Field testing of the Advanced Worker Protection System

AWPS is a life support system that allows a suited worker in operate in a chemically hazardous or radiologically hot environment for up to 2 hours with minimal heat stress and minimal encumbrance from his life support equipment. It consists of 3 parts: a backpack using liquid air to supply breathing gas and cooling power; a liquid cooling garment (LCG) that circulates water chilled from vaporizing and warming the cryogen; and a Level B protective garment which accommodates the low profile of the backpack, permits greater mobility and doesn`t require tape closure. The AWPS backpack and LCG are compatible with commercially available Level A protective garments. A one-hour demonstration of a AWPS prototype was done

Measurement of SARS-CoV-2 in air and on surfaces in Scottish hospitals

BackgroundThere are still uncertainties in our knowledge of the amount of SARS-CoV-2 virus present in the environment; where it can be found, and potential exposure determinants, limiting our ability to effectively model and compare interventions for risk management.AimThis study measured SARS-CoV-2 in three hospitals in Scotland on surfaces and air, alongside ventilation and patient care activities.MethodsAir sampling at 200 L/min for 20 minutes and surface sampling were performed in two wards designated to treat COVID-19 -positive patients and two non-COVID-19 wards across three hospitals in November and December 2020. FindingsDetectable samples of SARS-CoV-2 were found in COVID-19 treatment wards but not in non-COVID-19 wards. Most samples were below assay detection limits, but maximum concentrations reached 1.7x10 3 genomic copies/m3 in air and 1.9x10 4 copies per surface swab (3.2x10 2 copies/cm2 for surface loading). The estimated geometric mean air concentration (geometric standard deviation) across all hospitals was 0.41 (71) genomic copies/m3 and the corresponding values for surface contamination were 2.9 (29) copies/swab. SARS-CoV-2 RNA was found in non-patient areas (patient/visitor waiting rooms and personal protective equipment (PPE) changing areas) associated with COVID-19 treatment wards.ConclusionsNon-patient areas of the hospital may pose risks for infection transmission and further attention should be paid to these areas. Standardization of sampling methods will improve understanding of levels of environmental contamination. The pandemic has demonstrated a need to review and act upon the challenges of older hospital buildings meeting current ventilation guidance

The CI-FLOW Project: A System for Total Water Level Prediction from the Summit to the Sea

Kildow et al. (2009) reported that coastal states support 81% of the U.S. population and generate 83 percent [$11.4 trillion (U.S. dollars) in 2007] of U.S. gross domestic product. Population trends show that a majority of coastal communities have transitioned from a seasonal, predominantly weekend, tourist-based economy to a year-round, permanently based, business economy where industry expands along shorelines and the workforce commutes from inland locations. As a result of this transition, costs associated with damage to the civil infrastructure and disruptions to local and regional economies due to coastal flooding events are escalating, pushing requirements for a new generation of flood prediction technologies and hydrologic decision support tools

Genetic mechanisms of critical illness in COVID-19.

Host-mediated lung inflammation is present1, and drives mortality2, in the critical illness caused by coronavirus disease 2019 (COVID-19). Host genetic variants associated with critical illness may identify mechanistic targets for therapeutic development3. Here we report the results of the GenOMICC (Genetics Of Mortality In Critical Care) genome-wide association study in 2,244 critically ill patients with COVID-19 from 208 UK intensive care units. We have identified and replicated the following new genome-wide significant associations: on chromosome 12q24.13 (rs10735079, P = 1.65 × 10-8) in a gene cluster that encodes antiviral restriction enzyme activators (OAS1, OAS2 and OAS3); on chromosome 19p13.2 (rs74956615, P = 2.3 × 10-8) near the gene that encodes tyrosine kinase 2 (TYK2); on chromosome 19p13.3 (rs2109069, P = 3.98 ×  10-12) within the gene that encodes dipeptidyl peptidase 9 (DPP9); and on chromosome 21q22.1 (rs2236757, P = 4.99 × 10-8) in the interferon receptor gene IFNAR2. We identified potential targets for repurposing of licensed medications: using Mendelian randomization, we found evidence that low expression of IFNAR2, or high expression of TYK2, are associated with life-threatening disease; and transcriptome-wide association in lung tissue revealed that high expression of the monocyte-macrophage chemotactic receptor CCR2 is associated with severe COVID-19. Our results identify robust genetic signals relating to key host antiviral defence mechanisms and mediators of inflammatory organ damage in COVID-19. Both mechanisms may be amenable to targeted treatment with existing drugs. However, large-scale randomized clinical trials will be essential before any change to clinical practice

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Effects of fluoxetine on functional outcomes after acute stroke (FOCUS): a pragmatic, double-blind, randomised, controlled trial

