Search

International audience; We propose a new waveform for frequency-shift keying continuous phase modulation (FSK-CPM) that directly generates a single side band (SSB) spectrum. The original principle, inspired from quantum physics (levitons), is presented. From the simple analytical form of the modulation, orthonormal wave-functions and analytical expressions leading to the SSB power spectrum density are proposed. This CPM modulation displays a very compact spectrum, with 99% of the power in the primary bandwidth. Its SSB property makes this FSK-CPM scheme, hereby called SSB-FSK, a promising solution not sensitive to image frequency degradation and would allow large bit rates transmission at low carrier frequency.

In the setting of international disaster response, an important challenge is determining when it is appropriate to withdraw deployed assets as the acute disaster response transitions to recovery and rebuilding. We describe our experience with realtime data collection during our medical response to Typhoon Haiyan as a means to guide military aid mission parameters.The operational medical headquarters prospectively developed a database for use in this mission. Mobile medical teams (MMTs) were deployed to provide primary care, and the nurse designated to each MMT was responsible for entering and transmitting data daily to the medical headquarters. Data collected included the MMT location, basic patient demographics, the primary reason for the encounter and any treatment provided. These encounters were then classified as disaster, acute or chronic.Between Nov. 16 and Dec. 16, 2013, medical care was provided to 6596 local nationals; 238 (3.6%) had disaster-related illness or injury, 4321 (65.5%) had acute postdisaster medical conditions and 2037 (30.9%) sought medical care for chronic conditions. Of the 257 patients with traumatic injuries, 28 (11%) had disaster-related injuries and 214 (83%) had acute injuries that occurred postdisaster.The data collected during the mission to the Phillippines was compiled with performance metrics from the other Disaster Assistance Response Team components to help advise the Canadian government regarding mission duration. We recommended that data collection continue on all future missions and be modified to provide further information to larger disaster coordination teams, such as the United Nations Office for the Coordination of Humanitarian Affairs.Dans le domaine de l’intervention internationale en cas de catastrophe, il est souvent difficile de déterminer le moment approprié pour retirer les ressources déployées alors que l’on passe de la première intervention d’urgence à la période de rétablissement et de reconstruction. Nous décrirons ici notre expérience de collecte de données en temps réel durant notre intervention médicale après le typhon Haiyan, dans le but d’orienter les paramètres de mission de l’aide militaire.Le quartier général des opérations médicales avait préparé d’avance la base de données qui a été utilisée lors de cette mission. Des équipes médicales mobiles ont été déployées pour fournir des soins de base, et une infirmière ou un infirmier désigné dans chaque équipe était chargé d’entrer et de transmettre les données quotidiennement au quartier général des opérations médicales. Les données recueillies comprenaient la position de l’équipe médicale mobile, des données démographiques de base sur les patients, la raison première de la rencontre et les traitements fournis. Ces rencontres étaient ensuite classées comme catastrophiques, aiguës ou chroniques.Du 16 novembre au 16 décembre 2013, des soins médicaux ont été prodigués à 6596 Philippins; 238 personnes (3,6 %) avaient des maladies ou des blessures liées au typhon, 4321 personnes (65,5 %) avaient des problèmes médicaux aigus d’après catastrophe et 2037 personnes (30,9 %) avaient besoin de soins pour des affections chroniques. Des 257 patients ayant subi des lésions traumatiques, 28 (11 %) avaient des blessures liées à la catastrophe et 214 (83 %) avaient des blessures aiguës reçues après la catastrophe.Les données recueillies durant la mission aux Philippines ont été compilées avec les indicateurs de rendement des autres composantes de l’équipe d’intervention en cas de catastrophe pour conseiller le gouvernement canadien au sujet de la durée des missions. Nous recommandons que la collecte de données se poursuive durant toutes les missions futures et soit modifiée afin de fournir plus de renseignements aux plus grandes équipes de coordination des interventions en cas de catastrophe, comme le Bureau de la coordination des affaires humanitaires de l’Organisation des Nations Unies.

To provide clinicians with practical considerations for care of children with Ebola virus disease in resource-rich settings.Review of the published medical literature, World Health Organization and government documents, and expert opinion.There are limited data regarding Ebola virus disease in children; however, reported case-fatality proportions in children are high. Ebola virus may affect immune regulation and endothelial function differently in children than adults. Considerations for care of children with Ebola virus disease are presented.Ebola virus disease is a severe multisystem disease with high mortality in children and adults. Hospitals and clinicians must prepare to provide care for patients with Ebola virus disease before such patients present for care, with particular attention to rigorous infection control to limit secondary cases. Although there is no proven specific treatment for Ebola virus disease, meticulous supportive care offers patients the best chance of survival.

The SST-1 machine comprises a superconducting magnet system (SCMS), which includes TF and PF magnets. In order to charge the SCMS, we need superconducting current feeders consisting of SC feeders and vapor cooled current leads (VCCLs). We have installed all 10 (+/-) pairs of VCCLs for the TF and PF systems. While conducting initial engineering validation of the SST-1 machine, our prime objective was to produce circular plasma using only the TF system. During the SST-1 campaign I to VI, we have to stop the PF magnets cooling in order to get the cryo- stable conditions for current charging of the TF magnets system. In that case, the cooling of the PF current leads is not essential. It has been also observed that after aborting the PF system cooling, there was a limited experimental window of TF operation. Therefore, in the recent SST-1 campaign-VII, we removed the PF current leads (9 pairs) and kept only single (+/-) pair of the 10,000 A rated VCCLs to realize the charging of the TF system for the extended window of operation. We have observed a better cryogenic stability in the TF magnets after modifications in the CFS. In this paper, we report the comparison of the cool down performance for the SST-1 machine operation before and after modifications of the current feeders system.

