Investigating and Quantifying Molecular Complexity Using Assembly Theory and Spectroscopy.

Current approaches to evaluate molecular complexity use algorithmic complexity, rooted in computer science, and thus are not experimentally measurable. Directly evaluating molecular complexity could be used to study directed vs undirected processes in the creation of molecules, with potential applications in drug discovery, the origin of life, and artificial life. Assembly theory has been developed to quantify the complexity of a molecule by finding the shortest path to construct the molecule from building blocks, revealing its molecular assembly index (MA). In this study, we present an approach to rapidly infer the MA of molecules from spectroscopic measurements. We demonstrate that the MA can be experimentally measured by using three independent techniques: nuclear magnetic resonance (NMR), tandem mass spectrometry (MS/MS), and infrared spectroscopy (IR). By identifying and analyzing the number of absorbances in IR spectra, carbon resonances in NMR, or molecular fragments in tandem MS, the MA of an unknown molecule can be reliably estimated. This represents the first experimentally quantifiable approach to determining molecular assembly. This paves the way to use experimental techniques to explore the evolution of complex molecules as well as a unique marker of where an evolutionary process has been operating.

Reducing the time to activation of the emergency call system in operating theatres: effect of installing vertical red line indicators.

BACKGROUND: The 7th National Audit Project of the Royal College of Anaesthetists (NAP7) recommended that an emergency call system be immediately accessible in all anaesthesia locations. It is essential that all theatre team members can rapidly call for help to reduce the risk of patient harm. However, the ability of staff to activate this system in a timely manner can be affected by cluttered or unfamiliar environments and cognitive overload. One proposed strategy to enable rapid identification and activation of emergency call systems is to install a red vertical painted stripe on the wall from the ceiling to the activation button. We investigated the effect of introducing this vertical red line on activation times in operating theatres in the UK and Australia. METHODS: Operating theatre team members, including anaesthetists, surgeons, anaesthetic nurses, surgical and theatre nurses, operating theatre practitioners, and technicians, were approached without prior warning and asked to simulate activation of an emergency call. Vertical red lines were installed, and data collection repeated in the same operating theatres 4-12 months later. RESULTS: After installation of vertical red lines, the proportion of activations taking >10 s decreased from 31.9% (30/94) to 13.6% (17/125, P=0.001), and >20 s decreased from 19.1% (18/94) to 4.8% (6/125, P<0.001). The longest duration pre-installation was 120 s, and post-installation 35 s. CONCLUSIONS: This simple, safe, and inexpensive design intervention should be considered as a design standard in all operating theatres to minimise delays in calling for help.

What and when to debrief: a scoping review examining interprofessional clinical debriefing.

INTRODUCTION: Clinical debriefing (CD) improves teamwork and patient care. It is implemented across a range of clinical contexts, but delivery and structure are variable. Furthermore, terminology to describe CD is also inconsistent and often ambiguous. This variability and the lack of clear terminology obstructs understanding and normalisation in practice. This review seeks to examine the contextual factors relating to different CD approaches with the aim to differentiate them to align with the needs of different clinical contexts. METHODS: Articles describing CD were extracted from Medline, CINAHL, ERIC, PubMed, PsychINFO and Academic Search Complete. Empirical studies describing CD that involved two or more professions were eligible for inclusion. Included papers were charted and analysed using the Who-What-When-Where-Why-How model to examine contextual factors which were then used to develop categories of CD. Factors relating to what prompted debriefing and when debriefing occurred were used to differentiate CD approaches. RESULTS: Forty-six papers were identified. CD was identified as either prompted or routine, and within these overarching categories debriefing was further differentiated by the timing of the debrief. Prompted CD was either immediate or delayed and routine CD was postoperative or end of shift. Some contextual factors were unique to each category while others were relatively heterogeneous. These categories help clarify the alignment between the context and the intention of CD. CONCLUSIONS: The proposed categories offer a practical way to examine and discuss CD which may inform decisions about implementation. By differentiating CD according to relevant contextual factors, these categories may reduce confusion which currently hinders discourse and implementation. The findings from this review promote context-specific language and a shift away from conceptions of CD that embody a one-size-fits-all approach.

