The Swiss Neonatal Quality Cycle, a monitor for clinical performance and tool for quality improvement

BACKGROUND We describe the setup of a neonatal quality improvement tool and list which peer-reviewed requirements it fulfils and which it does not. We report on the so-far observed effects, how the units can identify quality improvement potential, and how they can measure the effect of changes made to improve quality. METHODS Application of a prospective longitudinal national cohort data collection that uses algorithms to ensure high data quality (i.e. checks for completeness, plausibility and reliability), and to perform data imaging (Plsek's p-charts and standardized mortality or morbidity ratio SMR charts). The collected data allows monitoring a study collective of very low birth-weight infants born from 2009 to 2011 by applying a quality cycle following the steps 'guideline - perform - falsify - reform'. RESULTS 2025 VLBW live-births from 2009 to 2011 representing 96.1% of all VLBW live-births in Switzerland display a similar mortality rate but better morbidity rates when compared to other networks. Data quality in general is high but subject to improvement in some units. Seven measurements display quality improvement potential in individual units. The methods used fulfil several international recommendations. CONCLUSIONS The Quality Cycle of the Swiss Neonatal Network is a helpful instrument to monitor and gradually help improve the quality of care in a region with high quality standards and low statistical discrimination capacity.

Temperature-Time History of Subducted Continental-Crust, Mount Olympos Region, Greece

In the Mt. Olympos region of northeastern Greece, continental margin strata and basement rocks were subducted and metamorphosed under blueschist facies conditions, and thrust over carbonate platform strata during Alpine orogenesis. Subsequent exposure of the subducted basement rocks by normal faulting has allowed an integrated study of the timing of metamorphism, its relationship to deformation, and the thermal history of the subducted terrane. Alpine low-grade metamorphic assemblages occur at four structural levels. Three thrust sheets composed of Paleozoic granitic basement and Mesozoic metasedimentary cover were thrust over Mesozoic carbonate rocks and Eocene flysch; thrusting and metamorphism occurred first in the highest thrust sheets and progressed downward as units were imbricated from NE to SW. 40Ar/39Ar spectra from hornblende, white mica, and biotite samples indicate that the upper two units preserve evidence of four distinct thermal events: (1) 293–302 Ma crystallization of granites, with cooling from >550°C to <325°C by 284 Ma; (2) 98–100 Ma greenschist to blueschist-greenschist transition facies metamorphism (T∼350–500°C) and imbrication of continental thrust sheets; (3) 53–61 Ma blueschist facies metamorphism and deformation of the basement and continental margin units at T<350–400°C; (4) 36–40 Ma thrusting of blueschists over the carbonate platform, and metamorphism at T∼200–350°C. Only the Eocene and younger events affected the lower two structural packages. A fifth event, indicated by diffusive loss profiles in microcline spectra, reflects the beginning of uplift and cooling to T<100–150°C at 16–23 Ma, associated with normal faulting which continued until Quaternary time. Incomplete resetting of mica ages in all units constrains the temperature of metamorphism during continental subduction to T≤350°C, the closure temperature for Ar in muscovite. The diffusive loss profiles in micas and K-feldspars enable us to “see through” the younger events to older events in the high-T parts of the release spectra. Micas grown during earlier metamorphic events lost relatively small amounts of Ar during subsequent high pressure-low temperature metamorphism. Release spectra from phengites grown during Eocene metamorphism and deformation record the ages of the Ar-loss events. Alpine deformation in northern Greece occurred over a long time span (∼90 Ma), and involved subduction and episodic imbrication of continental basement before, during, and after the collision of the Apulian and Eurasian plates. Syn-subduction uplift and cooling probably combined with intermittently higher cooling rates during extensional events to preserve the blueschist facies mineral assemblages as they were exhumed from depths of >20 km. Extension in the Olympos region was synchronous with extension in the Mesohellenic trough and the Aegean back-arc, and concurrent with westward-progressing shortening in the external Hellenides.

A Review of the Genus Iridogorgia (Octocorallia : Chrysogorgiidae) and Its Relatives, Chiefly from the North Atlantic Ocean

Exploration of the New England and Corner Rise Seamounts produced four new species of chrysogorgild octocorals with the spiral iridogorgiid growth form. Three species are described as new in the genus iridogorgia and one is described in the new genus Rhodaniridogoigia. Both genera have representatives in the Atlantic and Pacific Oceans. Iridogorgia magnispiralis sp. nov., is one of the largest octocorals encountered in the deep sea and seems to be widespread in the Atlantic.

