Morning quiet-time ionospheric current reversal at mid to high latitudes

The records of an array of magnetometers set up across the Australian mainland are examined. In addition to a well-defined current whorl corresponding to the ionospheric <i>S<sub>q</sub></i> current system, another system of eastward flowing currents is often found in the early morning. The system is most easily identified at observatories poleward of the focus of the <i>S<sub>q</sub></i> system, where a morning reversal from eastward to westward currents can be seen. The time of the reversal is usually later, sometimes up to 12h local noon, in June (Southern Winter) than in other seasons. There is some evidence of a similar current system at other longitudes and in the Northern Hemisphere. An important outcome of the study is that it enables identification of which features of a daily variation of the northward magnetic field Δ<i>X</i> relate to an <i>S<sub>q</sub></i> current whorl and which must be attributed to some other current system

Magnetohydrodynamic activity inside a sphere

We present a computational method to solve the magnetohydrodynamic equations in spherical geometry. The technique is fully nonlinear and wholly spectral, and uses an expansion basis that is adapted to the geometry: Chandrasekhar-Kendall vector eigenfunctions of the curl. The resulting lower spatial resolution is somewhat offset by being able to build all the boundary conditions into each of the orthogonal expansion functions and by the disappearance of any difficulties caused by singularities at the center of the sphere. The results reported here are for mechanically and magnetically isolated spheres, although different boundary conditions could be studied by adapting the same method. The intent is to be able to study the nonlinear dynamical evolution of those aspects that are peculiar to the spherical geometry at only moderate Reynolds numbers. The code is parallelized, and will preserve to high accuracy the ideal magnetohydrodynamic (MHD) invariants of the system (global energy, magnetic helicity, cross helicity). Examples of results for selective decay and mechanically-driven dynamo simulations are discussed. In the dynamo cases, spontaneous flips of the dipole orientation are observed.Comment: 15 pages, 19 figures. Improved figures, in press in Physics of Fluid

Electron Emission from Ferroelectric/Antiferroelectric Cathodes Excited by Short High-Voltage Pulses

Un-prepoled Lead Zirconate Titanate Lanthanum doped-PLZT ferroelectric cathodes have emitted intense current pulses under the action of a high voltage pulse of typically 8 kV/cm for PLZT of 8/65/35 composition and 25 kV/cm for PLZT of 4/95/5 composition. In the experiments described in this paper, the exciting electric field applied to the sample is directed from the rear surface towards the emitting surface. The resulting emission is due to an initial field emission from the metal of the grid deposited over the emitting surface with the consequent plasma formation and the switching of ferroelectric domains. These electrons may be emitted directly form the crystal or from the plasma. This emission requires the material in ferroelectric phase. In fact, PLZT cathodes of the 8/65/35 type, that is with high Titanium content, showing ferroelectric-paraelectric phase sequence, emit at room temperature, while PLZT cathodes of the 4/95/5 type, that is with low Titanium content, having antiferro-ferro-paraelectric phase sequence, emit strongly at a temperature higher than 130°C

A time-stepping dynamically-consistent spherical-shell dynamo code

A pseudo-spectral dynamo code, developed as a computational laboratory, is described. The magnetic, heat and Boussinesq Navier-Stokes equations, with inertia, non-linear advection, buoyancy with asymmetric gravity, Coriolis, viscous and Lorentz forces, are solved numerically in a rotating conducting fluid shell. The convection is thermally driven by prescribed boundary temperatures. The equations are discretised using toroidal-poloidal fields, Chebychev collocation in radius and spherical harmonic expansion in angles. Derivatives are performed spectrally. Products are evaluated in physical space for efficiency. Fields are transformed between physical and spectral spaces by fast Fourier and Gauss-Legendre methods. Linear terms are time-stepped implicitly and product terms explicitly using an Adams predictor/corrector. Results are presented for two benchmark models

Attributes of context relevant to healthcare professionals' use of research evidence in clinical practice: a multi-study analysis

Background: To increase the likelihood of successful implementation of evidence-based practices, researchers, knowledge users, and healthcare professionals must consider aspects of context that promote and hinder implementation in their setting. The purpose of the current study was to identify contextual attributes and their features relevant to implementation by healthcare professionals and compare and contrast these attributes and features across different clinical settings and healthcare professional roles. Methods: We conducted a secondary analysis of 145 semi-structured interviews comprising 11 studies (10 from Canada and one from Australia) investigating healthcare professionals’ perceived barriers and enablers to their use of research evidence in clinical practice. The data was collected using semi-structured interview guides informed by the Theoretical Domains Framework across different healthcare professional roles, settings, and practices. We analyzed these data inductively, using constant comparative analysis, to identify attributes of context and their features reported in the interviews. We compared these data by (1) setting (primary care, hospital-medical/surgical, hospital-emergency room, hospital-critical care) and (2) professional role (physicians and residents, nurses and organ donor coordinators). Results: We identified 62 unique features of context, which we categorized under 14 broader attributes of context. The 14 attributes were resource access, work structure, patient characteristics, professional role, culture, facility characteristics, system features, healthcare professional characteristics, financial, collaboration, leadership, evaluation, regulatory or legislative standards, and societal influences. We found instances of the majority (n = 12, 86%) of attributes of context across multiple (n = 6 or more) clinical behaviors. We also found little variation in the 14 attributes of context by setting (primary care and hospitals) and professional role (physicians and residents, and nurses and organ donor coordinators). Conclusions: There was considerable consistency in the 14 attributes identified irrespective of the clinical behavior, setting, or professional role, supporting broad utility of the attributes of context identified in this study. There was more variation in the finer-grained features of these attributes with the most substantial variation being by setting

