Impact of Irrigation on Midsummer Surface Fluxes and Temperature under Dry Synoptic Conditions: A Regional Atmospheric Model Study of the U.S. High Plains

The impact of irrigation on the surface energy budget in the U.S. high plains is investigated. Four 15-day simulations were conducted: one using a 1997 satellite-derived estimate of farmland acreage under irrigation in Nebraska (control run), two using the Olson Global Ecosystem (OGE) vegetation dataset (OGE wet run and OGE dry run), and the fourth with the Kuchler vegetation dataset (natural vegetation run) as lower boundary conditions in the Colorado State University Regional Atmospheric Modeling System (RAMS). In the control and OGE wet simulations, the topsoil in the irrigated locations, up to a depth of 0.2 m, was saturated at 0000 UTC each day for the duration of the experiment (1–15 July 1997). In the other two runs, the soil was allowed to dry out, except when replenished naturally by rainfall. Identical observed atmospheric conditions were used along the lateral boundary in all four cases. The area-averaged model-derived quantities for the grid centered over Nebraska indicate significant differences in the surface energy fluxes between the control (irrigated) and the ‘‘dry’’ simulations. For example, a 36% increase in the surface latent heat flux and a 2.68C elevation in dewpoint temperature between the control run and the OGE dry run is shown. Surface sensible heat flux of the control run was 15% less and the near-ground temperature was 1.28C less compared to the OGE dry run. The differences between the control run and the natural vegetation run were similar but amplified compared to the control run–OGE dry run comparisons. Results of statistical analyses of long-term(1921–2000) surface temperature data from two sites representing locations of extensive irrigated and nonirrigated land uses appear to support model results presented herein of an irrigationrelated cooling in surface temperature. Growing season monthly mean and monthly mean maximum temperature data for the irrigated site indicate a steady decreasing trend in contrast to an increasing trend at the nonirrigated site

Impact of Irrigation on Midsummer Surface Fluxes and Temperature under Dry Synoptic Conditions: A Regional Atmospheric Model Study of the U.S. High Plains

The impact of irrigation on the surface energy budget in the U.S. high plains is investigated. Four 15-day simulations were conducted: one using a 1997 satellite-derived estimate of farmland acreage under irrigation in Nebraska (control run), two using the Olson Global Ecosystem (OGE) vegetation dataset (OGE wet run and OGE dry run), and the fourth with the Kuchler vegetation dataset (natural vegetation run) as lower boundary conditions in the Colorado State University Regional Atmospheric Modeling System (RAMS). In the control and OGE wet simulations, the topsoil in the irrigated locations, up to a depth of 0.2 m, was saturated at 0000 UTC each day for the duration of the experiment (1–15 July 1997). In the other two runs, the soil was allowed to dry out, except when replenished naturally by rainfall. Identical observed atmospheric conditions were used along the lateral boundary in all four cases. The area-averaged model-derived quantities for the grid centered over Nebraska indicate significant differences in the surface energy fluxes between the control (irrigated) and the ‘‘dry’’ simulations. For example, a 36% increase in the surface latent heat flux and a 2.68C elevation in dewpoint temperature between the control run and the OGE dry run is shown. Surface sensible heat flux of the control run was 15% less and the near-ground temperature was 1.28C less compared to the OGE dry run. The differences between the control run and the natural vegetation run were similar but amplified compared to the control run–OGE dry run comparisons. Results of statistical analyses of long-term(1921–2000) surface temperature data from two sites representing locations of extensive irrigated and nonirrigated land uses appear to support model results presented herein of an irrigationrelated cooling in surface temperature. Growing season monthly mean and monthly mean maximum temperature data for the irrigated site indicate a steady decreasing trend in contrast to an increasing trend at the nonirrigated site

The role of knowledge management strategies and task knowledge in stimulating service innovation

