The aftermath of a perioperative death: who cares for the clinician?

Working in the perioperative environment entails exposure to traumatic and sometimes catastrophic events such as a perioperative death (PD). PD can be a uniquely devastating experience and has the potential to lead to long-term negative physical and psychological effects for the staff involved, especially when appropriate support is absent. In a number of practice settings, these destabilizing effects have been shown to detrimentally compromise individual and team performance.1 This is of particular concern in the perioperative setting, since deterioration of individual competence and subsequent team performance has been directly linked to poor patient outcomes. Despite numerous studies establishing this link, there has been little research exploring clinicians' experiences of PD and organisational support for front-line clinicians remains alarmingly inconsistent. The question remains, who is responsible to the clinician in the aftermath of a perioperative death

Infection Prevention and the Protective Effects of Unidirectional Displacement Flow Ventilation in the Turbulent Spaces of the Operating Room

Background: Unidirectional displacement flow (UDF) ventilation systems in operating rooms are characterized by a uniformity of velocity 80% and protect patients and operating room personnel against exposure to hazardous substances. However, the air below the surgical lights and in the surrounding zone is turbulent, which impairs the ventilation system’s effect. Aim: We first used the recovery time (RT) as specified in International Organization for Standardization 14644 to determine the particle reduction capacity in the turbulent spaces of an operating room with a UDF system. Methods: The uniformity of velocity was analyzed by comfort-level probe grid measurements in the protected area below a hemispherical closed-shaped and a semi-open column-shaped surgical light (tilt angles: 0/15/30) and in the surrounding zone of a research operating room. Thereafter, RTs were calculated. Results: At a supply air volume of 10,500 m3/h, the velocity, reported as average uniformity+standard deviation, was uniform in the protected area without lights (95.8% + 1.7%), but locally turbulent below the hemispherical closedshaped (69.3% + 14.6%), the semi-open column-shaped light (66.9% + 10.9%), and in the surrounding zone (51.5%+17.6%). The RTs ranged between 1.1 and 1.7 min below the lights and 3.5+0.28 min in the surrounding zone and depended exponentially on the volume flow rate. Conclusions: Compared to an RT of 20 min as required for operating rooms with mixed dilution flow, particles here were eliminated 12–18 times more quickly from below the surgical lights and 5.7 times from the surrounding zone. Thus, the effect of the lights was negligible and the UDF’s retained its strong protective effect

Pancreas Disease in Farmed Salmon - Health Management and Investigations at Irish Farm Sites 2005-2008

This publication constitutes the final report for the research project ST/05/01 “Site investigations and disease management of the pancreas disease virus in Irish farmed salmon”, funded under the NDP Marine RTDI Programme. Work undertaken within the project included longitudinal studies of rainbow trout and Atlantic salmon at sea following the course of infection, testing for vectors and reservoirs of the virus, molecular studies of the virus and an epidemiological investigation of pancreas disease in Ireland. Results have shown that although pancreas disease is endemic in marine farmed Atlantic salmon, no evidence of infection in rainbow trout farmed at sea was found. Serological and molecular based diagnostic methods were shown to be suitable for the screening of fish stocks for the presence of the virus. For the confirmation of clinical outbreaks, farm data and histopathological results should be included. The results also suggest that horizontal transmission of the virus may be the main route of infection between sites. The project also involved the technology transfer of molecular and serological diagnostic methods for pancreas disease between partners and the final chapter includes practical information on management of, and mitigation against, pancreas disease. Pathologies such as pancreas disease, heart and skeletal muscle inflammation and cardiomyopathy syndrome, pose a serious threat to salmonid farming in Ireland, Scotland and Norway. Most significant among this group of diseases is pancreas disease, a viral disease affecting Atlantic salmon during the marine stage of the production cycle. From the first description of pancreas disease in farmed Atlantic salmon from Scotland in 1976 the disease has now become endemic in Ireland and parts of Norway and continues to be significant in Scotland. The causal agent of pancreas disease, a salmonid alphavirus, has now been characterised and a closely related subtype of the virus is known to cause sleeping disease in farmed rainbow trout on continental Europe and in the United Kingdom. The Irish salmon farming industry has estimated that pancreas disease has resulted in a total loss of turnover of €35 million with €12 million loss of profit in the years 2003-2004. The economic impacts are estimated to be in the range of €100 million per year in Norway. In Scotland, pancreas disease and related pathologies are increasingly responsible for significant losses in marine salmon farms but these have yet to be quantified.Funder: Marine Institut

