Campylobacter Species Isolated from Pigs in Grenada Exhibited Novel Clones: Genotypes and Antimicrobial Resistance Profiles of Sequence Types.

Science.gov (United States)

Amadi, Victor A; Matthew-Belmar, Vanessa; Subbarao, Charmarthy; Kashoma, Isaac; Rajashekara, Gireesh; Sharma, Ravindra; Hariharan, Harry; Stone, Diana

2017-07-01

Infections caused by Campylobacter species pose a severe threat to public health worldwide. However, in Grenada, the occurrence and characteristics of Campylobacter in food animals, including pigs, remain mostly unknown. In this study, we identified the sequence types (STs) of Campylobacter from young healthy pigs in Grenada and compared the results with previous studies in Grenada and other countries. Antimicrobial resistance patterns and diversity of the Campylobacter clones were evaluated. Ninety-nine Campylobacter isolates (97 Campylobacter coli and 2 Campylobacter jejuni) were analyzed by multilocus sequence typing. Eighteen previously reported STs and 13 novel STs were identified. Of the 18 previously reported STs, eight STs (ST-854, -887, -1068, -1096, -1445, -1446, 1556, and -1579) have been associated with human gastroenteritis in different geographical regions. Among these 18 previously reported STs, ST-1428, -1096, -1450, and -1058 predominated and accounted for 18.2%, 14.1%, 11.1%, and 8.1% of all isolates, respectively. Of the 13 novel STs, ST-7675 predominated and accounted for 20% (4 of 20 isolates), followed by ST-7678, -7682, and -7691, each accounting for 10% (2 of 20 isolates). Antimicrobial resistance testing using Epsilometer test revealed a low resistance rate (1-3%) of all C. coli/jejuni STs to all antimicrobials except for tetracycline (1-10.1%). Some of the C. coli STs (13 STs, 24/99 isolates, 24.2%) were resistant to multiple antimicrobials. This is the first report on antimicrobial resistance and multidrug resistance patterns associated with Campylobacter STs recovered from swine in Grenada. This study showed that pigs in Grenada are not major reservoirs for STs of C. coli and C. jejuni that are associated with human gastroenteritis worldwide.

An Ethical Analysis of Reagan's Rhetoric Justifying the Invasion of Grenada.

Science.gov (United States)

Dowling, Ralph E.

A study examined the Ronald Reagan Administration's rhetoric about the invasion of Grenada to determine its ethical quality and whether the American public could make a fair judgment about the incident based on this rhetoric. Examination of President Reagan's rhetorical efforts revealed numerous violations of democratic ethical standards.…

An analysis of Grenada's power sector and energy resources: a role for renewable energy technologies?

International Nuclear Information System (INIS)

Wiesser, D.

2004-01-01

Presently, Grenada's power sector is fully dependent on fossil fuel imports for meeting the country's electricity demand. Electric utilities in Small Island Developing States (SIDS), in general, face high cost of electricity generation due to diseconomies of scale in production, consumption and logistical aspects. Grenada's private power monopoly is no exception and the high cost of import dependent electricity generation places an increasing burden on economic development. In light of rapid technological and economic improvement of renewable energy technologies (RETs), the country's abundant sources of renewable energy should be harnessed. Benefits are envisaged to include lower electricity cost, better environmental performance and a safer and diversified supply of energy. However, barriers for shifting power production towards meaningful contributions from RETs exist, both in government and industry. This work analyses important economic interactions between the power sector and economic development, bringing to attention the importance of power sector reform. Further, present problems of integrating RETs into the grid, ranging from technical and regulatory issues to shareholder interest are investigated. A summary and analysis of past research into renewable sources of energy (RES) underscore the potential for power production from RETs in Grenada. (author)

Saharan dust, climate variability, and asthma in Grenada, the Caribbean.

Science.gov (United States)

Akpinar-Elci, Muge; Martin, Francis E; Behr, Joshua G; Diaz, Rafael

2015-11-01

Saharan dust is transported across the Atlantic and interacts with the Caribbean seasonal climatic conditions, becoming respirable and contributing to asthma presentments at the emergency department. This study investigated the relationships among dust, climatic variables, and asthma-related visits to the emergency room in Grenada. All asthma visits to the emergency room (n = 4411) over 5 years (2001-2005) were compared to the dust cover and climatic variables for the corresponding period. Variation in asthma was associated with change in dust concentration (R(2) = 0.036, p asthma was positively correlated with rainfall (R(2) = 0.055, p asthma visits were inversely related to mean sea level pressure (R(2) = 0.123, p = 0.006) and positively correlated with relative humidity (R(2) = 0.593, p = 0.85). Saharan dust in conjunction with seasonal humidity allows for inhalable particulate matter that exacerbates asthma among residents in the Caribbean island of Grenada. These findings contribute evidence suggesting a broader public health impact from Saharan dust. Thus, this research may inform strategic planning of resource allocation among the Caribbean public health agencies.

Apparent Changes in the Abundance and Distribution of Anopheles Species on Grenada Island

Science.gov (United States)

1993-01-01

entomolbgica en Mexico, pp. 15-40. In: Me- morias del IV Simposio Nacional Entomologia Med- ica y Veterinaria, Oaxtepec, Mor., Mexico. Sociedad...Mexicana de Entomologia . Root, F. M. and J. Andrews. 1938. Malaria and anonheline survey of Grenada, B.W.I. Am. J. H Y ~ . 27:549-579. - Shannon, R

Prevalence, serovars and antimicrobial susceptibility of Salmonella spp. from wild and domestic green iguanas (Iguana iguana) in Grenada, West Indies.

Science.gov (United States)

Sylvester, W R B; Amadi, V; Pinckney, R; Macpherson, C N L; McKibben, J S; Bruhl-Day, R; Johnson, R; Hariharan, H

2014-09-01

Cloacal swabs from 62 green iguanas (Iguana iguana), including 47 wild and 15 domestic ones from five parishes of Grenada, were sampled during a 4-month period of January to April 2013 and examined by enrichment and selective culture for the presence of Salmonella spp. Fifty-five per cent of the animals were positive, and eight serovars of Salmonella were isolated. The most common serovar was Rubislaw (58.8%), a serovar found recently in many cane toads in Grenada, followed by Oranienburg (14.7%), a serovar that has been causing serious human disease outbreaks in Japan. Serovar IV:48:g,z51 :- (formerly, S. Marina) highly invasive and known for serious infections in children in the United States, constituted 11.8% of the isolates, all of them being from domestic green iguanas. Salmonella Newport, a serovar recently found in a blue land crab in Grenada, comprised 11.8% of the isolates from the green iguanas. The remaining four less frequent serovars included S. Javiana and S. Glostrup. Antimicrobial susceptibility tests conducted by a disc diffusion method against amoxicillin-clavulanic acid, ampicillin, cefotaxime, ceftazidime, ciprofloxacin, enrofloxacin, gentamicin, nalidixic acid, streptomycin, tetracycline and trimethoprim-sulfamethoxazole showed that drug resistance is minimal, with intermediate susceptibility, mainly to streptomycin, tetracycline and cefotaxime. This is the first report of isolation and antimicrobial susceptibilities of various Salmonella serovars from wild and domestic green iguanas in Grenada, West Indies. © 2013 Blackwell Verlag GmbH.

Planning and scheduling of semi-urgent surgeries

NARCIS (Netherlands)

Zonderland, Maartje Elisabeth; Boucherie, Richardus J.; Litvak, Nelli; Vleggeert-Lankamp, Carmen L.A.M.

2010-01-01

This paper investigates the trade-off between cancellations of elective surgeries due to semi-urgent surgeries, and unused operating room (OR) time due to excessive reservation of OR time for semi-urgent surgeries. Semi-urgent surgeries, to be performed soon but not necessarily today, pose an

Decreasing delays in urgent and expedited surgery in a university teaching hospital through audit and communication between peri-operative and surgical directorates.

Science.gov (United States)

Cosgrove, J F; Gaughan, M; Snowden, C P; Lees, T

2008-06-01

National Confidential Enquiry into Patient Outcome and Death guidelines for urgent surgery recommend a fully staffed emergency operating theatre and restriction of 'after-midnight' operating to immediate life-, limb- or organ-threatening conditions. Audit performed in our institution demonstrated significant decreases in waiting times for urgent surgery and an increased seniority of medical care associated with overnight pre-operative assessment of patients by anaesthetic trainees. Nevertheless, urgent cases continued to be delayed unnecessarily. A classification of delays was developed from existing guidelines and their incidence was audited. The results were disseminated to involved directorates. A repeat of the audit demonstrated a significant decrease in delays (p = 0.001), a significant increase in the availability of surgeons (p = 0.001) and a significant decrease in the median waiting time for urgent surgery compared to the first audit cycle and a previous standard (p auditing delays and disseminating the results of the audit significantly decreases delays and median waiting times for urgent surgery because of improved surgical availability.

A Conceptual Model for Urgent Acquisition Programs

Science.gov (United States)

2017-04-06

traditional acquisition to get things done quicker remaining a constant. “Recognizing this reality is the first step in building an acquisition system...an Operational Needs Statement or Joint Urgent Operational Needs Statement. Urgent acquisition policy focuses on getting capability to the field...typically funded for the equipping effort, which does not include funding for things like Service-wide production, training, or sustainment. In an AROC

How urgent is urgent? Analysing urgent out-patient referrals to an adult psychiatric service.

Science.gov (United States)

Cubbin, S; Llewellyn-Jones, S; Donnelly, P

2000-01-01

It was noticed that over some years the number of referrals to the outpatient clinic (from various sources) which were marked 'urgent' had increased. We aimed to examine who makes these urgent referrals and the clinical factors associated with 'urgent' status. A sample of 201 referrals over a 26-month period was examined. Details of the referral requests were collected using a specially designed form. After each 'urgent' assessment, the referral was scored for appropriateness. This gave an indication of the agreement between referrer and clinic doctor as to what should constitute an ¤ urgent' referral. The majority of urgent referrals were from community psychiatric nurses, who, together with psychiatric social workers, make the most appropriate referrals. The more appropriate referrals clearly specified the clinical factors associated with urgent need for review. Patients regarded as suicidal were not associated with significantly higher appropriateness scores. Referrers should try and make 'urgent' outpatient requests as specific as possible: more clinical detail gives a clearer picture to the clinic doctor. Telephone consultations with general practitioners may help to ascertain a clearer picture of urgent requests if detail is lacking. Health professionals may all benefit from education in suicidal risk assessment. ( Int J Psych Clin Pract 2000; 4: 233 - 235).

Grenada; Second Review Under the Extended Credit Facility, Request For a Waiver of a Performance Criterion, Request for Modification of Performance Criteria and Financing Assurances Review

OpenAIRE

International Monetary Fund

2015-01-01

EXECUTIVE SUMMARY Extended Credit Facility (ECF) Arrangement. The program was approved on June 26, 2014 and the first review completed on December 12, 2014. Grenada has received SDR 4.04 million (about US$5.9 million) so far under the arrangement and the equivalent of SDR 2 million (about US$3 million) will be made available upon Executive Board completion of the second review. Debt restructuring. Grenada has achieved a critical milestone in its debt restructuring, reaching agreement on key r...

Serological evidence of widespread exposure of Grenada fruit bats to chikungunya virus.

Science.gov (United States)

Stone, D; Lyons, A C; Huang, Y-J S; Vanlandingham, D L; Higgs, S; Blitvich, B J; Adesiyun, A A; Santana, S E; Leiser-Miller, L; Cheetham, S

2018-03-25

Antibody detection against selected potentially zoonotic vector-borne alphaviruses and flaviviruses was conducted on sera from bats from all six parishes in Grenada, West Indies. Sera were tested for (i) antibodies to flaviviruses West Nile virus, St. Louis encephalitis virus, Ilhéus virus, Bussuquara virus (BSQV), Rio Bravo virus and all four serotypes of dengue virus (DENV) by plaque reduction neutralization test (PRNT); (ii) antibodies to alphaviruses western equine encephalitis virus, Venezuelan equine encephalitis virus and eastern equine encephalitis virus by epitope-blocking enzyme-linked immunosorbent assay (ELISA); and (iii) antibodies to the alphavirus chikungunya (CHIKV) by PRNT. Two species of fruit bats were sampled, Artibeus jamaicensis and Artibeus lituratus, all roosting in or within 1,000 m of human settlements. Fifteen (36%) of the 42 bats tested for neutralizing antibodies to CHIKV were positive. The CHIKV-seropositive bats lived in localities spanning five of the six parishes. All 43 bats tested for epitope-blocking ELISA antibody to the other alphaviruses were negative, except one positive for Venezuelan equine encephalitis virus. All 50 bats tested for neutralizing antibody to flaviviruses were negative, except one that had a BSQV PRNT 80 titre of 20. The CHIKV serology results indicate that bats living close to and within human settlements were exposed to CHIKV in multiple locations. Importantly, bats for this study were trapped a year after the introduction and peak of the human CHIKV epidemic in Grenada. Thus, our data indicate that bats were exposed to CHIKV possibly during a time of marked decline in human cases. © 2018 Blackwell Verlag GmbH.

Intraoperative bleeding in dogs from Grenada seroreactive to Anaplasma platys and Ehrlichia canis.

Science.gov (United States)

Lanza-Perea, M; Zieger, U; Qurollo, B A; Hegarty, B C; Pultorak, E L; Kumthekar, S; Bruhl-Day, R; Breitschwerdt, E B

2014-01-01

Frequent exposure of Grenadian dogs to Rhipicephalus sanguineus results in Anaplasma platys, and Ehrlichia canis seroreactivity. During elective surgeries, substantial intraoperative hemorrhage occurs in some seroreactive dogs. To assess hemostatic parameters and bleeding tendencies as well as prevalence of PCR positivity in apparently healthy A. platys and E. canis seroreactive and seronegative free-roaming dogs from Grenada. Forty-seven elective surgery dogs allocated to 4 groups: Seronegative control (n = 12), A. platys (n = 10), E. canis (n = 14) and A. platys, and E. canis (n = 11) seroreactive. Preoperatively, hemostasis was assessed by platelet count, prothrombin time, activated partial thromboplastin time, and buccal mucosal bleeding time. Intra- and postoperative bleeding scores were subjectively assigned. Blood, spleen, bone marrow, and lymph node aspirates were tested by PCR. Bleeding scores in dogs coseroreactive for A. platys and E. canis were higher (P = .015) than those of seronegative dogs. A. platys DNA was amplified from 7/21 (33%) A. platys seroreactive dogs and from 1 E. canis seroreactive dog; E. canis DNA was amplified from 21/25 (84%) E. canis seroreactive dogs. E. canis DNA was amplified most often from blood, whereas A. platys DNA was amplified most often from bone marrow. Apparently healthy, free-roaming dogs coseropositive for A. platys and E. canis may have increased intraoperative bleeding tendencies despite normal hemostatic parameters. Future investigations should explore the potential for vascular injury as a cause for bleeding in these dogs. Improved tick control is needed for dogs in Grenada. Copyright © 2014 by the American College of Veterinary Internal Medicine.

Urgent Safety Measures in Japan after Great East Japan Earthquake

International Nuclear Information System (INIS)

Taniura, Wataru; Otani, Hiroyasu

2012-01-01

Due to tsunami triggered by the Great East Japan Earthquake, the operating and refueling reactor facilities at Fukushima Dai-ichi and Dai-ni Nuclear Power Plants caused a nuclear hazard. Given the fact, Japanese electric power companies voluntarily began to compile various urgent measures against tsunami. And then the Nuclear and Industrial Safety Agency (NISA) ordered the licensees to put into practice the voluntarily compiled urgent safety measures, in order to ensure the effectiveness of the means for recovering cooling functions along with avoiding the release of radioactive substances to the possible minimum, even if a huge tsunami following a severe earthquake hits nuclear power plants. The following describes the state and the effect of the urgent safety measures implemented for 44 reactors (under operation) and 1 reactor (under construction) in Japan and also describes the measures to be implemented by the licensees of reactor operation in the future.

Comparison of Open and Closed Hand Fractures and the Effect of Urgent Operative Intervention.

Science.gov (United States)

Minhas, Shobhit V; Catalano, Louis W

2018-06-13

To establish and compare the incidence of 30-day postoperative infection in surgically managed open and closed metacarpal and phalangeal fractures, and to determine whether open fractures treated urgently had a lower incidence of postoperative infection. We conducted a retrospective analysis of patient demographics, comorbidities, and 30-day infection rates of patients undergoing operative fixation of metacarpal, proximal, or middle phalanx fractures from 2008 to 2015 using the American College of Surgeons' National Surgical Quality Improvement Program database. A total of 3,506 patients were identified and patient variables and infection incidence were compared between open and closed injuries, as well as open injuries managed within 1 day of admission and those treated on an elective basis or treated more than 1 day after admission. Bivariate analysis was used to determine independent risk factors for postoperative infection. Although 34.2% of open hand fractures were taken urgently to the operating room, the diagnosis of open fractures along with nonurgent surgical treatment for open fractures was associated with a low incidence of postoperative infection. In addition, smoking was a risk factor for postoperative infection although anatomic location (phalanx vs metacarpal) was not. Patients undergoing surgery for metacarpal or proximal/middle phalangeal fractures are not at greater risk for infection based on the diagnosis of open fracture alone. In addition, patients with open fractures who are taken to the operating room more than 1 day from presentation did not have a higher incidence of infection. Smoking is associated with increased 30-day infection rates after surgery, and surgeons should identify these patients for preoperative risk stratification, counseling, and postoperative wound monitoring. Prognostic II. Copyright © 2018 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Survivability on the Island of Spice: The Development of the UH-60 Blackhawk and Its Baptism of Fire in Operation Urgent Fury

Science.gov (United States)

2015-06-12

SURVIVABILITY ON THE ISLAND OF SPICE : THE DEVELOPMENT OF THE UH-60 BLACKHAWK AND ITS BAPTISM OF FIRE IN OPERATION URGENT FURY......THESIS APPROVAL PAGE Name of Candidate: Major Matthew G. Easley Thesis Title: Survivability on the Island of Spice : The Development of the UH

Isolation and RFLP genotyping of toxoplasma gondii in free-range chicken(Gallus domesticus) in Grenada, West Indies, revealed widespread and dominance of clonal type III parasites

Science.gov (United States)

The objectives of the present cross sectional study were to estimate the prevalence and to isolate and genotype Toxoplasma gondii in free range chickens from Grenada, West Indies. Using the modified agglutination test, antibodies to T. gondii were found in 39 (26.9%) of 145 free-range chickens with ...

Clinical, Serological, and Molecular Observations from a Case Series Study during the Asian Lineage Zika Virus Outbreak in Grenada during 2016

Directory of Open Access Journals (Sweden)

Marco Brenciaglia

2018-01-01

Full Text Available This paper describes the spatial and temporal distribution of cases, demographic characteristics of patients, and clinical manifestations of Zika virus (ZIKV during the 2016 outbreak in Grenada. The first reported case was recorded in St. Andrew Parish in April, and the last reported case was seen in November, with peak transmission occurring in the last week of June, based on test results. Data were collected from a total of 514 patients, of whom 207 (40% tested positive for ZIKV. No evidence was found that testing positive for ZIKV infection was related to age, gender, or pregnancy status. Clinical presentation with rash (OR = 2.4, 95% CI = 1.5 to 3.7 or with lymphadenopathy (OR = 1.7, 95% CI = 1.0 to 2.9 were the only reported symptoms consistent with testing positive for ZIKV infection. During the Zika outbreak, the infection rate was 20 clinical cases per 10,000 in the population compared to 41 cases per 10,000 during the chikungunya outbreak in Grenada in 2014 and 17 cases per 10,000 during the dengue outbreak in 2001-2002. Even though the country has employed vector control programs, with no apparent decrease in infection rates, it appears that new abatement approaches are needed to minimize morbidity in future arbovirus outbreaks.

Urgent Safety Measures in Japan after Great East Japan Earthquake

International Nuclear Information System (INIS)

Taniura, W.; Otani, H.

2012-01-01

Due to tsunami triggered by the Great East Japan Earthquake on March 11, 2011, the operating and refueling reactor facilities at Fukushima Dai-ichi and Dai-ni Nuclear Power Plants of Tokyo Electric Power Co. caused a nuclear hazard. Japanese electric power companies voluntarily began to compile various urgent measures against tsunami within the week the hazard was caused. As for the urgent safety measures of each licensee, it is clarified that effective measures have been appropriately implemented as a result of the inspection of the national government, the verification based on the guideline of the Japan Society of Maintenology and the stress test. (author)

Isolation and RFLP Genotyping of Toxoplasma gondii in Free-Range Chickens (Gallus domesticus) in Grenada, West Indies, Revealed Widespread and Dominance of Clonal Type III Parasites.

Science.gov (United States)

Chikweto, Alfred; Sharma, Ravindra N; Tiwari, Keshaw P; Verma, Shiv K; Calero-Bernal, Rafael; Jiang, Tiantian; Su, Chunlei; Kwok, Oliver C; Dubey, Jitender P

2017-02-01

The objectives of the present cross-sectional study were to isolate and genotype Toxoplasma gondii in free-range chickens from Grenada, West Indies. Using the modified agglutination test, antibodies to T. gondii were found in 39 (26.9%) of 145 free-range chickens with titers of 25 in 7 chickens, 50 in 6 chickens, 100 in 2 chickens, and 200 or higher in 24 chickens. The hearts of the 39 seropositive chickens were bioassayed in mice; viable T. gondii was isolated from 20 and further propagated in cell culture. Genotyping of T. gondii DNA extracted from cell-cultured tachyzoites using the 10 PCR-restriction fragment length polymorphism (RFLP) markers SAG1, SAG2, SAG3, BTUB, GRA6, c22-8, c29-2, L358, PK1, and Apico revealed 4 genotypes, including ToxoDB PCR-RFLP no. 2 (Type III), no. 7, no. 13, and no. 259 (new). These results indicated that T. gondii population genetics in free-range chickens seems to be moderately diverse with ToxoDB no. 2 (Type III) as the most frequent (15/20 = 75%) compared to other genotypes in Grenada.

The Realities of War: Assessing the Operational Risk of Revoking the Combat Exclusion Policy

Science.gov (United States)

2013-05-23

Command CJCS Chairman of the Joint Chiefs of Staff CJTF Combined Joint Task Force CMH Center of Military History COIN Counterinsurgency COP ...fire, slaughtering Bishop and at least ten other civilians. 25 As word of Government Printing Office, 1984), 440. 23 Antigua, Dominica, Grenada...the handful of well-equipped FOBs it operated from during 2001-2003 to hundreds of combat outposts ( COP ) established near key

The HIV/AIDS epidemic in Grenada: A cross-sectional approach used to measure response variation regarding sexual behavior and health depending on the method of data collection.

Science.gov (United States)

Chaudhry, Muhammad Reza; Husain, Faisal; Armstrong, Elan G; Ferguson, James A

2018-06-01

The objective of this study was to determine the association between high-risk sexual behavior in relation to HIV transmission and prevalence among different groups of people in Grenada. In addition, this study intends to increase the involvement and improved services by Grenadian chapter of the Caribbean HIV/AIDS Partnership (GrenCHAP).A cross-sectional study was conducted over a 2-month period in Grenada, West Indies, to measure the responsive nature of different populations to an inquiry about HIV and sexual behavior. The 2 methods used to collect the data were online (via social media) and through an in-person interaction with local NGO GrenCHAP personnel. Survey responses were recorded via SurveyMonkey ending on April 11, 2014.The findings of the study were that there was an increased degree of frankness and demographic diversity in participants who responded online as opposed to in-person.People who responded online were more likely to engage in high-risk sexual behavior. GrenCHAP has the opportunity to contribute in the collection of invaluable data concerning HIV and other STIs because of its NGO status and anonymity.

Dengue in Grenada El dengue en el país de Granada

Directory of Open Access Journals (Sweden)

André Panagos

2005-04-01

Full Text Available OBJECTIVES: Dengue fever is endemic in the country of Grenada and is grossly underreported as a source of morbidity. The goal of this study was to assess the status of dengue fever in a representative community in Grenada. METHODS: Surveys were conducted in the Mont Tout/Grand Anse Valley area in the parish of St. George's from March to June 1996. The objectives of the survey were to: (1 to assess the knowledge, attitudes, and practices (KAP of residents; (2 to determine the presence of larval and adult Aedes aegypti and their potential breeding sites; and (3 to identify the seroprevalence of specific immunoglobulin G (IgG dengue antibodies in the local population. RESULTS: Out of the 102 respondents to the KAP survey, 100 of them (98% reported never having had dengue fever. Of the 75 persons who agreed to have blood samples taken, 70 of them (93% (95% confidence interval = 85.1%-97.8% tested positive with the IgG enzyme-linked immunosorbent assay, indicating past exposure. In terms of water storage, 98 of 102 respondents (96% stored fresh water in containers. The vector survey found 57 of the 102 households (56% had Ae. aegypti larvae in water containers on their property, and 94 of 102 dwellings (92% had adult Ae. aegypti mosquitoes indoors. CONCLUSIONS: Although many people were familiar with dengue fever and mosquitoes, the 1996 survey found that their knowledge of the important relationships among mosquitoes, human behavior, and disease transmission was incomplete. Since 1996, continued education efforts have been made in the public school system and with national public health campaigns, yet little effort has been specifically targeted towards our study community. These data suggest Grenada has a need for continued community education that addresses dengue fever transmission and Ae. aegypti reduction.OBJETIVOS: La fiebre del dengue es endémica en el país caribeño de Granada y es grande su subnotificación como fuente de morbilidad. El

Prevalence of Ehrlichia canis, Anaplasma platys, Babesia canis vogeli, Hepatozoon canis, Bartonella vinsonii berkhoffii, and Rickettsia spp. in dogs from Grenada.

Science.gov (United States)

Yabsley, Michael J; McKibben, John; Macpherson, Calum N; Cattan, Peggy F; Cherry, Natalie A; Hegarty, Barbara C; Breitschwerdt, Edward B; O'Connor, Tom; Chandrashekar, Ramaswamy; Paterson, Tara; Perea, Marta Lanza; Ball, Geoffrey; Friesen, Stanley; Goedde, Jill; Henderson, Brooke; Sylvester, Wayne

2008-02-14

To identify the tick-borne pathogens in dogs from Grenada, we conducted a serologic survey for Ehrlichia canis in 2004 (104 dogs) and a comprehensive serologic and molecular survey for a variety of tick-borne pathogens in 2006 (73 dogs). In 2004 and 2006, 44 and 32 dogs (42.3% and 43.8%) were seropositive for E. canis, respectively. In 2006, several tick-borne pathogens were identified by serology and PCR. DNA of E. canis, Anaplasma platys, Babesia canis vogeli, Hepatozoon canis, and Bartonella sp. were identified in 18 (24.7%), 14 (19.2%), 5 (7%), 5 (7%), and 1 (1.4%) dogs, respectively. Six (8.2%) dogs were seropositive for Bartonella vinsonii subsp. berkhoffii. All dogs were seronegative and PCR-negative for Rickettsia spp. Coinfection with two or three pathogens was observed in eight dogs. Partial 16S rRNA E. canis and A. platys sequences were identical to sequences in GenBank. Partial 18S rRNA gene sequences from the Grenadian H. canis were identical to each other and had one possible mismatch (ambiguous base) from H. canis detected from Spain and Brazil. Grenadian B. c. vogeli sequences were identical to B. c. vogeli from Brazil and Japan. All of the detected pathogens are transmitted, or suspected to be transmitted, by Rhipicephalus sanguineus. Results of this study indicate that dogs from Grenada are infected with multiple tick-borne pathogens; therefore, tick-borne diseases should be included as differentials for dogs exhibiting thrombocytopenia, leukopenia, fever, or lethargy. One pathogen, E. canis, is also of potential public health significance.

Study on treatment of postpartum hemorrhage with urgent interventional embolization

International Nuclear Information System (INIS)

Xi Jiayuan; Ren Shuping; Lu Liang; Jiao Cunxian; Liu Yunxia; Yang Yu; Deng Gang; Li Jikang; Cao Xinhua; Mi Lan

2002-01-01

Objective: To evaluate urgent selective arterial embolization to treat massive postpartum hemorrhage. Methods: Twenty-seven patients with ages of 21-53 years undergoing severe postpartum hemorrhage, were due to central placental previa, uterine atony, birth canal trauma, placenta accretio, cervical pregnancy etc. All of the patients had lost a volume of blood about 1000 ml to 5000 ml while the hemorrhage could not be controlled with vaginal packing and administration of uterotonic drugs. Urgent hemostatic embolization was performed for them. After angiography, super selective catheterization was performed for bilateral anterior division of internal iliac branch of uterine arteries and embolized with Gelfoam particles. Results: Catheterization success rate was 96.3%. Angiography showed ectopic uterine artery in one case. Immediate block of hemorrhage took place in 22 cases and gradual hemostasis appeared in 4 cases, the efficacy rate was 96.3%. The one with ectopic uterine artery was operated upon to ablate the uterus. 11 patients with (bleeding) shock and 8 patients with DIC were all saved. Conclusions: Urgent arterial embolization is an ideal method for treating life-threatening postpartum hemorrhage. The procedure saves the maternal uterus and is also effective for postpartum DIC

Coral reefs for coastal protection: A new methodological approach and engineering case study in Grenada.

Science.gov (United States)

Reguero, Borja G; Beck, Michael W; Agostini, Vera N; Kramer, Philip; Hancock, Boze

2018-03-15

Coastal communities in tropical environments are at increasing risk from both environmental degradation and climate change and require urgent local adaptation action. Evidences show coral reefs play a critical role in wave attenuation but relatively little direct connection has been drawn between these effects and impacts on shorelines. Reefs are rarely assessed for their coastal protection service and thus not managed for their infrastructure benefits, while widespread damage and degradation continues. This paper presents a systematic approach to assess the protective role of coral reefs and to examine solutions based on the reef's influence on wave propagation patterns. Portions of the shoreline of Grenville Bay, Grenada, have seen acute shoreline erosion and coastal flooding. This paper (i) analyzes the historical changes in the shoreline and the local marine, (ii) assess the role of coral reefs in shoreline positioning through a shoreline equilibrium model first applied to coral reef environments, and (iii) design and begin implementation of a reef-based solution to reduce erosion and flooding. Coastline changes in the bay over the past 6 decades are analyzed from bathymetry and benthic surveys, historical imagery, historical wave and sea level data and modeling of wave dynamics. The analysis shows that, at present, the healthy and well-developed coral reefs system in the southern bay keeps the shoreline in equilibrium and stable, whereas reef degradation in the northern bay is linked with severe coastal erosion. A comparison of wave energy modeling for past bathymetry indicates that degradation of the coral reefs better explains erosion than changes in climate and historical sea level rise. Using this knowledge on how reefs affect the hydrodynamics, a reef restoration solution is designed and studied to ameliorate the coastal erosion and flooding. A characteristic design provides a modular design that can meet specific engineering, ecological and

Land cover and forest formation distributions for St. Kitts, Nevis, St. Eustatius, Grenada and Barbados from decision tree classification of cloud-cleared satellite imagery. Caribbean Journal of Science. 44(2):175-198.

Science.gov (United States)

E.H. Helmer; T.A. Kennaway; D.H. Pedreros; M.L. Clark; H. Marcano-Vega; L.L. Tieszen; S.R. Schill; C.M.S. Carrington

2008-01-01

Satellite image-based mapping of tropical forests is vital to conservation planning. Standard methods for automated image classification, however, limit classification detail in complex tropical landscapes. In this study, we test an approach to Landsat image interpretation on four islands of the Lesser Antilles, including Grenada and St. Kitts, Nevis and St. Eustatius...

Urgent surgical management for embolized occluder devices in childhood: single center experience

Directory of Open Access Journals (Sweden)

Gokaslan Gokhan

2012-12-01

Full Text Available Abstract Background In this study, we sought to analyze our experience in urgent surgical management for embolized cardiac septal and ductal occluder devices resulting from trans-catheter closure of atrial septal defect, ventricular septal defect and patent ductus arteriosus in childhood patient group. Methods We retrospectively reviewed 9 patients (aged 2–15 years who underwent urgent surgery due to cardiac septal and ductal occluder embolization between January 2007 and December 2010. Congenital defects were atrial septal defect (n = 6, ventricular septal defect (n = 1, and patent ductus arteriosus (n = 2. Risk factors for device embolization and urgent surgical management techniques for embolized device removal were discussed. Results Removal of embolized devices in all cases and repair of damaged tricuspid valve in 2 patients were performed. Inevitably, all congenital defects were closed or ligated up to the primary defect. Total circulator arrest necessitated in 1 patient with ascending aortic device embolization. All operations were completed successfully and no hospital mortality or morbidity was encountered. Conclusions Although closure of left to right shunting defects by percutaneous occluder devices has a lot of advantages, device embolization is still a major complication. If embolized device retrieval fails with percutaneous intervention attempts, surgical management is the only method to remove embolized devices. In this circumstance, to provide an uneventful perioperative course, urgent management strategies should be well planned.

Urgent tracheostomy: four-year experience in a tertiary hospital.

Science.gov (United States)

Costa, Liliana; Matos, Ricardo; Júlio, Sara; Vales, Fernando; Santos, Margarida

2016-01-01

Urgent airway management is one of the most important responsibilities of otolaryngologists, often requiring a multidisciplinary approach. Urgent surgical airway intervention is indicated when an acute airway obstruction occurs or there are intubation difficulties. In these situations, surgical tracheostomy becomes extremely important. We retrospectively studied the patients who underwent surgical tracheostomy from 2011 to 2014 by an otolaryngologist team at the operating theater of the emergency department of a tertiary hospital. Indications, complications and clinical evolution of the patients were reviewed. The study included 56 patients (44 men and 12 women) with a median age of 55 years. The procedure was performed under local anesthesia in 21.4% of the patients. Two (3.6%) patients were subjected to conversion from cricothyrostomy to tracheostomy. Head and neck neoplasm was indicated in 44.6% of the patients, deep neck infection in 19.6%, and bilateral vocal fold paralysis in 10.7%. Stridor was the most frequent signal (51.8%). Of the 56 patients, 15 were transferred to another hospital. Among the other 41 patients, 21 were decannulated (average time: 4 months), and none of them were cancer patients. Complications occurred in 5 (12.2%) patients: hemorrhage in 3, surgical wound infection in 1, and cervico-thoracic subcutaneous emphysema in 1. No death was related to the procedure. Urgent tracheostomy is a life-saving procedure for patients with acute airway obstruction or with difficult intubation. It is a safe and effective procedure, with a low complication rate, and should be performed before the patient's clinical status turns into a surgical emergency situation.

Total hip arthroplasty for femoral neck fractures as an urgent procedure

Directory of Open Access Journals (Sweden)

Radoičić Dragan

2017-01-01

Full Text Available Background/Aim. Total hip arthroplasty (THA is one of the most widely accepted operative methods for femoral neck fracture (FNF in elderly. However, the data on the early THA for FNF are very limited. The aim of this study to determine if there were differences in postoperative complications and functional outcomes between an urgent and delayed THA following FNF. Methods. This prospective study included a total of 244 patients who had THA following FNF from January 2010 to January 2013. In the first group 41 FNF patients were treated with THA within less than 12 hours of admission. A total of 203 FNF patients were operated in delayed settings, of whom 162 required prolonged preoperative processing and comorbidities correction. The group II consisted of 41 FNF patients who were fit for the early surgery at admission, but the operation was delayed due to institution related reasons. Main outcome measurements included mortality, functional outcome assessement, cardiological and pulmonary complications, pressure ulcers, dislocations, infections, length of hospitalization and revisions. Results. There were no differences in terms of age, gender, type of implants, neither in mortality, nor complications. There were differences in hospital length of stay [t (51.72 = -10.25, p < 0.001]. The patients operated within less than 12 hours of admission, had significantly better scores at all three time points of functional outcome assessment: at discharge t (80 = 2.556, p < 0.012; one month t (80 = 4.731, p < 0.001; three months t (80 = 5.908, p < 0.001. Conclusion. THA for FNF as an urgent procedure is not a widely accepted concept. Our findings indicate that the early operative treatment, does not worsen clinical outcomes, and our results give an advantage to the policy of the early THA for FNF.

Benthic and fish population monitoring associated with a marine protected area in the nearshore waters of Grenada, Eastern Caribbean

Directory of Open Access Journals (Sweden)

Robert Anderson

2012-03-01

Full Text Available Annual benthic and fish population surveys were completed at five locations in the nearshore waters along Grenada´s southwest coast during 2008-2010. Two survey sites are located in a newly launched Marine Protected Area (MPA. Photo Quadrat (PQ and Point Line Intercept (PLI surveys were used to determine substrate cover. Algae was the primary live cover increasing significantly from 45.9% in 2008 to 52.7% in 2010 (PLI. Algae was also predominant (61.0%-59.3% in the PQ surveys although annual variation was not significant. Hard coral cover ranged from 16.5% to 15.4% (PLI and 11.4% to12.0% (PQ with no significant differences between years. Branching and encrusting corals occurred more frequently than massive corals. In the three annual surveys neither algal cover nor hard coral varied significantly between MPA and non-protected areas (PLI. Relative abundance of fishes along 30x2m belt transects did not vary significantly among years however density of fishes decreased significantly across years for most major groups. Chromis spp. dominated the survey sites at 65.2% in 2008 and 49.8% in 2010, followed by territorial damselfish,11.1% and 15.5%, wrasse increased from 7.3% to 15.5%. Both the substrate cover and fish survey data analyses indicated a stable but degraded community. Annual surveys are planned at these sites for the foreseeable future. Existing and future data from this project will be valuable in determining the efficacy of MPA management, guiding resource management decisions and monitoring the health status of Grenada’s valuable reef systemsUn estudio sobre poblaciones bentónicas y de peces fue realizado en cinco localidades en la zona costera en el suroeste de Grenada entre 2008 y 2010. Dos sitios se ubicaron en una Área Marina Portegida (AMP recientemente creada. Para determinar la cobertura se utilizaron foto-cuadrantes (FQ y transectos de intersección de puntos (TIP. Las algas fueron el principal componente del bentos

Single port laparoscopic colorectal surgery in debilitated patients and in the urgent setting.

