Effect of training on patient outcomes following lobectomy.

BACKGROUND: Little is known about the effect of surgical training on outcomes in thoracic surgery. The impact of surgeon training on outcomes following lung resection was examined, focusing on lobectomy as a marker operation. METHODS: 328 consecutive patients who underwent lobectomy at our institution between 1 October 2001 and 30 June 2003 were studied. Data were collected prospectively during the patient's admission as part of routine clinical practice and validated by a designated audit officer. Patient characteristics and postoperative outcomes were compared between trainee led and consultant led operations. RESULTS: In 115 cases (35.1%) the operation was performed by a trainee thoracic surgeon as the first operator. There were no significant differences in patient characteristics between the two groups. In-hospital mortality was similar for operations led by trainees and consultants (3.5% and 2.8%, respectively; p > 0.99). Outcomes in the two groups did not differ significantly with respect to respiratory, cardiovascular, renal, neurological, chest infection, bleeding, and gastrointestinal complications. Survival rates at 1 year were 82.6% for procedures led by trainees compared with 81.7% for procedures led by consultants (p = 0.83). CONCLUSIONS: With appropriate supervision, trainee thoracic surgeons can perform lobectomies safely without compromising short or intermediate term patient outcome.

The Opportunity Rover's Athena science investigation at Meridiani Planum, Mars.

The Mars Exploration Rover Opportunity has investigated the landing site in Eagle crater and the nearby plains within Meridiani Planum. The soils consist of fine-grained basaltic sand and a surface lag of hematite-rich spherules, spherule fragments, and other granules. Wind ripples are common. Underlying the thin soil layer, and exposed within small impact craters and troughs, are flat-lying sedimentary rocks. These rocks are finely laminated, are rich in sulfur, and contain abundant sulfate salts. Small-scale cross-lamination in some locations provides evidence for deposition in flowing liquid water. We interpret the rocks to be a mixture of chemical and siliciclastic sediments formed by episodic inundation by shallow surface water, followed by evaporation, exposure, and desiccation. Hematite-rich spherules are embedded in the rock and eroding from them. We interpret these spherules to be concretions formed by postdepositional diagenesis, again involving liquid water.

The Spirit Rover's Athena science investigation at Gusev Crater, Mars.

The Mars Exploration Rover Spirit and its Athena science payload have been used to investigate a landing site in Gusev crater. Gusev is hypothesized to be the site of a former lake, but no clear evidence for lacustrine sedimentation has been found to date. Instead, the dominant lithology is basalt, and the dominant geologic processes are impact events and eolian transport. Many rocks exhibit coatings and other characteristics that may be evidence for minor aqueous alteration. Any lacustrine sediments that may exist at this location within Gusev apparently have been buried by lavas that have undergone subsequent impact disruption.

Surficial deposits at Gusev Crater along Spirit Rover traverses.

The Mars Exploration Rover Spirit has traversed a fairly flat, rock-strewn terrain whose surface is shaped primarily by impact events, although some of the landscape has been altered by eolian processes. Impacts ejected basaltic rocks that probably were part of locally formed lava flows from at least 10 meters depth. Some rocks have been textured and/or partially buried by windblown sediments less than 2 millimeters in diameter that concentrate within shallow, partially filled, circular impact depressions referred to as hollows. The terrain traversed during the 90-sol (martian solar day) nominal mission shows no evidence for an ancient lake in Gusev crater.

Mars exploration.

An international flotilla of spacecraft are to be sent to Mars over the next decade in an effort to understand the planet's geology and climate history, and to determine whether some form of life ever started there. At least two spacecraft will be sent at each launch opportunity, and at times up to four spacecraft may be operating simultaneously at the planet.

North-south geological differences between the residual polar caps on Mars.

Polar processes can be sensitive indicators of global climate, and the geological features associated with polar ice caps can therefore indicate evolution of climate with time. The polar regions on Mars have distinctive morphologic and climatologic features: thick layered deposits, seasonal CO2 frost caps extending to mid latitudes, and near-polar residual frost deposits that survive the summer. The relationship of the seasonal and residual frost caps to the layered deposits has been poorly constrained, mainly by the limited spatial resolution of the available data. In particular, it has not been known if the residual caps represent simple thin frost cover or substantial geologic features. Here we show that the residual cap on the south pole is a distinct geologic unit with striking collapse and erosional topography; this is very different from the residual cap on the north pole, which grades into the underlying layered materials. These findings indicate that the differences between the caps are substantial (rather than reflecting short-lived differences in frost cover), and so support the idea of long-term asymmetry in the polar climates of Mars.

The state and future of Mars polar science and exploration.

