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Teamwork quality has been shown to influence patient safety, and simulation-based team-training (SBTT) is an effective means to increase this quality. However, long-term effects are rarely studied. This study aims to investigate the long-term effects of interprofessional SBTT in emergency medicine in terms of global confidence, self-efficacy in interprofessional communication and in emergency medicine situations. Newly graduated doctors, nurses, auxiliary nurses, and medical and nursing students participated. Four emergency medicine scenarios focused on teamwork according to the A-B-C-D-E-strategy. All participants increased their global confidence from 5.3 (CI 4.9-5.8) before to 6.8 (CI 6.4-7.2; p .0001) after SBTT. Confidence in interprofessional communication increased from 5.3 (CI 4.9-5.8) to 7.0 (CI 6.6-7.4; p .0001). Students had the greatest gain. The self-efficacy following the A-B-C-D-E strategy increased from 4.9 (CI 4.4-5.3) to 6.6 (CI 6.2-7.0). Again, students had the steepest increase. Newly graduated doctors achieved a superior increase in global confidence as compared to nurses and auxiliary nurses (p .0001). Their propensity to recommend SBTT to colleagues was 9.9 (CI 9.8-10.0). The positive effects were sustained over a six-month period, indicating that interprofessional SBTT had a positive impact on competence development, and a potential to contribute to increased team quality in emergency medicine care.

This paper outlines a qualitative investigation where wolf-focussed education was examined from the perspective of educators who work at programmes/centres around North America. Using a phenomenolo...

With the increasing acknowledgement of the benefits of early childhood education, there is a need to ask critical questions about whether ample leadership exists for guiding ambitious systemic chan...

This case was written to help prepare central office leaders who are expected to design systems and lead toward instructional improvement in the context of both educational accountability and implementation of standards with increased rigor. The intent of this case study is to encourage educators to examine the complex and multiple challenges of policy design and implementation when policy goals are far from current practice. Educators studying this case should examine the costs and benefits of bridging and buffering across organizational levels and how to best craft coherence between goals, needs, and resources at the central office and school levels.

Objective: Diabetic foot ulcer (DFU) infections are a growing public health problem, with increasing prevalence, poor response to antibiotics and bacterial resistance to traditional antimicrobials leading to increased morbidity and mortality. Bacteriophages (phages), the viruses that target specific bacteria, are one option for addressing bacterial infections, especially where antibiotics fail. Of particular value is a class of virulent staphylococcal phages that hit almost all Staphylococcus aureus, including most methicillin-resistant Staphylococcus aureus (MRSA) strains. Here we report a continuous case series assessing the effectiveness of treating infected and poorly vascularised toe ulcers with exposed bone, after failure of recommended antibiotic therapy, using topically applied Staphylococcus aureus-specific phage. Method: This was a compassionate-use case series of nine patients with diabetes and poorly perfused toe ulcers containing culture-proven Staphylococcus aureus infected bone and soft tissue, who had responded poorly to recommended antibiotic therapy. Six representative cases are presented here. The only generally accepted other option in each case was toe amputation. Exposed portions of the infected phalanges were removed in three cases and left in place in two cases. One case presented as a micro-clot induced gangrene following vascular stenting. In this case, phage were used to prevent infection. The phage used was a commercially available fully sequenced preparation of staphylococcal phage Sb-1. Phage solution was applied topically to the ulcerations once weekly, following standard good wound care. The amount of phage solution applied varied from 0.1 to 0.5 cc depending on volume and area of the ulceration. Results: All infections responded to the phage applications and the ulcers healed in an average of seven weeks with infected bone debridement. One ulcer, where vascularity was extremely poor and bone was not removed to preserve hallux function, required 18 weeks of treatment. In the case of the toe with the micro-clot gangrene, the toe was salvaged and healed in seven weeks without complications. Conclusion: Topical application of a staph mono-phage preparation can be used successfully to treat infected toe ulcerations with bone involvement, despite very poor vascularity and failure of antibiotic treatment. The success within this small series provides the groundwork for controlled clinical trials of staph phage for diabetic foot infections. Declaration of interest: The authors have no conflict of interest.

