Satellite-derived sandy shoreline trends and interannual variability along the Atlantic coast of Europe.

Monitoring sandy shoreline evolution from years to decades is critical to understand the past and predict the future of our coasts. Optical satellite imagery can now infer such datasets globally, but sometimes with large uncertainties, poor spatial resolution, and thus debatable outcomes. Here we validate and analyse satellite-derived-shoreline positions (1984-2021) along the Atlantic coast of Europe using a moving-averaged approach based on coastline characteristics, indicating conservative uncertainties of long-term trends around 0.4 m/year and a potential bias towards accretion. We show that west-facing open coasts are more prone to long-term erosion, whereas relatively closed coasts favor accretion, although most of computed trends fall within the range of uncertainty. Interannual shoreline variability is influenced by regionally dominant atmospheric climate indices. Quasi-straight open coastlines typically show the strongest and more alongshore-uniform links, while embayed coastlines, especially those not exposed to the dominant wave climate, show weaker and more variable correlation with the indices. Our results provide a spatial continuum between previous local-scale studies, while emphasizing the necessity to further reduce satellite-derived shoreline trend uncertainties. They also call for applications based on a relevant averaging approach and the inclusion of coastal setting parameters to unravel the forcing-response spectrum of sandy shorelines globally.

Why Reduced Inspiratory Pressure Could Determine Success of Non-Invasive Ventilation in Acute Hypoxic Respiratory Failure.

The magnitude of inspiratory effort relief within the first 2 hours of non-invasive ventilation for hypoxic respiratory failure was shown in a recent exploratory clinical study to be an early and accurate predictor of outcome at 24 hours. We simulated the application of non-invasive ventilation to three patients whose physiological and clinical characteristics match the data in that study. Reductions in inspiratory effort corresponding to reductions of esophageal pressure swing greater than 10 cmH2O more than halved the values of total lung stress, driving pressure, power and transpulmonary pressure swing. In the absence of significant reductions in inspiratory pressure, multiple indicators of lung injury increased after application of non-invasive ventilation. Clinical Relevance- We show using computer simulation that reduced inspiratory pressure after application of noninvasive ventilation translates directly into large reductions in multiple well-established indicators of lung injury, providing a potential physiological explanation for recent clinical findings.

A computational cardiopulmonary physiology simulator accurately predicts individual patient responses to changes in mechanical ventilator settings.

We present new results validating the capability of a high-fidelity computational simulator to accurately predict the responses of individual patients with acute respiratory distress syndrome to changes in mechanical ventilator settings. 26 pairs of data-points comprising arterial blood gasses collected before and after changes in inspiratory pressure, PEEP, FiO2, and I:E ratio from six mechanically ventilated patients were used for this study. Parallelized global optimization algorithms running on a high-performance computing cluster were used to match the simulator to each initial data point. Mean absolute percentage errors between the simulator predicted values of PaO2 and PaCO2 and the patient data after changing ventilator parameters were 10.3% and 12.6%, respectively. Decreasing the complexity of the simulator by reducing the number of independent alveolar compartments reduced the accuracy of its predictions. Clinical Relevance- These results provide further evidence that our computational simulator can accurately reproduce patient responses to mechanical ventilation, highlighting its usefulness as a clinical research tool.

Realization of a Novel Free-Piston Engine Generator for Hybrid-Electric Vehicle Applications.

Free-piston engine generators (FPEGs) have huge potential to be the principal energy conversion device for generating electricity from fuel as part of a hybrid-electric vehicle (EV) powertrain system. The principal advantages lay in the fact that they are theoretically more efficient, more compact, and more lightweight compared to other competing EV hybrid and range-extender solutions (internal combustion engines, rotary engines, fuel cells, etc.). However, this potential has yet to be realized. This article details a novel dual-piston FPEG configuration and presents the full layout of a system and provides technical evidence of a commercial FPEG system's likely size and weight. The work also presents the first results obtained from a project which set-out to realize an operational FPEG system in hardware through the development and testing of a flexible prototype test platform. The work presents the performance and control system characteristics, for a first of a kind system; these show great technical potential with stable and repeatable combustion events achieved with around 700 W per cylinder and 26% indicated efficiency.