The use of checklists in the intensive care unit: a scoping review.

BACKGROUND: Despite the extensive volume of research published on checklists in the intensive care unit (ICU), no review has been published on the broader role of checklists within the intensive care unit, their implementation and validation, and the recommended clinical context for their use. Accordingly, a scoping review was necessary to map the current literature and to guide future research on intensive care checklists. This review focuses on what checklists are currently used, how they are used, process of checklist development and implementation, and outcomes associated with checklist use. METHODS: A systematic search of MEDLINE (Ovid), Embase, Scopus, and Google Scholar databases was conducted, followed by a grey literature search. The abstracts of the identified studies were screened. Full texts of relevant articles were reviewed, and the references of included studies were subsequently screened for additional relevant articles. Details of the study characteristics, study design, checklist intervention, and outcomes were extracted. RESULTS: Our search yielded 2046 studies, of which 167 were selected for further analysis. Checklists identified in these studies were categorised into the following types: rounding checklists; delirium screening checklists; transfer and handover checklists; central line-associated bloodstream infection (CLABSI) prevention checklists; airway management checklists; and other. Of 72 significant clinical outcomes reported, 65 were positive, five were negative, and two were mixed. Of 122 significant process of care outcomes reported, 114 were positive and eight were negative. CONCLUSIONS: Checklists are commonly used in the intensive care unit and appear in many clinical guidelines. Delirium screening checklists and rounding checklists are well implemented and validated in the literature. Clinical and process of care outcomes associated with checklist use are predominantly positive. Future research on checklists in the intensive care unit should focus on establishing clinical guidelines for checklist types and processes for ongoing modification and improvements using post-intervention data.

Coleadership in Maternity Teams, a Randomized, Counterbalanced, Crossover Trial in Simulation.

OBJECTIVE: This study aimed to measure the effect of a coleadership model on team performance compared with singular leadership model in simulated maternity emergencies. METHODS: A randomized, counterbalanced, crossover trial was performed at 2 tertiary maternity hospitals. Teams of obstetric physicians and nurse/midwives responded to 2 simulated maternity emergencies in either a singular or coleadership model. The primary outcome measure was teamwork rated with the Auckland Team Behavior tool. Secondary outcome measures included clinical performance (completion of critical tasks, time to critical intervention, documentation), self-rated teamwork (TEAM tool) and workload. Participants also answered a survey assessing their views on the coleadership model. Paired t tests and mixed-effects linear regression considering team as a random effect were used to estimate the unadjusted and adjusted associations between leadership model and the outcomes of interest. RESULTS: There was no difference between leadership models for the primary outcome of teamwork (5.3 vs. 5.3, P = 0.91). Clinical outcome measures and self-rated teamwork scores were also similar. Team leaders reported higher workload than other team members, but these were not different between the leadership models. Participants viewed coleadership positively despite no measured objective evidence of benefit. CONCLUSIONS: A coleadership model did not lead to a difference in team performance within simulated maternity emergencies. Despite this, participants viewed coleadership positively.

Heterogeneity in biological assemblages and exposure in chemical risk assessment: Exploring capabilities and challenges in methodology with two landscape-scale case studies.