LENUS (Irish Health Repository)

Moftah, M

2012-09-01

Single port laparoscopy is a relatively new niche in the expanding spectrum of minimal access surgery for colorectal disease. To date the published experience has predominantly focused on planned operations for neoplasia in the elective setting. It seems probable however that the benefits of minimal abdominal wounding will be greatest among those patients with the highest risk of impaired wound healing. Combining this with the impression of improved cosmesis suggests that (the mostly young) patients with inflammatory bowel disease needing urgent operation are the most likely to appreciate and benefit from the extraoperative effort. The extension of single port surgery to the acute setting and for debilitated individuals is therefore a likely next step advance in broadening the category of patients for whom it represents a real benefit and ultimately aid in focusing by selection the subgroups for whom this technique is best suited and most appropriate. We describe here our approach (including routine use of a surgical glove port) to patients presenting for urgent colorectal operation for benign disease. As provision of specialized approaches regardless of timing or mode of presentation is a defining component of any specialty service, this concept will soon be more fully elucidated and established.

A data management system to enable urgent natural disaster computing

Science.gov (United States)

Leong, Siew Hoon; Kranzlmüller, Dieter; Frank, Anton

2014-05-01

consequences Hard deadline: Missing a hard deadline renders the computation useless and results in full catastrophic consequences. A prototype of this system has a REST-based service manager. The REST-based implementation provides a uniform interface that is easy to use. New and upcoming file transfer protocols can easily be extended and accessed via the service manager. The service manager interacts with the other four managers to coordinate the data activities so that the fundamental natural disaster urgent computing requirement, i.e. deadline, can be fulfilled in a reliable manner. A data activity can include data storing, data archiving and data storing. Reliability is ensured by the choice of a network of managers organisation model[1] the configuration manager and the fault tolerance manager. With this proposed design, an easy to use, resource-independent data management system that can support and fulfill the computation of a natural disaster prediction within stipulated deadlines can thus be realised. References [1] H. G. Hegering, S. Abeck, and B. Neumair, Integrated management of networked systems - concepts, architectures, and their operational application, Morgan Kaufmann Publishers, 340 Pine Stret, Sixth Floor, San Francisco, CA 94104-3205, USA, 1999. [2] H. Kopetz, Real-time systems design principles for distributed embedded applications, second edition, Springer, LLC, 233 Spring Street, New York, NY 10013, USA, 2011. [3] S. H. Leong, A. Frank, and D. Kranzlmu¨ ller, Leveraging e-infrastructures for urgent computing, Procedia Computer Science 18 (2013), no. 0, 2177 - 2186, 2013 International Conference on Computational Science. [4] N. Trebon, Enabling urgent computing within the existing distributed computing infrastructure, Ph.D. thesis, University of Chicago, August 2011, http://people.cs.uchicago.edu/~ntrebon/docs/dissertation.pdf.

Urgent surgery for complicated colonic diverticula.

Science.gov (United States)

Funariu, Gheorghe; Binţinţan, Vasile; Seicean, Radu

2006-03-01

The AIM of this retrospective study was to evaluate the emergency surgical treatment of life-threatening complications of colonic diverticula. In the last 11 years, 22 of 101 patients with colonic diverticula (22.1%) underwent urgent surgery for acute complications: perforated gangrenous diverticulitis with generalized peritonitis (n=8) or pericolic abscess (n=8), acute bowel obstruction (n=4) and severe diverticular bleeding (n=2). In all patients with diffuse peritonitis or acute obstruction the indication for surgery was decided on clinical basis and the complicated diverticula were recognized only intra-operatively. Emergency surgical strategy differed according to the type of complication and the biologic condition of the patient: segmental colectomy and primary anastomosis for diverticular perforation (n=4), colonic stenosis (n=3) or diverticular bleeding (n=2); Hartmann resection with late reconnecting anastomosis in patients with diverticular perforation (n=5) or colonic obstruction (n=1); diverticulectomy with peritoneal drainage (n=2) and colostomy and drainage followed by secondary colectomy (n=5) for diverticular perforations in patients with poor general condition. Only one patient (4.5%) died post-operatively of multiple organ failure from generalized peritonitis. There was no anastomotic leakage in patients with primary anastomosis. Six patients (27.2%) developed wound infection. Hospital stay ranged between 11 and 60 days, significantly longer in cases with two-stage operations. Primary colectomy with immediate or delayed anastomosis is the best surgical procedure for acute divericular complications in patients with good biologic status. Two-stage operations such as colostomy and drainage coupled with late colectomy remain the viable alternative in patients with advanced disease and critical biologic condition.

Mobile pediatric neurosurgery: rapid response neurosurgery for remote or urgent pediatric patients.

Science.gov (United States)

Owler, Brian K; Carmo, Kathryn A Browning; Bladwell, Wendy; Fa'asalele, T Arieta; Roxburgh, Jane; Kendrick, Tina; Berry, Andrew

2015-09-01

Time-critical neurosurgical conditions require urgent operative treatment to prevent death or neurological deficits. In New South Wales/Australian Capital Territory patients' distance from neurosurgical care is often great, presenting a challenge in achieving timely care for patients with acute neurosurgical conditions. A protocol was developed to facilitate consultant neurosurgery locally. Children with acute, time-critical neurosurgical emergencies underwent operations in hospitals that do not normally offer neurosurgery. The authors describe the developed protocol, the outcome of its use, and the lessons learned in the 9 initial cases where the protocol has been used. Three cases are discussed in detail. Nine children were treated by a neurosurgeon at 5 rural hospitals, and 2 children were treated at a smaller metropolitan hospital. Road ambulance, fixed wing aircraft, and medical helicopters were used to transport the Newborn and Paediatric Emergency Transport Service (NETS) team, neurosurgeon, and patients. In each case, the time to definitive neurosurgical intervention was significantly reduced. The median interval from triage at the initial hospital to surgical start time was 3:55 hours, (interquartile range [IQR] 03:29-05:20 hours). The median distance traveled to reach a patient was 232 km (range 23-637 km). The median interval from the initial NETS call requesting patient retrieval to surgical start time was 3:15 hours (IQR 00:47-03:37 hours). The estimated median "time saved" was approximately 3:00 hours (IQR 1:44-3:15 hours) compared with the travel time to retrieve the child to the tertiary center: 8:31 hours (IQR 6:56-10:08 hours). Remote urgent neurosurgical interventions can be performed safely and effectively. This practice is relevant to countries where distance limits urgent access for patients to tertiary pediatric care. This practice is lifesaving for some children with head injuries and other acute neurosurgical conditions.

Quantitative comparison of measurements of urgent care service quality.

Science.gov (United States)

Qin, Hong; Prybutok, Victor; Prybutok, Gayle

2016-01-01

Service quality and patient satisfaction are essential to health care organization success. Parasuraman, Zeithaml, and Berry introduced SERVQUAL, a prominent service quality measure not yet applied to urgent care. We develop an instrument to measure perceived service quality and identify the determinants of patient satisfaction/ behavioral intentions. We examine the relationships among perceived service quality, patient satisfaction and behavioral intentions, and demonstrate that urgent care service quality is not equivalent using measures of perceptions only, differences of expectations minus perceptions, ratio of perceptions to expectations, and the log of the ratio. Perceptions provide the best measure of urgent care service quality.

76 FR 80907 - TRICARE Prime Urgent Care Demonstration Project

Science.gov (United States)

2011-12-27

... care including minor illness or injury for Active Duty Family Members enrolled in TRICARE Prime or.... Current data indicates that the ADFMs frequently need urgent care while traveling to new duty stations for... DEPARTMENT OF DEFENSE Office of the Secretary TRICARE Prime Urgent Care Demonstration Project...

An audit of urgent referrals by the Procurator Fiscal to the Tayside Forensic Psychiatric Service.

Science.gov (United States)

White, T; Rutherford, H

2005-10-01

This study describes the demographic, offence and diagnostic characteristics of subjects referred by the Procurators Fiscal operating from three courts in Tayside, Scotland. A comparison is made of referrals made between 1988 to 1995 and 1997 to 1998. There was an increased rate of referral on an urgent basis over time, primarily involving patients already in contact with the psychiatric services, 37% of whom were detained and admitted to hospital. This urgent assessment ensured that mentally-disordered offenders were not remanded in custody simply for the preparation of a report, and it allowed an early assessment to be made regarding the suitability for diversion from prosecution. This outcome is compatible with guidelines issued by the Home Office in 1990 (Home Office, 1990).

Operational Law Handbook

Science.gov (United States)

1993-01-01

edifices, and items such as food stuffs and livestock esseantia to the survival of the cvlian population. n. Forcing a safeguard. Art. 102, UCMJ. Pmed...situation, particularly a climate where bodi des i quickly and when identification tap are lacking All of these problems existed in Grenada. Delay in...to federail agesieres is faidly suaightfrirward, and usuall can be arranged withiout cost to the aLEA . The process of laig equipment to State and

The effect of health and dental insurance on US children's dental care utilization for urgent and non-urgent dental problems - 2008.

Science.gov (United States)

Naavaal, Shillpa; Barker, Laurie K; Griffin, Susan O

2017-12-01

We examined the association between utilization of care for a dental problem (utilization-DP) and parent-reported dental problem (DP) urgency among children with DP by type of health care insurance coverage. We used weighted 2008 National Health Interview Survey data from 2,834 children, aged 2-17 years with at least one DP within the 6 months preceding survey. Explanatory variables were selected based on Andersen's model of healthcare utilization. Need was considered urgent if DP included toothache, bleeding gums, broken or missing teeth, broken or missing filling, or decayed teeth and otherwise as non-urgent. The primary enabling variable, insurance, had four categories: none, private health no dental coverage (PHND), private health and dental (PHD), or Medicaid/State Children's Health Insurance Program (SCHIP). Predisposing variables included sociodemographic characteristics. We used bivariate and multivariate analyses to identify explanatory variables' association with utilization-DP. Using logistic regression, we obtained adjusted estimates of utilization-DP by urgency for each insurance category. In bivariate analyses, utilization-DP was associated with both insurance and urgency. In multivariate analyses, the difference in percent utilizing care for an urgent versus non-urgent DP among children covered by Medicaid/SCHIP was 32 percentage points; PHD, 25 percentage points; PHND, 12 percentage points; and no insurance, 14 percentage points. The difference in utilization by DP urgency was higher for children with Medicaid/SCHIP compared with either PHND or uninsured children. Expansion of Medicaid/SCHIP may permit children to receive care for urgent DPs who otherwise may not, due to lack of dental insurance. © 2016 American Association of Public Health Dentistry.

Does peritoneal dialysis have a role in urgent-start end-stage kidney disease?

Science.gov (United States)

McQuillan, Rory F; Lok, Charmaine E

2018-04-19

Despite its many positive attributes, peritoneal dialysis remains underutilized, particularly in the United States. Urgent-start peritoneal dialysis (PD) has been proposed as a method of increasing PD prevalence. Urgent-start PD has been shown to be safe, feasible, and effective. However, urgent-start PD is also accompanied by several multidimensional challenges. This article is intended to equip the reader with a practical sense of whether an urgent-start PD program would be appropriate in his or her own clinical context and if appropriate, what factors would be necessary for such a program to flourish. As such, we summarize latent factors, which are necessary to consider before instituting an urgent-start PD. Then, using a series of clinical vignettes, highlight the component parts of a successful urgent-start PD program and the patient population who stand to benefit most from this strategy. The discussion is then balanced by presenting limitations to consider in the urgent-start PD approach. © 2018 Wiley Periodicals, Inc.

Urgent-Start Peritoneal Dialysis Complications: Prevalence and Risk Factors.

Science.gov (United States)

Xu, Damin; Liu, Tianjiao; Dong, Jie

2017-07-01

Mechanical complications are of particular concern in urgent-start peritoneal dialysis (PD) because of the shorter break-in period. However, risk factors have been reported inconsistently and data in urgent-start PD populations are limited. Observational cohort study. All patients treated with urgent-start PD, defined as PD therapy initiated within 1 week after catheter insertion, January 2003 to May 2013. Age, sex, abdominal surgery history, body mass index, hemoglobin level, albumin level, C-reactive protein level, break-in period (period between catheter insertion and PD therapy initiation), dialysate exchange volume, and use of overnight dwell. The presence of mechanical complications related to abdominal wall or catheter, including hernia, hydrothorax, hydrocele, subcutaneous leak, pericatheter leak, catheter malposition, omental wrap, and obstruction. 922 patients on urgent-start PD therapy were enrolled (mean age, 59.1±15.0 [SD] years). Prevalences of abdominal wall and catheter complications were 4.8% and 9.5%, respectively. The most common abdominal wall complication was hernia (55%), followed by hydrothorax (25%). On adjustment, male sex (HR, 5.41; 95% CI, 2.15-13.59; Pstart PD and conventional PD. Urgent-start PD is a safe and practicable approach. Male sex and history of abdominal surgery could contribute to the development of abdominal wall complications. Copyright © 2017 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

Urgent Aeromedical Evacuation Network Capacity Planning

Science.gov (United States)

2013-03-01

What if AMC had one strategically positioned AC for the Urgent / Priority AE mission and the redistribution needs they encounter? This idea stems ...KtMI~rAFB _~...,_ Po~AFB ;------------~ Service Tirr~e Estimates I CO\\" CLl "SIO\\" • C-378 performs bestfrom a cost perspective • Contracted

Is Urgent Evoke a Digital Ba?

DEFF Research Database (Denmark)

Wichmand, Mette

2018-01-01

of such a platform, the World Bank’s online game Urgent Evoke, which has been designed with the pur- pose of engaging citizens in developing innovative solutions for sociopolitical problems like poverty. The analysis is based on Nonaka’s concept of Ba, which means “place” and is described as a platform for advancing...

Profiles and behavioral consequences of child abuse among adolescent girls and boys from Barbados and Grenada.

Science.gov (United States)

Debowska, Agata; Boduszek, Daniel; Sherretts, Nicole; Willmott, Dominic; Jones, Adele D

2018-05-01

The current study used latent class analysis to uncover groups of youths with specific abuse (physical, emotional, and sexual) profiles in and outside the family, and identify how membership in each abuse group is associated with behavioral outcomes. Data were collected among a sample of male (n = 662; M age  = 13.02 years) and female (n = 689; M age  = 12.95 years) children and adolescents (9-17 years old) from Barbados and Grenada. Self-report surveys were completed by participants in school settings. Three latent classes of child abuse were distinguished among boys, including 'low abuse' (39.2% of the sample), 'physical and emotional abuse high outside/medium in the family' (43.2%), and 'high overall abuse' (17.6%). Among girls, four unique classes were recovered: 'low abuse' (40.7%), 'high physical and emotional abuse outside the family' (7.6%), 'high emotional and moderate physical abuse' (33.9%), and 'high overall abuse' (17.8%). Compared with members of low abuse groups, youths who reported having experienced high/moderate levels of various forms of violence, including those who were abused in multiple ways and across the two settings ('high overall abuse'), were significantly more likely to engage in violent and hostile behavior. Abused and non-abused youths did not differ on non-violent conflict resolution skills. The significance of present findings for future research and practice is discussed. Copyright © 2018 Elsevier Ltd. All rights reserved.

[Towards universal nomenclature for urgent surgical care].

Science.gov (United States)

Liakhovs'kyĭ, V I; Dem'ianiuk, D H; Kravtsiv, M I; Borkunov, A L; Sapun, L V

2013-06-01

In a modern professional literature the diseases, which undoubtedly threaten the patient's health and life, are called an urgent, special, emergent, fixed-date, etc. Not rare these terms are used simultaneously. Such a plurality of names of a quite dangerous state causes sometimes in these conditions uncertainty to seek help of a specialists and loss of a time. Modern dictionaries of a foreign languages words, of a foreign languages words in Ukrainian language, medical, big explanatory dictionary of a modern Ukrainian language definitely explains, that these terms are synonyms. All of them mean unconditional, timing. And every expression may be used in this context. The above mentioned suggestions and thoughts do not promote a secure fixing in the citizens consciousness the undoubtedness, the disease consequences danger, a threat to health and life. To deposit this in their awareness it is possible not by amorphous depiction, but using a singular, brief, firm term - an urgent.

Urgent X-ray examination of new-born babies. 1. Oesophagus-stomach

Energy Technology Data Exchange (ETDEWEB)

Ponhold, W; Poplavski, K [Vienna Univ. (Austria). Kinderklinik

1981-01-01

This paper provides the paediatrician using radiology and his assistants with exact and easily-understood instructions as to how to carry out an urgent X-ray examination of the oesophagus and the stomach. As far as an X-ray examination for the diagnosis of an atresia of the oesophagus, an oesophago-tracheo fistula and a pylorusstenosis, are concerned, fluoroscopy is in the first instance unnecessary, provided that an exact sequence of steps is kept to. Only in cases of long-term check-ups after oesophagus operations and oesophago-tracheo fistulas that are difficult to prove fluoroscopy is necessary. By carrying out the examinations suggested here, a correct diagnosis can be reached soon and exposure of the child to radiations kept to a minimum.

Agreement of 23 July 1996 between Grenada and the International Atomic Energy Agency for the application of safeguards in connection with the Treaty for the Prohibition of Nuclear Weapons in Latin America and the Treaty on the Non-Proliferation of Nuclear Weapons

Energy Technology Data Exchange (ETDEWEB)

NONE

1996-10-01

The document contains two parts. Part I stipulates the agreement of Grenada to accept safeguards on all source or special fissionable material in all peaceful nuclear activities within its territory , under its jurisdiction or carried out under its control anywhere, for the exclusive purpose of verifying that such material is not diverted to nuclear weapons or other nuclear explosive devices. Part II specifies the procedures to be applied in the implementation of the safeguards provisions of Part I.

Agreement of 23 July 1996 between Grenada and the International Atomic Energy Agency for the application of safeguards in connection with the Treaty for the Prohibition of Nuclear Weapons in Latin America and the Treaty on the Non-Proliferation of Nuclear Weapons

International Nuclear Information System (INIS)

1996-10-01

The document contains two parts. Part I stipulates the agreement of Grenada to accept safeguards on all source or special fissionable material in all peaceful nuclear activities within its territory , under its jurisdiction or carried out under its control anywhere, for the exclusive purpose of verifying that such material is not diverted to nuclear weapons or other nuclear explosive devices. Part II specifies the procedures to be applied in the implementation of the safeguards provisions of Part I

77 FR 42947 - Unexpected Urgent Refugee and Migration Needs

Science.gov (United States)

2012-07-20

... unexpected and urgent refugee and migration needs, including by contributions to international, governmental, and nongovernmental organizations and payment of administrative expenses of the Bureau of Population...

RECOMMENDATIONS OF PILOTING A HELICOPTER AND FIGHTING AGAINST EXTERNAL GOODS OSCILLATIONS DURING THE CONDUCT OF URGENT AERIAL WORKS WITH EXTERNAL SUSPENSION

Directory of Open Access Journals (Sweden)

A. A. Lebedev

2014-01-01

Full Text Available Сonsidered question of reducing oscillations of cargo on helicopter external sling to improve the safety and efficiency of flight operations during the conduct of urgent aerial works. Offered practical recommendations of piloting a helicopter and effective maneuvers to eliminate oscillations of cargo on external sling.

Urgent recommendation. Interim report

Energy Technology Data Exchange (ETDEWEB)

Nakano, Masayuki [International Affairs and Safeguards Division, Atomic Energy Bureau, Science and Technology Agency, Tokyo (Japan)

2000-12-01

The Investigation Committee for Critical Accident at Uranium Processing Plant was founded immediately after the accident to investigate the cause of the accident and to establish measures to prevent the similar accident. On September 30, 1999 around 10:35, the Japan's first criticality accident occurred at JCO Co. Ltd. Uranium processing plant (auxiliary conversion plant) located at Tokai-mura Ibaraki-ken. The criticality continued on and off for approximately 20 hours after the first instantaneous criticality. The accident led the recommendation of tentative evacuation and sheltering indoors for residents living in the neighborhood. The serious exposure to neutrons happened to three workers. The dominant effect is dose due to neutrons and gamma rays from the precipitation tank. When the accident took place, three workers dissolved sequentially about 2.4 kg uranium powder with 18.8 % enrichment in the 10-litter bucket with nitric acid. The procedure of homogenization of uranium nitrate was supposed to be controlled using the shape-limited narrow storage column. Actually, however, the thick and large precipitation tank was used. As a result, about 16.6 kg of uranium was fed into the tank, which presumably caused criticality. The first notification by JCO was delayed and the following communication was not smooth. This led to the delay of correct understanding of the situation and made the initial proper response difficult, then followed by insufficient communication between the nation, prefecture, and local authority. Urgent recommendations were made on the following items; (1) Safety measures to be taken at the accident site, (2) health cares for residents and others, (3) Comprehensive safety securing at nuclear operators such as Establishment of the effective audit system, Safety education for employees and Qualification and licensing system, Safety related documents, etc. (4) Reconstruction of the government's safety regulations such as How safety

Urgent recommendation. Interim report

International Nuclear Information System (INIS)

Nakano, Masayuki

2000-01-01

The Investigation Committee for Critical Accident at Uranium Processing Plant was founded immediately after the accident to investigate the cause of the accident and to establish measures to prevent the similar accident. On September 30, 1999 around 10:35, the Japan's first criticality accident occurred at JCO Co. Ltd. Uranium processing plant (auxiliary conversion plant) located at Tokai-mura Ibaraki-ken. The criticality continued on and off for approximately 20 hours after the first instantaneous criticality. The accident led the recommendation of tentative evacuation and sheltering indoors for residents living in the neighborhood. The serious exposure to neutrons happened to three workers. The dominant effect is dose due to neutrons and gamma rays from the precipitation tank. When the accident took place, three workers dissolved sequentially about 2.4 kg uranium powder with 18.8 % enrichment in the 10-litter bucket with nitric acid. The procedure of homogenization of uranium nitrate was supposed to be controlled using the shape-limited narrow storage column. Actually, however, the thick and large precipitation tank was used. As a result, about 16.6 kg of uranium was fed into the tank, which presumably caused criticality. The first notification by JCO was delayed and the following communication was not smooth. This led to the delay of correct understanding of the situation and made the initial proper response difficult, then followed by insufficient communication between the nation, prefecture, and local authority. Urgent recommendations were made on the following items; (1) Safety measures to be taken at the accident site, (2) health cares for residents and others, (3) Comprehensive safety securing at nuclear operators such as Establishment of the effective audit system, Safety education for employees and Qualification and licensing system, Safety related documents, etc. (4) Reconstruction of the government's safety regulations such as How safety regulation

SCINTIGRAPHY IN URGENT CONDITIONS AND COMPLICATIONS OF ACUTE DISEASES AND TRAUMAS

Directory of Open Access Journals (Sweden)

N. Ye. Kudryashova

2014-01-01

Full Text Available ABSTRACT. The data generalized in the review characterize radionuclide method as a high informative technique in diagnosis of the row of acute diseases and traumas and complications of them. It was shown that each radionuclide technique decides the concrete clinical tests and has a strictly definite place in the diagnostic algorithm. Urgent radionuclide techniques give the important information for the choice of the treatment’s policy or operation’s volume in such acute diseases as tromboembolism, arterial occlusions, small bowel obstruction, acute cholecystitis and cholelithiasis, acute myocardial infarct, rhabdomyolysis, differentiation of acute urological and acute abdominal surgical diseases and so on. The main aim of the work of our radionuclide department is to perfect, modificate of urgent radionuclide techniques and to correct the place of them in urgent conditions’s diagnostic algorithm for increasing of the quality and the rapidity in diagnosis. 

“Urgent water challenges are not sufficiently researched”

NARCIS (Netherlands)

Van der Zaag, P.; Gupta, J.; Darvis, L.P.

2009-01-01

In this opinion paper we submit that water experts conduct comparatively little research on the more urgent challenges facing the global community. Five specific biases are identified. First, research in the field of water and sanitation is heavily biased against sanitation. Second, research on food

Clinical outcome of acute nonvariceal upper gastrointestinal bleeding after hours: the role of urgent endoscopy.

Science.gov (United States)

Ahn, Dong-Won; Park, Young Soo; Lee, Sang Hyub; Shin, Cheol Min; Hwang, Jin-Hyeok; Kim, Jin-Wook; Jeong, Sook-Hyang; Kim, Nayoung; Lee, Dong Ho

2016-05-01

This study was performed to investigate the clinical role of urgent esophagogastroduodenoscopy (EGD) for acute nonvariceal upper gastrointestinal bleeding (ANVUGIB) performed by experienced endoscopists after hours. A retrospective analysis was performed for consecutively collected data of patients with ANVUGIB between January 2009 and December 2010. A total of 158 patients visited the emergency unit for ANVUGIB after hours. Among them, 60 underwent urgent EGD (within 8 hours) and 98 underwent early EGD (8 to 24 hours) by experienced endoscopists. The frequencies of hemodynamic instability, fresh blood aspirate on the nasogastric tube, and high-risk endoscopic findings were significantly higher in the urgent EGD group. Primary hemostasis was achieved in all except two patients. There were nine cases of recurrent bleeding, and 30-day mortality occurred in three patients. There were no significant differences between the two groups in primary hemostasis, recurrent bleeding, and 30-day mortality. In a multiple linear regression analysis, urgent EGD significantly reduced the hospital stay compared with early EGD. In patients with a high clinical Rockall score (more than 3), urgent EGD tended to decrease the hospital stay, although this was not statistically significant (7.7 days vs. 12.0 days, p > 0.05). Urgent EGD after hours by experienced endoscopists had an excellent endoscopic success rate. However, clinical outcomes were not significantly different between the urgent and early EGD groups.

The Military and The Media in Combat: Winning the Hearts and Minds of the American Public

National Research Council Canada - National Science Library

Stinnette, Murrell

2000-01-01

.... This paper seeks to frame the current relationship between the military and media by examining past operations in Grenada, Panama, and Iraq in terms of evolving media access and military control since Vietnam...

Examining dog owners' beliefs regarding rabies vaccination during government-funded vaccine clinics in Grenada to improve vaccine coverage rates.

Science.gov (United States)

Thomas, D; Delgado, A; Louison, B; Lefrancois, T; Shaw, J

2013-07-01

Vaccination of domestic pets is an important component of rabies control and prevention in countries where the disease is maintained in a wildlife reservoir. In Grenada, vaccine coverage rates were low, despite extensive public education and advertising of government-sponsored vaccine clinics where rabies vaccine is administered to animals at no cost to animal owners. Information was needed on reasons for decreased dog owner participation in government-funded rabies vaccination clinics. A total of 120 dog owners from 6 different parishes were asked to complete a questionnaire assessing their currently held beliefs about rabies vaccination and perception of the risk posed by rabies. Over 70% of respondents believed that problems in the organization and management of clinic sites could allow for fighting between dogs or disease spread among dogs, while 35% of owners did not believe that they had the ability or adequate help to bring their dogs to the clinic sites. Recommendations for improving vaccine coverage rates included: improved scheduling of clinic sites and dates; increased biosecurity at clinic locations; focused advertising on the availability of home visits, particularly for aggressive dogs or dogs with visible skin-related diseases such as mange; and the recruitment of community volunteers to assist with bringing dogs to the clinic sites. Copyright © 2013. Published by Elsevier B.V.

The Lived Experiences of Persons Hospitalized for Construction of an Urgent Fecal Ostomy.

Science.gov (United States)

Herlufsen, Per; Brødsgaard, Anne

The purpose of this study was to describe the lived experiences of hospital stays for patients undergoing urgent ostomy surgery. Qualitative, descriptive, phenomenological study. Six persons undergoing acute hospital admission and urgent ileostomy or colostomy surgery (either permanent or temporary) participated in the study. Participants were of Danish ethnicity and between the ages of 48 and 75 years. The research setting was the surgical department at a university hospital in the Capital Region of Denmark. Data collection and analyses were guided by a Reflective Lifeworld Research approach; this approach is based on phenomenological philosophy. Data were collected during in-depth interviews using a semistructured interview guide. Their average length was 50 minutes (range, 30-65 minutes). Interviews were digitally recorded and transcribed. Transcriptions were analyzed in 4 phases according to the principles of Reflective Lifeworld Research. The phenomenon we labeled "lived experiences of acute hospitalization with construction of an urgent unplanned fecal ostomy" comprised 4 constituents: (1) undergoing unexpected bodily changes, (2) partnership with professional caregivers, (3) experience of vulnerability, and (4) a lack of continuity. These constituents can be described as a number of challenges due to both hospitalization and ostomy creation. We found that individuals experience a number of challenges due to acute hospitalization and urgent construction of a fecal ostomy. These challenges are due to the unexpected bodily changes and interpersonal and organizational conditions. Nurses should be aware of not only the physical implications of urgent creation of a fecal ostomy but also the individual and psychological implications of this event.

Characterising non-urgent users of the emergency department (ED): A retrospective analysis of routine ED data.

Science.gov (United States)

O'Keeffe, Colin; Mason, Suzanne; Jacques, Richard; Nicholl, Jon

2018-01-01

The pressures of patient demand on emergency departments (EDs) continue to be reported worldwide, with an associated negative impact on ED crowding and waiting times. It has also been reported that a proportion of attendances to EDs in different international systems could be managed in settings such as primary care. This study used routine ED data to define, measure and profile non-urgent ED attendances that were suitable for management in alternative, non-emergency settings. We undertook a retrospective analysis of three years of Hospital Episode and Statistics Accident Emergency (HES A&E) data for one large region in England, United Kingdom (April 1st 2011 to March 31st 2014). Data was collected on all adult (>16 years) ED attendances from each of the 19 EDs in the region. A validated process based definition of non-urgent attendance was refined for this study and applied to the data. Using summary statistics non-urgent attenders were examined by variables hypothesised to influence them as follows: age at arrival, time of day and day of week and mode of arrival. Odds ratios were calculated to compare non-urgent attenders between groups. There were 3,667,601 first time attendances to EDs, of which 554,564 were defined as non-urgent (15.1%). Non-urgent attendances were significantly more likely to present out of hours than in hours (OR = 1.19, 95% CI: 1.18 to 1.20, Paged 16-44) compared to those aged 45-64 (odds ratio: 1.42, 95% CI: 1.41 to 1.43, Puse the ED to obtain healthcare that could be provided in a less urgent setting and also more likely to do this out of hours. Alternative services are required to manage non-urgent demand, currently being borne by the ED and the ambulance service, particularly in out of hours.

Comparison of usefulness of each of five predictors of mortality and urgent transplantation in patients with advanced heart failure.

Science.gov (United States)

Sachdeva, Amit; Horwich, Tamara B; Fonarow, Gregg C

2010-09-15

B-type natriuretic peptide (BNP), peak oxygen consumption (VO(2)), blood urea nitrogen (BUN), systolic blood pressure (SBP), and pulmonary capillary wedge pressure are all established predictors of mortality or urgent transplantation in patients with advanced heart failure (HF). However, their comparative predictive ability in estimating prognosis has not been well studied. We analyzed 1,215 patients with advanced systolic HF referred to a university center from 1999 to 2009. BUN, BNP, VO(2), SBP, and pulmonary capillary wedge pressure were measured as a part of the initial evaluation. The patients were divided into groups according to the best cutoffs for predicting both 1- and 2-year mortality from the analysis of the receiver operating characteristic curves (BNP > or =579 pg/ml, peak VO(2) or =53 mg/dl, SBP or =21 mm Hg). During a 2-year follow-up, 234 patients (19%) died, and 208 (17%) required urgent transplantation. BNP (odds ratio 4.3, 95% confidence interval 3.3 to 5.5) and peak VO(2) (odds ratio 4.5, 95% confidence interval 2.6 to 7.8) were the strongest predictors for death or urgent transplantation. On multivariate analyses, BNP and peak VO(2) were the strongest predictors for both death or urgent transplantation and all-cause mortality. The c-statistic was 0.756 for BNP, 0.701 for VO(2), 0.659 for BUN, 0.638 for SBP, and 0.650 for pulmonary capillary wedge pressure. In conclusion, of the 5 established predictors of outcomes in advanced HF, BNP was the most robust discriminator of risk and thus could be useful, along with other more traditional prognostic variables, in patient counseling regarding prognosis and determining the timing for heart transplantation. Copyright 2010 Elsevier Inc. All rights reserved.

3 CFR - Unexpected Urgent Refugee and Migration Needs Related to Gaza

Science.gov (United States)

2010-01-01

... urgent refugee and migration needs, including by contributions to international, governmental, and nongovernmental organizations and payment of administrative expenses of Bureau of Population, Refugees, and...

Characterising non-urgent users of the emergency department (ED: A retrospective analysis of routine ED data.

Directory of Open Access Journals (Sweden)

Colin O'Keeffe

Full Text Available The pressures of patient demand on emergency departments (EDs continue to be reported worldwide, with an associated negative impact on ED crowding and waiting times. It has also been reported that a proportion of attendances to EDs in different international systems could be managed in settings such as primary care. This study used routine ED data to define, measure and profile non-urgent ED attendances that were suitable for management in alternative, non-emergency settings.We undertook a retrospective analysis of three years of Hospital Episode and Statistics Accident Emergency (HES A&E data for one large region in England, United Kingdom (April 1st 2011 to March 31st 2014. Data was collected on all adult (>16 years ED attendances from each of the 19 EDs in the region. A validated process based definition of non-urgent attendance was refined for this study and applied to the data. Using summary statistics non-urgent attenders were examined by variables hypothesised to influence them as follows: age at arrival, time of day and day of week and mode of arrival. Odds ratios were calculated to compare non-urgent attenders between groups.There were 3,667,601 first time attendances to EDs, of which 554,564 were defined as non-urgent (15.1%. Non-urgent attendances were significantly more likely to present out of hours than in hours (OR = 1.19, 95% CI: 1.18 to 1.20, P<0.001. The odds of a non-urgent attendance were significantly higher for younger patients (aged 16-44 compared to those aged 45-64 (odds ratio: 1.42, 95% CI: 1.41 to 1.43, P<0.001 and the over 65's (odds ratio: 3.81, 95% CI: 3.78 to 3.85, P<0.001. Younger patients were significantly more likely to attend non-urgently out of hours compared to the 45-64's (OR = 1.24, 95% CI: 1.22 to 1.25, P<0.001 and the 65+'s (OR = 1.38, 95% CI: 1.35 to 1.40, P<0.001. 110,605/554,564 (19.9% of the non-urgent attendances arrived by ambulance, increasing significantly out of hours versus in hours (OR = 2

A strategic-interaction analysis of an urgent appeal system and its outcomes for garment workers

NARCIS (Netherlands)

den Hond, F; Stolwijk, S.; Merk, J.

2014-01-01

Within the global garment industry the term "urgent appeal" is used to describe a request for action to Western activist groups for support in a specific case of labor rights violations. The urgent appeal system has become an important strategy for the transnational antisweatshop movement. It is

77 FR 21389 - Unexpected Urgent Refugee and Migration Needs

Science.gov (United States)

2012-04-10

... April 3, 2012 Unexpected Urgent Refugee and Migration Needs Memorandum for the Secretary of State By the... 2(c)(1) of the Migration and Refugee Assistance Act of 1962 (the ``Act''), as amended, (22 U.S.C... United States Emergency Refugee and Migration Assistance Fund, for the purpose of meeting unexpected and...

Use of the emergency department for less-urgent care among type 2 diabetics under a disease management program

Directory of Open Access Journals (Sweden)

Myers Leann

2009-12-01

Full Text Available Abstract Background This study analyzed the likelihood of less-urgent emergency department (ED visits among type 2 diabetic patients receiving care under a diabetes disease management (DM program offered by the Louisiana State University Health Care Services Division (LSU HCSD. Methods All ED and outpatient clinic visits made by 6,412 type 2 diabetic patients from 1999 to 2006 were extracted from the LSU HCSD Disease Management (DM Evaluation Database. Patient ED visits were classified as either urgent or less-urgent, and the likelihood of a less-urgent ED visit was compared with outpatient clinic visits using the Generalized Estimating Equation methodology for binary response to time-dependent variables. Results Patients who adhered to regular clinic visit schedules dictated by the DM program were less likely to use the ED for less urgent care with odds ratio of 0.1585. Insured patients had 1.13 to 1.70 greater odds of a less-urgent ED visit than those who were uninsured. Patients with better-managed glycated hemoglobin (A1c or HbA1c levels were 82 times less likely to use less-urgent ED visits. Furthermore, being older, Caucasian, or a longer participant in the DM program had a modestly lower likelihood of less-urgent ED visits. The patient's Charlson Comorbidity Index (CCI, gender, prior hospitalization, and the admitting facility showed no effect. Conclusion Patients adhering to the DM visit guidelines were less likely to use the ED for less-urgent problems. Maintaining normal A1c levels for their diabetes also has the positive impact to reduce less-urgent ED usages. It suggests that successful DM programs may reduce inappropriate ED use. In contrast to expectations, uninsured patients were less likely to use the ED for less-urgent care. Patients in the DM program with Medicaid coverage were 1.3 times more likely to seek care in the ED for non-emergencies while commercially insured patients were nearly 1.7 times more likely to do so. Further

Predictors of Urgent Findings on Abdominopelvic CT in Patients with Crohn's Disease Presenting to the Emergency Department.

