Activity

004). FLC participation was also higher on these units (50% of debriefings [37%] vs 24% [37%];

= .014). Through qualitative analysis, we identified distinct debriefing themes, with teaming activities such as communication cited most often.

Implementation of a multidisciplinary debriefing process for ward deterioration events culminating in ICU transfer was associated with differential adoption across providers and FLC staffing models but not acuity or nurse staffing. Teaming activities were a debriefing priority. Future study will assess patient safety outcomes.

Implementation of a multidisciplinary debriefing process for ward deterioration events culminating in ICU transfer was associated with differential adoption across providers and FLC staffing models but not acuity or nurse staffing. Teaming activities were a debriefing priority. Future study will assess patient safety outcomes.The current revival of the American economy is being predicated on social distancing, specifically the Six-Foot Rule, a guideline that offers little protection from pathogen-bearing aerosol droplets sufficiently small to be continuously mixed through an indoor space. The importance of airborne transmission of COVID-19 is now widely recognized. While tools for risk assessment have recently been developed, no safety guideline has been proposed to protect against it. We here build on models of airborne disease transmission in order to derive an indoor safety guideline that would impose an upper bound on the “cumulative exposure time,” the product of the number of occupants and their time in an enclosed space. We demonstrate how this bound depends on the rates of ventilation and air filtration, dimensions of the room, breathing rate, respiratory activity and face mask use of its occupants, and infectiousness of the respiratory aerosols. By synthesizing available data from the best-characterized indoor spreading events with respiratory drop size distributions, we estimate an infectious dose on the order of 10 aerosol-borne virions. The new virus (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]) is thus inferred to be an order of magnitude more infectious than its forerunner (SARS-CoV), consistent with the pandemic status achieved by COVID-19. Case studies are presented for classrooms and nursing homes, and a spreadsheet and online app are provided to facilitate use of our guideline. Implications for contact tracing and quarantining are considered, and appropriate caveats enumerated. Particular consideration is given to respiratory jets, which may substantially elevate risk when face masks are not worn.From uncovering the structure of the atom to the nature of the universe, spectral measurements have helped some of science’s greatest discoveries. While pointwise spectral measurements date back to Newton, it is commonly thought that hyperspectral images originated in the 1970s. However, the first hyperspectral images are over a century old and are locked in the safes of a handful of museums. These hidden treasures are examples of the first color photographs and earned their inventor, Gabriel Lippmann, the 1908 Nobel Prize in Physics. Since the original work of Lippmann, the process has been predominately understood from the monochromatic perspective, with analogies drawn to Bragg gratings, and the polychromatic case treated as a simple extension. find more As a consequence, there are misconceptions about the invertibility of the Lippmann process. We show that the multispectral image reflected from a Lippmann plate contains distortions that are not explained by current models. We describe these distortions by directly modeling the process for general spectra and devise an algorithm to recover the original spectra. This results in a complete analysis of the Lippmann process. Finally, we demonstrate the accuracy of our recovery algorithm on self-made Lippmann plates, for which the acquisition setup is fully understood. However, we show that, in the case of historical plates, there are too many unknowns to reliably recover 19th century spectra of natural scenes.

The Initiating Dialysis Early and Late (IDEAL) trial, published in 2009, found no clinically measurable benefit with respect to risk of mortality or early complications with early dialysis initiation versus deferred dialysis start. After these findings, guidelines recommended an intent-to-defer approach to dialysis initiation, with the goal of deferring it until clinical symptoms arise.

To evaluate a four-component knowledge translation intervention aimed at promoting an intent-to-defer strategy for dialysis initiation, we conducted a cluster randomized trial in Canada between October 2014 and November 2015. We randomized 55 clinics, 27 to the intervention group and 28 to the control group. The educational intervention, using knowledge-translation tools, included telephone surveys from a knowledge-translation broker, a 1-year center-specific audit with feedback, delivery of a guidelines package, and an academic detailing visit. Participants included adults who had at least 3 months of predialysis care and who started dialysis in the first year after the intervention. The primary efficacy outcome was the proportion of patients who initiated dialysis early (at eGFR >10.5 ml/min per 1.73 m

). The secondary outcome was the proportion of patients who initiated in the acute inpatient setting.

The analysis included 3424 patients initiating dialysis in the 1-year follow-up period. Of these, 509 of 1592 (32.0%) in the intervention arm and 605 of 1832 (33.0%) in the control arm started dialysis early. There was no difference in the proportion of individuals initiating dialysis early or in the proportion of individuals initiating dialysis as an acute inpatient.

A multifaceted knowledge translation intervention failed to reduce the proportion of early dialysis starts in patients with CKD followed in multidisciplinary clinics.

ClinicalTrials.gov, NCT02183987. Available at https//clinicaltrials.gov/ct2/show/NCT02183987.

ClinicalTrials.gov, NCT02183987. Available at https//clinicaltrials.gov/ct2/show/NCT02183987.