Infections involving diabetic foot ulcers (DFU) are a major public health problem and have a substantial negative impact on patient outcomes. Osteomyelitis in an ulcerated foot substantially increases the difficulty of successful treatment. While literature suggests that osteomyelitis in selected patients can sometimes be treated conservatively, with no, or minimal removal of bone, we do not yet have clear treatment guidelines and the standard treatment failure fallback remains amputation. The authors report on the successful treatment, with a long term follow up, of a 63 YO diabetic female with distal phalangeal osteomyelitis using bacteriophage, a form of treatment offering the potential for improved outcomes in this era of escalating antibiotic resistance and the increasingly recognized harms associated with antibiotic therapy.

This chapter is based on the assumption that neglecting individual differences in psychological research impedes progress in psychological research. The existence of individual differences is a necessary condition for uncovering general rules of behavior. After describing the close connection between processes of motivation and self-regulation, the chapter will decompose popular global constructs of self-regulation into their functional components. This functional analysis of self-regulatory competences provides an explanation of the processes affecting the interaction between motivation and self-regulation. Additionally, individual differences regarding the regulation of positive and negative affect (e.g., action vs. state orientation) are of particular importance because the mental systems required for enacting intentions (action control) and learning from mistakes (personal growth) are activated by affect regulation.

We here present detailed descriptions of successful treatment of a series of diabetic toe ulcers using the Eliava BioPreparations' commercial preparation of the very well-studied anti-staphylococcal bacteriophage Sb-1. This chapter outlines what we feel is an appropriate mechanism to speed movement toward full-scale clinical trials with bacteriophage use to treat wound infections and to help address the crisis in antibiotic resistance.

Phages as bactericidal agents have been employed for 90 years as a means of treating bacterial infections in humans as well as other species, a process known as phage therapy. In this review we explore both the early historical and more modern use of phages to treat human infections. We discuss in particular the little-reviewed French early work, along with the Polish, US, Georgian and Russian historical experiences. We also cover other, more modern examples of phage therapy of humans as differentiated in terms of disease. In addition, we provide discussions of phage safety, other aspects of phage therapy pharmacology, and the idea of phage use as probiotics.

In this qualitative study, the elements and quality of musher-sled dog relationships were investigated. In-depth interviews with a narrative design were conducted with eight mushers from northern Minnesota and northwestern Ontario. The mushers were asked to contribute ideas by sharing stories and experiences of working with dogs, as well as art or photographs. While all the participants had their own ideas about musher-sled dog relationships, six themes emerged. The mushers stated the importance of getting to know the dogs, their respect for their sled dogs’ abilities, the idea of a two-way communication that takes place, the importance of trust, the notion of partnership, and what can be learned through working with sled dogs. This study supports other research suggesting that humans and animals engage in interspecies relationships and that these can be quality relationships with multiple elements. The importance of researching and teaching about dogs as subjects is discussed, as well as the significance of humans having direct experience with other animals.

The allergy history and physical examination remain the basis for diagnosis and treatment. Allergy testing tends to give a number of false positives and negatives, so a detailed history followed by history-driven testing cannot be omitted. Costs will be minimized, and patient satisfaction will be maximized.

Hintergrund Die Erfolge in der Behandlung der Psoriasis vulgaris sind nicht nur abhangig von der Wahl der Behandlungsmethode, sondern auch von psychosozialen Merkmalen der Patienten.

