Human Factors Applied to Perioperative Process Improvement

Human factors/ergonomics (HF/E) is its own scientific discipline that can be applied to understanding performance in perioperative medicine. Humans are not perfect decision makers and are affected by a variety of factors that can greatly harm their ability to perform, including attention, bias, stress, and fatigue. HF/E has a unique perspective on human error, and HF/E can illustrate how moving away from blame can enhance safety. HF/E offers strategies for undertaking a systematic approach to assessment of work processes in perioperative medicine that can be used to increase safety and wellbeing of patients and providers

The AntAWS dataset: a compilation of Antarctic automatic weather station observations

A new meteorological dataset derived from records of Antarctic automatic weather stations (here called the AntAWS dataset) at 3 h, daily and monthly resolutions including quality control information is presented here. This dataset integrates the measurements of air temperature, air pressure, relative humidity, and wind speed and direction from 267 Antarctic AWSs obtained from 1980 to 2021. The AWS spatial distribution remains heterogeneous, with the majority of instruments located in near-coastal areas and only a few inland on the East Antarctic Plateau. Among these 267 AWSs, 63 have been operating for more than 20 years and 27 of them in excess of more than 30 years. Of the five meteorological parameters, the measurements of air temperature have the best continuity and the highest data integrity. The overarching aim of this comprehensive compilation of AWS observations is to make these data easily and widely accessible for efficient use in local, regional and continental studies; it may be accessed at 10.48567/key7-ch19 (Wang et al., 2022). This dataset is invaluable for improved characterization of the surface climatology across the Antarctic continent, to improve our understanding of Antarctic surface snow-Atmosphere interactions including precipitation events associated with atmospheric rivers and to evaluate regional climate models or meteorological reanalysis products

The state of the Martian climate

60°N was +2.0°C, relative to the 1981–2010 average value (Fig. 5.1). This marks a new high for the record. The average annual surface air temperature (SAT) anomaly for 2016 for land stations north of starting in 1900, and is a significant increase over the previous highest value of +1.2°C, which was observed in 2007, 2011, and 2015. Average global annual temperatures also showed record values in 2015 and 2016. Currently, the Arctic is warming at more than twice the rate of lower latitudes

The AntAWS dataset: a compilation of Antarctic automatic weather station observations

A new meteorological dataset derived from records of Antarctic automatic weather stations (here called the AntAWS dataset) at 3 h, daily and monthly resolutions including quality control information is presented here. This dataset integrates the measurements of air temperature, air pressure, relative humidity, and wind speed and direction from 267 Antarctic AWSs obtained from 1980 to 2021. The AWS spatial distribution remains heterogeneous, with the majority of instruments located in near-coastal areas and only a few inland on the East Antarctic Plateau. Among these 267 AWSs, 63 have been operating for more than 20 years and 27 of them in excess of more than 30 years. Of the five meteorological parameters, the measurements of air temperature have the best continuity and the highest data integrity. The overarching aim of this comprehensive compilation of AWS observations is to make these data easily and widely accessible for efficient use in local, regional and continental studies; it may be accessed at https://doi.org/10.48567/key7-ch19 (Wang et al., 2022). This dataset is invaluable for improved characterization of the surface climatology across the Antarctic continent, to improve our understanding of Antarctic surface snow–atmosphere interactions including precipitation events associated with atmospheric rivers and to evaluate regional climate models or meteorological reanalysis products