Evidence for high levels of vertical transmission in Toxoplasma gondii

Toxoplasma gondii is a highly ubiquitous and prevalent parasite. Despite the cat being the only definitive host, it is found in almost all geographical areas and warm blooded animals. Three routes of transmission are recognised: ingestion of oocysts shed by the cat, carnivory and congenital transmission. In natural populations, it is difficult to establish the relative importance of these routes. This paper reviews recent work in our laboratory which suggests that congenital transmission may be much more important than previously thought. Using PCR detection of the parasite, studies in sheep show that congenital transmission may occur in as many as 66% of pregnancies. Furthermore, in families of sheep on the same farm, exposed to the same sources of oocysts, significant divergent prevalences of Toxoplasma infection and abortion are found between different families. The data suggest that breeding from infected ewes increases the risk of subsequent abortion and infection in lambs. Congenital transmission rates in a natural population of mice were found to be 75%. Interestingly, congenital transmission rates in humans were measured at 19.8%. The results presented in these studies differ from those of other published studies and suggest that vertical transmission may be much more important than previously thought

Detrital Neodymium and (Radio)Carbon as Complementary Sedimentary Bedfellows? The Western Arctic Ocean as a Testbed

Interactions between organic and detrital mineral phases strongly influence both the dispersal and accumulation of terrestrial organic carbon (OC) in continental margin sediments. Yet the complex interplay among biological, chemical, and physical processes limits our understanding of how organo-mineral interactions evolve during sediment transfer and burial. In particular, diverse OC sources and complex hydrodynamic processes hinder the assessment of how the partnership of organic matter and its mineral host evolves during supply and dispersal over continental margins. In this study, we integrate new and compiled sedimentological (grain size, surface area), organic (%OC, OC-δ13C, OC-F14C), and inorganic isotopic (εNd, 87Sr/86Sr) geochemical data for a broad suite of surface sediments spanning the Western Arctic Ocean from the Bering Sea to the Mackenzie River Delta that capture diverse sources and ages of both terrestrial and marine material deposited in contrasting shelf and slope settings. Spatial gradients in sediment properties were used to delineate regional sources and transport processes influencing the dispersion and persistence of OC-mineral particle associations during export and burial. We found strong relationships between physical parameters, aluminum content, and OC-14C suggesting that terrestrial OC remains tightly associated with its detrital mineral carrier during source-to-sink transport. Notably, carbon and neodymium isotopic data yield consistent information regarding organic matter provenance. Results obtained highlight the potential for coupled organic-inorganic tracer measurements to elucidate sediment sources and to constrain physical and geochemical processes during sediment mobilization and transport in the Western Arctic Ocean. Tandem measurements of carbon and Nd isotopes may provide a new way to identify large-scale biogeochemical and ecological changes in the sources, nature, and fate of OC stemming from predicted increases in sea ice loss and fluvial inputs of dissolved and particulate OC to this complex and dynamic high latitude marginal sea

Quantifying hiss-driven energetic electron precipitation: A detailed conjunction event analysis

Abstract We analyze a conjunction event between the Van Allen Probes and the low-altitude Polar Orbiting Environmental Satellite (POES) to quantify hiss-driven energetic electron precipitation. A physics-based technique based on quasi-linear diffusion theory is used to estimate the ratio of precipitated and trapped electron fluxes (R), which could be measured by the two-directional POES particle detectors, using wave and plasma parameters observed by the Van Allen Probes. The remarkable agreement between modeling and observations suggests that this technique is applicable for quantifying hiss-driven electron scattering near the bounce loss cone. More importantly, R in the 100-300 keV energy channel measured by multiple POES satellites over a broad L magnetic local time region can potentially provide the spatiotemporal evolution of global hiss wave intensity, which is essential in evaluating radiation belt electron dynamics, but cannot be obtained by in situ equatorial satellites alone. Key Points Measured and calculated hiss Bw from POES electron measurements agree well Electron ratio measured by POES is able to estimate hiss wave intensity This technique can be used to provide global hiss wave distributio

Effect of EMIC waves on relativistic and ultrarelativistic electron populations: Ground-based and Van Allen Probes observations

Abstract We study the effect of electromagnetic ion cyclotron (EMIC) waves on the loss and pitch angle scattering of relativistic and ultrarelativistic electrons during the recovery phase of a moderate geomagnetic storm on 11 October 2012. The EMIC wave activity was observed in situ on the Van Allen Probes and conjugately on the ground across the Canadian Array for Real-time Investigations of Magnetic Activity throughout an extended 18 h interval. However, neither enhanced precipitation of \u3e0.7 MeV electrons nor reductions in Van Allen Probe 90° pitch angle ultrarelativistic electron flux were observed. Computed radiation belt electron pitch angle diffusion rates demonstrate that rapid pitch angle diffusion is confined to low pitch angles and cannot reach 90°. For the first time, from both observational and modeling perspectives, we show evidence of EMIC waves triggering ultrarelativistic (~2-8 MeV) electron loss but which is confined to pitch angles below around 45° and not affecting the core distribution. Key Points EMIC wave activity is not associated with precipitation of MeV electrons EMIC waves do not deplete the ultra-relativistic belt down to 90° EMIC waves cause loss of low pitch angle electrons with energies ~2-8 MeV

