperatures. The relaxation rates of the α2-relaxation have a complex temperature dependence and bear similarities to a dynamic glass transition. The relaxation rates estimated by Hyper DSC, Fast Scanning calorimetry and AC Chip calorimetry have a different temperature dependence than the dielectric α2-relaxation and follow the VFT-behavior characteristic for glassy dynamics. Therefore, this process is called α1-relaxation. Its relaxation rates show a similarity with that of polyethylene. For this reason, the α1-relaxation is assigned to the dynamic glass transition of the alkyl chains in the intercolumnar space. Moreover, this process is not observed by dielectric spectroscopy, which supports its assignment. The α2-relaxation is assigned to small scale translatorial and/or small angle fluctuations of the cores. The neutron scattering data reveal two relaxation processes. The process observed at shorter relaxation times is assigned to the methyl group rotation. The second relaxation process at longer time scales agree in the temperature dependence of its relaxation rates with that of the dielectric γ-relaxation.

Images from the surface of asteroid Ryugu show rocks similar to carbonaceous chondrite meteorites

The near-Earth asteroid (162173) Ryugu is a 900-m-diameter dark object expected to contain primordial material from the solar nebula. The Mobile Asteroid Surface Scout (MASCOT) landed on Ryugu's surface on 3 October 2018. We present images from the MASCOT camera (MASCam) taken during the descent and while on the surface. The surface is covered by decimeter- to meter-sized rocks, with no deposits of fine-grained material. Rocks appear either bright, with smooth faces and sharp edges, or dark, with a cauliflower-like, crumbly surface. Close-up images of a rock of the latter type reveal a dark matrix with small, bright, spectrally different inclusions, implying that it did not experience extensive aqueous alteration. The inclusions appear similar to those in carbonaceous chondrite meteorites.

Visual Immunoprecipitate Assay (VIP) for Listeria monocytogenes and Related Listeria Species Detection in Selected Foods: Collaborative Study

Six foods representing a variety of food products were analyzed by the Assurance Listeria polyclonal enzyme immunoassay (EIA) and by either the Bacteriological Analytical Manual or the U.S. Department of Agriculture culture method for detecting Listeria monocytogenes and related Listeria species. Samples of each food type, at each inoculation level, were analyzed simultaneously by both methods. A total of 19 laboratories representing federal government agencies and private industry in the United States and Canada participated. Food types were inoculated with Listeria species including L. monocytogenes, with the exception of 3 lots of green beans, which were naturally contaminated. During this study, 1764 samples and controls were analyzed and confirmed, of which 492 were positive and 947 were negative by both methods. There were 159 samples that were positive by culture method but negative by the EIA and 188 that were negative by culture method but positive by EIA. Twenty-two samples were negative by EIA and by culture method but confirmed positive when Assurance selective enrichment broths were subcultured to selective agar. The Assurance polyclonal EIA for detecting L. monocytogenes and related Listeria species in foods has been adopted first action by AOAC INTERNATIONAL.

Assurance Polyclonal Enzyme Immunoassay for Detection of Listeria monocytogenes and Related Listeria Species in Selected Foods: Collaborative Study

Six foods representing a variety of food products were analyzed by the Assurance Listeria polyclonal enzyme immunoassay (EIA) and by either the Bacteriological Analytical Manual or the U.S. Department of Agriculture culture method for detecting Listeria monocytogenes and related Listeria species. Samples of each food type, at each inoculation level, were analyzed simultaneously by both methods. A total of 19 laboratories representing federal government agencies and private industry in the United States and Canada participated. Food types were inoculated with Listeria species including L. monocytogenes, with the exception of 3 lots of green beans, which were naturally contaminated. During this study, 1764 samples and controls were analyzed and confirmed, of which 492 were positive and 947 were negative by both methods. There were 159 samples that were positive by culture method but negative by the EIA and 188 that were negative by culture method but positive by EIA. Twenty-two samples were negative by EIA and by culture method but confirmed positive when Assurance selective enrichment broths were subcultured to selective agar. The Assurance polyclonal EIA for detecting L. monocytogenes and related Listeria species in foods has been adopted first action by AOAC INTERNATIONAL.