Development and characterization of a scaffold-free 3D spheroid model of iPSC-derived human cardiomyocytes

Purpose: Cardiomyocytes are terminally differentiated cells in the adult heart and ischemia and cardiotoxic compounds can lead to cell death and irreversible decline of cardiac function. As testing platforms, isolated organs and primary cells from rodents have been the standard in research and toxicology, but there is a need for better models that more faithfully recapitulate native human biology. Hence, a new in vitro model comprising the advantages of 3D cell culture and the availability of induced pluripotent stem cells (iPSC) from human origin was developed and characterized. Methods: Human cardiomyocytes (CMs) derived from induced pluripotent stem cells (iPSCs) were studied in standard 2D culture and as cardiac microtissues (MTs) formed in hanging drops. 2D cultures were examined using immunofluorescence microscopy and Western blotting while the cardiac MTs were subjected to immunofluorescence, contractility, and pharmacological investigations. Results: iPSC-derived CMs in 2D culture showed well-formed myofibrils, cell-cell contacts positive for connexin-43, and other typical cardiac proteins. The cells reacted to pro-hypertrophic growth factors with a substantial increase in myofibrils and sarcomeric proteins. In hanging drop cultures, iPSC-derived cardiomyocytes formed spheroidal MTs within 4 days showing a homogeneous tissue structure with well-developed myofibrils extending throughout the whole spheroid without a necrotic core. MTs showed spontaneous contractions for more than 4 weeks that were recorded by optical motion tracking, sensitive to temperature, and responsive to electrical pacing. Contractile pharmacology was tested with several agents known to modulate cardiac rate and viability. Calcium-transients underlay the contractile activity and were also responsive to electrical stimulation, caffeine-induced Ca2+-release, extracellular calcium levels. Conclusions: 3D culture using iPSC-derived human cardiomyocytes provides an organoid human-based cellular platform that is free of necrosis and recapitulates vital cardiac functionality, thereby providing new and promising relevant model for the evaluation and development of new therapies and detection of cardiotoxicity.

Crowdsourcing language change with smartphone applications

Crowdsourcing linguistic phenomena with smartphone applications is relatively new. In linguistics, apps have predominantly been developed to create pronunciation dictionaries, to train acoustic models, and to archive endangered languages. This paper presents the first account of how apps can be used to collect data suitable for documenting language change: we created an app, Dialäkt Äpp (DÄ), which predicts users’ dialects. For 16 linguistic variables, users select a dialectal variant from a drop-down menu. DÄ then geographically locates the user’s dialect by suggesting a list of communes where dialect variants most similar to their choices are used. Underlying this prediction are 16 maps from the historical Linguistic Atlas of German-speaking Switzerland, which documents the linguistic situation around 1950. Where users disagree with the prediction, they can indicate what they consider to be their dialect’s location. With this information, the 16 variables can be assessed for language change. Thanks to the playfulness of its functionality, DÄ has reached many users; our linguistic analyses are based on data from nearly 60,000 speakers. Results reveal a relative stability for phonetic variables, while lexical and morphological variables seem more prone to change. Crowdsourcing large amounts of dialect data with smartphone apps has the potential to complement existing data collection techniques and to provide evidence that traditional methods cannot, with normal resources, hope to gather. Nonetheless, it is important to emphasize a range of methodological caveats, including sparse knowledge of users’ linguistic backgrounds (users only indicate age, sex) and users’ self-declaration of their dialect. These are discussed and evaluated in detail here. Findings remain intriguing nevertheless: as a means of quality control, we report that traditional dialectological methods have revealed trends similar to those found by the app. This underlines the validity of the crowdsourcing method. We are presently extending DÄ architecture to other languages.

Do clinicians understand the size of treatment effects? A randomized survey across 8 countries.