Chemical exposure concentrations and the composition of ecological receptors (e.g., species) vary in space and time, resulting in landscape-scale (e.g. catchment) heterogeneity. Current regulatory, prospective chemical risk assessment frameworks do not directly address this heterogeneity because they assume that reasonably worst-case chemical exposure concentrations co-occur (spatially and temporally) with biological species that are the most sensitive to the chemical's toxicity. Whilst current approaches may parameterise fate models with site-specific data and aim to be protective, a more precise understanding of when and where chemical exposure and species sensitivity co-occur enables risk assessments to be better tailored and applied mitigation more efficient. We use two aquatic case studies covering different spatial and temporal resolution to explore how geo-referenced data and spatial tools might be used to account for landscape heterogeneity of chemical exposure and ecological assemblages in prospective risk assessment. Each case study followed a stepwise approach: i) estimate and establish spatial chemical exposure distributions using local environmental information and environmental fate models; ii) derive toxicity thresholds for different taxonomic groups and determine geo-referenced distributions of exposure-toxicity ratios (i.e., potential risk); iii) overlay risk data with the ecological status of biomonitoring sites to determine if relationships exist. We focus on demonstrating whether the integration of relevant data and potential approaches is feasible rather than making comprehensive and refined risk assessments of specific chemicals. The case studies indicate that geo-referenced predicted environmental concentration estimations can be achieved with available data, models and tools but establishing the distribution of species assemblages is reliant on the availability of a few sources of biomonitoring data and tools. Linking large sets of geo-referenced exposure and biomonitoring data is feasible but assessment of risk will often be limited by the availability of ecotoxicity data. The studies highlight the important influence that choices for aggregating data and for the selection of statistical metrics have on assessing and interpreting risk at different spatial scales and patterns of distribution within the landscape. Finally, we discuss approaches and development needs that could help to address environmental heterogeneity in chemical risk assessment.

Formalising the Pathways to Life Using Assembly Spaces.

Assembly theory (referred to in prior works as pathway assembly) has been developed to explore the extrinsic information required to distinguish a given object from a random ensemble. In prior work, we explored the key concepts relating to deconstructing an object into its irreducible parts and then evaluating the minimum number of steps required to rebuild it, allowing for the reuse of constructed sub-objects. We have also explored the application of this approach to molecules, as molecular assembly, and how molecular assembly can be inferred experimentally and used for life detection. In this article, we formalise the core assembly concepts mathematically in terms of assembly spaces and related concepts and determine bounds on the assembly index. We explore examples of constructing assembly spaces for mathematical and physical objects and propose that objects with a high assembly index can be uniquely identified as those that must have been produced using directed biological or technological processes rather than purely random processes, thereby defining a new scale of aliveness. We think this approach is needed to help identify the new physical and chemical laws needed to understand what life is, by quantifying what life does.

Clinicians' attitudes towards a co-leadership structure for maternity emergency teams: An interview study.

Shared leadership improves team performance in many domains and is present in some interprofessional healthcare teams. Despite the dominant paradigm of a singular obstetrician leader in maternity emergencies, co-leadership, a specific form of shared leadership, has been identified as a potentially beneficial to clinical care. This qualitative interview study addresses the gaps in knowledge regarding clinician attitudes toward co-leadership and how a co-leadership structure might be implemented within a maternity care setting. Twenty-five clinicians (midwives, obstetricians and anaesthetists) working in the birthing units of two tertiary maternity units were interviewed and a conventional content analysis conducted. Clinicians viewed co-leadership as potentially beneficial to patient care through improved leadership performance and co-leader back up behavior. Implementation of co-leadership was thought to require a supportive organizational culture, agreed patient management protocols and the participation in simulation training. Enacting co-leadership required adaptable leadership sharing practices, effective communication, and high levels of trust between the co-leaders. These findings inform the future implementation strategies for co-leadership in interprofessional healthcare teams.

A report on virtual 'Can't intubate, can't oxygenate' conference workshops at the 2021 Annual Scientific Meeting of the Australian and New Zealand College of Anaesthetists.