For almost all sales men, the strategy of time becomes the main key of selling effectiveness. Having appointment in a product’s presentation is oftenly measured by a very short times to deliver. In many cases, delivering the detail of products must be done at a sudden spot and extremely short time where he/she does not imagine before. This needs skill of designing the points of products and how to execute well in order to get the best memorable experience. Entertainment industry especially movie has a very unique on its competition. The development of technology totally delivers big change on how to produce a good film. In recent years, the capability of actor or actress is not the main consideration. We can find many brilliant of them have contributed playing the script however it’s not in line with the moviegers’ responses or the revenue itself. The interest of moviegoers on film sometimes can be seen by various factors. Sound effect, animation technology, pictures editing, original soundtrack, trailers, towards to the name of production house, are numbers of x-factors affecting the moviegoers.This paper intends to describe how the elevator speech-official movie trailer affects the moviegoers. Further this paper also intends to describe how the big production house affects the moviegoers. The analysis is measured by the regression which comes from one hundred respondent involved. The instrument used to collect data is by questionnaire. Most of respondents have the same response that almost all of the indicators have big effects for them. Keywords- Elevator Speech, Brand Awareness, Buying Decision

The shift of advertising strategey changed the budget of promotion in any enterprises (product and/or services). Consumer behavior has come to the digital trens (internet) which caused the marketers think harder regards to delivering its own product an/or services to consumers. Printed media, broadcast media and the technology too the online media has been proven by these enterprises. The differences of promotion strategy in media can be seen at the creatitvity of information delivered by online banner ads. This study tends to find the effectivity of Advan ads at detik.com using the EPIC Model. All of the factors show a good position of ads by looking at maps.

How does nature hold together protons and neutrons to form the wide variety of complex nuclei in the Universe? Describing many-nucleon systems from the fundamental theory of quantum chromodynamics has been the greatest challenge in answering this question. The chiral effective field theory description of the nuclear force now makes this possible but requires certain parameters that are not uniquely determined. Defining the nuclear force needs identification of observables sensitive to the different parametrizations. From a measurement of proton elastic scattering on ^{10}C at TRIUMF and ab initio nuclear reaction calculations, we show that the shape and magnitude of the measured differential cross section is strongly sensitive to the nuclear force prescription.

Background On a global scale scabies is one of the most common dermatological conditions, imposing a considerable economic burden on individuals, communities and health systems. There is substantial epidemiological evidence that in tropical regions scabies is often causing pyoderma and subsequently serious illness due to invasion by opportunistic bacteria. The health burden due to complicated scabies causing cellulitis, bacteraemia and sepsis, heart and kidney diseases in resource-poor communities is extreme. Co-infections of group A streptococcus (GAS) and scabies mites is a common phenomenon in the tropics. Both pathogens produce multiple complement inhibitors to overcome the host innate defence. We investigated the relative role of classical (CP), lectin (LP) and alternative pathways (AP) towards a pyodermic GAS isolate 88/30 in the presence of a scabies mite complement inhibitor, SMSB4. Methodology/Principal findings Opsonophagocytosis assays in fresh blood showed baseline immunity towards GAS. The role of innate immunity was investigated by deposition of the first complement components of each pathway, specifically C1q, FB and MBL from normal human serum on GAS. C1q deposition was the highest followed by FB deposition while MBL deposition was undetectable, suggesting that CP and AP may be mainly activated by GAS. We confirmed this result using sera depleted of either C1q or FB, and serum deficient in MBL. Recombinant SMSB4 was produced and purified from Pichia pastoris. SMSB4 reduced the baseline immunity against GAS by decreasing the formation of CP- and AP-C3 convertases, subsequently affecting opsonisation and the release of anaphylatoxin. Conclusions/Significance Our results indicate that the complement-inhibitory function of SMSB4 promotes the survival of GAS in vitro and inferably in the microenvironment of the mite-infested skin. Understanding the tripartite interactions between host, parasite and microbial pathogens at a molecular level may serve as a basis to develop improved intervention strategies targeting scabies and associated bacterial infections., Author summary The molecular mechanisms that underpin the link between scabies and bacterial pathogens were unknown. We proposed that scabies mites play a role in the establishment, proliferation and transmission of opportunistic pathogens. We investigated here the synergy between mites and one of the most recognised mite associated pathogens, Streptococcus pyogenes. As part of the innate immune response mammals have a pre-programmed ability to recognise and immediately act against substances derived from fungal and bacterial microorganisms. This is mediated through a sequential biochemical cascade involving over 30 different proteins (complement system) which as a result of signal amplification triggers a rapid killing response. The complement cascade produces peptides that attract immune cells, increases vascular permeability, coats (opsonises) the surfaces of a pathogen, marking it for destruction, and directly disrupts foreign plasma membranes. To prevent complement mediated damage of their gut cells, scabies mites secrete several classes of complement inhibiting proteins into the mite gut and excrete them into the epidermal mite burrows. Furthermore, these inhibitors also provide protection for S. pyogenes. We verified here specifically the impact of the mite complement inhibitor SMSB4, to identify the molecular mechanisms behind the long recognised tendency of S. pyogenes to infect mite-induced skin lesions.

