Cruise Report 69-S-1: Bottomfish Program

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Optimizing the integration of advanced practitioners in a department of surgery: An operational improvement model

Physician assistants (PAs) and nurse practitioners (NPs) have established themselves as key members of the healthcare team to supplement practicing physicians in patient care. PAs and NPs are collectively referred to as “advanced providers” (APs) and work not only in primary care but in general surgery and surgical subspecialties. Studies have addressed AP integration into the profession of medicine and have examined cost and efficacy of APs, attitudes about APs among residents, and educational impact of APs, but very little literature exists that describes a formalized approach to AP integration into a department of surgery, specifically with AP/resident integration. The purpose of this paper is to describe an initiative for developing an operational improvement model for APs working with residents on surgical inpatient services in a large academic health center. The model consists of four components and each component is described in detail from discovery state towards continuous improvement. Formal professional development opportunities for APs as well as appointing a Clinical Director for Surgical APs have positively impacted AP integration into the department of surgery

Zipline-Related Injuries Treated in US EDs, 1997-2012

Purpose To investigate the epidemiology of zipline-related injuries in the United States. Basic Procedures The National Electronic Injury Surveillance System database was used to examine non-fatal zipline-related injuries treated in US emergency departments (EDs) from 1997 through 2012. Sample weights were applied to calculate national estimates. Main Findings From 1997 through 2012, an estimated 16850 (95% CI, 13188-20512) zipline-related injuries were treated in US EDs. The annual injury rate per 1 million population increased by 52.3% from 7.64 (95% CI, 4.86-10.42) injuries in 2009 (the first year with a stable annual estimate) to 11.64 (95% CI, 7.83-15.45) injuries in 2012. Patients aged 0-9 years accounted for 45.0% of injuries, females made up 53.1% of injuries, and 11.7% of patients required hospitalization. Fractures accounted for the largest proportion of injuries (46.7%), and the upper extremities were the most commonly injured body region (44.1%). Falls were the most common mechanism of injury, accounting for 77.3% of injuries. Among cases where the location of the injury event was known, 30.8% of injuries occurred in a residential setting and 69.2% occurred in a public place. Principal Conclusions This study is the first to characterize the epidemiology of zipline-related injuries using a nationally representative database. The rapid increase in zipline-related injuries in recent years suggests the need for additional safety guidelines and regulations. Commercial ziplines and publicly accessible non-commercial ziplines should be subject to uniform safety standards in all states and jurisdictions across the US, and homemade ziplines should not be used

Admission to psychiatric hospital for mental illnesses 2 years prechildbirth and postchildbirth in Scotland: a health informatics approach to assessing mother and child outcomes

Objective: To identify factors associated with: admission to a specialist mother and baby unit (MBU) and the impact of perinatal mental illness on early childhood development using a data linkage approach in the 2 years prechildbirth and postchildbirth. Methods: Scottish maternity records (SMR02) were linked to psychiatric hospital admissions (SMR04). 3290 pregnancy-related psychiatric admissions for 1730 women were assessed. To investigate factors associated with MBU admission, the group of mothers admitted to an MBU were compared with those admitted to general psychiatric wards. To assess the impact of perinatal mental illness on early child development, a pragmatic indicator for ‘at potential risk of adversity’, defined as a child who was recorded as requiring intensive treatment at any time under the health plan indicators (HPI) and/or who had no record of completing three doses of the 5-in-1 vaccine by 12 months was generated. Logistic regression models were used to describe the association between each variable and the risk of admission between those with a history of prior psychiatric admission and those without. Results Women admitted to an MBU were significantly more likely to be admitted with non-affective psychosis (OR=1.97, 95% CI 1.22 to 3.18), affective psychosis (OR=2.44, 95% CI 1.37 to 4.33) and non-psychotic depressive episodes (OR=1.93, 95% CI 1.42 to 2.63). They were less likely to come from deprived areas (OR=0.68 95% CI 0.49 to 0.93). Women with a previous history of psychiatric admission were significantly more likely to be located in the two most deprived quintiles. Almost one-third (29%) of children born to mothers with a pregnancy-related psychiatric admission were assessed as ‘at potential risk of adversity.’ Conclusions: A health informatics approach has potential for improving understanding of social and clinical factors, which contribute to the outcomes of perinatal mental illness, as well as potential adverse developmental outcomes for offspring

A PC-based multispectral scanner data evaluation workstation: Application to Daedalus scanners

