Point Sensor Networks Struggle to Detect and Quantify Short Controlled Releases at Oil and Gas Sites.

This study evaluated multiple commercially available continuous monitoring (CM) point sensor network (PSN) solutions under single-blind controlled release testing conducted at operational upstream and midstream oil and natural gas (O&G) sites. During releases, PSNs reported site-level emission rate estimates of 0 kg/h between 38 and 86% of the time. When non-zero site-level emission rate estimates were provided, no linear correlation between the release rate and the reported emission rate estimate was observed. The average, aggregated across all PSN solutions during releases, shows 5% of the mixing ratio readings at downwind sensors were greater than the site's baseline plus two standard deviations. Four of seven total PSN solutions tested during this field campaign provided site-level emission rate estimates with the site average relative error ranging from -100% to 24% for solution D, -100% to -43% for solution E, -25% for solution F (solution F was only at one site), and -99% to 430% for solution G, with an overall average of -29% across all sites and solutions. Of all the individual site-level emission rate estimates, only 11% were within ±2.5 kg/h of the study team's best estimate of site-level emissions at the time of the releases.

Estimating Regional Methane Emission Factors from Energy and Agricultural Sector Sources Using a Portable Measurement System: Case Study of the Denver-Julesburg Basin.

Methane (CH4), a powerful greenhouse gas (GHG), has been identified as a key target for emission reduction in the Paris agreement, but it is not currently clear where efforts should be focused to make the greatest impact. Currently, activity data and standard emission factors (EF) are used to generate GHG emission inventories. Many of the EFs are globally uniform and do not account for regional variability in industrial or agricultural practices and/or regulation. Regional EFs can be derived from top-down emissions measurements and used to make bespoke regional GHG emission inventories that account for geopolitical and social variability. However, most large-scale top-down approaches campaigns require significant investment. To address this, lower-cost driving surveys (DS) have been identified as a viable alternative to more established methods. DSs can take top-down measurements of many emission sources in a relatively short period of time, albeit with a higher uncertainty. To investigate the use of a portable measurement system, a 2260 km DS was conducted throughout the Denver-Julesburg Basin (DJB). The DJB covers an area of 8000 km2 north of Denver, CO and is densely populated with CH4 emission sources, including oil and gas (O and G) operations, agricultural operations (AGOs), lakes and reservoirs. During the DS, 157 individual CH4 emission sources were detected; 51%, 43% and 4% of sources were AGOs, O and G operations, and natural sources, respectively. Methane emissions from each source were quantified using downwind concentration and meteorological data and AGOs and O and G operations represented nearly all the CH4 emissions in the DJB, accounting for 54% and 37% of the total emission, respectively. Operations with similar emission sources were grouped together and average facility emission estimates were generated. For agricultural sources, emissions from feedlot cattle, dairy cows and sheep were estimated at 5, 31 and 1 g CH4 head-1 h-1, all of which agreed with published values taken from focused measurement campaigns. Similarly, for O and G average emissions for well pads, compressor stations and gas processing plants (0.5, 14 and 110 kg CH4 facility-1 h-1) were in reasonable agreement with emission estimates from intensive measurement campaigns. A comparison of our basin wide O and G emissions to measurements taken a decade ago show a decrease of a factor of three, which can feasibly be explained by changes to O and G regulation over the past 10 years, while emissions from AGOs have remained constant over the same time period. Our data suggest that DSs could be a low-cost alternative to traditional measurement campaigns and used to screen many emission sources within a region to derive representative regionally specific and time-sensitive EFs. The key benefit of the DS is that many regions can be screened and emission reduction targets identified where regional EFs are noticeably larger than the regional, national or global averages.

Has the rescheduling of hydrocodone changed ED prescribing practices?