Made available in DSpace on 2019-10-04T12:41:13Z (GMT). No. of bitstreams: 0 Previous issue date: 2017-05-01 US National Science Foundation (NSF) OPUS (Opportunities for Promoting Understanding through Synthesis) award NSF Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) Research Council of Norway NSF DDEP grant PADI Foundation Ohio Chapter of the Nature Conservancy Ouachita National Forrest British Antarctic Survey Ohio Lake Erie Protection Fund United States Environmental Protection Agency Federal Aid in Sport Fish Restoration Program Carrying Capacity in Norwegian Aquaculture (CANO) - Research Council of Norway National Research Council Research Associateship New Zealand Ministry of Business, Innovation and Employment St. Johns River Water Management District (Florida) Maj and Tor Nessling Foundation US EPA STAR Fellowship Japan Society for the Promotion of Science KAKENHI EU BioFresh project, 7th Framework European program Biodiversity Grants Program (University of Alberta) Biodiversity Grants Program (Alberta Conservation Association) C/BAR grant from the Canadian Circumpolar Institute NSERC Canada Natural Sciences and Engineering Research Council (NSERC) Miami Univ, Dept Biol, Oxford, OH 45056 USA Univ Wisconsin, Ctr Limnol, Madison, WI 53706 USA Univ South Carolina, Baruch Marine Field Lab, Georgetown, SC USA Univ Western Australia, Ctr Neonatal Res & Educ, Perth, WA 6009, Australia Univ Alabama, Dept Biol Sci, Tuscaloosa, AL 35487 USA Miami Univ, Dept Biol, Hamilton, OH 45011 USA Univ Oslo, Nat Hist Museum, POB 1172, NO-0318 Oslo, Norway Univ Paul Sabatier, Lab Evolut & Diversite Biol, F-31062 Toulouse, France Virginia Commonwealth Univ, Dept Biol, Richmond, VA 23284 USA Univ Fed Rio Grande do Norte, Dept Ecol, Natal, RN, Brazil Univ Georgia, Odum Sch Ecol, Athens, GA 30602 USA Auburn Univ, Dept Biol Sci, Auburn, AL 36849 USA Univ Massachusetts, Sch Environm, Boston, MA 02125 USA British Antarctic Survey, High Cross, Cambridge CB3 0ET, England Ohio Dept Nat Resources, Div Wildlife, Inland Fisheries Res Unit, 10517 Canal Rd SE, Hebron, OH 43025 USA Montana State Univ, Dept Ecol, Bozeman, MT 59717 USA Ohio State Univ, Dept Ecol Evolut & Organismal Biol, Columbus, OH 43210 USA Rivers Sch, 333 Winter St, Boston, MA 02493 USA Inst Marine Res, POB 1870, N-5817 Bergen, Norway Univ St Thomas, Dept Biol, St Paul, MN 55105 USA Univ Arkansas, Dept Biol Sci, Fayetteville, AR 72701 USA Norwegian Inst Water Res, Gaustadalleen 21, NO-0349 Oslo, Norway Cornell Univ, Dept Ecol & Evolutionary Biol, Ithaca, NY 14853 USA Kansas State Univ, Div Biol, Ackert Hall, Manhattan, KS 66506 USA IRSN, LRD, SERIS, PRP ENV,Lab Radioprot, Rue Max Pol Fouchet BP10, F-50130 Octeville, France Univ Fed Mato Grosso do Sul, CCBS, Lab Ecol, Campo Grande, MS, Brazil Fed Off Environm FOEN, Water Div, CH-3003 Bern, Switzerland Univ Wyoming, Dept Zool & Physiol, Laramie, WY 82071 USA Sao Paulo State Univ, Inst Biosci, Dept Zool, BR-18618689 Botucatu, SP, Brazil Minnesota Dept Nat Resources, Fisheries Res, Bemidji, MN 56601 USA Univ Waikato, Sch Sci, Private Bag 3105, Hamilton 3240, New Zealand North Carolina Dept Environm & Nat Resources, Div Water Qual, 1617 Mail Serv Ctr, Raleigh, NC 27699 USA US EPA, Off Res & Dev, Natl Risk Management Res Lab, 26 W Martin Luther King Dr, Cincinnati, OH 45268 USA 16-3-1001 Toyokawa Cho, Hakodate, Hokkaido 0400065, Japan Univ Wisconsin Stout, Biol Dept, Menomonie, WI 54751 USA Wageningen Marine Res, POB 77, NL-4400 AB Yerseke, Netherlands Utah State Univ, Dept Watershed Sci, Logan, UT 84322 USA No Arizona Univ, Ctr Ecosyst Sci & Soc, Flagstaff, AZ 86011 USA Univ Notre Dame, Dept Biol Sci, Notre Dame, IN 46556 USA George Mason Univ, Smithsonian Mason Sch Conservat, 1500 Remount Rd, Front Royal, VA 22360 USA Univ Georgia, Warnell Sch Forestry & Nat Resources, Athens, GA 30602 USA Oak Ridge Natl Lab, Div Environm Sci, POB 2008, Oak Ridge, TN 37831 USA Loyola Univ, Dept Biol, Chicago, IL 60660 USA NorthTec, Appl & Environm Sci, 57 Raumanga Valley Rd,Private Bag 9019, Whangarei 0110, New Zealand Caravan Lab, 5729 36th Ave NE, Seattle, WA 98105 USA Swedish Univ Agr Sci, Dept Aquat Resources, Inst Coastal Res, S-74242 Oregrund, Sweden Muller Sars Soc, Free Basic Res, POB 5831, N-0308 Oslo, Norway Mediterranean Inst Oceanog, 235 Campus Luminy Case 901, F-13288 Marseille 09, France Univ Nacl La Pampa, Fac Ciencias Exactas & Nat, Dept Recursos Nat, Uruguay 151, RA-6300 Santa Rosa, La Pampa, Argentina Yale Univ, Dept Ecol & Evolutionary Biol, New Haven, CT 06520 USA Weizmann Inst Sci, Dept Mol Cell Biol, IL-7610001 Rehovot, Israel Virginia Wesleyan Coll, Dept Biol, Norfolk, VA 23502 USA Univ Minnesota, Math Sci & Technol Dept, Crookston, MN 56716 USA Cary Inst Ecosyst Studies, Millbrook, NY 12545 USA US Geol Survey, Patuxent Wildlife Res Ctr, SO Conte Anadromous Fish Lab, Turners Falls, MA 01376 USA Pyhajarvi Inst, Sepantie 7, FI-27500 Kauttua, Finland USDA ARS, Natl Sedimentat Lab, Water Qual & Ecol Res Unit, 598 McElroy Dr, Oxford, MS 38655 USA Nebraska Wesleyan Univ, Cooper Fdn Ctr Acad Resources, Lincoln, NE 68504 USA Univ Pittsburgh, Dept Microbiol & Mol Genet, Pittsburgh, PA 15219 USA Tohoku Univ, Grad Sch Life Sci, Aoba Ku, 6-3 Aramaki, Sendai, Miyagi 9808578, Japan Hiroshima Univ, Grad Sch Biosphere Sci, 4-4 Kagamiyama 1 Chome, Higashihiroshima 7398528, Japan Univ Montpellier, CNRS, Lab Biodiversite Marine & Ses Usages, F-34095 Montpellier, France Southern Illinois Univ, Dept Zool, Carbondale, IL 62901 USA Southern Illinois Univ, Ctr Ecol, Carbondale, IL 62901 USA Univ Idaho, Dept Fish & Wildlife Sci, Moscow, ID 83844 USA Agr & Agri Food Canada, Brandon Res Ctr, POB 1000A,RR 3, Brandon, MB R7A 5Y3, Canada Trent Univ, Dept Biol, Peterborough, ON K9L 0G2, Canada Polar Field Serv Inc, 8100 Shaffer Pkwy 100, Littleton, CO 80127 USA Kansas State Univ, US Geol Survey, Kansas Cooperat Fish & Wildlife Res Unit, Div Biol, Manhattan, KS 66506 USA Sao Paulo State Univ, Inst Biosci, Dept Zool, BR-18618689 Botucatu, SP, Brazil US National Science Foundation (NSF) OPUS (Opportunities for Promoting Understanding through Synthesis) award: DEB 0918993 NSF: DEB-1030242 CNPq: 304621/2015-3 NSF DDEP grant: 0951432 Ohio Lake Erie Protection Fund: SG189-02 United States Environmental Protection Agency: GL-97590101 Federal Aid in Sport Fish Restoration Program: F-69-P Carrying Capacity in Norwegian Aquaculture (CANO) - Research Council of Norway: 173537 New Zealand Ministry of Business, Innovation and Employment: UOWX0505 St. Johns River Water Management District (Florida): SK933AA US EPA STAR Fellowship: FP-91694301-1 Japan Society for the Promotion of Science KAKENHI: 15H02642 EU BioFresh project, 7th Framework European program: 226874 NSERC: 89673S