Science.gov (United States)

Jung, Yoon Suk; Park, Dong Il; Hong, Sung Noh; Kim, Eun Ran; Kim, Young Ho; Cheon, Jae Hee; Eun, Chang Soo; Han, Dong Soo; Lee, Chang Kyun; Kim, Jae Hak; Huh, Kyu Chan; Yoon, Soon Man; Song, Hyun Joo; Shin, Jeong Eun; Jeon, Seong Ran

2015-04-01

Patients with Crohn's disease (CD) are frequently exposed to diagnostic radiation, mainly as a result of abdominopelvic computed tomography (APCT) examinations. However, there are limited data on the impact of APCT on clinical management in this population. To investigate clinical predictors of urgent findings on APCT in patients with CD who presented to the emergency department (ED). A retrospective study was performed among patients with CD presenting to 11 EDs with a gastrointestinal complaint. The primary outcome, OPAN (obstruction, perforation, abscess, or non-CD-related urgent findings), included new or worsening CD-related urgent findings or non-CD-related urgent findings that required urgent or emergency treatment. Variables with P 100 beats/min (OR 2.33, 95 % CI 1.10-4.93), leukocyte count >10,000/mm(3) (OR 4.38, 95 % CI 2.10-9.13), and CRP >2.5 mg/dL (OR 3.11, 95 % CI 1.23-7.86) were identified as the independent predictors of OPAN, whereas biologic agent use (OR 0.37; 95 % CI 0.15-0.90) was identified as the negative predictor in patients with CD. Only 39 % of the APCTs performed in the ED among patients with CD showed urgent findings. Stricturing or penetrating disease, tachycardia, leukocytosis, and high CRP level were predictors of urgent CT findings, while biologic agent use was a negative predictor. To reduce unnecessary radiation exposure, the selection process for CD patients referred for APCT must be improved.

Actual Problems of Conclusion and Discharge of Urgent Labour Contracts

Directory of Open Access Journals (Sweden)

Shevelyova A. A.

2013-05-01

Full Text Available This article is devoted to the consideration of the questions connected with the conclusion and the termination of the urgent labour contract. The author, analyzing judicial practice, allocates the problems of separate regulation of the RF labour legislation enforcement.

An analysis of blood donation barriers experienced by North American and Caribbean university students in Grenada, West Indies.

Science.gov (United States)

Dean, Benjamin W; Hewitt, Sarah N; Begos, Morgan C; Gomez, Angela; Messam, Locksley L McV

2018-02-01

To estimate the associations of nationality, university program, donation history and gender, with blood donation barriers experienced by non-donating students on the day of a campus blood drive. This project focused particularly on nationality and the effect of the different blood donation cultures in the students' countries of origin. A retrospective cohort study of 398 North American and Caribbean university students was conducted at St. George's University, Grenada, in 2010. Data were collected from non-donating students on campus while a blood drive was taking place. Log-binomial regression was used to estimate associations between the exposures of interest and donation barriers experienced by the students. North American (voluntary blood donation culture) students were more likely than Caribbean (replacement blood donation culture) students to experience "Lack of Time" (relative risk (RR) = 1.57; 95% confidence interval (CI): 1.19-2.07) and "Lack of Eligibility" (RR = 1.55; 95% CI: 1.08-2.22) as barriers to donation. Conversely, Caribbean students were a third as likely to state "Lack of Incentive" (RR = 0.32; 95% CI: 0.20-0.50), "Fear of Infection" (RR = 0.35; 95% CI: 0.21-0.58), and "Fear of Needles" (RR = 0.32; 95% CI: 0.21-0.48) were barriers than North American students. University students from voluntary blood donation cultures are likely to experience different barriers to donation than those from replacement cultures. Knowledge of barriers that students from contrasting blood donation systems face provides valuable information for blood drive promotion in university student populations that contain multiple nationalities. Copyright © 2017 Elsevier Ltd. All rights reserved.

MEDICAL SERVICE - URGENT CALLS

CERN Multimedia

Service Médical

2000-01-01

IN URGENT NEED OF A DOCTOR GENEVA: EMERGENCY SERVICES GENEVA AND VAUD 144 FIRE BRIGADE 118 POLICE 117 CERN FIREMEN 767-44-44 ANTI-POISONS CENTRE Open 24h/24h 01-251-51-51 Patient not fit to be moved, call family doctor, or: GP AT HOME: Open 24h/24h 748-49-50 AMG- Association Of Geneva Doctors: Emergency Doctors at home 07h-23h 322 20 20 Patient fit to be moved: HOPITAL CANTONAL CENTRAL 24 Micheli-du-Crest 372-33-11 ou 382-33-11 EMERGENCIES 382-33-11 ou 372-33-11 CHILDREN'S HOSPITAL 6 rue Willy-Donzé 372-33-11 MATERNITY 32 bvd.de la Cluse 382-68-16 ou 382-33-11 OPHTHALMOLOGY 22 Alcide Jentzer 382-33-11 ou 372-33-11 MEDICAL CENTRE CORNAVIN 1-3 rue du Jura 345 45 50 HOPITAL DE LA TOUR Meyrin 719-61-11 EMERGENCIES 719-61-11 CHILDREN'S EMERGENCIES 719-61-00 LA TOUR MEDICAL CENTRE 719-74-00 European Emergency Call 112   FRANCE: EMERGENCY SERVICES 15 FIRE BRIGADE 18 POLICE 17 CERN FIREMEN AT HOME 00-41-22-767-44-44 ...

Where’s Cap Haitien? Validating the Principles of Peace Operations

Science.gov (United States)

1999-12-17

health risks to the military with exposure to disease, specifically malaria and dengue fever. Former members of the FAD’H posed potential security...Co (TACON) C/65 EN (L) (DS) (-) 3/58 MP CO (DS) 1/A/125SIGBN(+) DPSE 22 TPT 221 TPT 223 CATPT-2/416CABN SEC/351 AG CO (POSTAL) (DS) (-) MIST...Barbuda, the Bahamas, Barbados, Belize , Dominica, Grenada, Guyana, Jamaica, St. Kitts and Nevis, St. Lucia, St Vincent and the Grenadines, and Trinidad

Outcomes of urgent carotid endarterectomy for stable and unstable acute neurologic deficits.

Science.gov (United States)

Barbetta, Iacopo; Carmo, Michele; Mercandalli, Giulio; Lattuada, Patrizia; Mazzaccaro, Daniela; Settembrini, Alberto M; Dallatana, Raffaello; Settembrini, Piergiorgio G

2014-02-01

The aim of the study was to assess the outcomes of carotid endarterectomy (CEA) performed in an urgent setting on acutely symptomatic patients selected through a very simple protocol. From January 2002 to January 2012, 193 symptomatic patients underwent CEA. Of these, 90 presented with acute symptoms, and after a congruous carotid stenosis was identified, underwent urgent operations (group 1): 27 patients had transient ischemic attack (group 1A), 52 patients had mild to moderate stroke (group 1B), and 11 patients had stroke in evolution (group 1C). The remaining 103 patients with a nonrecent neurologic deficit were treated by elective surgery in the same period (group 2). End points were 30-day neurologic morbidity and mortality. The median delay of urgent CEA (U-CEA) from deficit onset was 48 hours (interquartile range, 13-117 hours). Groups 1 and 2 were comparable in demographics. Acute patients showed a higher rate of stroke at presentation (70% vs 37%; P = .001) and of history of coronary artery disease (30% vs 13.5%; P = .007). Acute patients sustained six postoperative strokes (6.6%). Neurologic outcomes were correlated to clinical presentation: no strokes occurred in group 1A patients, and 5.8% group 1B patients and 27.3% group 1C patients had postoperative stroke (P two thromboembolic strokes. Elective patients sustained four postoperative strokes (3.9%), with one death (0.9%) as a consequence of hyperperfusion cerebral edema. U-CEAs performed ≤48 hours from symptom onset had a lower postoperative stroke rate than those performed >48 hours (4.4% vs 8.8%; P = .3). Among patients presenting with a stroke (group 1B), the National Institutes of Health Stroke Scale (NIHSS) assessment at discharge showed improvement in 79% (although only 25% had ≥4 points in reduction), stability in 17%, and deterioration in 4%. Patients with moderate stroke were slightly better in NIHSS improvement than those with mild stroke (median NIHSS variation at discharge, -3 vs -1; P

78 FR 9569 - Unexpected Urgent Refugee and Migration Needs Relating to Syria

Science.gov (United States)

2013-02-08

... urgent refugee and migration needs, including by contributions to international, governmental, and nongovernmental organizations and payment of administrative expenses of the Bureau of Population, Refugees, and...

77 FR 58404 - Announcing the Award of Two Urgent Single-Source Grants To Support Unaccompanied Alien Children...

Science.gov (United States)

2012-09-20

...] Announcing the Award of Two Urgent Single-Source Grants To Support Unaccompanied Alien Children Program...) announces the award of two urgent single-source grants from the Unaccompanied Alien Children's Program to... providing services under the Unaccompanied Alien Children's program. Award Grantee organization Location...

The ED use and non-urgent visits of elderly patients

Directory of Open Access Journals (Sweden)

Umut Gulacti

2016-12-01

Full Text Available Objective: To evaluate the use of the emergency department (ED by elderly patients, their non-urgent visits and the prevalence of main disease for ED visits. Methods: This cross-sectional study was conducted on patients aged 65 years and over who visited the ED of a tertiary care university hospital in Turkey between January 2015 and January 2016 retrospectively. Results: A total of 36,369 elderly patients who visited the ED were included in the study. The rate of ED visits by elderly patients was higher than their representation within the general population (p < 0.001. While the rate of elderly patients visiting polyclinics was 15.8%, the rate of elderly patients visiting the ED was 24.3% (p < 0.001. For both genders, the rates of ED visits for patients between 65 and 74 years old was higher than for other elderly age groups (p < 0.001. The prevalence of upper respiratory tract infection (URTI was the highest within the elderly population (17.5%, CI: 17.1–17.9. The proportion of ED visits for non-urgent conditions was 23.4%. Most of the ED visits were during the non-business hours (51.1%, and they were highest in the winter season (25.9% and in January (10.2%. The hospitalization rate was 9.4%, and 37.9% of hospitalized patients were admitted to intensive care units. Conclusion: The proportion of ED visits by elderly patients was higher than their representation within the general population. Elderly patients often visited the ED instead of a polyclinic. The rate of inappropriate ED use by elderly patients in this hospital was higher than in other countries. Keywords: Non-urgent, Prevalence, Visit, Main disease, Elderly patient, Emergency department

OCOD-CTTP Test Evaluation Report.

Science.gov (United States)

Shorey, Leonard

Tests in social studies and integrated science given in Saint Vincent, Saint Lucia, Grenada, and Dominica were analyzed by the Organization for Co-operation in Overseas Development (OCOD) Comprehensive Teacher Training Program (CTTP) for discrimination, difficulty, and reliability, as well as other characteristics. There were 767 examinees for the…

Urgent Carotid Surgery: Is It Still out of Debate?

Directory of Open Access Journals (Sweden)

C. Battocchio

2012-01-01

Full Text Available Patients with symptomatic tight carotid stenosis have an increased short-time risk of stroke and an increased long-term risk of ischaemic vascular events compared with the general population. The aim of this study is to assess the safety, efficacy, and limitations of urgent CEA or CAS, in patients with carotid stenosis greater than 70% and clinically characterized by recurrent TIA or brain damage following a stroke (<2.5 cm. This study involved 28 patients divided into two groups. Group A consisted of sixteen patients who had undergone CEA, and group B consisted of twelve patients who had undergone CAS. Primary endpoints were mortality, neurological morbidity (by NIHSS and postoperative hemorrhagic cerebral conversion, at 30 days. Ten patients (62.5% of group A experienced an improvement in their initial neurological deficit while in 4 cases (26% the deficit remained stable. Two cases of neurologic mortality are presented. At 1 month, 9 patients (75% of group B experienced an improvement in their initial neurological deficit while 3 patients (25% had a neurological impairment. Urgent or deferred surgical or endovascular treatment have a satisfactory outcome considering the profile in very high-risk patient population. Otherwise in selected patients CEA seems to be preferred to CAS.

Use of a voice and video internet technology as an alternative to in-person urgent care clinic visits.

Science.gov (United States)

Brunett, Patrick H; DiPiero, Albert; Flores, Christine; Choi, Dongseok; Kum, Hayley; Girard, Donald E

2015-06-01

This study aimed to determine the feasibility of patient-initiated online Internet urgent care visits, and to describe patient characteristics, scope of care, provider adherence to protocols, and diagnostic and therapeutic utilization. A total of 456 unique patients were seen via Internet-based technology during the study period, generating 478 consecutive total patient visits. Of the 82 patients referred for an in-person evaluation, 75 patients (91.5%) reported to the clinic as instructed. None of the 82 patients recommended for in-person evaluation required an emergency department referral, hospital admission or urgent consultative referral. We conclude that real-time online primary and urgent care visits are feasible, safe and potentially beneficial in increasing convenient access to urgent and primary care. © The Author(s) 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Feasibility of Urgent-Start Peritoneal Dialysis in Older Patients with End-Stage Renal Disease: A Single-Center Experience.

Science.gov (United States)

Jin, Haijiao; Ni, Zhaohui; Mou, Shan; Lu, Renhua; Fang, Wei; Huang, Jiaying; Hu, Chunhua; Zhang, Haifen; Yan, Hao; Li, Zhenyuan; Yu, Zanzhe

2018-01-01

Patients with end-stage renal disease (ESRD) frequently require urgent-start dialysis. Recent evidence suggests that peritoneal dialysis (PD) might be a feasible alternative to hemodialysis (HD) in these patients, including in older patients. This retrospective study enrolled patients aged > 65 years with ESRD who underwent urgent dialysis without functional vascular access or PD catheter at a single center, from January 2011 to December 2014. Patients were grouped based on their dialysis modality (PD or HD). Patients unable to tolerate PD catheter insertion or wait for PD were excluded. Each patient was followed for at least 30 days after catheter insertion. Short-term (30-day) dialysis-related complications and patient survival were compared between the 2 groups. A total of 94 patients were enrolled, including 53 (56.4%) who underwent PD. The incidence of dialysis-related complications during the first 30 days was significantly lower in PD compared with HD patients (3 [5.7%] vs 10 [24.4%], p = 0.009). Logistic regression identified urgent-start HD as an independent risk factor for dialysis-related complications compared with urgent-start PD (odds ratio 4.760 [1.183 - 19.147], p = 0.028). The 6-, 12-, 24-, and 36-month survival rates in the PD and HD groups were 92.3% vs 94.6%, 82.4% vs 81.3%, 75.7% vs 74.2%, and 69.5% vs 60.6%, respectively, with no significant differences between the groups (log-rank = 0.011, p = 0.915). Urgent-start PD was associated with fewer short-term dialysis-related complications and similar survival to urgent-start HD in older patients with ESRD. Peritoneal dialysis may thus be a safe and effective dialysis modality for older ESRD patients requiring urgent dialysis. Copyright © 2018 International Society for Peritoneal Dialysis.

Impact on Quality When Pediatric Urgent Care Centers Are Staffed With Radiology Technologists.

Science.gov (United States)

Kan, J Herman; Orth, Robert C; Yen, Terry A; Schallert, Erica K; Zhang, Wei; Donnelly, Lane F

2018-02-02

The proliferation of pediatric urgent care centers has increased the need for diagnostic imaging support, but the impact of employing radiology technologists at these centers is not known. The purpose of this study was to evaluate radiographic impact and quality at urgent care centers with and without radiology technologists. A retrospective case-control study was conducted comparing 235 radiographic examinations (study) performed without and 83 examinations (control) performed with a radiology technologist at the authors' pediatric urgent care centers. Studies were evaluated for quality using a five-point, Likert-type scale (1 = poor, 5 = best) regarding field of view, presentation, and orthogonal view orientation. Studies were also evaluated for the incidence of positive results, need for repeat imaging, and discrepancies between initial study and follow-up. Imaging quality comparisons between study and control groups were statistically different for field of view (3.98 versus 4.29, P = .014), presentation (4.39 versus 4.51, P = .045), and orthogonal view orientation (4.45 versus 4.69, P = .033). The incidence of repeat imaging was similar (4.7% versus 2.4%, P = 0.526), as well as the discrepancy rates (3.4 versus 2.4%, P = 1.00). The incidence of abnormal radiographic findings for the study and control groups was similar (40.9% versus 34.9%, P = .363). Radiography is an important triage tool at pediatric urgent care centers. It is imperative to have optimal radiographic imaging for accurate diagnosis, and imaging quality is improved when radiology technologists are available. If not feasible or cost prohibitive, it is important that physicians be given training opportunities to bridge the quality gap when using radiographic equipment and exposing children to radiation. Copyright © 2018 American College of Radiology. Published by Elsevier Inc. All rights reserved.

Audit of radiology communication systems for critical, urgent, and unexpected significant findings.

Science.gov (United States)

Duncan, K A; Drinkwater, K J; Dugar, N; Howlett, D C

2016-03-01

To determine the compliance of UK radiology departments and trusts/healthcare organisations with National Patient Safety Agency and Royal College of Radiologist's published guidance on the communication of critical, urgent, and unexpected significant radiological findings. A questionnaire was sent to all UK radiology department audit leads asking for details of their current departmental policy regarding the issuing of alerts; use of automated electronic alert systems; methods of notification of clinicians of critical, urgent, and unexpected significant radiological findings; monitoring of results receipt; and examples of the more common types of serious pathologies for which alerts were issued. One hundred and fifty-four of 229 departments (67%) responded. Eighty-eight percent indicated that they had a policy in place for the communication of critical, urgent, and unexpected significant radiological findings. Only 34% had an automated electronic alert system in place and only 17% had a facility for service-wide electronic tracking of radiology reports. In only 11 departments with an electronic acknowledgement system was someone regularly monitoring the read rate. There is wide variation in practice across the UK with regard to the communication and monitoring of reports with many departments/trusts not fully compliant with published UK guidance. Despite the widespread use of electronic systems, only a minority of departments/trusts have and use electronic tracking to ensure reports have been read and acted upon. Copyright © 2015 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

The greenhouse effect: is it urgent to wait?; Effet de serre est-il urgent d'attendre?

Energy Technology Data Exchange (ETDEWEB)

Zentelin, J.L. [Universite d' Evry Val d' Essonne, 91 - Evry (France)

2005-01-01

The greenhouse effect and the depletion of oil reserves are 2 urgent matters, one imminent and the other latent. The handling of these 2 related issues requires reconciling the advocates of precaution and the supporters of progress, technology and ethics. This is not at all easy, particularly as the delay in the climatic catastrophe tends to hide the issue. It appears that there are much more reasons to act than to wait: -) the climate thread is underestimated because of the slow evolution of the consequences of climatic change, -) the possible improvement of current technologies will have a low impact, -) technological breakthroughs are too rare to rely on them, -) the capacity of new technologies to take over is always underestimated, -) the changes in the way of consuming energy requires time to involve large part of the population, and -) international mechanisms lacks efficiency and adequacy. (A.C.)

Régimen constitucional del internamiento involuntario y urgente por trastorno mental = Constitucional framework on involuntary and urgent confinement due to mental disorder

Directory of Open Access Journals (Sweden)

Juan Francisco Sánchez Barrilao

2013-05-01

Full Text Available El presente trabajo aborda el régimen constitucional de los internamientos involuntarios y urgentes por trastorno mental como un supuesto de limitación de derechos fundamentales (especialmente, libertad personal; y, en particular, a la vista de la doctrina contenida en la Sentencia del Tribunal Constitucional 141/2012, dictada en resolución de un recurso de amparo al respecto. En tal sentido, se analiza el marco normativo de dichos internamientos (distinguiendo entre el estrictamente constitucional, el internacional y el meramente legal, su naturaleza (en relación al internamiento como tal, como respecto a la intervención judicial que ha de autorizarlo, sus concretas garantías (en especial, a la vista de la STC 141/2012, así como diversas cuestiones abiertas por la anterior Sentencia, no obstante, y que requieren de oportuna respuesta legal. The following piece of paper deals with the constitutional rule of the involuntary and urgent confinements due to mental disorder as restricting fundamental rights (especially, personal liberty according to the principles established in the judgement of the Spanish Constitutional Court 141/2012. Accordingly, the legal frameworkof a such confinements is analysed (making a distinction among constitutional, international and legal rules, its nature (ref. both confinements itself, as the role of judge who must authorize, its specific guarantees (in accordance with the judgement STC 141/2012, as well as a variety of issues requiring a timely legal response.

Non-urgent accident and emergency department use as a socially shared custom: a qualitative study.

Science.gov (United States)

Keizer Beache, Simone; Guell, Cornelia

2016-01-01

We explored attitudes of non-urgent accident and emergency department (AED) patients in the middle-income healthcare setting Saint Vincent and the Grenadines (SVG) in the Caribbean to understand how and why they decide to seek emergency care and resist using primary care facilities. In 2013, we conducted 12 semistructured interviews with a purposive sample of non-urgent AED users from a variety of social backgrounds. Verbatim transcripts were analysed with a grounded theory approach. In this study, we found, first, that participants automatically chose to visit the AED and described this as a locally shared custom. Second, the healthcare system in SVG reinforced this habitual use of the AED, for example, by health professionals routinely referring non-urgent cases to the AED. Third, there was also some deliberate use; patients took convenience and the systemic encouragement into account to determine that the AED was the most appropriate choice for healthcare. We conclude that the attitudes and habits of the Vincentian non-urgent patient are major determinants of their AED use and are intricately linked to local, socially shared practices of AED use. Findings show that health services research should reconsider rational choice behaviour models and further explore customs of health-seeking. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

What we do | Page 67 | IDRC - International Development Research ...

International Development Research Centre (IDRC) Digital Library (Canada)

Results 661 - 670 of 1736 ... Grenada School Nutrition Study: Evidence to Inform Policy. Topic(s): Adolescent Health, Health Policy, Disadvantaged Groups, Food Policy, Student Behaviour, Surveys, School Environment, Neighbourhoods. Region(s): Americas, Grenada, North And Central America. The World Health ...

URGENT NEED OF A DOCTOR

CERN Multimedia

Medical Service

2001-01-01

IN URGENT NEED OF A DOCTOR GENEVA EMERGENCY SERVICES GENEVA AND VAUD 144 FIRE BRIGAD 118 POLICE 117 CERN FIREMEN 767-44-44 ANTI-POISONS CENTRE Open 24h/24h 01-251-51-51 Patient not fit to be moved, call family doctor, or: GP AT HOME, open 24h/24h 748-49-50 Association Of Geneva Doctors Emergency Doctors at home 07h-23h 322 20 20 Patient fit to be moved: HOPITAL CANTONAL CENTRAL 24 Micheli-du-Crest 372-33-11 ou 382-33-11 EMERGENCIES 382-33-11 ou 372-33-11 CHILDREN'S HOSPITAL 6 rue Willy-Donzé 372-33-11 MATERNITY 32 bvd.de la Cluse 382-68-16 ou 382-33-11 OPHTHALMOLOGY 22 Alcide Jentzer 382-33-11 ou 372-33-11 MEDICAL CENTRE CORNAVIN 1-3 rue du Jura 345 45 50 HOPITAL DE LA TOUR Meyrin EMERGENCIES 719-61-11 URGENCES PEDIATRIQUES 719-61-00 LA TOUR MEDICAL CENTRE 719-74-00 European EmergencyCall 112 FRANCE EMERGENCY SERVICES 15 FIRE BRIGADE 18 POLICE 17 CERN FIREMEN AT HOME 00-41-22-767-44-44 ANTI-POISONS CENTRE Open 24h/24h 04-72-11-69-11 All doctors will...

Emergency Department Referrals for Adolescent Urgent Psychiatric Consultation: Comparison of Clinical Characteristics of Repeat-presentations and Single-presentation.

Science.gov (United States)

Roberts, Nasreen; Nesdole, Robert; Hu, Tina

2018-01-01

a) to examine the demographic and clinical characteristics of repeat-presentations to an adolescent urgent psychiatric clinic, and b) to compare them with single-time presentation. This 18-month retrospective study compared repeat-presenters to age and gender matched single-time presenters. Demographic variables included age gender and ethnicity. Clinical variables included reason for referral, family history, diagnosis, recommendations and compliance. Data were analyzed using descriptive statistics, McNemar's Chi-square tests for matched pairs, and conditional logistic regression. Of 624 assessments 24% (N=151) were repeat-presentations. Compared with single-presentation, repeat-presentation group had a higher proportion of Aboriginal youth (X2 (1) = 108.28 p presentation group had higher odds of past hospital admission (OR: 3.50, p presentations for urgent psychiatric consultation constitute a quarter of referrals to the urgent psychiatric clinic. Identifying and addressing factors that contribute to repeat-presentations may, assist in improving treatment compliance by ensuring focused interventions and service delivery for these youth. In turn, this will improve access to the limited urgent services for other youth.

Space nonweaponization. An urgent task for arms control

International Nuclear Information System (INIS)

Du Xiangwan; Pan Jusheng; Zhang Xinwei; Du Shuhua; Xu Changgen

1990-05-01

The authors attempt to expound the basic points of veiw and put forward a proposal on the space nonweaponization. The authors analyse the nature of space weaponry and its impact on arms race and point out that the space nonweaponization is an urgent task for arms control. The relations between prohibition of space and ASAT weapons, between prohibition of space weapons and reduction of nuclear weapons and between space weapon and nuclear test are all analysed. The inadequacy of the existing space treaties is made clear based on the evaluation. It is hoped that a verifiable treaty on the prohibition of space weapons should be made and international cooperation on peaceful use of outer space is necessary

76 FR 14271 - Unexpected Urgent Refugee and Migration Needs Related to Libya

Science.gov (United States)

2011-03-16

... March 7, 2011 Unexpected Urgent Refugee and Migration Needs Related to Libya Memorandum for the... States, including section 2(c)(1) of the Migration and Refugee Assistance Act of 1962 (the ``Act''), as... million from the United States Emergency Refugee and Migration Assistance Fund, for the purpose of meeting...

Audit of radiology communication systems for critical, urgent, and unexpected significant findings

International Nuclear Information System (INIS)

Duncan, K.A.; Drinkwater, K.J.; Dugar, N.; Howlett, D.C.

2016-01-01

Aim: To determine the compliance of UK radiology departments and trusts/healthcare organisations with National Patient Safety Agency and Royal College of Radiologist's published guidance on the communication of critical, urgent, and unexpected significant radiological findings. Materials and methods: A questionnaire was sent to all UK radiology department audit leads asking for details of their current departmental policy regarding the issuing of alerts; use of automated electronic alert systems; methods of notification of clinicians of critical, urgent, and unexpected significant radiological findings; monitoring of results receipt; and examples of the more common types of serious pathologies for which alerts were issued. Results: One hundred and fifty-four of 229 departments (67%) responded. Eighty-eight percent indicated that they had a policy in place for the communication of critical, urgent, and unexpected significant radiological findings. Only 34% had an automated electronic alert system in place and only 17% had a facility for service-wide electronic tracking of radiology reports. In only 11 departments with an electronic acknowledgement system was someone regularly monitoring the read rate. Conclusion: There is wide variation in practice across the UK with regard to the communication and monitoring of reports with many departments/trusts not fully compliant with published UK guidance. Despite the widespread use of electronic systems, only a minority of departments/trusts have and use electronic tracking to ensure reports have been read and acted upon. - Highlights: • UK wide audit of communication of significant radiology results. • 88% of departments have a communication policy in place. • 34% of departments have an automated electronic alert system. • 17% of Trusts have facility for service wide electronic tracking of radiology reports.

75 FR 67015 - Unexpected Urgent Refugee And Migration Needs Resulting From Flooding InPakistan

Science.gov (United States)

2010-11-01

... September 3, 2010 Unexpected Urgent Refugee And Migration Needs Resulting From Flooding InPakistan... humanitarian needs resulting from recent devastating flooding in Pakistan. You are authorized and directed to...

The ED use and non-urgent visits of elderly patients.

Science.gov (United States)

Gulacti, Umut; Lok, Ugur; Celik, Murat; Aktas, Nurettin; Polat, Haci

2016-12-01

To evaluate the use of the emergency department (ED) by elderly patients, their non-urgent visits and the prevalence of main disease for ED visits. This cross-sectional study was conducted on patients aged 65 years and over who visited the ED of a tertiary care university hospital in Turkey between January 2015 and January 2016 retrospectively. A total of 36,369 elderly patients who visited the ED were included in the study. The rate of ED visits by elderly patients was higher than their representation within the general population (p elderly patients visiting polyclinics was 15.8%, the rate of elderly patients visiting the ED was 24.3% (p elderly age groups (p elderly population (17.5%, CI: 17.1-17.9). The proportion of ED visits for non-urgent conditions was 23.4%. Most of the ED visits were during the non-business hours (51.1%), and they were highest in the winter season (25.9%) and in January (10.2%). The hospitalization rate was 9.4%, and 37.9% of hospitalized patients were admitted to intensive care units. The proportion of ED visits by elderly patients was higher than their representation within the general population. Elderly patients often visited the ED instead of a polyclinic. The rate of inappropriate ED use by elderly patients in this hospital was higher than in other countries.

Urgent Protection versus Chronic Need: Clarifying the Dual Mandate of Child Welfare Services across Canada

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Nico Trocmé

2014-08-01

Full Text Available This study analyzed data from the 1998, 2003 and 2008 Canadian Incidence Study of reported child abuse and neglect (CIS and compared the profile of children who were reported for an urgent protection investigation versus any other investigation or assessment. As a proportion of all investigations, urgent protection cases have dropped from 28% of all investigations in 1998, to 19% in 2003, to 15% in 2008. Results from the CIS-2008 analysis revealed that 7% of cases involved neglect of a child under four, 4% of cases involved sexual abuse, 2% of cases involved physical abuse of a child under four and 1% of cases involved children who had sustained severe enough physical harm that medical treatment was required. The other 85% of cases of investigated maltreatment involved situations where concerns appear to focus less on immediate safety and more on the long-term effects of a range of family related problems. These findings underscore the importance of considering the dual mandate of child welfare mandates across Canada: intervening to assure the urgent protection and safety of the child versus intervening to promote the development and well-being of the child.

Aerobic bacteria from mucous membranes, ear canals, and skin wounds of feral cats in Grenada, and the antimicrobial drug susceptibility of major isolates.

Science.gov (United States)

Hariharan, Harry; Matthew, Vanessa; Fountain, Jacqueline; Snell, Alicia; Doherty, Devin; King, Brittany; Shemer, Eran; Oliveira, Simone; Sharma, Ravindra N

2011-03-01

In a 2-year period 54 feral cats were captured in Grenada, West Indies, and a total of 383 samples consisting of swabs from rectum, vagina, ears, eyes, mouth, nose and wounds/abscesses, were cultured for aerobic bacteria and campylobacters. A total of 251 bacterial isolates were obtained, of which 205 were identified to species level and 46 to genus level. A commercial bacterial identification system (API/Biomerieux), was used for this purpose. The most common species was Escherichia coli (N=60), followed by Staphylococcus felis/simulans (40), S. hominis (16), S. haemolyticus (12), Streptococcus canis (9), Proteus mirabilis (8), Pasteurella multocida (7), Streptococcus mitis (7), Staphylococcus xylosus (7), S. capitis (6), S. chromogenes (4), S. sciuri (3), S. auricularis (2), S. lentus (2), S. hyicus (2), Streptococcus suis (2) and Pseudomonas argentinensis (2). Sixteen other isolates were identified to species level. A molecular method using 16S rRNA sequencing was used to confirm/identify 22 isolates. Salmonella or campylobacters were not isolated from rectal swabs. E. coli and S. felis/simulans together constituted 50% of isolates from vagina. S. felis/simulans was the most common species from culture positive ear and eye samples. P. multocida was isolated from 15% of mouth samples. Coagulase-negative staphylococci were the most common isolates from nose and wound swabs. Staphylococcus aureus, or S. intemedius/S. pseudintermedius were not isolated from any sample. Antimicrobial drug resistance was minimal, most isolates being susceptible to all drugs tested against, including tetracycline. Copyright © 2010 Elsevier Ltd. All rights reserved.

Emergency Department Non-Urgent Visits and Hospital Readmissions Are Associated with Different Socio-Economic Variables in Italy.

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Pamela Barbadoro

Full Text Available The aim of this paper was to evaluate socio-economic factors associated to poor primary care utilization by studying two specific subjects: the hospital readmission rate, and the use of the Emergency Department (ED for non-urgent visits.The study was carried out by the analysis of administrative database for hospital readmission and with a specific survey for non-urgent ED use.Among the 416,698 sampled admissions, 6.39% (95% CI, 6.32-6.47 of re-admissions have been registered; the distribution shows a high frequency of events in the age 65-84 years group, and in the intermediate care hospitals (51.97%; 95%CI 51.37-52.57. The regression model has shown the significant role played by age, type of structure (geriatric acute care, and deprivation index of the area of residence on the readmission, however, after adjusting for the intensity of primary care, the role of deprivation was no more significant. Non-urgent ED visits accounted for the 12.10%, (95%CI 9.38-15.27 of the total number of respondents to the questionnaire (N = 504. The likelihood of performing a non-urgent ED visit was higher among patients aged <65 years (OR 3.2, 95%CI 1.3-7.8 p = 0.008, while it was lower among those perceiving as urgent their health problem (OR 0.50, 95%CI 0.30-0.90.In the Italian context repeated readmissions and ED utilization are linked to different trajectories, besides the increasing age and comorbidity of patients are the factors that are related to repeated admissions, the self-perceived trust in diagnostic technologies is an important risk factor in determining ED visits. Better use of public national health care service is mandatory, since its correct utilization is associated to increasing equity and better health care utilization.

Urgent reconstruction and re-equipping of coking plants

Energy Technology Data Exchange (ETDEWEB)

Kvitkin, I.A.; Martynenko, V.M.; Rozenfel' d, M.S.; Svyatogorov, A.A.; Shvartsman, I.G.

1986-03-01

This paper discusses the various options involved: complete or partial reconstruction of existing buildings and equipment or new construction with new equipment and new underground and surface communications. It explains that reconstruction work is divided into three phases: initial phase (clearance, dismantling, closing down coking batteries); basic phase (fitting heat-resistant materials, prestart-up assembly work); final phase (drying out, heating up, adjustments, start-up). A structured scheme for a typical initial phase is described and a method of calculating the durations of the various phases is discussed. Conclusion is that there is an urgent requirement for a document to be produced for the control of reconstruction work; it should contain standard durations and could serve as a standard for coking plant reconstruction work.

The RADCAT-3 system for closing the loop on important non-urgent radiology findings: a multidisciplinary system-wide approach.

Science.gov (United States)

Dibble, Elizabeth H; Swenson, David W; Cobb, Cynthia; Paul, Timothy J; Karn, Andrew E; Portelli, David C; Movson, Jonathan S

2017-04-01

The goal of this project was to create a system that was easy for radiologists to use and that could reliably identify, communicate, and track communication of important but non-urgent radiology findings to providers and patients. Prior to 2012, our workflow for communicating important non-urgent diagnostic imaging results was cumbersome, rarely used by our radiologists, and resulted in delays in report turnaround time. In 2012, we developed a new system to communicate important non-urgent findings (the RADiology CATegorization 3 (RADCAT-3) system) that was easy for radiologists to use and documented communication of results in the electronic medical record. To evaluate the performance of the new system, we reviewed our radiology reports before (June 2011-June 2012) and after (June 2012-June 2014) the implementation of the new system to compare utilization by the radiologists and success in communicating these findings. During the 12 months prior to implementation, 250 radiology reports (0.06 % of all reports) entered our workflow for communicating important non-urgent findings. One-hundred percent were successfully communicated. During the 24 months after implementation, 13,158 radiology reports (1.4 % of all reports) entered our new RADCAT-3 workflow (3995 (0.8 % of all reports) during year 1 and 9163 (1.9 % of all reports) during year 2). 99.7 % of those reports were successfully communicated. We created a reliable system to ensure communication of important but non-urgent findings with providers and/or patients and to document that communication in the electronic medical record. The rapid adoption of the new system by radiologists suggests that they found it easy to use and had confidence in its integrity. This system has the potential to improve patient care by improving the likelihood of appropriate follow-up for important non-urgent findings that could become life threatening.

The ED use and non-urgent visits of elderly patients

OpenAIRE

Gulacti, Umut; Lok, Ugur; Celik, Murat; Aktas, Nurettin; Polat, Haci

2016-01-01

Objective: To evaluate the use of the emergency department (ED) by elderly patients, their non-urgent visits and the prevalence of main disease for ED visits. Methods: This cross-sectional study was conducted on patients aged 65 years and over who visited the ED of a tertiary care university hospital in Turkey between January 2015 and January 2016 retrospectively. Results: A total of 36,369 elderly patients who visited the ED were included in the study. The rate of ED visits by elderly patien...

Emergency Department Non-Urgent Visits and Hospital Readmissions Are Associated with Different Socio-Economic Variables in Italy

OpenAIRE

Barbadoro, Pamela; Di Tondo, Elena; Menditto, Vincenzo Giannicola; Pennacchietti, Lucia; Regnicoli, Februa; Di Stanislao, Francesco; D?Errico, Marcello Mario; Prospero, Emilia

2015-01-01

Objective The aim of this paper was to evaluate socio-economic factors associated to poor primary care utilization by studying two specific subjects: the hospital readmission rate, and the use of the Emergency Department (ED) for non-urgent visits. Methods The study was carried out by the analysis of administrative database for hospital readmission and with a specific survey for non-urgent ED use. Results Among the 416,698 sampled admissions, 6.39% (95% CI, 6.32?6.47) of re-admissions have be...

The longitudinal BMI pattern and body composition of patients with anorexia nervosa who require urgent hospitalization: A case control study.

