Magnetospheric and solar wind dependences of coupled fast-mode resonances outside the plasmasphere

We investigate the magnetospheric and solar wind factors that control the occurrence probabilities, locations, and frequencies of standing Alfvén waves excited via coupled fast-mode resonances (cFMRs) in the outer magnetosphere's dawn and dusk sectors. The variation of these cFMR properties with the observed magnetospheric plasma density profiles and inputs to the semiempirically modeled magnetic field from the numerical cFMR calculations of Archer et al. (2015) are studied. The probability of cFMR occurrence increases with distance between the magnetopause and the Alfvén speed's local maximum. The latter's location depends on magnetospheric activity: during high activity it is situated slightly outside the plasmapause, whereas at low activity it is found at much larger radial distances. The frequencies of cFMR are proportional to the Alfvén speed near the magnetopause, which is affected by both density and magnetic field variations. The location of the excited resonance, however, depends on the relative steepness of the Alfvén speed radial profile. The steeper this is, the closer the resonance is to the outer boundary and vice versa. The variation of the density profiles with solar wind conditions and activity is also shown

Healthcare Analytics Leadership: Clinical & Business Intelligence Plan Development

Future healthcare leaders require expert knowledge and practical capabilities in the evaluation, selection, application and ongoing oversight of the best types of analytics to create continuous learning healthcare systems. These systems may result in continuously improving the demonstrable quality, safety and efficiency of healthcare organizations. Data is an asset for organizations. However, many companies do not know how to establish analytical road maps for future action. Population Health Intelligence describes a new discipline whose role is to collect, organize, harmonize, analyze, disseminate and act upon the data available to clinicians, health system leaders, the pharmaceutical and biotechnology industry, and healthcare payers. This webinar on Analytics Leadership will demonstrate how to create and implement Clinical & Business Intelligence Plans that transform data into actionable organizational insights. Agenda Introduction Healthcare Analytics Leadership: Clinical & Business Intelligence Plan Development Population Health Intelligence Presentation: 53:3

Conditions during adulthood affect cohort-specific reproductive success in an Arctic-nesting goose population

This is the final version of the article. Available from the publisher via the DOI in this record.Variation in fitness between individuals in populations may be attributed to differing environmental conditions experienced among birth (or hatch) years (i.e., between cohorts). In this study, we tested whether cohort fitness could also be explained by environmental conditions experienced in years post-hatch, using 736 lifelong resighting histories of Greenland white-fronted geese (Anser albifrons flavirostris) marked in their first winter. Specifically, we tested whether variation in age at first successful reproduction, the size of the first successful brood and the proportion of successful breeders by cohort was explained by environmental conditions experienced on breeding areas in west Greenland during hatch year, those in adulthood prior to successful reproduction and those in the year of successful reproduction, using North Atlantic Oscillation indices as proxies for environmental conditions during these periods. Fifty-nine (8%) of all marked birds reproduced successfully (i.e., were observed on wintering areas with young) only once in their lifetime and 15 (2%) reproduced successfully twice or thrice. Variation in age at first successful reproduction was explained by the environmental conditions experienced during adulthood in the years prior to successful reproduction. Birds bred earliest (mean age 4) when environmental conditions were 'good' prior to the year of successful reproduction. Conversely, birds successfully reproduced at older ages (mean age 7) if they experienced adverse conditions prior to the year of successful reproduction. Hatch year conditions and an interaction between those experienced prior to and during the year of successful reproduction explained less (marginally significant) variation in age at first successful reproduction. Environmental conditions did not explain variation in the size of the first successful brood or the proportion of successful breeders. These findings show that conditions during adulthood prior to the year of successful reproduction are most important in determining the age at first successful reproduction in Greenland white-fronted geese. Very few birds bred successfully at all (most only once), which suggests that May environmental conditions on breeding areas have cohort effects that influence lifetime (and not just annual) reproductive success.This research was funded through a joint PhD studentship from the Wildfowl & Wetlands Trust and the University of Exeter, and undertaken by MD Weegman. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript

Supporting Academic Primary Care Teams Serving Refugees: A Qualitative Study

Introduction: Primary care providers continue to experience significant challenges when caring for refugee patients, yet they are often refugees’ initial point of contact with the U.S. health care system. The purpose of this qualitative study is to expand our understanding of the experiences of academic primary care team members during clinical encounters with refugee patients. Methods: This multi-perspective, qualitative study included physicians (faculty and residents), nurse practitioners, pharmacists, nurses, and medical assistants (n=10), who have been working with refugee patients for at least one year at two family medicine residency clinics and/or a community health center. Semi-structured in-person interviews were conducted and audio-recorded, transcribed, and openly coded to identify emergent themes. Through an immersion/crystallization and consensus approach, data was categorized into domains and subthemes. Results: Major domains and subthemes emerged: Building relationships (over time, earning trust, cultural humility); Markers of success in clinical encounters (improving communication, adaptation); Knowledge of or lack of clinical resources (focused trainings, formal debriefs, access to resources, unwritten languages). Conclusion: Perceptions of success in clinical encounters with refugee patients were primarily associated with communication as opposed to achievement in numeric metrics (e.g. hypertension control). The development of any formalized trainings, tools, and resources to support primary care providers working with refugee patient populations should take these goals into consideration. Lastly, potential solutions were identified to address existing barriers for primary care providers in clinical encounters with refugee patients, but further research and development is necessary to assess their efficacy and utility

Early Perioperative Fluid Benchmarking to Predict Pancreaticoduodenectomy (PD) Outcomes

