Continental margins are dynamic, heterogeneous settings that can include canyons, seamounts, and banks. Two of the largest canyons in the world, Zhemchug and Pribilof, cut into the edge of the continental shelf in the southeastern Bering Sea. Here currents and upwelling interact to produce a highly productive area, termed the Green Belt, that supports an abundance of fishes and squids as well as birds and marine mammals. We show that in some areas the floor of these canyons harbors high densities of gorgonian and pennatulacean corals and sponges, likely due to enhanced surface productivity, benthic currents and seafloor topography. Rockfishes, including the commercially important Pacific ocean perch, Sebastes alutus, were associated with corals and sponges as well as with isolated boulders. Sculpins, poachers and pleuronectid flounders were also associated with corals in Pribilof Canyon, where corals were most abundant. Fishes likely use corals and sponges as sources of vertical relief, which may harbor prey as well as provide shelter from predators. Boulders may be equivalent habitat in this regard, but are sparse in the canyons, strongly suggesting that biogenic structure is important fish habitat. Evidence of disturbance to the benthos from fishing activities was observed in these remote canyons. Bottom trawling and other benthic fishing gear has been shown to damage corals and sponges that may be very slow to recover from such disturbance. Regulation of these destructive practices is key to conservation of benthic habitats in these canyons and the ecosystem services they provide.

The uptake of virtual simulation technologies in both military and civilian surgical contexts has been both slow and patchy. The failure of the virtual reality community in the 1990s and early 2000s to deliver affordable and accessible training systems stems not only from an obsessive quest to develop the ‘ultimate’ in so-called ‘immersive’ hardware solutions, from head-mounted displays to large-scale projection theatres, but also from a comprehensive lack of attention to the needs of the end users. While many still perceive the science of simulation to be defined by technological advances, such as computing power, specialized graphics hardware, advanced interactive controllers, displays and so on, the true science underpinning simulation—the science that helps to guarantee the transfer of skills from the simulated to the real—is that of human factors, a well-established discipline that focuses on the abilities and limitations of the end user when designing interactive systems, as opposed to the more commercially explicit components of technology. Based on three surgical simulation case studies, the importance of a human factors approach to the design of appropriate simulation content and interactive hardware for medical simulation is illustrated. The studies demonstrate that it is unnecessary to pursue real-world fidelity in all instances in order to achieve psychological fidelity—the degree to which the simulated tasks reproduce and foster knowledge, skills and behaviours that can be reliably transferred to real-world training applications.

Introduction

We investigated the effects on collaborative work within the UK National Health Service (NHS) of an intervention for service quality improvement: informal, structured, reciprocated, multidisciplinary peer review with feedback and action plans. The setting was care for chronic obstructive pulmonary disease (COPD).

Theory and methods

We analysed semi-structured interviews with 43 hospital respiratory consultants, nurses and general managers at 24 intervention and 11 control sites, as part of a UK randomised controlled study, the National COPD Resources and Outcomes Project (NCROP), using Scott's conceptual framework for action (inter-organisational, intra-organisational, inter-professional and inter-individual). Three areas of care targeted by NCROP involved collaboration across primary and secondary care.

Results

Hospital respiratory department collaborations with commissioners and hospital managers varied. Analysis suggested that this is related to team responses to barriers. Clinicians in unsuccessful collaborations told ‘atrocity stories’ of organisational, structural and professional barriers to service improvement. The others removed barriers by working with government and commissioner agendas to ensure continued involvement in patients' care. Multidisciplinary peer review facilitated collaboration between participants, enabling them to meet, reconcile differences and exchange ideas across boundaries.

Conclusions

The data come from the first randomised controlled trial of organisational peer review, adding to research into UK health service collaborative work, which has had a more restricted focus on inter-professional relations. NCROP peer review may only modestly improve collaboration but these data suggest it might be more effective than top-down exhortations to change when collaboration both across and within organisations is required.

Background

We report baseline data on the organisation of COPD care in UK NHS hospitals participating in the National COPD Resources and Outcomes Project (NCROP).

Methods

We undertook an initial survey of participating hospitals in 2007, looking at organisation and performance indicators in relation to general aspects of care, provision of non-invasive ventilation (NIV), pulmonary rehabilitation, early discharge schemes, and oxygen. We compare, where possible, against the national 2003 audit.

Results

100 hospitals participated. These were typically larger sized Units. Many aspects of COPD care had improved since 2003. Areas for further improvement include organisation of acute care, staff training, end-of-life care, organisation of oxygen services and continuation of pulmonary rehabilitation.