Evolutionary consequences of intra-patient phage predation on microbial populations

The impact of phage predation on bacterial pathogens in the context of human disease is not currently appreciated. Here, we show that predatory interactions of a phage with an important environmentally transmitted pathogen, Vibrio cholerae, can modulate the evolutionary trajectory of this pathogen during the natural course of infection within individual patients. We analyzed geographically and temporally disparate cholera patient stool samples from Haiti and Bangladesh and found that phage predation can drive the genomic diversity of intra-patient V. cholerae populations. Intra-patient phage-sensitive and phage-resistant isolates were isogenic except for mutations conferring phage resistance, and moreover, phage-resistant V. cholerae populations were composed of a heterogeneous mix of many unique mutants. We also observed that phage predation can significantly alter the virulence potential of V. cholerae shed from cholera patients. We provide the first molecular evidence for predatory phage shaping microbial community structure during the natural course of infection in humans. DOI: http://dx.doi.org/10.7554/eLife.03497.00

Effective Feedback to Improve Primary Care Prescribing Safety (EFIPPS) a pragmatic three-arm cluster randomised trial:designing the intervention (ClinicalTrials.gov registration NCT01602705)

Peer reviewedPublisher PD

No more 'business as usual' with audit and feedback interventions: towards an agenda for a reinvigorated intervention

Background: Audit and feedback interventions in healthcare have been found to be effective, but there has been little progress with respect to understanding their mechanisms of action or identifying their key ‘active ingredients.’ Discussion: Given the increasing use of audit and feedback to improve quality of care, it is imperative to focus further research on understanding how and when it works best. In this paper, we argue that continuing the ‘business as usual’ approach to evaluating two-arm trials of audit and feedback interventions against usual care for common problems and settings is unlikely to contribute new generalizable findings. Future audit and feedback trials should incorporate evidence- and theory-based best practices, and address known gaps in the literature. Summary: We offer an agenda for high-priority research topics for implementation researchers that focuses on reviewing best practices for designing audit and feedback interventions to optimize effectiveness

Application of theory to enhance audit and feedback interventions to increase the uptake of evidence-based transfusion practice: an intervention development protocol

Background: Audits of blood transfusion demonstrate around 20% transfusions are outside national recommendations and guidelines. Audit and feedback is a widely used quality improvement intervention but effects on clinical practice are variable, suggesting potential for enhancement. Behavioural theory, theoretical frameworks of behaviour change and behaviour change techniques provide systematic processes to enhance intervention. This study is part of a larger programme of work to promote the uptake of evidence-based transfusion practice. Objectives: The objectives of this study are to design two theoretically enhanced audit and feedback interventions; one focused on content and one on delivery, and investigate the feasibility and acceptability. Methods: Study A (Content): A coding framework based on current evidence regarding audit and feedback, and behaviour change theory and frameworks will be developed and applied as part of a structured content analysis to specify the key components of existing feedback documents. Prototype feedback documents with enhanced content and also a protocol, describing principles for enhancing feedback content, will be developed. Study B (Delivery): Individual semi-structured interviews with healthcare professionals and observations of team meetings in four hospitals will be used to specify, and identify views about, current audit and feedback practice. Interviews will be based on a topic guide developed using the Theoretical Domains Framework and the Consolidated Framework for Implementation Research. Analysis of transcripts based on these frameworks will form the evidence base for developing a protocol describing an enhanced intervention that focuses on feedback delivery. Study C (Feasibility and Acceptability): Enhanced interventions will be piloted in four hospitals. Semi-structured interviews, questionnaires and observations will be used to assess feasibility and acceptability. Discussion: This intervention development work reflects the UK Medical Research Council’s guidance on development of complex interventions, which emphasises the importance of a robust theoretical basis for intervention design and recommends systematic assessment of feasibility and acceptability prior to taking interventions to evaluation in a full-scale randomised study. The work-up includes specification of current practice so that, in the trials to be conducted later in this programme, there will be a clear distinction between the control (usual practice) conditions and the interventions to be evaluated

Use of Oral Cholera Vaccine in Haiti: A Rural Demonstration Project

A cholera epidemic has claimed the lives of more than 8,000 Haitians and sickened 650,000 since the outbreak began in October 2010. Early intervention in the epidemic focused on case-finding, treatment, and water and sanitation interventions for prevention of transmission. Use of oral cholera vaccine (OCV) as part of a complementary set of control activities was considered but initially rejected by policymakers. In December 2011, the Minister of Health of Haiti called for a demonstration of the acceptability and feasibility of the use of OCV in urban and rural Haiti. This paper describes the collaborative activity that offered OCV to one region of the Artibonite Department of rural Haiti in addition to other ongoing treatment and control measures. Despite logistics and cold chain challenges, 45,417 persons were successfully vaccinated with OCV in the region, and 90.8% of these persons completed their second dose