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Fatigue resulting from shift work and extended hours can compromise patient care and the safety and health of nurses, as well as increasing nursing turnover and health care costs.This research aimed to identify aspects of nurses' work patterns associated with increased risk of reporting fatigue-related outcomes.A national survey of work patterns and fatigue-related outcomes in 6 practice areas expected to have high fatigue risk (child health including neonatology, cardiac care/intensive care, emergency and trauma, in-patient mental health, medical, and surgical nursing).The 5-page online questionnaire included questions addressing: demographics, usual work patterns, work in the previous two weeks, choice about shifts, and four fatigue-related outcomes - having a sleep problem for at least 6 months, sleepiness (Epworth Sleepiness Scale), recalling a fatigue-related error in clinical practice in the last 6 months, and feeling close to falling asleep at the wheel in the last 12 months. The target population was all registered and enrolled nurses employed to work in public hospitals at least 30 h/week in one of the 6 practice areas. Participation was voluntary and anonymous.Respondents (n = 3133) were 89.8% women and 8% Māori (indigenous New Zealanders), median age 40 years, range 21-71 years (response rate 42.6%). Nurses were more likely than New Zealand adults in general to report chronic sleep problems (37.73% vs 25.09%, p 0.0001) and excessive sleepiness (33.75% vs 14.9%, p 0.0001). Fatigue-related error(s) in the last 6 months were recalled by 30.80% and 64.50% reported having felt sleepy at the wheel in the last 12 months. Logistic regression analyses indicated that fatigue-related outcomes were most consistently associated with shift timing and sleep. Risk increased with more night shifts and decreased with more nights with sleep between 11 p.m. and 7 a.m. and on which nurses had enough sleep to feel fully rested. Risk also increased with roster changes and more shift extensions greater than 30 min and decreased with more choice about shifts. Comparisons between intensive care/cardiac care and in-patient mental health nursing highlight that fatigue has different causes and consequences in different practice areas.Findings confirm the need for a more comprehensive and adaptable approach to managing fatigue. We advocate an approach that integrates safety management and scientific principles with nursing and management expertise. It should be data-driven, risk-focused, adaptable, and resilient in the face of changes in the services required, the resources available, and the overall goals of the healthcare system.

Spatio-temporal models are widely used in many research areas including ecology. The recent proliferation of the use of in-situ sensors in streams and rivers supports space-time water quality modelling and monitoring in near real-time. A new family of spatio-temporal models is introduced. These models incorporate spatial dependence using stream distance while temporal autocorrelation is captured using vector autoregression approaches. Several variations of these novel models are proposed using a Bayesian framework. The results show that our proposed models perform well using spatio-temporal data collected from real stream networks, particularly in terms of out-of-sample RMSPE. This is illustrated considering a case study of water temperature data in the northwestern United States., Comment: 30 pages, 10 figs

From a government perspective, shared-use or open-access infrastructure arrangements can provide significant prospects for sustainable development. The shared use of infrastructure built by mining companies can spur and support additional mining projects and other economic activities and services to the benefit of surrounding communities and other third-party beneficiaries. From the viewpoint of a mining company, however, such arrangements pose risks to profitability and may, in some instances, benefit competitors. This study uses lessons learned from the shared-use arrangements along the Carajás railway corridor in Brazil to shed light on how to strike a balance between divergent private and public interests, and how countries may learn from this approach in order to increase the benefits of existing and future shared-use projects.

This work aims to evaluate the carbon footprint (CF) of microalgae production in a closed pilot-scale multi-tubular photobioreactor (PBR), on a gate-to-gate approach. Primary data from real production conditions complemented with data from the literature and life cycle inventory databases was used. The carbon embedded in the PBR’s construction materials and nutrients necessary for the microalgae growth were considered. A global CF of 68.34 kg CO2-eq/kg dry biomass was obtained. A CF of 1.72 kg CO2-eq/kg dry biomass was calculated for the PBR construction stage, contributing to 3 % of the overall value. For 74 kg of dry biomass/year produced with this PBR, the CF for this stage was 66.62 kg CO2-eq/kg dry biomass, corresponding to 97 % of the total global CF. In this study, electricity production for the reactor operation is the major contributor (79 %) to the overall CF, followed by the production of nutrients used to prepare the culture medium (21 %). CO2 fixation by microalgae reduces the global value by 3 %.

Microbiological testing represents a significant expenditure for producers. Two new double sampling plans employing a compressed limit in the first stage of inspection were proposed to reduce the testing costs. These plans were designed for sanitary characteristics where the bacterial count generally fits a Poisson or a mixed-Poisson distribution. Both plans showed improved consumer protection with substantially smaller average sample size. The application of the new plans was validated using an empirical dataset of aerobic plate counts observed in milk powder samples. The new plans enabled a sample size reduction of between 20 and 75% compared to the actual sampling procedures.

