Background Public reporting of mortality, Patient Safety Indicators (PSI) and hospital-acquired conditions (HACs) is the reality of quality measurement. A review of our department's data identified ...opportunities for improvement. We began a surgeon-led 100% review of mortality, PSIs, and HACs to improve patient care and surgeon awareness of these metrics. Study Design From December 2012 through August 2013, there were 11,899 patients cared for on 12 surgical services. A surgeon from each service led monthly reviews of all mortality, PSIs, or HACs with central reporting of preventability and coding accuracy. We compared the University HealthSystem Consortium observed-to-expected (OE) mortality ratios (mean <1 fewer observed than expected deaths) and University HealthSystem Consortium relative rankings (lower number is better) before and after implementation. Statistical significance was p < 0.05 by Poisson regression. Results Of the 11,899 patients in the study period, there were 235 deaths, 290 PSIs, and 26 HACs identified and reviewed. The most common PSIs were postoperative deep vein thrombosis/pulmonary thromboembolism (n = 75), respiratory failure (n = 61), hemorrhage/hematoma (n = 33), and accidental puncture/laceration (n = 33). Before December 20, 2012, the OE ratio for mortality was consistently >1, then fell and remained <1 during the study period (p < 0.05). The OE mortality ratio in the fourth quarter of 2012 was 1.14 and fell to 0.88, 0.91, and 0.75 in the first, second, and third quarters of calendar year 2013 (p < 0.05). The overall Inpatient Quality Indicators #90 (composite postoperative mortality rank) rankings increased from 109 of 118 in the third quarter of 2012 to 47 of 119 in the third quarter of 2013. Conclusions A surgeon-led systematic review of mortality, PSIs, and HACs improved our OE ratio and University HealthSystem Consortium postsurgical relative rankings. Surgeon engagement and ownership is critical for success.
Objectives
Specialist healthcare cannot be provided in all locations. Helicopters can help to reduce the inherent geographical inequity caused by long distances or difficult terrain. However, the ...selective use of aeromedical retrieval could lead to other forms of health disparities. The aim of this project was to evaluate such inequities in access to helicopter transport.
Methods
This was a geospatial analysis of publicly available flight tracking data for 18 emergency medical helicopters in the state of Alabama for a 90‐day period between March 2019 and June 2019. Data are presented as the number of incidents attended per population, by population (total, insured, and uninsured), as funnel plots, by county. This method allows the identification of positive and negative outliers.
Results
We identified 672 likely scene retrieval flights. Twelve counties were probable (outside of 99% confidence interval CI) high outliers (more helicopter retrievals than expected), and 4 were possible (outside of 95% CI) high outliers. There were 5 possible low outliers (fewer helicopter retrievals than expected) and 6 probable low outliers. Analysis by insurance status revealed similar results. However, there was no easily discernible geographic pattern to this variability.
Conclusion
There is considerable geographical variability in the number of helicopter retrievals, with no easily discernable pattern. Some of this variability may be due to differences in injury epidemiology, but others may be due to case selection. However, the present data are insufficient to come to firm conclusions, and additional study is warranted.
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BackgroundTrauma is a major public health issue. In 2015, the White House launched the “Stop the Bleed” (STB) campaign, which aims to equip would-be bystanders with the ability and equipment to ...assist in bleeding emergencies. This study sought to estimate the number of patients who might benefit from STB intervention, in an everyday setting, and their spatial injury profile.MethodsThis is a retrospective analysis of trauma registry and medical examiners’ data, collected between 2013 and 2017. The majority of patients were male. The median age was 32 years. Incidents were geocoded by ZIP code, and mapped using Quantum Geographic Information System (QGIS).ResultsWe identified 139 patients from medical examiner records and UAB’s trauma registry who might have benefitted from STB intervention. The number of incidents per year ranged from 22 to 35, averaging 2.3 incidents per month. There was no evidence of geographical clustering, although the small number of incidents precluded a formal geostatistical analysis.ConclusionThe number of patients who might benefit from STB interventions on a daily basis is small, and incident locations are difficult to predict. Educating the public in how to stop bleeding is appealing, but providing easy and widespread access to STB kits may be difficult. Although there are parallels to the provision of cardiopulmonary resuscitation and defibrillation for cardiac arrest, there are also differences, which should not be overlooked.
