We present C ii observations of 20 strongly lensed dusty star-forming galaxies at 2.1 < z < 5.7 using Atacama Pathfinder EXperiment and Herschel. The sources were selected on their 1.4 mm flux (S
1.4 ...mm > 20 mJy) from the South Pole Telescope (SPT) survey, with far-infrared (FIR) luminosities determined from extensive photometric data. The C ii line is robustly detected in 17 sources, all but one being spectrally resolved. 11 out of 20 sources observed in C ii also have low-J CO detections from Australia Telescope Compact Array. A comparison with mid- and high-J CO lines from Atacama Large Millimeter/submillimeter Array reveals consistent C ii and CO velocity profiles, suggesting that there is little differential lensing between these species. The C ii, low-J CO and FIR data allow us to constrain the properties of the interstellar medium. We find C ii to CO(1–0) luminosity ratios in the SPT sample of 5200 ± 1800, with significantly less scatter than in other samples. This line ratio can be best described by a medium of C ii and CO emitting gas with a higher C ii than CO excitation temperature, high CO optical depth τCO(1–0) ≫ 1, and low to moderate C ii optical depth
$\tau _{{\rm C\,\small {II}}}$
≲ 1. The geometric structure of photodissociation regions allows for such conditions.
Luminous high-redshift quasars (QSOs) are thought to exist within the most massive dark matter haloes in the young Universe. As a consequence, they are likely to be markers for biased, overdense ...regions where early galaxies cluster, regions that eventually grow into the groups and clusters seen in the lower redshift Universe. In this paper, we explore the clustering of galaxies around z ∼ 5 QSOs as traced by Lyman break galaxies (LBGs). We target the fields of three QSOs using the same optical imaging and spectroscopy techniques as used in the ESO Remote Galaxy Survey (ERGS), which was successful in identifying individual clustered structures of LBGs. We use the statistics of the redshift clustering in ERGS to show that two of the three fields show significant clustering of LBGs at the QSO redshifts. Neither of these fields is obviously overdense in LBGs from the imaging alone; a possible reason why previous imaging-only studies of high redshift QSO environments have given ambiguous results. This result shows that luminous QSOs at z ∼ 5 are typically found in overdense regions. The richest QSO field contains at least nine spectroscopically confirmed objects at the same redshift, including the QSO itself, seven LBGs and a second fainter QSO. While this is a very strong observational signal of clustering at z ∼ 5, it is of similar strength to that seen in two structures identified in the 'blank sky' ERGS fields. This indicates that, while overdense, the QSO environments are not more extreme than other structures that can be identified at these redshifts. The three richest structures discovered in this work and in ERGS have properties consistent with that expected for protoclusters and likely represent the early stages in the build-up of massive current-day groups and clusters.
We present the average rest-frame spectrum of high-redshift dusty, star-forming galaxies from 250 to 770 GHz. This spectrum was constructed by stacking Atacama Large Millimeter/submillimeter Array ...(ALMA) 3 mm spectra of 22 such sources discovered by the South Pole Telescope and spanning z = 2.0-5.7. In addition to multiple bright spectral features of super(12)CO, CI, and H sub(2)O, we also detect several faint transitions of super(13)CO, HCN, HNC, HCO super(+), and CN, and use the observed line strengths to characterize the typical properties of the interstellar medium of these high-redshift starburst galaxies. We find that the super(13)CO brightness in these objects is comparable to that of the only other z > 2 star-forming galaxy in which super(13)CO has been observed. We show that the emission from the high-critical density molecules HCN, HNC, HCO super(+), and CN is consistent with a warm, dense medium with T sub(kin) ~ 55 K and n sub(H2), gap 10 super(5.5) cm super(-3). High molecular hydrogen densities are required to reproduce the observed line ratios, and we demonstrate that alternatives to purely collisional excitation are unlikely to be significant for the bulk of these systems. We quantify the average emission from several species with no individually detected transitions, and find emission from the hydride CH and the linear molecule CCH for the first time at high redshift, indicating that these molecules may be powerful probes of interstellar chemistry in high-redshift systems. These observations represent the first constraints on many molecular species with rest-frame transitions from 0.4 to 1.2 mm in star-forming systems at high redshift, and will be invaluable in making effective use of ALMA in full science operations.