As the planet's principal cold traps, the martian polar regions have accumulated extensive mantles of ice and dust that cover individual areas of approximately 10(6) km2 and total as much as 3-4 km thick. From the scarcity of superposed craters on their surface, these layered deposits are thought to be comparatively young--preserving a record of the seasonal and climatic cycling of atmospheric CO2, H2O, and dust over the past approximately 10(5)-10(8) years. For this reason, the martian polar deposits may serve as a Rosetta Stone for understanding the geologic and climatic history of the planet--documenting variations in insolation (due to quasiperiodic oscillations in the planet's obliquity and orbital elements), volatile mass balance, atmospheric composition, dust storm activity, volcanic eruptions, large impacts, catastrophic floods, solar luminosity, supernovae, and perhaps even a record of microbial life. Beyond their scientific value, the polar regions may soon prove important for another reason--providing a valuable and accessible reservoir of water to support the long-term human exploration of Mars. In this paper we assess the current state of Mars polar research, identify the key questions that motivate the exploration of the polar regions, discuss the extent to which current missions will address these questions, and speculate about what additional capabilities and investigations may be required to address the issues that remain outstanding.

Groundwater formation of martian valleys.

The martian surface shows large outflow channels, widely accepted as having been formed by gigantic floods that could have occurred under climatic conditions like those seen today. Also present are branching valley networks that commonly have tributaries. These valleys are much smaller than the outflow channels and their origins and ages have been controversial. For example, they might have formed through slow erosion by water running across the surface, either early or late in Mars' history, possibly protected from harsh conditions by ice cover. Alternatively, they might have formed through groundwater or ground-ice processes that undermine the surface and cause collapse, again either early or late in Mars' history. Long-duration surface runoff would imply climatic conditions quite different from the present environment. Here we present high-resolution images of martian valleys that support the view that ground water played an important role in their formation, although we are unable as yet to establish when this occurred.

Potential consequences of widespread antepartal use of ampicillin.

OBJECTIVE: Recommendations for the use of antenatal antibiotics in obstetrics have increased in the past few years, especially for prophylaxis against group B streptococci, for prolongation of the latency time in patients with preterm premature rupture of the membranes, and as an adjuvant treatment in preterm labor. Our objective was to determine whether the use of antenatal ampicillin affects the incidence of and resistance of early-onset neonatal sepsis with organisms other than group B streptococci. STUDY DESIGN: A prospective cohort study was performed between January 1, 1991, and December 31, 1996. Every case of blood culture-proven neonatal sepsis was prospectively surveyed. The type of bacteria isolated, drug resistance, antenatal antibiotic use and treatment indication, gestational age at delivery, and other antenatal and outcome variables were gathered. Early-onset neonatal sepsis was defined as disease onset within 7 days after birth. RESULTS: A total of 42 cases of early-onset neonatal sepsis among 29,897 neonates delivered were found during the 6-year period. Of these, 15 cases were due to group B streptococci and 27 were the result of non-group B streptococcal organisms (21 gram-negative rods and 6 gram-positive cocci). Among the 27 non-group B streptococcal cases, 15 mothers had received antenatal ampicillin and 13 of the 15 bacterial isolates from these neonates (87%) were resistant to ampicillin, versus only 2 ampicillin-resistant isolates (17%) among the 12 cases in which no antenatal antibiotics were administered (P = .0004). Of the 15 mothers who were treated with ampicillin, 13 received more than 1 dose. In evaluating each year of the study, the overall administration of antibiotics to pregnant women in the antenatal period increased from <10% in 1991 to 16.9% in 1996. The incidence of early-onset neonatal sepsis with group B streptococci decreased during this time, whereas the incidence of early-onset sepsis with non-group B streptococcal organisms, especially Escherichia coli, increased. CONCLUSIONS: The increased administration of antenatal ampicillin to pregnant women may be responsible for the increased incidence of early-onset neonatal sepsis with non-group B streptococcal organisms that are resistant to ampicillin. At this time penicillin G, rather than ampicillin, is therefore recommended for prophylaxis against group B streptococci. In addition, future studies are needed to determine whether alternate approaches, such as immunotherapy or vaginal washing, could be of benefit.

High-temperature silicate volcanism on Jupiter's moon Io.

Infrared wavelength observations of Io by the Galileo spacecraft show that at least 12 different vents are erupting lavas that are probably hotter than the highest temperature basaltic eruptions on Earth today. In at least one case, the eruption near Pillan Patera, two independent instruments on Galileo show that the lava temperature must have exceeded 1700 kelvin and may have reached 2000 kelvin. The most likely explanation is that these lavas are ultramafic (magnesium-rich) silicates, and this idea is supported by the tentative identification of magnesium-rich orthopyroxene in lava flows associated with these high-temperature hot spots.

