Reversible pulmonary artery perfusion abnormalities in the postpartum period as a precursor to the development of pulmonary arterial hypertension

Deterioration, or a new presentation, of pulmonary arterial hypertension (PAH), are recognized complications of pregnancy. In this report, we describe a patient with a family history of PAH who developed peripartum breathlessness and hypoxemia with ventilation-perfusion mismatch but no evidence of thromboembolism or PAH. Significantly reduced perfusion at both lung bases was noted on perfusion scintigraphy and three-dimensional magnetic resonance (3D-MR) perfusion maps in the immediate postpartum period. These abnormalities spontaneously resolved by 16 weeks postpartum, consistent with reversible pulmonary abnormalities of pulmonary perfusion. However, she developed new breathlessness four years later and was found to have developed PAH. This case provides a mechanism which may contribute to the high mortality seen in pregnant patients with PAH in the peripartum period

CE17015

In the southwest of Ireland and the Celtic Sea (ICES Divisions VIIaS, g & j), herring are an important commercial species to the pelagic and polyvalent fleet. For a period in the 1970s and1980s, larval surveys were conducted for herring in this area. However, since 1989, acoustic surveys have been carried out, and currently are the only tuning indices available for this stock. In the Celtic Sea and VIIj, herring acoustic surveys have been carried out since 1989. Since 2004 the survey has been fixed in October and carried out onboard the RV Celtic Explorer. The geographical confines of the annual 21 day survey have been modified in recent years to include areas to the south of the main winter spawning grounds in an effort to identify the whereabouts of winter spawning fish before the annual inshore spawning migration. Spatial resolution of acoustic transects has been increased over the entire south coast survey area. The acoustic component of the survey has been further complemented since 2004 by detailed hydrographic, marine mammal and seabird surveys

Contributory factors in surgical incidents as delineated by a confidential reporting system

Background Confidential reporting systems play a key role in capturing information about adverse surgical events. However, the value of these systems is limited if the reports that are generated are not subjected to systematic analysis. The aim of this study was to provide the first systematic analysis of data from a novel surgical confidential reporting system to delineate contributory factors in surgical incidents and document lessons that can be learned. Methods One-hundred and forty-five patient safety incidents submitted to the UK Confidential Reporting System for Surgery over a 10-year period were analysed using an adapted version of the empirically-grounded Yorkshire Contributory Factors Framework. Results The most common factors identified as contributing to reported surgical incidents were cognitive limitations (30.09%), communication failures (16.11%) and a lack of adherence to established policies and procedures (8.81%). The analysis also revealed that adverse events were only rarely related to an isolated, single factor (20.71%) – with the majority of cases involving multiple contributory factors (79.29% of all cases had more than one contributory factor). Examination of active failures – those closest in time and space to the adverse event – pointed to frequent coupling with latent, systems-related contributory factors. Conclusions Specific patterns of errors often underlie surgical adverse events and may therefore be amenable to targeted intervention, including particular forms of training. The findings in this paper confirm the view that surgical errors tend to be multi-factorial in nature, which also necessitates a multi-disciplinary and system-wide approach to bringing about improvements

Carrier capture dynamics of InAs/GaAs quantum dots

Carrier dynamics of a 1.3 mu m InAs/GaAs quantum dot amplifier is studied using heterodyne pump-probe spectroscopy. Measurements of the recovery times versus injection current reveal a power law behavior predicted by a quantum dot rate equation model. These results indicate that Auger processes dominate the carrier dynamics. (c) 2007 American Institute of Physics. (DOI:10.1063/1.2715115

Sensitivity analysis of an Advanced Gas-cooled Reactor control rod model

A model has been made of the primary shutdown system of an Advanced Gas-cooled Reactor nuclear power station. The aim of this paper is to explore the use of sensitivity analysis techniques on this model. The two motivations for performing sensitivity analysis are to quantify how much individual uncertain parameters are responsible for the model output uncertainty, and to make predictions about what could happen if one or several parameters were to change. Global sensitivity analysis techniques were used based on Gaussian process emulation; the software package GEM-SA was used to calculate the main effects, the main effect index and the total sensitivity index for each parameter and these were compared to local sensitivity analysis results. The results suggest that the system performance is resistant to adverse changes in several parameters at once

Effect of orientation on broadband acoustic scattering of Antarctic krill Euphausia superba : implications for inverting zooplankton spectral

