Individual surgeon mortality rates: can outliers be detected? A national utility analysis

Objectives: There is controversy on the proposed benefits of publishing mortality rates for individual surgeons. In some procedures, analysis at the level of an individual surgeon may lack statistical power. The aim was to determine the likelihood that variation in surgeon performance will be detected using published outcome data. Design: A national analysis surgeon-level mortality rates to calculate the level of power for the reported mortality rate across multiple surgical procedures. Setting: The UK from 2010 to 2014. Participants: Surgeons who performed colon cancer resection, oesophagectomy or gastrectomy, elective aortic aneurysm repair, hip replacement, bariatric surgery or thyroidectomy. Outcomes: The likelihood of detecting an individual with a 30-day, 90-day or in-patient mortality rate of up to 5 times the national mean or median (as available). This was represented using a novel heat-map approach. Results: Overall mortality rates for the procedures ranged from 0.07% to 4.5% and mean/median surgeon volume was between 23 and 75 cases. The national median case volume for colorectal (n=55) and upper gastrointestinal (n=23) cancer resections provides around 20% power to detect a mortality rate of 3 times the national median, while, for hip replacement, this is a rate 5 times the national average. At the mortality rates reported for thyroid (0.08%) and bariatric (0.07%) procedures, it is unlikely a surgeon would perform a sufficient number of procedures in his/her entire career to stand a good chance of detecting a mortality rate 5 times the national average. Conclusions: At present, surgeons with increased mortality rates are unlikely to be detected. Performance within an expected mortality rate range cannot be considered reliable evidence of acceptable performance. Alternative approaches should focus on commonly occurring meaningful outcome measures, with infrequent events analysed predominately at the hospital level

Intensive care utilisation and outcomes after high-risk surgery in Scotland: a population based cohort study.

Chief Scientist’s Office Scotland (grant no. CHZ/821/4)

Maternal pregnancy vitamin D supplementation increases offspring bone formation in response to mechanical loading : findings from a MAVIDOS trial sub-study

The Maternal Vitamin D Osteoporosis (MAVIDOS) trial reported higher total body bone mineral content in winter-born infants of mothers receiving vitamin D supplementation [1000 IU/day cholecalciferol] compared with placebo from 14 weeks gestation until delivery. This sub-study aimed to determine whether antenatal vitamin D supplementation altered postnatal bone formation in response to mechanical stimulation. Thirty-one children born to MAVIDOS participants randomised to either placebo (n=19) or cholecalciferol (n=12) were recruited at age 4-5 years. Children received whole body vibration (WBV) for 10 minutes on 5 consecutive days. Fasting blood samples for bone homeostasis, 25 hydroxyvitamin D (25OHD), parathyroid hormone (PTH), and bone turnover markers (Pro-collagen Type 1 N-terminal propeptide, P1NP; Cross-linked C-telopeptide of Type I Collagen, CTX) were collected pre-WBV and on day 8 (D8). Mean changes (D) in P1NP (ng/ml) between baseline and D8 in the vitamin-D intervention and placebo groups were 40.6 and -92.6 respectively and mean changes (Δ) in CTX (ng/ml) were 0.034 (intervention) and -0.084 (placebo) respectively. Between-group DP1NP difference was 133.2ng/ml [95% CI 0.4, 266.0; p=0.049] and ΔCTX 0.05ng/ml (95% CI -0.159, 0.26ng/mL; p=0.62). Antenatal vitamin-D supplementation resulted in increased P1NP in response to WBV, suggesting early life vitamin D supplementation increases the anabolic response of bone to mechanical loading in children

The first ever anti-football painting: A consideration of the soccer match in John Singer Sargent’s "Gassed"

The paper presents a discussion of Gassed, a large oil painting by John Singer Sargent displayed at the Imperial War Museum in London. Completed in 1919, Gassed is the major achievement from Sargent’s commission as an official war artist at the appointment of the British War Memorials Committee during the latter period of World War I. Prominent in the painting is a group of soldiers, blinded by a mustard gas attack, being lead to a casualty clearing station tent. In the distant background of the painting, another group of soldiers can be seen kitted out in football attire playing a match. The significance of this football imagery is our point of enquiry. As our title suggests, some recent interpretations regard the painting as offering critical reflection, from the time, about the symbolic links between sport and war. However, while the painting may certainly be left open to this type of viewer interpretation, archival and secondary resource material research does not support such a critical intention by the artist. Yet, nor is there evidence that Sargent’s intention was the projection of war-heroism. Rather, Sargent’s endeavour to faithfully represent what he observed allows Gassed to be regarded as a visual record of routine activity behind the lines and of football as an aspect of the daily life of British soldiers during the Great War