Exposure to environmental chemicals often induces changes in gene expression leading to a variety of developmental and physiological problems. Understanding the underlying mechanism of these changes will aid in assessing human risk to these chemicals. Traditional methods for analyzing protein-DNA interactions include in vivo footprinting and chromatin immunoprecipitation (ChIP). However, ChIP does not provide binding location, and conventional footprinting is too subjective and time consuming for comparing protein binding in toxicological studies. Here, in vivo DNase I footprinting is adapted for use with the automated DNA sequencer to provide a semiquantitative map of changes in DNA-protein interactions in the promoter of steroidogenic acute regulatory (StAR) protein. StAR is the rate-limiting step in testosterone biosynthesis and is downregulated following in utero di-butyl phthalate (DBP) treatment in rats through an unknown mechanism. In vivo footprinting identified three regions of altered DNase digestibility following DBP treatment, and EMSA identified the corresponding transcription factors as SF-1, c/ebp beta, and GATA4. ChIP assays confirmed changes in protein-binding activity of SF-1 and c/ebp beta, but only c/ebp beta gesponds to only DBP. This suggests that c/ebp beta ginding is involved in DBP-induced transcriptional changes. By tailoring in vivo footprinting for toxicological studies, it can provide a detailed and accurate map of protein-DNA interactions and is an excellent first step in determining the changes in the structure of transcriptional machinery following an exogenous chemical treatment.

Time-resolved measurements of GaN with different donors (oxygen or silicon) and acceptors (zinc or magnesium) showed pronounced bound exciton lines and their phonon replicas. The analysis included three phonon modes characteristic for the wurtzite (hexagonal) phase: A1(LO), E1(TO) and E2H. It was shown that relative amplitudes of replicas depended upon the chemical nature of the defects that the bind excitons. The replicas were stronger for acceptor- than for donor–related features. Huang-Rhys factors S = 0.06 ± 0.02 and S = 0.025 ± 0.01, were found for the A0X and the D0X LO replicas, respectively. A significant difference in phonon coupling to silicon and oxygen donor bound excitons has been observed. (© 2006 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim)

Significant influence of Mn centers on the radiative and nonradiative recombinations in Czochralski-grown InP:Mn crystals was observed. Time-resolved measurements showed that manganese recombination centers caused very fast, probably subpicosecond, decay of holes and excitons. This recombination was explained by the capture of holes on an excited state of the Mn acceptor. The holes trapping coefficient RMn determined on the order of 10−5 cm3/s provided an estimation of the Mn cross-section for hole capture σp of the order of 10−12 cm2. Electrical transport measurements showed that hopping conductivity dominated at low temperatures. From analysis of the hopping, the wavefunction radius of Mn-bound hole a f = 0.74 ± 0.1 nm was calculated. A model explaining the values of af is presented.

We report on a metal-polymer compound material with optical properties that can be reversibly switched all-optically. The key element is a metallic photonic crystal slab with an additional layer of photoaddressable material that provides a large variable birefringence and sharp resonances. Pump-probe experiments show a shift of the photonic crystal resonances that depends on the pump polarization and on the exposure. Comparison of the results with calculations from a scattering-matrix theory allows one to determine the refractive index changes for different polarization geometries and to model our compound material quantitatively.

Der Landschaftsverband Westfalen-Lippe hat den Autorinnen und Autoren ein spannendes Projekt aufgetragen, das in vielen Bereichen der psychiatrischen Pflege übernommen und modifiziert übertragen werden kann, lassen Sie sich von diesem Artikel anregen!

In female fish estrogen is required for the development of primary and secondary sex characteristics and is derived from the aromatization of androgens by aromatase. There are two isoforms of aromatase in several teleost species, brain and ovarian. The objective of this study was two-fold: clone and sequence the coding and promoter region of brain aromatase in medaka, and determine the effects of exposure to an environmental estrogen ( o , p -DDT) on sex determination and brain aromatase transcription and activity. The brain aromatase coding sequence was obtained by reverse transcription polymerase chain reaction (RT-PCR) and PCR-based genomic DNA walking was used to clone the promoter of the brain aromatase gene. The promoter sequence revealed potential binding sites for the estrogen receptor and for transcription factors involved in primary neurogenesis and sex determination. Medaka fry were exposed to increasing o , p -DDT concentrations (0–5.5 μg/L) from days 1 to 15 after hatch and brain aromatase expression and activity were measured on days 5, 9, and 14. A complete male-to-female sex reversal occurred at 5.5 μg/L o , p -DDT and aromatase activity and expression data showed a significant five-fold increase at this concentration at day 14. This information suggests that brain aromatase is involved in the abnormal sexual differentiation of fish treated with xenoestrogens.