Increased visual interest and affective responses to impossible figures in early infancy

This research evaluated infants' facial expressions as they viewed pictures of possible and impossible objects on a TV screen. Previous studies in our lab demonstrated that four-month-old infants looked longer at the impossible figures and fixated to a greater extent within the problematic region of the impossible shape, suggesting they were sensitive to novel or unusual object geometry. Our work takes studies of looking time data a step further, determining if increased looking co-occurs with facial expressions associated with increased visual interest and curiosity, or even puzzlement and surprise. We predicted that infants would display more facial expressions consistent with either "interest" or "surprise" when viewing the impossible objects relative to possible ones, which would provide further evidence of increased perceptual processing due to incompatible spatial information. Our results showed that the impossible cubes evoked both longer looking times and more reactive expressions in the majority of infants. Specifically, the data revealed significantly greater frequency of raised eyebrows, widened eyes and returns to looking when viewing impossible figures with the most robust effects occurring after a period of habituation. The pattern of facial expressions were consistent with the "interest" family of facial expressions and appears to reflect infants' ability to perceive systematic differences between matched pairs of possible and impossible objects as well as recognize novel geometry found in impossible objects. Therefore, as young infants are beginning to register perceptual discrepancies in visual displays, their facial expressions may reflect heightened attention and increased information processing associated with identifying irreconcilable contours in line drawings of objects. This work further clarifies the ongoing formation and development of early mental representations of coherent 3D objects.

Hayabusa2 arrives at the carbonaceous asteroid 162173 Ryugu-A spinning top-shaped rubble pile

The Hayabusa2 spacecraft arrived at the near-Earth carbonaceous asteroid 162173 Ryugu in 2018. We present Hayabusa2 observations of Ryugu's shape, mass, and geomorphology. Ryugu has an oblate "spinning top" shape, with a prominent circular equatorial ridge. Its bulk density, 1.19 ± 0.02 grams per cubic centimeter, indicates a high-porosity (>50%) interior. Large surface boulders suggest a rubble-pile structure. Surface slope analysis shows Ryugu's shape may have been produced from having once spun at twice the current rate. Coupled with the observed global material homogeneity, this suggests that Ryugu was reshaped by centrifugally induced deformation during a period of rapid rotation. From these remote-sensing investigations, we identified a suitable sample collection site on the equatorial ridge.

Noise-optimized ultrastable low-noise current amplifier

We have developed a noise-optimized ultrastable low-noise current amplifier (ULCA) aimed at reducing the uncertainty at low currents. It involves a thin-film resistor network with 6.75 GΩ at the high-ohmic path which reduces the noise level to 1.6 fA/Hz. Noise investigations as well as short-term and long-term stability studies were carried out. The stability of the input current gain was measured using a cryogenic current comparator at ±6.1 nA. Methods for investigating the measurement accuracy at low input currents of about 100 pA at a level of below one part in 10⁷ are introduced and experimentally verified. The performance of the noise-optimized ULCA is compared with that of the standard variant introduced in 2014. It is shown that the reduced noise floor is achieved without impairing the stability of the transresistance.

Multiple glassy dynamics in dipole functionalized triphenylene-based discotic liquid crystals revealed by broadband dielectric spectroscopy and advanced calorimetry - assessment of the molecular origin

