Innovative transportable laboratories for Polar science

The Netherlands Organisation for Scientific Research and the British Antarctic Survey have built a transportable laboratory facility, named the Dirck Gerritsz Laboratory, to accommodate new scientific research on and from the westernAntarctic Peninsula. The design provides a flexible,modular, plug-and-play, innovative and sustainable laboratory setup. The docking station houses four 20-foot ISO standard high-cube containers, each of which contains a different laboratory. Special technological features were used to minimise the environmental impact. The four laboratory containers are flexible and can be installed and used as required, and renewed or removedwhen necessary. The container laboratories have provided, since opening in 2013, enhanced facilities for global climate change research through studying the community composition of phytoplankton; the ecological impact of virus-induced mortality in different phytoplankton groups; dimethylsulphide and brominated compound fluxes; and CO2 concentrations and trace elements in sea water. Transportable research laboratory facilities provide an effective and efficient approach for undertaking scientific research in challenging environments and might be the start of a new way of undertaking research, including exchanging laboratory modules between research stations in Antarctica

二南斎智角編『はい諧水いらす』翻刻と解題 : 不角の弟子の撰集

Many trace elements like Mn, Fe, Co, Ni, Cu and Zn are essential for marine life, some trace elements are of concern as pollutants, e.g. Pb and Hg, while others, together with a diverse array of isotopes, are used to assess modern-ocean processes and the role of the ocean in past climate change. GEOTRACES is an international program that aims to measure the distribution of trace elements and isotopes throughout the world oceans to improve our understanding of their marine biogeochemical cycles. To contribute to GEOTRACES a new sampler system was developed at NIOZ allowing efficient sampling of large volumes of seawater under ultraclean conditions. The 24 "PRISTINE" samplers each with a volume of 24.4 L are made of a high-purity polymer Polyvinylidene Fluoride (PVDF) and are opened and closed using a butterfly-valve closing mechanism. The samplers are mounted on an all-titanium frame and deployed using a poly-aramide hydrowire (Super Aram) with internal power/signal conductors. Upon recovery the complete frame is immediately placed in its own clean-air laboratory unit. Samplers are (i) always closed when onboard, (ii) always mounted on the frame without the need for hand-carrying heavy samplers, and (iii) can be deployed again with minimal (manual) preparation. The PRISTINE ultraclean sampling system was used for the first time during the GA02 GEOTRACES cruises in the West Atlantic Ocean (2010-2012). During 60 full ocean depth stations all 24 samplers closed with a 100% success rate. Sampling proved to be much faster, less labor intensive, and ultraclean. A comparison of salinity, temperature, nutrient and oxygen data collected with the rectangular titanium frame with PRISTINE samplers and a traditional CTD frame with Niskin samplers showed that the CTD systems functioned equally well, that the PRISTINE samplers took discrete seawater samples without any inward leakage of seawater during the up-cast, and that no atmospheric oxygen contaminated the seawater samples in the PRISTINE samplers after return on deck. The excellent agreement between 13 trace elements sampled with PRISTINE and sampled during the cross over occupation of US-GEOTRACES at the Bermuda BATS site (32 degrees N, 64 degrees W) shows its suitability for ultraclean trace element and isotope sampling (see accompanying paper). (C) 2015 Elsevier B.V. All rights reserved

The surgical safety checklist and patient outcomes after surgery: a prospective observational cohort study, systematic review and meta-analysis

© 2017 British Journal of Anaesthesia Background: The surgical safety checklist is widely used to improve the quality of perioperative care. However, clinicians continue to debate the clinical effectiveness of this tool. Methods: Prospective analysis of data from the International Surgical Outcomes Study (ISOS), an international observational study of elective in-patient surgery, accompanied by a systematic review and meta-analysis of published literature. The exposure was surgical safety checklist use. The primary outcome was in-hospital mortality and the secondary outcome was postoperative complications. In the ISOS cohort, a multivariable multi-level generalized linear model was used to test associations. To further contextualise these findings, we included the results from the ISOS cohort in a meta-analysis. Results are reported as odds ratios (OR) with 95% confidence intervals. Results: We included 44 814 patients from 497 hospitals in 27 countries in the ISOS analysis. There were 40 245 (89.8%) patients exposed to the checklist, whilst 7508 (16.8%) sustained ≥1 postoperative complications and 207 (0.5%) died before hospital discharge. Checklist exposure was associated with reduced mortality [odds ratio (OR) 0.49 (0.32–0.77); P\u3c0.01], but no difference in complication rates [OR 1.02 (0.88–1.19); P=0.75]. In a systematic review, we screened 3732 records and identified 11 eligible studies of 453 292 patients including the ISOS cohort. Checklist exposure was associated with both reduced postoperative mortality [OR 0.75 (0.62–0.92); P\u3c0.01; I2=87%] and reduced complication rates [OR 0.73 (0.61–0.88); P\u3c0.01; I2=89%). Conclusions: Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine

Prospective observational cohort study on grading the severity of postoperative complications in global surgery research

Background The Clavien–Dindo classification is perhaps the most widely used approach for reporting postoperative complications in clinical trials. This system classifies complication severity by the treatment provided. However, it is unclear whether the Clavien–Dindo system can be used internationally in studies across differing healthcare systems in high- (HICs) and low- and middle-income countries (LMICs). Methods This was a secondary analysis of the International Surgical Outcomes Study (ISOS), a prospective observational cohort study of elective surgery in adults. Data collection occurred over a 7-day period. Severity of complications was graded using Clavien–Dindo and the simpler ISOS grading (mild, moderate or severe, based on guided investigator judgement). Severity grading was compared using the intraclass correlation coefficient (ICC). Data are presented as frequencies and ICC values (with 95 per cent c.i.). The analysis was stratified by income status of the country, comparing HICs with LMICs. Results A total of 44 814 patients were recruited from 474 hospitals in 27 countries (19 HICs and 8 LMICs). Some 7508 patients (16·8 per cent) experienced at least one postoperative complication, equivalent to 11 664 complications in total. Using the ISOS classification, 5504 of 11 664 complications (47·2 per cent) were graded as mild, 4244 (36·4 per cent) as moderate and 1916 (16·4 per cent) as severe. Using Clavien–Dindo, 6781 of 11 664 complications (58·1 per cent) were graded as I or II, 1740 (14·9 per cent) as III, 2408 (20·6 per cent) as IV and 735 (6·3 per cent) as V. Agreement between classification systems was poor overall (ICC 0·41, 95 per cent c.i. 0·20 to 0·55), and in LMICs (ICC 0·23, 0·05 to 0·38) and HICs (ICC 0·46, 0·25 to 0·59). Conclusion Caution is recommended when using a treatment approach to grade complications in global surgery studies, as this may introduce bias unintentionally

Critical care admission following elective surgery was not associated with survival benefit: prospective analysis of data from 27 countries

This was an investigator initiated study funded by Nestle Health Sciences through an unrestricted research grant, and by a National Institute for Health Research (UK) Professorship held by RP. The study was sponsored by Queen Mary University of London