A Brief Overview of the Life and Work of Lyon Henry Appleby, M.D. (1895-1970).

The life and work of Dr. Lyon Henry Appleby, M.D., portrays the essence of a devoted clinician committed to scholarly excellence. Born in Deseronto, Ontario, in 1895 and passing in 1970, Dr. Appleby influenced all areas of general surgery, most notably popularizing a procedure that bears his name today. After a tour in World War I, he quickly proved himself to be a dedicated clinician with roots in academia, which translated into excellence within the Department of Surgery at St. Paul\u27s Hospital in Vancouver, Canada. He served in various leadership roles including Chair of the Department of Surgery, President of the International College of Surgeons, and Fellow of the Royal College of Physicians and Surgeons. The Appleby procedure, or en bloc removal of the celiac axis, at the time of gastrectomy, is the technical focus of this paper, although reference is made to Appleby\u27s extensive contributions to historical medicine

Newborns should be receiving premedication before elective intubation

BACKGROUND: Intubation is a common neonatal procedure. Premedication is accepted as a standard of care, but its use is not universal and wide variations exist in practice. OBJECTIVE: To evaluate current practices for premedication use prior to elective neonatal intubation in South Africa (SA). METHOD: We invited 481 clinicians to participate in a cross-sectional web-based survey. RESULTS: We received responses from 28.3% of the clinicians surveyed; 54.1% were from the private sector and 45.9% from the state sector. Most respondents worked in medium-sized neonatal units with six to ten beds. Most paediatricians (76.0%) worked in the private sector, and 78.6% of neonatologists in the state sector. Premedication was practised by 71.9% of the respondents, but only 38.5% of neonatal units had a written policy. Sedatives were used for premedication by 63.2% of the respondents. Midazolam (41.5%), morphine (34.0%) and ketamine (20.8%) were most commonly used. Muscle relaxants and atropine were not routinely administered. Suxamethonium was the muscle relaxant of choice. Varied combinations of agents or single agents were used. Midazolam used alone was the preferred option. CONCLUSION: This first survey of premedication for neonatal intubation in SA revealed variations in practice, with a minority of clinicians following a written policy. The findings can be used to benchmark practice and inform the design of local collaborative trials aimed at determining optimal premedication prior to neonatal intubation. The survey demonstrates clinicians' reluctance to participate in surveys, suggesting a need for a national collaborative network to obtain representative data

Utilising graduate teaching assistants to implement active learning at university level

Active learning is recognised as a crucial component of university courses in enhancing performance and retention. However, universities face numerous challenges in broadening the provision of active learning, including time constraints, and a lack of staff training and confidence to develop appropriate activities.  This article outlines an approach taken at the University of Southampton to engage a team of graduate teaching assistants (GTAs) in the process of developing, delivering, and evaluating active learning resources to support small-group teaching in chemistry on a Science Foundation Year programme.  A team of four GTAs developed nine activities during the 2015/16 academic year, with evaluation supporting their enhancement for 2016/17.  The article outlines the progress of this work over two academic years, providing evidence of a positive impact on students and teachers alike.Keywords: Active learning; peer-assisted learning; GTA

Epidemiology of nontuberculous mycobacteria (NTM) amongst individuals with cystic fibrosis (CF)

AbstractBackgroundInfection by nontuberculous mycobacteria (NTM) in patients with cystic fibrosis (CF) is often associated with significant morbidity. Limited, conflicting results are published regarding risk factors for pulmonary NTM disease. We analysed factors potentially associated with NTM in a large population of European patients with CF.MethodsWe investigated associations between presence of NTM and various factors for patients registered in the European Cystic Fibrosis Society Patient Registry.Results374 (2.75%) of 13,593 patients studied had at least one positive NTM culture within the study year. Age- and FEV1-adjusted odds of NTM infection was more than 2.5 times higher (95%CI: 1.79; 3.60) in patients infected by Stenotrophomonas maltophilia than in patients not infected (p<0.0001), 2.36 times higher (95%CI: 1.80;3.08) in patients with ABPA than without (p<0.0001), 1.79 times higher (95%CI: 1.34; 2.38) in patients who use bronchodilators than in patients who don't (p<0.0001), 1.49 times higher (95%CI: 1.18; 1.89) in patients who use inhaled antibiotics than in patients who don't (p=0.001), and 1.30 times higher (95%CI: 1.02; 1.66) in patients who use rhDNase than in patients who don't (p=0.032).ConclusionsNTM-positive cultures in individuals with CF are associated with distinct clinical variables. Improved data collection identifying risk factors for NTM infection will allow more focused screening strategies, and influence therapeutic choices and infection control measures in high-risk patients