OBJECTIVE: The objective was to examine the effect of hydrocodone-containing product (HCP) rescheduling on the proportion of prescriptions for HCPs given to patients discharged from the emergency department (ED). METHODS: Electronic queries of ED records were used to identify patients aged 15 years and older discharged with a pain-related prescription in the 12 months before and after HCP rescheduling. Prescriptions were classified as HCPs; other Schedule II medications (eg, oxycodone products); other Schedule III medications (eg, codeine products); and non-Schedule II/III products (eg, nonsteroidal anti-inflammatory drugs). We compared the proportions of patients receiving each type of prescription before and after rescheduling using χ2 analysis and used logistic regression to explore the relationship between prescription type and time period while controlling for age, sex, race, and ethnicity. RESULTS: Before rescheduling, 58.1% (95% confidence interval [CI], 57.4-58.7) of patients receiving a pain-related prescription received an HCP; after rescheduling, 13.2% (95% CI, 12.7-13.7) received an HCP (P < .001). Concurrently, other Schedule III prescriptions increased (pre: 11.7% [CI, 11.3-12.2] vs post: 44.9% [CI, 44.2-45.6], P < .001)), as did non-Schedule II/III prescriptions (pre: 51.8% [CI, 51.2-52.5] vs post: 59.3% [CI, 58.6-60.0], P < .001). When controlling for demographic characteristics, patients remained less likely to receive an HCP after rescheduling (adjusted odds ratio [AOR], 0.11; CI, 0.10-0.11) and more likely to receive other Schedule III (AOR, 6.1; CI, 5.8-6.5) and non-Schedule II/III (AOR, 1.4; CI, 1.3-1.4) products. CONCLUSION: Rescheduling HCPs from Schedule III to Schedule II led to a substantial decrease in HCP prescriptions in our ED and an increase in prescriptions for other Schedule III and non-Schedule II/III products.

Measured versus predicted blood propofol concentrations in children during scoliosis surgery.

BACKGROUND: Propofol anesthesia is preferred during scoliosis surgery because it suppresses evoked potential spinal cord function less than other drugs and better enables the detection of spinal cord ischemia. In this study, we determined the difference between the true and predicted blood propofol levels during target-controlled infusions in children during scoliosis surgery. METHODS: Arterial blood propofol measured concentrations (Cm) were compared with predicted concentrations (Cp) approximately every 30 minutes during the maintenance phase of anesthesia in 20 children. Whole blood propofol concentrations were measured using a point-of-care blood propofol analyzer. Anesthesia management was not affected by the study. The median performance error, median absolute performance error, wobble, and divergence were calculated. RESULTS: Children were aged 9 to 17 years and weighed 26.5 to 95 kg. The Paedfusor model was used in 16 children and the Marsh model in 4 children. In 154 blood propofol measurements, the mean difference between the Cm and Cp was 1.5 µg·mL (limits of agreement, -1.4 to 4.5 µg·mL), and the mean performance error was 44.7% (limits of agreement, -40.1% to 130.2%). The median performance error and median absolute performance error for the whole group were 39.8% (range, -20.9% to 103.3%) and 39.8% (range, 20%-103.3%), respectively. The performance errors improved with increase in duration of infusion (divergence, -2.2 [range, -1.03 to 0.13]). Cm was almost always larger than Cp except in 2 children who had consistently lower Cm than Cp (lowest Cm(s) were 1.74 and 1.96 µg·mL when the Cp was 3 µg·mL); both had the Paedfusor model and their body weights were 28 and 33 kg. CONCLUSIONS: Propofol target-controlled infusion models had poor performance characteristics in children undergoing scoliosis surgery. Point-of-care propofol assay may enable adjustment of the infusion to better achieve the intended blood level.

Quality, satisfaction, and financial efficiency associated with elements of primary care practice transformation: preliminary findings.

PURPOSE: We examined quality, satisfaction, financial, and productivity outcomes associated with implementation of Care by Design (CBD), the University of Utah's version of the patient-centered medical home. METHODS: We measured the implementation of individual elements of CBD using a combination of observation, chart audit, and collection of data from operational reports. We assessed correlations between level of implementation of each element and measures of quality, patient and clinician satisfaction, financial performance, and efficiency. RESULTS: Team function elements had positive correlations (P ≤.05) with 6 quality measures, 4 patient satisfaction measure, and 3 clinician satisfaction measures. Continuity elements had positive correlations with 2 satisfaction measures and 1 quality measure. Clinician continuity was the key driver in the composite element of appropriate access. Unexpected findings included the negative correlation of use of templated questionnaires with 3 patient satisfaction measures. Trade-offs were observed for performance of blood draws in the examination room and the efficiency of visits, with some positive and some negative correlations depending on the outcome. CONCLUSIONS: Elements related to care teams and continuity appear to be key elements of CBD as they influence all 3 CBD organizing principles: appropriate access, care teams, and planned care. These relationships, as well as unexpected, unfavorable ones, require further study and refined analyses to identify causal associations.

Implementation of Care Management: An Analysis of Recent AHRQ Research.