The Human Phenotype Ontology (HPO) project, available at http://www.human-phenotype-ontology.org, provides a structured, comprehensive and well-defined set of 10,088 classes (terms) describing human ...phenotypic abnormalities and 13,326 subclass relations between the HPO classes. In addition we have developed logical definitions for 46% of all HPO classes using terms from ontologies for anatomy, cell types, function, embryology, pathology and other domains. This allows interoperability with several resources, especially those containing phenotype information on model organisms such as mouse and zebrafish. Here we describe the updated HPO database, which provides annotations of 7,278 human hereditary syndromes listed in OMIM, Orphanet and DECIPHER to classes of the HPO. Various meta-attributes such as frequency, references and negations are associated with each annotation. Several large-scale projects worldwide utilize the HPO for describing phenotype information in their datasets. We have therefore generated equivalence mappings to other phenotype vocabularies such as LDDB, Orphanet, MedDRA, UMLS and phenoDB, allowing integration of existing datasets and interoperability with multiple biomedical resources. We have created various ways to access the HPO database content using flat files, a MySQL database, and Web-based tools. All data and documentation on the HPO project can be found online.
Diversity Oriented Clicking (DOC) is a unified click‐approach for the modular synthesis of lead‐like structures through application of the wide family of click transformations. DOC evolved from the ...concept of achieving “diversity with ease”, by combining classic C−C π‐bond click chemistry with recent developments in connective SuFEx‐technologies. We showcase 2‐Substituted‐Alkynyl‐1‐Sulfonyl Fluorides (SASFs) as a new class of connective hub in concert with a diverse selection of click‐cycloaddition processes. Through the selective DOC of SASFs with a range of dipoles and cyclic dienes, we report a diverse click‐library of 173 unique functional molecules in minimal synthetic steps. The SuFExable library comprises 10 discrete heterocyclic core structures derived from 1,3‐ and 1,5‐dipoles; while reaction with cyclic dienes yields several three‐dimensional bicyclic Diels–Alder adducts. Growing the library to 278 discrete compounds through late‐stage modification was made possible through SuFEx click derivatization of the pendant sulfonyl fluoride group in 96 well‐plates—demonstrating the versatility of the DOC approach for the rapid synthesis of diverse functional structures. Screening for function against MRSA (USA300) revealed several lead hits with improved activity over methicillin.
Diversity‐oriented clicking (DOC) is a unified click chemistry approach for the synthesis of diverse lead‐like structures. Herein DOC is showcased through the application of novel highly activated2‐substituted‐alkynyl‐1‐sulfonyl fluoride (SASF) hubs in combination with a range of selective and robust click cycloaddition reactions, delivering an unprecedented SuFExable library of functional biologically active lead structures.
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We describe and validate a Monte Carlo model to track
photons over the full range of solar wavelengths as they travel into
optically thick Antarctic blue ice. The model considers both reflection and
...transmission of radiation at the surface of blue ice, scattering by air
bubbles within it, and spectral absorption due to the ice. The ice surface is treated as planar whilst bubbles are considered to be spherical scattering
centres using the Henyey–Greenstein approximation. Using bubble radii and
number concentrations that are representative of Antarctic blue ice, we
calculate spectral albedos and spectrally integrated downwelling and
upwelling radiative fluxes as functions of depth and find that, relative to
the incident irradiance, there is a marked subsurface enhancement in the
downwelling flux and accordingly also in the mean irradiance. This is due to the interaction between the refractive air–ice interface and the scattering interior and is particularly notable at blue and UV wavelengths which correspond to the minimum of the absorption spectrum of ice. In contrast the absorption path length at IR wavelengths is short and consequently the attenuation is more complex than can be described by a simple Lambert–Beer style exponential decay law – instead we present a triple-exponential fit to the net irradiance against depth. We find that there is a moderate dependence on the solar zenith angle and surface conditions such as altitude and cloud optical depth. Representative broadband albedos for blue ice are calculated in the range from 0.585 to 0.621. For macroscopic absorbing inclusions we observe both geometry- and size-dependent self-shadowing that reduces the
fractional irradiance incident on an inclusion's surface. Despite this, the
inclusions act as local photon sinks and are subject to fluxes that are
several times the magnitude of the single-scattering contribution. Such
enhancement may have consequences for the energy budget in regions of the
cryosphere where particulates are present near the surface. These results
also have particular relevance to measurements of the internal radiation
field: account must be taken of both self-shadowing and the optical effect
of introducing the detector. Turning to the particular example of englacial
meteorites, our modelling predicts iron meteorites to reside at much reduced
depths than previously suggested in the literature (< 10 cm vs.