A new pixel detector for the CMS experiment was built in order to cope with the instantaneous luminosities anticipated for the Phase I Upgrade of the LHC . The new CMS pixel detector provides four-hit tracking with a reduced material budget as well as new cooling and powering schemes. A new front-end readout chip mitigates buffering and bandwidth limitations, and allows operation at low comparator thresholds. In this paper, comprehensive test beam studies are presented, which have been conducted to verify the design and to quantify the performance of the new detector assemblies in terms of tracking efficiency and spatial resolution. Under optimal conditions, the tracking efficiency is 99.95 ± 0.05%, while the intrinsic spatial resolutions are 4.80 ± 0.25 μm and 7.99 ± 0.21 μm along the 100 μm and 150 μm pixel pitch, respectively. The findings are compared to a detailed Monte Carlo simulation of the pixel detector and good agreement is found., Journal of Instrumentation, 12, ISSN:1748-0221

BACKGROUND Natural disasters, industrial accidents, terrorism attacks, and pandemics all have the capacity to result in large numbers of critically ill or injured patients. This supplement provides suggestions for all those involved in a disaster or pandemic with multiple critically ill patients, including front-line clinicians, hospital administrators, professional societies, and public health or government officials. The field of disaster medicine does not have the required body of evidence needed to undergo a traditional guideline development process. In result, consensus statement-development methodology was used to capture the highest-caliber expert opinion in a structured, scientific approach. METHODS Task Force Executive Committee members identified core topic areas regarding the provision of care to critically ill or injured patients from pandemics or disasters and subsequently assembled an international panel for each identified area. International disaster medicine experts were brought together to identify key questions (in a population, intervention, comparator, outcome [PICO]-based format) within each of the core topic areas. Comprehensive literature searches were then conducted to identify studies upon which evidence-based recommendations could be made. No studies of sufficient quality were identified. Therefore, the panel developed expert opinion-based suggestions that are presented in this supplement using a modified Delphi process. RESULTS A total of 315 suggestions were drafted across all topic groups. After two rounds of a Delphi consensus-development process, 267 suggestions were chosen by the panel to include in the document and published in a total of 12 manuscripts composing the core chapters of this supplement. Draft manuscripts were prepared by the topic editor and members of the working groups for each of the topics, producing a total of 11 papers. Once the preliminary drafts were received, the Executive Committee (Writing Committee) then met to review, edit, and promote alignment of all of the primary drafts of the manuscripts prepared by the topic editors and their groups. The topic editors then revised their manuscripts based on the Executive Committee's edits and comments. The Writing Committee subsequently reviewed the updated drafts and prepared the final manuscripts for submission to the Guidelines Oversight Committee (GOC). The manuscripts subsequently underwent review by the GOC, including external review as well as peer review for the journal publication. The Writing Committee received the feedback from the reviewers and modified the manuscripts as required. CONCLUSIONS Based on a robust and transparent process, this project used rigorous methodology to produce clinically relevant, trustworthy consensus statements, with the aim to provide needed guidance on treatment and procedures for practitioners, hospital administrators, and public health and government officials when addressing the care of critically ill or injured patients in disasters or pandemics.

This article focuses on the conceptualization, construction, and implementation of a graduate course in counseling and human sexuality from the perspective of its first-time instructor as well as its eight students. Through the use of the first-person narrative, this conceptual article conveys the interpersonal and intrapersonal experiences of the participants and provides a critique of the course’s major components with the goal of informing and encouraging the ongoing teaching and expansion of sexuality-related course offerings in counselor education programs.

Amplification of the MYCN proto-oncogene is associated with a poor prognosis in patients with metastatic neuroblastoma (NB). MYCN encodes the N-Myc protein, a transcriptional regulator that dimerizes with the Max transcription factor, binds to E-box DNA sequences, and regulates genes involved in cell growth and apoptosis. Overexpression of N-Myc leads to transcriptional activation and an increase in NB cell proliferation. Mxi1, a member of the Myc family of transcriptional regulators, also binds to Max. However, Mxi1 is a transcriptional repressor and inhibits proliferation of NB cells, suggesting that Mxi1 functions as an N-Myc antagonist. Our laboratory previously identified Mxi1-0, an alternatively transcribed Mxi1 isoform. Mxi1-0 has properties distinct from those of Mxi1; in contrast to Mxi1, Mxi1-0 is unable to suppress c-Myc-dependent transcription. We now show that Mxi1-0 expression increases in response to MYCN overexpression in NB cells, with a positive correlation between MYCN and MXI1-0 RNA levels. We also show that N-Myc expression differentially regulates the MXI1 and MXI1-0 promoters: Increased MYCN expression suppresses MXI1 promoter activity while enhancing transcription through the MXI1-0 promoter. Finally, induction of Mxi1-0 leads to increased proliferation, whereas expression of Mxi1 inhibits cell growth, indicating differential roles for these two proteins. These data suggest that N-Myc differentially regulates the expression of MXI1 and MXI1-0 and can alter the balance between the two transcription factors. Furthermore, MXI1-0 appears to be a downstream target of MYCN-dependent signaling pathways and may contribute to N-Myc-dependent cell growth and proliferation.

Bioterrorism is not only a reality of the times in which we live but bioweapons have been used for centuries. Critical care physicians play a major role in the recognition of and response to a bioterrorism attack. Critical care clinicians must be familiar with the diagnosis and management of the most likely bioterrorism agents, and also be adequately prepared to manage a mass casualty situation. This article reviews the epidemiology, diagnosis, and treatment of the most likely agents of biowarfare and bioterrorism.