Objective Spreading depolarization (SD) occurs after traumatic brain injury, subarachnoid hemorrhage, malignant hemispheric stroke and intracranial hemorrhage. SD has been associated with secondary brain injury, which can be reduced by ketamine. In this present study frequency bands of electrocorticographic (ECoG) recordings were investigated with regards to SDs. Methods A total of 43 patients after acute brain injury were included in this retrospective and explorative study. Relative delta 0.5–4Hz, theta 4–8Hz, alpha 8–13Hz and beta 13–40Hz bands were analyzed with regards to SD occurrence and analgesic and sedative administration. Higher frequencies, including gamma 40–70Hz, fast gamma 70–100Hz and high frequency oscillations 100–200Hz were analyzed in a subset of patients with a sampling rate of up to 400Hz. Results A close association of relative beta frequency and SD was found. Relative beta frequency was suppressed up to two hours prior to SD when compared to hours with no SD. This finding was partially explained by administration of ketamine. Even after removal of all patient data during administration of ketamine, SDs occurred predominantly during times with low relative beta frequency in a patient-independent analysis. Conclusion Suppression of beta frequency by ketamine or without ketamine is associated with low SD counts. Significance Alteration of beta frequency might help to predict occurrence of SDs in acutely brain injured patients.

Sampling inspection plans are principally used to determine whether a batch of food is contaminated or not. In this theoretical research, we study the effect of increasing the analytical unit amount on the performance of microbiological sampling plans, and on the resulting quality after inspection. We discuss several scenarios of homogeneous and inhomogeneous contamination for assessing the consumer's risk. Several statistical approaches to describe the effect of an increase in analytical amount are studied. We provided a procedure for designing of the sampling plan for a given consumer's risk and according to different dispersion parameters and contamination levels.

Numerous organisations collect data in the Great Barrier Reef (GBR), but they are rarely analysed together due to different program objectives, methods, and data quality. We developed a weighted spatio-temporal Bayesian model and used it to integrate image-based hard-coral data collected by professional and citizen scientists, who captured and/or classified underwater images. We used the model to predict coral cover across the GBR with estimates of uncertainty; thus filling gaps in space and time where no data exist. Additional data increased the model's predictive ability by 43%, but did not affect model inferences about pressures (e.g. bleaching and cyclone damage). Thus, effective integration of professional and high-volume citizen data could enhance the capacity and cost-efficiency of monitoring programs. This general approach is equally viable for other variables collected in the marine environment or other ecosystems; opening up new opportunities to integrate data and provide pathways for community engagement/stewardship.

Background: Disease progression and delayed neurological complications are common after aneurysmal subarachnoid hemorrhage (aSAH). We explored the potential of quantitative blood-brain barrier (BBB) imaging to predict disease progression and neurological outcome. Methods: Data were collected as part of the Co-Operative Studies of Brain Injury Depolarizations (COSBID). We analyzed retrospectively, blindly and semi-automatically magnetic resonance images from 124 aSAH patients scanned at 4 time points (24-48 h, 6-8 days, 12-15 days and 6-12 months) after the initial hemorrhage. Volume of brain with apparent pathology and BBB dysfunction (BBBD), subarachnoid space and lateral ventricles were measured. Neurological status on admission was assessed using the Fisher grades, World Federation of Neurosurgical Societies and Rosen-Macdonald (RMS) scores. Clinical outcome at 6 months or later was assessed using the extended Glasgow outcome scale. Findings: Based on repeated volumetric measures of pathological brain tissue and CSF, patients were categorized as having either progressive (increased pathology; 64%) or nonprogressive (36%) disease course. No differences were found between the two groups in aneurysm locations, neurological status on admission, initial brain pathology or treatment (coiling or clipping). Females were older and more likely to have a non-progressive course compared to males (p=0·01). Progressive course was associated with worse outcome at ≥6 months. A substantial brain volume with BBBD was found already 24-48 h after admission, and persisted at all time points. Brain volume with BBBD was significantly larger in patients with progressive course. BBBD increased the likelihood of a normal brain tissue to become pathological (p

Testing composite samples is a useful strategy to achieve sampling economy. Several studies have shown the effectiveness of this technique under the assumption of perfect mixing of primary samples. This paper investigates the effect of imperfect composite sample preparation on the performance of two and three-class variables sampling inspection plans, and identifies scenarios in which testing composite samples is not advantageous. The design of sampling plans using composite samples is discussed and an implementation guide based on two points of the OC curve for perfect and imperfect mixing is provided.