Evolution of density perturbations in a realistic universe

Prompted by the recent more precise determination of the basic cosmological parameters and growing evidence that the matter-energy content of the universe is now dominated by dark energy and dark matter we present the general solution of the equation that describes the evolution of density perturbations in the linear approximation. It turns out that as in the standard CDM model the density perturbations grow very slowly during the radiation dominated epoch and their amplitude increases by a factor of about 4000 in the matter and later dark energy dominated epoch of expansion of the universe.Comment: 19 pages, 4 figure

An implantable mixed-signal CMOS die for battery-powered in vivo blowfly neural recordings

© 2018 A mixed-signal die containing two differential input amplifiers, a multiplexer and a 50 KSPS, 10-bit SAR ADC, has been designed and fabricated in a 0.35 μm CMOS process for in vivo neural recording from freely moving blowflies where power supplied voltage drops quickly due to the space/weight limited insufficient capacity of the battery. The designed neural amplifier has a 66 + dB gain, 0.13 Hz-5.3 KHz bandwidth and 0.39% THD. A 20% power supply voltage drop causes only a 3% change in amplifier gain and 0.9-bit resolution degrading for SAR ADC while the on-chip data modulation reduces the chip size, rendering the designed chip suitable for battery-powered applications. The fabricated die occupies 1.1 mm2 while consuming 238 μW, being suitable for implantable neural recordings from insects as small as a blowfly for electrophysiological studies of their sensorimotor control mechanisms. The functionality of the die has been validated by recording the signals from identified interneurons in the blowfly visual system

Perceptions of COVID-19 vaccines among healthcare assistants: A national survey

Background: Limited COVID-19 vaccination acceptance among healthcare assistants (HCAs) may adversely impact older adults, who are at increased risk for severe COVID-19 infections. Our study objective was to evaluate the perceptions of COVID-19 vaccine safety and efficacy in a sample of frontline HCAs, overall and by race and ethnicity. Methods: An online survey was conducted from December 2020 to January 2021 through national e-mail listserv and private Facebook page for the National Association of Health Care Assistants. Responses from 155 HCAs, including certified nursing assistants, home health aides, certified medical assistants, and certified medication technicians, were included. A 27-item survey asked questions about experiences and perceptions of COVID-19 vaccines, including how confident they were that COVID-19 vaccines are safe, effective, and adequately tested in people of color. Multivariable regression was used to identify associations with confidence in COVID-19 vaccines. Results: We analyzed data from 155 completed responses. Among respondents, 23.9% were black and 8.4% Latino/a. Most respondents worked in the nursing home setting (53.5%), followed by hospitals (12.9%), assisted living (11.6%), and home care (10.3%). Respondents expressed low levels of confidence in COVID-19 vaccines, with fewer than 40% expressing at least moderate confidence in safety (38.1%), effectiveness (31.0%), or adequate testing in people of color (27.1%). Non-white respondents reported lower levels of confidence in adequate testing of vaccines compared to white respondents. In bivariate and adjusted models, respondents who gave more favorable scores of organizational leadership at their workplace expressed greater confidence in COVID-19 vaccines. Conclusion: Frontline HCAs reported low confidence in COVID-19 vaccines. Stronger organizational leadership in the workplace appears to be an important factor in influencing HCA's willingness to be vaccinated. Action is needed to enhance COVID-19 vaccine uptake in this important population with employers playing an important role to build vaccine confidence and trust among employees. © 2021 The American Geriatrics Society

Spherical Curvature Inhomogeneities in String Cosmology

We study the evolution of non-linear spherically symmetric inhomogeneities in string cosmology. Friedmann solutions of different spatial curvature are matched to produce solutions which describe the evolution of non-linear density and curvature inhomogeneities. The evolution of bound and unbound inhomogeneities are studied. The problem of primordial black hole formation is discussed in the string cosmological context and the pattern of evolution is determined in the pre- and post-big-bang phases of evolution.Comment: 19 pages, Latex, 4 figure

Automated Coronal Hole Detection using Local Intensity Thresholding Techniques

We identify coronal holes using a histogram-based intensity thresholding technique and compare their properties to fast solar wind streams at three different points in the heliosphere. The thresholding technique was tested on EUV and X-ray images obtained using instruments onboard STEREO, SOHO and Hinode. The full-disk images were transformed into Lambert equal-area projection maps and partitioned into a series of overlapping sub-images from which local histograms were extracted. The histograms were used to determine the threshold for the low intensity regions, which were then classified as coronal holes or filaments using magnetograms from the SOHO/MDI. For all three instruments, the local thresholding algorithm was found to successfully determine coronal hole boundaries in a consistent manner. Coronal hole properties extracted using the segmentation algorithm were then compared with in situ measurements of the solar wind at 1 AU from ACE and STEREO. Our results indicate that flux tubes rooted in coronal holes expand super-radially within 1 AU and that larger (smaller) coronal holes result in longer (shorter) duration high-speed solar wind streams