A selected series of dipole functionalized triphenylene-based discotic liquid crystals (DLCs) was synthesized and investigated in a systematic way to reveal the phase behavior and molecular dynamics. The later point is of particular importance to understand the charge transport in such systems which is the key property for their applications such as organic field-effect transistors, solar cells or as nanowires in molecular electronics, and also to tune the properties of DLCs. The mesomorphic properties were studied by polarizing optical microscopy, X-ray diffraction, and differential scanning calorimetry, which were compared to the corresponding unfunctionalized DLC. The molecular dynamics were investigated by a combination of state-of-the-art broadband dielectric spectroscopy (BDS) and advanced calorimetry such as fast scanning calorimetry (FSC) and specific heat spectroscopy (SHS). Besides localized fluctuations, surprisingly multiple glassy dynamics were detected for all materials for the first time. Glassy dynamics were proven for both processes unambiguously due to the extraordinary broad frequency range covered. The α1-process is attributed to fluctuations of the alky chains in the intercolumnar space because a polyethylene-like glassy dynamics is observed. This corresponds to a glass transition in a confined three-dimensional space. The α2-process found at temperatures lower than α1-process, is assigned to small scale rotational and/or translational in plane fluctuations of the triphenylene core inside distorted columns. This can be considered as a glass transition in a one-dimensional fluid. Therefore, obtained results are of general importance to understand the glass transition, which is an unsolved problem of condensed matter science.

Randomized Clinical Dose-Response Study to Evaluate Plaque Removal by Three Experimental Sodium Bicarbonate Toothpastes Using a Single Brushing Model

OBJECTIVES

This randomized, examiner-blind, crossover clinical study compared the plaque removal efficacy of three experimental toothpastes containing 20%, 35%, and 50% w/w sodium bicarbonate (NaHCO3) with commercial toothpastes containing 67% and 0% w/w NaHCO3 (positive and negative controls, respectively).

METHODS

Fifty-six adults with a mean Turesky Modification of the Quigley-Hein Plaque Index (TPI) score of = 2.00 at screening and at the first treatment visit (pre-brushing) were randomized to a supervised single, timed (one minute) brushing with a 0%, 20%, 35%, 50%, or 67% w/w NaHCO3-containingtoothpaste. TPI was measured pre- and post-brushing. Participants completed five treatment visits, separated by a four- to six-day washout, and brushed once with each toothpaste. The primary efficacy analysis was change in whole mouth TPI score from pre- to post-brushing between the positive and negative control toothpastes (validation step). Secondary analyses were comparisons between each experimental toothpaste and the control toothpastes. Change in TPI score was analyzed using a mixed effect analysis of covariance.

RESULTS

The difference in adjusted mean TPI change from pre- to post-brushing between the 67% and 0% w/w NaHCO3 toothpastes was -0.01 points (95% CI -0.06, 0.04), with no statistically significant difference between them (p = 0.6674). As such, study validity was not attained. Differences in adjusted mean change from pre- to post-brushing between each experimental toothpaste and the positive and negative controls ranged from 0.00 to -0.02 points. Twenty-two treatment-emergent, treatment-related adverse events, all oral, were reported by 17 participants (30.4%). These were spread uniformly across test toothpastes and controls. No serious adverse events were reported.

CONCLUSIONS

There was no statistically significant difference in change in mean TPI score between toothpastes containing 67% w/w NaHCO3 and 0% w/w NaHCO3 following a single timed brushing. This unexpected observation may be attributed to lower than expected reduction in overall plaque and a possible Hawthorne effect. As study validation was not met, no further conclusions can be made. The study products were generally well tolerated.

What initiatives do healthcare leaders agree are needed for healthcare system improvement? Results of a modified-Delphi study

PURPOSE

The purpose of this paper is to identify five quality improvement initiatives for healthcare system leaders, produced by such leaders themselves, and to provide some guidance on how these could be implemented.

DESIGN/METHODOLOGY/APPROACH

A multi-stage modified-Delphi process was used, blending the Delphi approach of iterative information collection, analysis and feedback, with the option for participants to revise their judgments.

FINDINGS

The process reached consensus on five initiatives: change information privacy laws; overhaul professional training and work in the workplace; use co-design methods; contract for value and outcomes across health and social care; and use data from across the public and private sectors to improve equity for vulnerable populations and the sickest people.

