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Tracheal intubation is a high-risk intervention for exposure to airborne infective pathogens, including the novel coronavirus disease 2019 (COVID-19). During the recent pandemic, personal protective equipment (PPE) was essential to protect staff during intubation but is recognized to make the practical conduct of anesthesia and intubation more difficult. In the early phase of the coronavirus pandemic, some simple alterations were made to the emergency anesthesia standard operating procedure (SOP) of a prehospital critical care service to attempt to maintain high intubation success rates despite the challenges posed by wearing PPE. This retrospective observational cohort study aims to compare first-pass intubation success rates before and after the introduction of PPE and an altered SOP.
Methodology:
A retrospective observational cohort study was conducted from January 1, 2019 through August 30, 2021. The retrospective analysis used prospectively collected data using prehospital electronic patient records. Anonymized data were held in Excel (v16.54) and analyzed using IBM SPSS Statistics (v28). Patient inclusion criteria were those of all ages who received a primary tracheal intubation attempt outside the hospital by critical care teams. March 27, 2020 was the date from which the SOP changed to mandatory COVID-19 SOP including Level 3 PPE – this date is used to separate the cohort groups.
Results:
Data were analyzed from 1,266 patients who received primary intubations by the service. The overall first-pass intubation success rate was 89.7% and the overall intubation success rate was 99.9%. There was no statistically significant difference in first-pass success rate between the two groups: 90.3% in the pre-COVID-19 group (n = 546) and 89.3% in the COVID-19 group (n = 720); Pearson chi-square 0.329; P = .566. In addition, there was no statistical difference in overall intubation success rate between groups: 99.8% in the pre-COVID-19 group and 100.0% in the COVID-19 group; Pearson chi-square 1.32; P = .251.
Non-drug-assisted intubations were more than twice as likely to require multiple attempts in both the pre-COVID-19 group (n = 546; OR = 2.15; 95% CI, 1.19-3.90; P = .01) and in the COVID-19 group (n = 720; OR = 2.5; 95% CI, 1.5-4.1; P = <.001).
Conclusion:
This study presents simple changes to a prehospital intubation SOP in response to COVID-19 which included mandatory use of PPE, the first intubator always being the most experienced clinician, and routine first use of video laryngoscopy (VL). These changes allowed protection of the clinical team while successfully maintaining the first-pass and overall success rates for prehospital tracheal intubation.
A nonlinear ensemble-variational data assimilation is performed in order to estimate the unknown flow field over a slender cone at Mach 6, from isolated wall-pressure measurements. The cost functional accounts for discrepancies in wall-pressure spectra and total intensity between the experiment and the prediction using direct numerical simulations, as well as our relative confidence in the measurements and the estimated state. We demonstrate the robustness of the predicted flow by direct propagation of posterior statistics. The approach provides a unique first look at the flow beyond the sensor data, and rigorously accounts for the role of nonlinearity, unlike previous efforts that adopted ad hoc inflow syntheses. Away from the wall, two- and three-dimensional assimilated states both show rope-like structures, qualitatively similar to independent schlieren visualizations. Despite this resemblance, and even though the planar second modes are the most unstable upstream, three-dimensional waves must be included in the assimilation in order to accurately reproduce the wall-pressure measurements recorded in the AFRL Ludwieg Tube facility. The results highlight the importance of three-dimensionality of the field and of the base-state distortion on the instability waves in this experiment, and motivate future measurements that probe the three-dimensional nature of the flow field.