ObjectivesTo assess local, state, federal, and global pandemic influenza preparedness by identifying pandemic plans at the local, state, federal, and global levels, and to identify any information technology (IT) systems in these plans to support critical care triage during an influenza pandemic in the Canadian province of Ontario.MethodsThe authors used advanced MEDLINE and Google search strategies and conducted a comprehensive review of key pandemic influenza Web sites. Descriptive data extraction and analysis for IT systems were conducted on all of the included pandemic plans.ResultsA total of 155 pandemic influenza plans were reviewed: 29 local, 62 state, 63 federal, and 1 global. We found 70 plans that examined IT systems (10 local, 33 state, 26 federal, 1 global), and 85 that did not (19 local, 29 state, 37 federal). Of the 70 plans, 64 described surveillance systems (10 local, 32 state, 21 federal, 1 global), 2 described patient data collection systems (1 state, 1 federal); 4 described other types of IT systems (4 federal), and none were intended for triage.ConclusionsAlthough several pandemic plans have been drafted, the majority are high-level general documents that do not describe IT systems. The plans that discuss IT systems focus strongly on surveillance, which fails to recognize the needs of a health care system responding to an influenza pandemic. The best examples of the types of IT systems to guide decision making during a pandemic were found in the Kansas and the Czech Republic pandemic plans, because these systems were designed to collect both patient and surveillance data. Although Ontario has yet to develop such an IT system, several IT systems are in place that could be leveraged to support critical care triage and medical response during an influenza pandemic. (Disaster Med Public Health Preparedness. 2013;7:287-291)

Analytical chemistry is key to the functioning of a modern society. From early days, ethics in measurements have been a concern and that remains today, especially as we have come to rely more on the application of analytical science in many aspects of our lives. The main aim of this Feature is to suggest ways of introducing the topic of social responsibility and its relation to analytical chemistry in undergraduate or graduate chemistry courses.

In 1681 a monk under the patronage of the royal court at Ava was requested to compile a bibliography of authoritative Buddhist scripture. Uttamasikkha was tasked with cataloguing which texts then circulating in Burma were part of the Pitakat or Buddhist 'canon', most likely in connection with a project to copy a new set of manuscripts for the king's merit. (1) This canon was defined for him as comprising those texts that contained 'the profound and venerable speech (nhup nak tau) of the Lord Buddha, Solitary Buddhas (paccekabuddha), or the Enlightened (arhat)', as opposed to those that were 'the work of deities, sages (rsi), or unenlightened masters learned in the scriptures'. (2) The bibliographical project he faced presupposed an ideal literary hierarchy as well as a practical uncertainty about the relative authority of texts lying in Burmese manuscript libraries. After itemising in detail what he considers to be the legitimate contents of the Pitakat, Uttamasikkha turns his attention to works written by deities and sages. Here he provides a list of several texts and genres--comprising law, astrology and alchemy, Sanskrit grammar, and politics (niti) (3)--and singles out thirteen legal treatises by name. Among these thirteen is included the Gold Line Dhammasat of Manusara, which was compiled less than thirty years prior under the guidance of a celebrated monk, Tipitakalankara Munindaghosa. Uttamasikkha concludes his bibliography by cautioning that these legal and other treatises were written by sages and wise men and that they are excluded from or 'outside' (bahira) the category of canon--they are 'not Buddhist texts (sasana tau kyamh, ma hut) and pose a danger (antaray) to the path and fruition of nibbana'. (4) How is it that a legal text, and one compiled with the help of a famous monk no less, might pose a danger to Buddhist enlightenment? What were the taxonomies of authoritative scripture or countervailing ideologies of law that could enable such a criticism? These questions raised by Uttamasikkha's bibliography are important not only for the history of Burmese law, they relate to fundamental uncertainties in the minds of monastic commentators about the legitimacy of the heterogeneous corpora of Buddhist texts and their associated practices in premodern Burma. Debates about the proper boundaries of Buddhist scripture characterise a significant proportion of seventeenth through nineteenth-century Burmese monastic writings. The prevalence of such debates shows clearly that the scope of the canon was not universally fixed, and that the classification of Buddhist texts as belonging to or excluded from the Pitakat was in the process of ongoing formulation. According to 'Theravada' tradition the contents of the Pali canon or Tipitaka were established by the early fifth century CE when Buddhaghosa, a monk who was an affiliate of the Sinhalese Mahavihara fraternity, explicitly demarcated its limits in certain of his commentaries. (5) Although there is strong evidence that this authoritative Mahaviharin framework of understanding the parameters of scripture was known in Burma from the thirteenth century (for there is evidence that Buddhaghosa's texts were transmitted in Burma then) we can be equally certain on the basis of later evidence that it was not universally accepted, but rather exerted varying degrees of influence on Buddhist culture at different times and places. Thus the presence or absence of notions of textual authority must be approached as the outcome of specific intellectual histories and in relation to local textual and commentarial practices. (6) The principles guiding the inclusion of a text in the category of Pitakat are not fully explicit or standardised across seventeenth through nineteenth-century Burmese literature; however, the majority of authors who discuss the issue follow the Pali commentaries in taking the criterion of sanghayana tan (Pali, sangiti-arulha, 'presented at a recitation')--whether a text was recited during the first three Buddhist Councils or 'Communal Recitations' (sangiti) and thus worthy of the status of the 'word of the Buddha' (Buddhavacana)--as primary. …

Demand for intensive care unit (ICU) resources often exceeds supply, and shortages of ICU beds and staff are likely to persist. Triage requires careful weighing of the benefits and risks involved in ICU admission while striving to guarantee fair distribution of available resources. We must ensure that the patients who occupy ICU beds are those most likely to benefit from the ICU's specialized technology and professionals. Although prognosticating is not an exact science, preference should be given to patients who are more likely to survive if admitted to the ICU but unlikely to survive or likely to have more significant morbidity if not admitted. To provide general guidance for intensivists in ICU triage decisions, a task force of the World Federation of Societies of Intensive and Critical Care Medicine addressed 4 basic questions regarding this process. The team made recommendations and concluded that triage should be led by intensivists considering input from nurses, emergency medicine professionals, hospitalists, surgeons, and allied professionals. Triage algorithms and protocols can be useful but can never supplant the role of skilled intensivists basing their decisions on input from multidisciplinary teams. Infrastructures need to be organized efficiently both within individual hospitals and at the regional level. When resources are critically limited, patients may be refused ICU admission if others may benefit more on the basis of the principle of distributive justice.

