22 research outputs found

    Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH): a stepped-wedge cluster-randomised trial

    Get PDF
    BACKGROUND: Emergency abdominal surgery is associated with poor patient outcomes. We studied the effectiveness of a national quality improvement (QI) programme to implement a care pathway to improve survival for these patients. METHODS: We did a stepped-wedge cluster-randomised trial of patients aged 40 years or older undergoing emergency open major abdominal surgery. Eligible UK National Health Service (NHS) hospitals (those that had an emergency general surgical service, a substantial volume of emergency abdominal surgery cases, and contributed data to the National Emergency Laparotomy Audit) were organised into 15 geographical clusters and commenced the QI programme in a random order, based on a computer-generated random sequence, over an 85-week period with one geographical cluster commencing the intervention every 5 weeks from the second to the 16th time period. Patients were masked to the study group, but it was not possible to mask hospital staff or investigators. The primary outcome measure was mortality within 90 days of surgery. Analyses were done on an intention-to-treat basis. This study is registered with the ISRCTN registry, number ISRCTN80682973. FINDINGS: Treatment took place between March 3, 2014, and Oct 19, 2015. 22 754 patients were assessed for elegibility. Of 15 873 eligible patients from 93 NHS hospitals, primary outcome data were analysed for 8482 patients in the usual care group and 7374 in the QI group. Eight patients in the usual care group and nine patients in the QI group were not included in the analysis because of missing primary outcome data. The primary outcome of 90-day mortality occurred in 1210 (16%) patients in the QI group compared with 1393 (16%) patients in the usual care group (HR 1·11, 0·96-1·28). INTERPRETATION: No survival benefit was observed from this QI programme to implement a care pathway for patients undergoing emergency abdominal surgery. Future QI programmes should ensure that teams have both the time and resources needed to improve patient care. FUNDING: National Institute for Health Research Health Services and Delivery Research Programme

    The Distribution of Small-Scale Irregularities in the E-Region, and Its Tendency to Match the Spectrum of Field-Aligned Current Structures in the F-Region

    Get PDF
    We associate new data from icebear, a coherent scatter radar located in Saskatchewan, Canada, with scale-dependent physics in the ionosphere. We subject the large-scale icebear 3D echo patterns (treated as 2D point clouds) to a data analysis technique hitherto never applied to the ionosphere, a technique that is widely applied in cosmological red-shift surveys to characterize the spatial clustering of galaxies. The technique results in a novel method to calculate the spatial power spectral density of the greater ionospheric irregularity field. We compare results from this method to in-situ plasma density and magnetic field observations from the Swarm mission. We show that there is a remarkable similarity between echo clustering spectra in the E-region and the field-aligned current structuring spectrum observed in the F-region: a clear and characteristic preferred scale (5 km) both in the E- and F-region spectra. We discuss the possibility that this represents evidence of an energy injection into the ionospheric irregularity field via energetic particle precipitation, but offer alternative interpretations with wider connotations for the ionosphere-magnetosphere system. These findings open new and promising avenues of research for the study of the location of ionospheric scatter echoes with 3D information. It constitutes a novel way to consider the pattern of ionospheric irregularities over wide fields of view when there is an abundance of radar echoes, which allows for the analysis of radar data as point clouds

    Measuring small-scale plasma irregularities in the high-latitude E- and F-regions simultaneously

    No full text
    The ionosphere, Earth’s space environment, exhibits widespread turbulent structuring, or plasma irregularities, visualized by the auroral displays seen in Earth’s polar regions. Such plasma irregularities have been studied for decades, but plasma turbulence remains an elusive phenomenon. We combine scale-dependent measurements from a ground-based radar with satellite observations to characterize small-scale irregularities simultaneously in the bottomside and topside ionosphere and perform a statistical analysis on an aggregate from both instruments over time. We demonstrate the clear mapping of information vertically along the ionospheric altitude column, for field-perpendicular wavelengths down to 1.5 km. Our results paint a picture of the northern hemisphere high-latitude ionosphere as a turbulent system that is in a constant state of growth and decay; energy is being constantly injected and dissipated as the system is continuously attempting an accelerated return to equilibrium. We connect the widespread irregularity dissipation to Pedersen conductance in the E-region, and discuss the similarities between irregularities found in the polar cap and in the auroral region in that context. We find that the effects of a conducting E-region on certain turbulent properties (small-scale spectral index) is near ubiquitous in the dataset, and so we suggest that the electrodynamics of a conducting E-region must be considered when discussing plasma turbulence at high latitudes. This intimate relationship opens up the possibility that E-region conductivity is associated with the generation of F-region irregularities, though further studies are needed to assess that possibility

    icebearcanada/cavsiopy: v1.1.1

    No full text
    patch release: 'attitude_3d_ground_quiver' has been enhanced to display a line connecting the subsatellite point with the ground target on the ground map. name changes for several functions in auxiliary directory

    icebearcanada/cavsiopy: v1.2.2

    No full text
    slew_example.py: added to examples in attitude_analysis.py: functions in utils.py and complement_missing_sofa.py are now embedded in attitude_analysis.py use_rotation_matrices.py: utils.py and missing_complement_sofa.py imports removed attitude_analysis.spacecraft_distance_from_a_point: fixed a minor bug, which caused the distance array to return empty. requirements.txt: version numbers were added for dependencies. .readthedocs.yaml: version number and installation instructions corrected

    Macrocyclic inhibitors of 3C and 3C-like proteases of picornavirus, norovirus, and coronavirus

    Get PDF
    The design, synthesis, and in vitro evaluation of the first macrocyclic inhibitor of 3C and 3C-like proteases of picornavirus, norovirus, and coronavirus are reported. The in vitro inhibitory activity (50% effective concentration) of the macrocyclic inhibitor toward enterovirus 3C protease (CVB3 Nancy strain), and coronavirus (SARS-CoV) and norovirus 3C-like proteases, was determined to be 1.8, 15.5 and 5.1 μM, respectively
    corecore