We report on efficient THz pulse generation via optical rectification with femtosecond laser pulses focused to a line by a cylindrical lens. This configuration provides phase-matched conditions in the superluminal regime. 35 pJ THz pulses have been generated with this technique in a stoichiometric LiNbO3 crystal pumped by 2 μJ femtosecond laser pulses at room temperature. An unusual superquadratic rise of the THz pulse energy with the laser pulse energy has been observed at high laser energies. This extraordinary energy dependence of the THz generation efficiency is explained by self-focusing of the laser beam in the crystal. Z-scan measurements and comparison of the THz pulse spectra created with laser pulses having different energies confirm this interpretation.

Time-resolved photoluminescence measurements of high-quality GaN show that the spectra of two-electron satellites (TES) in GaN include also lines coming from excited states of a donor-bound exciton (D 0 X) complex. The lines connected with recombination from the ground and excited states have generally similarly long lifetimes (1.1–1.4 ns, in the case of an exciton bound to oxygen donor). However, analysis of initial dynamics (between 0 and 0.5 ns) shows some transfer of energy between the lines. In fact, the ground-state-related line reaches its maximum 0.1 ns after the excited-state–related line. A rate-equation model taking into account internal transitions in the D 0 X complex gives a characteristic internal time constant of about 0.2 ns.

The optical properties of a photonic crystal slab made of periodic arrays of gold nanowires on top of different dielectric substrates, supporting and not supporting the guided modes are discussed. While only Rayleigh-type anomalies are observed for thin dielectric substrates, thicker waveguiding substrates demonstrate strong coupling phenomena. It is shown that the interaction between the quasiguided modes in the photonic crystal slab and the localised plasmons in metal nanostructures results in the formation of a strongly coupled waveguide-plasmon polariton. The formation of the new quasiparticle manifests itself in the strong anticrossing between quasiguided modes and plasmon resonances in the measured as well as calculated optical spectra. The effect opens new possibilities for photonic band gap engineering in metallic-dielectric photonic crystals. (© 2005 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim)

We report on dynamics of excitons in CdxZn1−xTe/ZnTe quantum dots (QDs) and present information of excitonic transport and recombination. Due to different growth methods, samples with different QD's densities were obtained. Time-resolved measurements reveal three decay mechanisms: (i) radiative recombination of excitons in the individual QDs; (ii) thermally activated escape of excitons and (iii) escape due to tunneling (hopping). In the high QD-density samples the hopping (rHB=2700 ns−1) is two orders of magnitude more efficient than in the low QD-density samples (rHB=33 ns−1). Radiative recombination rates are similar in both types of samples, rR=1–1.3 ns−1. Due to the good radiative to nonradiative recombination ratio, the low-density QDs can be a potential source of entangled photon pairs.

We present optical properties of GaN/AlGaN structures containing quantum dots, which were obtained in a low-pressure MOVPE reactor on a SiH4-treated surface. Photoluminescence (PL) shows two bright PL bands (P1, P2) and one weak PL band (P3) at energies of 3.48 eV, 3.44 eV and 3.35 eV, respectively. Time-resolved PL shows that the P1, P2 and P3 bands have lifetimes of about 0.05 ns, 0.4 ns and 1.3 ns, respectively. Micro-photoluminescence measurements reveal that these bands consist in fact of many sharp lines coming from small spots on the sample. Such behaviour is characteristic for quantum dots or islands. The P2 shows significant spectral shift with time. As confirmed by power dependent measurements, the spectral shift is due to excitation of high-energy quantum dots followed by diffusion of excitons between QDs to lower energies. Excitation distribution parameters found at low temperature allow explaining of the behaviour of the PL at higher temperatures. (© 2005 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim)