Early views of the martian surface from the Mars Orbiter Camera of Mars Global Surveyor.

High-resolution images of the martian surface at scales of a few meters show ubiquitous erosional and depositional eolian landforms. Dunes, sandsheets, and drifts are prevalent and exhibit a range of morphology, composition (inferred from albedo), and age (as seen in occurrences of different dune orientations at the same location). Steep walls of topographic depressions such as canyons, valleys, and impact craters show the martian crust to be stratified at scales of a few tens of meters. The south polar layered terrain and superposed permanent ice cap display diverse surface textures that may reflect the complex interplay of volatile and non-volatile components. Low resolution regional views of the planet provide synoptic observations of polar cap retreat, condensate clouds, and the lifecycle of local and regional dust storms.

Evidence for a subsurface ocean on Europa.

Ground-based spectroscopy of Jupiter's moon Europa, combined with gravity data, suggests that the satellite has an icy crust roughly 150 km thick and a rocky interior. In addition, images obtained by the Voyager spacecraft revealed that Europa's surface is crossed by numerous intersecting ridges and dark bands (called lineae) and is sparsely cratered, indicating that the terrain is probably significantly younger than that of Ganymede and Callisto. It has been suggested that Europa's thin outer ice shell might be separated from the moon's silicate interior by a liquid water layer, delayed or prevented from freezing by tidal heating; in this model, the lineae could be explained by repetitive tidal deformation of the outer ice shell. However, observational confirmation of a subsurface ocean was largely frustrated by the low resolution (>2 km per pixel) of the Voyager images. Here we present high-resolution (54 m per pixel) Galileo spacecraft images of Europa, in which we find evidence for mobile 'icebergs'. The detailed morphology of the terrain strongly supports the presence of liquid water at shallow depths below the surface, either today or at some time in the past. Moreover, lower-resolution observations of much larger regions suggest that the phenomena reported here are widespread.

Geological evidence for solid-state convection in Europa's ice shell.

The ice-rich surface of the jovian satellite Europa is sparsely cratered, suggesting that this moon might be geologically active today. Moreover, models of the satellite's interior indicate that tidal interactions with Jupiter might produce enough heat to maintain a subsurface liquid water layer. But the mechanisms of interior heat loss and resurfacing are currently unclear, as is the question of whether Europa has (or had at one time) a liquid water ocean. Here we report on the morphology and geological interpretation of distinct surface features-pits, domes and spots-discovered in high-resolution images of Europa obtained by the Galileo spacecraft. The features are interpreted as the surface manifestation of diapirs, relatively warm localized ice masses that have risen buoyantly through the subsurface. We find that the formation of the features can be explained by thermally induced solid-state convection within an ice shell, possibly overlying a liquid water layer. Our results are consistent with the possibility that Europa has a liquid water ocean beneath a surface layer of ice, but further tests and observations are needed to demonstrate this conclusively.

Episodic plate separation and fracture infill on the surface of Europa. Galileo Imaging Team.

Images obtained by the Voyager spacecraft revealed dark, wedge-shaped bands on Europa that were interpreted as evidence that surface plates, 50-100 km across, moved and rotated relative to each other. This implied that they may be mechanically decoupled from the interior by a layer of warm ice or liquid water. Here we report similar features seen in higher resolution images (420 metres per pixel) obtained by the Galileo spacecraft that reveal new details of wedge-band formation. In particular, the interior of one dark band shows bilateral symmetry of parallel lineaments and pit complexes which indicates that plate separation occurred in discrete episodes from a central axis. The images also show that this style of tectonic activity involved plates < 10 km across. Although this tectonic style superficially resembles aspects of similar activity on Earth, such as sea-floor spreading and the formation of ice leads in polar seas, there are significant differences in the underlying physical mechanisms: the wedge-shaped bands on Europa most probably formed when lower material (ice or water) rose to fill the fractures that widened in response to regional surface stresses.

Prolonged bedrest during pregnancy: does the risk of deep vein thrombosis warrant the use of routine heparin prophylaxis?