High-redshift quasars can be used to trace the early growth of massive galaxies and may be triggered by galaxy–galaxy interactions. We present Multi-Object Spectroscopic Explorer (MUSE) science ...verification data on one such interacting system consisting of the well-studied z = 3.2 PKS1614+051 quasar, its AGN companion galaxy and bridge of material radiating in Ly α between the quasar and its companion. We find a total of four companion galaxies (at least two galaxies are new discoveries), three of which reside within the likely virial radius of the quasar host, suggesting that the system will evolve into a massive elliptical galaxy by the present day. The MUSE data are of sufficient quality to split the extended Ly α emission line into narrow velocity channels. In these the gas can be seen extending towards each of the three neighbouring galaxies suggesting that the emission-line gas originates in a gravitational interaction between the galaxies and the quasar host. The photoionization source of this gas is less clear but is probably dominated by the two AGN. The quasar's Ly α emission spectrum is double peaked, likely due to absorbing neutral material at the quasar's systemic redshift with a low column density as no damping wings are present. The spectral profiles of the AGN and bridge's Ly α emission are also consistent with absorption at the same redshift indicating that this neutral material may extend over >50 kpc. The fact that the neutral material is seen in the line of sight to the quasar and transverse to it, and the fact that we see the quasar and it also illuminates the emission-line bridge, suggests that the quasar radiates isotropically and any obscuring torus is small. These results demonstrate the power of MUSE for investigating the dynamics of interacting systems at high redshift.
Radio galaxies are among the most massive galaxies in the high-redshift Universe and are known to often lie in protocluster environments. We have studied the fields of seven z = 2.2 radio galaxies ...with High Acuity Wide field K-band Imager (HAWK-I) narrow-band and broad-band imaging in order to map out their environment using Hα emitters (HAEs). The results are compared to the blank field HAE survey HiZELS. All of the radio galaxy fields are overdense in HAEs relative to a typical HiZELS field of the same area and four of the seven are richer than all except one of 65 essentially random HiZELS subfields of the same size. The star formation rates of the massive HAEs are lower than those necessary to have formed their stellar population in the preceding Gyr – indicating that these galaxies are likely to have formed the bulk of their stars at higher redshifts, and are starting to quench.
Current uses of medication-related clinical decision support (CDS) and recommendations for improving these systems are reviewed.
Using a systematic approach, articles published from 2007 through 2014 ...were identified in MEDLINE and EMBASE using MeSH terms and keywords relating to the 5 basic medication-related CDS functionalities. A total of 156 full-text articles and 28 conference abstracts were reviewed across each of the 5 areas: drug-drug interaction (DDI) checks (
= 78), drug allergy checks (
= 20), drug dose support (
= 55), drug duplication checks (
= 11), and drug formulary support (
= 20). The success of medication-related CDS depends on users finding the alerts valuable and acting on the information received. Improving alert specificity and sensitivity is important for all domains. Tiering is important for improving the acceptance of DDI alerts. The ability to perform appropriate cross-sensitivity checks is key to producing appropriate drug allergy checks. Drug dosage alerts should be individualized and deliver practical recommendations. How the system is configured to identify certain drug duplications is important to prevent possible patient toxicity. Accurate knowledge databases are needed to produce relevant drug formulary alerts and encourage formulary adherence. Medication-related CDS is still relatively immature in some organizations and has substantial room for improvement. For example, decision support should consider more patient-specific factors, human factors principles should always be considered, and alert specificity must be improved in order to reduce alert fatigue.
Standardization, integration of patient-specific parameters, and consideration of human factors design principles are central to realizing the potential benefits of medication-related CDS.
An integrated curriculum is one where the summation of different academic disciplines forms a coherent whole and, importantly, where the relationships between the different disciplines have been ...carefully and strategically considered when forming the composite. Within pharmacy curriculum integration is important in order to produce graduates who have the capacity to apply their knowledge to a range of complex problems where available information is often incomplete. This paper discusses the development of an integrated curriculum in which students are presented with an organized, logical sequence of material, but still challenged to make their own integrations and develop as integrative thinkers. An evidence-based model upon which an interdisciplinary undergraduate pharmacy curriculum can be built is presented.
Objective: To understand the different types and causes of prescribing errors associated with computerized provider order entry (CPOE) systems, and recommend improvements in these systems.
Materials ...and Methods: We conducted a systematic review of the literature published between January 2004 and June 2015 using three large databases: the Cumulative Index to Nursing and Allied Health Literature, Embase, and Medline. Studies that reported qualitative data about the types and causes of these errors were included. A narrative synthesis of all eligible studies was undertaken.
Results: A total of 1185 publications were identified, of which 34 were included in the review. We identified 8 key themes associated with CPOE-related prescribing errors: computer screen display, drop-down menus and auto-population, wording, default settings, nonintuitive or inflexible ordering, repeat prescriptions and automated processes, users’ work processes, and clinical decision support systems. Displaying an incomplete list of a patient’s medications on the computer screen often contributed to prescribing errors. Lack of system flexibility resulted in users employing error-prone workarounds, such as the addition of contradictory free-text comments. Users’ misinterpretations of how text was presented in CPOE systems were also linked with the occurrence of prescribing errors.