RESEARCH LIMITATIONS/IMPLICATIONS

Information could not be gathered from all participants at each stage of the modified-Delphi process, and the participants did not include patients and families, potentially limiting the scope and nature of input.

PRACTICAL IMPLICATIONS

The practical implications are a set of findings based on what leaders would bring to a decision-making table in an ideal world if given broad scope and capacity to make policy and organisational changes to improve healthcare systems.

ORIGINALITY/VALUE

This study adds to the literature a suite of recommendations for healthcare quality improvement, produced by a group of experienced healthcare system leaders from a range of contexts.

Measurement of sub-picoampere direct currents with uncertainties below ten attoamperes

A new type of the ultrastable low-noise current amplifier (ULCA) is presented. It involves thick-film resistors to achieve a high feedback resistance of 185 GΩ at the input amplifier. An improved noise level of 0.4 fA/Hz with a 1/f corner of about 30 μHz and an effective input bias current well below 100 aA are demonstrated. For small direct currents, measurement uncertainties below 10 aA are achievable even without current reversal or on/off switching. Above about 1 pA, the stability of the ULCA's resistor network limits the relative measurement uncertainty to about 10 parts per million. The new setup is used to characterize and optimize the noise in the wiring installed on a dilution refrigerator for current measurements on single-electron transport pumps. In a test configuration connected to the wiring in a pulse tube refrigerator, a total noise floor of 0.44 fA/Hz was achieved including the contributions of amplifier and cryogenic wiring.

The Case for Quality Improvement

Healthcare systems around the world are facing increasing public and government scrutiny, financial pressures and challenges from growing complexity. There is a need to accelerate the pace of change, and improve the quality of care while reducing cost. These changes must centre on improving care and increasing accountability for quality in the system. But how do we achieve this goal?

Diagnostic and prognostic value of in vivo proton MR spectroscopy for Zellweger syndrome spectrum patients

Defects in the biogenesis of peroxisomes cause a clinically and genetically heterogeneous group of neurometabolic disorders, the Zellweger syndrome spectrum (ZSS). Diagnosis predominantly is based on characteristic clinical symptoms, a typical biochemical profile, as well as on identification of the molecular defect in any of the 12 known human PEX genes. The diagnostic workup can be hindered if the typical clinical symptoms are missing and predicting the clinical course of a given patient is almost unfeasible. As a safe and noninvasive method to analyze specific chemical compounds in localized brain regions, in vivo proton magnetic resonance spectroscopy (MRS) can provide an indication in this diagnostic process and may help predict the clinical course. However, to date, there are very few reports on this topic. In this study, we performed localized in vivo proton MRS without confounding contributions from T1- and T2-relaxation effects at 2 Tesla in a comparably large group of seven ZSS patients. Patients' absolute metabolite concentrations in cortical gray matter, white matter, and basal ganglia were assessed and compared with age-matched control values. Our results confirm and extend knowledge about in vivo MRS findings in ZSS patients. Besides affirmation of nonspecific reduction of N-acetylaspartate + N-acetylaspartylglutamate (tNAA) in combination with lipid accumulation as a diagnostic hint for this disease group, the amount of tNAA loss seems to reflect disease burden and may prove to be of prognostic value regarding the clinical course of an already diagnosed patient.

Reducing current noise in cryogenic experiments by vacuum-insulated cables

We measure the current noise of several cryogenic cables in a pulse tube based dilution refrigerator at frequencies between about 1 mHz and 50 kHz. We show that vibration-induced noise can be efficiently suppressed by using vacuum-insulated cables between room temperature and the 2nd pulse tube stage. A noise peak below 4 fA at the 1.4 Hz operation frequency of the pulse tube and a white noise density of 0.44 fA/Hz in the millihertz range are obtained.

Using systems thinking to support clinical system transformation

Purpose

– The British Columbia Ministry of Health’s Clinical Care Management initiative was used as a case study to better understand large-scale change (LSC) within BC’s health system. Using a complex system framework, the purpose of this paper is to examine mechanisms that enable and constrain the implementation of clinical guidelines across various clinical settings.

