Striking fear into students' hearts: Unforeseen consequences of prescribing education.

Purpose: Undergraduate medical education (UGME) has to prepare students to do safety-critical work (notably, to prescribe) immediately after qualifying. Despite hospitals depending on them, medical graduates consistently report feeling unprepared to prescribe and they sometimes harm patients. Research clarifying how to prepare students better could improve healthcare safety.

Readiness to prescribe: Using educational design to untie the Gordian Knot.

Introduction: Junior residents routinely prescribe medications for hospitalised patients with only arms-length supervision, which compromises patient safety. A cardinal example is insulin prescribing, which is commonplace, routinely delegated to very junior doctors, difficult, potentially very dangerous, and getting no better. Our aim was to operationalise the concept of 'readiness to prescribe' by validating an instrument to quality-improve residents' workplace prescribing education.

Learning to prescribe intravenous fluids: A scoping review.

Introduction: Prescribing intravenous (IV) fluid therapy is a core skill expected of qualified doctors at the point of graduation, but medical graduates often feel ill-equipped to perform this task. This lack of preparedness contributes to treatment-related patient harm. This scoping review maps the current state of published evidence about how junior doctors prescribe IV fluid therapy and learn how to do it.

Non-invasive, multi-modal sensing of skin stretch and bioimpedance for detecting infiltration during intravenous therapy.

Intravenous infiltration is a condition wherein an infused solution leaks inadvertently into soft tissue surrounding a hypodermic needle site. This occurrence affects approximately 6.5% of patients in hospitals worldwide, and can lead to severe tissue damage if not treated immediately.

Core conditions for alpha heating attained in direct-drive inertial confinement fusion.

It is shown that direct-drive implosions on the OMEGA laser have achieved core conditions that would lead to significant alpha heating at incident energies available on the National Ignition Facility (NIF) scale. The extrapolation of the experimental results from OMEGA to NIF energy assumes only that the implosion hydrodynamic efficiency is unchanged at higher energies. This approach is independent of the uncertainties in the physical mechanism that degrade implosions on OMEGA, and relies solely on a volumetric scaling of the experimentally observed core conditions.

Publisher's Note: Demonstration of Fuel Hot-Spot Pressure in Excess of 50 Gbar for Direct-Drive, Layered Deuterium-Tritium Implosions on OMEGA [Phys. Rev. Lett. 117, 025001 (2016)].

This corrects the article DOI: 10.1103/PhysRevLett.117.

Demonstration of Fuel Hot-Spot Pressure in Excess of 50 Gbar for Direct-Drive, Layered Deuterium-Tritium Implosions on OMEGA.

A record fuel hot-spot pressure P_{hs}=56±7  Gbar was inferred from x-ray and nuclear diagnostics for direct-drive inertial confinement fusion cryogenic, layered deuterium-tritium implosions on the 60-beam, 30-kJ, 351-nm OMEGA Laser System. When hydrodynamically scaled to the energy of the National Ignition Facility, these implosions achieved a Lawson parameter ∼60% of the value required for ignition [A. Bose et al.

First-principles equation of state of polystyrene and its effect on inertial confinement fusion implosions.

Obtaining an accurate equation of state (EOS) of polystyrene (CH) is crucial to reliably design inertial confinement fusion (ICF) capsules using CH/CH-based ablators. With first-principles calculations, we have investigated the extended EOS of CH over a wide range of plasma conditions (ρ=0.1to100g/cm(3) and T=1000 to 4,000,000 K).

Hydrogel Antimicrobial Capture Coatings for Endotracheal Tubes: A Pharmaceutical Strategy Designed to Prevent Ventilator-Associated Pneumonia.

This paper presents a novel strategy for the prevention of ventilator-associated pneumonia that involves coating poly(vinyl chloride, PVC) endotracheal tubes (ET) with hydrogels that may be subsequently used to entrap nebulized antimicrobial solutions. Candidate hydrogels were prepared containing a range of ratios of hydroxyethyl methacrylate (HEMA) and methacrylic acid (MAA) from 100:0 to 70:30 using free radical polymerization and, when required, simultaneous attachment to PVC was performed. The mechanical properties, glass transition temperatures, swelling kinetics, uptake of gentamicin from an aqueous medium, and gentamicin release were characterized.

First-principles opacity table of warm dense deuterium for inertial-confinement-fusion applications.

Accurate knowledge of the optical properties of a warm dense deuterium-tritium (DT) mixture is important for reliable design of inertial confinement fusion (ICF) implosions using radiation-hydrodynamics simulations. The opacity of a warm dense DT shell essentially determines how much radiation from hot coronal plasmas can be deposited in the DT fuel of an imploding capsule. Even for the simplest species of hydrogen, the accurate calculation of their opacities remains a challenge in the warm-dense matter regime because strong-coupling and quantum effects play an important role in such plasmas.

Hot-spot mix in ignition-scale inertial confinement fusion targets.

Mixing of plastic ablator material, doped with Cu and Ge dopants, deep into the hot spot of ignition-scale inertial confinement fusion implosions by hydrodynamic instabilities is diagnosed with x-ray spectroscopy on the National Ignition Facility. The amount of hot-spot mix mass is determined from the absolute brightness of the emergent Cu and Ge K-shell emission. The Cu and Ge dopants placed at different radial locations in the plastic ablator show the ablation-front hydrodynamic instability is primarily responsible for hot-spot mix.