DNA repair pathways and hereditary cancer susceptibility syndromes.

Every living organism is exposed to numerous genomic insults on a daily basis as a consequence of cellular metabolism and exposure to environmental agents capable of interacting with the genome (e.g. chemicals, toxins, pollutants, UV and ionizing radiation) (1). Maintenance of the integrity of the genome is paramount to the survival and propagation of a species and involves the continuous activity of a variety of DNA repair pathways. Inherited mutations in genes involved in DNA damage recognition and repair lead to disease by destabilization of the genome and increased mutagenesis. In fact, it is common for cancer cells to exhibit loss of genomic stability presumably as a result of clonally acquired mutations in DNA repair genes (2). Currently, roughly 150 DNA repair genes have been identified in humans (3) and a variety of familial cancer predisposition and/or premature aging syndromes are now linked to various loss-of-function mutations in these genes (4). Genetic interaction between DNA repair pathways and global cell differentiation pathways is supported by phenotypic similarities between inactivating mutations in a DNA repair, cell cycle arrest and apoptosis proteins. Though there is clearly some degree of functional redundancy between DNA repair pathways for correction of specific DNA lesions, the particular clinical characteristics of a repair defect can be predicted by the specific repair pathway affected (5). Patients with cancer predisposition syndromes often have multiple family members affected by cancer, develop cancer at an early age, and are at risk for developing multiple primary tumors over time (6, 7). Though patients with identifiable cancer predisposition syndromes are rare, defining their molecular defects has led to widespread applicability by uncovering relevant molecular pathways that are perturbed via somatic (non-inherited) mutations in the majority of sporadic cancers. In this review, we describe general molecular mechanisms of major forms of DNA repair and illustrate clinical consequences of deficiencies in these pathways. For more in depth detail, the reader is referred to several recent reviews and texts (2, 8-13).

Implementation of electronic medical records in hospitals: two case studies.

There is evidence that health information technology can improve quality, safety and reduce costs but that health care providers needed more information about how to implement these technologies to realise its potential. This paper summarises the research and proposes a theory of implementation based on the research evidence. The second part describes two implementations of electronic medical record systems and compares the theory against the findings of these two case studies. The paper provides implementers with research-informed guidance about effective implementation, contributes to developing implementation theory and notes policy implications for current national strategies for IT in health.

Inorganic arsenic inhibits the nucleotide excision repair pathway and reduces the expression of XPC.

Chronic exposure to arsenic, most often through contaminated drinking water, has been linked to several types of cancer in humans, including skin and lung cancer. However, the mechanisms underlying its role in causing cancer are not well understood. There is evidence that exposure to arsenic can enhance the carcinogenicity of UV light in inducing skin cancers and may enhance the carcinogenicity of tobacco smoke in inducing lung cancers. The nucleotide excision repair (NER) pathway removes different types of DNA damage including those produced by UV light and components of tobacco smoke. The aim of the present study was to investigate the effect of sodium arsenite on the NER pathway in human lung fibroblasts (IMR-90 cells) and primary mouse keratinocytes. To measure NER, we employed a slot-blot assay to quantify the introduction and removal of UV light-induced 6-4 photoproducts (6-4 PP) and cyclobutane pyrimidine dimers (CPDs). We find a concentration-dependent inhibition of the removal of 6-4 PPs and CPDs in both cell types treated with arsenite. Treatment of both cell types with arsenite resulted in a significant reduction in the abundance of XPC, a protein that is critical for DNA damage recognition in NER. The abundance of RNA expressed from several key NER genes was also significantly reduced by treatment of IMR-90 cells with arsenite. Finally, treatment of IMR-90 cells with MG-132 abrogated the reduction in XPC protein, suggesting an involvement of the proteasome in the reduction of XPC protein produced by treatment of cells with arsenic. The inhibition of NER by arsenic may reflect one mechanism underlying the role of arsenic exposure in enhancing cigarette smoke-induced lung carcinogenesis and UV light-induced skin cancer, and it may provide some insights into the emergence of arsenic trioxide as a chemotherapeutic agent.