Design/methodology/approach

– Researchers applied a general model of complex adaptive systems plus two specific conceptual frameworks (realist evaluation and system dynamics mapping) to define and study enablers and constraints. Focus group sessions and interviews with clinicians, executives, managers and board members were validated through an online survey.

Findings

– The functional themes for managing large-scale clinical change included: creating a context to prepare clinicians for health system transformation initiatives; promoting shared clinical leadership; strengthening knowledge management, strategic communications and opportunities for networking; and clearing pathways through the complexity of a multilevel, dynamic system.

Research limitations/implications

– The action research methodology was designed to guide continuing improvement of implementation. A sample of initiatives was selected; it was not intended to compare and contrast facilitators and barriers across all initiatives and regions. Similarly, evaluating the results or process of guideline implementation was outside the scope; the methods were designed to enable conversations at multiple levels – policy, management and practice – about how to improve implementation. The study is best seen as a case study of LSC, offering a possible model for replication by others and a tool to shape further dialogue.

Practical implications

– Recommended action-oriented strategies included engaging local champions; supporting local adaptation for implementation of clinical guidelines; strengthening local teams to guide implementation; reducing change fatigue; ensuring adequate resources; providing consistent communication especially for front-line care providers; and supporting local teams to demonstrate the clinical value of the guidelines to their colleagues.

Originality/value

– Bringing a complex systems perspective to clinical guideline implementation resulted in a clear understanding of the challenges involved in LSC.

Fitting Higgs data with nonlinear effective theory

In a recent paper we showed that the electroweak chiral Lagrangian at leading order is equivalent to the conventional [Formula: see text] formalism used by ATLAS and CMS to test Higgs anomalous couplings. Here we apply this fact to fit the latest Higgs data. The new aspect of our analysis is a systematic interpretation of the fit parameters within an EFT. Concentrating on the processes of Higgs production and decay that have been measured so far, six parameters turn out to be relevant: [Formula: see text], [Formula: see text], [Formula: see text], [Formula: see text], [Formula: see text], [Formula: see text]. A global Bayesian fit is then performed with the result [Formula: see text], [Formula: see text], [Formula: see text], [Formula: see text], [Formula: see text], [Formula: see text]. Additionally, we show how this leading-order parametrization can be generalized to next-to-leading order, thus improving the [Formula: see text] formalism systematically. The differences with a linear EFT analysis including operators of dimension six are also discussed. One of the main conclusions of our analysis is that since the conventional [Formula: see text] formalism can be properly justified within a QFT framework, it should continue to play a central role in analyzing and interpreting Higgs data.

Exploring distributed leadership in the BC Sepsis Network

Commissioned research was undertaken to explore the role of networks in supporting large-scale change and improvement. Participatory action research and social network analysis were used to study the BC Sepsis Network. Findings of this research include insights into distributed leadership, enablers and barriers within a network approach; the importance of relationships and trust; and the need for meaningful and timely data. Recommendations are made for health leaders who are considering utilizing networks for improving patient quality and safety.

Gamification as a strategy to engage and motivate clinicians to improve care

Approaching change through seeking commitment rather than requiring compliance is an effective way to promote desired behaviours in healthcare. Gamification was explored as a technique to engage clinicians in the adoption of sepsis identification and management tools. Positive extrinsic (eg, feedback and rewards) and intrinsic (eg, mastery, autonomy, relatedness, and purpose) motivators were integrated into a campaign to save lives, leading to a significant reduction in severe sepsis mortality and improvement in processes of care.