Science.gov (United States)

Kawai, Keisuke; Yamashita, Sakino; Yamanaka, Takeharu; Gondo, Motoharu; Morita, Chihiro; Nozaki, Takehiro; Takakura, Shu; Hata, Tomokazu; Yamada, Yu; Matsubayashi, Sunao; Takii, Masato; Kubo, Chiharu; Sudo, Nobuyuki

2011-12-05

The prevention of serious physical complications in anorexia nervosa (AN) patients is important. The purpose of this study is to clarify which physical and social factors are related to the necessity for urgent hospitalization of anorexia nervosa (AN) patients in a long-term starvation state. We hypothesized that the change of longitudinal BMI, body composition and social background would be useful as an index of the necessity for urgent hospitalization. AN patients were classified into; urgent hospitalization, due to disturbance of consciousness or difficulty walking(n = 17); planned admission (n = 96); and outpatient treatment only groups (n = 136). The longitudinal BMI pattern and the clinical features of these groups were examined. In the hospitalization groups, comparison was done of body composition variation and the social background, including the educational level and advice from family members. After adjusting for age and duration of illness, the BMI of the urgent hospitalization group was lower than that of the other groups at one year before hospitalization (P < 0.01) and decreased more rapidly (P < 0.01). Urgent hospitalization was associated with the fat free mass (FFM) (P < 0.01). Between the groups, no considerable difference in social factors was found. The longitudinal pattern of BMI and FFM may be useful for understanding the severity in AN from the viewpoint of failure of the homeostasis system.

Blowhole colostomy for the urgent management of distal large bowel obstruction.

Science.gov (United States)

Kasten, Kevin R; Midura, Emily F; Davis, Bradley R; Rafferty, Janice F; Paquette, Ian M

2014-05-01

Complete obstruction of the distal colon or rectum often presents as a surgical emergency. This study evaluated the efficacy of blowhole colostomy versus transverse loop colostomy for the emergent management of distal large intestinal obstruction. Retrospective chart review of all colostomy procedures (CPT 44320) performed for complete distal large bowel obstruction during the past 6 y in a university hospital practice was undertaken. Blowhole was compared with loop colostomy with a primary endpoint of successful colonic decompression. One hundred forty-one patients underwent colostomy creation during the study period. Of these, 61 were completed for acute obstruction of the distal colon or rectum (19 blowhole versus 42 loop colostomy). No differences between study groups were seen in age, gender, body mass index, malnutrition, American Society of Anesthesiology class, time to liquid or regular diet, 30-d or inhospital mortality, or rates of complications. Patients undergoing blowhole colostomy had significantly higher cecal diameters at diagnosis (9.14 versus 7.31 cm, P = 0.0035). Operative time was shorter in blowhole procedures (43 versus 51 min, P = 0.017). Postoperative length of stay was significantly shorter for blowhole colostomy (6 versus 8 d, P = 0.014). The primary endpoint of successful colonic decompression was met in all colostomy patients. Diverting blowhole colostomy is a safe, quick, and effective procedure for the urgent management of distal colonic obstruction associated with obstipation and massive distention. Copyright © 2014 Elsevier Inc. All rights reserved.

Urgent Biophilia: Human-Nature Interactions and Biological Attractions in Disaster Resilience

Directory of Open Access Journals (Sweden)

Keith G. Tidball

2012-06-01

Full Text Available This contribution builds upon contemporary work on principles of biological attraction as well as earlier work on biophilia while synthesizing literatures on restorative environments, community-based ecological restoration, and both community and social-ecological disaster resilience. It suggests that when humans, faced with a disaster, as individuals and as communities and populations, seek engagement with nature to further their efforts to summon and demonstrate resilience in the face of a crisis, they exemplify an urgent biophilia. This urgent biophilia represents an important set of human-nature interactions in SES characterized by hazard, disaster, or vulnerability, often appearing in the 'backloop' of the adaptive cycle. The relationships that human-nature interactions have to other components within interdependent systems at many different scales may be one critical source of resilience in disaster and related contexts. In other words, the affinity we humans have for the rest of nature, the process of remembering that attraction, and the urge to express it through creation of restorative environments, which may also restore or increase ecological function, may confer resilience across multiple scales. In making this argument, the paper also represents a novel contribution to further theorizing alternatives to anthropocentric understandings of human-nature relations, and strongly makes the case for humans as part of, not separate from, ecosystems.

The impact of an early-morning radiologist work shift on the timeliness of communicating urgent imaging findings on portable chest radiography.

Science.gov (United States)

Kaewlai, Rathachai; Greene, Reginald E; Asrani, Ashwin V; Abujudeh, Hani H

2010-09-01

The aim of this study was to assess the potential impact of staggered radiologist work shifts on the timeliness of communicating urgent imaging findings that are detected on portable overnight chest radiography of hospitalized patients. The authors conducted a retrospective study that compared the interval between the acquisition and communication of urgent findings on portable overnight critical care chest radiography detected by an early-morning shift for radiologists (3 am to 11 am) with historical experience with a standard daytime shift (8 am to 5 pm) in the detection and communication of urgent findings in a similar patient population a year earlier. During a 4-month period, 6,448 portable chest radiographic studies were interpreted on the early-morning radiologist shift. Urgent findings requiring immediate communication were detected in 308 (4.8%) studies. The early-morning shift of radiologists, on average, communicated these findings 2 hours earlier compared with the historical control group (P chest radiography of hospitalized patients. Published by Elsevier Inc.

IN URGENT NEED OF A DOCTOR

CERN Multimedia

Medical Service

2001-01-01

IN URGENT NEED OF A DOCTOR GENEVA EMERGENCY SERVICES GENEVA AND VAUD 144 FIRE BRIGADE 118 POLICE 117 CERN FIREMEN 767-44-44 ANTI-POISONS CENTRE Open 24h/24h 01-251-51-51 Patient not fit to be moved, call family doctor, or: GP AT HOME, open 24h/24h 748-49-50 Association Of Geneva Doctors Emergency Doctors at home 07h-23h 322 20 20 Patient fit to be moved: HOPITAL CANTONAL CENTRAL 24 Micheli-du-Crest 372-33-11 ou 382-33-11 EMERGENCIES 382-33-11 ou 372-33-11 CHILDREN'S HOSPITAL 6 rue Willy-Donzé 372-33-11 MATERNITY 32 bvd.de la Cluse 382-68-16 ou 382-33-11 OPHTHALMOLOGY 22 Alcide Jentzer 382-33-11 ou 372-33-11 MEDICAL CENTRE CORNAVIN 1-3 rue du Jura 345 45 50 HOPITAL DE LA TOUR Meyrin EMERGENCIES 719-61-11 URGENCES PEDIATRIQUES 719-61-00 LA TOUR MEDICAL CENTRE 719-74-00 European Emergency Call 112 FRANCE EMERGENCY SERVICES 15 FIRE BRIGADE 18 POLICE 17 CERN FIREMEN AT HOME 00-41-22-767-44-44 ANTI-POISONS CENTRE Open 24h/24h 04-72-11-69-11 All doctors ...

Risks associated with managing asthma without a preventer: urgent healthcare, poor asthma control and over-the-counter reliever use in a cross-sectional population survey.

Science.gov (United States)

Reddel, Helen K; Ampon, Rosario D; Sawyer, Susan M; Peters, Matthew J

2017-09-25

Overuse of asthma relievers, particularly without anti-inflammatory preventers, increases asthma risks. This study aimed to identify how many reliever-only users have urgent healthcare, explore their attitudes and beliefs about asthma and its treatment, and investigate whether purchasing over-the-counter relievers was associated with worse asthma outcomes than by prescription. Cross-sectional population-based Internet survey in Australia. Of 2686 participants ≥16 years with current asthma randomly drawn from a web-based panel, 1038 (50.7% male) used only reliever medication. Urgent asthma-related healthcare; Asthma Control Test (ACT); patient attitudes about asthma and medications; reliever purchase (with/without prescription). Of 1038 reliever-only participants, 23.3% had required urgent healthcare for asthma in the previous year, and only 36.0% had a non-urgent asthma review. Those needing urgent healthcare were more likely than those without such events to be male (56.5% vs 49.0%, p=0.003) and current smokers (29.4% vs 23.3%, p=0.009). Only 30.6% had well-controlled asthma (ACT ≥20) compared with 71.0% of those with no urgent healthcare (pasthma symptoms (vs 5.5% of those without urgent healthcare). Those with urgent healthcare were more frustrated by their asthma and less happy with how they managed it, and they were less confident about their ability to manage worsening asthma, but just as likely as those without urgent healthcare to manage worsening asthma themselves rather than visit a doctor. Reliever-only users purchasing over-the-counter relievers were no more likely than those purchasing relievers by prescription to have uncontrolled asthma (35.9% vs 40.6%, p=0.23) but were less likely to have had a non-urgent asthma review. One-quarter of the reliever-only population had needed urgent asthma healthcare in the previous year, demonstrating the importance of identifying such patients. Their attitudes and beliefs suggest opportunities for targeting this

Urgent embolization for the treatment of serious epistaxis in nasopharyngeal carcinoma after radiotherapy

International Nuclear Information System (INIS)

Zhu Jun; Ni Caifang; Liu Yizhi; Jing Yonghai; Zhu Xiaoli; Zou Jianwei

2009-01-01

Objective: To discuss the clinical effect and safety of urgent embolization with arterial catheterization in the treatment of serious epistaxis in patients with nasopharyngeal carcinoma after radiotherapy. Methods: Fifteen patients with nasopharyngeal carcinoma occurred serious epistaxis after radiotherapy. Because of failure to respond to the treatment of nasal packing and medication, embolization of the bleeding arteries with gelfoam or steel coils was carried out within 1-4 hours after the bleeding. The target arteries were judged by the internal and external carotid angiographic findings. Results: The embolization procedure was successfully completed, in all of 15 patients within 1.5 hours with the technical successful rate of 100%. The bleeding ceased in all 15 patients with the effective rate of 100%. Mild facial palsy occurred in 2 cases, and facial pain of the affected side in one case. All above symptoms were relived and disappeared in about one week after the procedure, leaving no serious complications. Conclusion: Urgent arterial embolization is an effective, safe and simple method for controlling the serious epistaxis in nasopharyngeal carcinoma after radiotherapy. (authors)

Impact of Marijuana Legalization in Colorado on Adolescent Emergency and Urgent Care Visits.

Science.gov (United States)

Wang, George Sam; Davies, Sara Deakyne; Halmo, Laurie Seidel; Sass, Amy; Mistry, Rakesh D

2018-03-30

Approximately 6%-8% of U.S. adolescents are daily/past-month users of marijuana. However, survey data may not reliably reflect the impact of legalization on adolescents. The objective was to evaluate the impact of marijuana legalization on adolescent emergency department and urgent cares visits to a children's hospital in Colorado, a state that has allowed both medical and recreational marijuana. Retrospective review of marijuana-related visits by International Classification of Diseases codes and urine drug screens, from 2005 through 2015, for patients ≥ 13 and marijuana-related visits were identified. Behavioral health evaluation was obtained for 2,813 (67%); a psychiatric diagnosis was made for the majority (71%) of these visits. Coingestants were common; the most common was ethanol (12%). Marijuana-related visits increased from 1.8 per 1,000 visits in 2009 to 4.9 in 2015. (p = marijuana use, our data demonstrate a significant increase in adolescent marijuana-associated emergency department and urgent cares visits in Colorado. Copyright © 2018 The Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Safely Enabling Civilian Unmanned Aerial System (UAS) Operations in Low-Altitude Airspace by Unmanned Aerial System Traffic Management (UTM)

Science.gov (United States)

Kopardekar, Parimal Hemchandra

2015-01-01

Many UAS will operate at lower altitude (Class G, below 2000 feet). There is an urgent need for a system for civilian low-altitude airspace and UAS operations. Stakeholders want to work with NASA to enable safe operations.

The longitudinal BMI pattern and body composition of patients with anorexia nervosa who require urgent hospitalization: A case control study

Directory of Open Access Journals (Sweden)

Kawai Keisuke

2011-12-01

Full Text Available Abstract Background The prevention of serious physical complications in anorexia nervosa (AN patients is important. The purpose of this study is to clarify which physical and social factors are related to the necessity for urgent hospitalization of anorexia nervosa (AN patients in a long-term starvation state. We hypothesized that the change of longitudinal BMI, body composition and social background would be useful as an index of the necessity for urgent hospitalization. Methods AN patients were classified into; urgent hospitalization, due to disturbance of consciousness or difficulty walking(n = 17; planned admission (n = 96; and outpatient treatment only groups (n = 136. The longitudinal BMI pattern and the clinical features of these groups were examined. In the hospitalization groups, comparison was done of body composition variation and the social background, including the educational level and advice from family members. Results After adjusting for age and duration of illness, the BMI of the urgent hospitalization group was lower than that of the other groups at one year before hospitalization (P Conclusions The longitudinal pattern of BMI and FFM may be useful for understanding the severity in AN from the viewpoint of failure of the homeostasis system.

Newly Discovered Orangutan Species Requires Urgent Habitat Protection.

Science.gov (United States)

Sloan, Sean; Supriatna, Jatna; Campbell, Mason J; Alamgir, Mohammed; Laurance, William F

2018-05-03

Nater, et al.[1] recently identified a new orangutan species (Pongo tapanuliensis) in northern Sumatra, Indonesia-just the seventh described species of living great ape. The population of this critically-endangered species is perilously small, at only ∼800 individuals [1], ranking it among the planet's rarest fauna. We assert that P. tapanuliensis is highly vulnerable to extinction because its remaining habitat is small, fragmented, and poorly protected. While road incursions within its habitat are modest-road density is only one-eighth that of northern Sumatra-over one-fifth of its habitat is zoned for agricultural conversion or is comprised of mosaic agricultural and regrowth/degraded forest. Additionally, a further 8% will be affected by flooding and infrastructure development for a hydroelectric project. We recommend urgent steps to increase the chance that P. tapanuliensis will persist in the wild. Copyright © 2018 Elsevier Ltd. All rights reserved.

Derivation and validation of a diagnostic score based on case-mix groups to predict 30-day death or urgent readmission.

Science.gov (United States)

van Walraven, Carl; Wong, Jenna; Forster, Alan J

2012-01-01

Between 5% and 10% of patients die or are urgently readmitted within 30 days of discharge from hospital. Readmission risk indexes have either excluded acute diagnoses or modelled them as multiple distinct variables. In this study, we derived and validated a score summarizing the influence of acute hospital diagnoses and procedures on death or urgent readmission within 30 days. From population-based hospital abstracts in Ontario, we randomly sampled 200 000 discharges between April 2003 and March 2009 and determined who had been readmitted urgently or died within 30 days of discharge. We used generalized estimating equation modelling, with a sample of 100 000 patients, to measure the adjusted association of various case-mix groups (CMGs-homogenous groups of acute care inpatients with similar clinical and resource-utilization characteristics) with 30-day death or urgent readmission. This final model was transformed into a scoring system that was validated in the remaining 100 000 patients. Patients in the derivation set belonged to 1 of 506 CMGs and had a 6.8% risk of 30-day death or urgent readmission. Forty-seven CMG codes (more than half of which were directly related to chronic diseases) were independently associated with this outcome, which led to a CMG score that ranged from -6 to 7 points. The CMG score was significantly associated with 30-day death or urgent readmission (unadjusted odds ratio for a 1-point increase in CMG score 1.52, 95% confidence interval [CI] 1.49-1.56). Alone, the CMG score was only moderately discriminative (C statistic 0.650, 95% CI 0.644-0.656). However, when the CMG score was added to a validated risk index for death or readmission, the C statistic increased to 0.759 (95% CI 0.753-0.765). The CMG score was well calibrated for 30-day death or readmission. In this study, we developed a scoring system for acute hospital diagnoses and procedures that could be used as part of a risk-adjustment methodology for analyses of postdischarge

Effect of marital status on the outcome of patients undergoing elective or urgent coronary revascularization.

Science.gov (United States)

Barbash, Israel M; Gaglia, Michael A; Torguson, Rebecca; Minha, Sa'ar; Satler, Lowell F; Pichard, Augusto D; Waksman, Ron

2013-10-01

Marriage confers various health advantages in the general population. However, the added value of marriage among patients who undergo percutaneous coronary intervention (PCI) beyond the standard cardiovascular risk factors is not clear. This study aimed to assess the effects of marital status on outcomes of patients undergoing elective or urgent PCI. Clinical observational analysis of consecutive patients undergoing elective or urgent PCI from 1993 to 2011 was performed. Patients were stratified by marital status, comparing married to unmarried patients. Clinical outcome up to 12 months was obtained by telephone contact or office visit. A total of 11,216 patients were included in the present analysis; 55% were married and 45% unmarried. Significant differences in baseline characteristics were noted, including a lower prevalence of hypertension (86% vs 88%), diabetes (34% vs 38%), and smoking (19% vs 25%) among married vs unmarried patients, respectively (P married patients had a higher prevalence of hypercholesterolemia and family history of coronary artery disease. Early and late major adverse cardiac event rates were significantly lower for married vs unmarried patients up to 1 year (13.3% vs 8.2%, P Married status was independently associated with improved outcome in multivariable analysis (hazard ratio 0.7, 95% CI 0.6-0.9). Married patients who undergo urgent or elective PCI have superior short- and long-term outcomes up to 1 year when compared with unmarried patients. These benefits persist after adjustment for multiple traditional cardiovascular risk factors. © 2013.

75 FR 67013 - Unexpected Urgent Refugee and Migration Needs Resulting from Violence in Kyrgyzstan

Science.gov (United States)

2010-11-01

... August 26, 2010 Unexpected Urgent Refugee and Migration Needs Resulting from Violence in Kyrgyzstan... laws of the United States, including section 2(c)(1) of the Migration and Refugee Assistance Act of... amount not to exceed $9.5 million from the United States Emergency Refugee and Migration Assistance Fund...

If climate action becomes urgent: The importance of response times for various climate strategies

NARCIS (Netherlands)

van Vuuren, D.P.; Stehfest, E.

2013-01-01

Most deliberations on climate policy are based on a mitigation response that assumes a gradually increasing reduction over time. However, situations may occur where a more urgent response is needed. A key question for climate policy in general, but even more in the case a rapid response is needed,

Patient Reasons for Non-Urgent Utilization of the Dwight David Eisenhower Army Medical Center Emergency Department

National Research Council Canada - National Science Library

Sizemore, Charles J

2004-01-01

.... A review of the present body of literature revealed common themes why non-urgent patients typically present at emergency departments, the impacts to hospitals, and possible initiatives that could be...

Relevance of Riverine Capability for Today’s Portuguese Navy

Science.gov (United States)

2009-01-01

Crespo, 537-550. 21 Cann, Brown Waters ofAfrica, 46. 22 Jose Alberto Lopes Carvalheira, "Acyao da Marinha em Aguas Interiores (1961-1971)" [Naval...Lopes Carvalheira, Jose Alberto. "Acyao da Marinha em Aguas Interiores (1961-1971)." [Naval Operations in Inland Waters (1961-1971)]. In the...Americas Country Antigua and Barbados Argentina Aruba Barbados Bermuda Bolivia Brazil Canada Chile Colombia Cuba Dominica Dominican Republic Equator Grenada

Treatment of Childhood Diarrhoea by Operators of Drug Stores in ...

African Journals Online (AJOL)

We recommend an urgent program of intervention targeted specifically at drug store operator/attendants on the management of diarrhoea in the short term while ORT instructions and management of diarrhoea be incorporated into health education curriculum in primary and secondary schools in Nigeria. Nigerian Medical ...

SMTMS - SM18 Magnet Tests Management System: a Brief User Guide for Operation

CERN Document Server

Chohan, N; CERN. Geneva. AB Department

2004-01-01

As the number of magnets to be tested under cryogenic conditions increased during the course of 2003, it was clear that a versatile computer-based tool was urgently required for keeping track of all the necessary tests that were carried out for each magnet as well as the outcome of the tests. It was also essential to keep track of the times taken during different phases in magnet preparation for the tests, including Cryogenic connections, cool-downs, warm ups and so forth. SMTMS uses the CERN provided backbone in Web based services and Access database to fulfil these urgent needs and was successfully made operational within a very short time. It has considerably eased & simplified the work in operation for cold testing the magnets with a few permanent core operational staff and a considerably large number of rotational personnel of short duration. This is because SMTMS is now the exclusive & unique Web-based tool to manage the tests and collate the essential electrical characterisation and quench resu...

Cerebral oxygenation monitoring in patients with bilateral carotid stenosis undergoing urgent cardiac surgery: Observational case series

Directory of Open Access Journals (Sweden)

Dincer Aktuerk

2016-01-01

Full Text Available Background: Patients with significant bilateral carotid artery stenosis requiring urgent cardiac surgery have an increased risk of stroke and death. The optimal management strategy remains inconclusive, and the available evidence does not support the superiority of one strategy over another. Materials and Methods: A number of noninvasive strategies have been developed for minimizing perioperative stroke including continuous real-time monitoring of cerebral oxygenation with near-infrared spectroscopy (NIRS. The number of patients presenting with this combination (bilateral significant carotid stenosis requiring urgent cardiac surgery in any single institution will be small and hence there is a lack of large randomized studies. Results: This case series describes our early experience with NIRS in a select group of patients with significant bilateral carotid stenosis undergoing urgent cardiac surgery (n = 8. In contrast to other studies, this series is a single surgeon, single center study, where the entire surgery (both distal ends and proximal ends was performed during single aortic clamp technique, which effectively removes several confounding variables. NIRS monitoring led to the early recognition of decreased cerebral oxygenation, and corrective steps (increased cardiopulmonary bypass flow, increased pCO 2 , etc., were taken. Conclusion: The study shows good clinical outcome with the use of NIRS. This is our "work in progress," and we aim to conduct a larger study.

75 FR 34617 - Unexpected Urgent Refugee and Migration Needs Related to Somalia and Food Pipeline Breaks for...

Science.gov (United States)

2010-06-18

... unexpected and urgent refugee and migration needs, including by contributions to international, governmental, and nongovernmental organizations and payment of administrative expenses of the Bureau of Population...

Surgical Site Infections and Associated Operative Characteristics.

Science.gov (United States)

Waltz, Paul K; Zuckerbraun, Brian S

Surgical site infection (SSI) contributes significantly to surgical morbidity. Patient factors and operative factors contribute to the risk of development of SSI. This review focuses on understanding operative characteristics that are associated with an increased risk of SSI. Much attention has been given to protocol care to reduce SSI, such as hair removal, skin preparation, and pre-operative antibiotic agents. Even with this, the appropriate antibiotic and re-dosing regimens often remain a challenge. Other operative factors such as blood loss/transfusion, emergency/urgent cases, duration of the operation, type of anesthesia, and resident involvement are also potentially modifiable to reduce the risk of SSI. Data are reviewed to highlight the increased risk associated with such factors. Strategies to reduce risk, such as operative care bundles, have significant promise to reduce the incidence of SSI for any given procedure.

"Why Is This Patient Being Sent Here?": Communication from Urgent Care to the Emergency Department.

Science.gov (United States)

Gardner, Rebekah; Choo, Esther K; Gravenstein, Stefan; Baier, Rosa R

2016-03-01

Despite patients' increasing use of urgent care centers (UCC), little is known about how urgent care clinicians communicate with the emergency department (ED). To assess ED clinicians' perceptions of the quality and consistency of communication when patients are referred from UCCs to EDs. Emergency medicine department chairs distributed a brief, electronic survey to a statewide sample of ED clinicians via e-mail. The survey included multiple-choice and free-text questions focused on types of communication desired and received from UCCs, types of test results available on transfer, and suggestions for improvement. Of 199 ED clinicians, 102 (51.3%) responded. More than four out of five respondents "somewhat" or "strongly agreed" that each of the following would be helpful: a telephone call, the reason for referral, specific concern, a copy of the chart, and UCC contact information. However, ED clinicians reported not consistently receiving these: only a fifth (21.6%) of clinicians reported receiving the specific concern for their last 5 patients transferred from a UCC, and 34.3% recalled receiving a copy of the chart. Overall, 54.9% reported receiving laboratory test results "often or almost always," 49.0% electrocardiograms, and 44.1% imaging reports. Qualitative analysis revealed several themes: incomplete data when patients are referred; barriers to discussion between ED and urgent care clinicians; and possible solutions to improve communication. Our findings highlight variation in communication from UCCs to EDs, indicating a need to improve communication standards and practices. We identify several potential ways to improve this clinical information hand-off. Copyright © 2016 Elsevier Inc. All rights reserved.

3 CFR - Unexpected Urgent Refugee and Migration Needs Related to the Continuing Conflict in Pakistan

Science.gov (United States)

2010-01-01

... 3 The President 1 2010-01-01 2010-01-01 false Unexpected Urgent Refugee and Migration Needs Related to the Continuing Conflict in Pakistan Presidential Documents Other Presidential Documents... to the Continuing Conflict in Pakistan Memorandum for the Secretary of State By the authority vested...

[Are urgent imaging tests indicated in the management of acute pancreatitis?].

Science.gov (United States)

Fornell Pérez, R; Lozano Rodríguez, A

2016-01-01

Acute pancreatitis is a common emergency within abdominal disease. It is accepted that two of three conditions must be fulfilled for its diagnosis: characteristic clinical presentation, characteristic laboratory findings, and/or characteristic diagnostic imaging findings. The first two conditions are the most often used, probably for reasons of efficiency and frequency. Nevertheless, the need for imaging studies is sometimes a source of conflict. For this reason, we decided to review the current evidence regarding the indication of urgent imaging tests in the management of acute pancreatitis. Copyright © 2015 SERAM. Published by Elsevier España, S.L.U. All rights reserved.

El Mapa de la Incapacidad en España una necesidad urgente

OpenAIRE

Araceli López-Guillén García; José Manuel Vicente Pardo

2015-01-01

Resumen: Es urgente adaptar los sistemas de recogida de datos en incapacidad laboral para conseguir una mejor explotación epidemiológica de los mismos que facilite conocer la situación, análisis y planificación estratégica sobre incapacidad, creando con una base de datos mínimos básicos el Mapa de la Incapacidad en España permitiendo conocer las causas y el impacto de las situaciones de incapacidad laboral, practicar una gestión integral de recursos, prevenir las situaciones de incapacidad la...

Prevalence of sickle cell disease among Grenadian newborns.

Science.gov (United States)

Antoine, Magdalene; Lee, Ketty; Donald, Tyhiesia; Belfon, Yonni; Drigo, Ali; Polson, Sharon; Martin, Francis; Mitchell, George; Etienne-Julan, Maryse; Hardy-Dessources, Marie-Dominique

2018-03-01

Objective To establish the birth prevalence of sickle cell disease in Grenada, with a view to assess the requirement for a population-based neonatal screening programme. Methods A two-year pilot neonatal screening programme, involving the Ministry of Health of Grenada, the Sickle Cell Association of Grenada, and the diagnostic laboratory of hemoglobinopathies of the University Hospital of Guadeloupe, was implemented in 2014-2015 under the auspices of the Caribbean Network of Researchers on Sickle Cell Disease and Thalassemia. Results Analysis of 1914 samples processed identified the following abnormal phenotypes: 10 FS, 2 FSC, 183 FAS, 63 FAC. These data indicate β s and β c allele frequencies of 0.054 and 0.018, respectively. Conclusion Neonatal screening conducted in the framework of this Caribbean cooperation can allow rapid detection and earlier management of affected children.

76 FR 53295 - Unexpected Urgent Refugee and Migration Needs Related to the Horn of Africa

Science.gov (United States)

2011-08-25

...-12 of August 8, 2011--Unexpected Urgent Refugee and Migration Needs Related to the Horn of Africa... Migration Needs Related to the Horn of Africa Memorandum for the Secretary of State By the authority vested... Department of State, related to the humanitarian crisis in the Horn of Africa. You are authorized and...

Operational integration in primary health care: patient encounters and workflows.

Science.gov (United States)

Sifaki-Pistolla, Dimitra; Chatzea, Vasiliki-Eirini; Markaki, Adelais; Kritikos, Kyriakos; Petelos, Elena; Lionis, Christos

2017-11-29

Despite several countrywide attempts to strengthen and standardise the primary healthcare (PHC) system, Greece is still lacking a sustainable, policy-based model of integrated services. The aim of our study was to identify operational integration levels through existing patient care pathways and to recommend an alternative PHC model for optimum integration. The study was part of a large state-funded project, which included 22 randomly selected PHC units located across two health regions of Greece. Dimensions of operational integration in PHC were selected based on the work of Kringos and colleagues. A five-point Likert-type scale, coupled with an algorithm, was used to capture and transform theoretical framework features into measurable attributes. PHC services were grouped under the main categories of chronic care, urgent/acute care, preventive care, and home care. A web-based platform was used to assess patient pathways, evaluate integration levels and propose improvement actions. Analysis relied on a comparison of actual pathways versus optimal, the latter ones having been identified through literature review. Overall integration varied among units. The majority (57%) of units corresponded to a basic level. Integration by type of PHC service ranged as follows: basic (86%) or poor (14%) for chronic care units, poor (78%) or basic (22%) for urgent/acute care units, basic (50%) for preventive care units, and partial or basic (50%) for home care units. The actual pathways across all four categories of PHC services differed from those captured in the optimum integration model. Certain similarities were observed in the operational flows between chronic care management and urgent/acute care management. Such similarities were present at the highest level of abstraction, but also in common steps along the operational flows. Existing patient care pathways were mapped and analysed, and recommendations for an optimum integration PHC model were made. The developed web

Environmental Assessment of Urgent-Relief Acceptance of Foreign Research Reactor Spent Nuclear Fuel

International Nuclear Information System (INIS)

1994-04-01

The Department of Energy has completed the Environmental Assessment (EA) of Urgent-Relief Acceptance of Foreign Research Reactor Spent Nuclear Fuel and issued a Finding of No Significant Impact (FONSI) for the proposed action. The EA and FONSI are enclosed for your information. The Department has decided to accept a limited number of spent nuclear fuel elements (409 elements) containing uranium that was enriched in the United States from eight research reactors in Austria, Denmark, Germany, Greece, the Netherlands, Sweden, and Switzerland. This action is necessary to maintain the viability of a major US nuclear weapons nonproliferation program to limit or eliminate the use of highly enriched uranium in civil programs. The purpose of the EA is to maintain the cooperation of the foreign research reactor operators with the nonproliferation program while a more extensive Environmental Impact Statement (EIS) is prepared on a proposed broader policy involving the acceptance of up to 15,000 foreign research reactor spent fuel elements over a 10 to 15 year period. Based on an evaluation of transport by commercial container liner or chartered vessel, five eastern seaboard ports, and truck and train modes of transporting the spent fuel overland to the Savannah River Sits, the Department has concluded that no significant impact would result from any combination of port and made of transport. In addition, no significant impacts were found from interim storage of spent fuel at the Savannah River Site

Environmental Assessment of Urgent-Relief Acceptance of Foreign Research Reactor Spent Nuclear Fuel

Energy Technology Data Exchange (ETDEWEB)

1994-04-01

The Department of Energy has completed the Environmental Assessment (EA) of Urgent-Relief Acceptance of Foreign Research Reactor Spent Nuclear Fuel and issued a Finding of No Significant Impact (FONSI) for the proposed action. The EA and FONSI are enclosed for your information. The Department has decided to accept a limited number of spent nuclear fuel elements (409 elements) containing uranium that was enriched in the United States from eight research reactors in Austria, Denmark, Germany, Greece, the Netherlands, Sweden, and Switzerland. This action is necessary to maintain the viability of a major US nuclear weapons nonproliferation program to limit or eliminate the use of highly enriched uranium in civil programs. The purpose of the EA is to maintain the cooperation of the foreign research reactor operators with the nonproliferation program while a more extensive Environmental Impact Statement (EIS) is prepared on a proposed broader policy involving the acceptance of up to 15,000 foreign research reactor spent fuel elements over a 10 to 15 year period. Based on an evaluation of transport by commercial container liner or chartered vessel, five eastern seaboard ports, and truck and train modes of transporting the spent fuel overland to the Savannah River Sits, the Department has concluded that no significant impact would result from any combination of port and made of transport. In addition, no significant impacts were found from interim storage of spent fuel at the Savannah River Site.

Improving the transport of urgent specimens to an off-site laboratory using a novel sticker-tracker.

Science.gov (United States)

Sepahzad, Afsoon; Ejiofor, Florence; Giles, Susan; Klaber, Robert

2013-01-01

Obtaining results for urgent microbiology specimens in an efficient manner is imperative to ensure that patients receive appropriate antibiotic therapy. A previous audit carried out in the Paediatric department of a central teaching hospital and a number of clinical incidents, highlighted a delay in transport of specimens (exceeding eight hours) and 'missing' specimens. This results in empirical antibiotic treatment of infection, with delay in confirming microbiology result and unnecessary, distressing repeat investigation. As an initial step we sought staff opinion to further explore the problem. A sticker was designed for the microbiology specimen bag to assign accountability, track each step in the transport process and to raise awareness of the problem. The sticker required the member of staff responsible at each stage of the process to time, date and sign it, to allow tracking of potential delays. The new sticker tracking system was promoted and launched in the Paediatric department. Initial challenges included lack of awareness of the protocol and lack of pods for sending urgent specimens. The team met regularly and completed stickers were analysed weekly to identify on-going issues and to devise solutions. Consequently total transport time was reduced to an average of 69 minutes by September (within four hr target). Our intervention improved the efficiency and reliability of urgent specimen transport. This is likely to result in safer antibiotic use and avoid the need for repeat investigation. The system is now also used in the Neonatal department and has lead to the development of a new 'Central Specimens Reception'.

Multiple Repeated Cesarean Deliveries: Operative Complications in the Fourth and Fifth Surgeries in Urgent and Elective Cases

Directory of Open Access Journals (Sweden)

Ali Gedikbasi

2010-12-01

Conclusion: Multiple repeated cesarean sections increase the risks for operative complications and poor perinatal outcomes. Patients must be informed about the related risks of multiple repeated cesarean sections and tubal ligation needs to be encouraged.

Quality of emergency rooms and urgent care services: user satisfaction.

Science.gov (United States)

Lima, Cássio de Almeida; Santos, Bruna Tatiane Prates dos; Andrade, Dina Luciana Batista; Barbosa, Francielle Alves; Costa, Fernanda Marques da; Carneiro, Jair Almeida

2015-01-01

To evaluate the quality of emergency rooms and urgent care services according to the satisfaction of their users. A cross-sectional descriptive study with a quantitative approach. The sample comprised 136 users and was drawn at random. Data collection took place between October and November 2012 using a structured questionnaire. Participants were mostly male (64.7%) aged less than 30 years (55.8%), and the predominant level of education was high school (54.4%). Among the items evaluated, those that were statistically associated with levels of satisfaction with care were waiting time, confidence in the service, model of care, and the reason for seeking care related to acute complaints, cleanliness, and comfortable environment. Accessibility, hospitality, and infrastructure were considered more relevant factors for patient satisfaction than the cure itself.

75 FR 25271 - Office of Refugee Resettlement; Urgent Single Source Grant to Survivors of Torture International...

Science.gov (United States)

2010-05-07

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Administration for Children and Families Office of Refugee Resettlement; Urgent Single Source Grant to Survivors of Torture International (SOTI) AGENCY: Office of Refugee... effects of torture. (2) Social and legal services for victims of torture. (3) Research and training for...

Current status of alcohol marketing policy--an urgent challenge for global governance.

Science.gov (United States)

Casswell, Sally

2012-03-01

To review research literature and available information on the extent and impacts of marketing, current policy response and the interests engaged in the policy debate in order to inform recommendations for policy change on alcohol marketing. Relevant literature, including systematic reviews and publicly available information (websites and participant observation) is reviewed and synthesized. Alcohol marketing has expanded markedly in the past 50 years and, while there remains uncertainty about the impact across the population, there is now clear evidence of its impact on the consumption of young people. Few countries have effective policy in place restricting alcohol marketing, and there is a lack of an international response to alcohol marketing which crosses national boundaries. The protection of alcohol marketing has been a major focus for vested interest groups and this has affected governmental response at national and international levels. There has been a lack of non-governmental organization engagement. The policy response to tobacco marketing provides a clear contrast to that of alcohol marketing policy and provides a model for alcohol marketing policy. The global exposure of young people to alcohol marketing requires an urgent policy response. The Framework Convention on Tobacco Control provides an appropriate model for global governance to control alcohol marketing. There are extant examples of national level legislation achieving comprehensive bans with France's Loi Evin providing a feasible model. Resources from philanthropic organizations to allow non-governmental organization engagement are urgently required, as is engagement by the governmental sector independent of commercial influence. © 2012 The Author, Addiction © 2012 Society for the Study of Addiction.

The carcinogenic effects of aspartame: The urgent need for regulatory re-evaluation.

Science.gov (United States)

Soffritti, Morando; Padovani, Michela; Tibaldi, Eva; Falcioni, Laura; Manservisi, Fabiana; Belpoggi, Fiorella

2014-04-01

Aspartame (APM) is an artificial sweetener used since the 1980s, now present in >6,000 products, including over 500 pharmaceuticals. Since its discovery in 1965, and its first approval by the US Food and Drugs Administration (FDA) in 1981, the safety of APM, and in particular its carcinogenicity potential, has been controversial. The present commentary reviews the adequacy of the design and conduct of carcinogenicity bioassays on rodents submitted by G.D. Searle, in the 1970s, to the FDA for market approval. We also review how experimental and epidemiological data on the carcinogenic risks of APM, that became available in 2005 motivated the European Commission (EC) to call the European Food and Safety Authority (EFSA) for urgent re-examination of the available scientific documentation (including the Searle studies). The EC has further requested that, if the results of the evaluation should suggest carcinogenicity, major changes must be made to the current APM specific regulations. Taken together, the studies performed by G.D. Searle in the 1970s and other chronic bioassays do not provide adequate scientific support for APM safety. In contrast, recent results of life-span carcinogenicity bioassays on rats and mice published in peer-reviewed journals, and a prospective epidemiological study, provide consistent evidence of APM's carcinogenic potential. On the basis of the evidence of the potential carcinogenic effects of APM herein reported, a re-evaluation of the current position of international regulatory agencies must be considered an urgent matter of public health. © 2014 Wiley Periodicals, Inc.

Urgent medical response in CBR incidents

International Nuclear Information System (INIS)

Castulik, P.; Slabotinsky, J.; Kralik, L.; Bradka, S.

