The rapid response system: an integrative review

© 2019, © 2019 Informa UK Limited, trading as Taylor & Francis Group. Background: Clinical deterioration and adverse events in hospitals is an increasing cause for concern. Rapid response systems have been widely implemented to identify deteriorating patients. Aim: We aimed to examine the literature highlighting major historical trends leading to the widespread adoption of rapid response systems, focussing on Australian issues and identifying future focus areas. Method: Integrative literature review including published and grey literature. Results: Seventy-eight sources including journal articles and Australian government matierlas resulted. Pertinent themes were the increasing acuity and aging of the population, importance of hospital cultures, the emerging role of the consumer, and proliferation, evolution and standardisation of rapid response systems. Discussion: Translating evidence to usual care practice is challenging and strongly driven by local factors and political imperatives. Conclusion: Rapid response systems are complex interventions requiring consideration of contextual factors at all levels. Appropriate resources, a skilled workforce and positive workplace cultures are needed for these systems to reach their full potential

The enigma of Oligocene climate and global surface temperature evolution.

Falling atmospheric CO2 levels led to cooling through the Eocene and the expansion of Antarctic ice sheets close to their modern size near the beginning of the Oligocene, a period of poorly documented climate. Here, we present a record of climate evolution across the entire Oligocene (33.9 to 23.0 Ma) based on TEX86 sea surface temperature (SST) estimates from southwestern Atlantic Deep Sea Drilling Project Site 516 (paleolatitude ∼36°S) and western equatorial Atlantic Ocean Drilling Project Site 929 (paleolatitude ∼0°), combined with a compilation of existing SST records and climate modeling. In this relatively low CO2 Oligocene world (∼300 to 700 ppm), warm climates similar to those of the late Eocene continued with only brief interruptions, while the Antarctic ice sheet waxed and waned. SSTs are spatially heterogenous, but generally support late Oligocene warming coincident with declining atmospheric CO2 This Oligocene warmth, especially at high latitudes, belies a simple relationship between climate and atmospheric CO2 and/or ocean gateways, and is only partially explained by current climate models. Although the dominant climate drivers of this enigmatic Oligocene world remain unclear, our results help fill a gap in understanding past Cenozoic climates and the way long-term climate sensitivity responded to varying background climate states

Remote Sensing-Driven Pacific Oyster (Crassostrea gigas) Growth Modeling to Inform Offshore Aquaculture Site Selection

Aquaculture increasingly contributes to global seafood production, requiring new farm sites for continued growth. In France, oyster cultivation has conventionally taken place in the intertidal zone, where there is little or no further room for expansion. Despite interest in moving production further offshore, more information is needed regarding the biological potential for offshore oyster growth, including its spatial and temporal variability. This study shows the use of remotely-sensed chlorophyll-a and total suspended matter concentrations retrieved from the Medium Resolution Imaging Spectrometer (MERIS), and sea surface temperature from the Advanced Very High Resolution Radiometer (AVHRR), all validated using in situ matchup measurements, as input to run a Dynamic Energy Budget (DEB) Pacific oyster growth model for a study site along the French Atlantic coast (Bourgneuf Bay, France). Resulting oyster growth maps were calibrated and validated using in situ measurements of total oyster weight made throughout two growing seasons, from the intertidal zone, where cultivation currently takes place, and from experimental offshore sites, for both spat (R2 = 0.91; RMSE = 1.60 g) and adults (R2 = 0.95; RMSE = 4.34 g). Oyster growth time series are further digested into industry-relevant indicators, such as time to achieve market weight and quality index, elaborated in consultation with local producers and industry professionals, and which are also mapped. Offshore growth is found to be feasible and to be as much as two times faster than in the intertidal zone (p < 0.001). However, the potential for growth is also revealed to be highly variable across the investigated area. Mapping reveals a clear spatial gradient in production potential in the offshore environment, with the northeastern segment of the bay far better suited than the southwestern. Results also highlight the added value of spatiotemporal data, such as satellite image time series, to drive modeling in support of marine spatial planning. The current work demonstrates the feasibility and benefit of such a coupled remote sensing modeling approach within a shellfish farming context, responding to real and current interests of oyster producers

A strategy for the characterization of minute chromosome rearrangements using multiple color fluorescence in situ hybridization with chromosome-specific DNA libraries and YAC clones

The identification of marker chromosomes in clinical and tumor cytogenetics by chromosome banding analysis can create problems. In this study, we present a strategy to define minute chromosomal rearrangements by multicolor fluorescence in situ hybridization (FISH) with whole chromosome painting probes derived from chromosome-specific DNA libraries and Alu-polymerase chain reaction (PCR) products of various region-specific yeast artificial chromosome (YAC) clones. To demonstrate the usefulness of this strategy for the characterization of chromosome rearrangements unidentifiable by banding techniques, an 8p+ marker chromosome with two extra bands present in the karyotype of a child with multiple anomalies, malformations, and severe mental retardation was investigated. A series of seven-color FISH experiments with sets of fluorochrome-labeled DNA library probes from flow-sorted chromosomes demonstrated that the additional segment on 8p+ was derived from chromosome 6. For a more detailed characterization of the marker chromosome, three-color FISH experiments with library probes specific to chromosomes 6 and 8 were performed in combination with newly established telomeric and subtelomeric YAC clones from 6q25, 6p23, and 8p23. These experiments demonstrated a trisomy 6pter6p22 and a monosomy 8pter8p23 in the patient. The present limitations for a broad application of this strategy and its possible improvements are discusse

First Fruits of the Spitzer Space Telescope: Galactic and Solar System Studies

This article provides a brief overview of the Spitzer Space Telescope and discusses its initial scientific results on galactic and solar system science.Comment: Review article to appear in slightly different format in Vol.44 of Annual Reviews of Astronomy and Astrophysics, 200

Pressure-induced oversaturation and phase transition in zeolitic imidazolate frameworks with remarkable mechanical stability.