Improving care for British Columbians: the critical role of physician engagement

Canadian provinces are addressing quality of care and patient safety in a systemic way, but obtaining physician involvement in system improvement continues to be a challenge. To address this issue, individual physicians, physician groups, the British Columbia Medical Association, the health authorities, the BC Patient Safety & Quality Council (BCPSQC) and the Ministry of Health have come together to support physician involvement and foster physician satisfaction. Building on earlier work on patient safety, in 2010 the ministry developed a comprehensive strategy for system-wide improvement, focusing on achieving critical population, patient and sustainability outcomes. Central to this plan is the acknowledged need to involve healthcare providers of all disciplines, in particular physicians. Today, BC physicians are leading large-scale provincial clinical improvement in three interdependent areas: Clinical Care Management, Integrated Primary and Community Care, and the National Surgical Quality Improvement Program. To further physicians' key contributions to BC's healthcare system, the BCPSQC, physician-ministry committees, health authorities and the Ministry will continue to engage physicians through practice support, feedback, financial recognition and information exchange, and by supporting improvements in the care provided to patients.

High-resolution dielectric study reveals pore-size-dependent orientational order of a discotic liquid crystal confined in tubular nanopores

We report a high-resolution dielectric study on a pyrene-based discotic liquid crystal (DLC) in the bulk state and confined in parallel tubular nanopores of monolithic silica and alumina membranes. The positive dielectric anisotropy of the DLC molecule at low frequencies (in the quasistatic case) allows us to explore the thermotropic collective orientational order. A face-on arrangement of the molecular discs on the pore walls and a corresponding radial arrangement of the molecules is found. In contrast to the bulk, the isotropic-to-columnar transition of the confined DLC is continuous, shifts with decreasing pore diameter to lower temperatures, and exhibits a pronounced hysteresis between cooling and heating. These findings corroborate conclusions from previous neutron and x-ray-scattering experiments as well as optical birefringence measurements. Our study also indicates that the relative simple dielectric technique presented here is a quite efficient method in order to study the thermotropic orientational order of DLC-based nanocomposites.

EUROPattern Suite technology for computer-aided immunofluorescence microscopy in autoantibody diagnostics

Antinuclear autoantibodies (ANA) are highly informative biomarkers in autoimmune diagnostics. The increasing demand for effective test systems, however, has led to the development of a confusingly large variety of different platforms. One of them, the indirect immunofluorescence (IIF), is regarded as the common gold standard for ANA screening, as described in a position statement by the American College of Rheumatology in 2009. Technological solutions have been developed aimed at standardization and automation of IIF to overcome methodological limitations and subjective bias in IIF interpretation. In this review, we present the EUROPattern Suite, a system for computer-aided immunofluorescence microscopy (CAIFM) including automated acquisition of digital images and evaluation of IIF results. The system was originally designed for ANA diagnostics on human epithelial cells, but its applications have been extended with the latest system update version 1.5 to the analysis of antineutrophil cytoplasmic antibodies (ANCA) and anti-dsDNA antibodies.

Ultrastable low-noise current amplifier: a novel device for measuring small electric currents with high accuracy

An ultrastable low-noise current amplifier (ULCA) is presented. The ULCA is a non-cryogenic instrument based on specially designed operational amplifiers and resistor networks. It involves two stages, the first providing a 1000-fold current gain and the second performing a current-to-voltage conversion via an internal 1 MΩ reference resistor or, optionally, an external standard resistor. The ULCA's transfer coefficient is highly stable versus time, temperature, and current amplitude within the full dynamic range of ±5 nA. The low noise level of 2.4 fA/√Hz helps to keep averaging times short at small input currents. A cryogenic current comparator is used to calibrate both input current gain and output transresistance, providing traceability to the quantum Hall effect. Within one week after calibration, the uncertainty contribution from short-term fluctuations and drift of the transresistance is about 0.1 parts per million (ppm). The long-term drift is typically 5 ppm/yr. A high-accuracy variant is available that shows improved stability of the input gain at the expense of a higher noise level of 7.5 fA/√Hz. The ULCA also allows the traceable generation of small electric currents or the calibration of high-ohmic resistors.