BACKGROUND Meta-analyses of continuous outcomes typically provide enough information for decision-makers to evaluate the extent to which chance can explain apparent differences between interventions. The interpretation of the magnitude of these differences - from trivial to large - can, however, be challenging. We investigated clinicians' understanding and perceptions of usefulness of 6 statistical formats for presenting continuous outcomes from meta-analyses (standardized mean difference, minimal important difference units, mean difference in natural units, ratio of means, relative risk and risk difference). METHODS We invited 610 staff and trainees in internal medicine and family medicine programs in 8 countries to participate. Paper-based, self-administered questionnaires presented summary estimates of hypothetical interventions versus placebo for chronic pain. The estimates showed either a small or a large effect for each of the 6 statistical formats for presenting continuous outcomes. Questions addressed participants' understanding of the magnitude of treatment effects and their perception of the usefulness of the presentation format. We randomly assigned participants 1 of 4 versions of the questionnaire, each with a different effect size (large or small) and presentation order for the 6 formats (1 to 6, or 6 to 1). RESULTS Overall, 531 (87.0%) of the clinicians responded. Respondents best understood risk difference, followed by relative risk and ratio of means. Similarly, they perceived the dichotomous presentation of continuous outcomes (relative risk and risk difference) to be most useful. Presenting results as a standardized mean difference, the longest standing and most widely used approach, was poorly understood and perceived as least useful. INTERPRETATION None of the presentation formats were well understood or perceived as extremely useful. Clinicians best understood the dichotomous presentations of continuous outcomes and perceived them to be the most useful. Further initiatives to help clinicians better grasp the magnitude of the treatment effect are needed.

Racking the brain: detection of cerebral edema on postmortem computed tomography compared with forensic autopsy

PURPOSE The purpose of this study was to compare postmortem computed tomography with forensic autopsy regarding their diagnostic reliability of differentiating between pre-existing cerebral edema and physiological postmortem brain swelling. MATERIALS AND METHODS The study collective included a total of 109 cases (n=109/200, 83 male, 26 female, mean age: 53.2 years) and were retrospectively evaluated for the following parameters (as related to the distinct age groups and causes of death): tonsillar herniation, the width of the outer and inner cerebrospinal fluid spaces and the radiodensity measurements (in Hounsfield Units) of the gray and white matter. The results were compared with the findings of subsequent autopsies as the gold standard for diagnosing cerebral edema. p-Values <0.05 were considered statistically significant. RESULTS Cerebellar edema (despite normal postmortem swelling) can be reliably assessed using postmortem computed tomography and is indicated by narrowed temporal horns and symmetrical herniation of the cerebellar tonsils (p<0.001). There was a significant difference (p<0.001) between intoxication (or asphyxia) and all other causes of death; the former causes demonstrated higher deviations of the attenuation between white and gray matter (>20 Hounsfield Units), and the gray to white matter ratio was >1.58 when leukoencephalopathy was excluded. CONCLUSIONS Despite normal postmortem changes, generalized brain edema can be differentiated on postmortem computed tomography, and white and gray matter Hounsfield measurements help to determine the cause of death in cases of intoxication or asphyxia. Racking the brain about feasible applications for a precise and reliable brain diagnostic forensic radiology method has just begun.

Yoga off the mat: How far and to whom do the benefits extend?

At least 15 million American adults have participated in yoga at least once in their lifetime (Saper, Eisenberg, Davis, Culpepper, & Phillips, 2004). The field of yoga research is relatively new in the United States, and the majority of studies have concentrated on yoga's effect on measures of physiology (cardiovascular disease, diabetes, obesity) or psychological measures of stress and anxiety. This review attempted to identify studies that had been conducted measuring a different set of outcome measures, specifically violence, trauma, eating, and other behavioral disorders. In 9 of 10 studies reviewed, researchers observed statistically significant effects of yoga interventions. Effects were most evident within multifaceted studies that combined intensive yoga practice with group discussion and training. Only one group (Mitchell, Mazzeo, Rausch, & Cooke, 2007) failed to observe any significant differences between yoga practice groups and control groups. Effects were seen in both sexes, although a majority of the studies were aimed specifically at women. All studies were limited by small sample size and lack of follow-up data. Future research should seek to increase sample size, to diversify recruitment to allow for the randomization of treatment and control groups, and to allow for long-term follow-up.^

Implementing and evaluating a Web -based close call reporting system at an urban hospital