Optical rectification of ultrashort near-IR laser pulses with tilted pulse fronts and pulse energies of a few μJ in Mg-doped stoichiometric LiNbO3 cooled to low temperature is a powerful technique for efficient generation of THz pulses. The pulse energy critically depends on the Mg doping (necessary for preventing photorefractive damage) and can be easily increased by a factor of three if the MgO content is reduced. Pulse energies up to 400 pJ at repetition rates of 200 kHz and 3.4% quantum conversion efficiency are achieved at 77 K. At 10 K, changing the tilt angle of the pump pulse front results in continuous tuning of the frequency across the 1.0–4.4 THz range. The temporal pulse shapes measured by electro-optic sampling are in good agreement with the signal calculated by a simple theory. This model predicts tunability on a considerably broader range and narrower spectra even at room temperature if GaSe is used instead of LiNbO3. The advantages of the velocity matching technique utilizing tilted pulse fronts are analyzed in comparison with quasi-phase-matching in periodically poled LiNbO3 crystals. The first method provides a ten times higher pulse energy conversion efficiency.

A theoretical formulation that treats the correlated space–time–frequency characteristics of pump–probe transmission spectra in optically transparent media is presented. The influence of a spatial aperture on time–frequency-resolved pump–probe signals with a finite beam size and crossing angle is demonstrated for some typical optical crystals. The breakdown of the conventional plane-wave and collinear configuration approximations that neglect spatial dispersion of laser fields is highlighted via both theory and experiment. It is shown that the spatial correlation in the time–frequency-resolved pump–probe polarization is a basic feature of nonlinear optical spectroscopy of optically thick materials, as the light pulses are practically of finite spatial overlap with a crossing geometry. The possibility of utilizing appropriately arranged spatial apertures to measure the properties of nonlinear materials such as the nonlinear refractive index and the two-photon absorption cross section are addressed.

The nonlinear propagation of subpicosecond pulses resonant to the hh 1s exciton in Bragg-periodic multiple quantum wells is investigated experimentally and theoretically. We show coherent pulse breakup and its suppression for increasing pulse intensity in good agreement with calculations based on the semiconductor Maxwell-Bloch equations. For highly nonlinear excitation, pulse compression is observed which is strongly enhanced by the additional contribution of self-phase modulation in the barrier and substrate material.

We study the transmission properties of metallic nanowire arrays on dielectric waveguide substrates. The optical response of these metallic photonic crystal slabs is strongly affected by the coupling between their photonic (waveguide mode) and electronic (localized particle plasmon) resonances. A large Rabi splitting of 240 meV is found in transmission measurements when waveguide mode and particle plasmon are tuned to resonance. Our experimental results agree well with scattering matrix calculations.

We study the dephasing of polaritons excited in metallic photonic crystal slabs where surface plasmons of metallic nanoparticles are coupled with waveguide modes in the substrate. The dephasing times measured by nonlinear interferometric autocorrelation techniques employing sub-15 fs laser pulses can be increased by more than a factor of two as compared to the pure particle plasmon coherence time if the two resonances are strongly coupled. Such coupling leads to strong modifications of the second harmonic spectrum.

There are three exciton branches in wurzite-GaN: A, B and C. Here, time-resolved photoluminescence and magneto-optic spectroscopy of the B-exciton are presented, both free (FX B ) and bound to donor (D 0 X B ) in homoepitaxial GaN. The free B-exciton has an energy of about 3.483 eV and a very short lifetime of about 20 ps. The B-exciton bound to donor (D 0 X B ) has an energy of 3.475 eV and a lifetime longer than the free excitons but shorter than the lifetime of the A-exciton bound to donor. It is shown that a simple model based on an invariant expression describes properly the behavior of D 0 X A and D 0 X B in a magnetic field. Results of resonance excitation experiments suggest that in many cases the process of binding a free exciton to a donor conserves the exciton type and that the relaxation of B- to A-exciton takes place later. Moreover, thermal excitation of D 0 X A to D 0 X B has been observed.