Verhaltensauffälligkeiten mit 9 Jahren zur Vorhersage von Schulproblemen im Alter von 11 und 15 Jahren

Verhaltensauffälligkeiten im Kindesalter stellen einen Risikofaktor für psychische Auffälligkeiten und verminderte schulische Leistungsfähigkeit dar. Die Studie untersucht, ob eine geringere Funktionalität im Grundschulalter die Auftretenswahrscheinlichkeit von Schulproblemen in der Adoleszenz erhöht. Fragebogendaten der 9-, 11- und 15-Jahres Nachuntersuchungen der MAS-Geburtskohorte (N=1314 Baselineerhebung bei Geburt; 47.9 % Mädchen, 52.1 % Jungen) werden ausgewertet. Erhoben werden Funktionalität auf den Dimensionen Psychisches Wohlergehen, Körperlicher Status, Soziale Beziehungen und Alltagsfunktionsfähigkeit zu 9 Jahren sowie das Vorkommen von Schulproblemen mit 11 und 15 Jahren. Eine geringere Funktionalität im Alter von 9 Jahren geht mit einer erhöhten Auftretenswahrscheinlichkeit von Schulproblemen mit 11 (adjustierte Odds Ratio [aOR]=3.53, 95 %Konfidenzintervall [KI] 2.20 – 5.66) und 15 Jahren (aOR=3.22, 95 %KI 1.85 – 5.62) einher. Diese Effekte zeigen sich deutlicher für Jungen als für Mädchen. Bereits Grundschulkinder können Einschränkungen in ihrer Funktionalität zeigen, welche über Jahre stabil zu bleiben scheinen und mit Schulproblemen in der Adoleszenz einhergehen können.

Thermotropic orientational order of discotic liquid crystals in nanochannels: an optical polarimetry study and a Landau-de Gennes analysis

Optical polarimetry measurements of the orientational order of a discotic liquid crystal based on a pyrene derivative confined in parallelly aligned nanochannels of monolithic, mesoporous alumina, silica, and silicon as a function of temperature, channel radius (3-22 nm) and surface chemistry reveal a competition of radial and axial columnar orders. The evolution of the orientational order parameter of the confined systems is continuous, in contrast to the discontinuous transition in the bulk. For channel radii larger than 10 nm we suggest several, alternative defect structures, which are compatible both with the optical experiments on the collective molecular orientation presented here and with a translational, radial columnar order reported in previous diffraction studies. For smaller channel radii our observations can semi-quantitatively be described by a Landau-de Gennes model with a nematic shell of radially ordered columns (affected by elastic splay deformations) that coexists with an orientationally disordered, isotropic core. For these structures, the cylindrical phase boundaries are predicted to move from the channel walls to the channel centres upon cooling, and vice-versa upon heating, in accord with the pronounced cooling/heating hystereses observed and the scaling behavior of the transition temperatures with the channel diameter. The absence of experimental hints of a paranematic state is consistent with a biquadratic coupling of the splay deformations to the order parameter.

Structure-property relationship of anilino-squaraines in organic solar cells

Soluble molecular semiconductors are a promising alternative to semiconducting polymers in the field of organic photovoltaics. Here, three custom-made symmetric 1,3-bis(N,N-alkylated-2,6-dihydroxy-anilino)squaraines containing systematic variations in their molecular structures are compared regarding their applicability as donor materials in bulk-heterojunction solar cells. The terminal substitution pattern of the squaraines is varied from cyclic over linear to branched including a stereogenic center. Single crystal structures are determined, and, in the case of chiral squaraine, unusual formation of stereoisomer co-crystals is revealed. The thin film absorbance spectra show characteristic signatures of H- and J-bands or hint at the formation of tautomers. The general feasibility of these model compounds for photovoltaic applications is studied by light-induced electron spin resonance spectroscopy. The impact of the different molecular substitution patterns on aggregation behavior and, consequently, their optoelectronic solid state properties including charge carrier mobility and finally the solar cell performance are investigated.

