Optimising a method for aragonite precipitation in simulated biogenic calcification media.

Resolving how factors such as temperature, pH, biomolecules and mineral growth rate influence the geochemistry and structure of biogenic CaCO3, is essential to the effective development of palaeoproxies. Here we optimise a method to precipitate the CaCO3 polymorph aragonite from seawater, under tightly controlled conditions that simulate the saturation state (Ω) of coral calcification fluids. We then use the method to explore the influence of aspartic acid (one of the most abundant amino acids in coral skeletons) on aragonite structure and morphology. Using ≥200 mg of aragonite seed (surface area 0.84 m2), to provide a surface for mineral growth, in a 330 mL seawater volume, generates reproducible estimates of precipitation rate over Ωaragonite = 6.9-19.2. However, unseeded precipitations are highly variable in duration and do not provide consistent estimates of precipitation rate. Low concentrations of aspartic acid (1-10 µM) promote aragonite formation, but high concentrations (≥ 1 mM) inhibit precipitation. The Raman spectra of aragonite precipitated in vitro can be separated from the signature of the starting seed by ensuring that at least 60% of the analysed aragonite is precipitated in vitro (equivalent to using a seed of 200 mg and precipitating 300 mg aragonite in vitro). Aspartic acid concentrations ≥ 1mM caused a significant increase in the full width half maxima of the Raman aragonite v1 peak, reflective of increased rotational disorder in the aragonite structure. Changes in the organic content of coral skeletons can drive variations in the FWHM of the Raman aragonite ν1 peak, and if not accounted for, may confuse the interpretation of calcification fluid saturation state from this parameter.

Biomonitoring of arsenic in woodworkers exposed to CCA and evaluation of other non-occupational sources in Uruguay.

In Uruguay wood-impregnation plants use chromated copper arsenate (CCA) as preservative applying good manufacture practices (GMP). This study aims a retrospective evaluation of toxicologically relevant species levels in CCA exposed woodworker's urine (As-U) and an assessment of the effects of work risk factors and non-occupational sources in As-U of workers from a selected plant. From 2014 to 2016, As-U in 212 urine samples (As-U) of 73 woodworkers from six CCA impregnation plants were determined. In one of these plants, 35 workers were interviewed to obtain individual data of work tasks, lifestyles, diet, habits, etc. that may contribute to their overall exposure to Arsenic. Responses were statistically evaluated. Out of the 212 urine samples from 73 woodworkers, 96% showed lower levels of As-U than those established by health regulations (<35µgL-1). According to their work tasks 34% of 35 surveyed workers showed high exposure risk to As and 29% moderate exposure risk. Although they have lower levels of As-U owing to their personal protective equipment, As-U significantly correlate to work risk factors. Consumption of bottled water could also contribute to As-U levels as a non-occupational source. These results confirm that efforts of Uruguayan authorities to promote GMP were successful and justify the importance and frequency of As-U systematic biomonitoring for occupational risk assessment. A significant accomplishment of this work is that non-occupational sources of As-like bottled water consumption should also be considered in future studies.

Resultados de la instauración provisional de un sistema voluntario y anónimo de notificación de incidentes en seguridad del paciente en el SAMU de Asturias / Results of provisional use of a system for voluntary anonymous reporting of incidents that threaten patient safety in the emergency medical services of Asturias

Objetivos: Conocer los incidentes y eventos adversos (EA) que se notificaron en el Servicio de Atención Médica Urgente (SAMU) de Asturias y caracterizarlos, evaluando sus consecuencias, el retraso asistencial provocado y su evitabilidad. Método: Estudio observacional y prospectivo en el que se analizaron las notificaciones realizadas por los profesionales sanitarios del SAMU Asturias, en un sistema de notificación diseñado por los investigadores. Resultados: Se obtuvo una tasa de notificación de 0,5% (IC 95%: 0,41-0,54). Un 74,7% supusieron daño al paciente. El 37,6% de los problemas estuvo relacionado con el centro coordinador de urgencias (CCU), 13,4% con el transporte, 10,8% con el vehículo y 8,8% con problemas de comunicación. Un 70% de los sucesos adversos (SA) notificados conllevó un retraso en la asistencia sanitaria. Un 55% de las notificaciones del CCU en las que hubo riesgo SAC (Severity Assessment Code) correspondió a problemas de recursos humanos y materiales. Los notificantes consideraron que un 88,1% eran evitables. Un 46,2% de los EA precisaron algún tipo de intervención para paliar sus efectos. Las medidas más propuestas por los profesionales para evitar los EA fueron aumento de recursos humanos y materiales (28,3%), elaboración de protocolos (14,5%) y cumplimiento de criterios de calidad (9,7%). Conclusiones: Fomentar la cultura de seguridad y la notificación de los profesionales sanitarios es de especial importancia en nuestro medio, por el número de EA graves, para así conocer los errores y establecer medidas para evitarlos. Los CCU son lugares sensibles para la aparición, detección y notificación de Incidentes (AU)