Discussion and Conclusions: Human factors design is important to reduce error rates. Drop-down menus should be designed with safeguards to decrease the likelihood of selection errors. Development of more sophisticated clinical decision support, which can perform checks on free-text, may also prevent errors. Further research is needed to ensure that systems minimize error likelihood and meet users’ workflow expectations.
Health behavior changes made by patients during the perioperative period can impact the outcomes and success of elective surgeries. However, there remains a limited understanding of how best to ...support patients during this time, particularly through the use of digital health interventions. Recognizing and understanding the potential unmet needs of elective orthopedic surgery patients is central to motivating healthier behavior change, improving recovery, and optimizing overall surgical success in the short and long term.
The aim of this study is to explore patient perspectives on technology features that would help support them to change their lifestyle behaviors during the pre- and postoperative periods, and that could potentially maintain long-term healthy lifestyles following recovery.
Semistructured interviews with pre- and postoperative elective orthopedic patients were conducted between May and June 2020 using telephone and video call-based software. Patient perspectives on the use of digital technologies to complement current surgical care and support with lifestyle behavior changes were discussed. Interviews were audio recorded and transcribed verbatim. Reflexive thematic analysis enabled the development of themes from the data, with QSR NVivo software (version 12) facilitating data management. Ethical approval was obtained from the National Health Service Health Research Authority.
A total of 18 participants were interviewed. Four themes were developed from the data regarding the design and functionality of digital technologies to best support the perioperative journey. These center around an intervention's ability to incorporate interactive, user-centered features; direct a descriptive and structured recovery; enable customizable, patient-controlled settings; and deliver both general and specific surgical advice in a timely manner. Interventions that are initiated preoperatively and continued postoperatively were perceived as beneficial. Interventions designed with personalized milestones were found to better guide patients through a structured recovery. Individualized tailoring of preparatory and recovery information was desired by patients with previously high levels of physical activity before surgery. The use of personalized progression-based exercises further encouraged physical recovery; game-like rewards and incentives were regarded as motivational for making and sustaining health behavior change. In-built video calling and messaging features offered connectivity with peers and clinicians for supported care delivery.
Specific intervention design and functionality features can provide better, structured support for elective orthopedic patients across the entire surgical journey and beyond. This study provides much-needed evidence relating to the optimal design and timing of digital interventions for elective orthopedic surgical patients. Findings from this study suggest a desire for personalized perioperative care, in turn, supporting patients to make health behavior changes to optimize surgical success. These findings should be used to influence future co-design projects to enable the design and implementation of patient-focused, tailored, and targeted digital health technologies within modern health care settings.
ObjectivesTo systematically review the effectiveness of community pharmacy-delivered interventions for alcohol reduction, smoking cessation and weight management.DesignSystematic review and ...meta-analyses. 10 electronic databases were searched from inception to May 2014.Eligibility criteria for selecting studiesStudy design: randomised and non-randomised controlled trials; controlled before/after studies, interrupted times series. Intervention: any relevant intervention set in a community pharmacy, delivered by the pharmacy team. No restrictions on duration, country, age, or language.Results19 studies were included: 2 alcohol reduction, 12 smoking cessation and 5 weight management. Study quality rating: 6 ‘strong’, 4 ‘moderate’ and 9 ‘weak’. 8 studies were conducted in the UK, 4 in the USA, 2 in Australia, 1 each in 5 other countries. Evidence from 2 alcohol-reduction interventions was limited. Behavioural support and/or nicotine replacement therapy are effective and cost-effective for smoking cessation: pooled OR was 2.56 (95% CI 1.45 to 4.53) for active intervention vs usual care. Pharmacy-based interventions produced similar weight loss compared with active interventions in other primary care settings; however, weight loss was not sustained longer term in a range of primary care and commercial settings compared with control. Pharmacy-based weight management interventions have similar provider costs to those delivered in other primary care settings, which are greater than those delivered by commercial organisations. Very few studies explored if and how sociodemographic or socioeconomic variables moderated intervention effects. Insufficient information was available to examine relationships between effectiveness and behaviour change strategies, implementation factors, or organisation and delivery of interventions.ConclusionsCommunity pharmacy-delivered interventions are effective for smoking cessation, and demonstrate that the pharmacy is a feasible option for weight management interventions. Given the potential reach, effectiveness and associated costs of these interventions, commissioners should consider using community pharmacies to help deliver public health services.
![The nature of the [C ii] em...](http://api.summon.serialssolutions.com/2.0.0/image/issn/XR4PS5YY4K/0035-8711/small "The nature of the [C ii] emission in dusty star-forming galaxies from the SPT survey")
PDF
