691 research outputs found
Three years of Extreme Physiology & Medicine
No full text© 2015 Grocott and Montgomery. This article is distributed under the terms of the Creative Commons Attribution 4.0 Interna‑
tional License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in
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mons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecom‑
mons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated
Standardisation of perioperative outcome measures
No full textComment on : Standards for definitions and use of outcome measures for clinical effectiveness research in perioperative medicine: European Perioperative Clinical Outcome (EPCO) definitions: a statement from the ESA-ESICM joint taskforce on perioperative outcome measures. [Eur J Anaesthesiol. 2015
Survival after postoperative morbidity: a longitudinal observational cohort study.
No full textBACKGROUND: Previous studies have suggested that there may be long-term harm associated with postoperative complications. Uncertainty exists however, because of the need for risk adjustment and inconsistent definitions of postoperative morbidity. METHODS: We did a longitudinal observational cohort study of patients undergoing major surgery. Case-mix adjustment was applied and morbidity was recorded using a validated outcome measure. Cox proportional hazards modelling using time-dependent covariates was used to measure the independent relationship between prolonged postoperative morbidity and longer term survival. RESULTS: Data were analysed for 1362 patients. The median length of stay was 9 days and the median follow-up time was 6.5 yr. Independent of perioperative risk, postoperative neurological morbidity (prevalence 2.9%) was associated with a relative hazard for long-term mortality of 2.00 [P=0.001; 95% confidence interval (CI) 1.32-3.04]. Prolonged postoperative morbidity (prevalence 15.6%) conferred a relative hazard for death in the first 12 months after surgery of 3.51 (P<0.001; 95% CI 2.28-5.42) and for the next 2 yr of 2.44 (P<0.001; 95% CI 1.62-3.65), returning to baseline thereafter. CONCLUSIONS: Prolonged morbidity after surgery is associated with a risk of premature death for a longer duration than perhaps is commonly thought; however, this risk falls with time. We suggest that prolonged postoperative morbidity measured in this way may be a valid indicator of the quality of surgical healthcare. Our findings reinforce the importance of research and quality improvement initiatives aimed at reducing the duration and severity of postoperative complications
Attachment formation during partitioning of oblique convergence in the Ketilidian orogen, south Greenland
No full textSubhorizontal attachment zones provide coupling between lithospheric layers in orogenic belts. A mid-crustal attachment zone is exposed in the Palaeoproterozoic Ketilidian orogen, south Greenland, which formed as a result of north-directed oblique convergence at a cordilleran-type margin. Rifting (c. 2.1 Ga) and compressional deformation and magmatism (> 1850 Ma) on the continental margin was followed by an extended sinistral transpression from 1850 to 1730 Ma now separated into three episodes or peaks of activity. The first episode was focused on the back-arc region and was followed by the main arc construction phase during which transpression was partitioned into strike-slip and contraction components. Despite the longevity of this active margin system, individual tectonic events took place rapidly, e.g. development of fore-arc D1-D3 and accompanying high-temperature, low-pressure metamorphism took place over c. 12 Ma. We explain the fore-arc and batholith evolution by the upward migration of an underlying attachment structure through the upper crustal partitioned blocks. This migration may be attributed to an increase in the geothermal gradient accompanied by, or followed by, exhumation of the mid-crust. The partially molten, hence weak, attachment zone solidified and strengthened during cooling before emplacement of the post-orogenic rapakivi suite during the third distinct phase of mild sinistral transpression
Variation of Saturn's UV aurora with SKR phase
No full textpeer reviewedIt is well known that a wide range of kronian magnetospheric phenomena, including the Saturn kilometric radiation (SKR), exhibit oscillations near the planetary rotation period. However, although the SKR is believed to be generated by unstable auroral electrons, no connection has been established to date between diurnal SKR modulations and UV auroral power. We use an empirical SKR phase determined from Cassini observations to order the 'quiet time' total emitted UV auroral power as observed by the Hubble Space Telescope in programs during the interval 2005-2009. Our results indicate that both the northern and southern UV powers are dependent on SKR phase, varying diurnally by factors of similar to 3. We also show that the UV variation originates principally from the morning half of the oval, consistent with previous observations of the SKR sources. Citation: Nichols, J. D., B. Cecconi, J. T. Clarke, S. W. H. Cowley, J.-C. Gerard, A. Grocott, D. Grodent, L. Lamy, and P. Zarka (2010), Variation of Saturn's UV aurora with SKR phase, Geophys. Res. Lett., 37, L15102, doi: 10.1029/2010GL044057
The wound dressing supply chain within England's National Health Service: unravelling the context for users