Conclusion

Key Points: positive change occurs over time and repeated audit seems to deliver some improvement in services. It is necessary to assess interventions such as the Peer Review used in the NCROP to achieve more comprehensive and rapid change.

This review outlines some of the issues surrounding ergonomics that are relevant to medical and surgical practice and to health care in general

A laboratory-scale unit containing about 360 kg of washed river gravel was designed to [ill] the use of rocks for heat storage. The unit was operated under varying conditions of temperature, relative humidity, and the addition of volatile nutrients over a 4-month period. Effluent air and rock surfaces were monitored for the presence of microorganisms. After 2 weeks, virtually no microorganisms were detected in the effluent air except when dry soil or compost was added as the inoculum. A small number of heat-resistant bacteria, but no fungi, were found to survive on the rock surfaces. Microorganisms isolated were either sporeforming bacteria or actinomycetes closely resembling Thermoactinomyces vulgaris. Microbial colonization of rock beds used for solar heat storage does not appear likely under routine operation.

The effect of azathioprine on macromolecular biosynthesis was studied in mouse spleen cells cultured in vitro. The rate of incorporation of 3H-thymidine, 3H-uridine, and 14C-leucine into acid-insoluble material was used to measure deoxyribonucleic acid, ribonucleic acid, and protein synthesis. Results indicate that azathioprine inhibited nucleic acid and protein synthesis at levels which did not decrease cell viability.

Dobrogosz, Walter J. (The Pennsylvania State University, University Park) and Robert W. Stone. Oxidative metabolism in Pediococcus pentosaceus. II. Factors controlling the formation of oxidative activities. J. Bacteriol. 84:724–729. 1962.—Studies were conducted on some factors which regulate the formation of oxidative activities in Pediococcus pentosaceus, a homofermentative lactic acid organism. Oxidative abilities were defined as the capacities to oxidize glucose and glycerol, and to exhibit catalase activity. Factors such as the type of growth substrate, the growth substrate concentration, pH, and oxygen tension were considered. The results suggested that the development of oxidative activities in this organism is under adaptive control and subject to repression by the well-known “glucose effect,” as well as by anaerobiosis. In addition to the necessity for the formation of aerobic systems for the metabolism of glycerol, which can be utilized only under aerobic conditions, data are presented which suggest that aerobic reactions may play a physiologically important role toward the induction of growth on other substrates such as d-xylose and lactose.

Dobrogosz, Walter J. (Pennsylvania State University, University Park) and Robert W. Stone. Oxidative metabolism in Pediococcus pentosaceus. I. Role of oxygen and catalase. J. Bacteriol. 84:716–723. 1962.—Studies were conducted on the physiological behavior of several strains of Pediococcus pentosaceus isolated from alfalfa silages. Although these organisms are regarded as homofermentative lactic acid bacteria which metabolize carbohydrates via the classic reactions of glycolysis, this investigation showed that they were capable of developing other physiologically important reactions related to carbohydrate metabolism. Growth on glycerol, for example, was shown to depend on the development of aerobic reactions, and was directly related to the catalase content of the various strains tested. These organisms were shown to be devoid of a cytochrome system, thus implicating an active flavoprotein system in oxidative reactions. A study of the end products of aerobic glycerol metabolism suggested that glycerol was oxidized to the pyruvate level, with subsequent reactions involving pyruvate leading to the accumulation of lactate, acetate, acetoin, and CO2 in a molar ratio of approximately 1:1:1:3.

Rabbit papilloma virus seems uniquely to begin its proliferation in the nucleolus of infected cells. In cells near the germinal layer of the stratum Malpighii spherical viral bodies seem to develop within a reticulum which forms out of the fine granular matrix of the nucleolus. The virus may later fill the nucleus and spread into the whole cell. The age of the cell, determined by its position in the Malpighian layer and by the extent of keratinization, can be correlated with the viral development.

The results of treatment of tuberculous meningitis in Highland Alameda County Hospital, since the advent of streptomycin, in 34 cases were: dead, 21 patients, or 61 per cent; alive, 10 patients, or 29 per cent. Three cases were excluded from the ultimate report due to inadequate follow-up. The mean survival time of the ten survivors at the time of report was 35 months, the longest being 74 months.

The composite results of treatment elsewhere, as reported in the literature, have been: dead, 892, or 59 per cent; alive, 629, or 41 per cent.

The pathogenesis of the disease and the effects of chemotherapy are discussed.

A therapeutic regimen for tuberculous meningitis is presented, which has been used at Highland Hospital since INH became established as the most effective component in the combined chemotherapeutic attack on the disease.

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