Background: The estimated economic cost of Clostridioides difficile infection (CDI) is $5.4 billion annually, primarily attributed to acute-care costs. We previously reported data from ECOSPOR III that SER-109, an investigational oral microbiome therapeutic, was superior to placebo in reducing recurrent CDI (rCDI) in adults at 8 weeks after treatment, with a 68% relative risk reduction. Adults with rCDI have more hospitalizations and emergency room (ER) visits (defined herein as healthcare resource utilization, HRU) compared to those without recurrence. Thus, we evaluated incidence of HRU. Methods: Adults with rCDI (≥3 episodes in 12 months) were screened at 56 US and Canadian sites and were randomized 1:1 to SER-109 (4 capsules × 3 days) or placebo following resolution of CDI with standard-of-care CDI antibiotics. The primary end point was rCDI at 8 weeks. Exploratory end points included cumulative incidence of hospitalizations through 24 weeks after treatment. Here, we report cumulative incidence of all-cause HRU through 8 weeks after treatment. Results: In total, 281 patients were screened and 182 were randomized (59.9% female; mean age 65.5 years; 98.9% outpatient). Overall, 31 patients (17%) had 38 hospitalizations or ER visits through week 8 (11 events in 10 SER-109 patients and 27 events in 21 placebo patients) (Table 1). The cumulative incidence of HRU was lower in SER-109–treated patients compared to placebo at both weeks 4 and 8 with most events (65.8%) recorded within 4 weeks after treatment. The adjusted HRU incidence rate (by person time, age, sex, and antibiotic use) was also lower in SER-109–treated patients compared to placebo at weeks 4 and 8 (0.256 [95% CI, 0.096–0.683] versus 0.417 [95% CI, 0.199–0.873], respectively). Conclusions: SER-109–treated patients had less HRU compared to placebo patients through 8 weeks after treatment in this mostly outpatient population. These data suggest a potential benefit of SER-109 in reducing HRU, thus lowering the healthcare burden of rCDI.
A national survey characterized training and career development for translational researchers through Clinical and Translational Science Award (CTSA) T32/TL1 programs. This report summarizes program goals, trainee characteristics, and mentorship practices.
Methods:
A web link to a voluntary survey was emailed to 51 active TL1 program directors and administrators. Descriptive analyses were performed on aggregate data. Qualitative data analysis used open coding of text followed by an axial coding strategy based on the grounded theory approach.
Results:
Fifty out of 51 (98%) invited CTSA hubs responded. Training program goals were aligned with the CTSA mission. The trainee population consisted of predoctoral students (50%), postdoctoral fellows (30%), and health professional students in short-term (11%) or year-out (9%) research training. Forty percent of TL1 programs support both predoctoral and postdoctoral trainees. Trainees are diverse by academic affiliation, mostly from medicine, engineering, public health, non-health sciences, pharmacy, and nursing. Mentor training is offered by most programs, but mandatory at less than one-third of them. Most mentoring teams consist of two or more mentors.
Conclusions:
CTSA TL1 programs are distinct from other NIH-funded training programs in their focus on clinical and translational research, cross-disciplinary approaches, emphasis on team science, and integration of multiple trainee types. Trainees in nearly all TL1 programs were engaged in all phases of translational research (preclinical, clinical, implementation, public health), suggesting that the CTSA TL1 program is meeting the mandate of NCATS to provide training to develop the clinical and translational research workforce.
Aquí presentamos el descubrimiento de una banca jeroglífica esculpida del sitio maya de Ixtutz, Petén, Guatemala. Analizamos la inscripción jeroglífica en la banca y discutimos la historia del objecto en el contexto de su producción, su desmantelamiento y reutilización subsecuente, y la remoción de unas piezas del sitio. Mostramos que dos bloques inscritos de caliza, uno de ellos en una colección privada en Bruselas y el otro en el Los Angeles County Museum of Art, Los Angeles, California, pertenecen al mismo trono, y llamamos para su repatriación voluntaria a Guatemala.
The Variables and Slow Transients Survey (VAST) on the Australian Square Kilometre Array Pathfinder (ASKAP) is designed to detect highly variable and transient radio sources on timescales from 5 s to
$\sim\!5$
yr. In this paper, we present the survey description, observation strategy and initial results from the VAST Phase I Pilot Survey. This pilot survey consists of
$\sim\!162$
h of observations conducted at a central frequency of 888 MHz between 2019 August and 2020 August, with a typical rms sensitivity of
$0.24\ \mathrm{mJy\ beam}^{-1}$
and angular resolution of
$12-20$
arcseconds. There are 113 fields, each of which was observed for 12 min integration time, with between 5 and 13 repeats, with cadences between 1 day and 8 months. The total area of the pilot survey footprint is 5 131 square degrees, covering six distinct regions of the sky. An initial search of two of these regions, totalling 1 646 square degrees, revealed 28 highly variable and/or transient sources. Seven of these are known pulsars, including the millisecond pulsar J2039–5617. Another seven are stars, four of which have no previously reported radio detection (SCR J0533–4257, LEHPM 2-783, UCAC3 89–412162 and 2MASS J22414436–6119311). Of the remaining 14 sources, two are active galactic nuclei, six are associated with galaxies and the other six have no multi-wavelength counterparts and are yet to be identified.