Purpose. The objectives were to describe the management and outcomes of acute leukemia (AL) patients admitted to the ICU and to identify predictors of ICU mortality.Methods. Data was retrospectively collected from the medical records of all patients with AML or ALL admitted to the Mount Sinai Hospital ICU from August 2009 to December 2012.Results. 151 AL patients (117 AML, 34 ALL) were admitted to the ICU. Mean age was 54 (SD 15) years, median APACHE II score was 27 (IQR 22–33), and 50% were female. While in ICU, 128 (85%) patients had sepsis and 56 (37%) had ARDS. The majority of patients required invasive organ support: 94 (62%) required mechanical ventilation while 23 (15%) received renal replacement therapy. Multivariable analysis identified SOFA score (OR 1.18, 95% CI 1.01–1.38) and invasive ventilation (OR 9.64, 95% CI 3.39–27.4) as independent predictors of ICU mortality. Ninety-four (62%) patients survived to ICU discharge. Only 39% of these 94 patients discharged were alive 12 months after ICU admission.Conclusions. AL patients admitted to the ICU had a 62% ICU survival rate; yet only 25% of cohort patients were alive 12 months after ICU admission. Higher admission SOFA scores and invasive ventilation are independently associated with a greater risk of dying in the ICU.

Ion-conducting membranes are essential components in many electrochemical devices, but they often add substantial cost, limit performance, and are susceptible to degradation. This work investigates membraneless electrochemical flow cells for hydrogen production from water electrolysis that are based on angled mesh flow-through electrodes. These devices can be fabricated with as few as three parts (anode, cathode, and cell body), reflecting their simplicity and potential for low-cost manufacture. 3D printing was used to fabricate prototype electrolyzers that were demonstrated to be electrolyte agnostic, modular, and capable of operating with minimal product crossover. Prototype electrolyzers operating in acidic and alkaline solutions achieved electrolysis efficiencies of 61.9% and 72.5%, respectively, (based on the higher heating value of H2) when operated at 100 mA cm−2. Product crossover was investigated using in situ electrochemical sensors, in situ imaging, and by gas chromatography (GC). GC analysis found that 2.8% of the H2 crossed over from the cathode to the anode stream under electrolysis at 100 mA cm−2 and fluid velocity of 26.5 cm s−1. Additionally, modularity was demonstrated with a three-cell stack, and high-speed video measurements tracking bubble evolution from electrode surfaces provide valuable insight for the further optimization of electrolyzer design and performance.

Despite the widespread popularity of tattoos in the U.S. and worldwide, little consideration has been given to the occupational risk factors that tattoo artists face. Tattoo artists are exposed to many of the same risk factors faced by occupations such as dentistry and cosmetology, including prolonged static work postures and sustained gripping of hand held tools. However, no research has evaluated the extent to which the tattooing profession is adversely affected by its occupational demands. Utilizing a survey of tattoo artists, this research sought to benchmark the prevalence of symptoms commonly associated with the development of musculoskeletal disorders. The survey results revealed that tattoo artists experience high levels of discomfort in the lower back, neck, shoulders, and upper extremities and that these levels significantly exceed discomfort reported in professions that expose workers to similar ergonomic risk factors.

the goal of this study was to better understand population characteristics of Villosa iris (Lea) (Rainbow Shell) in the Spring River drainage in north-central Arkansas through documenting seasonal spatial patterns, movement behavior, population size, size-frequency distributions, sex ratios, and fecundity. We conducted monthly mark and recapture sampling between May and September 2007 (i.e., before, during, and after spawning) and documented the sex, size, fecundity, and spatial location of individual Rainbow Shell at 2 sites (SFSR1 and SR1). Population estimates were relatively high at both sites with 166 ± 32 (SE) and 381 ± 37 (SE) individuals at SFSR1 and SR1, respectively. Sex ratio was highly skewed toward males at SFSR1 with a ratio of 1.0:2.6, but only slightly skewed at SR1 with a ratio of 1.0:1.3. Mean fecundity was 27,849 ± 11,653 (SE) and 15,089 ± 11,710 (SE) glochidia at SFSR1 and SR1, respectively. Spatially, statistically more males were found upstream of non-gravid females during t...

Minor groove hydrogen bonding (HB) interactions between DNA polymerases (pols) and N3 of purines or O2 of pyrimidines have been proposed to be essential for DNA synthesis from results obtained using various nucleoside analogues lacking the N3 or O2 contacts that interfered with primer extension. Because there has been no direct structural evidence to support this proposal, we decided to evaluate the contribution of minor groove HB interactions with family B pols. We have used RB69 DNA pol and 3-deaza-2'-deoxyadenosine (3DA), an analogue of 2-deoxyadenosine, which has the same HB pattern opposite T but with N3 replaced with a carbon atom. We then determined pre-steady-state kinetic parameters for the insertion of dAMP opposite dT using primer/templates (P/T)-containing 3DA. We also determined three structures of ternary complexes with 3DA at various positions in the duplex DNA substrate. We found that the incorporation efficiency of dAMP opposite dT decreased 10(2)-10(3)-fold even when only one minor groove HB interaction was missing. Our structures show that the HB pattern and base pair geometry of 3DA/dT is exactly the same as those of dA/dT, which makes 3DA an optimal analogue for probing minor groove HB interactions between a DNA polymerase and a nucleobase. In addition, our structures provide a rationale for the observed 10(2)-10(3)-fold decrease in the rate of nucleotide incorporation. The minor groove HB interactions between position n - 2 of the primer strand and RB69pol fix the rotomer conformations of the K706 and D621 side chains, as well as the position of metal ion A and its coordinating ligands, so that they are in the optinal orientation for DNA synthesis.

El siguiente articulo presenta algunas aproximaciones a la politica de reconstruccion desarrollada en Chile luego del terremoto/tsunami que afecto al pais el 27 de febrero del ano 2010. Se propone la idea de dispositivo biopolitico desde una arista del pensamiento de Foucault como posibilidad interpretativa frente a las acciones politicas desarrolladas tras la catastrofe. Se intenta vislumbrar algunas de las lineas del dispositivo puesto en marcha, considerando los procesos de objetivacion y subjetivacion puestos en marcha por la politica, y, a su vez, las resistencias presentadas frente a dichos procesos.

The adenine base analogue 2-aminopurine (2AP) is a potent base substitution mutagen in prokaryotes because of its enhanceed ability to form a mutagenic base pair with an incoming dCTP. Despite more than 50 years of research, the structure of the 2AP-C base pair remains unclear. We report the structure of the 2AP-dCTP base pair formed within the polymerase active site of the RB69 Y567A-DNA polymerase. A modified wobble 2AP-C base pair was detected with one H-bond between N1 of 2AP and a proton from the C4 amino group of cytosine and an apparent bifurcated H-bond between a proton on the 2-amino group of 2-aminopurine and the ring N3 and O2 atoms of cytosine. Interestingly, a primer-terminal region rich in AT base pairs, compared to GC base pairs, facilitated dCTP binding opposite template 2AP. We propose that the increased flexibility of the nucleotide binding pocket formed in the Y567A-DNA polymerase and increased "breathing" at the primer-terminal junction of A+T-rich DNA facilitate dCTP binding opposite template 2AP. Thus, interactions between DNA polymerase residues with a dynamic primer-terminal junction play a role in determining base selectivity within the polymerase active site of RB69 DNA polymerase.