2009-01-01

During CBR incidents with releases of hazardous materials (HazMat), there is extremely urgent aim of first rescuing responders to safe the life for as much as possible victims and reducing health consequences from the exposure of the HazMat. Highest priority of the response is to be applied, if victims are exposed with chemicals through their airways and/or mucous membranes. There is general approach in the emergency medical services (EMS) stated that the victims being in critical status have to receive emergency medical care on-site even prior the transportation to a medical facility. However, in a case of CBR events the EMS prefer to provide the First Aid for victims to be already decontaminated as mass casualties, e.g. by the firemen and transferred to a safe zone. This approach is to be time consuming and thus creating delays in medical care not in the favor of a victim's successful survival. In order to overcome this approach, there are needs for eminent ceasing of the victims exposure, protection of breathing tract/ventilation support and administration of antidotes, if available. All this have to be done in shortest time since HazMat incident/accident occurs. This presentation is focusing on emergency provisions for saving victims directly in contaminated environment through the assistance by responders, concentrating on search and rescue of victims, their emergency decontamination, breathing protection, clothing removal, ventilation support, antidote administration, fixing and bandage of trauma injuries prior transportation and/or mass decontamination. This experience is shared based on a field exercise with the EMS volunteers (Red Cross), fire brigade volunteers and university's students.(author)

The hydrogen economy urgently needs environmentally sustainable hydroelectricity

International Nuclear Information System (INIS)

Goodland, R.

1995-01-01

Only two sources of energy were said to have the capacity to bridge the transition to fully sustainable and renewable energy, namely natural gas and hydro. The argument was made that because of this advantage, both forms will have to be promoted fast, since the transition to sustainable energy is urgent. In so far as natural gas supplies are concerned, it was estimated that they will last for perhaps the next 50 years, whereas hydroelectric potential is practically unlimited. Developing nations could vastly accelerate their development, reduce poverty and approach sustainability by exporting hydro to industrial countries. Similarly, industrial nations switching from fossil fuels to hydrogen could move up the environmental ranking, and significantly help alleviating global pollution and climate risks. Environmental ranking of new energy sources, world reservoirs of hydroelectric power, environmental and social ranking of hydro sites, the environmental impacts of hydro projects, and the concept of environmental sustainability in hydro reservoirs, were summarized. Greater acceptance of the need for sustainable development by the hydro industry was urged, along with more care in selecting hydro development sites with sustainability as a prime objective. 23 refs., 6 figs

Conservative approach versus urgent appendectomy in surgical management of acute appendicitis with abscess or phlegmon Resultados del tratamiento conservador inicial y de la cirugía urgente en la apendicitis aguda evolucionada

Directory of Open Access Journals (Sweden)

J. M. Aranda-Narváez

2010-11-01

Full Text Available Background: Surgical management of acute appendicitis with appendiceal abscess or phlegmon remains controversial. We studied the results of initial conservative treatment (antibiotics and percutaneous drainage if necessary, with or without interval appendectomy compared with immediate surgery. Methods: We undertook an observational, retrospective cohort study of patients with a clinical and radiological diagnosis of acute appendicitis with an abscess or phlegmon, treated in our hospital between January 1997 and March 2009. Patients younger than 14, with severe sepsis or with diffuse peritonitis were excluded. A study group of 15 patients with acute appendicitis complicated with an abscess or phlegmon underwent conservative treatment. A control group was composed of the other patients, who all underwent urgent appendectomy, matched for age and later randomized 1:1. The infectious risk stratification was established with the National Nosocomial Infections Surveillance System (NNIS index. Dependent variables were hospital stay and surgical site infection. Analysis was with SPSS, with p Introducción: Existe controversia acerca del tratamiento idóneo de la apendicitis aguda evolucionada en forma de absceso o flemón. Realizamos un estudio para la evaluación de resultados del tratamiento conservador inicial (antibiótico y drenaje percutáneo si se precisa, con/sin apendicectomía diferida y del tratamiento quirúrgico urgente. Método: Estudio observacional analítico de cohortes retrospectivas. Criterios de inclusión: pacientes con diagnóstico clínico y radiológico de apendicitis aguda evolucionada en forma de absceso o flemón, tratados en nuestro hospital entre enero 1997 y marzo 2009, excluyendo pacientes pediátricos, con sepsis grave o peritonitis difusa. En 15 pacientes con apendicitis complicada con absceso o flemón (cohorte de estudio se indicó tratamiento conservador inicial. El grupo control se obtuvo del resto de pacientes (en

Role of enhanced multi-detector-row computed tomography before urgent endoscopy in acute upper gastrointestinal bleeding.

Science.gov (United States)

Miyaoka, Youichi; Amano, Yuji; Ueno, Sayaka; Izumi, Daisuke; Mikami, Hironobu; Yazaki, Tomotaka; Okimoto, Eiko; Sonoyama, Takayuki; Ito, Satoko; Fujishiro, Hirofumi; Kohge, Naruaki; Imaoka, Tomonori

2014-04-01

Multi-detector-row computed tomography (MDCT) has been reported to be a potentially useful modality for detection of the bleeding origin in patients with acute upper massive gastrointestinal (GI) bleeding. The purpose of this study is to investigate the efficacy of MDCT as a routine method for detecting the origin of acute upper GI bleeding prior to urgent endoscopy. Five hundred seventy-seven patients with acute upper GI bleeding (514 nonvariceal patients, 63 variceal patients) who underwent urgent upper GI endoscopy were retrospectively analyzed. Patients were divided into three groups: enhanced MDCT, unenhanced MDCT, and no MDCT before endoscopy. The diagnostic accuracy of MDCT for detection of the bleeding origin was evaluated, and the average procedure times needed to endoscopically identify the bleeding origin were compared between groups. Diagnostic accuracy among endoscopists was 55.3% and 14.7% for the enhanced MDCT and unenhanced MDCT groups, respectively. Among nonvariceal patients, accuracy was 50.2% in the enhanced MDCT group, which was significantly better than that in the unenhanced MDCT group (16.5%). In variceal patients, accuracy was significantly better in the enhanced MDCT group (96.4%) than in the unenhanced MDCT group (0.0%). These accuracies were similar to those achieved by expert radiologists. The average procedure time to endoscopic detection of the bleeding origin in the enhanced MDCT group was significantly faster than that in the unenhanced MDCT and no-MDCT groups. Enhanced MDCT preceding urgent endoscopy may be an effective modality for the detection of bleeding origin in patients with acute upper GI bleeding. © 2013 Journal of Gastroenterology and Hepatology Foundation and Wiley Publishing Asia Pty Ltd.

Is operational research delivering the goods? The journey to success in low-income countries

OpenAIRE

Zachariah, R; Ford, N; Maher, D; Bissell, K; Van den Bergh, R; van den Boogaard, W; Reid, T; Castro, K G; Draguez, B; von Schreeb, J; Chakaya, J; Atun, R; Lienhardt, C; Enarson, D A; Harries, A D

2012-01-01

Operational research in low-income countries has a key role in filling the gap between what we know from research and what we do with that knowledge-the so-called know-do gap, or implementation gap. Planned research that does not tangibly affect policies and practices is ineffective and wasteful, especially in settings where resources are scarce and disease burden is high. Clear parameters are urgently needed to measure and judge the success of operational research. We define operational rese...

Integrating community children’s nursing in urgent and emergency care: a qualitative comparison of two teams in North West England

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Kyle Richard G

2012-07-01

Full Text Available Abstract Background Despite the policy principle that “children are best cared for at home whenever possible” children continue to have high rates of emergency department (ED attendance and emergency hospital admission. Community Children’s Nursing Teams (CCNTs can care for acutely ill children at home but their potential to provide an alternative to ED attendance and hospitalisation depends on effective integration with other services in the urgent care system, such as EDs and Observation and Assessment Units (OAUs. Although challenges of integrating CCNTs have been identified, there has been no comparative assessment of the factors that facilitate or hinder integration of care of acutely ill children by CCNTs with the urgent care system. The aim of this study was to identify enablers and barriers to integration of CCNTs with urgent and emergency care. Methods Comparative case studies were conducted of two CCNTs serving Primary Care Trusts in North West England. Twenty-two health professionals including CCNT managers and staff; paediatricians; nurses; children’s ward, ED and OAU staff; commissioners of children’s services; GPs and primary care staff were interviewed between June 2009 and February 2010. Qualitative data were analysed thematically using the Framework approach. Results Barriers to integration included paediatricians’ perceived lack of ownership of the CCNT, poor communication between consultants and community children’s nurses (CCNs, and weak personal relationships. This prevented early referral to the CCNT as an alternative to hospital care. Enablers of integration included co-location and rotation of CCNs through urgent care settings including OAUs and EDs. This enabled nurses to develop skills, make decisions about referral to home care and gain the confidence of referring clinicians. Conclusions Integration of CCNTs at multiple points in the urgent care system is required in order to provide an alternative to

Priority and Negotiation Based Dynamic Spectrum Allocation Scheme for Multiple Radio Access Network Operators

Science.gov (United States)

Kim, Hoon; Hyon, Taein; Lee, Yeonwoo

Most of previous works have presented the dynamic spectrum allocation (DSA) gain achieved by utilizing the time or regional variations in traffic demand between multi-network operators (NOs). In this paper, we introduce the functionalities required for the entities related with the spectrum sharing and allocation and propose a spectrum allocation algorithm while considering the long-term priority between NOs, the priority between multiple class services, and the urgent bandwidth request. To take into account the priorities among the NOs and the priorities of multiple class services, a spectrum sharing metric (SSM) is proposed, while a negotiation procedure is proposed to treat the urgent bandwidth request.

Train operation in emergencies

CERN Document Server

Jia, Limin; Qin, Yong

2017-01-01

This book presents the latest findings on train operation theories and methods in the context of emergencies. It examines and assesses a range of aspects—including the definition of a railway emergency, transport organization modes in emergencies, calculating railway transport capacity in emergencies, line planning in emergencies, train re-pathing in emergencies and train re-scheduling in emergencies—that are urgently needed in the railway transportation field, which faces the serious challenge of dealing with emergencies worldwide. The book highlights the latest research results in an integrated and systematic way, and the methodology presented is oriented on real-world problems, allowing it to be used not only directly in railway operational management, but also as the point of departure for further applications or theoretical research. As such, the book will be of considerable interest to graduate students and researchers in the field of traffic and transportation engineering.>.

Estacionalidad e impacto del turismo en la atención urgente hospitalaria y primaria

OpenAIRE

Mateu Sbert, Josep

2015-01-01

Los servicios de urgencias médicas hospitalarios y de atención primaria son considerados claves en el funcionamiento del sistema sanitario. Modelizar el comportamiento temporal de las visitas urgentes es fundamental para planificar adecuadamente su demanda, especialmente en aquellas regiones donde se producen altas oscilaciones estacionales de población. El objetivo de esta tesis doctoral es estimar el impacto del turismo sobre las series de urgencias médicas de titularidad pública, tanto de ...

FFR-guided multivessel stenting reduces urgent revascularization compared with infarct-related artery only stenting in ST-elevation myocardial infarction: A meta-analysis of randomized controlled trials.

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Gupta, Ankur; Bajaj, Navkaranbir S; Arora, Pankaj; Arora, Garima; Qamar, Arman; Bhatt, Deepak L

2018-02-01

Randomized controlled trials (RCTs) have shown fractional flow reserve-guided (FFR) multivessel stenting to be superior to infarct-related artery (IRA) only stenting in patients with ST-elevation myocardial infarction (STEMI) and multivessel disease. This effect was mainly driven by a reduction in overall repeat revascularization. However, the ability to assess the effect of this strategy on urgent revascularization or reinfarction was underpowered in individual trials. We searched Pubmed, EMBASE, Cochrane CENTRAL, and Web of Science for RCTs of FFR-guided multivessel stenting versus IRA-only stenting in STEMI with multivessel disease. The outcomes of interest were death, reinfarction, urgent, and non-urgent repeat revascularization. Risk ratios (RR) were pooled using the DerSimonian and Laird random-effects model. After review of 786 citations, 2 RCTs were included. The pooled results demonstrated a significant reduction in the composite of death, reinfarction, or revascularization in the FFR-guided multivessel stenting group versus IRA-only stenting group (RR [95%, Confidence Interval]: 0.49 [0.33-0.72], p<0.001). This risk reduction was driven mainly by a reduction in repeat revascularization, both urgent (0.41 [0.24-0.71], p=0.002) and non-urgent revascularization (0.31 [0.19-0.50], p<0.001). Pooled RR for reinfarction was lower in the FFR-guided strategy, but was not statistically significant (0.71[0.39-1.31], p=0.28). This systematic review and meta-analysis suggests that a strategy of FFR-guided multivessel stenting in STEMI patients reduces not only overall repeat revascularization but also urgent revascularization. The effect on reinfarction needs to be evaluated in larger trials. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.

Land cover and forest formation distributions for St. Kitts, Nevis, St. Eustatius, Grenada and Barbados from decision tree classification of cloud-cleared satellite imagery

Science.gov (United States)

Helmer, E.H.; Kennaway, T.A.; Pedreros, D.H.; Clark, M.L.; Marcano-Vega, H.; Tieszen, L.L.; Ruzycki, T.R.; Schill, S.R.; Carrington, C.M.S.

2008-01-01

Satellite image-based mapping of tropical forests is vital to conservation planning. Standard methods for automated image classification, however, limit classification detail in complex tropical landscapes. In this study, we test an approach to Landsat image interpretation on four islands of the Lesser Antilles, including Grenada and St. Kitts, Nevis and St. Eustatius, testing a more detailed classification than earlier work in the latter three islands. Secondly, we estimate the extents of land cover and protected forest by formation for five islands and ask how land cover has changed over the second half of the 20th century. The image interpretation approach combines image mosaics and ancillary geographic data, classifying the resulting set of raster data with decision tree software. Cloud-free image mosaics for one or two seasons were created by applying regression tree normalization to scene dates that could fill cloudy areas in a base scene. Such mosaics are also known as cloud-filled, cloud-minimized or cloud-cleared imagery, mosaics, or composites. The approach accurately distinguished several classes that more standard methods would confuse; the seamless mosaics aided reference data collection; and the multiseason imagery allowed us to separate drought deciduous forests and woodlands from semi-deciduous ones. Cultivated land areas declined 60 to 100 percent from about 1945 to 2000 on several islands. Meanwhile, forest cover has increased 50 to 950%. This trend will likely continue where sugar cane cultivation has dominated. Like the island of Puerto Rico, most higher-elevation forest formations are protected in formal or informal reserves. Also similarly, lowland forests, which are drier forest types on these islands, are not well represented in reserves. Former cultivated lands in lowland areas could provide lands for new reserves of drier forest types. The land-use history of these islands may provide insight for planners in countries currently considering

Global occupational health: current challenges and the need for urgent action.

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Lucchini, Roberto G; London, Leslie

2014-01-01

Global occupational health and safety (OHS) is strictly linked to the dynamics of economic globalization. As the global market is increasing, the gap between developed and underdeveloped countries, occupational diseases, and injuries affect a vast number of workers worldwide. Global OHS issues also become local in developed countries due to many factors, including untrained migrant workers in the informal sector, construction, and agriculture. To identify the current status and challenges of global occupational health and safety and the needs for preventive action. Absence of OHS infrastructure amplifies the devastating consequences of infectious outbreaks like the Ebola pandemic and tuberculosis. Interventions in global OHS are urgently needed at various levels: 1. Increased governmental funding is needed for international organizations like the World Health Organization and the International Labor Organization to face the increasing demand for policies, guidance, and training. 2. Regulations to ban and control dangerous products are needed to avoid the transfer of hazardous production to developing countries. 3. The OHS community must address global OHS issues through advocacy, position papers, public statements, technical and ethical guidelines, and by encouraging access of OHS professionals from the developing countries to leadership positions in professional and academic societies. 4. Research, education, and training of OHS professionals, workers, unions and employers are needed to address global OHS issues and their local impact. 5. Consumers also can influence significantly the adoption of OHS practices by demanding the protection of workers who are producing he goods that are sold in the global market. Following the equation of maximized profits prompted by the inhibition of OHS is an old practice that has proven to cause significant costs to societies in the developed world. It is now an urgent priority to stop this process and promote a harmonized global

OPERATIONAL DISTRIBUTION OF THE TRAIN TRAFFIC VOLUME ON THE SECTIONS OF RAILWAY OPERATING DOMAIN

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G. Ya. Моzolevich

2013-10-01

Full Text Available Purpose. The task of the operational distribution of train traffic volume on the sections of operating domain is the optimization one. It is solved in the operational conditions by the dispatch station. The article sets the problem of formalizing and finding the new ways to solve this urgent problem. Methodology. A new approach to solving the problem of operational distribution of train traffic volume on the sections of the rail network with a choice of routes for all train traffics was proposed. Findings. A study of possible routes for the train traffic handle on the operating domain used for mass freight transportations between Krivyi Rih and Donbas was carried out. The use of the proposed method allowed us to obtain a rational distribution of trains on the rail network sections. Originality. The method of train traffic volume distribution in the network under operational conditions was improved. The method, as opposed to the current one allows one to select the route of separate units handle (according to the criteria of the weighted average cost for 1 ton of cargo. Practical value. The use of the proposed technology of the operational distribution of train traffic volume will increase the efficiency of the railways in general and ensure the competitiveness of rail transportations. The methodology implementation involves the use of railway dispatch station for the automated workplaces with appropriate informational support.

Finding the moral fiber: Why reform is urgently needed for a fair cotton trade

OpenAIRE

Pfeifer, K.; Kripke, G.; Alpert, E.

2004-01-01

Metadata only record US subsidies have led to depressed world cotton prices, which in turn have cost countries in Africa millions of dollars in lost export earnings. Oxfam estimates that sub-Saharan African countries lost $305 million due to US subsidies in crop year 2001. Because cotton is an important livelihood for millions of poor people, Oxfam believes action is urgently needed to reform the distortions in cotton trade that undermine the value of cotton to developing countries. The ce...

Urgent consultations at the dermatology department of Basel University Hospital, Switzerland: characterisation of patients and setting - a 12-month study with 2,222 patients data and review of the literature.

Science.gov (United States)

Ruzza, N; Itin, P H; Beltraminelli, H

2014-01-01

Urgent consultations for skin disorders are commonly done in different settings. Scarce data exist about the characteristics of these patients. The aim of this study was to analyse specific characteristics of patients receiving an urgent consultation at a dermatology department in a university hospital. We prospectively recorded the data of all patients having had an urgent consultation during a period of 12 months. We registered 2,222 urgent consultations. The most frequent diagnoses were eczemas (24.8%), dermatomycoses (5.1%) and dermatitis not otherwise specified (4.8%). The most frequent treatments were topical steroids, emollients, topical antibiotics, systemic antihistamines, antibiotics and virostatics. 2.2% of patients were hospitalized, 78.8% asked for a consultation for a disease lasting less than 4 weeks, and 6.9% presented the same day as the skin disease appeared. This study shows the characteristics of patients receiving an urgent dermatologic consultation. It underlines the need for collaboration between dermatologists, other physicians, general practitioners and nurses. © 2014 S. Karger AG, Basel.

Urgent carotid stenting before cardiac surgery in a young male patient with acute ischemic stroke caused by aortic and carotid dissection

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Popović Rade

2016-01-01

Full Text Available Introduction. Acute aortic dissection (AD is the most common life-threatening disorder affecting the aorta. Neurological symptoms are present in 17-40% of cases. The management of these patients is controversial. Case report. We presented a 37-year-old man admitted for complaining of left-sided weak-ness. Symptoms appeared two hours before admission. The patient had no headache, neither thoracic pain. Neurological examination showed mild confusion, left-sided hemiplegia, National Institutes of Health Stroke Scale (NIHSS score was 10. Ischemic stroke was suspected, brain multislice computed tomography (MSCT and angiography were performed and right intrapetrous internal carotid artery dissection noted. Subsequent color Doppler ultrasound of the carotid arteries showed dissection of the right common carotid artery (CCA. The patient underwent thoracic and abdominal MSCT aortography which showed ascending aortic dissection from the aortic root, propagating in the brachiocephalic artery and the right CCA. Digital subtraction angiography was performed subsequently and two stents were successfully implanted in the brachiocephalic artery and the right CCA prior to cardiac surgery, only 6 hours after admission. The ascending aorta was reconstructed with graft interposition and the aortic valve re-suspended. The patient was hemodynamically stable and with no neurologic deficit after surgery. Unfortinately, at the operative day 6, mediastinitis developed and after intensive treatment the patients died 35 days after admission. Conclusion. In young patients with suspected stroke and oscillatory neurological impairment urgent MSCT angiography of the brain and neck and/or Doppler sonography of the carotid and vertebral artery are mandatory to exclude carotid and aortic dissection. The prompt diagnosis permits urgent carotid stenting and cardiosurgery. To the best of our knowledge, this is the first published case of immediate carotid stenting in acute ischemic

Recent progress of applying mesenchymal stem cells in therapy of urgent radiation damage

International Nuclear Information System (INIS)

Liu Jiangong; Guo Wanlong; Zhang Shuxian; Duan Zhikai

2010-01-01

At present, Cytokine therapy is the main strategy capable of preventing and reducing the acute radiation syndrome (ARS). With the problem of difficult match and severe graft versus host disease, haemopoietic stem cells can be used to find some effective approaches to treat acute radiation damage. Mesenchymal stem cells are of great therapeutic potential due to their particular characteristics including secretion of hematopoietic cytokine, reconstruction hemopoietic microenvironment, poor-immunogenicity, ease of reception ectogenic gene transfection and expression. This paper is to summarize the studies of biological characteristics of MSC and its application prospects in urgent radiation damage. (authors)

Financial Mechanism for the Implementation of Strategic and Operational Financial Decisions of Modern Enterprises

Science.gov (United States)

Nikeriasova, Veronika V.; Ordov, Konstantin V.; Khvostenko, Oleg A.

2016-01-01

In modern conditions of world depression, it is urgent for increasing the efficiency of the financial mechanism. Company's future depends on the correct choice of the financial mechanism strategy. The article deals with the issues of improving the financial mechanism of enterprises in the implementation of strategic and operational financial…

A Parallel World for the World Bank: A Case Study of Urgent: Evoke, An Educational Alternate Reality Game

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David I. Waddington

2013-01-01

Full Text Available In 2010, the World Bank launched Urgent: Evoke, an alternate reality game. Conceived in response to the demands of African universities, the game was designed to promote the World Bank Institute’s vision of positive global change through social innovation, and made substantial use of Web 2.0 tools such as blogs, personal profiles, and social networks. This article offers a case study of Urgent: Evoke, divided into four sections: first, the potential to use video games as citizenship education tools is discussed; second, the unique game genre (alternate reality games into which Evoke falls is explained and some possible uses of this genre in higher education are examined; third, the functioning of the Evoke game world is explained; and fourth, the results of the Evoke educational project are assessed. The case study concludes with some commentary on Evoke’s ideological message, which those less sympathetic to capitalism may view as problematic.

Urgent Coronary Artery Bypass Surgery in a Patient with Postinfarction Angina and Active Myelomonocytic Leukaemia

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Samuel Anthony Galea

2016-11-01

Full Text Available Chronic myelomonocytic leukaemia (CMML is a myelodysplastic/myeloproliferative neoplasm affecting the production and differentiation of the monocyte cell lineage. Cardiac surgery in the context of CMML poses challenges that are not routinely encountered. This is the first reported case in the literature of a patient with active CMML undergoing urgent on-pump coronary artery bypass grafting. A 68-year-old Caucasian man with a history of hypertension, hyperlipidaemia, hypothyroidism, and hypercholesterolaemia, who had been diagnosed by the haematologists with CMML a few months earlier but had remained untreated, underwent urgent surgical coronary revascularisation because of postinfarction angina following a non-ST elevation myocardial infarction associated with troponin I rise. The patient had fulminant postoperative myelomonocytic leukaemoid reaction, with a clinical picture of severe systemic inflammatory response syndrome and multiple organ dysfunction syndrome. This led to extensive vasodilation and heart failure that resulted in the death of the patient. Various authors have suggested different techniques and treatment options, each attempting to mitigate the effect of the postoperative inflammatory response. However, this is a high-risk endeavour with a myriad of inflammatory signals mobilised into action because of the surgical insult. Off-pump surgery or preoperative pharmacological attenuation of CMML activity might have dampened this response and resulted in a positive outcome for the patient.

Urgent Living-Donor Liver Transplantation in a Patient With Concurrent Active Tuberculosis: A Case Report.

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Jung, B-H; Park, J-I; Lee, S-G

2018-04-01

Although active tuberculosis (TB) is considered a contraindication for liver transplantation (LT), this is the only treatment in patients with liver failure and concurrent active TB. We report a case with successful urgent living-donor LT for irreversible liver failure in the presence of active TB. A 48-year-old man, with a history of decompensated alcoholic liver cirrhosis, was presented with stupor. At admission, his consciousness had deteriorated to semi-coma, and his renal function also rapidly deteriorated to hepatorenal syndrome. A preoperative computed tomography scan of the chest revealed several small cavitary lesions in both upper lobes, and acid-fast bacillus stain from his sputum was graded 2+. Adenosine deaminase levels from ascites were elevated, suggesting TB peritonitis. A first-line anti-TB drug regimen was started immediately (rifampin, isoniazid, levofloxacin, and amikacin). An urgent living-donor LT was performed 2 days later. After LT, the regimen was changed to second-line anti-TB drugs (amikacin, levofloxacin, cycloserine, and pyridoxine). The sputum acid-fast bacillus stain tested negative on postoperative day 10. His liver function remained well preserved, even after the reversion to first-line anti-TB treatment. The patient recovered without any anti-TB medication-related complications and was discharged. LT can be prudently performed as a life-saving option, particularly for patients with liver failure and concurrent active TB. Copyright © 2018 Elsevier Inc. All rights reserved.

Initial Experience of a Primary Urgent Care Clinic Curriculum and Subspecialty Lectureship Series Implementation in a Los Angeles County Hospital.

Science.gov (United States)

Agrawal, Harsh; Martinez, Anna; Volkmann, Elizabeth R; Melamed, Oleg; Wali, Soma

2017-05-01

Urgent care clinics are extremely busy in the University of California-Los Angeles (UCLA) County hospital system. We determined that residents and medical students in the internal medicine residency program who are rotating through these clinics did not receive enough teaching during their rotation. We decided to create and implement an urgent care curriculum and lectures to help achieve structure for the rotation. The goal of this series was to educate and assist residents in the primary care setting to comfortably manage subspecialty conditions, help reduce the already-overwhelmed county subspecialty referral system, and promote learning. The Olive View-UCLA Medical Center internal medicine residency program has a total of 74 residents, which includes postgraduate year-1 (PGY-1) to PGY-4, with PGY-4 being combined internal medicine-pediatrics or emergency medicine-internal medicine residents. We used core curriculum topics as provided by the Accreditation Council for Graduate Medical Education to design the curriculum. We sent e-mails to the stakeholders whom we identified as the residents and the attending physicians working in urgent care, inquiring after topics they wanted to discuss during the rotation. Using these responses we compiled a list of all of the topics that could be discussed and reviewed during the rotation. These topics were broken down into short 10- to 15-minute-long lectures. During the lectures, we provided a retrospective post- then prequestionnaire to the residents for evaluation of the program and the lectures. A benefit of the post-then-pre design is that participants answer the postquestions and the prequestions together after the lecture, thereby reducing the possibility of response shift bias. Of the 74 residents in the program, 25 responded; the response rate was approximately 33%. Regarding content, 92% (23) said it was appropriate, 4% (1) said it was too low a level, and 4% (1) did not respond. Overall, 36% (9) said the lecture was

Bullying Victimization (Being Bullied) Among Adolescents Referred for Urgent Psychiatric Consultation: Prevalence and Association With Suicidality.

Science.gov (United States)

Alavi, Nazanin; Roberts, Nasreen; Sutton, Chloe; Axas, Nicholas; Repetti, Leanne

2015-10-01

To examine the prevalence of bullying victimization among adolescents referred for urgent psychiatric consultation, to study the association between bullying victimization and suicidality, and to examine the relation between different types of bullying and suicidality. A retrospective chart review was conducted for all adolescents referred to a hospital-based urgent consultation clinic. Our study sample consisted of adolescents with a history of bullying victimization. The Research Ethics Board of Queen's University provided approval. Data analysis was conducted using SPSS (IBM SPSS Inc, Armonk, NY). Chi-square tests were used for sex, suicidal ideation, history of physical and sexual abuse, and time and type of bullying, and an independent sample t test was used for age. The prevalence of bullying victimization was 48.5% (182 of 375). There was a significant association between being bullied and suicidal ideation (P = 0.01), and between sex and suicidal ideation (P ≤ 0.001). Victims of cyberbullying reported more suicidal ideation than those who experienced physical or verbal bullying (P = 0.04). Bullying victimization, especially cyberbullying, is associated with increased risk of suicidal ideation among adolescents referred for psychiatric risk assessment. The detailed history of the type and duration of bullying experienced by the victims should be considered when conducting a psychiatric risk assessment.

76 FR 35719 - Unexpected Urgent Refugee and Migration Needs Related to Libya and C[ocirc]te d'Ivoire

Science.gov (United States)

2011-06-20

... June 8, 2011 Unexpected Urgent Refugee and Migration Needs Related to Libya and C[ocirc]te d'Ivoire... laws of the United States, including section 2(c)(1) of the Migration and Refugee Assistance Act of... amount not to exceed $15 million from the United States Emergency Refugee and Migration Assistance Fund...

76 FR 53913 - Award of an Urgent Single-Source Grant to Survivors of Torture International (SOTI) in San Diego...

Science.gov (United States)

2011-08-30

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Office of Refugee Resettlement Award of an Urgent Single... Refugee Resettlement, ACF, HHS. ACTION: Notice; correction. CFDA Number: 93.604. SUMMARY: The Office of Refugee Resettlement, ACF, HHS published a document in the Federal Register of August 16, 2011 (76 FR...

[Budget impact analysis of idarucizumab for the management of patients treated with dabigatran in emergency / urgent situations in Italy

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Andrea Belisari

2016-06-01

CONCLUSION: Idarucizumab for the management of patients treated with dabigatran in emergency / urgent situations has the potential for substantial savings, compared to treatments currently available. This preliminary assessment will require further confirmatory evidence when the product will become available in Italian healthcare setting. [Article in Italian

Occupational stressors among nurses working in urgent and emergency care units

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Denyson Santana PEREIRA

Full Text Available The study aimed to assess occupational stressors among nurses working in urgent and emergency care facilities. It is a descriptive research developed in two public hospitals of different complexity degrees, with 49 nurses. Data were collected from June to September 2011. The Bianchi's Stress Scale, which is composed of six domains: Relationship, Unit functioning, Staff management, Nursing care, Unit coordination, and Work conditions was used to assess occupational stressors based on the regular activities performed by nurses. Data were analyzed by using descriptive statistics and Mann Whitney-U test. For the nurses working in the high complexity healthcare facility - hospital A the most stressful domain was Nursing care, while for those professionals working in the medium complexity healthcare facility - hospital B, Staff management was the most stressful domain. The nurses from hospital A perceived care-related activities as more stressful, while for those in hospital B administrative activities were considered more stressful.

Components of Hospital Perioperative Infrastructure Can Overcome the Weekend Effect in Urgent General Surgery Procedures.

Science.gov (United States)

Kothari, Anai N; Zapf, Matthew A C; Blackwell, Robert H; Markossian, Talar; Chang, Victor; Mi, Zhiyong; Gupta, Gopal N; Kuo, Paul C

2015-10-01

We hypothesized that perioperative hospital resources could overcome the "weekend effect" (WE) in patients undergoing emergent/urgent surgeries. The WE is the observation that surgeon-independent patient outcomes are worse on the weekend compared with weekdays. The WE is often explained by differences in staffing and resources resulting in variation in care between the week and weekend. Emergent/urgent surgeries were identified using the Healthcare Cost and Utilization Project State Inpatient Database (Florida) from 2007 to 2011 and linked to the American Hospital Association (AHA) Annual Survey Database to determine hospital level characteristics. Extended median length of stay (LOS) on the weekend compared with the weekdays (after controlling for hospital, year, and procedure type) was selected as a surrogate for WE. Included were 126,666 patients at 166 hospitals. A total of 17 hospitals overcame the WE during the study period. Logistic regression, controlling for patient characteristics, identified full adoption of electronic medical records (OR 4.74), home health program (OR 2.37), pain management program [odds ratio (OR) 1.48)], increased registered nurse-to-bed ratio (OR 1.44), and inpatient physical rehabilitation (OR 1.03) as resources that were predictors for overcoming the WE. The prevalence of these factors in hospitals exhibiting the WE for all 5 years of the study period were compared with those hospitals that overcame the WE (P surgery procedures. Improved hospital perioperative infrastructure represents an important target for overcoming disparities in surgical care.

Foreign bodies in upper gastrointestinal tract and urgent endoscopic interventions – review of a ten-year period

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Pavel Skok

2005-07-01

Full Text Available Background: Foreign bodies in the upper digestive tube are rarely the cause of an urgent condition in gastroenterology. They usually enter the digestive tube during nutrition or by mistake. However, certain groups of the population such as convicts or psychiatric patients tend to swallow them intentionally. The authors aim was to assess the percentage of patients in which urgent endoscopic investigation revealed true foreign bodies in the upper digestive tube, to evaluate the success of endoscopic procedures and the resolution of eventual complications.Patients and methods: The study includes patients in which urgent endoscopic investigations of the upper digestive tract were performed in a 10-year period (1 January 1994 to 31 December 2003.Results: Altogether 6416 patients were investigated, mean age 59.3 years, SD ± 17.2 years, range 1–106 years, 2452 females and 3964 males. In 51 patients, 0.8% of all subjects, foreign bodies were detected in the esophagus or stomach. In these patients a total of 65 endoscopic investigations were performed, in 94% the foreign bodies were removed endoscopically (48/51 patients, in three cases the endoscopic procedures were not successful. Among the foreign bodies removed were various metal or plastic objects: coins, keys, screws, hooks, batteries, razor blades, needles, parts of kitchen, toilet or writing utensils, lighters, buttons, toys, a toothbrush as well as impacted pieces of bone. In the patients with successful endoscopic removal of the objects, no significant complications were noted. In 3 patients (3/48, 6.3% only mild hemorrhages from the region of the esophagogastric junction were observed.Conclusions: The technological development of endoscopic instruments made it possible to carry out different therapeutic procedures. The method has proved successful in removing foreign bodies from the upper digestive tube. Various factors affect the success of the procedure, the more important being adequate

Improvement of human operator vibroprotection system in the utility machine

Science.gov (United States)

Korchagin, P. A.; Teterina, I. A.; Rahuba, L. F.

2018-01-01

The article is devoted to an urgent problem of improving efficiency of road-building utility machines in terms of improving human operator vibroprotection system by determining acceptable values of the rigidity coefficients and resistance coefficients of operator’s cab suspension system elements and those of operator’s seat. Negative effects of vibration result in labour productivity decrease and occupational diseases. Besides, structure vibrations have a damaging impact on the machine units and mechanisms, which leads to reducing an overall service life of the machine. Results of experimental and theoretical research of operator vibroprotection system in the road-building utility machine are presented. An algorithm for the program to calculate dynamic impacts on the operator in terms of different structural and performance parameters of the machine and considering combination of external pertrubation influences was proposed.

Healthcare worker exposure to Middle East respiratory syndrome coronavirus (MERS-CoV: Revision of screening strategies urgently needed

Directory of Open Access Journals (Sweden)

Hala Amer

2018-06-01

Conclusions: The data obtained in this study support the widespread testing of all close contacts of MERS-CoV cases, regardless of the significance of the contact or presence or absence of symptoms. In addition, urgent careful review of guidance regarding the return of asymptomatic MERS-CoV-positive HCWs under investigation to active duty is needed.

Relationship between seasonal weather changes, risk of dehydration, and incidence of severe bradyarrhythmias requiring urgent temporary transvenous cardiac pacing in an elderly population

Science.gov (United States)

Palmisano, Pietro; Accogli, Michele; Zaccaria, Maria; Vergari, Alessandra; De Luca De Masi, Gabriele; Negro, Luca; De Blasi, Sergio

2014-09-01

There is little information on any seasonal variations or meteorological factors associated with symptomatic bradyarrhythmias requiring cardiac pacing. The aim of this single-center study was to investigate the seasonal distribution of the incidence of severe, life-threatening bradyarrhythmias requiring urgent temporary transvenous cardiac pacing in an elderly population. Consecutive patients who underwent urgent temporary transvenous cardiac pacing between 2007 and 2012 were enrolled. The baseline characteristics of the patients and some meteorological parameters, including the calculation the daily heat index (HI), were recorded. During the study period, 79 consecutive patients (mean age 82 ± 8 years, 41 % male) underwent urgent temporary transvenous cardiac pacing, mainly for third-degree atrioventricular block (79 %). The incidence of bradyarrhythmias was significantly higher in summer than in the other seasons ( P 90 °F for >3 h per day for at least 10 days ( P renal function impairment and hyperkalemia (all P < 0.05). This study showed an increased incidence of severe bradyarrhythmias in an elderly population during the hottest months of the year. In these months, in subjects characterized by increased susceptibility to dehydration, the risk of developing bradyarrhythmias was increased significantly.

Training manual for process operation and management of radioactive waste treatment facility

Energy Technology Data Exchange (ETDEWEB)

Shon, J. S.; Kim, K. J.; Ahn, S. J. [and others

2004-12-01

Radioactive Waste Treatment Facility (RWTF) has been operating for safe and effective treatment of radioactive wastes generated in the Korea Atomic Energy Research Institute (KAERI). In RWTF, there are evaporation, bituminization and solar evaporation processes for liquid waste, solid waste treatment process and laundry process. As other radioactive waste treatment facilities in foreign countries, the emergency situation such as fire and overflow of liquid waste can be taken place during the operation and result in the spread of contamination of radioactivity. So, easy and definite operating procedure is necessary for the safe operation of the facility. This manual can be available as easy and concise training materials for new employees and workers dispatched from service agency. Especially, in case of emergency urgently occurred during operation, everyone working in the facility can quickly stop the facility following this procedure.

