Biogenic Macroporosity and lts Lattice Boltzmann Method Permeability in the Karst Biscayne Aquifer

We focus on two major problems in the study of paleokarst of the Biscayne aquifer in southeastem Florida: ( 1 ), current conceptual models of karst aquifers do not adequately characterize much of the eogenetic rnacropore system within the carbonate rocks of the Biscayne aquifer, and (2) standard laboratory core-analysis rnethods cannol be used lo accurately measure the permeability of highly macroporous carbonate core samples

How to co-design a prototype of a clinical practice tool: a framework with practical guidance and a case study

Clinical tools for use in practice-such as medicine reconciliation charts, diagnosis support tools and track-and-trigger charts-are endemic in healthcare, but relatively little attention is given to how to optimise their design. User-centred design approaches and co-design principles offer potential for improving usability and acceptability of clinical tools, but limited practical guidance is currently available. We propose a framework (FRamework for co-dESign of Clinical practice tOols or 'FRESCO') offering practical guidance based on user-centred methods and co-design principles, organised in five steps: (1) establish a multidisciplinary advisory group; (2) develop initial drafts of the prototype; (3) conduct think-aloud usability evaluations; (4) test in clinical simulations; (5) generate a final prototype informed by workshops. We applied the framework in a case study to support co-design of a prototype track-and-trigger chart for detecting and responding to possible fetal deterioration during labour. This started with establishing an advisory group of 22 members with varied expertise. Two initial draft prototypes were developed-one based on a version produced by national bodies, and the other with similar content but designed using human factors principles. Think-aloud usability evaluations of these prototypes were conducted with 15 professionals, and the findings used to inform co-design of an improved draft prototype. This was tested with 52 maternity professionals from five maternity units through clinical simulations. Analysis of these simulations and six workshops were used to co-design the final prototype to the point of readiness for large-scale testing. By codifying existing methods and principles into a single framework, FRESCO supported mobilisation of the expertise and ingenuity of diverse stakeholders to co-design a prototype track-and-trigger chart in an area of pressing service need. Subject to further evaluation, the framework has potential for application beyond the area of clinical practice in which it was applied

How to specify healthcare process improvements collaboratively using rapid, remote consensus-building: a framework and a case study of its application

Abstract: Background: Practical methods for facilitating process improvement are needed to support high quality, safe care. How best to specify (identify and define) process improvements – the changes that need to be made in a healthcare process – remains a key question. Methods for doing so collaboratively, rapidly and remotely offer much potential, but are under-developed. We propose an approach for engaging diverse stakeholders remotely in a consensus-building exercise to help specify improvements in a healthcare process, and we illustrate the approach in a case study. Methods: Organised in a five-step framework, our proposed approach is informed by a participatory ethos, crowdsourcing and consensus-building methods: (1) define scope and objective of the process improvement; (2) produce a draft or prototype of the proposed process improvement specification; (3) identify participant recruitment strategy; (4) design and conduct a remote consensus-building exercise; (5) produce a final specification of the process improvement in light of learning from the exercise. We tested the approach in a case study that sought to specify process improvements for the management of obstetric emergencies during the COVID-19 pandemic. We used a brief video showing a process for managing a post-partum haemorrhage in women with COVID-19 to elicit recommendations on how the process could be improved. Two Delphi rounds were then conducted to reach consensus. Results: We gathered views from 105 participants, with a background in maternity care (n = 36), infection prevention and control (n = 17), or human factors (n = 52). The participants initially generated 818 recommendations for how to improve the process illustrated in the video, which we synthesised into a set of 22 recommendations. The consensus-building exercise yielded a final set of 16 recommendations. These were used to inform the specification of process improvements for managing the obstetric emergency and develop supporting resources, including an updated video. Conclusions: The proposed methodological approach enabled the expertise and ingenuity of diverse stakeholders to be captured and mobilised to specify process improvements in an area of pressing service need. This approach has the potential to address current challenges in process improvement, but will require further evaluation

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

Prominence of ichnologically influenced macroporosity in the karst Biscayne aquifer: stratiform “super-K” zones

A combination of cyclostratigraphic, ichnologic, and borehole geophysical analyses of continuous core holes; tracer-test analyses; and lattice Boltzmann flow simulations was used to quantify biogenic macroporosity and permeability of the Biscayne aquifer, southeastern Florida. Biogenic macroporosity largely manifests as: (1) ichnogenic macroporosity primarily related to postdepositional burrowing activity by callianassid shrimp and fossilization of components of their complex burrow systems (Ophiomorpha); and (2) biomoldic macroporosity originating from dissolution of fossil hard parts, principally mollusk shells. Ophiomorpha-dominated ichnofabric provides the greatest contribution to hydrologic characteristics in the Biscayne aquifer in a 345 km (super 2) study area. Stratiform tabular-shaped units of thalassinidean-associated macroporosity are commonly confined to the lower part of upward-shallowing high-frequency cycles, throughout aggradational cycles, and, in one case, they stack vertically within the lower part of a high-frequency cycle set. Broad continuity of many of the macroporous units concentrates groundwater flow in extremely permeable passageways, thus making the aquifer vulnerable to long-distance transport of contaminants. Ichnogenic macroporosity represents an alternative pathway for concentrated groundwater flow that differs considerably from standard karst flow-system paradigms, which describe groundwater movement through fractures and cavernous dissolution features. Permeabilities were calculated using lattice Boltzmann methods (LBMs) applied to computer renderings assembled from X-ray computed tomography scans of various biogenic macroporous limestone samples. The highest simulated LBM permeabilities were about five orders of magnitude greater than standard laboratory measurements using air-permeability methods, which are limited in their application to extremely permeable macroporous rock samples. Based on their close conformance to analytical solutions for pipe flow, LBMs offer a new mean