Identification and characterisation of the high-risk surgical population in the United Kingdom

INTRODUCTION: Little is known about mortality rates following general surgical procedures in the United Kingdom. Deaths are most common in the 'high-risk' surgical population consisting mainly of older patients, with coexisting medical disease, who undergo major surgery. Only limited data are presently available to describe this population. The aim of the present study was to estimate the size of the high-risk general surgical population and to describe the outcome and intensive care unit (ICU) resource use. METHODS: Data on inpatient general surgical procedures and ICU admissions in 94 National Health Service hospitals between January 1999 and October 2004 were extracted from the Intensive Care National Audit & Research Centre database and the CHKS database. High-risk surgical procedures were defined prospectively as those for which the mortality rate was 5% or greater. RESULTS: There were 4,117,727 surgical procedures; 2,893,432 were elective (12,704 deaths; 0.44%) and 1,224,295 were emergencies (65,674 deaths; 5.4%). A high-risk population of 513,924 patients was identified (63,340 deaths; 12.3%), which accounted for 83.8% of deaths but for only 12.5% of procedures. This population had a prolonged hospital stay (median, 16 days; interquartile range, 9–29 days). There were 59,424 ICU admissions (11,398 deaths; 19%). Among admissions directly to the ICU following surgery, there were 31,633 elective admissions with 3,199 deaths (10.1%) and 24,764 emergency admissions with 7,084 deaths (28.6%). The ICU stays were short (median, 1.6 days; interquartile range, 0.8–3.7 days) but hospital admissions for those admitted to the ICU were prolonged (median, 16 days; interquartile range, 10–30 days). Among the ICU population, 40.8% of deaths occurred after the initial discharge from the ICU. The highest mortality rate (39%) occurred in the population admitted to the ICU following initial postoperative care on a standard ward. CONCLUSION: A large high-risk surgical population accounts for 12.5% of surgical procedures but for more than 80% of deaths. Despite high mortality rates, fewer than 15% of these patients are admitted to the ICU

Newborns should be receiving premedication before elective intubation

Background. Intubation is a common neonatal procedure. Premedication is accepted as a standard of care, but its use is not universal and wide variations exist in practice.Objective. To evaluate current practices for premedication use prior to elective neonatal intubation in South Africa (SA).Method. We invited 481 clinicians to participate in a cross-sectional web-based survey.Results. We received responses from 28.3% of the clinicians surveyed; 54.1% were from the private sector and 45.9% from the state sector. Most respondents worked in medium-sized neonatal units with six to ten beds. Most paediatricians (76.0%) worked in the private sector, and 78.6% of neonatologists in the state sector. Premedication was practised by 71.9% of the respondents, but only 38.5% of neonatal units had a written policy. Sedatives were used for premedication by 63.2% of the respondents. Midazolam (41.5%), morphine (34.0%) and ketamine (20.8%) were most commonly used. Muscle relaxants and atropine were not routinely administered. Suxamethonium was the muscle relaxant of choice. Varied combinations of agents or single agents were used. Midazolam used alone was the preferred option.Conclusion. This first survey of premedication for neonatal intubation in SA revealed variations in practice, with a minority of clinicians following a written policy. The findings can be used to benchmark practice and inform the design of local collaborative trials aimed at determining optimal premedication prior to neonatal intubation. The survey demonstrates clinicians’ reluctance to participate in surveys, suggesting a need for a national collaborative network to obtain representative data

Horn Coupled Multichroic Polarimeters for the Atacama Cosmology Telescope Polarization Experiment