The COVID-19 pandemic has had profound implications for continuing medical education. Travel restrictions, lockdowns and social distancing in an effort to curb spread have meant that medical conferences have been postponed or cancelled. When the Australian and New Zealand College of Anaesthetists made the decision to commit to a fully virtual 2021 Annual Scientific Meeting, the organising committee investigated the viability of presenting a virtual 'Can't intubate, can't oxygenate' workshop. A workshop was designed comprising a lecture, case scenario discussion and demonstration of emergency front-of-neck access techniques broadcast from a central hub before participants separated into Zoom® (Zoom Video Communications, San Jose, CA, USA) breakout rooms for hands-on practice, guided by facilitators working virtually from their own home studios. Kits containing equipment including a 3D printed larynx, cannula, scalpel and bougie were sent to workshop participants in the weeks before the meeting. Participants were asked to complete pre- and post-workshop surveys. Of 42 participants, 32 responded, with the majority rating the workshop 'better than expected'. All except two respondents felt the workshop met learning objectives. Themes of positive feedback included being impressed with the airway model, the small group size, content and delivery. Feedback focused on previously unperceived advantages of virtual technical skills workshops, including convenience, equitable access and the reusable airway model. Disadvantages noted by respondents included lack of social interaction, inability to trial more expensive airway equipment, and some limitations of the ability of facilitators to review participants' technique. Despite limitations, in our experience, virtual workshops can be planned with innovative solutions to deliver technical skills education successfully.

Exploring and mapping chemical space with molecular assembly trees.

The rule-based search of chemical space can generate an almost infinite number of molecules, but exploration of known molecules as a function of the minimum number of steps needed to build up the target graphs promises to uncover new motifs and transformations. Assembly theory is an approach to compare the intrinsic complexity and properties of molecules by the minimum number of steps needed to build up the target graphs. Here, we apply this approach to prebiotic chemistry, gene sequences, plasticizers, and opiates. This allows us to explore molecules connected to the assembly tree, rather than the entire space of molecules possible. Last, by developing a reassembly method, based on assembly trees, we found that in the case of the opiates, a new set of drug candidates could be generated that would not be accessible via conventional fragment-based drug design, thereby demonstrating how this approach might find application in drug discovery.

The use of ecological models to assess the effects of a plant protection product on ecosystem services provided by an orchard.

The objective of this case study was to explore the feasibility of using ecological models for applying an ecosystem services-based approach to environmental risk assessment using currently available data and methodologies. For this we used a 5 step approach: 1) selection of environmental scenario, 2) ecosystem service selection, 3) development of logic chains, 4) selection and application of ecological models and 5) detailed ecosystem service assessment. The study system is a European apple orchard managed according to integrated pest management principles. An organophosphate insecticide was used as the case study chemical. Four ecosystem services are included in this case study: soil quality regulation, pest control, pollination and recreation. Logic chains were developed for each ecosystem service and describe the link between toxicant effects on service providing units and ecosystem services delivery. For the soil quality regulation ecosystem service, springtails and earthworms were the service providing units, for the pest control ecosystem service it was ladybirds, for the pollination ecosystem service it was honeybees and for the recreation ecosystem service it was the meadow brown butterfly. All the ecological models addressed the spatio-temporal magnitude of the direct effects of the insecticide on the service providing units and ecological production functions were used to extrapolate these outcomes to the delivery of ecosystem services. For all ecosystem services a decision on the acceptability of the modelled and extrapolated effects on the service providing units could be made using the protection goals as set by the European Food Safety Authority (EFSA). Developing quantitative ecological production functions for extrapolation of ecosystem services delivery from population endpoints remains one of the major challenges. We feel that the use of ecological models can greatly add to this development, although the further development of existing ecological models, and of new models, is needed for this.

Child Fluoride Varnish Programs Implementation: A Consensus Workshop and Actions to Increase Scale-Up in Australia.

This paper presents the findings of the National Fluoride Varnish Workshop in 2018 along with subsequent actions to scale-up the use of fluoride varnish nationally in Australia. The use of fluoride varnish programs to prevent dental caries in high-risk child populations is an evidence-based population health approach used internationally. Such programs have not been implemented at scale nationally in Australia. A National Fluoride Varnish Consensus Workshop was held in Sydney in November 2018 with an aim of sharing the current work in this area being undertaken by various Australian jurisdictions and seeking consensus on key actions to improve the scale-up nationally. Forty-four people attended the Workshop with oral health representatives from all Australian state and territory health departments, as well as the Australian Dental Association (ADA) at both NSW branch and Federal levels. There was strong support for further scale-up of fluoride varnish programs nationally and to see the wider use of having non-dental professionals apply the varnish. This case study identifies key actions required to ensure scale-up of systematic fluoride varnish programs as part of a strategic population oral health approach to preventing dental caries among high-risk children who may not routinely access dental care.