Medical errors and close calls are pervasive in health care. It is hypothesized that the causes of close calls are the same as for medical errors; therefore learning about close calls can help prevent errors and increase patient safety. Yet despite efforts to encourage close call reporting, close calls as well as medical errors are under-reported in health care. The purpose of this dissertation was to implement and evaluate a web-based anonymous close call reporting system in three units at an urban hospital. ^ The study participants were physicians, nurses and medical technicians (N = 187) who care for patients in the Medical Intermediate Care Unit, the Surgical Intermediate Care Unit, and the Coronary Catheterization Laboratory in the hospital. We provided educational information to the participants on how to use the system and e-mailed and delivered paper reminders to report to the participants throughout the 19-month project. We surveyed the participants at the beginning and at the end of the study to assess their attitudes and beliefs regarding incident reporting. We found that the majority of the health care providers in our study are supportive of incident reporting in general but in practice very few had actually reported an error or a close call, semi-structured interview 20 weeks after we made the close call reporting system available. The purpose of the interviews was to further assess the participants' attitudes regarding incident reporting and the reporting system. Our findings suggest that the health care providers are supportive of medical error reporting in general, but are not convinced of the benefit of reporting close calls. Barriers to close call reporting cited include lack of time, heavy workloads, preferring to take care of close calls "on the spot", and not seeing the benefits of close call reporting. Consequently only two = close calls were reported via the system by two separate caregivers during the project. ^ The findings suggest that future efforts to increase close call reporting must address barriers to reporting, especially the belief among care givers that it is not worth taking time from their already busy schedules to report close calls. ^

Grain-size analysis and geochemistry of sediment core GeoB13602-1

Grain-size, terrigenous element and rock magnetic remanence data of Quaternary marine sediments retrieved at the NW African continental margin off Gambia (gravity core GeoB 13602-1, 13°32.71' N, 17°50.96'W) were jointly analyzed by end-member (EM) unmixing methods to distinguish and budget past terrigenous fluxes. We compare and cross-validate the identified single-parameter EM systems and develop a numerical strategy to calculate associated multi-parameter EM properties. One aeolian and two fluvial EMs were found. The aeolian EM is much coarser than the fluvial EMs and is associated with a lower goethite/hematite ratio, a higher relative concentration of magnetite and lower Al/Si and Fe/K ratios. Accumulation rates and grain sizes of the fluvial sediment appear to be primarily constrained by shore distance (i.e., sea-level fluctuations) and to a lesser extent by changes in hinterland precipitation. High dust fluxes occurred during the Last Glacial Maximum (LGM) and during Heinrich Stadials (HS) while the fluvial input remained unchanged. Our approach reveals that the LGM dust fluxes were ~7 times higher than today's. However, by far the highest dust accumulation occurred during HS 1 (~300 g m**-2 yr** -1), when dust fluxes were ~80 fold higher than today. Such numbers have not yet been reported for NW Africa, and emphasize strikingly different environmental conditions during HSs. They suggest that deflation rate and areal extent of HSs dust sources were much larger due to retreating vegetation covers. Beyond its regional and temporal scope, this study develops new, in principle, generally applicable strategies for multi-method end-member interpretation, validation and flux budgeting calibration.

Caracterización del perfil cultural del suelo en una pastizal natural : Santa Fe (Argentina)

En la región pampeana son comunes las áreas mal drenadas destinadas a ganadería en base a pastizales naturales. En ellas la vegetación natural es compleja y está influenciada por la interacción de aspectos climáticos, edáficos y por la historia del uso y del manejo. Las características edáficas afectadas por el manejo se expresan en el perfil cultural del suelo (PC); su caracterización es una herramienta importante para identificar limitantes a la productividad y aportar elementos para la toma de decisiones de manejo. Ante la ausencia de métodos que caractericen y cuantifiquen el estado del PC, se propone un índice (IPC) que, considerando el reconocimiento y la valoración de ciertas características edáficas indicadoras, asigna un valor numérico al estado del PC. En un pastizal natural, próximo a una cañada ubicada en el sur de la provincia de Santa Fe, se reconocieron tres áreas o unidades forrajeras (UF) con cierta homogeneidad en las características edáficas, forrajeras y paisajísticas. En las mismas se caracterizó el estado del PC y se calculó el IPC. El método desarrollado permitió identificar en cada UF limitantes edáficas derivadas del manejo y, a partir del índice generado, clasificar los respectivos PC según su estado.

Balance energético en unidades de tierra de una cuenca rural basado en un sistema de información geográfica.

El objetivo de este trabajo fue desarrollar una metodología de procesamiento de información espacial basada en un Sistema de Información Geográfica (SIG), para la determinación del balance de energía en unidades de tierra (UT) definidas en una cuenca hidrográfica rural. Se determinaron las UT a partir de mapas de unidades de paisaje y de mapas de estratos de superficie operada por productor. Se caracterizaron los ingresos (IE) y egresos energéticos (EE) en los sistemas de producción agrícolas. Se calculó la energía neta (EN) y la relación EE/IE (Re). Los datos se analizaron mediante un ANVA (p < 0,05). Los parámetros IE, EE, EN y Re no fueron significativamente diferentes entre UT, por lo que se infiere que el modelo productivo actualmente desarrollado, desde el punto de vista energético, resulta similar. Se hallaron relaciones de interés entre las variables de estudio y su ubicación geográfica, lo que permite recomendar para los sistemas agrícolas de una cuenca rural la planificación general del uso de la energía considerando las capacidades de los SIG.