Care management (CM) is a promising team-based, patient-centered approach "designed to assist patients and their support systems in managing medical conditions more effectively." As little is known about its implementation, this article describes CM implementation and associated lessons from 12 Agency for Healthcare Research and Quality-sponsored projects. Two rounds of data collection resulted in project-specific narratives that were analyzed using an iterative approach analogous to framework analysis. Informants also participated as coauthors. Variation emerged across practices and over time regarding CM services provided, personnel delivering these services, target populations, and setting(s). Successful implementation was characterized by resource availability (both monetary and nonmonetary), identifying as well as training employees with the right technical expertise and interpersonal skills, and embedding CM within practices. Our findings facilitate future context-specific implementation of CM within medical homes. They also inform the development of medical home recognition programs that anticipate and allow for contextual variation.

Teamwork as an essential component of high-reliability organizations.

Organizations are increasingly becoming dynamic and unstable. This evolution has given rise to greater reliance on teams and increased complexity in terms of team composition, skills required, and degree of risk involved. High-reliability organizations (HROs) are those that exist in such hazardous environments where the consequences of errors are high, but the occurrence of error is extremely low. In this article, we argue that teamwork is an essential component of achieving high reliability particularly in health care organizations. We describe the fundamental characteristics of teams, review strategies in team training, demonstrate the criticality of teamwork in HROs and finally, identify specific challenges the health care community must address to improve teamwork and enhance reliability.

Superior Mesenteric Artery Syndrome with Abdominal Compartment Syndrome.

Superior Mesenteric Artery (SMA) syndrome is a condition in which the duodenum becomes compressed between the SMA and the aorta, resulting in bowel obstruction which subsequently compresses surrounding structures. Pressure on the inferior vena cava (IVC) and aorta decreases cardiac output which compromises distal blood flow, resulting in abdominal compartment syndrome with ischemia and renal failure. A 15-year-old male with SMA syndrome presented with 12 hours of pain, a distended, rigid abdomen, mottled skin below the waist, and decreased motor and sensory function in the lower extremities. Exploratory laparotomy revealed ischemic small bowel and stomach with abdominal compartment syndrome. Despite decompression, the patient arrested from hyperkalemia following reperfusion.

Species difference in adaptive use of public information in sticklebacks.

Animals foraging on variable food sources can refine their estimates of patch quality by monitoring the success of others (i.e. collect 'public information'). Here, we show that both three-spined sticklebacks (Gasterosteus aculeatus) and nine-spined sticklebacks (Pungitius pungitius) use past cues provided by others to locate food but only nine-spined sticklebacks use prior public information to assess patch quality, regardless of whether demonstrators were conspecifics or heterospecifics. Moreover, nine-spined but not three-spined sticklebacks preferentially hid in vegetation during the demonstration, a position from which they could observe both patches simultaneously and collect public information. We conclude that species differences in the use of public information can be explained by variations in habitat choice and response to predation. Our findings expand current understanding of the scope of public-information use in animals by showing that fishes can use public-information in a foraging context and from heterospecifics. The study suggests that public-information use is an adaptation that allows animals vulnerable to predation to acquire valuable foraging information at low risk.

Sharks in danger.

Many shark populations are in danger of extinction as a direct result of man's activities. A change in attitude and a greater understanding of species' requirements are needed to prevent further destruction and replenish numbers, thus sustaining trade, fisheries and sport activity.

Connecting the dots and merging meaning: using mixed methods to study primary care delivery transformation.

OBJECTIVE: To demonstrate the value of mixed methods in the study of practice transformation and illustrate procedures for connecting methods and for merging findings to enhance the meaning derived. DATA SOURCE/STUDY SETTING: An integrated network of university-owned, primary care practices at the University of Utah (Community Clinics or CCs). CC has adopted Care by Design, its version of the Patient Centered Medical Home. STUDY DESIGN: Convergent case study mixed methods design. DATA COLLECTION/EXTRACTION METHODS: Analysis of archival documents, internal operational reports, in-clinic observations, chart audits, surveys, semistructured interviews, focus groups, Centers for Medicare and Medicaid Services database, and the Utah All Payer Claims Database. PRINCIPAL FINDINGS: Each data source enriched our understanding of the change process and understanding of reasons that certain changes were more difficult than others both in general and for particular clinics. Mixed methods enabled generation and testing of hypotheses about change and led to a comprehensive understanding of practice change. CONCLUSIONS: Mixed methods are useful in studying practice transformation. Challenges exist but can be overcome with careful planning and persistence.

How much do doctors use quality of life information in primary care? Testing the trans-theoretical model of behaviour change.