Laser-beam zooming to mitigate crossed-beam energy losses in direct-drive implosions.

Spherically symmetric direct-drive-ignition designs driven by laser beams with a focal-spot size nearly equal to the target diameter suffer from energy losses due to crossed-beam energy transfer (CBET). Significant reduction of CBET and improvements in implosion hydrodynamic efficiency can be achieved by reducing the beam diameter. Narrow beams increase low-mode perturbations of the targets because of decreased illumination uniformity that degrades implosion performance.

Native kidney BK virus nephropathy associated with chronic lymphocytic leukaemia.

BK virus nephropathy (BKVN) is a well-recognized complication of renal transplantation. Several cases of native kidney BKVN following other solid organ or bone marrow transplants have been reported. We describe a patient with chronic lymphocytic leukaemia who presented with deteriorating renal function with no history of solid organ or bone marrow transplantation.

Demonstration of the highest deuterium-tritium areal density using multiple-picket cryogenic designs on OMEGA.

The performance of triple-picket deuterium-tritium cryogenic target designs on the OMEGA Laser System [T. R. Boehly, Opt.

Generalized measurable ignition criterion for inertial confinement fusion.

A multidimensional measurable criterion for central ignition of inertial-confinement-fusion capsules is derived. The criterion accounts for the effects of implosion nonuniformities and depends on three measurable parameters: the neutron-averaged total areal density (rhoR(n)(tot)), the ion temperature (T(n)), and the yield over clean (YOC=ratio of the measured neutron yield to the predicted one-dimensional yield). The YOC measures the implosion uniformity.

High-areal-density fuel assembly in direct-drive cryogenic implosions.

The first observation of ignition-relevant areal-density deuterium from implosions of capsules with cryogenic fuel layers at ignition-relevant adiabats is reported. The experiments were performed on the 60-beam, 30-kJUV OMEGA Laser System [T. R.

Role of hot-electron preheating in the compression of direct-drive imploding targets with cryogenic D2 ablators.

The compression of direct-drive, spherical implosions is studied using cryogenic D2 targets on the 60-beam, 351-nm OMEGA laser with intensities ranging from approximately 3x10(14) to approximately 1x10(15) W/cm2. The hard-x-ray signal from hot electrons generated by laser-plasma instabilities increases with laser intensity, while the areal density decreases. Mitigating hot-electron production, by reducing the laser intensity to approximately 3x10(14) W/cm2, results in areal density of the order of approximately 140 mg/cm2, in good agreement with 1D simulations.

Studies of plastic-ablator compressibility for direct-drive inertial confinement fusion on OMEGA.

The compression of planar plastic targets was studied with x-ray radiography in the range of laser intensities of I approximately 0.5 to 1.5x10(15) W/cm2 using square (low-compression) and shaped (high-compression) pulses.

Pharmaceutical strategies to prevent ventilator-associated pneumonia.

The increasing incidence of hospital-acquired (nosocomial) infection is a disturbing phenomenon resulting in significant patient mortality and putting considerable strain on healthcare budgets and personnel. One particularly serious aspect of nosocomial infection is that of ventilator-associated pneumonia (VAP). This arises in patients who receive mechanical ventilation within the intensive care unit.

Redistribution and abnormal activity of phospholipase A(2) isoenzymes in postinfarct congestive heart failure.

Cardiac sarcolemmal (SL) cis-unsaturated fatty acid sensitive phospholipase D (cis-UFA PLD) is modulated by SL Ca(2+)-independent phospholipase A(2) (iPLA(2)) activity via intramembrane release of cis-UFA. As PLD-derived phosphatidic acid influences intracellular Ca(2+) concentration and contractile performance of the cardiomyocyte, changes in iPLA(2) activity may contribute to abnormal function of the failing heart. We examined PLA(2) immunoprotein expression and activity in the SL and cytosol from noninfarcted left ventricular (LV) tissue of rats in an overt stage of congestive heart failure (CHF).

Induction of Ca-independent PLA(2) and conservation of plasmalogen polyunsaturated fatty acids in diabetic heart.

Diabetes-induced changes in phospholipase A(2) (PLA(2)) activity have been measured in several tissues but are undefined in diabetic myocardium. We measured ventricular PLA(2) activity in control, streptozotocin-induced diabetic, and insulin-treated diabetic rats and characterized myocardial phospholipids to determine whether diabetes altered myocardial phospholipid metabolism. Increased membrane-associated Ca(2+)-independent PLA(2) (iPLA(2)) activity was observed in diabetes that was selective for arachidonylated phospholipids.

Demonstration of synergy with fluconazole and either ibuprofen, sodium salicylate, or propylparaben against Candida albicans in vitro.

The combination of fluconazole with either ibuprofen, sodium salicylate, or propylparaben resulted in synergistic activity (fractional inhibitory index, < 0.5) against Candida albicans NCYC 620 in a microdilution checkerboard assay. Synergism between miconazole and ibuprofen was also demonstrated.