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Background: Optimizing preoperative anemia is a required component of the Joint Commission Patient Blood Management Certification and an important component of Enhanced Recovery After Surgery. Objective: To describe a preoperative anemia protocol developed and implemented at the Kaiser Permanente San Jose Medical Center in California to facilitate preoperative identification and treatment of anemia. Methods: The protocol included all operations at risk of causing substantial blood loss. It excluded emergent operations and those for which the patient had a normal last hemoglobin value within the prior 12 months unless newly developed anemia was suspected. Eligible patients were screened for laboratory evaluation, and those with anemia were treated for reversible causes. Consistency was ensured by physician, staff, and patient education, and by use of electronic health records. Administration of intravenous iron and erythropoietin and consultation with specialists were expedited as part of a management algorithm. Results: Among 510 patients enrolled during 1 year, 442 (87%) received anemia screening laboratory tests. Half of those with laboratory results were eligible for further optimization: 207 had anemia and 21 had iron deficiency without anemia. Among the 228 patients eligible for optimization, 189 (83%) had anemia addressed preoperatively. Of 129 patients with iron deficiency anemia, 102 (79%) received intravenous iron preoperatively, with a mean preoperative increase in hemoglobin level by 0.98 g/dL (n = 79). Conclusion: Integration of specialty services, optimization of technology, and consistency across practitioners were crucial for successful implementation and sustainability of a preoperative anemia protocol developed to expedite and enhance best practices. [ABSTRACT FROM AUTHOR]

Researchers, policymakers, and the general public increasingly agree on the importance of subjective well-being as an indicator of individual and societal welfare. A vast literature has emerged over the last twenty years documenting the many variables that influence subjective well-being. The purpose of this study is to quantify the relative importance of these determinants in an attempt to synthesize the main strands in the literature and inform policy formulations. We use in our analysis three years’ worth of data from the Gallup World Poll, including 153 countries and ten geopolitical regions. We estimate the relative importance of four major domains of subjective well-being using a basic model with 25 independent variables, and a broader set of seven domains using an extended model with 60 independent variables. Our results show that material well-being is the main determinant of subjective well-being across all ten geopolitical regions. A particularly strong determinant of subjective well-being in our study is feelings about household income, whereas community functioning, governance and altruistic behaviors have a relatively low importance. Our results suggest that subjective material well-being and its objective determinants, including economic growth and income inequality, should remain at the center of the research and policy agenda. Further research is recommended to ascertain the relative importance of social, physical and purpose well-being. [ABSTRACT FROM AUTHOR]

Nature 503, 385-388 (2013); doi:10.1038/nature12740 In this Letter, the 'received' date should have been 29 June 2012, rather than 29 June 2013. This has been corrected online in the HTML [...]

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The fabrication and optical characterization of germanium-core, borosilicate glass-cladded optical fibers are presented. A 'rod in tube' method was used, where fibers were drawn from a preform of molten semiconductor in borosilicate glass tubing at 1000°C. The transmission spectra of the fibers, and the materials that compose the fibers were carried out using FTIR. The drawn fibers were also characterized by TEM. Low oxygen content of less than 1% after 50nm depth into the core is one of the advantages of the low working temperature. [ABSTRACT FROM AUTHOR]