Are service firms that enact strategies to manage their new service development (NSD) knowledge able to generate a sustainable competitive advantage (SCA)? Based on analysis of data from a large survey of service companies, the answer is yes. We find that companies employing the knowledge management strategies of codification and personalization reflect higher levels of NSD knowledge. However, the two strategies vary in their individual performance outcomes, with codification promoting NSD proficiency (an ability to execute NSD activities) and personalization promoting greater NSD innovativeness (market perception of the company as novel and as an innovator). When used together, the two strategies magnify NSD knowledge, which when combined with NSD proficiency and NSD innovativeness, promote a SCA. Therefore, companies planning to invest in a knowledge management system should heed the outcomes desired from their NSD process. A system based on documentation exemplifies a codification strategy and will drive NSD proficiency; a system emphasizing interpersonal communication exemplifies a personalization strategy and will drive NSD innovativeness. A system that blends the two strategies appears the most advantageous for service companies’ NSD efforts aiming to build a long-term sustainable competitive advantage

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

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

Convalescent plasma in patients admitted to hospital with COVID-19 (RECOVERY): a randomised controlled, open-label, platform trial

SummaryBackground Azithromycin has been proposed as a treatment for COVID-19 on the basis of its immunomodulatoryactions. We aimed to evaluate the safety and efficacy of azithromycin in patients admitted to hospital with COVID-19.Methods In this randomised, controlled, open-label, adaptive platform trial (Randomised Evaluation of COVID-19Therapy [RECOVERY]), several possible treatments were compared with usual care in patients admitted to hospitalwith COVID-19 in the UK. The trial is underway at 176 hospitals in the UK. Eligible and consenting patients wererandomly allocated to either usual standard of care alone or usual standard of care plus azithromycin 500 mg once perday by mouth or intravenously for 10 days or until discharge (or allocation to one of the other RECOVERY treatmentgroups). Patients were assigned via web-based simple (unstratified) randomisation with allocation concealment andwere twice as likely to be randomly assigned to usual care than to any of the active treatment groups. Participants andlocal study staff were not masked to the allocated treatment, but all others involved in the trial were masked to theoutcome data during the trial. The primary outcome was 28-day all-cause mortality, assessed in the intention-to-treatpopulation. The trial is registered with ISRCTN, 50189673, and ClinicalTrials.gov, NCT04381936.Findings Between April 7 and Nov 27, 2020, of 16 442 patients enrolled in the RECOVERY trial, 9433 (57%) wereeligible and 7763 were included in the assessment of azithromycin. The mean age of these study participants was65·3 years (SD 15·7) and approximately a third were women (2944 [38%] of 7763). 2582 patients were randomlyallocated to receive azithromycin and 5181 patients were randomly allocated to usual care alone. Overall,561 (22%) patients allocated to azithromycin and 1162 (22%) patients allocated to usual care died within 28 days(rate ratio 0·97, 95% CI 0·87–1·07; p=0·50). No significant difference was seen in duration of hospital stay (median10 days [IQR 5 to >28] vs 11 days [5 to >28]) or the proportion of patients discharged from hospital alive within 28 days(rate ratio 1·04, 95% CI 0·98–1·10; p=0·19). Among those not on invasive mechanical ventilation at baseline, nosignificant difference was seen in the proportion meeting the composite endpoint of invasive mechanical ventilationor death (risk ratio 0·95, 95% CI 0·87–1·03; p=0·24).Interpretation In patients admitted to hospital with COVID-19, azithromycin did not improve survival or otherprespecified clinical outcomes. Azithromycin use in patients admitted to hospital with COVID-19 should be restrictedto patients in whom there is a clear antimicrobial indication