Background Results of small trials indicate that fluoxetine might improve functional outcomes after stroke. The FOCUS trial aimed to provide a precise estimate of these effects. Methods FOCUS was a pragmatic, multicentre, parallel group, double-blind, randomised, placebo-controlled trial done at 103 hospitals in the UK. Patients were eligible if they were aged 18 years or older, had a clinical stroke diagnosis, were enrolled and randomly assigned between 2 days and 15 days after onset, and had focal neurological deficits. Patients were randomly allocated fluoxetine 20 mg or matching placebo orally once daily for 6 months via a web-based system by use of a minimisation algorithm. The primary outcome was functional status, measured with the modified Rankin Scale (mRS), at 6 months. Patients, carers, health-care staff, and the trial team were masked to treatment allocation. Functional status was assessed at 6 months and 12 months after randomisation. Patients were analysed according to their treatment allocation. This trial is registered with the ISRCTN registry, number ISRCTN83290762. Findings Between Sept 10, 2012, and March 31, 2017, 3127 patients were recruited. 1564 patients were allocated fluoxetine and 1563 allocated placebo. mRS data at 6 months were available for 1553 (99·3%) patients in each treatment group. The distribution across mRS categories at 6 months was similar in the fluoxetine and placebo groups (common odds ratio adjusted for minimisation variables 0·951 [95% CI 0·839–1·079]; p=0·439). Patients allocated fluoxetine were less likely than those allocated placebo to develop new depression by 6 months (210 [13·43%] patients vs 269 [17·21%]; difference 3·78% [95% CI 1·26–6·30]; p=0·0033), but they had more bone fractures (45 [2·88%] vs 23 [1·47%]; difference 1·41% [95% CI 0·38–2·43]; p=0·0070). There were no significant differences in any other event at 6 or 12 months. Interpretation Fluoxetine 20 mg given daily for 6 months after acute stroke does not seem to improve functional outcomes. Although the treatment reduced the occurrence of depression, it increased the frequency of bone fractures. These results do not support the routine use of fluoxetine either for the prevention of post-stroke depression or to promote recovery of function. Funding UK Stroke Association and NIHR Health Technology Assessment Programme

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

The National Weather Service River Forecast System

Proceedings of the 1999 Georgia Water Resources Conference, March 30 and 31, Athens, Georgia.The National Weather Service River Forecast System (NWSRFS) comprises techniques and programs for developing river forecasts. NWSRFS contains three major systems which are utilized to set up and use hydrologic and hydraulic models in river forecasting. The three systems include the Calibration System, the Operational Forecast System (OFS), and the Ensemble Streamflow Prediction System (ESP). These systems are evaluated frequently, and changes are made as becomes necessary. New components are added to improve the flexibility and functionality of the NWSRFS. Each system is interrelated and can be used with different models to produce a river forecast. This paper will describe each system and how the National Weather Service Southeast River Forecast Center (SERFC) uses them to produce river forecasts which are disseminated to the public.Sponsored and Organized by: U.S. Geological Survey, Georgia Department of Natural Resources, The University of Georgia, Georgia State University, Georgia Institute of TechnologyThis book was published by the Institute of Ecology, The University of Georgia, Athens, Georgia 30602-2202 with partial funding provided by the U.S. Department of Interior, geological Survey, through the Georgia Water Research Insttitute as authorized by the Water Research Institutes Authorization Act of 1990 (P.L. 101-397). The views and statements advanced in this publication are solely those of the authors and do not represent official views or policies of the University of Georgia or the U.S. Geological Survey or the conference sponsors

Modelling Information Assurance: A Value Focused Thinking Approach

The information revolution has brought forth new and improved capabilities to rapidly disseminate and employ information in decision-making. These capabilities are critical to the civilian and military infrastructures of the United States, and act as force enhancers and enablers for the Armed Forces. These capabilities, however, often rely upon systems interconnected throughout the world, resulting in potentially increased vulnerability to attack. To add to this problem, elusive, threatening forces (national and transnational) originating from anywhere on the globe are likely to offer opponents less reliant on information technology an asymmetric advantage over information-reliant nations like the United States. To date, effective methods and measures to specifically value information and information systems are lacking. This thesis develops a first cut methodology facilitating the identification of key information, generating information assurance strategies and implementing measures to assess them

Drought in Southwest Georgia and the Use of Ensemble Streamflow Prediction

Proceedings of the 2001 Georgia Water Resources Conference, April 26 and 27, 2001, Athens, Georgia.Ensemble Streamflow Prediction (ESP) was used to produce medium to long-range streamflow forecasts at two sites within the upper part of the Flint River Basin in Georgia. Forecasts using ESP for mean monthly streamflows from July through September 2000 were produced. These were compared to actual streamflows by using provisional data from the U.S. Geological Survey (USGS). ESP has been used mainly assuming that each year of meteorological data is equally likely to occur in the future. This means that equal yearly weights are assigned. In this paper, an alternative is presented, that of deriving variable yearly weights based on precipitation outlooks. 'Precipitation outlooks issued by the National Oceanic and Atmospheric Administration (NOAA) through the Climate Prediction Center (CPC) were used in this study. Curves showing probability of exceedance were derived for equal and variable weights. It is thought that variable weights should be adopted; however, further investigation on their derivation is suggested. An evaluation of the range of influence of initial conditions should also be considered so that a meaningful forecast window can be determined.Sponsored and Organized by: U.S. Geological Survey, Georgia Department of Natural Resources, Natural Resources Conservation Service, The University of Georgia, Georgia State University, Georgia Institute of TechnologyThis book was published by the Institute of Ecology, The University of Georgia, Athens, Georgia 30602-2202. The views and statements advanced in this publication are solely those of the authors and do not represent official views or policies of The University of Georgia, the U.S. Geological Survey, the Georgia Water Research Institute as authorized by the Water Resources Research Act of 1990 (P.L. 101-397) or the other conference sponsors