The bakers' yeast Saccharomyces cerevisiae utilizes a high affinity Ca(2+) influx system (HACS) to survive assaults by mating pheromones, tunicamycin, and azole-class antifungal agents. HACS consists of two known subunits, Cch1 and Mid1, that are homologous and analogous to the catalytic α-subunits and regulatory α2δ-subunits of mammalian voltage-gated calcium channels, respectively. To search for additional subunits and regulators of HACS, a collection of gene knock-out mutants was screened for abnormal uptake of Ca(2+) after exposure to mating pheromone or to tunicamycin. The screen revealed that Ecm7 is required for HACS function in most conditions. Cycloheximide chase experiments showed that Ecm7 was stabilized by Mid1, and Mid1 was stabilized by Cch1 in non-signaling conditions, suggesting they all interact. Ecm7 is a member of the PMP-22/EMP/MP20/Claudin superfamily of transmembrane proteins that includes γ-subunits of voltage-gated calcium channels. Eleven additional members of this superfamily were identified in yeast, but none was required for HACS activity in response to the stimuli. Remarkably, many dozens of genes involved in vesicle-mediated trafficking and protein secretion were required to prevent spontaneous activation of HACS. Taken together, the findings suggest that HACS and calcineurin monitor performance of the membrane trafficking system in yeasts and coordinate compensatory processes. Conservation of this quality control system in Candida glabrata suggests that many pathogenic species of fungi may utilize HACS and calcineurin to resist azoles and other compounds that target membrane biosynthesis.

We have previously observed that stepwise replacement of amino acid residues in the nascent base-pair binding pocket of RB69 DNA polymerase (RB69pol) with Ala or Gly expanded the space in this pocket, resulting in a progressive increase in misincorporation. However, in vivo results with similar RB69pol nascent base-pair binding pocket mutants showed that mutation rates, as determined by the T4 phage rI forward assay and rII reversion assay, were significantly lower for the RB69pol S565G/Y567A double mutant than for the Y567A single mutant, the opposite of what we would have predicted. To investigate the reasons for this unexpected result, we have determined the pre-steady-state kinetic parameters and crystal structures of relevant ternary complexes. We found that the S565G/Y567A mutant generally had greater base selectivity than the Y567A mutant and that the kinetic parameters for dNMP insertion, excision of the 3'-terminal nucleotide residue, and primer extension beyond a mispair differed not only between these two mutants but also between the two highly mutable sequences in the T4 rI complementary strand. Comparison of the crystal structures of these two mutants with correct and incorrect incoming dNTPs provides insight into the unexpected increase in the fidelity of the S565G/Y567A double mutant. Taken together, the kinetic and structural results provide a basis for integrating and interpreting in vivo and in vitro observations.

Infectious diseases following natural disasters tend to occur as a result of the prolonged secondary effects of the disaster, mostly when there is an interruption of public health measures resulting from destruction of the local infrastructure. This article will review the infectious risks that occur as a result of natural disasters, with a focus on the mechanism of disease spread, infectious diseases after specific disasters, and various evidence-based interventions.(Disaster Med Public Health Preparedness. 2010;4:232-238)

We studied how habitat selection influences the distribution and densities of a stenotypic yellowcheek darter Etheostoma moorei (Raney and Suttkus) and eurytypic rainbow darter E. caeruleum (Storer) in a headwater stream subjected to periodic drying. We spatially sampled in habitats within riffle substrates and at four sites four to six times per year in the Middle Fork of the Little Red River. Yellowcheek darters were associated with cobble and gravel more than rainbow darters. Rainbow darters moved along the substrate surface and positioned themselves further downstream in riffles, whereas yellowcheek darters occurred further upstream in or near crevices between gravel and cobble. Neither species was found in the hyporheic zone during riffle drying. The rainbow darters used pools during riffle drying but not yellowcheek darters, which could explain recolonization of previously dry upstream sites by rainbow darters but not yellowcheek darters. Rainbow darters were at their greatest densities in upstream riffles where yellowcheek darters had not recolonized, suggesting niche partitioning. These temporal differences in microhabitat selection appear to enable the coexistence of these two sympatric and ecologically similar darters.

Family engagement in home visiting (HV) is challenging. This study related attachment security of home visitors (n=48) and mothers (n=328) to family engagement in an HV program to prevent child maltreatment. Attachment security was assessed by using the Attachment Style Questionnaire to measure attachment anxiety and attachment avoidance. Family engagement was defined as receipt of a high dose of visits and home visitor response to intimate partner violence (IPV) and poor maternal mental health as measured via record review and by maternal report of trust in the home visitor. Home visitors had lower attachment anxiety and avoidance than mothers. Families were likely to receive a high dose of services if either the mother or home visitor was high on attachment anxiety. Home visitors high on attachment anxiety were less likely to respond to IPV and poor maternal mental health; home visitors high on attachment avoidance were more likely to respond to these issues. Mothers with high attachment anxiety were less trusting of highly anxious home visitors and more trusting of avoidant home visitors. HV programs should consider the influence of both home visitor and maternal attachment style on family engagement. © 2010 Wiley Periodicals, Inc.

Faced with increased demands for critical care services as a result of the novel H1N1 pandemic, hospitals must prepare a surge response in an attempt to manage these needs. In preparing for a surge response, factors to consider are staff, stuff (supplies and equipment), space, and systems necessary to respond to the event. This article uses this general framework to discuss surge issues in the context of H1N1 challenges that we are facing currently and to provide specific advice for hospitals. Particular attention is given to how hospitals can estimate the potential impact of H1N1 and pharmaceutical stockpiling.

Purpose To provide recommendations and standard operating procedures for intensive care unit (ICU) and hospital preparations for an influenza pandemic or mass disaster with a specific focus on critical care triage.