No full textAim: to explore the representation of user needs (nurses and patients, both individuals and groups) at the industrial (wound dressing manufacture) and National Health Service interface.Main issues: the wound dressing supply chain is outlined, tracking organizational changes. The methods that are used to transfer user information between industries that produce dressings and those using the products are reviewed in terms of their ability to communicate what users need from dressings. Organizational policies and systems are outlined, with the focus on their role in facilitating the communication of user needs.Conclusion: methods for generating user information that can directly inform dressing design are needed together with interactive communication routes within the supply chain, specifically between users, manufacturers, purchasers and suppliers. This will facilitate dual benefits for nursing management through improvements in purchasing decisions and nurses’ management of wound car
Towards a synthesis of substorm electrodynamics : HF radar and auroral observations
No full textAt 08:35 UT on 21 November 2004, the onset of an interval of substorm activity was captured in the southern hemisphere by the Far UltraViolet (FUV) instrument on board the IMAGE spacecraft. This was accompanied by the onset of Pi2 activity and subsequent magnetic bays, evident in ground magnetic data from both hemispheres. Further intensifications were then observed in both the auroral and ground magnetic data over the following ~3 h. During this interval the fields-of-view of the two southern hemisphere Tasman International Geospace Enviroment Radars (TIGER) moved through the evening sector towards midnight. Whilst initially low, the amount of backscatter from TIGER increased considerably during the early stages of the expansion phase such that by ~09:20 UT an enhanced dusk flow cell was clearly evident. During the expansion phase the equatorward portion of this flow cell developed into a narrow high-speed flow channel, indicative of the auroral and sub-auroral flows identified in previous studies (e.g. Freeman et al., 1992; Parkinson et al., 2003). At the same time, higher latitude transient flow features were observed and as the interval progressed the flow reversal region and Harang discontinuity became very well defined. Overall, this study has enabled the spatial and temporal development of many different elements of the substorm process to be resolved and placed within a simple conceptual framework of magnetospheric convection. Specifically, the detailed observations of ionospheric flows have illustrated the complex interplay between substorm electric fields and associated auroral dynamics. They have helped define the distinct nature of different substorm current systems such as the traditional substorm current wedge and the more equatorward currents associated with polarisation electric fields. Additionally, they have revealed a radar signature of nightside reconnection which provides the promise of quantifying nightside reconnection in a way which has already proved extremely successful in studies of the dayside magnetosphere
Disconnection: the user voice within the wound dressing supply chain
No full textAim: this study examined the user voice in England’s National Health Service (NHS) wound dressing supply chain.Background: the impetus for this work came from involvement in a collaboration between industry and clinicians, entitled Woundcare Research for Appropriate Products. Experiences from that study highlighted the notable absence of research about the impact of the supply chain on the users of dressings.Method: interview data are presented following an outline of the grounded theory method used. These data were obtained from key stakeholders (n = 41) within the wound dressing supply chain such as nurses, manufacturers, distributors, professional organizations, government organizations and user groups.Results: the consequences of supply disconnection revealed haphazard supply, unmet user needs and lack of information transfer between player groups.Conclusions and implications for nursing management: these consequences explain the lack of user voice in the supply chain and have far-reaching implications for nursing management, through purchasing decisions and nurses’ management of wound car
Cardiopulmonary exercise testing for the evaluation of perioperative risk in non-cardiopulmonary surgery
No full textThe use of cardiopulmonary exercise testing (CPET) as a preoperative risk stratification tool for a range of non-cardiopulmonary surgery is increasing. The utility of CPET in this role is dependent on the technology being able to identify accurately and reliably those patients at increased risk of perioperative events when compared with existing risk stratification tools. This article identifies and reviews systematically the current literature regarding the use of CPET as a preoperative tool for stratifying risk in major non-cardiopulmonary surgery. Specifically, it focuses on evaluating the capacity of CPET variables to predict the risk of postoperative complications and mortality in comparison to other methods of risk assessment. Furthermore, the potential for combining results from CPET and non-CPET methods of risk prediction to enhance the capacity to identify high risk patients is considered. The review indicates that CPET can identify patients at increased risk of adverse perioperative outcomes. However, the selection of variables and threshold values to indicate high risk differ for different surgical procedures and underlying conditions. Furthermore, the available data suggest that CPET variables outperform alternative methods of preoperative risk stratification. Several studies also identify that CPET variables may be used in combination with non-CPET variables to increase perioperative risk prediction accuracy. These findings illustrate that CPET has the capacity to identify patients at increased risk of adverse outcome before a range of non-cardiopulmonary surgical procedures. Further research is required to optimise its use, potentially by combining CPET results with alternative methods of risk stratification
Isolated generalized tonic-clonic seizure at high altitude in a young male trekker with a positive family history of seizure.
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