Human albumin solutions in intensive care: A review.

Albumin plays a key role in the critically ill patient acting as a prognostic marker and as a therapy in the form of human albumin solutions. However, the use of human albumin solution has varied over time with notable differences between health systems. Whilst its use is widely accepted for some clinical indications, its role has not always been clear in the critically ill and has been found to be harmful in some cohorts. Numerous studies have showed conflicting results and critical care clinicians have not always been guided by robust evidence. Nonetheless, at present the use of human albumin solution appears to be increasing again in the United Kingdom. Below, we discuss the latest evidence base for its use in critically ill patients.

Lung-protective ventilation vs conventional ventilation in emergency surgery.

Lung-protective ventilation significantly reduces mortality in patients with acute respiratory distress syndrome, but do the advantages of this approach transfer from the intensive care unit to the operating room?

How a quality improvement initiative can be used to promote single sex accommodation.

The NHS is committed to delivering privacy and dignity to all patients. To this end, the Department of Health has implemented initiatives to eliminate mixed sex wards. Salford Royal Foundation Trust is committed to three guiding principles of clean, safe and personal care. In April 2008, the trust launched its quality improvement strategy, and the single sex project within this aims to ensure that 95% of patients are admitted directly to single sex accommodation. This initiative implemented a number of tests of change relating to workforce and culture, facilities and planning, and communication. To examine whether these tests had resulted in an improvement, outcome, process and balancing measures were designed. The outcome measures showed the trust reached a compliancerate of 93% of all patients admitted to three clinical areas.

Author Correction: Quantifying uncertainties of sandy shoreline change projections as sea level rises.

A correction to this article has been published and is linked from the HTML and PDF versions of this paper. The error has not been fixed in the paper.

Quantifying uncertainties of sandy shoreline change projections as sea level rises.

Sandy shorelines are constantly evolving, threatening frequently human assets such as buildings or transport infrastructure. In these environments, sea-level rise will exacerbate coastal erosion to an amount which remains uncertain. Sandy shoreline change projections inherit the uncertainties of future mean sea-level changes, of vertical ground motions, and of other natural and anthropogenic processes affecting shoreline change variability and trends. Furthermore, the erosive impact of sea-level rise itself can be quantified using two fundamentally different models. Here, we show that this latter source of uncertainty, which has been little quantified so far, can account for 20 to 40% of the variance of shoreline projections by 2100 and beyond. This is demonstrated for four contrasting sandy beaches that are relatively unaffected by human interventions in southwestern France, where a variance-based global sensitivity analysis of shoreline projection uncertainties can be performed owing to previous observations of beach profile and shoreline changes. This means that sustained coastal observations and efforts to develop sea-level rise impact models are needed to understand and eventually reduce uncertainties of shoreline change projections, in order to ultimately support coastal land-use planning and adaptation.