Reflexiones en torno a propuestas de educación para mujeres privadas de libertad en unidades penitenciarias de Mendoza

En este ensayo se reflexiona sobre algunas propuestas educativas de Nivel Superior para mujeres privadas de libertad en unidades penitenciarias de Mendoza. Algunos de los condicionantes que estas mujeres deben enfrentar, si bien fueron observados en torno a experiencias de educación universitaria, permiten entrever, limitaciones que aparecen, en general, cuando se trata del ejercicio del derecho a la educación por parte de mujeres. Cada logro va acompañado, a la vez, de relegaciones, o al menos de postergaciones, ya que se trata de avances que se obtienen una vez que han sido conseguidos para los hombre que están privados de libertad.

Chemical composition of clay minerals from ODP Leg 168 sites

The exchangeable cation compositions of organic-poor terrigenous sediments containing smectite as primary ion exchanger from a series of holes along ODP Leg 168 transect on the eastern flank of the Juan de Fuca Ridge have been examined as a function of distance from the ridge axis and burial depth. The total cation exchange capacity (CEC) values of the sediments ranged from 2 to 59 meq/100 g, increasing with increases in the wt.% smectite. At the seafloor, the exchangeable cation compositions involving Na, K, Mg, and Ca, expressed in terms of equivalent fraction, are nearly constant regardless of the different transect sites: XNa = 0.21 ± 0.04, XK = 0.08 ± 0.01, XMg = 0.33 ± 0.09, and XCa = 0.38 ± 0.09. The calculated selectivity coefficients of the corresponding quaternary exchange reactions, calculated using porewater data, are in log units -5.45 ± 0.39 for Na, 1.97 ± 0.49 for K, 0.42 ± 0.41 for Mg, and 3.06 ± 0.69 for Ca. The exchangeable cation compositions below the seafloor change systematically with distance from the ridge crest and burial depth, conforming to the trends of the same cations in the porewaters. The selectivities for Na and Mg are roughly constant at temperatures from 2 to 66°C, indicating that the equivalent fractions of these two cations are independent of sediment alteration taking place on the ridge flank. Unlike Na and Mg, the temperature influence is significant for K and Ca, with Ca-selectivity decreases being coupled with increases in K-selectivity. Although potentially related to diagenetic and/or hydrothermal mineral precipitation or recrystallization, no evidence of such alteration was detected by XRD and TEM. In sites where upwelling of hydrothermal fluids from basement is occurring, the K-selectivity of the sediment is appreciably higher than at the other sites and corresponds to the formation of (Fe, Mg) rich smectite and zeolites. Our study indicates that local increases in K-selectivity at hydrothermal sites are caused by the formation of these authigenic minerals.

Mineralogy of southern Kerguelen Plateau sediments

Kaolinite, goethite, minor hematite, and gibbsite were found in fluvial upper Lower Cretaceous basal sediment from the Southern Kerguelen Plateau, Sites 748 and 750, 55°S latitude. This mineral assemblage, derived from the weathering of basalt, indicates near-tropical weathering conditions with high orographic rainfall, at least 100 cm per year. The climate deteriorated by the Turonian or Coniacian, as indicated by the decline in kaolinite content of this sediment. The Upper Cretaceous sediment at Site 748 consists of 200 m of millimeter-laminated, sparsely fossiliferous, wood-bearing glauconitic siltstone and clay stone with siderite concretions deposited on a shelf below wave base. Some graded and cross beds indicate that storms swept over the shelf and reworked the sediment. Overlying this unit is 300 m of intermittently partly silicified, bryozoan-inoceramid-echinoderm-rich glauconitic packstones, grainstones, and wackestones. The dominant clay mineral in both units is identical to the mineral composition of the glauconite pellets: randomly interstratified smectite-mica. The clay fraction has a higher percent of expandable layers than the mineral of the glauconite pellets, and the clay of the underlying subunit has a higher percentage of expandable layers than the clay of the carbonate subunit. Potassium levels mirror these mineral variations, with higher K levels in minerals that have a lower percentage of expandable layers. The decrease in expandability of the mineral in the upper subunit is attributed to diagenesis, the result of higher porosity.