∼ 40 cm) and further shows a size dependency that may explain
the observed bias in their Antarctic size distribution.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
This study examines the adequacy of the existing Brewer network to supplement other networks from the ground and space to detect SO2 plumes of volcanic origin. It was found that large volcanic ...eruptions of the last decade in the Northern Hemisphere have a positive columnar SO2 signal seen by the Brewer instruments located under the plume. It is shown that a few days after the eruption the Brewer instrument is capable of detecting significant columnar SO2 increases, exceeding on average 2 DU relative to an unperturbed pre-volcanic 10-day baseline, with a mean close to 0 and σ = 0.46, as calculated from the 32 Brewer stations under study. Intercomparisons with independent measurements from the ground and space as well as theoretical calculations corroborate the capability of the Brewer network to detect volcanic plumes. For instance, the comparison with OMI (Ozone Monitoring Instrument) and GOME-2 (Global Ozone Monitoring Experiment-2) SO2 space-borne retrievals shows statistically significant agreement between the Brewer network data and the collocated satellite overpasses in the case of the Kasatochi eruption. Unfortunately, due to sparsity of satellite data, the significant positive departures seen in the Brewer and other ground networks following the Eyjafjallajökull, Bárðarbunga and Nabro eruptions could not be statistically confirmed by the data from satellite overpasses. A model exercise from the MACC (Monitoring Atmospheric Composition and Climate) project shows that the large increases in SO2 over Europe following the Bárðarbunga eruption in Iceland were not caused by local pollution sources or ship emissions but were clearly linked to the volcanic eruption. Sulfur dioxide positive departures in Europe following Bárðarbunga could be traced by other networks from the free troposphere down to the surface (AirBase (European air quality database) and EARLINET (European Aerosol Research Lidar Network)). We propose that by combining Brewer data with that from other networks and satellites, a useful tool aided by trajectory analyses and modelling could be created which can also be used to forecast high SO2 values both at ground level and in air flight corridors following future eruptions.
Groundwater abstracted from aquifers in the Vale of Pickering, North Yorkshire, UK and monitored over the period 2015–2022, shows evidence of variable but commonly high concentrations of dissolved ...CH4. Sampled groundwater from the Jurassic organic-rich Kimmeridge Clay Formation (boreholes up to 180 m depth) has concentrations up to 57 mg/L, and concentrations up to 59 mg/L are found in groundwater from underlying confined Corallian Group limestone (borehole depths 50–227 m). The high concentrations are mainly from boreholes in the central parts of the vale. Small concentrations of ethane (C2H6, up to 800 μg/L) have been found in the Kimmeridge Clay and confined Corallian groundwaters, and of propane (C3H8, up to 160 μg/L) in deeper boreholes (110–180 m) from these formations. The concentrations are typically higher in groundwater from the deeper boreholes and vary with hydrostatic pressure, reflecting the pressure control on CH4 solubility. The occurrences contrast with groundwater from shallow Quaternary superficial deposits which have low CH4 concentrations (up to 0.39 mg/L), and with the unconfined and semi-confined sections of the Corallian aquifer (up to 0.7 mg/L) around the margins of the vale. Groundwater from the Quaternary, Kimmeridge Clay formations and to a small extent the confined Corallian aquifer, supports local private-water supplies, that from the peripheral unconfined sections of Corallian also supports public supply for towns and villages across the region.