Objectives: To describe the reported incidents and adverse events in the emergency medical services of Asturias, Spain, and assess their consequences, delays caused, and preventability. Methods: Prospective, observational study of incidents reported by the staff of the emergency medical services of Asturias after implementation of a system devised by the researchers. Results: Incident reports were received for 0.48% (95% CI, 0.41%-0.54%) of the emergencies attended. Patient safety was compromised in 74.7% of the reported incidents. Problems arising in the emergency response coordination center (ERCC) accounted for 37.6% of the incidents, transport problems for 13.4%, vehicular problems for 10.8%, and communication problems for 8.8%. Seventy percent of the reported incidents caused delays in care; 55% of the reported incidents that put patients at risk (according to severity assessment code ratings) corresponded to problems related to human or material resources. A total of 88.1% of the incidents reported were considered avoidable. Some type of intervention was required to attenuate the effects of 46.2% of the adverse events reported. The measures that staff members most often proposed to prevent adverse events were to increase human and material resources (28.3%), establish protocols (14.5%), and comply with quality of care recommendations (9.7%). Conclusions: It is important to promote a culture of safety and incident reporting among health care staff in Asturias given the number of serious adverse events. Reporting is necessary for understanding the errors made and taking steps to prevent them. The ERCC is the point in the system where incidents are particularly likely to appear and be noticed and reported (AU)

[Results of provisional use of a system for voluntary anonymous reporting of incidents that threaten patient safety in the emergency medical services of Asturias]. / Resultados de la instauración provisional de un sistema voluntario y anónimo de notificación de incidentes en seguridad del paciente en el SAMU de Asturias.

OBJECTIVES: To describe the reported incidents and adverse events in the emergency medical services of Asturias, Spain, and assess their consequences, delays caused, and preventability. MATERIAL AND METHODS: Prospective, observational study of incidents reported by the staff of the emergency medical services of Asturias after implementation of a system devised by the researchers. RESULTS: Incident reports were received for 0.48% (95% CI, 0.41%-0.54%) of the emergencies attended. Patient safety was compromised in 74.7% of the reported incidents. Problems arising in the emergency response coordination center (ERCC) accounted for 37.6% of the incidents, transport problems for 13.4%, vehicular problems for 10.8%, and communication problems for 8.8%. Seventy percent of the reported incidents caused delays in care; 55% of the reported incidents that put patients at risk (according to severity assessment code ratings) corresponded to problems related to human or material resources. A total of 88.1% of the incidents reported were considered avoidable. Some type of intervention was required to attenuate the effects of 46.2% of the adverse events reported. The measures that staff members most often proposed to prevent adverse events were to increase human and material resources (28.3%), establish protocols (14.5%), and comply with quality of care recommendations (9.7%). CONCLUSION: It is important to promote a culture of safety and incident reporting among health care staff in Asturias given the number of serious adverse events. Reporting is necessary for understanding the errors made and taking steps to prevent them. The ERCC is the point in the system where incidents are particularly likely to appear and be noticed and reported.

OBJETIVO: Conocer los incidentes y eventos adversos (EA) que se notificaron en el Servicio de Atención Médica Urgente (SAMU) de Asturias y caracterizarlos, evaluando sus consecuencias, el retraso asistencial provocado y su evitabilidad. METODO: Estudio observacional y prospectivo en el que se analizaron las notificaciones realizadas por los profesionales sanitarios del SAMU Asturias, en un sistema de notificación diseñado por los investigadores. RESULTADOS: Se obtuvo una tasa de notificación de 0,5% (IC 95%: 0,41-0,54). Un 74,7% supusieron daño al paciente. El 37,6% de los problemas estuvo relacionado con el centro coordinador de urgencias (CCU), 13,4% con el transporte, 10,8% con el vehículo y 8,8% con problemas de comunicación. Un 70% de los sucesos adversos (SA) notificados conllevó un retraso en la asistencia sanitaria. Un 55% de las notificaciones del CCU en las que hubo riesgo SAC (Severity Assessment Code) correspondió a problemas de recursos humanos y materiales. Los notificantes consideraron que un 88,1% eran evitables. Un 46,2% de los EA precisaron algún tipo de intervención para paliar sus efectos. Las medidas más propuestas por los profesionales para evitar los EA fueron aumento de recursos humanos y materiales (28,3%), elaboración de protocolos (14,5%) y cumplimiento de criterios de calidad (9,7%). CONCLUSIONES: Fomentar la cultura de seguridad y la notificación de los profesionales sanitarios es de especial importancia en nuestro medio, por el número de EA graves, para así conocer los errores y establecer medidas para evitarlos. Los CCU son lugares sensibles para la aparición, detección y notificación de Incidentes.