Peer mentorship and positive effects on student mentor and mentee retention and academic success

This study examined how the introduction of peer mentorship in an undergraduate health and social welfare programme at a large northern university affected student learning. Using an ethnographic case study approach, the study draws upon data collected from a small group of mentors and their mentees over a period of one academic year using interviews, reflective journals, assessment and course evaluation data. Analysis of the data collected identified a number of key findings: peer mentorship improves assessment performance for both mentee and mentor; reduces stress and anxiety, enhances participation and engagement in the academic community, and adds value to student outcomes

Gill Damage to Atlantic Salmon (Salmo salar) Caused by the Common Jellyfish (Aurelia aurita) under Experimental Challenge

Peer-reviewed. Copyright © 2011 E.J. Baxter et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.Background: Over recent decades jellyfish have caused fish kill events and recurrent gill problems in marine-farmed salmonids. Common jellyfish (Aurelia spp.) are among the most cosmopolitan jellyfish species in the oceans, with populations increasing in many coastal areas. The negative interaction between jellyfish and fish in aquaculture remains a poorly studied area of science. Thus, a recent fish mortality event in Ireland, involving Aurelia aurita, spurred an investigation into the effects of this jellyfish on marine-farmed salmon. Methodology/Principal Findings: To address the in vivo impact of the common jellyfish (A. aurita) on salmonids, we exposed Atlantic salmon (Salmo salar) smolts to macerated A. aurita for 10 hrs under experimental challenge. Gill tissues of control and experimental treatment groups were scored with a system that rated the damage between 0 and 21 using a range of primary and secondary parameters. Our results revealed that A. aurita rapidly and extensively damaged the gills of S. salar, with the pathogenesis of the disorder progressing even after the jellyfish were removed. After only 2 hrs of exposure, significant multi-focal damage to gill tissues was apparent. The nature and extent of the damage increased up to 48 hrs from the start of the challenge. Although the gills remained extensively damaged at 3 wks from the start of the challenge trial, shortening of the gill lamellae and organisation of the cells indicated an attempt to repair the damage suffered. Conclusions: Our findings clearly demonstrate that A. aurita can cause severe gill problems in marine-farmed fish. With aquaculture predicted to expand worldwide and evidence suggesting that jellyfish populations are increasing in some areas, this threat to aquaculture is of rising concern as significant losses due to jellyfish could be expected to increase in the future

Respiratory health status is impaired in UK HIV-positive adults with virologically suppressed HIV infection

OBJECTIVES: We sought to evaluate whether people living with HIV (PLWH) using effective antiretroviral therapy (ART) have worse respiratory health status than similar HIV-negative individuals. METHODS: We recruited 197 HIV-positive and 93 HIV-negative adults from HIV and sexual health clinics. They completed a questionnaire regarding risk factors for respiratory illness. Respiratory health status was assessed using the St George's Respiratory Questionnaire (SGRQ) and the Medical Research Council (MRC) breathlessness scale. Subjects underwent spirometry without bronchodilation. RESULTS: PLWH had worse respiratory health status: the median SGRQ Total score was 12 [interquartile range (IQR) 6-25] in HIV-positive subjects vs. 6 (IQR 2-14) in HIV-negative subjects (P < 0.001); breathlessness was common in the HIV-positive group, where 47% compared with 24% had an MRC breathlessness score ≥ 2 (P = 0.001). Eighteen (11%) HIV-positive and seven (9%) HIV-negative participants had airflow obstruction. In multivariable analyses (adjusted for age, gender, smoking, body mass index and depression), HIV infection remained associated with higher SGRQ and MRC scores, with an adjusted fold-change in SGRQ Total score of 1.54 [95% confidence interval (CI) 1.14-2.09; P = 0.005] and adjusted odds ratio of having an MRC score of ≥ 2 of 2.45 (95% CI 1.15-5.20; P = 0.02). Similar findings were obtained when analyses were repeated including only HIV-positive participants with a viral load < 40 HIV-1 RNA copies/mL. CONCLUSIONS: Despite effective ART, impaired respiratory health appears more common in HIV-positive adults, and has a significant impact on health-related quality of life