Zeolitic imidazolate frameworks (ZIFs) 7 and 9 are excellent candidates for CO2 adsorption and storage. Here, high-pressure X-ray diffraction is used to further understand their potential in realistic industrial applications. ZIF-7 and ZIF-9 are shown be able to withstand high hydrostatic pressures whilst retaining their porosity and structural integrity through a new ferroelastic phase transition. This stability is attributed to the presence of sterically large organic ligands. Results confirm the notable influence of guest occupancy on the response of ZIFs to pressure; oversaturation of ZIFs with solvent molecules greatly decreases their compressibility and increases their resistance to amorphisation. By comparing the behaviours of both ZIFs under high pressure, it is demonstrated that their mechanical stability is not affected by metal substitution. The evacuated ZIF-7 phase, ZIF-7-II, is shown to be able to recover to the ZIF-7 structure with excellent resistance to pressure. Examining the pressure-related structural behaviours of ZIF-7 and ZIF-9, we have assessed the great industrial potential of ZIFs.This work was supported by the Cambridge Commonwealth, European and International Trust; China Scholarship Council; Trinity Hall, University of Cambridge; UK Science & Technology Facilities Council. We thank anonymous reviewers for their valuable suggestions on the improvement of this manuscript.This is the final version of the article. It first appeared from the Royal Society of Chemistry via http://dx.doi.org/10.1039/C4DT02680

Mass extinctions and supernova explosions

A nearby supernova (SN) explosion could have negatively influenced life on Earth, maybe even been responsible for mass extinctions. Mass extinction poses a significant extinction of numerous species on Earth, as recorded in the paleontologic, paleoclimatic, and geological record of our planet. Depending on the distance between the Sun and the SN, different types of threats have to be considered, such as ozone depletion on Earth, causing increased exposure to the Sun's ultraviolet radiation, or the direct exposure of lethal x-rays. Another indirect effect is cloud formation, induced by cosmic rays in the atmosphere which result in a drop in the Earth's temperature, causing major glaciations of the Earth. The discovery of highly intensive gamma ray bursts (GRBs), which could be connected to SNe, initiated further discussions on possible life-threatening events in Earth's history. The probability that GRBs hit the Earth is very low. Nevertheless, a past interaction of Earth with GRBs and/or SNe cannot be excluded and might even have been responsible for past extinction events.Comment: Chapter for forthcoming book: Handbook of Supernovae, P. Murdin and A. Alsabeti (eds.), Springer International Publishing (in press

Pregnant women with bronchial asthma benefit from progressive muscle relaxation: A randomized, prospective, controlled trial

Background: Asthma is a serious medical problem in pregnancy and is often associated with stress, anger and poor quality of life. The aim of this study was to determine the efficacy of progressive muscle relaxation (PMR) on change in blood pressure, lung parameters, heart rate, anger and health-related quality of life in pregnant women with bronchial asthma. Methods: We treated a sample of 64 pregnant women with bronchial asthma from the local population in an 8-week randomized, prospective, controlled trial. Thirty-two were selected for PMR, and 32 received a placebo intervention. The systolic blood pressure, forced expiratory volume in the first second, peak expiratory flow and heart rate were tested, and the State-Trait Anger Expression Inventory and Health Survey (SF-36) were employed. Results: According to the intend-to-treat principle, a significant reduction in systolic blood pressure and a significant increase in both forced expiratory volume in the first second and peak expiratory flow were observed after PMR. The heart rate showed a significant increase in the coefficient of variation, root mean square of successive differences and high frequency ranges, in addition to a significant reduction in low and middle frequency ranges. A significant reduction on three of five State-Trait Anger Expression Inventory scales, and a significant increase on seven of eight SF-36 scales were observed. Conclusions: PMR appears to be an effective method to improve blood pressure, lung parameters and heart rate, and to decrease anger levels, thus enhancing health-related quality of life in pregnant women with bronchial asthma. Copyright (c) 2006 S. Karger AG, Basel

The Swiss cheese model of safety incidents: are there holes in the metaphor?

BACKGROUND: Reason's Swiss cheese model has become the dominant paradigm for analysing medical errors and patient safety incidents. The aim of this study was to determine if the components of the model are understood in the same way by quality and safety professionals. METHODS: Survey of a volunteer sample of persons who claimed familiarity with the model, recruited at a conference on quality in health care, and on the internet through quality-related websites. The questionnaire proposed several interpretations of components of the Swiss cheese model: a) slice of cheese, b) hole, c) arrow, d) active error, e) how to make the system safer. Eleven interpretations were compatible with this author's interpretation of the model, 12 were not. RESULTS: Eighty five respondents stated that they were very or quite familiar with the model. They gave on average 15.3 (SD 2.3, range 10 to 21) "correct" answers out of 23 (66.5%) – significantly more than 11.5 "correct" answers that would expected by chance (p < 0.001). Respondents gave on average 2.4 "correct" answers regarding the slice of cheese (out of 4), 2.7 "correct" answers about holes (out of 5), 2.8 "correct" answers about the arrow (out of 4), 3.3 "correct" answers about the active error (out of 5), and 4.1 "correct" answers about improving safety (out of 5). CONCLUSION: The interpretations of specific features of the Swiss cheese model varied considerably among quality and safety professionals. Reaching consensus about concepts of patient safety requires further work