Introduction: PD is a complex operation associated with a marked systemic inflammatory response and significant fluid shifts. Establishing a benchmark for ideal perioperative fluid management is critical to optimising PD patient recovery. Methods: In this retrospective study, we evaluated perioperative fluid data for patients undergoing PD. We compared an optimal benchmark group who were discharged home by postoperative day five (≤5day) to a group of patients with an in hospital recovery greater than ten days (≥10day). Results: Seventy-six patients who underwent PD between June 2015 and November 2016 were evaluated. The ≤5day group had a significantly lower intraoperative fluid administration (5.4 vs. 6.6 L, p= 0.012), despite similar operative times (447 mins and 476 mins, respectively). POD1 cumulative fluid balance was lower in the ≤5day group compared to the ≥10day group, 7.8L (97 mL/kg) vs. 9.7L (148 mL/kg) (p= 0.002), respectively. As expected, the postoperative complication rate was reduced in the ≤5day group (5% vs. 95%). Complications included pancreatic fistula (40%), delayed gastric emptying (53%), and intra-abdominal infection (16%). The median weight change from baseline to POD5 was -0.2 Kg for the ≤5day group compared to +2.9 Kg for ≥10day group (p= 0.000006). Conclusions: Patients in the benchmark PD group received less fluid intraoperatively, had a lower cumulative fluid balance by POD1, and were able to return to their preoperative weight by POD5 when compared to ≥10day group. These data offer insights into optimal fluid administration for PD patients

Frequency variability of standing Alfven waves excited by fast mode resonances in the outer magnetosphere

NASA. Grant Number: NAS5-0209

Oxygen Delivery Through Nasal Cannulae to Preterm Infants: Can Practice Be Improved?

ABSTRACT. Objective. Oxygen delivery through nasal cannulae to convalescent preterm infants is a common but largely unstudied practice. To learn more about current nasal cannula oxygen delivery practices, we examined the variations in oxygen delivery through nasal cannulae among the centers of the Neonatal Research Network, the frequency of prescription of low levels of oxygen, and the success of weaning to room air. We hypothesized that some infants treated with oxygen through nasal cannulae were receiving oxygen levels equivalent to those of room air. Methods. This was a descriptive, nested, cohort study of nasal cannula oxygen prescription among 187 infants with birth weights of <1250 g. All infants were studied at a postmenstrual age of 36 weeks, with a timed oxygen reduction challenge to establish their ability to be weaned to room air. The results of this challenge were compared with the fraction of inspired oxygen (FIO 2 ) delivered, calculated as effective FIO 2 . Infants who maintained oxygen saturation values of >90% during oxygen weaning and during a 30-minute period in room air were defined as passing the challenge. Results. Fifty-two infants (27.8%) were receiving oxygen concentrations and flow rates through nasal cannulae that delivered an effective FIO 2 of <0.23, of whom 16 were receiving oxygen concentrations and flow rates that delivered an effective FIO 2 of 0.21. In addition, 22 infants (11.8%) were prescribed room air through nasal cannulae intentionally. Seventy-two percent of those prescribed an effective FIO 2 of <0.23 passed the room air challenge. Conclusions. Prescription of oxygen with combinations of flow rates and oxygen concentrations that delivered a low effective FIO 2 was common. We speculate that some of this, including the inadvertent prescription of an effective FIO 2 equivalent to that of room air, is related to lack of knowledge of the effective FIO 2 . Routine calculation of effective FIO 2 values may prompt earlier trials of room air and thus reduce unnecessary days of oxygen therapy. Pediatrics 2005;116:857-861; oxygen therapy, premature infants

Integrated population modelling reveals a perceived source to be a cryptic sink

This is the final version of the article. Available from the publisher via the DOI in this record.Demographic links among fragmented populations are commonly studied as source-sink dynamics, whereby source populations exhibit net recruitment and net emigration, while sinks suffer net mortality but enjoy net immigration. It is commonly assumed that large, persistent aggregations of individuals must be sources, but this ignores the possibility that they are sinks instead, buoyed demographically by immigration. We tested this assumption using Bayesian integrated population modelling of Greenland white-fronted geese (Anser albifrons flavirostris) at their largest wintering site (Wexford, Ireland), combining capture-mark-recapture, census and recruitment data collected from 1982 to 2010. Management for this subspecies occurs largely on wintering areas; thus, study of source-sink dynamics of discrete regular wintering units provides unprecedented insights into population regulation and enables identification of likely processes influencing population dynamics at Wexford and among 70 other Greenland white-fronted goose wintering subpopulations. Using results from integrated population modelling, we parameterized an age-structured population projection matrix to determine the contribution of movement rates (emigration and immigration), recruitment and mortality to the dynamics of the Wexford subpopulation. Survival estimates for juvenile and adult birds at Wexford and adult birds elsewhere fluctuated over the 29-year study period, but were not identifiably different. However, per capita recruitment rates at Wexford in later years (post-1995) were identifiably lower than in earlier years (pre-1995). The observed persistence of the Wexford subpopulation was only possible with high rates of immigration, which exceeded emigration in each year. Thus, despite its apparent stability, Wexford has functioned as a sink over the entire study period. These results demonstrate that even large subpopulations can potentially be sinks, and that movement dynamics (e.g. immigration) among winters can dramatically obscure key processes driving subpopulation size. Further, novel population models which integrate capture-mark-recapture, census and recruitment data are essential to correctly ascribing source-sink status and accurately informing development of site-safeguard networks.This research was funded through a joint PhD studentship to M.D.W. from the Wildfowl & Wetlands Trust and the University of Exeter, and through a NERC grant (NE/L007770/1) to D.J.