SEER*Educate: Use of Abstracting Quality Index Scores to Monitor Improvement of All Employees.

Integral parts of the Seattle-Puget Sound's Cancer Surveillance System registry's continuous improvement model include the incorporation of SEER*Educate into its training program for all staff and analyzing assessment results using the Abstracting Quality Index (AQI). The AQI offers a comprehensive measure of overall performance in SEER*Educate, which is a Web-based application used to personalize learning and diagnostically pinpoint each staff member's place on the AQI continuum. The assessment results are tallied from 6 abstracting standards within 2 domains: incidence reporting and coding accuracy. More than 100 data items are aligned to 1 or more of the 6 standards to build an aggregated score that is placed on a continuum for continuous improvement. The AQI score accurately identifies those individuals who have a good understanding of how to apply the 6 abstracting standards to reliably generate high quality abstracts.

The quantitative measurement of organizational culture in health care: a review of the available instruments.

OBJECTIVE: To review the quantitative instruments available to health service researchers who want to measure culture and cultural change. DATA SOURCES: A literature search was conducted using Medline, Cinahl, Helmis, Psychlit, Dhdata, and the database of the King's Fund in London for articles published up to June 2001, using the phrase "organizational culture." In addition, all citations and the gray literature were reviewed and advice was sought from experts in the field to identify instruments not found on the electronic databases. The search focused on instruments used to quantify culture with a track record, or potential for use, in health care settings. DATA EXTRACTION: For each instrument we examined the cultural dimensions addressed, the number of items for each questionnaire, the measurement scale adopted, examples of studies that had used the tool, the scientific properties of the instrument, and its strengths and limitations. PRINCIPAL FINDINGS: Thirteen instruments were found that satisfied our inclusion criteria, of which nine have a track record in studies involving health care organizations. The instruments varied considerably in terms of their grounding in theory, format, length, scope, and scientific properties. CONCLUSIONS: A range of instruments with differing characteristics are available to researchers interested in organizational culture, all of which have limitations in terms of their scope, ease of use, or scientific properties. The choice of instrument should be determined by how organizational culture is conceptualized by the research team, the purpose of the investigation, intended use of the results, and availability of resources.

Does organisational culture influence health care performance? A review of the evidence.

OBJECTIVE: To review the evidence for a relationship between organisational culture and health care performance. METHODS: Qualitative comprehensive review: all empirical studies exploring a relationship between organisational culture (broadly defined) and health care performance (broadly defined) were identified by a comprehensive search of the literature. Study methods and results were analysed qualitatively to provide a narrative review with integrative discussion. RESULTS: Ten studies met the inclusion criteria. There was considerable variation in the design, study setting, quality of reporting and aspects of culture/performance considered. Four of the ten studies reviewed in detail claimed to have uncovered supportive evidence for the hypothesis that culture and performance are linked. All the other studies failed to find a link, though none provided strong evidence against the hypothesis. CONCLUSIONS: There is some evidence to suggest that organisational culture may be a relevant factor in health care performance, yet articulating the nature of that relationship proves difficult. Simple relationships such as 'strong culture leads to good performance' are not supported by this review. Instead, the evidence suggests a more contingent relationship, in that those aspects of performance valued within different cultures may be enhanced within organisations that exhibit those cultural traits. A striking finding is the difficulty in defining and operationalising both 'culture' and 'performance' as variables that are conceptually and practically distinct. Considerably greater methodological ingenuity will be required to unravel the relationship(s) between organisational culture(s) and performance(s). Current policy prescriptions, which seek service improvements through cultural transformation, are in need of a more secure evidential base.

Primary care trusts. The human touch.

Research with six primary care trusts, started in 2001, suggests that many lack access to relevant expertise in human resources management. Where PCTs do have human resources directors, they are often being asked to act on strategic issues which are outside their experience. PCTs required to rely on acute trusts' HR departments for HR expertise find this unsatisfactory as the issues facing the two sectors are so different. The status of HR management in PCTs needs to be boosted.