Author Posting. © Acoustical Society of America, 1998. This article is posted here by permission of Acoustical Society of America for personal use, not for redistribution. The definitive version was published in Journal of the Acoustical Society of America 104 (1998): 2121-2135, doi:10.1121/1.423726.Acoustic scattering experiments involving simultaneous acquisition of broadband echoes and video footage from several Antarctic krill were carried out to determine the effect of animal orientation on echo spectral structure. A novel video analysis technique, applied to extract krill angle of orientation corresponding to each insonification, revealed that echo spectra from krill near broadside incidence relative to the incident acoustic wave exhibited widely spaced, deep nulls, whereas off-broadside echo spectra had a more erratic structure, with several closely spaced nulls of variable depth. The pattern of changes in echo spectra with orientation for the experimentally measured acoustic returns was very similar to theoretically predicted patterns based on a distorted wave Born approximation (DWBA) model. Information contained in the broadband echo spectra of the krill was exploited to invert the acoustic returns for angle of orientation by applying a newly developed Covariance Mean Variance Classification (CMVC) approach, using generic and animal-specific theoretical and empirical model spaces. The animal-specific empirical model space was best able to invert for angle of orientation. The CMVC inversion technique can be implemented using a generic empirical model space to determine angle of orientation based on broadband echoes from individual zooplankton in the field.L.V.MT.’s research was supported by the Ocean Acoustics, Oceanic Biology and URIP programs of the Office of Naval Research Grant Nos. N00014-89-J-1729, N00014-95-1-0287, and N00014-92-J-1527, the Biological Oceanography program of the National Science Foundation Grant No. OCE-9201264, and the WHOI/MIT Joint Program Education Office

Role and application of three-dimensional transthoracic echocardiography in the assessment of left and right ventricular volumes and ejection fraction: a UK nationwide survey

Three-dimensional echocardiography (3DE) imaging has permitted advancements in the quantification of left ventricular (LV) and right ventricular (RV) volumes and ejection fraction. We evaluated the availability of 3DE equipment / analysis software, the integration of 3DE assessment of the LV and RV in routine clinical practice, current training provisions in 3DE, and aimed to ascertain barriers preventing the routine use of 3DE for volumetric analysis. Through the British Society of Echocardiography (BSE) regional representatives’ network, echocardiographers were invited to participate in an open online survey. A total of 181 participants from echocardiography departments in the United Kingdom (UK), the majority from tertiary centres (61%), completed the 28-question survey. For 3DE quantification, 3DE-LV was adopted more frequently than 3DE-RV (48% vs 11%, respectively). Imaging feasibility was a recognised factor in 3DE RV and LV adoption. Many respondents had access to 3D probes (93%). The largest observed barriers to 3DE routine use were training deficiencies, with 83% reporting they would benefit from additional training opportunities and the duration of time permitted for the scan, with 68% of responders reporting allowances of less than the BSE standard of 45–60 min per patient (8% < 30-min). Furthermore, of those respondents who had undertaken professional accreditation, competence in 3DE was not formally assessed in 89%. This UK survey also reported good accessibility to magnetic resonance imaging (72%), which was related to overall 3DE adoption. In summary, although 3DE is now readily available, it remains underutilised. Further training opportunities, integrated formal assessment, improved adoption of BSE minimum recommended scanning times, alongside industry and societal support, may increase 3DE utilisation in routine practice

A one health approach to strengthening antimicrobial stewardship in Wakiso District, Uganda

Antimicrobial stewardship (AMS), as one of the global strategies to promote responsible use of antimicrobials to prevent antimicrobial resistance (AMR), remains poor in many low-and middle-income countries (LMICs). We implemented a project aimed at strengthening AMS in Wakiso district, Uganda using a One Health approach. A total of 86 health practitioners (HPs), including animal health workers, and 227 community health workers (CHWs) participated in training workshops, and over 300 pupils from primary schools were sensitized on AMR, AMS, and infection prevention and control (IPC). We further established two multidisciplinary online communities of practice (CoPs) for health professionals and students, with a current membership of 321 and 162, respectively. In addition, a Medicine and Therapeutics Committee (MTC) was set up at Entebbe Regional Referral Hospital. The project evaluation, conducted three months after training, revealed that the majority of the HPs (92.2%) and CHWs (90.3%) reported enhanced practices, including improved hand washing (57.3% and 81.0%, respectively). In addition, 51.5% of the HPs reported a reduction in the quantity of unnecessary antibiotics given per patient. This project demonstrates that AMS interventions using a One Health approach can promote understanding of the prudent use of antimicrobials and improve practices at health facilities and in communities