Training manual for process operation and management of radioactive waste treatment facility

International Nuclear Information System (INIS)

Shon, J. S.; Kim, K. J.; Ahn, S. J.

2004-12-01

Radioactive Waste Treatment Facility (RWTF) has been operating for safe and effective treatment of radioactive wastes generated in the Korea Atomic Energy Research Institute (KAERI). In RWTF, there are evaporation, bituminization and solar evaporation processes for liquid waste, solid waste treatment process and laundry process. As other radioactive waste treatment facilities in foreign countries, the emergency situation such as fire and overflow of liquid waste can be taken place during the operation and result in the spread of contamination of radioactivity. So, easy and definite operating procedure is necessary for the safe operation of the facility. This manual can be available as easy and concise training materials for new employees and workers dispatched from service agency. Especially, in case of emergency urgently occurred during operation, everyone working in the facility can quickly stop the facility following this procedure

A prospective study to assess the value of MMP-9 in improving the appropriateness of urgent referrals for colorectal cancer

Directory of Open Access Journals (Sweden)

Hobbs Richard FD

2006-10-01

Full Text Available Abstract Background Bowel cancer is common and is a major cause of death. Most people with bowel symptoms who meet the criteria for urgent referral to secondary care will not be found to have bowel cancer, and some people who are found to have cancer will have been referred routinely rather than urgently. If general practitioners could better identify people who were likely to have bowel cancer or conditions that may lead to bowel cancer, the pressure on hospital clinics may be reduced, enabling these patients to be seen more quickly. Increased levels of an enzyme called matrix metalloproteinase 9 (MMP-9 have been found to be associated with such conditions, and this can be measured from a blood sample. This study aims to find out whether measuring MMP-9 levels could improve the appropriateness of urgent referrals for patients with bowel symptoms. Methods People aged 18 years or older referred to a colorectal clinic will be asked to complete a questionnaire about symptoms, recent injuries or chronic illnesses (these can increase the level of matrix metalloproteinases and family history of bowel cancer. A blood sample will be taken from people who consent to take part to assess MMP-9 levels, and the results of examination at the clinic and/or investigations arising from the clinic visit will be collected from hospital records. The accuracy of MMP-9 will be assessed by comparing the MMP-9 level with the resulting diagnosis. The combination of factors (e.g. symptoms and MMP-9 level that best predict a diagnosis of malignancy (invasive disease or polyps will be determined. Discussion Although guidelines are in place to facilitate referrals to colorectal clinics, symptoms alone do not adequately distinguish people with malignancy from people with benign conditions. This study will establish whether MMP-9 could assist this process. If this were the case, measurement of MMP-9 levels could be used by general practitioners to assist in the identification

Design Methodology of a Sensor Network Architecture Supporting Urgent Information and Its Evaluation

Science.gov (United States)

Kawai, Tetsuya; Wakamiya, Naoki; Murata, Masayuki

Wireless sensor networks are expected to become an important social infrastructure which helps our life to be safe, secure, and comfortable. In this paper, we propose design methodology of an architecture for fast and reliable transmission of urgent information in wireless sensor networks. In this methodology, instead of establishing single complicated monolithic mechanism, several simple and fully-distributed control mechanisms which function in different spatial and temporal levels are incorporated on each node. These mechanisms work autonomously and independently responding to the surrounding situation. We also show an example of a network architecture designed following the methodology. We evaluated the performance of the architecture by extensive simulation and practical experiments and our claim was supported by the results of these experiments.

Servant leadership: An urgent style for the current political leadership in South Africa

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Mookgo S. Kgatle

2018-05-01

Full Text Available The aspects of the political leadership in South Africa discussed in this article include, among others, abuse of power, corruption and lack of public accountability. In response to these aspects, the article demonstrates that servant leadership is an urgent style for the current state of political leadership in South Africa. The article discusses key aspects of the current political leadership in South Africa as a point of departure. The article also discusses the theological foundation and key principles of servant leadership in order to apply them to the current state of political leadership in South Africa Intradisciplinary and/or interdisciplinary implications: Servant leadership principles as outlined from a theological point of view are applied to the aspects of political leadership in South Africa.

Using systems thinking to identify workforce enablers for a whole systems approach to urgent and emergency care delivery: a multiple case study.

Science.gov (United States)

Manley, Kim; Martin, Anne; Jackson, Carolyn; Wright, Toni

2016-08-09

Overcrowding in emergency departments is a global issue, which places pressure on the shrinking workforce and threatens the future of high quality, safe and effective care. Healthcare reforms aimed at tackling this crisis have focused primarily on structural changes, which alone do not deliver anticipated improvements in quality and performance. The purpose of this study was to identify workforce enablers for achieving whole systems urgent and emergency care delivery. A multiple case study design framed around systems thinking was conducted in South East England across one Trust consisting of five hospitals, one community healthcare trust and one ambulance trust. Data sources included 14 clinical settings where upstream or downstream pinch points are likely to occur including discharge planning and rapid response teams; ten regional stakeholder events (n = 102); a qualitative survey (n = 48); and a review of literature and analysis of policy documents including care pathways and protocols. The key workforce enablers for whole systems urgent and emergency care delivery identified were: clinical systems leadership, a single integrated career and competence framework and skilled facilitation of work based learning. In this study, participants agreed that whole systems urgent and emergency care allows for the design and implementation of care delivery models that meet complexity of population healthcare needs, reduce duplication and waste and improve healthcare outcomes and patients' experiences. For this to be achieved emphasis needs to be placed on holistic changes in structures, processes and patterns of the urgent and emergency care system. Often overlooked, patterns that drive the thinking and behavior in the workplace directly impact on staff recruitment and retention and the overall effectiveness of the organization. These also need to be attended to for transformational change to be achieved and sustained. Research to refine and validate a single

The urgent requirement for new radioanalytical certified reference materials for nuclear safeguards, forensics, and consequence management

International Nuclear Information System (INIS)

Inn, K.G.W.; Martin Johnson, Jr.C.; Warren Oldham; Lav Tandon; Simon Jerome; Thomas Schaaff; Robert Jones; Daniel Mackney; Pam MacKill; Brett Palmer

2013-01-01

A multi-agency workshop was held from 25 to 27 August 2009, at the National Institute of Standards and Technology (NIST), to identify and prioritize the development of radioanalytical Certified Reference Materials (CRMs, generally provided by National Metrology Institutes; Standard Reference Materials, a CRM issued by NIST) for field and laboratory nuclear measurement methods to be used to assess the consequences of a domestic or international nuclear event. Without these CRMs, policy makers concerned with detecting proliferation and trafficking of nuclear materials, attribution and retribution following a nuclear event, and public health consequences of a nuclear event would have difficulty making decisions based on analytical data that would stand up to scientific, public, and judicial scrutiny. The workshop concentrated on three areas: post-incident Improvised Nuclear Device (IND) nuclear forensics, safeguard materials characterization, and consequence management for an IND or a Radiological Dispersion Device detonation scenario. The workshop identified specific CRM requirements to fulfill the needs for these three measurement communities. Of highest priority are: (1) isotope dilution mass spectrometry standards, specifically 233 U, 236 gNp, 244 Pu, and 243 Am, used for quantitative analysis of the respective elements that are in critically short supply and in urgent need of replenishment and certification; (2) CRMs that are urgently needed for post-detonation debris analysis of actinides and fission fragments, and (3) CRMs used for destructive and nondestructive analyses for safeguards measurements, and radioisotopes of interest in environmental matrices. (author)

System of urgent psychological aid to subjects of educational settings in the USA (review of the studies for the last decade

Directory of Open Access Journals (Sweden)

Pavlova T. S.

2012-06-01

Full Text Available The article analyzes the strategies of urgent psychological aid in the USA in a chronological order: preparation for critical situations in educational settlements (school crisis plans, immediate reaction to a crisis (the first psychological aid, work with psychological trauma.

Streamlining air import operations by trade facilitation measures

Directory of Open Access Journals (Sweden)

Yuri da Cunha Ferreira

2017-12-01

Full Text Available Global operations are subject to considerable uncertainties. Due to the Trade Facilitation Agreement that became effective in February 2017, the study of measures to streamline customs controls is urgent. This study aims to assess the impact of trade facilitation measures on import flows. An experimental study was performed in the largest cargo airport in South America through discrete-event simulation and design of experiments. Operation impacts of three trade facilitation measures are assessed on import flow by air. We shed light in the following trade facilitation measures: the use of X-ray equipment for physical inspection; increase of the number of qualified companies in the trade facilitation program; performance targets for customs officials. All trade facilitation measures used indicated potential to provide more predictability, cost savings, time reduction, and increase in security in international supply chain.

The perceived urgency of auditory warning alarms used in the hospital operating room is inappropriate.

Science.gov (United States)

Mondor, Todd A; Finley, G Allen

2003-03-01

To examine the perceived urgency of 13 auditory warning alarms commonly occurring in the hospital operating room. Undergraduate students, who were naïve with respect to the clinical situation associated with the alarms, judged perceived urgency of each alarm on a ten-point scale. The perceived urgency of the alarms was not consistent with the actual urgency of the clinical situation that triggers it. In addition, those alarms indicating patient condition were generally perceived as less urgent than those alarms indicating the operation of equipment. Of particular interest were three sets of alarms designed by equipment manufacturers to indicate specific priorities for action. Listeners did not perceive any differences in the urgency of the 'information only', 'medium' and 'high' priority alarms of two of the monitors with all judged as low to moderate in urgency. In contrast, the high priority alarm of the third monitor was judged as significantly more urgent than its low and medium urgency counterparts. The alarms currently in use do not convey the intended sense of urgency to naïve listeners, and this holds even for two sets of alarms designed specifically by manufacturers to convey different levels of urgency.

The urgent need for clinical, diagnostic, and operational research for management of Buruli ulcer in Africa.

Science.gov (United States)

O'Brien, Daniel P; Comte, Eric; Serafini, Micaela; Ehounou, Geneviève; Antierens, Annick; Vuagnat, Hubert; Christinet, Vanessa; Hamani, Mitima D; du Cros, Philipp

2014-05-01

Despite great advances in the diagnosis and treatment of Buruli ulcer, it is one of the least studied major neglected tropical diseases. In Africa, major constraints in the management of Buruli ulcer relate to diagnosis and treatment, and accessibility, feasibility, and delivery of services. In this Personal View, we outline key areas for clinical, diagnostic, and operational research on this disease in Africa and propose a research agenda that aims to advance the management of Buruli ulcer in Africa. A model of care is needed to increase early case detection, to diagnose the disease accurately, to simplify and improve treatment, to reduce side-effects of treatment, to deal with populations with HIV and tuberculosis appropriately, to decentralise care, and to scale up coverage in populations at risk. This approach will require commitment and support to strategically implement research by national Buruli ulcer programmes and international technical and donor organisations, combined with adaptations in programme design and advocacy. A critical next step is to build consensus for a research agenda with WHO and relevant groups experienced in Buruli ulcer care or related diseases, and we call on on them to help to turn this agenda into reality. Copyright © 2014 Elsevier Ltd. All rights reserved.

The on-line European Community urgent radiological information exchange (ECURIE) information system

International Nuclear Information System (INIS)

De Cort, M.; Breitenbach, L.; De Vries, G.

1998-01-01

Immediately after the accident at the Chernobyl NPP, both the International Atomic Energy Agency (IAEA) and the Commission of the European Communities (CEC) set up a system to meet the requirements for early warning and exchange of information. The Environment Institute of the CEC JRC-Ispra provides technical assistance for the European community Urgent Radiological Information Exchange system (ECURIE). By this system, Member State contact points can exchange information in a coded format. In order to facilitate the use and to assure the data quality, a Coding-Decoding Software (CDS) was developed in collaboration with the I.A.E.A. A new version, called CoDecS, is under development. An ECURIE data bank is under construction, which will automatically recognize and store incoming ECURIE messages. Further on, query and reporting software will be developed. The background objectives and the conceptual basis for the structure of the on-line information system is described. (author)

Urgent need for warming experiments in tropical forests

Science.gov (United States)

Calaveri, Molly A.; Reed, Sasha C.; Smith, W. Kolby; Wood, Tana E.

2015-01-01

powerful and urgent way forward in order to improve our understanding of tropical forest responses to climate change.

Is operational research delivering the goods? The journey to success in low-income countries.

Science.gov (United States)

Zachariah, Rony; Ford, Nathan; Maher, Dermot; Bissell, Karen; Van den Bergh, Rafael; van den Boogaard, Wilma; Reid, Tony; Castro, Kenneth G; Draguez, Bertrand; von Schreeb, Johan; Chakaya, Jeremiah; Atun, Rifat; Lienhardt, Christian; Enarson, Don A; Harries, Anthony D

2012-05-01

Operational research in low-income countries has a key role in filling the gap between what we know from research and what we do with that knowledge-the so-called know-do gap, or implementation gap. Planned research that does not tangibly affect policies and practices is ineffective and wasteful, especially in settings where resources are scarce and disease burden is high. Clear parameters are urgently needed to measure and judge the success of operational research. We define operational research and its relation with policy and practice, identify why operational research might fail to affect policy and practice, and offer possible solutions to address these shortcomings. We also propose measures of success for operational research. Adoption and use of these measures could help to ensure that operational research better changes policy and practice and improves health-care delivery and disease programmes. Copyright © 2012 Elsevier Ltd. All rights reserved.

Álcool, direção automotiva e o Programa Vida Urgente na visão de jovens voluntários Vida Urgente Program, alcohol and driving: young volunteers' view

Directory of Open Access Journals (Sweden)

Andréa dos Santos Nascimento

2011-08-01

Full Text Available O objetivo deste estudo é analisar as representações sociais dos jovens voluntários do Programa Vida Urgente, do Espírito Santo, acerca do trabalho por eles realizado. Foram realizadas 20 entrevistas com roteiro semiestruturado objetivando conhecer a opinião sobre os efeitos da própria atuação e a visão que possuem do programa. Para tanto foram entrevistados jovens de ambos os sexos, com idades entre 15 e 26 anos, posteriormente divididos em dois grupos com base no critério de tempo de atuação nas ações do Programa: G1 - 06 a 12 meses e G2 - acima de 12 meses. Por meio da análise de conteúdo, verificou-se que a afinidade com a proposta do trabalho voluntário e a valorização do discurso da conscientização são alguns dos motivos para o ingresso no Programa. Os entrevistados informaram ter identificado maior receptividade no público-alvo, o que é percebido por eles como uma mudança positiva no comportamento dos motoristas abordados.This study's goal is to analyze the social representations of the young volunteers of Vida Urgente Program of Espírito Santo about the work developed by them. 20 interviews were carried out using a semi-structured questionnaire with the objective to know the opinion about the effects of their performance and the vision they possess about the program. For such, 20 participants of both sexes with ages from 15 to 26 years were interviewed, subsequently divided into two groups according to the time of participation in the Program: G1 - 06 to 12 months and G2 - above 12 months. Using content analysis, it was verified that the affinity with the program's proposal of volunteer work and valorization of the speech of awareness are some of the reasons to enter the program. The respondents informed having identified larger receptivity from the target-public, which is perceived by them as a positive change on approached drivers.

Convenience, quality and choice: Patient and service-provider perspectives for treating primary care complaints in urgent care settings.

Science.gov (United States)

Sturgeon, David

2017-11-01

To investigate why patients chose to attend two, nurse-led, minor injury units (MIUs) to access primary healthcare services rather than attend their GP practice. Since the 1980's, healthcare organisations in the UK and elsewhere have implemented an increasingly consumer-orientated model of healthcare provision. As a result, patients with non-urgent presentations are attending Emergency Departments (EDs) and other urgent care facilities in growing numbers. A comparative case study approach was adopted and between October 2014 and May 2015 the researcher was embedded as a participant observer as part of the emergency nurse practitioner team at two, nurse-led, MIUs (site A and B). During this time, 40 patients, 17 service-providers and 1 senior manager were interviewed. Patients and service-providers at both sites identified convenience and quality of care as the principle reasons patients presented for primary healthcare services at MIUs rather than their GP practice. Service-providers were aware that by providing treatment, they established a precedent and a sense of expectation for future care. Patients are acting rationally and predictably in response to healthcare policy promises regarding choice, expectation created by service-providers, and local demographic factors. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

Ultrasound assisted extraction of polyphenols from Punica granatum (Grenada) fruit

International Nuclear Information System (INIS)

Rodriguez Chanfrau, Jorge Enrique; Lopez Armas, Marilyn

2014-01-01

Extraction of bioactive compounds from vegetable materials is a classical operation applied in many industrial processes. Few studies have made reference to processes to obtain extracts from Punica granatum. This fruit is generally consumed as such or as fermented juices. In Cuba, it is known as grenade and numerous studies have shown antiviral, antioxidant and antimicrobial properties. Maceration process is the main used technology in the preparation of extracts from Punica granatum fruit, being this a long and expensive process. Ultrasound-assisted extractions have been proven to significantly decreased extraction time and increased extraction yields in many vegetable materials. However, few papers report the use of this methodology in the extraction processes of Punica granatum. To evaluate an ultrasound-assisted extraction process to extract polyphenols from Punica granatum fruit

Italy-Greece cooperation for transplantation of medically urgent Greek patients: is it an effective, efficient model?

Science.gov (United States)

Peritore, D; Pretagostini, R; Di Ciaccio, P; Fiaschetti, P; Gabbrielli, F; Oliveti, A; Stabile, D; Ricci, A; Vaia, F; Nanni Costa, A

2012-09-01

In 2005 the Italian National Transplant Centre (CNT) signed a cooperation agreement with the Hellenic Transplant Organization (HTO) fostering the transfer and transplantation of urgent Greek liver patients at Italian transplantation centers. So as to not reduce access to transplantation for Italian patients, the agreement provided compensation for organs allocated to Greek transplant recipients. The aim of this study was to analyze the flow of patients from Greece to Italy and the number of received livers to consider the possibility to extend this kind of agreement to other countries, so that this should not penalize Italian recipients. The agreement provides the possibility for Greek patients affected by acute disease to be transferred to Italian transplantation centers participating in the agreement. Until 2008 livers transplanted into Greek recipients were returned through a preferential offer of surplus Greek organs, whereas from 2009 an obligation of payback was introduced. During the reviewed period requests for transfer, transferred patients, and number of patients who later underwent transplantation in Italy were 56, 26, and 23, respectively. Livers offered by the Greek organization that were accepted, transferred, and transplanted in Italy have been 82, 50, and 44, respectively. According to our analysis, the cooperation has had as positive impact for both Greece, which has difficulties transplanting urgent recipient because of the low number of donors, and for Italy, which is not penalized by the use of an organ in a Greek recipients, but is also rewarded for helpfulness. Copyright © 2012 Elsevier Inc. All rights reserved.

Risk score for identifying adults with CSF pleocytosis and negative CSF Gram stain at low risk for an urgent treatable cause

NARCIS (Netherlands)

Hasbun, Rodrigo; Bijlsma, Merijn; Brouwer, Matthijs C.; Khoury, Nabil; Hadi, Christiane M.; van der Ende, Arie; Wootton, Susan H.; Salazar, Lucrecia; Hossain, Md Monir; Beilke, Mark; van de Beek, Diederik

2013-01-01

We aimed to derive and validate a risk score that identifies adults with cerebrospinal fluid (CSF) pleocytosis and a negative CSF Gram stain at low risk for an urgent treatable cause. Patients with CSF pleocytosis and a negative CSF Gram stain were stratified into a prospective derivation (n = 193)

Improving efficiency and saving money in an otolaryngology urgent referral clinic.

Science.gov (United States)

Ibrahim, Nader; Virk, Jagdeep; George, Jason; Elmiyeh, Behrad; Singh, Arvind

2015-06-16

A closed loop audit of the ear nose and throat (ENT) urgent referral clinic at a London hospital was conducted assessing the number of patients reviewed, referral source, appropriateness of referral, presenting complaint and assigned follow-up appointments. Data was sourced from clinic letters and the patient appointment system over a 3-mo period. The initial cycle analysed 490 patients and the subsequent cycle 396. The initial audit yielded clinically relevant and cost effective recommendations which were implemented, and the audit cycle was subsequently repeated. The re-audit demonstrated decreased clinic numbers from an average 9.8 to 7.2 patients per clinic, in keeping with ENT United Kingdom guidelines. A 21% decrease in patient follow-up and 13% decrease in inappropriate referrals was achieved. Direct bookings into outpatient clinics decreased by 8%, due to correct referral pathway utilisation. Comparisons of all data sets were found to show statistical significance P saving of £32490 in a period of 3 mo (£590 per clinic). We demonstrated that simple guidelines, supervision and consultant-led education which are non-labour intensive can have a significant impact on service provision and cost.

Urgent intra-arterial thrombolytic therapy for acute ischemic stroke

International Nuclear Information System (INIS)

Jin Zhengyu; Zhang Qing; Huang Yining; Cui Liying; Yang Ning; Liu Wei; Pan Jie; Gao Shan; Ye Jian; Xu Weihai; Liu Fangjian; Wang Leying; Chen Jun; Dai Jianping

2002-01-01

Objective: The authors report the results of urgent intra-arterial thrombolysis (IAT) in patients within 6 h of acute ischemic stroke onset. The purpose of the study was to observe the safety and efficacy of IAT and to analysis the predictive factors related to the outcome. Methods: 25 patients were treated by IAT using urokinase (UK) or recombinant Streptokinase (r-SK) in Union hospital. Primary neuroradiological assessment was performed with CT in all patients. Mechanical disruption of clot remnants was attempted after UK or r-SK was infused. Angiographic recanalization was classified according to Thrombolysis In Myocardial Infarction (TIMI) grades. Clinical outcome was classified as good for Modified Rankin Scale (MRS) scores of 0 to 3 and poor for MRS scores of 4 to 6. Results: There are 18(72%) of patients TIMI 0-1 and 7(28%) patients TIMI 2 before thrombolysis was performed. The rates of complete/partial recanalization just after infusion were 72%, minimal or no recanalization were 28%. 18(72%) of the 25 patients had good outcome, 7(28%) had poor outcome. Cerebral hemorrhage occurred in 4 of the 25 patients, all with poor outcome. Conclusion: Intra-arterial thrombolysis (IAT) is feasible and safe in the setting of acute stroke. Collateral circulation, recanalization and improvement by 4 or more points on NIHSSS within 24 hours were significantly associated with good outcome, there was significantly association between no recanalization and cerebral hemorrhage and death. The key to improve the effect of IAT was successful recanalization

The urgent need to internalize CO2 emission costs

International Nuclear Information System (INIS)

Goodland, R.; El Serafy, S.

1998-01-01

Despite growing manifestations of global warming and the commitment of most nations to move towards reducing greenhouse gas (GHG) emissions, a simple device that can be effective in reducing GHG emissions continues to be overlooked or even rejected. This is to acknowledge the fact that carbon emissions inflict global costs that are not borne by emitters. This paper advocates that all activities emitting or saving carbon emissions should internalize the carbon cost inflicted or avoided by new projects involving CO 2 . Considering the current wide range of carbon cost estimates, the paper recommends that a two-stage approach be adopted. Firstly, incorporate carbon costs in project analysis only theoretically in order to differentiate objectively among alternative designs involving carbon emissions of varying degrees. Different estimates of the costs of a ton of carbon would be used in order to test the sensitivity of rates of return to alternative carbon costs. While this process would have the effect of screening the allocation of scarce investment funds among projects that affect global warming in different degrees, it should be viewed as only a first step. Secondly, we advocate a rigorous process of passing through estimated carbon costs to the ultimate users of the services of carbon-emitting projects and processes. It is this ultimate process that will secure the urgently needed transition from the current dependence on fossil fuels to more benign sources of energy that would reduce climate-change risks. Since the time available is limited, the paper points out the urgency of these proposals that are crucial for sustainability

Predictive Factors of One-Year Mortality in a Cohort of Patients Undergoing Urgent-Start Hemodialysis.

Directory of Open Access Journals (Sweden)

Luciene P Magalhães

Full Text Available Chronic kidney disease (CKD affects 10-15% of adult population worldwide. Incident patients on hemodialysis, mainly those on urgent-start dialysis at the emergency room, have a high mortality risk, which may reflect the absence of nephrology care. A lack of data exists regarding the influence of baseline factors on the mortality of these patients. The aim of this study was to evaluate the clinical and laboratory characteristics of this population and identify risk factors that contribute to their mortality.We studied 424 patients who were admitted to our service between 01/2006 and 12/2012 and were followed for 1 year. We analyzed vascular access, risk factors linked to cardiovascular disease (CVD and mineral and bone disease associated with CKD (CKD-MBD, and clinical events that occurred during the follow-up period. Factors that influenced patient survival were evaluated by Cox regression analysis.The patient mean age was 50 ± 18 years, and 58.7% of them were male. Hypertension was the main cause of primary CKD (31.8%. Major risk factors were smoking (19.6%, dyslipidemia (48.8%, and CVD (41%. Upon admission, most patients had no vascular access for hemodialysis (89.4%. Biochemical results showed that most patients were anemic with high C-reactive protein levels, hypocalcemia, hyperphosphatemia, elevated parathyroid hormone and decreased 25-hydroxy vitamin D. At the end of one year, 60 patients died (14.1%. These patients were significantly older, had a lower percentage of arteriovenous fistula in one year, and low levels of 25-hydroxy vitamin D.The combined evaluation of clinical and biochemical parameters and risk factors revealed that the mortality in urgent-start dialysis is associated with older age and low levels of vitamin D deficiency. A lack of a permanent hemodialysis access after one year was also a risk factor for mortality in this population.

15 CFR 748.14 - Import Certificate for firearms destined for Organization of American States member countries.

Science.gov (United States)

2010-01-01

..., Colombia, Costa Rica, Dominica, Dominican Republic, Ecuador, El Salvador, Grenada, Guatemala, Guyana, Haiti, Honduras, Jamaica, Mexico, Nicaragua, Panama, Paraguay, Peru, St. Kitts and Nevis, Saint Lucia, Saint...

Biological hazards of radioactivity and the biological consequences of radionuclide emissions from routine operation of nuclear power reactors

International Nuclear Information System (INIS)

Stendig-Lindberg, G.

1978-01-01

The biological hazards of radioactivity and the biological consequences of radionuclide emissions from the routine operation of nuclear power reactors are reviewed. ICRP and Scandinavian recommendations for the limitation of annual radiation doses are presented. The contribution of environmental conditions to radiation hazard is also discussed. It is concluded that a review of the justification of nuclear power is urgently needed. (H.K.)

HESS Opinions "Urgent water challenges are not sufficiently researched"

Directory of Open Access Journals (Sweden)

L. P. Darvis

2009-06-01

Full Text Available In this opinion paper we submit that water experts conduct comparatively little research on the more urgent challenges facing the global community. Five specific biases are identified. First, research in the field of water and sanitation is heavily biased against sanitation. Second, research on food security is biased in favour of conventional irrigation and fails to address the problems and opportunities of rainfed agriculture. Third, insufficient water research is dedicated to developmental compared to environmental issues. Fourth, too little research is conducted on adaptation to climate change by developing countries. And finally, research on water governance has a fascination for conflict but too little eye for cooperation and meeting basic needs. This paper illustrates these biases with bibliometric indicators extracted from the ISI Web of Science. There is a stark mismatch between the global demand for knowledge and the supply of it. This mismatch is identified here as a problem that we water scientists must confront and resolve. We still lack a full understanding why this divergence between demand and supply occurs and persists; an understanding that is required to guide us towards aligning our research priorities to societal demands. The paper, however, makes some inferences. On the one hand, we should promote the global South to create its own research biases and allow it to develop alternative solutions. Simultaneously we would benefit from critical examination of our own research practice. Although this paper addresses a critical challenge it does not aim to be exhaustive or definitive. We merely identify the persistence of intransigent water problems as a valid research object in itself.

Urgent Optic Nerve Decompression via an Endoscopic Endonasal Transsphenoidal Approach for Craniopharyngioma in a 12-Month-Old Infant: A Case Report.

Science.gov (United States)

Shibata, Teishiki; Tanikawa, Motoki; Sakata, Tomohiro; Mase, Mitsuhito

2018-01-01

Craniopharyngiomas are benign tumors and account for approximately 5.6-13% of all intracranial tumors in children. Diagnosis of pediatric craniopharyngioma is often delayed until the tumor becomes relatively large and manifests severe visual and/or endocrine disturbance. Endoscopic endonasal approaches have recently been introduced to surgery for craniopharyngioma. These techniques, however, have rarely been utilized in patients affected with craniopharyngioma as young as 1 year old. This report documents a 12-month-old male infant with sellar craniopharyngioma who presented with acute total vision loss. To increase the chances of visual recovery, an endoscopic endonasal optic nerve decompression was performed as an urgent procedure. After decompression, which resulted in improvement of his visual disturbance, gross total resection of the tumor was undertaken through an anterior interhemispheric approach at a later date. Tumor mass reduction through an endoscopic endonasal transsphenoidal approach followed by secondary radical total resection under craniotomy was considered to be useful in cases such as this when urgent optic nerve decompression is required. © 2018 S. Karger AG, Basel.

Wire-guided (Seldinger technique intubation through a face mask in urgent, difficult and grossly distorted airways

Directory of Open Access Journals (Sweden)

Jake M Heier

2012-01-01

Full Text Available We report two cases of successful urgent intubation using a Seldinger technique for airway management through an anesthesia facemask, while maintaining ventilation in patients with difficult airways and grossly distorted airway anatomy. In both cases, conventional airway management techniques were predicted to be difficult or impossible, and a high likelihood for a surgical airway was present. This technique was chosen as it allows tracheal tube placement through the nares during spontaneous ventilation with the airway stented open and oxygen delivery with either continuous positive airway pressure and/or pressure support ventilation. This unhurried technique may allow intubation when other techniques are unsuitable, while maintaining control of the airway.

Chemical Pesticides and Human Health: The Urgent Need for a New Concept in Agriculture.

Science.gov (United States)

Nicolopoulou-Stamati, Polyxeni; Maipas, Sotirios; Kotampasi, Chrysanthi; Stamatis, Panagiotis; Hens, Luc

2016-01-01

The industrialization of the agricultural sector has increased the chemical burden on natural ecosystems. Pesticides are agrochemicals used in agricultural lands, public health programs, and urban green areas in order to protect plants and humans from various diseases. However, due to their known ability to cause a large number of negative health and environmental effects, their side effects can be an important environmental health risk factor. The urgent need for a more sustainable and ecological approach has produced many innovative ideas, among them agriculture reforms and food production implementing sustainable practice evolving to food sovereignty. It is more obvious than ever that the society needs the implementation of a new agricultural concept regarding food production, which is safer for man and the environment, and to this end, steps such as the declaration of Nyéléni have been taken.

Operative management of Marfan syndrome: The Johns Hopkins experience.

Science.gov (United States)

Baumgartner, W A; Cameron, D E; Redmond, J M; Greene, P S; Gott, V L

1999-06-01

Doctor Antoine Marfan described the first case of Marfan syndrome in 1896. It was over 50 years later that the development of aortic aneurysms and subsequent rupture was appreciated as the most life-threatening component of the syndrome. Doctor Vincent Gott, at our institution, performed the first Bentall procedure for an aneurysm of the ascending aorta in 1976. Since that time, the aortic root has been replaced in 231 Marfan patients. Of this group, 218 patients had a composite graft repair, 11 had an aortic root replacement with a homograft, and 2 patients had valve sparing procedures. There were 168 males and 63 females. Of the total 231 patients, 150 were operated on by Dr Gott. The remaining 81 patients were operated on by 10 other Hopkins surgeons. The average diameter of the ascending aorta was 6.8 cm, with a range from 4.5 to 10. The average aortic diameter of 43 patients who had an ascending aortic dissection was 7.3 cm. Fourteen of these patients had dissection with an aortic diameter of 6.5 cm or less. Among the 198 patients who underwent elective repair, there was no 30-day mortality. Thirty-three patients underwent urgent repair with 2 deaths, yielding a 30-day mortality of 6.1%. The mortality for the entire group of patients was 0.9%. Complications associated with this series of patients included 8 with endocarditis, 7 with thromboembolism, and 4 late coronary dehiscences. Actuarial survival was 88% at 5 years, 81% at 10 years, and 75% at 20 years. Multivariate analysis revealed New York Heart Association classification, male gender and urgent surgery as independent risk factors for mortality. Marfan patients with aortic aneurysms can undergo elective surgery with a low operative risk and excellent long-term survival with low morbidity. We feel that elective resection of an aneurysm in a Marfan patient should occur when it approaches a diameter of 5.5 cm. It is essential that a timely diagnosis be made in this group of young patients.

Improvement Approach for the Operation of the K-HPES in Nuclear Power Plants

International Nuclear Information System (INIS)

Yoon, Young S.; Lee, Dhong H.; Jeong, Choong H.

2008-01-01

The safety-related events attributable to human factors can provide invaluable safety information that reveal the latent vulnerabilities in NPPs, when carried out effectively. The Korean nuclear utility has developed and operated K-HPES to report and manage the HEREs. However, recent periodic inspections found some operational problems in the K-HPES. This paper suggested several improvement directions of K-HPES operation, such as defining the criteria to evaluate the safety-significance of the reported events, preparing an alternative way to motivate reporting culture, revising the K-HPES to avoid the hindsight bias of the investigators, and supplementing the writing materials or training programs to prevent misunderstanding of the K-HPES. For effective management of the safety information, such as the human error related events, it is an important and urgent issue to improve the management practice of the KHPES reports

15 CFR 2013.1 - Designations.

Science.gov (United States)

2010-01-01

... LAW § 2013.1 Designations. In accordance with section 771(36) of the Tariff Act of 1930, as amended... Salvador Fiji Gabon Grenada Guatemala Honduras Jamaica Malaysia Malta Mauritius Morocco Namibia Panama...

Chemical pesticides and human health: The urgent need for a new concept in agriculture

Directory of Open Access Journals (Sweden)

Polyxeni Nicolopoulou-Stamati

2016-07-01

Full Text Available The industrialization of the agricultural sector has increased the chemical burden on natural ecosystems. Pesticides are agrochemicals used in agricultural lands, public health programs and urban green areas in order to protect plants and humans from various diseases. However, due to their known ability to cause a large number of negative health and environmental effects, their side effects can be an important environmental health risk factor. The urgent need for a more sustainable and ecological approach has produced many innovative ideas, among them agriculture reforms and food production implementing sustainable practice evolving to food sovereignty. It is more obvious than ever that the society needs the implementation of a new agricultural concept regarding food production which is safer for man and the environment, and to this end, steps such as the declaration of Nyéléni have been taken.

78 FR 59743 - Bureau of Consular Affairs; Registration for the Diversity Immigrant (DV-2015) Visa Program

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2013-09-27

... result in Web site delays. No late entries or paper entries will be accepted. The law allows only one... Dominica Grenada Guatemala Guyana Honduras Nicaragua Panama Paraguay Saint Kitts and Nevis Saint Lucia...

8 CFR 1236.1 - Apprehension, custody, and detention.

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2010-01-01

... release would not pose a danger to the safety of other persons or of property. If an alien meets this..., The Georgia Ghana Grenada Guyana Hungary Jamaica Kazakhstan Kiribati Kuwait Kyrgyzstan Malaysia Malta...

Fusion is urgent needed for the developing countries

International Nuclear Information System (INIS)

Li Jiangang

2005-01-01

Energy is a global problem, as it is central to economic development, climate and environment, and international stability and sustainability. Energy need is expected to double in 40 years and an even larger increase is needed to lift the world out of poverty. 80% of world's energy is generated by burning fossil fuels, which is driving climate change and generating pollution. China will grow up to be a moderate developed country in 2050. The coal-centred energy structure will remain until 2050. Annual Energy Consumption per person will increase from near 1 TCE to no less than 3 TCE ( at present time, US: 11.5 TCE; West Europe: 5.6 TCE; Japan: 5.1 TCE) Estimated Energy Demand: increasing from near 1B TCE to over 4B TCE within next 3-4 decades. To realize the long-term sustainable development, it is necessary for China to explore reliable ways and develop thousands of GW non- fossil fuel power. The fission energy is a transit solution. To build hundreds of GW Fission Nuclear Power Plants in China - social problems, safety and environmental concerns, technical difficulties should be solved in near future. It is crucial and urgent for China to realize the controlled Nuclear Fusion Energy for our long-term development in the future as early as possible. Fusion shows environmentally responsible and intrinsically safe, the supplies of fuel are essentially limitless. JET has produced 16MW of fusion power and shown that fusion can be mastered on earth. Fusion has a long and successful history of international collaboration with obvious benefits to all partners for peaceful purpose. ITER is a device for us to bring the Sun to earth for the first time in the history. A properly organised and funded fusion development programme could lead to a proto-type fusion power plant to generate electricity to the grid within about 30 years (ITER+IFMIF). For developing countries, such as China and India, fusion is one of the very few options for large-scale sustainable energy generation

Idarucizumab in Three Patients Needing Urgent Surgical Intervention and One Case of Intravenous Thrombolysis in Ischaemic Stroke

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Fredrik Andreas von Wowern

2017-05-01

Full Text Available Objective: To describe the benefits of reversal of the anticoagulation effects of dabigatran etexilate in patients requiring urgent surgery or thrombolysis for ischaemic stroke. Materials and methods: Four patients, treated with dabigatran etexilate and presenting with cholecystitis, tibial fracture, lower limb ischaemia and ischaemic stroke, respectively. Results: Administration of idarucizumab normalized bleeding parameters and provided safe conditions for surgery and, in one case, successful thrombolysis of an ischaemic stroke. Conclusion: The introduction of an effective reversal agent for dabigatran etexilate allows physicians perform surgery under conditions of normal coagulation and permits thrombolysis in patients with ischaemic stroke despite being treated with dabigatran etexilate.

Cyborg practices: call-handlers and computerised decision support systems in urgent and emergency care.

