ABSTRACT
Deaths in hospital represent a vital learning opportunity for both individual clinicians and the wider healthcare system. Many deaths are reviewed and discussed in morbidity and mortality meetings, with the Royal College of Physicians promoting Structured Judgement Review (SJR) methodology to support this discussion. An analysis of 1 year of SJRs in one hospital was undertaken, generating a toolkit to support junior doctors in evaluating in-hospital deaths. Here, the opportunities and limitations of this analysis are discussed, with consideration of ways to improve the uptake of SJR across the hospital team. These reviews exemplify one way of maximising learning from in-hospital deaths.
Subject(s)
Hospitals , Physicians , Humans , Delivery of Health Care , Hospital Mortality , Medical Staff, HospitalABSTRACT
BACKGROUND: Exposure to SARS-CoV-2 was widespread in hospitals during 2020. The risk of infection after in-hospital exposure has not yet been quantified and effective strategies to prevent it remain unclear. METHODS: All incidences of patient-to-patient exposure to SARS-CoV-2 on non-COVID wards between October and December 2020 at a UK hospital trust were identified. Patient contacts were traced, and data collected on SARS-CoV-2 testing, symptoms, and outcomes. Factors associated with acquiring infection and mortality were investigated. RESULTS: Of 575 patients exposed, 118 (19.5%) tested positive within 14 days of their exposure, with secondary attack rates (SAR) ranging from 0 to 72%. 68.6% (81/118) of secondary cases had not been in the same bay as the index case.For exposed patients, sharing a bay with the index case and having spent longer on the ward with them were associated with acquiring infection (ORs of 3.8, 95% CI: 1.89, 7.74, and 1.08, 95% CI: 1.01, 1.15 respectively). 71% of secondary cases tested positive while asymptomatic and 94.6% had tested negative earlier in their admission. CONCLUSIONS: This is the first study to describe the outcomes of a cohort of patients exposed to COVID-19 in hospital. Exposure to COVID-19 in hospital commonly leads to transmission that is not confined to the index case's bay. This study confirms that asymptomatic testing is important and suggests that an increased frequency of testing may be beneficial. Moreover, we provide factors that can be used to identify the contacts at the greatest risk of acquiring infection.
ABSTRACT
The availability of in situ spectrophotometers, such as the S::CAN spectro::lyser, has expanded the possibilities for high-frequency water quality data collection. However, biological and chemical fouling can degrade the performance of in situ spectrophotometers, especially in saline environments with rapid flow rates. A complex freshwater washing system has been previously designed to reduce chemical fouling for the S::CAN spectro::lyser spectrophotometer. In the current study, we present a simpler, cheaper alternative: the attachment of a sacrificial zinc anode. Results are presented detailing the S::CAN spectro::lyser performance with and without the addition of the sacrificial anode. Attachment of the zinc anode provided efficient corrosion protection during 2-wk deployments in a highly dynamic (average tidal range, 2.5 m) saline tidal saltmarsh creek at Groves Creek, Skidaway Institute of Oceanography, Savannah, GA.
ABSTRACT
We studied the effects of future climate change scenarios on plankton communities of a Norwegian fjord using a mesocosm approach. After the spring bloom, natural plankton were enclosed and treated in duplicates with inorganic nutrients elevated to pre-bloom conditions (N, P, Si; eutrophication), lowering of 0.4 pH units (acidification), and rising 3°C temperature (warming). All nutrient-amended treatments resulted in phytoplankton blooms dominated by chain-forming diatoms, and reached 13-16 µg chlorophyll (chl) a l-1. In the control mesocosms, chl a remained below 1 µg l-1. Acidification and warming had contrasting effects on the phenology and bloom-dynamics of autotrophic and heterotrophic microplankton. Bacillariophyceae, prymnesiophyceae, cryptophyta, and Protoperidinium spp. peaked earlier at higher temperature and lower pH. Chlorophyta showed lower peak abundances with acidification, but higher peak abundances with increased temperature. The peak magnitude of autotrophic dinophyceae and ciliates was, on the other hand, lowered with combined warming and acidification. Over time, the plankton communities shifted from autotrophic phytoplankton blooms to a more heterotrophic system in all mesocosms, especially in the control unaltered mesocosms. The development of mass balance and proportion of heterotrophic/autotrophic biomass predict a shift towards a more autotrophic community and less-efficient food web transfer when temperature, nutrients and acidification are combined in a future climate-change scenario. We suggest that this result may be related to a lower food quality for microzooplankton under acidification and warming scenarios and to an increase of catabolic processes compared to anabolic ones at higher temperatures.
