The development of a space climatology: 2. The distribution of power input into the magnetosphere on a 3‐hourly timescale

Paper 1 in this series (Lockwood et al., 2018a, https://doi.org/10.1029/2018SW001856) showed that the power input into the magnetosphere Pα is an ideal coupling function for predicting geomagnetic “range” indices that are strongly dependent on the substorm current wedge and that the optimum coupling exponent α is 0.44 for all averaging timescales, τ, between 1 min and 1 year. The present paper explores the implications of these results. It is shown that the form of the distribution of Pα at all averaging timescales τ is set by the interplanetary magnetic field orientation factor via the nature of solar wind‐magnetosphere coupling (due to magnetic reconnection in the dayside magnetopause) and that at τ = 3 hr (the timescale of geomagnetic range indices) the normalized Pα (divided by its annual mean, that is, τ=3hr/τ=1yr) follows a Weibull distribution with k of 1.0625 and λ of 1.0240. This applies to all years to a useful degree of accuracy. It is shown that exploiting the constancy of this distribution and using annual means to predict the full distribution gives the probability of space weather events in the largest 10% and 5% to within uncertainties of magnitude 10% and 12%, respectively, at the one sigma level

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Proceedings of the Thirteenth International Society of Sports Nutrition (ISSN) Conference and Expo

Meeting Abstracts: Proceedings of the Thirteenth International Society of Sports Nutrition (ISSN) Conference and Expo Clearwater Beach, FL, USA. 9-11 June 201

Outcomes following small bowel obstruction due to malignancy in the national audit of small bowel obstruction

Introduction Patients with cancer who develop small bowel obstruction are at high risk of malnutrition and morbidity following compromise of gastrointestinal tract continuity. This study aimed to characterise current management and outcomes following malignant small bowel obstruction. Methods A prospective, multicentre cohort study of patients with small bowel obstruction who presented to UK hospitals between 16th January and 13th March 2017. Patients who presented with small bowel obstruction due to primary tumours of the intestine (excluding left-sided colonic tumours) or disseminated intra-abdominal malignancy were included. Outcomes included 30-day mortality and in-hospital complications. Cox-proportional hazards models were used to generate adjusted effects estimates, which are presented as hazard ratios (HR) alongside the corresponding 95% confidence interval (95% CI). The threshold for statistical significance was set at the level of P ≤ 0.05 a-priori. Results 205 patients with malignant small bowel obstruction presented to emergency surgery services during the study period. Of these patients, 50 had obstruction due to right sided colon cancer, 143 due to disseminated intraabdominal malignancy, 10 had primary tumours of the small bowel and 2 patients had gastrointestinal stromal tumours. In total 100 out of 205 patients underwent a surgical intervention for obstruction. 30-day in-hospital mortality rate was 11.3% for those with primary tumours and 19.6% for those with disseminated malignancy. Severe risk of malnutrition was an independent predictor for poor mortality in this cohort (adjusted HR 16.18, 95% CI 1.86 to 140.84, p = 0.012). Patients with right-sided colon cancer had high rates of morbidity. Conclusions Mortality rates were high in patients with disseminated malignancy and in those with right sided colon cancer. Further research should identify optimal management strategy to reduce morbidity for these patient groups

National prospective cohort study of the burden of acute small bowel obstruction

Background Small bowel obstruction is a common surgical emergency, and is associated with high levels of morbidity and mortality across the world. The literature provides little information on the conservatively managed group. The aim of this study was to describe the burden of small bowel obstruction in the UK. Methods This prospective cohort study was conducted in 131 acute hospitals in the UK between January and April 2017, delivered by trainee research collaboratives. Adult patients with a diagnosis of mechanical small bowel obstruction were included. The primary outcome was in‐hospital mortality. Secondary outcomes included complications, unplanned intensive care admission and readmission within 30 days of discharge. Practice measures, including use of radiological investigations, water soluble contrast, operative and nutritional interventions, were collected. Results Of 2341 patients identified, 693 (29·6 per cent) underwent immediate surgery (within 24 h of admission), 500 (21·4 per cent) had delayed surgery after initial conservative management, and 1148 (49·0 per cent) were managed non‐operatively. The mortality rate was 6·6 per cent (6·4 per cent for non‐operative management, 6·8 per cent for immediate surgery, 6·8 per cent for delayed surgery; P = 0·911). The major complication rate was 14·4 per cent overall, affecting 19·0 per cent in the immediate surgery, 23·6 per cent in the delayed surgery and 7·7 per cent in the non‐operative management groups (P < 0·001). Cox regression found hernia or malignant aetiology and malnutrition to be associated with higher rates of death. Malignant aetiology, operative intervention, acute kidney injury and malnutrition were associated with increased risk of major complication. Conclusion Small bowel obstruction represents a significant healthcare burden. Patient‐level factors such as timing of surgery, acute kidney injury and nutritional status are factors that might be modified to improve outcomes

An In Vitro Diagnostic for Multiple Sclerosis Based on C-peptide Binding to Erythrocytes

Objective: To investigate the utility of a blood-based lab test as an aid in identifying patients with Multiple Sclerosis (MS). Methods: Whole blood from subjects with MS, non-MS neurologic diseases, and healthy controls was centrifuged to isolate erythrocytes. Following the addition of exogenous C-peptide, the supernatant was assayed for remaining C-peptide using an enzyme linked immunosorbent assay (ELISA). Results: The cohort included subjects with MS (n = 86), other non-MS neurologic diseases (OND n = 75), and healthy controls (n = 39). The average C-peptide bound to erythrocytes in MS samples (3.51 ± 0.59 pmol) was significantly higher than non-MS subjects (2.23 ± 0.51 pmol; p < 0.001) and healthy controls (1.99 ± 0.32 pmol; p < 0.001). Using a cutoff of 3.04 pmol of C-peptide uptake, the test exhibited a sensitivity of 98.3% and specificity of 89.5%. A receiver-operator characteristic (ROC) curve generated from the ratio of the sensitivity to 1-selectivity resulted in an area under the curve of 0.97. Conclusions: Exogenous C-peptide binding to erythrocytes has potential value in distinguishing MS subjects from non-MS neurologic diseases and healthy controls

Solar forcing of winter climate variability in the Northern Hemisphere

An influence of solar irradiance variations on Earth’s surface climate has been repeatedly suggested, based on correlations between solar variability and meteorological variables1. Specifically, weaker westerly winds have been observed in winters with a less active sun, for example at the minimum phase of the 11-year sunspot cycle2, 3, 4. With some possible exceptions5, 6, it has proved difficult for climate models to consistently reproduce this signal7, 8. Spectral Irradiance Monitor satellite measurements indicate that variations in solar ultraviolet irradiance may be larger than previously thought9. Here we drive an ocean–atmosphere climate model with ultraviolet irradiance variations based on these observations. We find that the model responds to the solar minimum with patterns in surface pressure and temperature that resemble the negative phase of the North Atlantic or Arctic Oscillation, of similar magnitude to observations. In our model, the anomalies descend through the depth of the extratropical winter atmosphere. If the updated measurements of solar ultraviolet irradiance are correct, low solar activity, as observed during recent years, drives cold winters in northern Europe and the United States, and mild winters over southern Europe and Canada, with little direct change in globally averaged temperature. Given the quasiregularity of the 11-year solar cycle, our findings may help improve decadal climate predictions for highly populated extratropical region