Science.gov (United States)

Pope, Catherine; Halford, Susan; Turnbull, Joanne; Prichard, Jane

2014-06-01

This article draws on data collected during a 2-year project examining the deployment of a computerised decision support system. This computerised decision support system was designed to be used by non-clinical staff for dealing with calls to emergency (999) and urgent care (out-of-hours) services. One of the promises of computerised decisions support technologies is that they can 'hold' vast amounts of sophisticated clinical knowledge and combine it with decision algorithms to enable standardised decision-making by non-clinical (clerical) staff. This article draws on our ethnographic study of this computerised decision support system in use, and we use our analysis to question the 'automated' vision of decision-making in healthcare call-handling. We show that embodied and experiential (human) expertise remains central and highly salient in this work, and we propose that the deployment of the computerised decision support system creates something new, that this conjunction of computer and human creates a cyborg practice.

Sistema de Apoio à Decisão para o Transporte Não Urgente de Doentes em Veículo Partilhado

Directory of Open Access Journals (Sweden)

José António Oliveira

2014-06-01

Full Text Available O transporte não urgente de doentes em Portugal foi alvo de reformulação legislativa de modo a reduzir os custos que acarretava. Neste artigo apresentam-se métodos heurísticos para a formação de agrupamentos de doentes a serem transportados na mesma viatura. São apresentados resultados computacionais que validam os algoritmos desenvolvidos. Os algoritmos podem ser facilmente integrados num sistema de apoio à decisão.

Research and increase of expertise in arachno-entomology are urgently needed.

Science.gov (United States)

Mehlhorn, Heinz; Al-Rasheid, Khaled A S; Al-Quraishy, Saleh; Abdel-Ghaffar, Fathy

2012-01-01

Considering the contents of international journals of parasitology dealing with broader topics inside this field show that rather a few papers appear with studies in the discipline of arachno-entomology. In the journals Journal of Parasitology, Parasitology Research and Trends in Parasitology, the relations of published papers on protozoology, helminthology and arachno-entomology showed that in all three journals, papers on protozoans were the most common, while those on helminths of any kind reached the second place being rather as common as the protozoan papers in Parasitology Research and in the Journal of Parasitology. In Trends of Parasitology, however, the papers on helminths reached only about 25% of the numbers published on protozoan topics. But in all three journals-and this is important-the papers on arachno-entomological themes were scarce reaching less than the half of the protozoan papers in Parasitology Research, and only about 15% in the Journal of Parasitology and in the Trends of Parasitology. These disproportions between the three great subdivisions of targets in the focus of parasitological research are dangerous, since this lack exists already for several decades and thus led to a backlog of unsolved increasing problems that are caused by ticks, mites, insects and/or parasitic crustaceans especially in times of intensive globalization and global warming. Studies on the biology, vectorship, invasion and spreading of wanted vectors and on the control of pests and parasites belonging to the field of arachno-entomology are urgently needed.

Possible classification of the methods of operational research applicable in the field of defense

Directory of Open Access Journals (Sweden)

Mučibabić Spasoje

2006-01-01

Full Text Available The overall dynamic development of operational research in various fields of human activities urges the need for a clearer and mathematically more explicit classification of its methods. This need is also very urgent in the field of defense, particularly because of the complications of modern conflicts, as well as of new security requirements. One of the possible classifications of methods based on the theory of games as a mathematical model for solving conflict situations is presented in this paper. The connections between methods and their mathematical description are underlined.

African Journals Online: Suriname

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El Salvador, Equatorial Guinea, Eritrea, Estonia, Ethiopia, Faeroe Islands, Falkland Islands (Malvinas), Fiji, Finland, France, France, MEtropolitan, French Guiana, French Polynesia, French Southern Territories, Gabon, Gambia, The, Georgia, Germany, Ghana, Gibraltar, Greece, Greenland, Grenada, Guam, Guatemala ...

African Journals Online: Argentina

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El Salvador, Equatorial Guinea, Eritrea, Estonia, Ethiopia, Faeroe Islands, Falkland Islands (Malvinas), Fiji, Finland, France, France, MEtropolitan, French Guiana, French Polynesia, French Southern Territories, Gabon, Gambia, The, Georgia, Germany, Ghana, Gibraltar, Greece, Greenland, Grenada, Guam, Guatemala ...

African Journals Online: Angola

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El Salvador, Equatorial Guinea, Eritrea, Estonia, Ethiopia, Faeroe Islands, Falkland Islands (Malvinas), Fiji, Finland, France, France, MEtropolitan, French Guiana, French Polynesia, French Southern Territories, Gabon, Gambia, The, Georgia, Germany, Ghana, Gibraltar, Greece, Greenland, Grenada, Guam, Guatemala ...

African Journals Online: Netherlands

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El Salvador, Equatorial Guinea, Eritrea, Estonia, Ethiopia, Faeroe Islands, Falkland Islands (Malvinas), Fiji, Finland, France, France, MEtropolitan, French Guiana, French Polynesia, French Southern Territories, Gabon, Gambia, The, Georgia, Germany, Ghana, Gibraltar, Greece, Greenland, Grenada, Guam, Guatemala ...

What we do | Page 158 | IDRC - International Development ...

International Development Research Centre (IDRC) Digital Library (Canada)

Electronic Government : Caribbean Pilot Project. Caribbean countries are increasingly adopting information and communication technologies (ICTs) in the process of modernizing their public sectors. North And Central America, South America, West Indies, Antigua And Barbuda, Grenada, Jamaica. PROJECT ...

African Journals Online: Mongolia

African Journals Online (AJOL)

... Faeroe Islands, Falkland Islands (Malvinas), Fiji, Finland, France, France, MEtropolitan, French Guiana, French Polynesia, French Southern Territories, Gabon, Gambia, The, Georgia, Germany, Ghana, Gibraltar, Greece, Greenland, Grenada, Guam, Guatemala, Guernsey, Guinea, Guinea-Bissau, Guyana, Haiti, Honduras ...

Seeing Through the Conflict: Military-Media Relations

National Research Council Canada - National Science Library

Snyder, John

2003-01-01

.... The media have often called this determination censorship." Since the U.S. military's 1983 invasion of Grenada, commanders have done a questionable job of accommodating the media, as evident by the findings of the Sidle and Hoffman Panels...

: tous les projets | Page 502 | CRDI - Centre de recherches pour le ...

International Development Research Centre (IDRC) Digital Library (Canada)

End Date: 4 novembre 2009. Sujet: YOUTH UNEMPLOYMENT, YOUTH UNREST, TRAINING PROGRAMMES, INFORMATION TECHNOLOGY, YOUNG WORKERS. Région: North and Central America, South America, West Indies, Dominica, Grenada, Jamaica, Saint Kitts and Nevis, Saint Lucia, Trinidad and Tobago.

The imitator of nuclear explosion signals for field operations

International Nuclear Information System (INIS)

Wang Lusong; Xie Yujun; Tan Youjin; Wang Liping

1999-01-01

According to the present system of the nuclear explosion monitoring equipment (NEME), the imitator of nuclear explosion signals for field operation is urgently needed by NEME, which has been fitted out to the army and some new types that will be finalized soon. The authors have made the imitator for the equipment, and as the cause of this research, it can be used not only in training and maintenance for army but also in research and production for scientific research institutions and industrial enterprise. Function of this imitator is to imitate the NEMP, the light and shock wave signals of nuclear explosion in proper order. The time difference of the process accords with the true location of nuclear explosion. This research is of great military importance

Urgent endoscopic retrograde cholangiopancreatography is not superior to early ERCP in acute biliary pancreatitis with biliary obstruction without cholangitis.

Science.gov (United States)

Lee, Hee Seung; Chung, Moon Jae; Park, Jeong Youp; Bang, Seungmin; Park, Seung Woo; Song, Si Young; Chung, Jae Bock

2018-01-01

Acute pancreatitis is a common diagnosis worldwide, with gallstone disease being the most prevalent cause (50%). The American College of Gastroenterology recommends urgent endoscopic retrograde cholangiopancreatography (ERCP) (within 24 h) for patients with biliary pancreatitis accompanied by cholangitis. Most international guidelines recommend that ERCP be performed within 72 h in patients with biliary pancreatitis and a bile duct obstruction without cholangitis, but the optimal timing for endoscopy is controversial. We investigated the optimal timing for ERCP in patients with biliary pancreatitis and a bile duct obstruction without cholangitis, and whether performing endoscopy within 24 h is superior to performing it after 24 h. We analyzed the clinical data of 505 patients with newly diagnosed acute pancreatitis, from January 1, 2005 to December 31, 2014. We divided the patients into two groups according to the timing of ERCP: pancreatitis and a bile duct obstruction without cholangitis. The mean age of the patients was 55 years (range: 26-90 years). Bile duct stones and biliary sludge were identified on endoscopy in 45 (61.6%) and 11 (15.0%) patients, respectively. The timing of ERCP within 72 h was not associated with ERCP-related complications (P = 0.113), and the total length of hospital stay was not different between urgent and early ERCP (5.9 vs. 5.7 days, P = 0.174). No significant differences were found in total length of hospitalization or procedural-related complications, in patients with biliary pancreatitis and a bile duct obstruction without cholangitis, according to the timing of ERCP (< 24 h vs. 24-72 h).

Reducing maternal mortality in Nigeria: the need for urgent changes in financing for maternal health in the Nigerian health system.

Science.gov (United States)

Ebeigbe, P N

2013-06-01

Nigeria's maternal mortality indices are among the worst in the world. Various approaches aimed at combatting the persistently high maternal mortality rates in the past have been ineffective. The objective of this article was to evaluate the fairness and equitability of financing for maternal health in the Nigerian health system. A review of the performance of the Nigerian Health system with regards to financing for maternal healthcare and comparison with other health systems utilising internationally accepted criteria was done. Household out-of -pocket payment was found to be the largest source of health care financing in the Nigerian health system contributing as much as 65.6 % of total health expenditure. This is in sharp contrast to the performance of more effective health systems like that in South Africa where health care is free for pregnant and breast feeding mothers. The result is that South Africa reports less than a tenth of total maternal mortalities reported from Nigeria annually. The current Nigeria health financing system is not equitable and appears to encourage maternal mortalities since it does not cater for the most vulnerable. There is an urgent need for a review of financing of maternal health in Nigeria to achieve universal access to maternal health care. An urgent overhaul of the currently under performing National Health Insurance scheme or adoption of the simpler system based on funding from taxation with universal access for health care including maternal care and services free at the point of access is suggested.

[Application of the Decasan at the practice of urgent surgery].

Science.gov (United States)

Konovalov, E P; Terletskiĭ, V N; Pliatsok, A A; Gumeniuk, N I; Padiĭ, V I; Iakovlev, B F

2004-09-01

The results of complex treatment of 37 patients operated on for the various acute abdominal surgical diseases were presented. Among them 22 patients for locally treated 0.02% antiseptical solution Decametoxin were used. Positively impact clinical course of the diseases reducing their purulent and septic morbidity rate in particular were evidenced separately in the patients operated on for acute necrotic pancreatitis.

Accidents involving Brazilian indigenous treated at urgent and emergency services of the Unified Health System.

Science.gov (United States)

Souza, Edinilsa Ramos de; Njaine, Kathie; Mascarenhas, Márcio Dênis Medeiros; Oliveira, Maria Conceição de

2016-12-01

Abstract We analyzed the accidents with Brazilian indigenous treated at urgent and emergency services of the Unified Health System (SUS). Data were obtained from the 2014 Viva Survey, which included 86 services from 24 capitals and the Federal District. The demographic profile of the indigenous, the event and the attendance were characterized. Most of the attended people were male in the 20-39 years age group. Falls and traffic accidents were the main reasons for attendance. Alcohol use was informed by 5.6% of the attended people, a figure that increases to 19.1% in traffic accidents, 26.1% among drivers and 22.8% among motorcyclists. There was a statistical difference between genders in relation to age, disability, place of occurrence of the event, work-related event and victim's condition in the traffic accident. We emphasize the importance of providing visibility to accidents with indigenous and engage them in the prevention of such events. Data reliability depends on the adequate completion in indigenous health information systems.

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Military Training and Education: an Opportunity for V4 Co-Operation

Directory of Open Access Journals (Sweden)

Milan ŠUPLATA

2015-03-01

Full Text Available The Visegrad Group needs success stories if its defence co-operation is to develop. The recent differences between Poland and the rest of the region, as well as the closing window of opportunity to improve interoperability through the ISAF mission, make the hunger for concrete examples of co-operation even more urgent. Education and training projects are not only comparatively easily to implement in terms of time and money, but also represent a way of bringing the region’s civilian and military leaders closer together in terms of strategic thinking. Regional defence collaboration is also one of the ways to materialize NATO’s Smart Defence agenda. For the whole region, the way to keep Visegrad defence cooperation alive is not straightforward and certain, but it is likely to prove rewarding in the long term. It presents not only a chance to keep the whole region better prepared militarily, but also to build a more cohesive strategic awareness, thanks to intensive communication at all levels.

Engagement of the Slovak Armed Forces in Future Crisis Management Operations

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Peter PINDJÁK

2014-09-01

Full Text Available During the past two decades, the Armed Forces of the Slovak Republic (AF SR have participated in more than thirty operations under major international organizations and coalitions. Despite the political interest to sustain active engagement of the AF SR in international crisis management operations, the declining level of capabilities coupled with the urgent need to modernize most of the military equipment compels the Slovak Ministry of Defense to commence a complex optimization process. Even though the evolving security environment continues to widen the spectrum of military capabilities, AF SR will need to prioritize and optimize their capabilities selectively. The defense planners must make sure that the AF SR will develop and maintain the necessary spectrum of capabilities required for the most likely deployment scenario. The optimization process should be conducted within a long-term conceptual plan that clearly defines the future course of the AF SR development within a limited financial frame. At the same time, the optimization endeavor must include a certain degree of flexibility that will allow for necessary adjustments based on specific operational requirements. In the end, the AF SR may become a modern and flexible instrument of power that could be engaged in crisis management operations abroad, upholding national and international interests effectively.

78 FR 61871 - Grenada Railway, LLC-Rail Line in Grenada, Montgomery, Carroll, Holmes, Yazoo and Madison...

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2013-10-04

... the Surface Transportation Board will hold a public meeting concerning the rail line embargo at issue... the effects of the embargo. DATES: Date/Location: The public meeting will take place on Friday... lawfulness of an embargo GRYR imposed on a portion of the Line in 2011.\\1\\ In doing so, the Board directed...

Targeting U. S. Technologies: A Trend Analysis of Cleared Industry Reporting

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2013-01-01

conducted a scientic analysis that traced a particular disease outbreak to one specic London well, and demonstrated that cholera befell only those...Islands Chile Colombia Costa Rica Cuba Curacao Dominica Dominican Republic Ecuador El Salvador Grenada Guatemala Guyana Haiti Honduras Jamaica Mexico

The duplex-Doppler colour echography of the scrotum and testicles in adults and boys. II. the contribution of the urgent study of acute scrotum symptoms; Ecografia duples-Doppler color del escroto y el testiculo en el adulto y el nino. II. Aportacion al estudio urgente del escroto agudo

Energy Technology Data Exchange (ETDEWEB)

Rangel-Villalobos, E.; Jimenez-Castellanos, R.; Bustos, C.; Linares, A.; Gonzalez-Prada, F. [Hospital Universitario Virgen Macarena. Sevilla (Spain)

1999-07-01

To analyse the findings, contributions and limitations of the Doppler echography for the urgent study of acute scrotum symptoms, both in adults and in boys. 60 patients (22 adults and 38 boys) with acute scrotal symptomatology were examined using B mode echography, followed by a colour duplex-Doppler (CDD) echography with a lineal 7.5 MHz transducer. We compared the findings obtained with those of the healthy contralateral testicle and with surgery or clinical-echographical evolution. The most common pathology was inflammation (27%) followed by ischemic (24%) and traumatic (17%). 12% of the patients had miscellaneous conditions. To conclude, in 20% of the cases the B mode and the Doppler examination was normal, the symptoms were resolved spontaneously. After carrying out the CDD only 14 (23%) of the cases needed immediate surgery and 3 (5%) delayed surgery, the remaining 43 (72%) patients responded to the traditional treatment. The CDD allows for a safe, quick and harmless diagnosis in practically all the acute scrotum cases, for both adults and boys. Its limitations in pre-puberty patients or in cases that were atypical are overcome when put in the hands of an expert radiologist, as they need a longer exploration time and suitable Doppler equipment. The main contribution to the urgent diagnosis of acute scrotum symptoms is that it accurately establishes which patients should be chosen for immediate surgery. (Author) 33 refs.

El Mapa de la Incapacidad en España una necesidad urgente

Directory of Open Access Journals (Sweden)

Araceli López-Guillén García

2015-09-01

Full Text Available Resumen: Es urgente adaptar los sistemas de recogida de datos en incapacidad laboral para conseguir una mejor explotación epidemiológica de los mismos que facilite conocer la situación, análisis y planificación estratégica sobre incapacidad, creando con una base de datos mínimos básicos el Mapa de la Incapacidad en España permitiendo conocer las causas y el impacto de las situaciones de incapacidad laboral, practicar una gestión integral de recursos, prevenir las situaciones de incapacidad laboral, potenciar los mecanismos de detección de la enfermedad y los aspectos preventivos de la salud laboral, mejorar la gestión sanitaria que precisa y la protección socio laboral. Conclusiones: Proponemos la base mínima de datos para la elaborar el Mapa de Incapacidad. Conociendo el impacto incapacitante de la pérdida de salud en la población trabajadora se procederá a una mejor gestión y adecuación de recursos atencionales, promocionales, preventivos, reintegradores, y prestacionales en torno a la incapacidad temporal y permanente. Conocer nuestra población "incapacitada (por enfermedad" es fundamental para cualquier análisis sobre impacto y necesidades de protección social, para contrastarla con la población activa, la población en formación o inactiva previa a la edad laboral, y la población inactiva jubilada.

Operating room scheduling and surgeon assignment problem under surgery durations uncertainty.

Science.gov (United States)

Liu, Hongwei; Zhang, Tianyi; Luo, Shuai; Xu, Dan

2017-12-29

Scientific management methods are urgently needed to balance the demand and supply of heath care services in Chinese hospitals. Operating theatre is the bottleneck and costliest department. Therefore, the surgery scheduling is crucial to hospital management. To increase the utilization and reduce the cost of operating theatre, and to improve surgeons' satisfaction in the meantime, a practical surgery scheduling which could assign the operating room (OR) and surgeon for the surgery and sequence surgeries in each OR was provided for hospital managers. Surgery durations were predicted by fitting the distributions. A two-step mixed integer programming model considering surgery duration uncertainty was proposed, and sample average approximation (SAA) method was applied to solve the model. Durations of various surgeries were log-normal distributed respectively. Numerical experiments showed the model and method could get good solutions with different sample sizes. Real-life constraints and duration uncertainty were considered in the study, and the model was also very applicable in practice. Average overtime of each OR was reducing and tending to be stable with the number of surgeons increasing, which is a discipline for OR management.

Extended training to prepare GPs for future workforce needs: a qualitative investigation of a 1-year fellowship in urgent care.

Science.gov (United States)

Dale, Jeremy; Russell, Rachel; Harkness, Frances; Wilkie, Veronica; Aiello, Matthew

2017-09-01

It has been argued that UK general practice specialist training should be extended to better prepare GPs for the challenges facing 21st-century health care. Evidence is needed to inform how this should occur. To investigate the experience of recently trained GPs undertaking a 1-year full-time fellowship programme designed to provide advanced skills training in urgent care, integrated care, leadership, and academic practice; and its impact on subsequent career development. Semi-structured interviews conducted longitudinally over 2 years augmented by observational data in the West Midlands, England. Participants were interviewed on at least three occasions: twice while undertaking the fellowship, and at least once post-completion. Participants' clinical and academic activities were observed. Data were analysed using a framework approach. Seven GPs participated in the pilot scheme. The fellowship was highly rated and felt to be balanced in terms of the opportunities for skill development, academic advancement, and confidence building. GPs experienced enhanced employability on completing the scheme, and at follow-up were working in a variety of primary care/urgent care interface clinical and leadership roles. Participants believed it was making general practice a more attractive career option for newly qualified doctors. The 1-year fellowship provides a defined framework for training GPs to work in an enhanced manner across organisational interfaces with the skills to support service improvement and integration. It appears to be well suited to preparing GPs for portfolio roles, but its wider applicability and impact on NHS service delivery needs further investigation. © British Journal of General Practice 2017.

Application of technetium-99m hexamethylpropylene amine oxime single-photon emission tomography to neurologic prognosis in patients undergoing urgent carotid surgery

International Nuclear Information System (INIS)

Shvera, I.Y.; Cherniavsky, A.M.; Ussov, W.Yu.; Plotnikov, M.P.; Sokolov, A.A.; Shipulin, V.M.; Chernov, V.I.

1995-01-01

In this study we aimed to work out a quantitative prognostic index for preoperative assessment of brain technetium-99m hexamethylpropylene amine oxime (HMPAO) single-photon emission tomography (SPET) in patients referred for urgent carotid endarterectomy due to acute abstructive disease of the internal carotid artery (ICA) and neurological deficit. To this end we compared data from preoperative SPET studies with the postinterventional changes in neurological status in 20 patients (17 males, three females; mean age 53 years, SD 4 years) with acute ischaemic cerebral disorders induced by obstruction of the ICA. Carotid obstruction was diagnosed by ultrasound B-mode study. All patients underwent urgent carotid endarterectomy from the ICA. Patients were divided into two groups in accordance with the results of postoperative follow-up: group A comprised patients with significant (more than 3 points) postoperative improvement in neurological condition as quantified by the Canadian Neurological Scale (11 patients); group B consisted of patients with minimal improvement or deterioration (nine, three of whom died). All patients were studied preoperatively by 99m Tc-HMPAO SPET. The volume of nonperfused tissue (VS, cm 3 ) was quantified using the Mountz technique. Hypoperfused volume (V hypoperf , cm 3 ) in the affected hemisphere was calculated as the total volume of voxels with 99m Tc-HMPAO uptake hypoperf ). Patients with preoperative PF values 8.90 comprised patients who demonstrated minimal improvement or deterioration. PF values in the range 8.20-8.90 carried an indefinite prognosis. (orig.)

IAEA calls for urgent action on nuclear situation in Iraq

International Nuclear Information System (INIS)

2003-01-01

Full text: The Director General of the International Atomic Energy Agency (IAEA), Dr. Mohamed ElBaradei, called on the United States and other Coalition authorities to allow IAEA experts to return to Iraq to address a possible radiological emergency there. 'I am deeply concerned by the almost daily reports of looting and destruction at nuclear sites and about the potential radiological safety and security implications of nuclear and radiological materials that may no longer be under control.' Such reports have described among other things yellow cake emptied on the ground from containers then taken for domestic use, and radioactive sources being stolen and removed from their shielding. 'We have a moral responsibility to establish the facts without delay and take urgent remedial action,' said Dr. ElBaradei. As hostilities in Iraq were coming to an end, Dr. ElBaradei wrote on 10 April to the US government bringing its attention to the need to secure the nuclear material stored at Tuwaitha - Iraq's nuclear research centre - and under IAEA seal since 1991. The IAEA also provided the United States with information about the nuclear material, radioactive sources, and nuclear waste in Iraq. The IAEA received oral assurances that physical protection of the site was in place; but following reports of looting there and at other sites, Dr. ElBaradei wrote again on 29 April, emphasizing the responsibility of the Coalition forces to maintain appropriate protection over the materials in question. This includes natural and low-enriched uranium, radioactive sources such as Cobalt 60 and Caesium 137, and nuclear waste. Dr. ElBaradei regrets that the IAEA has to date not received a response. He again urged that the Agency be allowed to send a safety and security team to Iraq so that a potentially serious humanitarian situation can be addressed without further delay. The IAEA has experienced international teams of radiation safety, nuclear security and emergency response specialists

Continued expansion of the trans-Atlantic invasive marine angiosperm Halophila stipulacea in the Eastern Caribbean

NARCIS (Netherlands)

Willette, D.A.; Chalifour, J.; Debrot, A.O.; Engel, M.S.; Miller, J.; Oxenford, H.A.; Short, F.T.; Steiner, S.; Vedie, F.

2014-01-01

Halophila stipulacea (Hydrocharitaceae) is reported for the first time from Aruba, Curaçao, Grenadines (Grenada), St. Eustatius, St. John (US Virgin Islands), St. Martin (France), and St. Vincent and the Grenadines, bringing the total number of known occurrences from eastern Caribbean islands to 19.

Characteristics of motorcyclists involved in road traffic accidents attended at public urgent and emergency services.

Science.gov (United States)

Mascarenhas, Márcio Dênis Medeiros; Souto, Rayone Moreira Costa Veloso; Malta, Deborah Carvalho; Silva, Marta Maria Alves da; Lima, Cheila Marina de; Montenegro, Marli de Mesquita Silva

2016-12-01

Injuries resulting from motorcycle road traffic accidents are an important public health issue in Brazil. This study aimed to describe the characteristics of motorcyclists involved in traffic accidents attended in public urgent and emergency services in the state capitals and the Federal District. This is a cross-sectional study based on data from the Violence and Accident Surveillance System (VIVA Survey) in 2014. Data were analyzed according to sociodemographic, event and attendance characteristics. Proportional differences between genders were analyzed by chi-square test (Rao-Scott) with 5% significance level. Motorcyclist-related attendances (n = 9,673) reported a prevalence of men (gender ratio = 3.2), young people aged 20-39 years (65.7%), black / brown (73.6%), paid work (76.4%). Helmet use was reported by 79.1% of the victims, 13.3% had consumed alcohol in the six hours prior to the accident, 41.4% of the events were related to the victim's work. Accidents were more frequent on weekends, in the morning and late afternoon. These characteristics can support the development of public accident prevention policies and health promotion.

Funding for tuberculosis research—an urgent crisis of political will, human rights, and global solidarity

Directory of Open Access Journals (Sweden)

Mike Frick

2017-03-01

Full Text Available Tuberculosis (TB killed more people in 2015 than any other single infectious agent, but funding for research to develop better prevention, diagnosis, and treatment methods for TB declined to its lowest level in 7 years. TB research and development (R&D is woefully underfunded, a situation best viewed as a crisis of political will and a failure on the part of governments to see unmet innovation needs in the TB response as a human rights issue requiring immediate action. Over 60% of available money for TB R&D comes from public sources, and 67% of public money comes from a single country: the USA. The election of Donald Trump to the US presidency in November 2016 has introduced great uncertainty into the support that science generally, and TB research in particular, will receive in the coming years. Advocacy on the part of all actors—from civil society to TB-affected communities to scientists themselves—is urgently needed to increase US government support for TB research moving forward.

Funding for tuberculosis research-an urgent crisis of political will, human rights, and global solidarity.

Science.gov (United States)

Frick, Mike

2017-03-01

Tuberculosis (TB) killed more people in 2015 than any other single infectious agent, but funding for research to develop better prevention, diagnosis, and treatment methods for TB declined to its lowest level in 7 years. TB research and development (R&D) is woefully underfunded, a situation best viewed as a crisis of political will and a failure on the part of governments to see unmet innovation needs in the TB response as a human rights issue requiring immediate action. Over 60% of available money for TB R&D comes from public sources, and 67% of public money comes from a single country: the USA. The election of Donald Trump to the US presidency in November 2016 has introduced great uncertainty into the support that science generally, and TB research in particular, will receive in the coming years. Advocacy on the part of all actors-from civil society to TB-affected communities to scientists themselves-is urgently needed to increase US government support for TB research moving forward. Copyright © 2016 The Author(s). Published by Elsevier Ltd.. All rights reserved.

Operational Definition of Active and Healthy Ageing (AHA)

DEFF Research Database (Denmark)

Bousquet, J; Kuh, D; Bewick, M

2015-01-01

Health is a multi-dimensional concept, capturing how people feel and function. The broad concept of Active and Healthy Ageing was proposed by the World Health Organisation (WHO) as the process of optimizing opportunities for health to enhance quality of life as people age. It applies to both...... individuals and population groups. A universal Active and Healthy Ageing definition is not available and it may differ depending on the purpose of the definition and/or the questions raised. While the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA) has had a major impact......, a definition of Active and Healthy Ageing is urgently needed. A meeting was organised in Montpellier, France, October 20-21, 2014 as the annual conference of the EIP on AHA Reference Site MACVIA-LR (Contre les Maladies Chroniques pour un Vieillissement Actif en Languedoc Roussillon) to propose an operational...

Floodplain Submission for Grenada County MS

Data.gov (United States)

Federal Emergency Management Agency, Department of Homeland Security — The Floodplain Mapping/Redelineation study deliverables depict and quantify the flood risks for the study area. The primary risk classifications used are the...

Per Diem Tables

International Development Research Centre (IDRC) Digital Library (Canada)

Marissa Farruggia

15 oct. 2016 ... Everywhere / Dans tout le pays. 362. FINLAND / FINLANDE. Helsinki. 458. FINLAND / FINLANDE. Elsewhere / Ailleurs dans le pays. 380. FRANCE ... GREECE / GRÈCE. Athens / Athènes. 439. GREECE / GRÈCE. Elsewhere / Ailleurs dans le pays. 308. GRENADA / GRENADE. Everywhere / Dans tout le ...

Exploring the Use of Information Communication Technologies by Selected Caribbean Extension Officers

Science.gov (United States)

Strong, Robert; Ganpat, Wayne; Harder, Amy; Irby, Travis L.; Lindner, James R.

2014-01-01

Purpose: The purpose of this study was to describe selected Caribbean extension officers' technology preferences and examine factors that may affect their technology preferences. Design/methodology/approach: The sample consisted of extension officers (N = 119) participating in professional development training sessions in Grenada, Belize and Saint…

Economic growth cannot be taken for granted: Need for urgent reforms – an interview with Dr. A. Virmani

Directory of Open Access Journals (Sweden)

Charan Singh

2013-12-01

Full Text Available Growth of the Indian economy has suffered in the recent years as indicated by decline in industrial production, capital formation, exports, etc. Weakening of aggregate demand and decline in investment could be some of the contributing factors for this phenomenon. While the slowdown can also be attributed to global slowdown, a high current account deficit and gross fiscal deficit, and continuance of a high rate of inflation are some of the most worrying signs for the policy makers. Restoration of fiscal sustainability and macroeconomic balance through stepped-up reforms are some of the key issues that need urgent focus of the government.

Shellfish as reservoirs of bacterial pathogens

Directory of Open Access Journals (Sweden)

Harry Hariharan

2016-04-01

Full Text Available The objective of this article is to present an overview on bacterial pathogens associated with shellfish in Grenada and other countries including the authors’ experience. Although there have been considerable published work on vibrios, there is a lack of information on Salmonella serovars associated with various shellfish. In Grenada, for instance the blue land crabs collected from their habitats were found to harbor several Salmonella serovars. Also, it is notable that only minimal research has been done on shellfish such as conchs and whelks, which are common in the Caribbean and West Indies. Information on anaerobic bacteria, particularly, non-spore forming bacteria associated with shellfish, in general, is also scanty. This review re-examines this globally important topic based on the recent findings as well as past observations. Strategies for reduction of bacteria in oysters are briefly mentioned because of the fact that oysters are consumed commonly without complete cooking.

Urgent Virtual Machine Eviction with Enlightened Post-Copy

Science.gov (United States)

2015-12-01

suspended at one point, and then resumed on the destination. State transfer during the course of migration is 3 (x1000) (x1000) (x1000) Figure 2: Live...determined by a one-time operation upon the request by the hypervisor. There is no need for always tracking them during the course of the guest’s normal...memory is in use, almost all of which is by Memcached. MySQL : The VMs run MySQL 5.6, and the clients execute OLTPBenchmark [3] using the Twitter

Logistics and outcome in urgent and emergency colorectal surgery

DEFF Research Database (Denmark)

Elshove-Bolk, J.; Ellensen, V. S.; Baatrup, G.

2010-01-01

died were less likely to be operated by a subspecialized colorectal surgeon (17%. vs 30%, P = 0.001). The anaesthesiologist was a resident in most of the cases (> 75%) for both those who survived and those who died. Surgery performed out-of-office hours was common in both groups, although the patients...

Determination of the Cascade Reservoir Operation for Optimal Firm-Energy Using Genetic Algorithms

Directory of Open Access Journals (Sweden)

Azmeri

2013-08-01

Full Text Available Indonesia today face a new paradigm in water management where aim to apply integrated water resources management has become unavoidable task in purpose of achieving greater level of effectiveness and efficiency. On of most interesting case study is the case of Citarum river, one of the most potential river for water supply in West Java, Indonesia. Alongside the river, Saguling, Cirata and Djuanda Reservoirs had been constructed in series/cascade. Saguling and Cirata reservoirs are particularly operated for hydroelectric power and Djuanda is multipurpose reservoir mainly operated for irrigation and contribute domestic water supply for Jakarta (capital city of Indonesia. Basically all reservoirs are relying on same resources, therefore this condition has considered addressing management and operational problem. Therefore, an approach toward new management and operation system are urgently required in order to achieve the effective and efficient output and to avoid conflicts of water used. This study aims to obtain energy production from Citarum Cascade Reservoir System using Genetic Algorithms optimization with the objective function to maximize firm-energy. Firm-energy is the minimum energy requirements must be available in a certain time period. Then, the result obtained by using the energy produced by GA is compared to the conventional searching technique of Non-Linier Programming (NLP. The GA derived operating curves reveal the higher energy and firm-energy than NLP model

Building a Smooth Medical Service for Operating Room Using RFID Technologies

Directory of Open Access Journals (Sweden)

Lun-Ping Hung

2014-01-01

Full Text Available Due to the information technology advancement, the feasibility for the establishment of mobile medical environments has been strengthened. Using RFID to facilitate the tracing of patients’ mobile position in hospital has attracted more attentions from researchers due to the demand on advanced features. Traditionally, the management of surgical treatment is generally manually operated and there is no consistent operating procedure for patients transferring among wards, surgery waiting rooms, operating rooms, and recovery rooms, resulting in panicky and urgent transferring work among departments and, thus, leading to delays and errors. In this paper, we propose a new framework using radio frequency identification (RFID technology for a mobilized surgical process monitoring system. Through the active tag, an application management system used before, during, and after the surgical processes has been proposed. The concept of signal level matrix, SLM, was proposed to accurately identify patients and dynamically track patients’ location. By updating patient’s information real-time, the preprocessing time needed for various tasks and incomplete transfers among departments can be reduced, the medical resources can be effectively used, unnecessary medical disputes can be reduced, and more comprehensive health care environment can be provided. The feasibility and effectiveness of our proposed system are demonstrated with a number of experimental results.

DoD Global Emerging Infections System Annual Report, Fiscal Year 2002

Science.gov (United States)

2002-01-01

France Grenada Guatemala Guyana Haiti Honduras India Indonesia Jamaica Jordan Kazakhstan Japan Laos Malaysia Maldives Mexico Myanmar Nepal Nicaragua...illness from adenovirus types 7 and 3 in healthy young adults. Clin Infect Dis. 2002;34(3):577-82. 37 55. Ryan MAK, Smith TC, Honner WK, Gray GC. Varicella

Developing Food-Based Dietary Guidelines to Promote Healthy Diets and Lifestyles in the Eastern Caribbean

Science.gov (United States)

Albert, Janice L.; Samuda, Pauline M.; Molina, Veronika; Regis, Theresa Marietta; Severin, Merlyn; Finlay, Betty; Prevost, Jacqueline Lancaster

2007-01-01

Obesity, cardiovascular diseases, and diabetes are becoming leading causes of morbidity and mortality in the Eastern Caribbean countries of St. Vincent and the Grenadines, Saint Lucia, Grenada, and Dominica. To promote healthful diets and lifestyles and encourage behavioral changes, Food-Based Dietary Guidelines (FBDG) were developed for the…

The Factors of Soldier’s Load

Science.gov (United States)

1994-06-03

turtles . My ruck weighed 120 pounds. American Airborne Soldier Grenada, 1983 One of the tenets of Army doctrine in Field Manual 100-5 QIp.r.aition•. is...from a lack of the appropriate physical conditioning in some units; and the more nebulous problem of insufficient logistical challenges built into

Our Culture Is Who We Are! "Rescuing" Grenadian Identity through Musicking and Music Education

Science.gov (United States)

Sirek, Danielle

2018-01-01

In this article I explore the relationships between identities and musicking in Grenada, West Indies, taking into account the understandings of community and nationhood that foreground and inform identity discourse in the Grenadian context. Through the dual lenses of music education and ethnomusicology, I analyze musicking and music education…

Virtual Reality Robotic Operation Simulations Using MEMICA Haptic System

Science.gov (United States)

Bar-Cohen, Y.; Mavroidis, C.; Bouzit, M.; Dolgin, B.; Harm, D. L.; Kopchok, G. E.; White, R.

2000-01-01

There is an increasing realization that some tasks can be performed significantly better by humans than robots but, due to associated hazards, distance, etc., only a robot can be employed. Telemedicine is one area where remotely controlled robots can have a major impact by providing urgent care at remote sites. In recent years, remotely controlled robotics has been greatly advanced. The robotic astronaut, "Robonaut," at NASA Johnson Space Center is one such example. Unfortunately, due to the unavailability of force and tactile feedback capability the operator must determine the required action using only visual feedback from the remote site, which limits the tasks that Robonaut can perform. There is a great need for dexterous, fast, accurate teleoperated robots with the operator?s ability to "feel" the environment at the robot's field. Recently, we conceived a haptic mechanism called MEMICA (Remote MEchanical MIrroring using Controlled stiffness and Actuators) that can enable the design of high dexterity, rapid response, and large workspace system. Our team is developing novel MEMICA gloves and virtual reality models to allow the simulation of telesurgery and other applications. The MEMICA gloves are designed to have a high dexterity, rapid response, and large workspace and intuitively mirror the conditions at a virtual site where a robot is simulating the presence of the human operator. The key components of MEMICA are miniature electrically controlled stiffness (ECS) elements and Electrically Controlled Force and Stiffness (ECFS) actuators that are based on the sue of Electro-Rheological Fluids (ERF). In this paper the design of the MEMICA system and initial experimental results are presented.