In late 1989, a personal computer (PC)-based data evaluation workstation was developed to support post flight processing of Multispectral Atmospheric Mapping Sensor (MAMS) data. The MAMS Quick View System (QVS) is an image analysis and display system designed to provide the capability to evaluate Daedalus scanner data immediately after an aircraft flight. Even in its original form, the QVS offered the portability of a personal computer with the advanced analysis and display features of a mainframe image analysis system. It was recognized, however, that the original QVS had its limitations, both in speed and processing of MAMS data. Recent efforts are presented that focus on overcoming earlier limitations and adapting the system to a new data tape structure. In doing so, the enhanced Quick View System (QVS2) will accommodate data from any of the four spectrometers used with the Daedalus scanner on the NASA ER2 platform. The QVS2 is designed around the AST 486/33 MHz CPU personal computer and comes with 10 EISA expansion slots, keyboard, and 4.0 mbytes of memory. Specialized PC-McIDAS software provides the main image analysis and display capability for the system. Image analysis and display of the digital scanner data is accomplished with PC-McIDAS software

Coaligned observations of solar magnetic fields at different heights: MSFC Center director's discretionary fund final report (Project No. 88-10)

The objective was to develop the capability for and coaligned observations of the structure and evolution of the Sun's magnetic field at two different heights in the solar atmosphere: the photosphere, which is the lowest region observable with optical telescopes; and the chromosphere, which lies just above the photosphere and is the region where the magnetic field dominates the gas motion so that a well-ordered structure governed by the field is observed. By obtaining this three-dimensional picture of the solar magnetic field, a better understanding can be developed of the magnetic forces that produce and control the dynamic, high-energy phenomena occurring in the solar atmosphere that can affect the entire heliosphere, including the terrestrial environment

The Structure of the Homunculus. II. Modeling the Physical Conditions in η Carinae\u27s Molecular Shell

We present models that reproduce the observed double-shell structure of the Homunculus Nebula around η Carinae, including the stratification of infrared H2 and [Fe II] emission seen in data obtained with the Phoenix spectrograph on Gemini South, as well as the corresponding stratified grain temperature seen in thermal-infrared data. Tuning the model to match the observed shell thickness allows us to determine the threshold density that permits survival of H2. An average density of nH~=(0.5-1)×107 cm-3 in the outer zone is required to allow H2 to exist at all latitudes in the nebula, and for Fe+ to recombine to Fe0. This gives independent confirmation of the very large mass of the Homunculus, indicating a total of roughly 15-35 M☉ (although we note reasons why the lower end of this range is favored). At the interface between the atomic and molecular zones, we predict a sharp drop in the dust temperature, in agreement with the bimodal dust color temperatures observed in the two zones. In the outer molecular shell, the dust temperature drops to nearly the blackbody temperature, and becomes independent of grain size because of self-shielding at shorter UV wavelengths and increased heating at longer wavelengths. This relaxes constraints on large grain sizes suggested by near-blackbody color temperatures. Finally, from the strength of infrared [Fe II] emission in the inner shell we find that the gas-phase Fe abundance is roughly solar. This is astonishing in such a dusty object, where one normally expects gaseous iron to be depleted by 2 orders of magnitude. Based in part on observations obtained at the Gemini Observatory, which is operated by AURA, under a cooperative agreement with the NSF on behalf of the Gemini partnership: the National Science Foundation (US), the Particle Physics and Astronomy Research Council (UK), the National Research Council (Canada), CONICYT (Chile), the Australian Research Council (Australia), CNPq (Brazil), and CONICET (Argentina)

Evidence of a Mira-like tail and bow shock about the semi-regular variable V CVn from four decades of polarization measurements

Polarization is a powerful tool for understanding stellar atmospheres and circumstellar environments. Mira and semi-regular variable stars have been observed for decades and some are known to be polarimetrically variable, however, the semi-regular variable V Canes Venatici displays an unusually large, unexplained amount of polarization. We present ten years of optical polarization observations obtained with the HPOL instrument, supplemented by published observations spanning a total interval of about forty years for V CVn. We find that V CVn shows large polarization variations ranging from 1 - 6%. We also find that for the past forty years the position angle measured for V CVn has been virtually constant suggesting a long-term, stable, asymmetric structure about the star. We suggest that this asymmetry is caused by the presence of a stellar wind bow shock and tail, consistent with the star's large space velocity.Comment: 8 pages, 5 figures, 1 table. Accepted for publication in A&