The beginning of all 75 lightning flashes in two small thunderstorms was investigated using an array of electric field change (E‐change) meters and an array of VHF sensors with the goal of determining if an initial E‐change (IEC) preceded the initial breakdown (IB) pulses in each flash. IECs were found at the beginning of all 62 flashes in Storm 1 and all 13 flashes in Storm 2. Hence, it is concluded that an IEC is a fundamental part of most or all lightning initiations and that an IEC is needed prior to the first IB pulse in a flash. IEC durations averaged 0.23 ms for cloud‐to‐ground (CG) flashes (range 0.08–0.54 ms) and averaged 2.7 ms for normal intracloud (IC) flashes (range 0.04–9.8 ms). IEC point dipole moments averaged 26 C m for CG flashes (range 4–86 C m) and averaged −140 C m for normal IC flashes (range −8 to −650 C m). IEC current moments averaged 120 kA m for CG flashes (range 41–410 kA m) and averaged −91 kA m for normal IC flashes (range −2 to −630 kA m). E‐change data support the suggestion that weak narrow bipolar event type events initiate some lightning flashes, but 41 of the 75 flashes had no detectable initiating pulse > 0.04 V m−1 range normalized to 100 km. Two flashes had two IECs; the second IEC of each flash initiated a new lightning channel that propagated in a new direction and at a higher altitude than the original development after the first IEC.
OBJECTIVEDeep vein thrombosis (DVT) is a major focus of patient safety indicators and a common cause of morbidity and mortality. Many practices have employed lower-extremity screening ultrasonography in addition to chemoprophylaxis and the use of sequential compression devices in an effort to reduce poor outcomes. However, the role of screening in directly decreasing pulmonary emboli (PEs) and mortality is unclear. At the University of Mississippi Medical Center, a policy change provided the opportunity to compare independent groups: patients treated under a prior paradigm of weekly screening ultrasonography versus a post–policy change group in which weekly surveillance was no longer performed.METHODSA total of 2532 consecutive cases were reviewed, with a 4-month washout period around the time of the policy change. Criteria for inclusion were admission to the neurosurgical service or consultation for ≥ 72 hours and hospitalization for ≥ 72 hours. Patients with a known diagnosis of DVT on admission or previous inferior vena cava (IVC) filter placement were excluded. The primary outcome examined was the rate of PE diagnosis, with secondary outcomes of all-cause mortality at discharge, DVT diagnosis rate, and IVC filter placement rate. A p value < 0.05 was considered significant.RESULTSA total of 485 patients met the criteria for the pre–policy change group and 504 for the post–policy change group. Data are presented as screening (pre–policy change) versus no screening (post–policy change). There was no difference in the PE rate (2% in both groups, p = 0.72) or all-cause mortality at discharge (7% vs 6%, p = 0.49). There were significant differences in the lower-extremity DVT rate (10% vs 3%, p < 0.01) or IVC filter rate (6% vs 2%, p < 0.01).CONCLUSIONSBased on these data, screening Doppler ultrasound examinations, in conjunction with standard-of-practice techniques to prevent thromboembolism, do not appear to confer a benefit to patients. While the screening group had significantly higher rates of DVT diagnosis and IVC filter placement, the screening, additional diagnoses, and subsequent interventions did not appear to improve patient outcomes. Ultimately, this makes DVT screening difficult to justify.
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