Dissolved methane/ethane (C1/C2) ratios and stable-isotopic compositions (δ13C-CH4, δ2H-CH4 and δ13C-CO2) suggest that the high-CH4 groundwater from both the Kimmeridge Clay and confined Corallian formations derives overwhelmingly from biogenic reactions, the methanogenesis pathway by CO2 reduction. A small minority of groundwater samples shows a more enriched δ13C-CH4 composition (−50 to −44 ‰) which has been interpreted as due to anaerobic or aerobic methylotrophic oxidation in situ or post-sampling oxidation, rather than derivation by a thermogenic route.
Few of the existing groundwater sites are proximal to abandoned or disused conventional hydrocarbon wells that exist in the region, and little evidence has been found for an influence on groundwater dissolved gases from these sites. The Vale of Pickering has also been under recent consideration for development of an unconventional hydrocarbon (shale-gas) resource. In this context, the monitoring of dissolved gases has been an important step in establishing the high-CH4 baseline of groundwaters from Jurassic deposits in the region and in apportioning their sources and mechanisms of genesis.
•High concentrations of methane found in groundwater from Jurassic aquifers, Yorkshire.•Ethane and minor propane also detected.•Concentrations vary with depth, pumping and inflows of water with differing chemistry.•C1/C2 ratios and methane isotopic compositions show dominance of biogenic methane.•Methane inferred to be generated by a CO2 reduction pathway.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Abstract
Iron-rich meteorites are significantly underrepresented in collection statistics from Antarctica. This has led to a hypothesis that there is a sparse layer of iron-rich meteorites hidden ...below the surface of the ice, thereby explaining the apparent shortfall. As standard Antarctic meteorite collecting techniques rely upon a visual surface search approach, the need has thus arisen to develop a system that can detect iron objects under a few tens of centimetres of ice, where the expected number density is of the order one per square kilometre. To help answer this hypothesis, a large-scale pulse induction metal detector array has been constructed for deployment in Antarctica. The metal detector array is 6 m wide, able to travel at 15 km h
-1
and can scan 1 km
2
in ~11 hours. This paper details the construction of the metal detector system with respect to design criteria, notably the ruggedization of the system for Antarctic deployment. Some preliminary results from UK and Antarctic testing are presented. We show that the system performs as specified and should reach the pre-agreed target of the detection of a 100 g iron meteorite at 300 mm when deployed in Antarctica.
Standardization of tumor assessment lays the foundation for validation of grading systems, permits reproducibility of oncologic studies among investigators, and increases confidence in the ...significance of study results. Currently, there is minimal methodological standardization for assessing tumors in veterinary medicine, with few attempts to validate published protocols and grading schemes. The current article attempts to address these shortcomings by providing standard guidelines for tumor assessment parameters and protocols for evaluating specific tumor types. More detailed information is available in the Supplemental Files, the intention of which is 2-fold: publication as part of this commentary, but more importantly, these will be available as “living documents” on a website (www.vetcancerprotocols.org), which will be updated as new information is presented in the peer-reviewed literature. Our hope is that veterinary pathologists will agree that this initiative is needed, and will contribute to and utilize this information for routine diagnostic work and oncologic studies. Journal editors and reviewers can utilize checklists to ensure publications include sufficient detail and standardized methods of tumor assessment. To maintain the relevance of the guidelines and protocols, it is critical that the information is periodically updated and revised as new studies are published and validated with the intent of providing a repository of this information. Our hope is that this initiative (a continuation of efforts published in this journal in 2011) will facilitate collaboration and reproducibility between pathologists and institutions, increase case numbers, and strengthen clinical research findings, thus ensuring continued progress in veterinary oncologic pathology and improving patient care.
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