Early infestations by arthropod pests induce unique changes in plant compositional traits and leaf reflectance.

BACKGROUND: With steadily growing interest in the use of remote-sensing technologies to detect and diagnose pest infestations in crops, it is important to investigate and characterize possible associations between crop leaf reflectance and unique pest-induced changes in plant compositional traits. Accordingly, we compiled plant compositional traits from chrysanthemum and gerbera plants in four treatments: non-infested, or infested with mites, thrips or whiteflies, and we acquired hyperspectral leaf reflectance data from the same plants over time (0-14 days). RESULTS: Plant compositional traits changed significantly in response to arthropod infestations, and individual chrysanthemum and gerbera plants were classified with 78% and 80% accuracy, respectively. Based on leaf reflectance, individual plants from the four treatments were classified with moderate accuracy levels of 76% (gerbera) and 73% (chrysanthemum) but with a clear distinction between non-infested and infested plants. Accurate and consistent diagnosis of biotic stressors was not achieved. CONCLUSION: To our knowledge, this is the first study in which infestations by multiple economically important arthropod pests are directly compared and associated with leaf reflectance responses and changes in plant compositional traits. It is important to highlight that imposed stress levels were low, period of infestation was short, and hyperspectral remote-sensing data were acquired at four time points with analyses based on large data sets (3826 leaf reflectance profiles for chrysanthemum and 4041 for gerbera). This study provides novel insight into crop responses to different biotic stressors and into possible associations between plant compositional traits and hyperspectral leaf reflectance data acquired from crop leaves.

Assessing chemical risk within an ecosystem services framework: Implementation and added value.

An ecosystem services (ES) approach to chemical risk assessment has many potential advantages, but there are also substantial challenges regarding its implementation. We report the findings of a multi-stakeholder workshop that evaluated the feasibility of adopting an ES approach to chemical risk assessment using currently available tools and data. Also evaluated is the added value such an approach would bring to environmental decision making. The aim was to build consensus across disparate stakeholders and to co-produce a common understanding of the regulatory benefits and feasibility of implementing an ES approach in European chemicals regulation. Workshop discussions were informed by proof of concept studies and resulted in the development of a novel tiered framework for assessing chemical risk to ES delivery. There was consensus on the substantial added value of adopting an ES-based approach for regulatory decision making. Ecosystem services provide a common currency and a 'unifying approach' across environmental compartments, stressors and regulatory frameworks. The ES approach informs prioritisation of risk and remedial action and aids risk communication and risk management. It facilitates a more holistic assessment, enables ES trade-offs to be compared across alternative interventions, and supports comparative risk assessments and a socio-economic analysis of management options and decisions. Key to realising this added value is a shift away from using a single threshold value to categorise risk, towards a consideration of the exposure-effect distribution for individual ES of interest. Also required is the development of an integrated systems-level approach across regulatory frameworks and agreement on specific protection goals and scenarios for framing environmental risk assessments. The need to further develop tools for extrapolating toxicity data to service providers and ES delivery, including logic chains and ecological production functions, was highlighted. Also agreed was the need for methods and metrics for ES valuation to be used in assessing trade-offs.

Assessing the feasibility and value of employing an ecosystem services approach in chemical environmental risk assessment under the Water Framework Directive.