Abstract WP399: Improving Stroke and TIA Care in the Emergency Department: Results from a Provincial Stroke Improvement Collaborative

Background: Stroke and transient ischemic attack (TIA) are common disorders cared for by emergency physicians. Best practices exist for the management of these disorders; however, these are not always followed.

OBJECTIVES: This study sought to measure the impact of a coordinated, provincial structured improvement collaborative, on care for stroke and TIA patients within emergency departments (ED’s) in British Columbia.

METHODS: This study was a qualitative and quantitative process evaluation of a provincial improvement collaborative. The collaborative followed an Institute of Healthcare Improvement (IHI) Methodology, consisting of five workshops, bi-weekly webinars, and improvement coaching and support, over a 10-month period, from Sept 2011 to June 2012. This evaluation examined process measures of success, such as self-reported improvement and adherence to certain clinical process measures (e.g. time to CT). Collaborative participants submitted monthly reports that quantified their improvement using the Self Assessment Score, which is used in IHI Collaborative Methodology.

RESULTS: 17 multidisciplinary teams participated, representing 27% of all ED’s in British Columbia (29 / 108), and all five Health Authorities. Further, all but one of the province’s tPA enabled sites were represented. 90% of teams (15 / 17) reported a median Self Assessment Score greater than 4.5/5.0, indicating significant and sustainable improvements in stroke and TIA care. No teams dropped out of the Collaborative. Teams reported a mean of 5.5 (SD 2.4) significant improvements within their ED. For example, shortened door-to-CT times, improved triage and training, and implementation of standardized swallowing screens were shown. This collaborative showed higher success rates of self-reported improvement (typically only 30% of teams achieve significant improvement) and lower rates of dropouts, than the published literature.

CONCLUSIONS: Using an IHI structured collaborative format, a provincial stroke & TIA emergency department quality improvement initiative was able to achieve significant improvements in adherence to best practices. A formal outcome evaluation is planned to measure the impact on stroke incidence, disability, and mortality.

Short term clinical efficacy of new meridol HALITOSIS tooth & tongue gel in combination with a tongue cleaner to reduce oral malodor

OBJECTIVE

This study evaluated the short term efficacy of tongue cleaning with meridol HALITOSIS tooth & tongue gel in comparison to mechanical tongue cleaning alone and untreated after five and 60 minutes in patients with an oral cause of bad breath.

METHODS

Fifty-four male and female subjects with an intra-oral cause of halitosis (organoleptic ratings > or = 2 and volatile sulphur compounds > or = 50 ppb) participated in this crossover study and were assigned to six different treatment sequences (ABC, ACB, BAC, BCA, CAB, CBA) with no treatment (A), mechanical tongue cleaning alone (B), and tongue cleaning with tooth & tongue gel applied to the tongue cleaner (C). Efficacy was assessed by organoleptic ratings and volatile sulphur compound measurements five and 60 minutes after treatment

RESULTS

Cleaning the tongue with tooth & tongue gel applied onto the tongue cleaner resulted in significantly reduced organoleptic ratings (p < 0.001 for the five-minute assessment; p = 0.001 for the 60-minute assessment) and volatile sulphur compounds (H2S + CH3SH: p = 0.005 for the five-minute assessment; p = 0.003 for the 60-minute assessment) compared to no treatment at the five- and 60-minute assessment time points, while mechanical tongue cleaning alone was less effective in reducing organoleptic ratings (p = 0.008 for the five-minute assessment; p = 0.144 for the 60-minute assessment) and volatile sulphur compounds (H2S + CH3SH: p = 0.261 for the five-minute assessment; p = 0.365 for the 60-minute assessment).

CONCLUSIONS

Single tongue cleaning with meridol HALITOSIS tooth & tongue gel had a positive effect on halitosis five and 60 minutes after treatment. Tongue cleaning with tooth & tongue gel in combination with other oral hygiene procedures is a promising approach to control halitosis.