Multichroic polarization sensitive detectors enable increased sensitivity and spectral coverage for observations of the Cosmic Microwave Background (CMB). An array optimized for dual frequency detectors can provide 1.7 times gain in sensitivity compared to a single frequency array. We present the design and measurements of horn coupled multichroic polarimeters encompassing the 90 and 150 GHz frequency bands and discuss our plans to field an array of these detectors as part of the ACTPol project

NuSTAR Observations of the Magnetar 1E 2259+586

We report on new broad band spectral and temporal observations of the magnetar 1E 2259+586, which is located in the supernova remnant CTB 109. Our data were obtained simultaneously with the Nuclear Spectroscopic Telescope Array (NuSTAR) and Swift, and cover the energy range from 0.5-79 keV. We present pulse profiles in various energy bands and compare them to previous RXTE results. The NuSTAR data show pulsations above 20 keV for the first time and we report evidence that one of the pulses in the double-peaked pulse profile shifts position with energy. The pulsed fraction of the magnetar is shown to increase strongly with energy. Our spectral analysis reveals that the soft X-ray spectrum is well characterized by an absorbed double-blackbody or blackbody plus power-law model in agreement with previous reports. Our new hard X-ray data, however, suggests that an additional component, such as a power-law, is needed to describe the NuSTAR and Swift spectrum. We also fit the data with the recently developed coronal outflow model by Beloborodov for hard X-ray emission from magnetars. The outflow from a ring on the magnetar surface is statistically preferred over outflow from a polar cap.Comment: 37 pages, 9 figures, corresponding author, [email protected]

Validating the simulation of beam-ion charge exchange in MAST Upgrade

Simulation of the impact of charge-exchange (CX) reactions on beam ions in the Mega Amp Spherical Tokamak (MAST) Upgrade was compared to measurements carried out with a fission chamber (neutron fluxes) and a fast ion deuterium-alpha (FIDA) diagnostic. A simple model was developed to reconstruct the outer-midplane neutral density based on measurements of deuterium-alpha emission from edge neutrals, and on Thomson scattering measurements of electron density and temperature. The main computational tools used were the ASCOT orbit-following code and the FIDASIM code for producing synthetic FIDA signals. The neutral density reconstruction agrees qualitatively with SOLPS-ITER modelling and yields a synthetic passive FIDA signal that is consistent with measurement. When CX losses of beam ions are accounted for, predicted neutron emission rates are quantitatively more consistent with measurement. It was necessary to account for CX losses of beam ions in simulations to reproduce the measured passive FIDA signal quantitatively and qualitatively. The results suggest that the neutral density reconstruction is a good approximation, that CX with edge neutrals causes significant beam-ion losses in MAST Upgrade, typically 20% of beam power, and that the ASCOT fast-ion CX model can be used to accurately predict the redistribution and loss of beam ions due to CX

The Nuclear Spectroscopic Telescope Array (NuSTAR)

The Nuclear Spectroscopic Telescope Array (NuSTAR) is a NASA Small Explorer mission that will carry the first focusing hard X-ray (5 -- 80 keV) telescope to orbit. NuSTAR will offer a factor 50 -- 100 sensitivity improvement compared to previous collimated or coded mask imagers that have operated in this energy band. In addition, NuSTAR provides sub-arcminute imaging with good spectral resolution over a 12-arcminute field of view. After launch, NuSTAR will carry out a two-year primary science mission that focuses on four key programs: studying the evolution of massive black holes through surveys carried out in fields with excellent multiwavelength coverage, understanding the population of compact objects and the nature of the massive black hole in the center of the Milky Way, constraining explosion dynamics and nucleosynthesis in supernovae, and probing the nature of particle acceleration in relativistic jets in active galactic nuclei. A number of additional observations will be included in the primary mission, and a guest observer program will be proposed for an extended mission to expand the range of scientific targets. The payload consists of two co-aligned depth-graded multilayer coated grazing incidence optics focused onto solid state CdZnTe pixel detectors. To be launched in early 2012 on a Pegasus rocket into a low-inclination Earth orbit. Data will be publicly available at GSFC's High Energy Astrophysics Science Archive Research Center (HEASARC) following validation at the science operations center located at Caltech.Comment: 9 pages, 5 figures, to appear in Proceedings of the SPIE, Space Telescopes and Instrumentation 2010: Ultraviolet to Gamma Ra