Lidar reveals the presence of a precinct at the Classic Maya city of Tikal that probably reproduces the Ciudadela and Temple of the Feathered Serpent at the imperial capital of Teotihuacan.
Coronavirus disease 2019 (COVID-19) vaccination effectiveness in healthcare personnel (HCP) has been established. However, questions remain regarding its performance in high-risk healthcare occupations and work locations. We describe the effect of a COVID-19 HCP vaccination campaign on SARS-CoV-2 infection by timing of vaccination, job type, and work location.
Methods:
We conducted a retrospective review of COVID-19 vaccination acceptance, incidence of postvaccination COVID-19, hospitalization, and mortality among 16,156 faculty, students, and staff at a large academic medical center. Data were collected 8 weeks prior to the start of phase 1a vaccination of frontline employees and ended 11 weeks after campaign onset.
Results:
The COVID-19 incidence rate among HCP at our institution decreased from 3.2% during the 8 weeks prior to the start of vaccinations to 0.38% by 4 weeks after campaign initiation. COVID-19 risk was reduced among individuals who received a single vaccination (hazard ratio [HR], 0.52; 95% confidence interval [CI], 0.40–0.68; P < .0001) and was further reduced with 2 doses of vaccine (HR, 0.17; 95% CI, 0.09–0.32; P < .0001). By 2 weeks after the second dose, the observed case positivity rate was 0.04%. Among phase 1a HCP, we observed a lower risk of COVID-19 among physicians and a trend toward higher risk for respiratory therapists independent of vaccination status. Rates of infection were similar in a subgroup of nurses when examined by work location.
Conclusions:
Our findings show the real-world effectiveness of COVID-19 vaccination in HCP. Despite these encouraging results, unvaccinated HCP remain at an elevated risk of infection, highlighting the need for targeted outreach to combat vaccine hesitancy.
Patients with single-ventricle CHD undergo a series of palliative surgeries that culminate in the Fontan procedure. While the Fontan procedure allows most patients to survive to adulthood, the Fontan circulation can eventually lead to multiple cardiac complications and multi-organ dysfunction. Care for adolescents and adults with a Fontan circulation has begun to transition from a primarily cardiac-focused model to care models, which are designed to monitor multiple organ systems, and using clues from this screening, identify patients who are at risk for adverse outcomes. The complexity of care required for these patients led our centre to develop a multidisciplinary Fontan Management Programme with the primary goals of earlier detection and treatment of complications through the development of a cohesive network of diverse medical subspecialists with Fontan expertise.
The first demonstration of laser action in ruby was made in 1960 by T. H. Maiman of Hughes Research Laboratories, USA. Many laboratories worldwide began the search for lasers using different materials, operating at different wavelengths. In the UK, academia, industry and the central laboratories took up the challenge from the earliest days to develop these systems for a broad range of applications. This historical review looks at the contribution the UK has made to the advancement of the technology, the development of systems and components and their exploitation over the last 60 years.
This chapter provides an overview of body image disorders as they pertain to men. Body image encapsulates thoughts, beliefs, and feelings about one’s physical appearance. For some men, these thoughts, beliefs, and feelings are neutral, or even positive. This is ideal, insofar as one’s body ought to be a functional and useful asset that allows an individual to live life on their own terms. Yet for others, these thoughts, beliefs, and feelings are decidedly negative.
Advanced imaging techniques are enhancing research capacity focussed on the developmental origins of adult health and disease (DOHaD) hypothesis, and consequently increasing awareness of future health risks across various subareas of DOHaD research themes. Understanding how these advanced imaging techniques in animal models and human population studies can be both additively and synergistically used alongside traditional techniques in DOHaD-focussed laboratories is therefore of great interest. Global experts in advanced imaging techniques congregated at the advanced imaging workshop at the 2019 DOHaD World Congress in Melbourne, Australia. This review summarizes the presentations of new imaging modalities and novel applications to DOHaD research and discussions had by DOHaD researchers that are currently utilizing advanced imaging techniques including MRI, hyperpolarized MRI, ultrasound, and synchrotron-based techniques to aid their DOHaD research focus.