State of the climate in 2018

In 2018, the dominant greenhouse gases released into Earth’s atmosphere—carbon dioxide, methane, and nitrous oxide—continued their increase. The annual global average carbon dioxide concentration at Earth’s surface was 407.4 ± 0.1 ppm, the highest in the modern instrumental record and in ice core records dating back 800 000 years. Combined, greenhouse gases and several halogenated gases contribute just over 3 W m−2 to radiative forcing and represent a nearly 43% increase since 1990. Carbon dioxide is responsible for about 65% of this radiative forcing. With a weak La Niña in early 2018 transitioning to a weak El Niño by the year’s end, the global surface (land and ocean) temperature was the fourth highest on record, with only 2015 through 2017 being warmer. Several European countries reported record high annual temperatures. There were also more high, and fewer low, temperature extremes than in nearly all of the 68-year extremes record. Madagascar recorded a record daily temperature of 40.5°C in Morondava in March, while South Korea set its record high of 41.0°C in August in Hongcheon. Nawabshah, Pakistan, recorded its highest temperature of 50.2°C, which may be a new daily world record for April. Globally, the annual lower troposphere temperature was third to seventh highest, depending on the dataset analyzed. The lower stratospheric temperature was approximately fifth lowest. The 2018 Arctic land surface temperature was 1.2°C above the 1981–2010 average, tying for third highest in the 118-year record, following 2016 and 2017. June’s Arctic snow cover extent was almost half of what it was 35 years ago. Across Greenland, however, regional summer temperatures were generally below or near average. Additionally, a satellite survey of 47 glaciers in Greenland indicated a net increase in area for the first time since records began in 1999. Increasing permafrost temperatures were reported at most observation sites in the Arctic, with the overall increase of 0.1°–0.2°C between 2017 and 2018 being comparable to the highest rate of warming ever observed in the region. On 17 March, Arctic sea ice extent marked the second smallest annual maximum in the 38-year record, larger than only 2017. The minimum extent in 2018 was reached on 19 September and again on 23 September, tying 2008 and 2010 for the sixth lowest extent on record. The 23 September date tied 1997 as the latest sea ice minimum date on record. First-year ice now dominates the ice cover, comprising 77% of the March 2018 ice pack compared to 55% during the 1980s. Because thinner, younger ice is more vulnerable to melting out in summer, this shift in sea ice age has contributed to the decreasing trend in minimum ice extent. Regionally, Bering Sea ice extent was at record lows for almost the entire 2017/18 ice season. For the Antarctic continent as a whole, 2018 was warmer than average. On the highest points of the Antarctic Plateau, the automatic weather station Relay (74°S) broke or tied six monthly temperature records throughout the year, with August breaking its record by nearly 8°C. However, cool conditions in the western Bellingshausen Sea and Amundsen Sea sector contributed to a low melt season overall for 2017/18. High SSTs contributed to low summer sea ice extent in the Ross and Weddell Seas in 2018, underpinning the second lowest Antarctic summer minimum sea ice extent on record. Despite conducive conditions for its formation, the ozone hole at its maximum extent in September was near the 2000–18 mean, likely due to an ongoing slow decline in stratospheric chlorine monoxide concentration. Across the oceans, globally averaged SST decreased slightly since the record El Niño year of 2016 but was still far above the climatological mean. On average, SST is increasing at a rate of 0.10° ± 0.01°C decade−1 since 1950. The warming appeared largest in the tropical Indian Ocean and smallest in the North Pacific. The deeper ocean continues to warm year after year. For the seventh consecutive year, global annual mean sea level became the highest in the 26-year record, rising to 81 mm above the 1993 average. As anticipated in a warming climate, the hydrological cycle over the ocean is accelerating: dry regions are becoming drier and wet regions rainier. Closer to the equator, 95 named tropical storms were observed during 2018, well above the 1981–2010 average of 82. Eleven tropical cyclones reached Saffir–Simpson scale Category 5 intensity. North Atlantic Major Hurricane Michael’s landfall intensity of 140 kt was the fourth strongest for any continental U.S. hurricane landfall in the 168-year record. Michael caused more than 30 fatalities and $25 billion (U.S. dollars) in damages. In the western North Pacific, Super Typhoon Mangkhut led to 160 fatalities and$6 billion (U.S. dollars) in damages across the Philippines, Hong Kong, Macau, mainland China, Guam, and the Northern Mariana Islands. Tropical Storm Son-Tinh was responsible for 170 fatalities in Vietnam and Laos. Nearly all the islands of Micronesia experienced at least moderate impacts from various tropical cyclones. Across land, many areas around the globe received copious precipitation, notable at different time scales. Rodrigues and Réunion Island near southern Africa each reported their third wettest year on record. In Hawaii, 1262 mm precipitation at Waipā Gardens (Kauai) on 14–15 April set a new U.S. record for 24-h precipitation. In Brazil, the city of Belo Horizonte received nearly 75 mm of rain in just 20 minutes, nearly half its monthly average. Globally, fire activity during 2018 was the lowest since the start of the record in 1997, with a combined burned area of about 500 million hectares. This reinforced the long-term downward trend in fire emissions driven by changes in land use in frequently burning savannas. However, wildfires burned 3.5 million hectares across the United States, well above the 2000–10 average of 2.7 million hectares. Combined, U.S. wildfire damages for the 2017 and 2018 wildfire seasons exceeded $40 billion (U.S. dollars)

Ventricular Dysrhythmias Associated with Poisoning and Drug Overdose: A 10-Year Review of Statewide Poison Control Center Data from California

