The structural stability of soil is a physical characteristic that affects soil degradation processes. Calcium‐based amendments, such as calcium carbonate, calcium sulfate, and calcium oxide/hydroxide, have been shown to improve the stability of soil aggregates. This study seeks to determine which calcium‐based soil amendments, and at what concentration, are the most efficient in improving aggregate stability of sandy topsoils derived from granitic and metamorphic parent materials, and to analyze the mechanisms involved. In the pot experiment, soils amended with CaCO3, CaCl2, and CaSO4 did not present significant differences in aggregate stability compared to the control or among each other. In contrast, Ca(OH)2 soil amendment brought the greatest stability to the soil aggregates. A dose of 1% Ca(OH)2 significantly increased the stability of soil aggregates. This effect is due to the reaction of Ca(OH)2 with atmospheric CO2 which leads to the formation of CaCO3, a delayed reaction not showed by the other soil amendments tested. Likewise, the greater solubility of Ca(OH)2 compared to CaCO3 exerts a greater aggregation effect on soil. Thus, the mechanism of action of Ca(OH)2 is related to cementation, rather than flocculation. Future studies should be carried out to demonstrate the effectiveness of Ca(OH)2 under field conditions.

RATIONALE Sepsis is the leading cause of mortality among medical patients in the Philippine General Hospital (PGH). A previous study illustrated variations in sepsis management. The Department of Medicine developed a sepsis pathway based on the Surviving Sepsis Campaign bundles to standardize care and improve outcomes. We determined the coverage and compliance with the pathway, the barriers to compliance and sepsis-related mortality. METHODS This was a single-center mixed methods study on the pilot implementation of the sepsis pathway (April 8 to July 7, 2019) in the medical service areas, i.e. emergency department (ED), medical wards and medical intensive care unit (MICU), of a tertiary level teaching hospital. We tracked all medicine charity admissions with infections to determine coverage. Compliance and patient outcomes were assessed through chart reviews. Focus group discussions and interviews were done to identify barriers to implementing the sepsis bundle. RESULTS Among 296 admissions with infections (49% female, mean age 51.4 years), there were 422 patient-days eligible for pathway coverage but only 199 patient-days (47.16%) were covered. The ED had the highest coverage rate. Overall mortality rate among the admissions was at 39.2%. Among septic patients who were covered, 40% died. Missed cases were associated with increased odds of in-hospital death (adjusted odds ratio [aOR]: 1.42, 95% CI: 1.13 to 1.88) on multivariate analysis. Compliance with recommended diagnostics was high except for lactate and bilirubin. Blood cultures were sent 98% of the time. Only 35% of patients received antibiotics by one hour after activation. Fluids recorded over 6 hours were inadequate (mean 4.77 mL/kg, standard deviation: 2.82 mL/kg). Of 73 patients with hypotension needing fluid resuscitation, only 12 had blood pressure documented 30 minutes post-activation. Stakeholders identified inadequate human and physical resources, hospital policy changes and pathway form construction as barriers to compliance. Fellows, nurses, and students reported lack of orientation on their roles.

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A255 criteria, of which 3,152 (15.1%) underwent additional diagnostic imaging in the 6 months post-index. White women were 1.12 times more likely to be recalled than African-American women (p< 0.001). Average costs per patient recalled were $838 among white women and $804 among African-American women. Overall, 28.6% of costs were from additional imaging (diagnostic mammography and/or ultrasound), 39.2% were from guided biopsy procedures, and 24.4% from open biopsy. Recall-related office visits, MRI, fine needle aspiration, and ductogram accounted for < 5% of recall costs. Individual recall procedure rates were substantively similar between White and African-American recalled patients but African-American women had higher per-patient imaging costs and lower per-patient open biopsy costs. CONCLUSIONS: Improving breast cancer screening with a more accurate mammogram may significantly reduce Medicaid costs as approximately one-in-six women undergo additional diagnostic imaging following a screening mammogram with substantial associated costs. Recall rate and costs varied by race.OBJECTIVES: To describe the burden of recall following traditional screening mammography from the perspective of US self-insured employers. METHODS: The Truven Health MarketScan Commercial and Health and Productivity Management Databases were used to identify female employees aged 40-65 years undergoing screening mammography (index event) in 2010-2012 with at least 12 months pre-and 6 months post-index continuous enrollment; patients with a breast cancer diagnosis in the pre-index period were excluded. Recall was defined as receipt of diagnostic mammogram or ultrasound in the six months following the index screen. Employer cost per recall (2013 US$) was the sum of breast-related imagining procedures and associated diagnostic procedure costs in the 6 months post-index, excluding patient payments and breast cancer treatment costs. Absenteeism costs were calculated using a wage constant ($38/hour). RESULTS: Of the 339,912 patients who met the study criteria, 47,321 (13.4%) underwent additional diagnostic imaging within 6 months post-index with an average direct medical cost to employers of $1,279 per patient recalled. Nearly one-fourth (23.4%) of recall costs was attributable to additional imaging (diagnostic mammography or ultrasound), 40.0% was attributable to guided biopsy and 28.0% attributable to open biopsy. One-fifth (21.9%) of recalled patients had at least two days with recallrelated procedures while 4.2% had at least three recall event days. Absenteeism costs were $948 in the 30 days following recall among patients with absenteeism claims (67.2%), increasing to $4,472 over 6 months post-recall among patients with absenteeism claims (81.9%). Short-term disability claims increased following recall (4.0% vs. 4.4%, p< 0.01), with an average cost per claim of $10,849. CONCLUSIONS: Recall following traditional mammography represents a significant cost burden to employers with nearly one-in-six female employees with a new screening mammogram ...

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