Objectives The detection of the hemodynamic and propagation patterns of spreading depolarizations (SDs) in the gyrencephalic brain using intrinsic optical signal imaging (IOS). Methods The convexity of the brain surface was surgically exposed in fourteen male swine. Within the boundaries of this window, brains were immersed and preconditioned with an elevated K+ concentration (7 mmol/l) in the standard Ringer lactate solution for 30–40 min. SDs were triggered using 3–5 μl of 1 mol/l KCl solution. Changes in tissue absorbency or reflection were registered with a CCD camera at a wavelength of 564 nm (14 nm FWHM), which was mounted 25 cm above the exposed cortex. Additional monitoring by electrocorticography and laser-Doppler was used in a subset of animals (n = 7) to validate the detection of SD. Results Of 198 SDs quantified in all of the experiments, 187 SDs appeared as radial waves that developed semi-planar fronts. The morphology was affected by the surface of the gyri, the sulci and the pial vessels. Other SD patterns such as spirals and reverberating waves, which have not been described before in gyrencephalic brains, were also observed. Diffusion gradients created in the cortex surface (i.e., KCl concentrations), sulci, vessels and SD–SD interactions make the gyrencephalic brain prone to the appearance of irregular SD waves. Conclusion The gyrencephalic brain is capable of irregular SD propagation patterns. The irregularities of the gyrencephalic brain cortex may promote the presence of re-entrance waves, such as spirals and reverberating waves.

Variables sampling plans for microbial safety are usually based on the log transformation of the observed counts. We propose a new variables plan for lognormal data using the angular transformation. In a comparison with the classic approach, this new method shows more stringency and allows the use of smaller sample sizes to obtain the same level of consumer protection. This transformation is robust when the underlying distribution departs from the lognormal distribution as well as in the presence of contamination. A description of the new plan and the software codes are provided.

La despolarizacion cortical extendida (cortical spreading depolarization en ingles) es una onda de despolarizacion casi completa de las celulas neuronales y de la glia acoplada a una respuesta de vasoconstriccion y dilatacion vascular que ocurre en la migrana con aura, la hemorragia subaracnoidea, la hemorragia intracerebral, el traumatismo craneoencefalico y el ictus isquemico. Estas ondas de despolarizacion se caracterizan por un cambio de potencial negativo con una amplitud de entre -10 a -30 mV, una duracion de ~1 min y cambios en la homeostasis ionica cerebral intracelular y extracelular. Bajo situaciones patologicas de hipoperfusion estas ondas despolarizantes pueden conducir a estres oxidativo, agravamiento de estados hipoxicos y muerte neuronal debido a vasoconstriccion arterial intensa causada por una repuesta hemodinamica inversa, fenomeno denominado isquemia extendida (spreading ischemia). En los ultimos anos se ha podido confirmar electrofisiologicamente la presencia de estas ondas despolarizantes propagandose en el cerebro humano y se ha visto una asociacion entre su incidencia y el deterioro neurologico. Actualmente se esta recogiendo evidencia clinica que apoya no solo su coexistencia con el dano neuronal, sino su causalidad. Existen medidas terapeuticas probadas en laboratorio que podrian reducir los efectos de este elemento fisiopatologico en el dano cerebral

Introduction Cortical spreading depressions (CSDs) are waves of near-complete cellular depolarization that spread slowly across the cortical surface (2–5 mm/min) and result in transient loss of cell signaling capabilities. CSDs is a biomarker of neuronal damage described in several clinical hypoxic-ischemic conditions However, only has been found in one patient operated for Giant pituitary adenoma. Methods This is a prospective study that included adult patients undergoing elective craniotomy for epileptogenic supratentorial lesions lasting >2 h. Electrocorticographic recordings were obtained from time of dural opening through the time of dural closure, using a standard 1 × 8 silver electrode coupled with a full-spectrum DC amplifier (0–45 Hz, Notch: 60 Hz). We analyzed the clinical and socio-demographic characteristics. The data were processed using the COSBID research group methodology to evaluate for slow potential changes coupled with suppression of high-frequency ECoG propagating across the electrodes. Describe statistics were used. Results We included 16 patients, mean age 37 (19–75) years-old, 50% male, underwent 4 callosotomies and 12 temporal lesionectomies (3 cortical dysplasia, 2 cavernomas, 5 gliomas and 2 dermoid cystic). All the patients had history of symptomatic epilepsy and none had postsurgical complications and only 2 patients post-callosotomy continued with seizures at 6 months of follow-up. We didn’t find any CSD during these neurosurgeries. Conclusion CSDs were absent during lesional epilepsy surgery. Future studies are needed to confirm these findings.