Background: Ventricular dysrhythmias are a serious consequence associated with drug overdose and chemical poisoning. The risk factors for the type of ventricular dysrhythmia and the outcomes by drug class are not well documented. Objective: The aim of this study was to determine the most common drugs and chemicals associated with ventricular dysrhythmias and their outcomes. Methods: We reviewed all human exposures reported to a statewide poison control system between 2002 and 2011 that had a documented ventricular dysrhythmia. Cases were differentiated into two groups by type of arrhythmia: (1) ventricular fibrillation and/or tachycardia (VT/VF); and (2) torsade de pointes (TdP). Results: Among the 300 potential cases identified, 148 cases met the inclusion criteria. Of these, 132 cases (89 %) experienced an episode of VT or VF, while the remaining 16 cases (11 %) had an episode of TdP. The most commonly involved therapeutic classes of drugs associated with VT/VF were antidepressants (33/132, 25 %), stimulants (33/132, 25 %), and diphenhydramine (16/132, 12.1 %). Those associated with TdP were antidepressants (4/16, 25 %), methadone (4/16, 25 %), and antiarrhythmics (3/16, 18.75 %). Drug exposures with the greatest risk of death in association with VT/VF were antidepressant exposure [odds ratio (OR) 1.71; 95 % confidence interval (CI) 0.705–4.181] and antiarrhythmic exposure (OR 1.75; 95 % CI 0.304–10.05), but neither association was statistically significant. Drug exposures with a statistically significant risk for TdP included methadone and antiarrhythmic drugs. Conclusions: Antidepressants and stimulants were the most common drugs associated with ventricular dysrhythmias. Patients with suspected poisonings by medications with a high risk of ventricular dysrhythmia warrant prompt ECG monitoring

Macromolecular shape and interactions in layer-by-layer assemblies within cylindrical nanopores

Layer-by-layer (LbL) deposition of polyelectrolytes and proteins within the cylindrical nanopores of anodic aluminum oxide (AAO) membranes was studied by optical waveguide spectroscopy (OWS). AAO has aligned cylindrical, nonintersecting pores with a defined pore diameter d(0) and functions as a planar optical waveguide so as to monitor, in situ, the LbL process by OWS. The LbL deposition of globular proteins, i.e., avidin and biotinylated bovine serum albumin was compared with that of linear polyelectrolytes (linear-PEs), both species being of similar molecular weight. LbL deposition within the cylindrical AAO geometry for different pore diameters (d(0) = 25-80 nm) for the various macromolecular species, showed that the multilayer film growth was inhibited at different maximum numbers of LbL steps (n(max)). The value of nmax was greatest for linear-PEs, while proteins had a lower value. The cylindrical pore geometry imposes a physical limit to LbL growth such that nmax is strongly dependent on the overall internal structure of the LbL film. For all macromolecular species, deposition was inhibited in native AAO, having pores of d(0) = 25-30 nm. Both, OWS and scanning electron microscopy showed that LbL growth in larger AAO pores (d(0) > 25-30 nm) became inhibited when approaching a pore diameter of d(eff,n_max),= 25-35 nm, a similar size to that of native AAO pores, with d(0) = 25-30 nm. For a reasonable estimation of d(eff,n_max), the actual volume occupied by a macromolecular assembly must be taken into consideration. The results clearly show that electrostatic LbL allowed for compact macromolecular layers, whereas proteins formed loosely packed multilayers

Human Factors Applied to Perioperative Process Improvement

Human factors/ergonomics (HF/E) is its own scientific discipline that can be applied to understanding performance in perioperative medicine. Humans are not perfect decision makers and are affected by a variety of factors that can greatly harm their ability to perform, including attention, bias, stress, and fatigue. HF/E has a unique perspective on human error, and HF/E can illustrate how moving away from blame can enhance safety. HF/E offers strategies for undertaking a systematic approach to assessment of work processes in perioperative medicine that can be used to increase safety and wellbeing of patients and providers

Human Factors Applied to Perioperative Process Improvement

Human factors/ergonomics (HF/E) is its own scientific discipline that can be applied to understanding performance in perioperative medicine. Humans are not perfect decision makers and are affected by a variety of factors that can greatly harm their ability to perform, including attention, bias, stress, and fatigue. HF/E has a unique perspective on human error, and HF/E can illustrate how moving away from blame can enhance safety. HF/E offers strategies for undertaking a systematic approach to assessment of work processes in perioperative medicine that can be used to increase safety and wellbeing of patients and providers