The Pleurobemini (Bivalvia: Unionida) represent approximately one-third of freshwater mussel diversity in North America. Species identification within this group is challenging due to morphological convergence and phenotypic plasticity. Accurate species identification, including characterisation of currently unrecognised taxa, is required to develop effective conservation strategies because many species in the group are imperiled. We examined 575 cox1 sequences from 110 currently recognised species (including 13 Fusconaia and 21 Pleurobema species) to understand phylogenetic relationships among pleurobemine species (mainly Fusconaia and Pleurobema) and to delineate species boundaries. The results of phylogenetic analyses showed no geographic structure within widespread species and illustrated a close relationship between Elliptio lanceolata and Parvaspina collina. Constraint tests supported monophyly of the genera Fusconaia and Pleurobema, including the subgenus P. (Sintoxia). Furthermore, results revealed multiple conspecifics, including P. hanleyianum and P. troschelianum, P. chattanoogaense and P. decisum, P. clava and P. oviforme, P. rubrum and P. sintoxia, F. askewi and F. lananensis, and F. cerina and F. flava. Species delimitation analyses identified three currently unrecognised taxa (two in Fusconaia and one in Pleurobema). Further investigation using additional genetic markers and other lines of evidence (e.g. morphology, life history, ecology) are necessary before any taxonomic changes are formalised.

The catalytic mechanism of DNA polymerases involves multiple steps that precede and follow the transfer of a nucleotide to the 3′-hydroxyl of the growing DNA chain. Here we report a single-molecule approach to monitor the movement of E. coli DNA polymerase I (Klenow fragment) on a DNA template during DNA synthesis with single base-pair resolution. As each nucleotide is incorporated, the single-molecule Förster resonance energy transfer intensity drops in discrete steps to values consistent with single-nucleotide incorporations. Purines and pyrimidines are incorporated with comparable rates. A mismatched primer/template junction exhibits dynamics consistent with the primer moving into the exonuclease domain, which was used to determine the fraction of primer-termini bound to the exonuclease and polymerase sites. Most interestingly, we observe a structural change after the incorporation of a correctly paired nucleotide, consistent with transient movement of the polymerase past the preinsertion site or a conformational change in the polymerase. This may represent a previously unobserved step in the mechanism of DNA synthesis that could be part of the proofreading process.

We report the longitudinal distribution and population characteristics of Micropterus dolomieu (Smallmouth Bass), M. salmoides (Largemouth Bass), and M. punctulatus (Spotted Bass) of the lower Eleven Point River of Arkansas. Smallmouth Bass were the most abundant species collected, followed by Largemouth Bass and Spotted Bass. Abundance of Smallmouth Bass was greatest upstream and declined significantly downstream; abundance of Spotted Bass was significantly greater downstream. Largemouth Bass were evenly distributed throughout the river. Associated with these species distribution trends were a downstream decline in stream slope and velocity, and an increase in the proportion of pools relative to riffles and runs. Proportional stock structures were similar and relatively low for each species (range = 22.9–32.3). Growth rates of Smallmouth Bass and Spotted Bass were high relative to other study populations, with age-3 fish reaching ≈300 mm total length. Diets of adult Smallmouth Bass and Spotted B...

Flow methods of analysis represent one of the most studied and practiced areas of analytical chemistry. Two major international conferences are regularly held devoted to these methods. The International Conference on Flow Analysis (FA) began in 1979, and the International Conference on Flow Injection Analysis (ICFIA) began in 1989, originally as the Winter Conference on Flow Injection Analysis (WCFIA). ICFIA has been held jointly with the Japanese Association for Flow Injection Analysis (JAFIA) since 1998. A historical account is given of these two conferences, with references to proceedings and reports of the conferences.

Background: Few published data exist with respect to current implementation of interventions that increase patient safety in intensive care units (ICUs) Furthermore, even less published data exist that address implementation of outcome-related methodologies of patient safety interventions in ICUs. Objective: The purpose of this study was threefold: (1) to increase implementation rates of known, evidence-based interventions in the Dartmouth Hitchcock Medical Center (DHMC) ICU that have been demonstrated to reduce morbidity and mortality in critically ill patients; (2) to develop a durable and reproducible intervention model that can be applied not only to various aspects of ICU medicine but to any healthcare microsystem that is process oriented; and (3) to design an “ICU-specific” value compass. Design: Using a before/after study design, the interventions involved: (1) establishing a systematic approach to integrate the delivery of proven ICU safety measures; (2) using the design of the various tools to develop a method for team communication and team building; (3) incorporating prompts into a ICU progress note for the healthcare team to address three evidence-based measures on a daily basis; and (4) using a data wall to demonstrate progress and to provide “real-time” feedback for error correction. Setting and participants: In the before and after study, two groups of 40 consecutive patients admitted to DHMC’s Intensive Care Unit were evaluated. The first group of patients was admitted between April and May of 2003. The second group of 40 patients was admitted between May and June of 2004. To ensure process stability, control data were also collected on patients at an interval time point between these two groups. Main outcome measures: Three evidence-based interventions were identified that reduce the likelihood of adverse events resulting simply from an ICU stay: (1) prophylaxis against venous thrombo-embolic disease (venous thromboembolism or deep vein thrombosis); (2) prophylaxis against ventilator-associated pneumonia (VAP); and (3) prophylaxis against stress-ulcers (SU). Two data points were obtained per patient per day corresponding to the work shift schedule in the ICU. The unit of measure was patient-shift observation. A limited data set was collected before implementing the change package to ensure system stability. Results: Both traditional statistical analysis and statistical process control (SPC) were used to evaluate the results. For each metric, it was possible to demonstrate an increase in the measure of the mean, reduced point-to-point variation as well as a substantial narrowing of the control limits indicating improved process control. Limitations: By virtue of the involvement of the researcher in the data collection for the control group, the potential existed for methodological bias by acting on the information collected. There was also the lack of a cohesive data structure from which to collect information (ie, the hospital computer speaks one language, the ventilator a second and the monitoring systems a third). Conclusions: A model for changing the ICU microsystem at DHMC was created that enabled successful implementation of evidence-based measures by maximising the natural flow of work and fostering a team-based culture to improve patient safety. Unique to this method and unlike currently available methods that define only the delivery of the appropriate intervention as success, system success was defined in terms of both true positives, namely delivering care when it is indicated, as well as true negatives, not delivering care when there is none indicated, to offer a more comprehensive system review. Additionally, the method of data collection allowed simplified defect analysis, thereby eliminating a resource-consuming audit of data after the fact. This approach, therefore, provides a basis for adapting and redesigning the PDSA cycle so as to specifically apply this type of “disciplinary” work.