This is the first study to assess the risk of clinically apparent DVT in pregnant women placed in the hospital at prolonged bedrest. The outcome is discussed with reference to the risks associated with heparin. Information, including delivery data, length of hospital stay, and discharge diagnoses were extracted from a prospectively collected computerized data bank of all deliveries that occurred over a 5.5-year period at Long Beach Memorial Women's Hospital in Long Beach, California, and at St. Joseph's Hospital in Milwaukee, Wisconsin. One group consisted of all pregnant women who had been hospitalized at prolonged antepartum bedrest, as defined by 3 weeks or more. The other group consisted of the remaining population of women whose deliveries occurred during the same time period. There were 48,525 deliveries during the study period, and 266 (0.5%) women were hospitalized at prolonged antepartum bedrest. The mean number of days in the hospital for these women was 34.6 +/- 14 (range 21-82 days). Of these women, one received prophylactic heparin for a prior history of DVT. There were no cases of DVT in the 265 women who did not receive heparin, risk = 0.0 (CI = 0.00-0.99). Of these 265 women, 234 were hospitalized up to the day of delivery. Of these 234 women, 154 (65.8%) underwent cesarean section and no case of DVT occurred in the postoperative period, risk = 0.0 (CI = 0.0-1.7). Out of the remaining 48,259 women who were not hospitalized at prolonged bedrest, there were 18 cases of clinically apparent DVT, and the longest antepartum hospitalization was 4 days. A conservative risk of complications with prophylactic heparin therapy is 1.0% or greater. Although the risk of DVT in pregnant women hospitalized at prolonged bedrest is not zero, our study indicates that it is very low (< 1.0%). Whereas a risk of DVT of at least 1.0% could warrant heparin prophylaxis, even with 265 patients at prolonged bedrest and 48,525 controls, this risk could not be demonstrated. Using a power analysis with an alpha of 0.05 and a power of 80% to demonstrate this risk, one would need 247 cases and approximately 49,000 controls, which were clearly achieved in this study. In view of the risks associated with heparin, routine antenatal prophylaxis is not recommended unless other risk factors for DVT are present.

Galileo's First Images of Jupiter and the Galilean Satellites

The first images of Jupiter, Io, Europa, and Ganymede from the Galileo spacecraft reveal new information about Jupiter's Great Red Spot (GRS) and the surfaces of the Galilean satellites. Features similar to clusters of thunderstorms were found in the GRS. Nearby wave structures suggest that the GRS may be a shallow atmospheric feature. Changes in surface color and plume distribution indicate differences in resurfacing processes near hot spots on Io. Patchy emissions were seen while Io was in eclipse by Jupiter. The outer margins of prominent linear markings (triple bands) on Europa are diffuse, suggesting that material has been vented from fractures. Numerous small circular craters indicate localized areas of relatively old surface. Pervasive brittle deformation of an ice layer appears to have formed grooves on Ganymede. Dark terrain unexpectedly shows distinctive albedo variations to the limit of resolution.

Water erosion on Mars and its biologic implications.

The Martian surface shows abundant evidence of water erosion. Liquid water is unstable under present climatic conditions but conditions may have been different in the past. The planet has been volcanically active throughout its history. The combination of water and volcanism must have commonly resulted in hydrothermal environments similar to those in which grow the most primitive terrestrial life-forms.

Water on early Mars.

Large flood channels, valley networks and a variety of features attributed to the action of ground ice indicate that Mars emerged from heavy bombardment 3.8 Ga ago, with an inventory of water at the surface equivalent to at least a few hundred metres spread over the whole planet, as compared with 3 km for the Earth. The mantle of Mars is much drier than that of the Earth, possibly as a result of global melting at the end of accretion and the lack of plate tectonics to subsequently reintroduce water into the interior. The surface water resided primarily in a porous, kilometres-thick megaregolith created by the high impact rates. Under today's climatic conditions groundwater is trapped below a thick permafrost zone. At the end of heavy bombardment any permafrost zone would have been much thinner because of the high heat flows, but climatic conditions may have been very different then, as suggested by erosion rates 1000 times higher than subsequent rates. Water trapped below the permafrost periodically erupted onto the surface to form large flood channels and lakes. Given abundant water at the surface and sustained volcanism, hydrothermal activity must have frequently occurred but we have yet to make the appropriate observations to detect the results of such activity.

First images of asteroid 243 ida.

The first images of the asteroid 243 Ida from Galileo show an irregular object measuring 56-kilometers by 24 kilometers by 21 kilometers. Its surface is rich in geologic features, including systems of grooves, blocks, chutes, albedo features, crater chains, and a full range of crater morphologies. The largest blocks may be distributed nonuniformly across the surface; lineaments and dark-floored craters also have preferential locations. Ida is interpreted to have a substantial regolith. The high crater density and size-frequency distribution (-3 differential power-law index) indicate a surface in equilibrium with saturated cratering. A minimum model crater age for Ida-and therefore for the Koronis family to which Ida belongs-is estimated at 1 billion years, older than expected.