The feasibility and added value of an ecosystem services approach in retrospective environmental risk assessment were evaluated using a site-specific case study in a lowland UK river. The studied water body failed to achieve good ecological status temporarily in 2018, due in part to the exceedance of the environmental quality standard (annual average EQS) for zinc. Potential ecosystem service delivery was quantified for locally prioritised ecosystem services: regulation of chemical condition; maintaining nursery populations and habitats; recreational fishing; nature watching. Quantification was based on observed and expected taxa or functional groups within WFD biological quality elements, including macrophytes, benthic macroinvertebrates and fish, and on published functional trait data for constituent taxa. Benthic macroinvertebrate taxa were identified and enumerated before, during and after zinc EQS exceedance, enabling a generic retrospective risk assessment for this biological quality element, which was found to have good ecosystem service potential. An additional targeted risk assessment for zinc was based on laboratory-based species sensitivity distributions normalised using biotic-ligand modelling to account for site-specific, bioavailability-corrected zinc exposure. Risk to ecosystem services for diatoms (microalgae) was found to be high, while risks for benthic macroinvertebrates and fish were found to be low. The status of potential ecosystem service delivery (ESD) by fish was equivalent to high ecological status defined under the WFD, while ESD was higher for benthic macroinvertebrates than defined by WFD methods. The illustrated ecosystem services approach uses readily available data and adds significantly to the taxonomic approach currently used under the WFD by using functional traits to evaluate services that are prioritised as being important in water bodies. The main shortcomings of the illustrated approach were lack of: representation of bacteria and fungi; WFD predicted species lists for diatoms and macrophytes; site-specific functional trait data required for defining actual (rather than potential) ecosystem service delivery.

Identifying molecules as biosignatures with assembly theory and mass spectrometry.

The search for alien life is hard because we do not know what signatures are unique to life. We show why complex molecules found in high abundance are universal biosignatures and demonstrate the first intrinsic experimentally tractable measure of molecular complexity, called the molecular assembly index (MA). To do this we calculate the complexity of several million molecules and validate that their complexity can be experimentally determined by mass spectrometry. This approach allows us to identify molecular biosignatures from a set of diverse samples from around the world, outer space, and the laboratory, demonstrating it is possible to build a life detection experiment based on MA that could be deployed to extraterrestrial locations, and used as a complexity scale to quantify constraints needed to direct prebiotically plausible processes in the laboratory. Such an approach is vital for finding life elsewhere in the universe or creating de-novo life in the lab.

Shared Leadership in Healthcare Action Teams: A Systematic Review.

OBJECTIVES: The aims of this review were to consolidate the reported literature describing shared leadership in healthcare action teams (HCATs) and to review the reported outcomes related to leadership sharing in healthcare emergencies. METHODS: A systematic search of the English language literature before November 2017 was performed using PsycINFO, MEDLINE, PubMed, CINAHL, and EMBASE. Articles describing sharing of leadership functions in HCATs were included. Healthcare teams performing routine work were excluded. Studies were reviewed for type of leadership sharing and sharing-related outcomes. RESULTS: Thirty-three articles met the inclusion criteria. A variety of shared leadership models were described across the following three categories: spontaneous collaboration, intuitive working relations, and institutionalized practices. While leadership sharing has the potential for both positive and negative influences on team performance, only six articles reported outcomes potentially attributable to shared leadership. CONCLUSIONS: Despite strong evidence for a positive relationship between shared leadership and team performance in other domains, there is limited literature describing shared leadership models in HCATs. The association between shared leadership and team performance in HCATs is a rich area for further investigation.

Preliminary report of a simulation community of practice needs analysis.

AIM: To understand the current needs related to education and training, and other investment priorities, in simulated learning environments in Australia following a significant period of government funding for simulation-based learning. METHODS: A mixed methods study, comprising qualitative focus groups and individual interviews, followed by a quantitative cross-sectional survey informed by themes emerging from the qualitative data. FINDINGS: Two focus groups and 22 individual interviews were conducted. Participants included simulation educators, technical users and new adopters. Survey data were collected from 152 responses. Barriers at the introduction and maintenance stages of simulated learning included irregular staff training resulting in inconsistent practice, and lack of onsite technical support. Educators lacked skills in some simulation and debriefing techniques, and basic education and research skills were limited, while technicians raised concerns regarding the maintenance of equipment and managing budgets. DISCUSSION AND CONCLUSION: Despite its effectiveness as an education tool, barriers remain at the introduction and maintenance stages of simulated learning environments. Efforts to improve the integrity and sustainability of simulation training should be informed by a comprehensive needs analysis. The resulting data should be used to address barriers in a way that maximises the limited resources and funding available for this important learning tool.