Improvement of Intraoperative Antibiotic Prophylaxis in Prolonged Cardiac Surgery by Automated Alerts in the Operating Room

Abstract Objective: To assess the impact of an automated intraoperative alert to redose prophylactic antibiotics in prolonged cardiac operations. Design: Randomized, controlled, evaluator-blinded trial. Setting: University-affiliated hospital. Patients: Patients undergoing cardiac surgery that lasted more than 4 hours after the preoperative administration of cefazolin, unless they were receiving therapeutic antibiotics at the time of surgery. Intervention: Randomization to an audible and visual reminder on the operating room computer console at 225 minutes after the administration of preoperative antibiotics (reminder group, n = 137) or control (n = 136). After another 30 minutes, the circulating nurse was required to indicate whether a follow-up dose of antibiotics had been administered. Results: Intraoperative redosing was significantly more frequent in the reminder group (93 of 137; 68%) than in the control group (55 of 136; 40%) (adjusted odds ratio, 3.31; 95% confidence interval, 1.97 to 5.56; P < .0001). The impact of the reminder was even greater when compared with the 6 months preceding the study period (129 of 480; 27%; P < .001), suggesting some spillover effect on the control group. Redosing was formally declined for 19 of the 44 patients in the reminder group without redosing. The rate of surgical-site infection in the reminder group (5 of 137; 4%) was similar to that in the control group (8 of 136; 6%; P = .42), but significantly lower than that in the pre-study period (48 of 480; 10%; P = .02). Conclusion: The use of an automatic reminder system in the operating room improved compliance with guidelines on perioperative antibiotic prophylaxi

Marginalised or enabled voices? 'User participation' in policy and practice

The idea of participation has been central to many policy developments in recent years. Both Conservative and Labour governments have used notions of participation and involvement in attempts to justify and implement their social policies. Yet, despite a plethora of initiatives and guidance around ‘participation’ emerging from all levels of government, and a substantial academic literature, there remains a major, and potentially damaging, lack of clarity over many aspects of participation, while the secret of achieving ‘real’ participation appears to continue to remain elusive

Phytoplankton and light limitation in the Southern Ocean: Learning from high-nutrient high-chlorophyll areas

Most of the Southern Ocean is a high-nutrient, low-chlorophyll (HNLC) area. There are exceptions to this situation downstream of some of the islands, where iron from the islands or surrounding shallow plateau fertilizes the mixed layer and causes a phytoplankton bloom in spring and summer. The main locations where this occurs are downstream of the South Georgia, Crozet, and Kerguelen islands. Data on mixed layer depths from Argo float profiles together with Sea-viewing Wide Field-of-view Sensor chlorophyll a (chl a) and photosynthetically available radiation from these high-nutrient, high-chlorophyll (HNHC) areas are combined to study the effects of mixed layer-averaged light availability on phytoplankton concentrations in areas where iron limitation has been lifted. The results of this analysis are then transferred to HNLC areas to assess the potential importance of light limitation through the year. We conclude that light limitation does not significantly constrain the annual integrated standing stock of chl a in the HNLC Southern Ocea

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

Fire as a fundamental ecological process: Research advances and frontiers

© 2020 The Authors.Fire is a powerful ecological and evolutionary force that regulates organismal traits, population sizes, species interactions, community composition, carbon and nutrient cycling and ecosystem function. It also presents a rapidly growing societal challenge, due to both increasingly destructive wildfires and fire exclusion in fire‐dependent ecosystems. As an ecological process, fire integrates complex feedbacks among biological, social and geophysical processes, requiring coordination across several fields and scales of study. Here, we describe the diversity of ways in which fire operates as a fundamental ecological and evolutionary process on Earth. We explore research priorities in six categories of fire ecology: (a) characteristics of fire regimes, (b) changing fire regimes, (c) fire effects on above‐ground ecology, (d) fire effects on below‐ground ecology, (e) fire behaviour and (f) fire ecology modelling. We identify three emergent themes: the need to study fire across temporal scales, to assess the mechanisms underlying a variety of ecological feedbacks involving fire and to improve representation of fire in a range of modelling contexts. Synthesis: As fire regimes and our relationships with fire continue to change, prioritizing these research areas will facilitate understanding of the ecological causes and consequences of future fires and rethinking fire management alternatives.Support was provided by NSF‐DEB‐1743681 to K.K.M. and A.J.T. We thank Shalin Hai‐Jew for helpful discussion of the survey and qualitative methods.Peer reviewe

The jewel house of art and nature : containing divers rare and profitable inventions, together with sundry new experiments in the art of husbandry with divers chimical conclusions concerning the art of distillation, and the rare practises uses thereof. Faithfully and familiarly set down, according to the authours own experience. Wherunto is added, a rare and excellent discourse of minerals, stones, gums, and rosins; with the vertues and use thereof

by Hugh Pla