This study aimed to find out whether General Practitioners (GPs) use quality of life (QOL) information in primary care, to explore their reasoning and to assess any barriers to use. A second purpose was to see whether the Trans-Theoretical Model (TTM) of behaviour change could be applied to doctor's use of QOL information in primary care. A representative, cross-sectional sample of 800 GPs was approached in a national postal survey; 280 (38%) provided qualitative and quantitative information. Most GPs said that QOL was interesting and important. Users had seen more information and scales, and were more aware of its uses; only 8% had ever used formal standardised questionnaires. The main barriers to implementation were a shortage of time and information, and experience with using QOL assessment. A sizable minority wanted to know more. Seventy-one percent would use QOL to monitor treatment effectiveness. The five stages of the TTM were used to identify whether GP's were predisposed to use QOL information from their knowledge levels and values. While there was some support for the model, the TTM did not sensitively and reliably discriminate between users and non-users on all variables, and so has limited value here.

Rethinking adaptation: the niche-construction perspective.

Niche construction refers to the capacity of organisms to construct, modify, and select important components of their local environments, such as nests, burrows, pupal cases, chemicals, and nutrients. A small but increasing number of evolutionary biologists regard niche construction as an evolutionary process in its own right, rather than as a mere product of natural selection. Through niche construction organisms not only influence the nature of their world, but also in part determine the selection pressures to which they and their descendants are exposed, and they do so in a non-random manner. Mathematical population genetics analyses have revealed that niche construction is likely to be evolutionarily consequential because of the feedback that it generates in the evolutionary process. A parallel movement has emerged in ecosystem ecology, where researchers stress the utility of regarding organisms as ecosystem engineers, who partly control energy and matter flows. From the niche construction standpoint, the evolving complementary match between organisms and environments is the product of reciprocal interacting processes of natural selection and niche construction. This essay reviews the arguments put forward in favor of the niche-construction perspective.

Molecular analysis of maltotriose transport and utilization by Saccharomyces cerevisiae.

Efficient fermentation of maltotriose is a desired property of Saccharomyces cerevisiae for brewing. In a standard wort, maltotriose is the second most abundant sugar, and slower uptake leads to residual maltotriose in the finished product. The limiting factor of sugar metabolism is its transport, and there are conflicting reports on whether a specific maltotriose permease exists or whether the mechanisms responsible for maltose uptake also carry out maltotriose transport. In this study, radiolabeled maltotriose was used to show that overexpression of the maltose permease gene, MAL61, in an industrial yeast strain resulted in an increase in the rate of transport of maltotriose as well as maltose. A strain derived from W303-1A and lacking any maltose or maltotriose transporter but carrying a functional maltose transport activator (MAL63) was developed. By complementing this strain with permeases encoded by MAL31, MAL61, and AGT1, it was possible to measure their specific transport kinetics by using maltotriose and maltose. All three permeases were capable of high-affinity transport of maltotriose and of allowing growth of the strain on the sugar. Maltotriose utilization from the permease encoded by AGT1 was regulated by the same genetic mechanisms as those involving the maltose transcriptional activator. Competition studies carried out with two industrial strains, one not containing any homologue of AGT1, showed that maltose uptake and maltotriose uptake were competitive and that maltose was the preferred substrate. These results indicate that the presence of residual maltotriose in beer is not due to a genetic or physiological inability of yeast cells to utilize the sugar but rather to the lower affinity for maltotriose uptake in conjunction with deteriorating conditions present at the later stages of fermentation. Here we identify molecular mechanisms regulating the uptake of maltotriose and determine the role of each of the transporter genes in the cells.

Characterization of the putative maltose transporters encoded by YDL247w and YJR160c.

The maltose permease family of Saccharomyces cerevisiae comprises five proteins, three of which are characterized, MAL31, MAL61 and AGT1 and two putative permeases, YDL247w (MPH2) and YJR160c (MPH3). The two uncharacterized permeases share 100% identity and have 75% identity with MAL31 and MAL61 and 55% identity with AGT1. Characterization of the genes YDL247w and YJR160c confirmed that they encode alpha-glucoside permeases capable of transporting maltose, maltotriose, alpha-methylglucoside and turanose. Analysis of the promoter regions identified regulatory elements, binding sites for the transcriptional activator, Malx3p and the inhibitory protein, Mig1p. Further analysis of the flanking sequences located blocks of identity covering five open reading frames, indicating that this region was involved in chromosomal block duplication. The members of the maltose permease family are proteins that have strongly overlapping but nevertheless distinct functions, which is a selective advantage for yeast, as it reflects successful adaptation to the variety of environmental conditions to which the yeast cells are exposed; such adaptability is very important in an industrial context.