Training for managing impacted fetal head at caesarean birth: multimethod evaluation of a pilot

Peer reviewed: TrueAcknowledgements: The authors thank all maternity service users for their time and insights through the patient and public involvement workshops and the facilitators at the maternity units for their support and help. For recruitment and communications support, the authors thank the Avoiding Brain Injury in Childbirth (ABC) communications team with members from the Royal College of Midwives (RCM), Royal College of Obstetricians and Gynaecologists and The Healthcare Improvement Studies Institute (THIS Institute). The authors are grateful for the many and varied contributions from colleagues across the ABC programme team and external to the team, including the visual designers (Dan Gould Design, Soapbox) and video agency (Hobson Curtis).Background: Implementation of national multiprofessional training for managing the obstetric emergency of impacted fetal head (IFH) at caesarean birth has potential to improve quality and safety in maternity care, but is currently lacking in the UK. Objectives: To evaluate a training package for managing IFH at caesarean birth with multiprofessional maternity teams. Methods: The training included an evidence-based lecture supported by an animated video showing management of IFH, followed by hands-on workshops and real-time simulations with use of a birth simulation trainer, augmented reality and management algorithms. Guided by the Kirkpatrick framework, we conducted a multimethod evaluation of the training with multiprofessional maternity teams. Participants rated post-training statements about relevance and helpfulness of the training and pre-training and post-training confidence in their knowledge and skills relating to IFH (7-point Likert scales, strongly disagree to strongly agree). An ethnographer recorded sociotechnical observations during the training. Participants provided feedback in post-training focus groups. Results: Participants (N=57) included 21 midwives, 25 obstetricians, 7 anaesthetists and 4 other professionals from five maternity units. Over 95% of participants agreed that the training was relevant and helpful for their clinical practice and improving outcomes following IFH. Confidence in technical and non-technical skills relating to managing IFH was variable before the training (5%–92% agreement with the pre-training statements), but improved in nearly all participants after the training (71%–100% agreement with the post-training statements). Participants and ethnographers reported that the training helped to: (i) better understand the complexity of IFH, (ii) recognise the need for multiprofessional training and management and (iii) optimise communication with those in labour and their birth partners. Conclusions: The evaluated training package can improve self-reported knowledge, skills and confidence of multiprofessional teams involved in management of IFH at caesarean birth. A larger-scale evaluation is required to validate these findings and establish how best to scale and implement the training

Training for managing impacted fetal head at caesarean birth: multimethod evaluation of a pilot

Background Implementation of national multiprofessional training for managing the obstetric emergency of impacted fetal head (IFH) at caesarean birth has potential to improve quality and safety in maternity care, but is currently lacking in the UK.Objectives To evaluate a training package for managing IFH at caesarean birth with multiprofessional maternity teams.Methods The training included an evidence-based lecture supported by an animated video showing management of IFH, followed by hands-on workshops and real-time simulations with use of a birth simulation trainer, augmented reality and management algorithms. Guided by the Kirkpatrick framework, we conducted a multimethod evaluation of the training with multiprofessional maternity teams. Participants rated post-training statements about relevance and helpfulness of the training and pre-training and post-training confidence in their knowledge and skills relating to IFH (7-point Likert scales, strongly disagree to strongly agree). An ethnographer recorded sociotechnical observations during the training. Participants provided feedback in post-training focus groups.Results Participants (N=57) included 21 midwives, 25 obstetricians, 7 anaesthetists and 4 other professionals from five maternity units. Over 95% of participants agreed that the training was relevant and helpful for their clinical practice and improving outcomes following IFH. Confidence in technical and non-technical skills relating to managing IFH was variable before the training (5%–92% agreement with the pre-training statements), but improved in nearly all participants after the training (71%–100% agreement with the post-training statements). Participants and ethnographers reported that the training helped to: (i) better understand the complexity of IFH, (ii) recognise the need for multiprofessional training and management and (iii) optimise communication with those in labour and their birth partners.Conclusions The evaluated training package can improve self-reported knowledge, skills and confidence of multiprofessional teams involved in management of IFH at caesarean birth. A larger-scale evaluation is required to validate these findings and establish how best to scale and implement the training