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

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

Dimethyl fumarate in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial

Dimethyl fumarate (DMF) inhibits inflammasome-mediated inflammation and has been proposed as a treatment for patients hospitalised with COVID-19. This randomised, controlled, open-label platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]), is assessing multiple treatments in patients hospitalised for COVID-19 (NCT04381936, ISRCTN50189673). In this assessment of DMF performed at 27 UK hospitals, adults were randomly allocated (1:1) to either usual standard of care alone or usual standard of care plus DMF. The primary outcome was clinical status on day 5 measured on a seven-point ordinal scale. Secondary outcomes were time to sustained improvement in clinical status, time to discharge, day 5 peripheral blood oxygenation, day 5 C-reactive protein, and improvement in day 10 clinical status. Between 2 March 2021 and 18 November 2021, 713 patients were enroled in the DMF evaluation, of whom 356 were randomly allocated to receive usual care plus DMF, and 357 to usual care alone. 95% of patients received corticosteroids as part of routine care. There was no evidence of a beneficial effect of DMF on clinical status at day 5 (common odds ratio of unfavourable outcome 1.12; 95% CI 0.86-1.47; p = 0.40). There was no significant effect of DMF on any secondary outcome

Using intermittent pulse oximetry to guide neonatal oxygen therapy in a low-resource context

OBJECTIVE: To evaluate the effectiveness of intermittent pulse oximetry in guiding oxygen therapy in neonates in a low-resource setting. DESIGN AND SETTING: Prospective validation study at three hospitals in southwest Nigeria. We performed concealed continuous pulse oximetry on participants to evaluate intermittent SpO2 monitoring. PATIENTS: We recruited all preterm or low birthweight neonates, and all term neonates who required oxygen therapy, who were admitted to the neonatal ward(s) of the study hospitals during the study period. MAIN OUTCOME MEASURES: Proportion of time preterm/low birthweight neonates on oxygen spent within, above and below the target SpO2 range of 90%-95%; and the proportion of time term neonates and neonates not on oxygen spent within and below the target range of 90%-100%. RESULTS: Preterm/low birthweight neonates receiving oxygen therapy (group A) spent 15.7% (95% CI 13.3 to 18.9) of time in the target SpO2 range of 90%-95%. They spent 75.0% (63.6-81.1) of time above 95%, and 2.7% (1.7-5.6) of time below 85%. Term neonates and all neonates not receiving oxygen (group B) spent 97.3% (95% CI 96.4 to 98.6) of time within the target range of 90%-100%, and 0.9% (0.3-1.4) of time below 85%. Guidelines recommended SpO2 monitoring 3 times per day for all patients, however neonates in groups A and B were monitored an average of 4.7 and 5.3 times per day, respectively. CONCLUSIONS: To better maintain SpO2 within the target range, preterm/low birthweight neonates on oxygen should have their SpO2 monitored more frequently than the current 4.7 times per day. In all other neonates, however, monitoring SpO2 5.3 times per day appears suitable

Implementation of data triangulation and dashboard development for COVID-19 vaccine adverse event following immunisation (AEFI) data in Nigeria

Nigeria began administering COVID-19 vaccines on 5 March 2021 and is working towards the WHO’s African regional goal to fully vaccinate 70% of their eligible population by December 2022. Nigeria’s COVID-19 vaccination information system includes a surveillance system for COVID-19 adverse events following immunisation (AEFI), but as of April 2021, AEFI data were being collected and managed by multiple groups and lacked routine analysis and use for action. To fill this gap in COVID-19 vaccine safety monitoring, between April 2021 and June 2022, the US Centers for Disease Control and Prevention, in collaboration with other implementing partners led by the Institute of Human Virology Nigeria, supported the Government of Nigeria to triangulate existing COVID-19 AEFI data. This paper describes the process of implementing published draft guidelines for data triangulation for COVID-19 AEFI data in Nigeria. Here, we focus on the process of implementing data triangulation rather than analysing the results and impacts of triangulation. Work began by mapping the flow of COVID-19 AEFI data, engaging stakeholders and building a data management system to intake and store all shared data. These datasets were used to create an online dashboard with key indicators selected based on existing WHO guidelines and national guidance. The dashboard went through an iterative review before dissemination to stakeholders. This case study highlights a successful example of implementing data triangulation for rapid use of AEFI data for decision-making and emphasises the importance of stakeholder engagement and strong data governance structures to make data triangulation successful