The use of health information technology in seven nations.

OBJECTIVE: To assess the state of health information technology (HIT) adoption and use in seven industrialized nations. DESIGN: We used a combination of literature review, as well as interviews with experts in individual nations, to determine use of key information technologies. MAIN OUTCOME MEASURES: We examined rates of electronic health record (EHR) use in ambulatory care and hospital settings, along with current activities in health information exchange (HIE) in seven countries: the United States (U.S.), Canada, United Kingdom (UK), Germany, Netherlands, Australia, and New Zealand (NZ). RESULTS: Four nations (the UK, Netherlands, Australia, and NZ) had nearly universal use of EHRs among general practitioners (each >90%) and Germany was far along (40-80%). The U.S. and Canada had a minority of ambulatory care physicians who used EHRs consistently (10-30%). While there are no high quality data for the hospital setting from any of the nations we examined, evidence suggests that only a small fraction of hospitals (<10%) in any single country had the key components of an EHR. HIE efforts were a high priority in all seven nations but the early efforts have had varying degrees of active clinical data exchange. CONCLUSION: We examined HIT adoption in seven industrialized nations and found that many have achieved high levels of ambulatory EHR adoption but lagged with respect to inpatient EHR and HIE. These data suggest that increased efforts will be needed if interoperable EHRs are soon to become ubiquitous in these seven nations.

Improving quality through effective implementation of information technology in healthcare.

OBJECTIVE: To describe an implementation of one information technology system (electronic medical record, EMR) in one hospital, the perceived impact, the factors thought to help and hinder implementation and the success of the system and compare this with theories of effective IT implementation. To draw on previous research, empirical data from this study is used to develop IT implementation theory. DESIGN: Qualitative case study, replicating the methods and questions of a previously published USA EMR implementation study using semi-structured interviews and documentation. SETTING: Large Swedish teaching hospital shortly after a merger of two hospital sites. PARTICIPANTS: Thirty senior clinicians, managers, project team members, doctors and nurses. RESULTS: The Swedish implementation was achieved within a year and for under half the budget, with a generally popular EMR which was thought to save time and improve the quality of patient care. Evidence from this study and findings from the more problematic USA implementation case suggests that key factors for cost effective implementation and operation were features of the system itself, the implementation process and the conditions under which the implementation was carried out. CONCLUSION: There is empirical support for the IT implementation theory developed in this study, which provides a sound basis for future research and successful implementation. Successful implementation of an EMR is likely with an intuitive system, requiring little training, already well developed for clinical work but allowing flexibility for development, where clinicians are involved in selection and in modification for their department needs and where a realistic timetable is made using an assessment of the change-capability of the organization. Once a system decision is made, the implementation should be driven by top and departmental leaders assisted by competent project teams involving information technology specialists and users. Corrections for unforeseen eventualities will be needed, especially with less developed systems, requiring regular reviews of progress and modifications to systems and timetables to respond to user needs.

Implementing culture change in health care: theory and practice.

OBJECTIVES: To review some of the key debates relating to the nature of organizational culture and culture change care organizations and systems. METHODS: A literature review was conducted that covered both theoretical contributions and published studies of the processes and outcomes of culture change programmes across a range of health and non-health care settings. RESULTS: There is little consensus among scholars over the precise meaning of organizational culture. Competing claims exist concerning whether organizational cultures are capable of being shaped by external manipulation to beneficial effect. A range of culture change models has been developed. A number of underlying factors that commonly attenuate culture change programmes can be identified. Key factors that appear to impede culture change across a range of sectors include: inadequate or inappropriate leadership; constraints imposed by external stakeholders and professional allegiances; perceived lack of ownership; and subcultural diversity within health care organizations and systems. CONCLUSIONS: Managing organizational culture is increasingly viewed as an essential part of health system reform. To transform the culture of a whole health system such as the UK National Health Service would be a complex, multi-level, and uncertain process, comprising a range of interlocking strategies and supporting tactics unfolding over a period of years.