One of Nick’s key early achievements at QIMR was to establish a twin study on melanoma risk factors. The Brisbane Twin Nevus Study (BTNS) had an initial focus on nevus (mole) count in adolescents but, reflecting Nick’s broad interests, expanded in scope enormously over the decades. In the skin cancer arena, BTNS was essential to genetic discoveries in melanoma, eye color and pigmentation. Later studies amassed data on thousands of phenotypes, ranging from molecular phenotypes such as gene expression to studies where gene mapping findings in adolescents turned out to have translational potential in late-onset diseases. Nick’s twin data have formed the basis for an enormous range of discoveries, with Nick and his colleagues continuing to capitalize on these data.
Pharmacokinetics refers to the effects the body has upon a consumed drug, by considering a variety of processes which a dug undergoes during its time within the body. In contrast pharmacodynamics can be considered as the effects a drug has upon the body that has consumed it, by considering the drug’s effects at its principal sites of action. Safe and effective therapeutic management of drugs for individual patients requires application of pharmacokinetic and pharmacodynamic principles to enhance efficacy and minimize toxicity. Chapter 5 (Pharmacogenomics and Psychopharmacology) provides a detailed review of the genes relevant for drug absorption, distribution, metabolism and excretion. As such these issues are only dealt with briefly in this chapter.
This final chapter considers the future growth of data science and the role of information professionals as they continue to reposition themselves in the changing information ecosystem. Short of a worldwide catastrophe, it is impossible to see anything but the continued rapid growth of data over the coming years. Whatever measure is used, data production and consumption is expected to rise. For example, the Computer Information System Company (Cisco) predicts that by 2022 there will be more internet traffic per year than there was between 1984 and 2016 (Cooney, 2018).
The way particular sets of data are able to be used will differ. With the introduction of the GDPR access to personal data is already restricted, but whether we are talking big data, little data or some as yet unheralded type of data – there will be more data and more data science.
This growth will be accompanied by many opportunities for data science in the sciences, arts and humanities, as well as in homes, offices, businesses and of course libraries. Data science work has been described as the ‘sexiest job of the 21st century’ (Davenport and Patil, 2012), and while that is a description that is rarely levelled at library and information professionals, this book should have helped to persuade readers that there are opportunities for library and information professionals to help others apply data science methods, and to use data science methodologies in their own work.
This chapter consists of three parts:
a list of eight challenges facing data science; although it is a field in the ascendency, associated with progress and all things modern, it is essential that we are aware of some of the challenges data science continues to face, and don't get caught up in the more extreme hyperbole of the hype cycle
a list of ten steps that would-be library and information science professionals might take when embarking on a career in data science librarianship; as has been frequently expressed throughout this book, a lot falls under the data science umbrella, and the practical first steps are all too easily overlooked
a short call to play; there is no book or course that can give more than the most basic of introductions to data science.
Today there are vast quantities and varieties of data, with new data sources emerging all the time. This makes any attempt to provide an overview of data a futile and quickly outdated task. Therefore this chapter considers some of the data that is available according to three features: whether it is ‘big data’, its format, and its source.
‘Big data’ is typically used to describe the large quantities of data now being generated and the complex infrastructure needed for their collection and analysis, and it can be contrasted with small data sets that can be simply gathered and analysed on a desktop. Data format provides an overview of some of the ways data can appear, from tables of data in documents through to APIs and linked data. Finally data sources looks more closely at some of the sources of data that are currently publicly available, as well as some of the additional data a library or information professional may have access to.
Big data
The term ‘big data’ can be traced back to the mid-1990s (Kitchin and McArdle, 2016), although it really entered the public consciousness in 2012. The New York Times ran articles with titles such as ‘The Age of Big Data’ (Lohr, 2012a) and ‘How Big Data Became So Big’ (Lohr, 2012b); the Guardian had ‘Why Big Data is Now Such a Big Deal’ (Naughton, 2012b) and ‘Big Data: revolution by numbers’ (Naughton, 2012a); and Big Data, BigImpact (WEF, 2012) was a topic at Davos in 2012. Google Trends shows there was a rapid rise in online searches for the term over the year, and since then there has been a raft of popular science and business publications devoted to the subject: Big Data (Mayer-Schönberger and Cukier, 2013); Big Data (Marr, 2015); Big Data for Small Business for Dummies (Marr, 2016); and Big Data: does size matter? (Harkness, 2016).
Despite the rapid growth in the popularity of big data, pinning down what is meant by the term is more difficult.