We present results of temperature-dependent, time-resolved photoluminescence (PL) measurements on a set of Ga 1− x In x N ( x ≅0.08) layers grown at the same conditions on three different substrates: bulk (high pressure grown) GaN, SiC and Al 2 O 3 . At 9 K, the maximum of the PL occurs at about 3.1 eV. The linewidths are 48, 80 and 90 meV for the layers grown on GaN, Al 2 O 3 and SiC, respectively. The smallest width suggests the highest homogeneity of the GaInN/GaN. The PL lifetimes (about 0.8 ns) and intensities are similar in all three samples. The spectral diffusion of the PL (shift of the PL peak energy with time) is thermally activated. The highest shift (Δ E =90 meV) and an activation energy E a =80 meV are observed in the GaInN/SiC sample, the lowest (Δ E E (interpreted as a conduction and valence band fluctuation amplitude) found in the layer grown on GaN is due to the low dislocation concentration resulting from the good lattice matching.

We use an optical method based on sub-picosecond pulses moving in a nonlinear medium to generate relativistic dipoles that emit Cherenkov phonon–polariton radiation. Experiments on ZnTe and ZnSe reveal emission at subluminal speeds involving frequencies below those of the corresponding infrared-active phonon. The generation of Cherenkov radiation and impulsive stimulated Raman scattering by polaritons are the same physical phenomenon.

We present time-resolved photoluminescence investigations of field-effect structures containing quantum dots (QDs). The high electrical field in those devices significantly influences carrier dynamics. Photoluminescence (PL) from the ground state occurs at an energy of 1.35 eV, but after strong excitation the PL band can reach up to 1.5 eV due to stale filling. After strong excitation, a few hundred picoseconds of slow PL decay are observed. Then the emission from the QDs performs a step-like quenching. The remaining luminescence has a long lifetime (about 1 ns) and its maximum occurs at about 1.35 eV. Numerical calculations suggest that the step-like PL quenching is caused by a decay of screening of the electrical field in the region with QDs.

We present extinction measurements on rectangular two-dimensional arrays of gold nanoparticles on a dielectric waveguide. The spectra exhibit spectrally narrow bands of suppressed extinction within the particle–plasmon resonance, resulting from destructive interference between the incident light field and the excited waveguide modes. The dependence of the spectral position of these high-transmission bands on different waveguide modes is investigated in detail.

Charged particles traveling through matter at speeds larger than the phase velocity of light in the medium emit Cherenkov radiation. Calculations reveal that a given angle of the radiation conical wavefront is associated with two velocities, one above and one below a certain speed threshold. Emission at subluminal but not superluminal speeds is predicted and verified experimentally for relativistic dipoles generated with an optical method based on subpicosecond pulses moving in a nonlinear medium. The dipolar Cherenkov field, in the range of infrared-active phonons, is identical to that of phonon polaritons produced by impulsive laser excitation.

Impulsive simulated Raman scattering with fs optical pulses is applied to investigate the frequency dependence of phonon-polariton lifetimes in GaP. Three different frequency dependent decay channels are determined for polariton modes in the frequency range 335-364 cm -1 which can be attributed to anharmonic decay of the polariton into acoustic phonons (LA+TA) at the x and K points of the Brillouin zone. Besides one-phonon (TO and LO) excitations, we observe also two-phonon (2TA) contributions to the signal.

Time- and spectrally resolved reflectivity measurements on multiple-quantum-well structures excited by ultrashort laser pulses are presented. In Bragg structures, where the interwell distance amounts to half the optical wavelength at the exciton resonance, superradiant coupling of the polarization dynamics within different quantum wells leads to an enhancement of the reflectivity strength and linewidth. We show that the superradiance is not limited to the heavy-hole exciton but can be observed even on excited and light-hole exciton states as well as on correlated electron-hole pair states. These coupling effects grow with the number of quantum wells. For our samples containing 60 and 30 quantum wells, pronounced superradiant enhanced reflectivity is present even at high excitation intensities and high temperatures, showing the insensitivity of radiative coupling with respect to incoherent scattering processes. Our findings are in good agreement with solutions of the semiconductor Maxwell-Bloch equations.