Health literacy in the urgent care setting: What factors impact consumer comprehension of health information?

Science.gov (United States)

Alberti, Traci L; Morris, Nancy J

2017-05-01

An increasing number of Americans are using urgent care (UC) clinics due to: improved health insurance coverage, the need to decrease cost, primary care offices with limited appointment availability, and a desire for convenient care. Patients are treated by providers they may not know for episodic illness or injuries while in pain or not feeling well. Treatment instructions and follow-up directions are provided quickly. To examine health literacy in the adult UC population and identify patient characteristics associated with health literacy risk. As part of a larger cross-sectional study, UC patients seen between October 2013 and January 2014 completed a demographic questionnaire and the Newest Vital Sign. Descriptive, nonparametric analyses, and a multinomial logistic regression were done to assess health literacy, associated and predictive factors. A total of 57.5% of 285 participants had adequate health literacy. The likelihood of limited health literacy was associated with increased age (p literacy is common in a suburban UC setting, increasing the risk that consumers may not understand vital health information. Clear provider communication and confirmation of comprehension of discharge instructions for self-management is essential to optimize outcomes for UC patients. ©2017 American Association of Nurse Practitioners.

Trans fatty acid content in Serbian margarines: Urgent need for legislative changes and consumer information.

Science.gov (United States)

Vučić, Vesna; Arsić, Aleksandra; Petrović, Snježana; Milanović, Sandra; Gurinović, Mirjana; Glibetić, Maria

2015-10-15

This study examined the fatty acid (FA) composition of 13 (7 soft and 6 hard) Serbian margarines. Significantly higher amounts of trans fatty acids (TFA) were found in hard margarines (up to 28.84% of total FA), than in soft ones (0.17-6.89%). Saturated FA (SFA) were present with 22.76-51.17%. Oleic acid ranged from 26.78% to 43.78%. The proportion of polyunsaturated FA (PUFA) was 22.15-49.29% in soft margarines, but only 8.02-15.28% in hard margarines, probably due to the hydrogenisation process. The atherogenic and thrombogenic indexes (AI and TI, respectively) in soft margarines were relatively low (AI 0.23-0.63 and TI 0.44-0.97), but in hard margarines AI and particularly TI were high (1.03-1.67 and 1.96-3.04, respectively). These findings suggest that FA composition of Serbian margarines should be improved by replacing atherogenic TFA and SFA with beneficial ones, in order to avoid adverse effects on health. Therefore legislative changes and consumer information are urgently needed. Copyright © 2015 Elsevier Ltd. All rights reserved.

The urgent neurological consultation in the population of the province of Ferrara, Italy.

Science.gov (United States)

Govoni, Vittorio; Della Coletta, Elena; Fallica, Elisa; Cesnik, Edward

2018-05-01

In the province of Ferrara, Italy, the urgent neurological consultation (UNC) cases in the population correspond to the resident outpatients who undergo a UNC in the ER of the university hospital of Ferrara (UHFe). Thanks to this health organization a retrospective survey identified 612 UNC cases (range of age 7-102 years, median 67,5 years) in the study period giving a period prevalence rate of 173 per 100,000 (95% CI 159.3-187.3) which increased with age (χ 2 for trend = 178.4 p  0.70). The prevalence rate decreased with the distance between the patients' residence and the UHFe (χ 2 for trend = 82.9, p < 0.001). The commonest clinical conditions requiring UNCs were acute cerebrovascular disorders (28%), headache (14%), and vertigo (9%). The hospital admission rate was 32.5% which increased with age (χ 2 for trend = 35.8, p < 0.001). The commonest discharge diagnoses of the admitted cases were ischemic stroke (57.3%), epilepsy (7%), TIA (6%), and intraparenchymal hemorrhage (5.5%). Acute cerebrovascular disease accounted for 69% of the discharge diagnoses. The survey showed that the UNCs' demand was higher than previous Italian data confirming that acute cerebrovascular disease is the most frequent acute neurological condition requiring attention in the ER. It also suggested that the UNCs could be poorly appropriate. These findings would require the healthcare administrators attention.

Caribbean male: macho and insensitive?

Science.gov (United States)

1991-01-01

185, 50, and 104 men aged 15-44 years were interviewed, respectively, in Barbados, St. Lucia, and Grenada in three attitudinal studies designed to get an objective look at male attitudes in the region on family planning and human sexuality. Qualitative information was obtained on fertility and contraceptive use, attitudes toward premarital sex, fidelity and relationships, and influences upon male behavior. Men wanted an average of 2.5 children in Barbados, 4 in St. Lucia, and 3.5 in Grenada. Monogamy was not paramount, with 56% of Grenadian men reporting having overlapping sexual relations. There was also a substantial tolerance for illegitimacy, especially among married men and men with post-secondary education. In St. Lucia, relationships are conducted on the man's terms. For example, men may have sexual relationships with multiple women, but it is unacceptable for women to have other men. Most men, however, agreed that fathers should have a say in the upbringing of their children and should visit and support them financially even if the parents do not live together. Many respondents had unstable relationships with their fathers, and a large proportion had not lived with them. 63% of respondents knew their fathers had outside women. Men were aware and supportive of family planning, and generally try to use contraception. 78% of men interviewed in Grenada and 75% of men interviewed in St. Lucia endorse birth control, while 52% of the respondents in St. Lucia practice family planning. Younger, relatively inexperienced men were most typically in need of more knowledge and greater practice of family planning. Family planning programs should be targeted accordingly.

Urinary cotinine testing as pre-operative assessment of patients undergoing free flap surgery.

Science.gov (United States)

Reinbold, C; Rausky, J; Binder, J-P; Revol, M

2015-02-01

The identified risks of smoking with regard to operated tissues are so elevated that it is clearly dangerous to operate a smoker when the proposed intervention is neither vital nor urgent. The aim of this prospective study was to evaluate a simple method of screening patients who smoke, with the evaluation carried out before agreeing to carry out free tissue transfer. The purpose of the testing was to hold the patient responsible for his actions and minimize smoking-related complications by cancelling or postponing the planned operation if the patient continued to smoke. Screening included use of a standardized questionnaire at the first consultation and detection of cotinine using a urine test strip 7 days before the scheduled surgery. Patients were informed that in the event of positive results, the operation would not take place. A six-week preoperative smoking cessation period was mandatory. Seventy-six patients were included in this study. Among them, 25 (32.9%) reported being former smokers and 11 (14.5%) admitted in the initial questionnaire to being active smokers. Six patients (7.9%), including one self-reported non-smoker, tested positive for cotinine, and their operations were cancelled. Screening using a questionnaire and cotinine detection appeared to constitute a simple, inexpensive, rapid and reliable test. It allowed us to refuse to operate 6 non-compliant patients and was thereby likely to diminish morbidity in the free tissue transfers carried out in our ward. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

Co-operation with Eastern Europe countries taking ENAC as an example

International Nuclear Information System (INIS)

Taylor, D.

1994-01-01

In the aftermath of the Chernobyl accident, the European Community launched an ambitious programme of nuclear safety assistance. The purpose of this programme is to improve the safety of the Nuclear Power stations in Eastern Europe and the former Soviet Union plants. It was felt in the Western European nuclear industry that the emphasis should be on finding practical solutions to improve the most urgent problems. To achieve this objective, the nuclear industry in Western Europe founded a consortium called ENAC (European Nuclear Assistance Consortium) comprising companies form seven European countries ( Great Britain, France, Germany, Spain, Belgium, Italy, Netherlands). The co-operation between theses companies and the Russian designers would ensure that the solutions developed meet the approval of all interested parties. This presentation outlines the overall objectives of ENAC. 2 tabs., 1 fig

Liver diseases: A major, neglected global public health problem requiring urgent actions and large-scale screening.

Science.gov (United States)

Marcellin, Patrick; Kutala, Blaise K

2018-02-01

CLDs represent an important, and certainly underestimated, global public health problem. CLDs are highly prevalent and silent, related to different, sometimes associated causes. The distribution of the causes of these diseases is slowly changing, and within the next decade, the proportion of virus-induced CLDs will certainly decrease significantly while the proportion of NASH will increase. There is an urgent need for effective global actions including education, prevention and early diagnosis to manage and treat CLDs, thus preventing cirrhosis-related morbidity and mortality. Our role is to increase the awareness of the public, healthcare professionals and public health authorities to encourage active policies for early management that will decrease the short- and long-term public health burden of these diseases. Because necroinflammation is the key mechanism in the progression of CLDs, it should be detected early. Thus, large-scale screening for CLDs is needed. ALT levels are an easy and inexpensive marker of liver necroinflammation and could be the first-line tool in this process. © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Impact of air pollution on the burden of chronic respiratory diseases in China: time for urgent action.

Science.gov (United States)

Guan, Wei-Jie; Zheng, Xue-Yan; Chung, Kian Fan; Zhong, Nan-Shan

2016-10-15

In China, where air pollution has become a major threat to public health, public awareness of the detrimental effects of air pollution on respiratory health is increasing-particularly in relation to haze days. Air pollutant emission levels in China remain substantially higher than are those in developed countries. Moreover, industry, traffic, and household biomass combustion have become major sources of air pollutant emissions, with substantial spatial and temporal variations. In this Review, we focus on the major constituents of air pollutants and their impacts on chronic respiratory diseases. We highlight targets for interventions and recommendations for pollution reduction through industrial upgrading, vehicle and fuel renovation, improvements in public transportation, lowering of personal exposure, mitigation of the direct effects of air pollution through healthy city development, intervention at population-based level (systematic health education, intensive and individualised intervention, pre-emptive measures, and rehabilitation), and improvement in air quality. The implementation of a national environmental protection policy has become urgent. Copyright © 2016 Elsevier Ltd. All rights reserved.

Just War Theory and Presidential Discourse Prior to Conflict

Science.gov (United States)

2014-12-04

Topic This paper studies the public statements of US presidents to ascertain justifications for war or armed intervention. Edward J. Lordan used a... paradise , Grenada was “a Soviet- Cuban Colony, being readied as a major military bastion to export terror and undermine democracy.”29 Later in the speech

32 CFR 47.3 - Definitions.

Science.gov (United States)

2010-07-01

... follows: (1) The incursion into Lebanon in 1958, and the peacekeeping force there in 1983 and 1984. (2... Grenada in 1983. Civilian or contractual group. An organization similarly situated to the Women's Air... the Women's Air Forces Service Pilots when it existed as an identifiable group at the time the service...

Workforce Development for Communities in Crisis and Transition: A Case Study of the Windward Islands.

Science.gov (United States)

Whittington, L. Alfons

The Windward Islands (Dominica, Grenada, St. Lucia, and St. Vincent and the Grenadines) have taken several approaches to educate the work force and prepare for the technology-driven society of the future. These approaches include government initiatives, such as the governments' commitment to primary education and more recently to secondary…

Working group on unbundling of electricity trade operations 2. A group report

International Nuclear Information System (INIS)

2000-09-01

The current unbundling of operations in accounts has proved inadequate. No formula or model that could be made binding by provisions have been defined for unbundled accounts. In addition, unbundling can draw a distinct line between commercial activities and network operations, which have assumed various authoritative functions. Against this background, the need for clearer unbundling has become more marked. The working group suggests that the current provisions on unbundling of trade operations should be tightened and that the unbundling should be made clearer especially in terms of allocation of joint costs. For this, the necessary preparations by the authorities should be initiated urgently. At the same time, the working group proposes that network operations should be unbundled from other operations by incorporation or by unbundling them into a separate public utility. The smallest electric utilities should be exempted from the obligation of incorporating network operations. According to the working group, the lower limit could be fixed e.g. at 70 GWh a year. The working group also suggests that the licensees must own the electricity networks they operate. The licensees could not rent their networks from the mother company nor lease them from a financing company. The model proposed by the working group would redress the major problems connected with the supervision of the electricity market. The monopoly, i.e. the electricity network operations, under the supervision of the Electricity Market Authority could thus be unbundled. This would improve the functioning of the market and facilitate the supervision. However, the model would not abolish the tax concession of municipal public utilities in competitive trade operations, production and sale of electricity. The tax concession may affect the competitive situation on the electricity market. (orig.)

Surgical site infections following craniotomy focusing on possible post-operative acquisition of infection: prospective cohort study.

Science.gov (United States)

Sneh-Arbib, O; Shiferstein, A; Dagan, N; Fein, S; Telem, L; Muchtar, E; Eliakim-Raz, N; Rubinovitch, B; Rubin, G; Rappaport, Z H; Paul, M

2013-12-01

Neurosurgery is characterized by a prolonged risk period for surgical site infection (SSI), mainly related to the presence of cerebrospinal fluid (CSF) drains. We aimed to examine factors associated with post-neurosurgical SSIs, focusing on post-operative factors. A prospective cohort study was conducted in a single center over a period of 18 months in Israel. Included were adult patients undergoing clean or clean-contaminated craniotomy, including craniotomies with external CSF drainage or shunts. SSIs were defined by the Centers for Disease Control and Prevention (CDC) criteria for healthcare-associated infections. All patients were followed up for 90 days and those with foreign body insertion for 1 year. We compared patients with and without SSI. A multivariable regression analysis for SSI was conducted including uncorrelated variables significantly associated with SSI. A total of 502 patients were included, with 138 (27.5%) undergoing emergent or urgent craniotomy. The overall SSI rate was 5.6% (28 patients), of which 3.2% (16 patients) were intracerebral. Non-elective surgery, external CSF drainage/monitoring devices, re-operation, and post-operative respiratory failure were independently associated with subsequent SSI. External CSF devices was the only significant risk factor for intracerebral SSIs (p operative infection acquisition through external CSF devices. Standard operating procedures for their maintenance are necessary.

Perceptions of urgency: defining the gap between what physicians and nurses perceive to be an urgent issue.

Science.gov (United States)

Quan, S D; Morra, D; Lau, F Y; Coke, W; Wong, B M; Wu, R C; Rossos, P G

2013-05-01

and context, not clinical condition. Most disagreement occurred when nurses used urgent messaging for time sensitive but not clinically urgent issues in an effort to expedite the resolution of their issue by the physicians. These results indicate the need for clinical communication systems to incorporate decision support around both clinical prioritization and expected response time in their design. Effective interprofessional communication is essential to the provision of safe, quality-based healthcare; these results highlight some of the sociotechnical aspects of health information technology implementation that must be considered. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Offshore Financial Operations, Development Strategy or Neo-liberal Illusion? The case of the First International Bank of Grenada

Directory of Open Access Journals (Sweden)

James C. Wardally

2009-12-01

Full Text Available With declining Foreign aid flows to the region, Caribbean countries now need to intensify their focus on national and regional means of financing development. The Monterrey Consensus (2002 notes that many developing countries increasingly depend on local funds to finance their development needs. Domestic financial institutions are important in this respect, as by intermediating between savers and borrowers, they can efficiently mobilize and use society’s savings (Levine 1997.

Review of the West Indian Arachnocoris Scott, 1881 (Hemiptera: Nabidae), with descriptions of two new species, and a catalog of the species

Science.gov (United States)

Javier E. Mercado; Jorge A. Santiago-Blay; Michael D. Webb

2016-01-01

We review the West Indian species of Arachnocoris, a genus of spider-web dwelling kleptoparasitic nabids. We recognize five species: A. berytoides Uhler from Grenada, A. darlingtoni n. sp. from Hispaniola, A. karukerae Lopez-Moncet from Guadeloupe, A. portoricensis n. sp. from Puerto Rico, and A. trinitatis Bergroth from Trinidad. West Indian Arachnocoris...

Development of a Distance Education Network in the OECS. Feasibility Study. Filling a Gap in a Way that Makes Sense. Report of a Consultancy to the Commonwealth of Learning.

Science.gov (United States)

Roberts, Judy

A study was conducted to determine the feasibility of a distance education network in the Eastern Caribbean. Two types of consultations were completed: a brief site survey of four Eastern Caribbean states (Grenada, Dominica, Antigua, and Saint Lucia) and a workshop in Saint Lucia to which education officials from government agencies and higher…

Parents were accurate proxy reporters of urgent pediatric asthma health services: a retrospective agreement analysis.

Science.gov (United States)

Ungar, Wendy J; Davidson-Grimwood, Sara R; Cousins, Martha

2007-11-01

To assess agreement between parents' proxy reports of children's respiratory-related health service use and administrative data. A retrospective analysis of statistical agreement between clinical and claims data for reports of physician visits, emergency department (ED) visits, and hospitalizations in 545 asthmatic children recruited from sites in the greater Toronto area was conducted. Health services use data were extracted from the Ontario Health Insurance Plan and Canadian Institute for Health Information databases for each child for the interval coinciding with the proxy report for each health service type. Agreement between administrative data and respondent reports (n=545) was substantial for hospitalizations in the past year (kappa=0.80 [0.74, 0.86]), moderate for ED visits in the past year (kappa=0.60 [0.53, 0.67]), and slight for physician visits (kappa=0.13 [0.00, 0.27]) in the past 6 months. Income, parent's education, and child quality-of-life symptom scores did not affect agreement. Agreement for ED visits was significantly higher (Pasthma attack in the past 6 months (kappa=0.61 [0.54, 0.68]) compared to children who did not (kappa=0.25 [0.00, 0.59]). Parents of asthmatic children are reliable reporters of their child's respiratory-related urgent health services utilization.

A measure for provisional-and-urgent sanitary improvement in developing countries: septic-tank performance improvement.

Science.gov (United States)

Harada, H; Dong, N T; Matsui, S

2008-01-01

Although many cities have planed to develop sewerages in developing countries, sewerage establishment still requires huge investment and engineering efforts. Improvement of existing sanitation facilities may contribute the betterment of urban sanitation before sewerage establishment. The purpose of this study is to propose a measure to improve urban sanitation in areas where a sewerage development plan is proposed but has not been yet established, based on a case study in Hanoi, Vietnam. We found that 90.5% of human excreta flowed into septic tanks. However, 89.6% of septic tanks have never been desludged in the past and their performance was observed to be at a low level. The study also showed that if they introduce regular desludging with a frequency of once a year, they can eliminate 72.8% of COD loads from septic tanks. It was indicated that the performance can be dramatically recovered by regular desludging, which could contribute urban sanitation improvement in Hanoi. In conclusion, the performance recovery of septic tanks by regular desludging was proposed as a provisional-and-urgent measure for urban sanitation improvement, together with the septage treatment in sewage sludge treatment facilities, which should be established earlier than other facilities of sewage treatment systems. IWA Publishing 2008.

Obesity in African-American Women--The Time Bomb is Ticking: An Urgent Call for Change.

Science.gov (United States)

Fowler, Barbara A

2015-12-01

The "time bomb is ticking" because there is an obesity crisis associated with higher rates of chronic diseases such as stroke, hypertension, type 2 diabetes, and some forms of cancer in African-American women compared to White women. African-American women incur higher medical costs from hospitalizations, decreased productivity in the work setting, lost wages, the needfor medical benefits and pharmacy-associated costs, and more time away from family than White women. Numerous factors, such as the socio-cultural context of eating, acceptance of a larger weight status, the emotionally liberating effects offood, and preference for highfat and high caloric, sugary-content, and sodium-laden food influences the obesity crisis in African-American women. The interplay of poverty and lower socioeconomic status, residential segregation, health literacy, availability of fast foods and scarce produce in local convenience food marts, physical inactivity, and conflicting messages from social media public service announcements (PSAs) and ads in national magazines affect the obesity crisis in African-American women. There is an urgent call for sustainable, community-driven health policy initiatives that improve access to healthy foods in lower-income, minority communities. Furthermore, African-American women are challenged to modify their health behaviors by preparing healthy meals for themselves and theirfamilies, and by engaging in physical activity.

Business operations and decommissioning strategy for imperial college London research reactor 'Consort' - A financial risk management approach

International Nuclear Information System (INIS)

Franklin, S.J.; Gardner, D.; Mumford, J.; Lea, R.; Knight, J.

2005-01-01

Imperial College London (IC) operates commercially a 100 kW research reactor, and as site licensee is responsible for funding both operations and eventual decommissioning. With long lead times ahead urgent decisions on the future business options have had to be made in 2004/5 including choices on whether to move to early decommissioning, recognising the high costs entailed, or to pursue continuing operations involving life extension measures such as refuelling. To develop a coherent overall approach strategy a financial risk driven programme was initiated to help define a robust transparent business and termination case for the reactor. This study was carried out in collaboration with a UK firm of financial risk experts, PURE Risk Management Ltd (PURE), working within a dedicated IC London reactor project team. This work evaluated immediate closure options due to financial constraints or life limiting failures, and options for continuing operation extending to 2028. Decommissioning and clean up were reviewed. Bespoke financial models created single value cost outputs and ranges of probabilistic net present values (NPV) for decommissioning costs and financial provisions to meet those costs at various levels of risk acceptance and regulatory compliance. (author)

[Intelligent operating room suite : From passive medical devices to the self-thinking cognitive surgical assistant].

Science.gov (United States)

Kenngott, H G; Wagner, M; Preukschas, A A; Müller-Stich, B P

2016-12-01

Modern operating room (OR) suites are mostly digitally connected but until now the primary focus was on the presentation, transfer and distribution of images. Device information and processes within the operating theaters are barely considered. Cognitive assistance systems have triggered a fundamental rethinking in the automotive industry as well as in logistics. In principle, tasks in the OR, some of which are highly repetitive, also have great potential to be supported by automated cognitive assistance via a self-thinking system. This includes the coordination of the entire workflow in the perioperative process in both the operating theater and the whole hospital. With corresponding data from hospital information systems, medical devices and appropriate models of the surgical process, intelligent systems could optimize the workflow in the operating theater in the near future and support the surgeon. Preliminary results on the use of device information and automatically controlled OR suites are already available. Such systems include, for example the guidance of laparoscopic camera systems. Nevertheless, cognitive assistance systems that make use of knowledge about patients, processes and other pieces of information to improve surgical treatment are not yet available in the clinical routine but are urgently needed in order to automatically assist the surgeon in situation-related activities and thus substantially improve patient care.

The duplex-Doppler colour echography of the scrotum and testicles in adults and boys. II. the contribution of the urgent study of acute scrotum symptoms

International Nuclear Information System (INIS)

Rangel-Villalobos, E.; Jimenez-Castellanos, R.; Bustos, C.; Linares, A.; Gonzalez-Prada, F.

1999-01-01

To analyse the findings, contributions and limitations of the Doppler echography for the urgent study of acute scrotum symptoms, both in adults and in boys. 60 patients (22 adults and 38 boys) with acute scrotal symptomatology were examined using B mode echography, followed by a colour duplex-Doppler (CDD) echography with a lineal 7.5 MHz transducer. We compared the findings obtained with those of the healthy contralateral testicle and with surgery or clinical-echographical evolution. The most common pathology was inflammation (27%) followed by ischemic (24%) and traumatic (17%). 12% of the patients had miscellaneous conditions. To conclude, in 20% of the cases the B mode and the Doppler examination was normal, the symptoms were resolved spontaneously. After carrying out the CDD only 14 (23%) of the cases needed immediate surgery and 3 (5%) delayed surgery, the remaining 43 (72%) patients responded to the traditional treatment. The CDD allows for a safe, quick and harmless diagnosis in practically all the acute scrotum cases, for both adults and boys. Its limitations in pre-puberty patients or in cases that were atypical are overcome when put in the hands of an expert radiologist, as they need a longer exploration time and suitable Doppler equipment. The main contribution to the urgent diagnosis of acute scrotum symptoms is that it accurately establishes which patients should be chosen for immediate surgery. (Author) 33 refs

Contrasting sedimentary processes along a convergent margin: the Lesser Antilles arc system

Science.gov (United States)

Picard, Michel; Schneider, Jean-Luc; Boudon, Georges

2006-12-01

Sedimentation processes occurring in an active convergent setting are well illustrated in the Lesser Antilles island arc. The margin is related to westward subduction of the North and/or the South America plates beneath the Caribbean plate. From east to west, the arc can be subdivided into several tectono-sedimentary depositional domains: the accretionary prism, the fore-arc basin, the arc platform and inter-arc basin, and the Grenada back-arc basin. The Grenada back-arc basin, the fore-arc basin (Tobago Trough) and the accretionary prism on the east side of the volcanic arc constitute traps for particles derived from the arc platform and the South American continent. The arc is volcanically active, and provides large volumes of volcaniclastic sediments which accumulate mainly in the Grenada basin by volcaniclastic gravity flows (volcanic debris avalanches, debris flows, turbiditic flows) and minor amounts by fallout. By contrast, the eastern side of the margin is fed by ash fallout and minor volcaniclastic turbidites. In this area, the dominant component of the sediments is pelagic in origin, or derived from South America (siliciclastic turbidites). Insular shelves are the locations of carbonate sedimentation, such as large platforms which develop in the Limestone Caribbees in the northern part of the margin. Reworking of carbonate material by turbidity currents also delivers lesser amounts to eastern basins of the margin. This contrasting sedimentation on both sides of the arc platform along the margin is controlled by several interacting factors including basin morphology, volcanic productivity, wind and deep-sea current patterns, and sea-level changes. Basin morphology appears to be the most dominant factor. The western slopes of the arc platform are steeper than the eastern ones, thus favouring gravity flow processes.

The Psychological Assessment in Operational Events

International Nuclear Information System (INIS)

Abramova, V.N.; Volkov, E.V.

1998-01-01

The possibilities of Psychological Assessment in Operational Events in nuclear power engineering are discussed. The approach of psychology use in quantitative analysis of direct and root causes of operational events is presented. The main attention is paid to the practical method of investigation of an individual who makes an error. The socio-technical system elements can be considered by this method as the external conditions, affecting correctness or errors of actions. The types of errors (violation, mistake, slips) can be clarified. The direct causes of failures and sources of probable root causes of errors also can be defined. Experience shows that the psychological situation of events caused by a human error depends on professional competence, motivation and some professionally important psychological qualities of a person, his functional state, psycho-physiological qualities, characteristics of mentality, attention and memory. In an emergency situation successful personnel performance is mainly effected by such professional qualities as the ability to take the lead in actions, to resolve urgent problems of minimizing the scale of the accident significance; personal participation in dangerous procedures of the accident follow-up, even risking one's life; devotion to one's job; resolute and bold actions; high level of self-control; thoroughness and conscientiousness. External means of activity, influencing the events, include ergonomic characteristics of working place, ergonomics of events technology. External means can be also defined by socio-psychological situation in a group, which refers to the data of social conditions, social-political situation, relationships between people, and by organizational factors. (authors)

Utilización por cuenta propia de los Servicios de Urgencias Hospitalarias: razones que dan las personas con problemas de salud de baja complejidad para utilizar estos servicios Non-Urgent and Non-Referred Patients Presenting to the Emergency Department (ED: Understanding the Reasons of the Non Urgent Patients to Visit the ED

Directory of Open Access Journals (Sweden)

Manuel Espinel Vallejo

2011-09-01

ó acudir a urgencias porque no mejoró con el tratamiento que le prescribió el MC (71% y porque no estaba satisfecho con el tratamiento y quería una segunda opinión (39%. El 70% consideró que su problema de salud no era grave pero pensaba que sí era merecedor de atención urgente o rápida. El 63% expresó alta preocupación por su problema. El 63% consideró que el actual problema de salud no podía ser resuelto por su MC en caso de ser atendido en ese momento. Finalmente el 50% consideró que el SUH tenía más capacidad para resolver los problemas de salud que el CS. Conclusión: La mejor eficacia y efectividad, en términos de uso y gestión de recursos técnicos y del tiempo para resolver el problema de salud, y la comodidad, en términos de horarios, disponibilidad y accesibilidad, parecen ser las principales razones por las cuales las personas con problemas de salud de baja complejidad utilizan por cuenta propia los SUH. La preocupación, más que la gravedad, parece movilizar activamente la búsqueda de solución al problema de salud de manera rápida y urgente. Estas razones parecen estar condicionadas en la experiencia institucional previa con el CS.

Objectives: The objectives of this study are: 1 To understand the reasons of non-urgent non-referred patients to use the Emergency Department (ED, 2 To understand the “urgency” and “concern” perceptions of non-urgent non-referring patients. 3 To determinate the associated factors with the use the ED for non-urgent non-referred patients. Methods: Design: Descriptive cross-sectional study. Setting: Emergency Department (ED of “Infanta Cristina” General Hospital, Parla, Madrid, Spain. Patients: non-referred non-urgent adult patients were selected by Emergency Department Triage system in levels IV and V, on weekdays between 10:00 and 22:00 hours, from April 26 to July 30, 2010, to be surveyed using a structured face

Operational High Resolution Chemical Kinetics Simulation, Phase I

Data.gov (United States)

National Aeronautics and Space Administration — Numerical simulations of chemical kinetics are critical to addressing urgent issues in both the developed and developing world. Ongoing demand for higher resolution...

Perfil de la demanda urgente e influencia del fútbol televisado en un servicio extrahospitalario en la Zona Básica de Salud de Tafalla, Navarra

OpenAIRE

Pérez-Ciordia, Ignacio; Catalán Fabo, Francisca; Zalacain Nicolay, Fernando; Barriendo Antoñanzas, Maite; Solaegui Diaz de Guereñu, Ramón; Guillén Grima, Francisco

2003-01-01

Fundamento: La demanda a los servicios de urgencias, tanto hospitalarios como extrahospitalarios, mantiene un ritmo creciente. El objetivo del presente trabajo es doble: cuantificación y estudio de las características personales de los usuarios demandantes de atención urgente y valorar si el fútbol televisado influye en la utilización del servicio de urgencias. Métodos: Estudio descriptivo longitudinal (9.723 usuarios demandantes) y estudio de casos y controles (1.284 usuarios demandantes) se...

San Jose Accord: energy aid or petroleum-marketing strategy

Energy Technology Data Exchange (ETDEWEB)

1982-09-30

The San Jose Accord was signed in San Jose, Costa Rica on August 3, 1980 by the Presidents of Venezuela and Mexico, whereby the two countries mutually committed to supply the net imported domestic oil consumption of several Central American and Caribbean countries. Countries initially participating in the program are: Barbados, Costa Rica, Dominican Republic, El Salvador, Guatemala, Honduras, Jamaica, Nicaragua, and Panama. Seven eastern Caribbean countries were to meet on October 7 to petition for inclusion in the Accord, namely: Antigua, St. Kitt/Nevis, Montserrat, Dominica, St. Lucia, St. Vincent, and Grenada. The official language of the Accord is presented, and the operative status of the Accord two years after signing is discussed. Specific briefs about some of the individual countries in the Accord are included. The fuel price/tax series for the Western Hemisphere countries is updated.

The impact of operating heavy equipment vehicles on lower back disorders.

Science.gov (United States)

Waters, Thomas; Genaidy, Ash; Barriera Viruet, Heriberto; Makola, Mbulelo

2008-05-01

Literature reviews examining the relationship between heavy equipment vehicle (HEV) operation and the development of musculoskeletal disorders have generally been qualitative in nature and have not employed an evidence-based assessment procedure. This research determines the extent to which whole-body vibration/shock and working postures are associated with lower back and neck disorders among HEV operators, while accounting for individual (i.e. age, gender, prior history of back or neck disorders) and occupational (i.e. material handling, climatic conditions, psychosocial factors) confounders. Published articles were obtained from a search of electronic databases and from bibliographies in the identified articles. A critical appraisal of these articles was conducted using an epidemiological appraisal instrument (Genaidy et al. 2007). The meta-analysis was conducted using statistical techniques employing fixed-effect and random-effect models. Eighteen articles reporting observational studies satisfied the inclusion criteria adopted for this research. The methodological qualities of the published studies ranged from marginal to average. The meta-relative risk was found to be 2.21, indicating that operators exposed to driving HEVs are at more than twice the risk of developing lower back pain in comparison to those not exposed to driving HEVs. Therefore, it seems possible that there is a causal relationship between working as a HEV operator and development of lower back disorders. Prospective cohort studies are urgently needed to confirm the outcomes of this evidence-based methodology (based in part on the meta-analysis) and the biological plausibility should be further explored. The reported findings point to a need for improved ergonomic design of HEVs.

Is food allergen analysis flawed? Health and supply chain risks and a proposed framework to address urgent analytical needs.

Science.gov (United States)

Walker, M J; Burns, D T; Elliott, C T; Gowland, M H; Mills, E N Clare

2016-01-07

Food allergy is an increasing problem for those affected, their families or carers, the food industry and for regulators. The food supply chain is highly vulnerable to fraud involving food allergens, risking fatalities and severe reputational damage to the food industry. Many facets are being pursued to ameliorate the difficulties including better food labelling and the concept of thresholds of elicitation of allergy symptoms as risk management tools. These efforts depend to a high degree on the ability reliably to detect and quantify food allergens; yet all current analytical approaches exhibit severe deficiencies that jeopardise accurate results being produced particularly in terms of the risks of false positive and false negative reporting. If we fail to realise the promise of current risk assessment and risk management of food allergens through lack of the ability to measure food allergens reproducibly and with traceability to an international unit of measurement, the analytical community will have failed a significant societal challenge. Three distinct but interrelated areas of analytical work are urgently needed to address the substantial gaps identified: (a) a coordinated international programme for the production of properly characterised clinically relevant reference materials and calibrants for food allergen analysis; (b) an international programme to widen the scope of proteomics and genomics bioinformatics for the genera containing the major allergens to address problems in ELISA, MS and DNA methods; (c) the initiation of a coordinated international programme leading to reference methods for allergen proteins that provide results traceable to the SI. This article describes in more detail food allergy, the risks of inapplicable or flawed allergen analyses with examples and a proposed framework, including clinically relevant incurred allergen concentrations, to address the currently unmet and urgently required analytical requirements. Support for the

156 THE GULF WAR AS A FALL OUT OF THE CHANGING GLOBAL ...

African Journals Online (AJOL)

US-led UN forces bombarded Iraq out of Kuwait in 1991 left much to be ... testified that “the Gulf War resulted from a long range Anglo-American policy to control ... the Eastern bloc and the attendant end of the Cold War, it is the position of this ..... Nicaragua, Grenada and Panama nor was USSR given any in Afghanistan.

: tous les projets | Page 503 | CRDI - Centre de recherches pour le ...

International Development Research Centre (IDRC) Digital Library (Canada)

Région: North and Central America, South America, West Indies, Dominica, Grenada, Jamaica, Saint Kitts and Nevis, Saint Lucia, Trinidad and Tobago. Programme: Économies en réseaux. Financement total : CA$ 299,791.00. Partenariat pour l'accès à l'emploi grâce à la technologie dans les Amériques : initiative des ...

[Anaesthetic management of patients in the third trimester of pregnancy undergoing urgent laparoscopic surgery. Experience in a general hospital].

Science.gov (United States)

López-Collada Estrada, María; Olvera Martínez, Rosalba

2016-01-01

Laparoscopic surgery is well accepted as a safe technique when performed on a third trimester pregnant woman. The aim is to describe the anaesthetic management of a group of patients undergoing this type of surgery. An analysis was made of records of 6 patients in their third trimester of pregnancy and who underwent urgent laparoscopic surgery from 2011 to 2013. The study included 6 patients, with a diagnosis of acute cholecystitis in 4 of them. The other 2 patients had acute appendicitis, both of who presented threatened preterm labour. The most frequent indications for laparoscopic surgery during the last trimester of birth were found to be acute cholecystitis and acute appendicitis. Acute appendicitis is related to an elevated risk of presenting threatened preterm labour. Copyright © 2015 Academia Mexicana de Cirugía A.C. Publicado por Masson Doyma México S.A. All rights reserved.

Center for Nuclear Safety in Central and Eastern Europe: a platform for co-operation

International Nuclear Information System (INIS)

Tomik, L.; Kichev, E.

2003-01-01

The paper presents a summary of the current status and the activities of the Centre of Nuclear Safety in Central and Eastern Europe (CENS). The CENS is a non-profit and independent association supported by the Swiss and Slovak Governments. The main mission of the CENS is to provide an independent platform for technical co-operation between the regulatory authorities of the Western and Eastern countries. The key partners of the CENS are the Swiss Federal Nuclear Safety Inspectorate (HSK), the International Atomic Energy Agency (IAEA), the US Department of Energy (US DOE), the Nuclear Regulatory Authority of the Slovak Republic (UJD), the Gesellschaft fuer Anlagen-und Reaktorsicherheit mbH (GRS), Germany and the Institute of Radiation Protection and Nuclear Safety (IRSN), France. The CENS programs for 2003-2004 are presented. It can be considered as a complement to the IAEA activities in the area of short-term and event urgent planning. CENS projects as an example are presented. CENS proposals for co-operation with the Bulgarian institutions are made in connection with the topics of the forum round table discussions

Mitigation for the Construction and Operation of Libby Dam, 2004-2005 Annual Report.

Energy Technology Data Exchange (ETDEWEB)

Dunnigan, James; DeShazer, Jay; Garrow, Larry (Montana Department of Fish, Wildlife and Parks, Libby, MT)

2005-06-01

''Mitigation for the Construction and Operation of Libby Dam'' is part of the Northwest Power and Conservation Council's (NPCC) resident fish and wildlife program. The program was mandated by the Northwest Planning Act of 1980, and is responsible for mitigating damages to fish and wildlife caused by hydroelectric development in the Columbia River Basin. The objective of Phase I of the project (1983 through 1987) was to maintain or enhance the Libby Reservoir fishery by quantifying seasonal water levels and developing ecologically sound operational guidelines. The objective of Phase II of the project (1988 through 1996) was to determine the biological effects of reservoir operations combined with biotic changes associated with an aging reservoir. The objectives of Phase III of the project (1996 through present) are to implement habitat enhancement measures to mitigate for dam effects, to provide data for implementation of operational strategies that benefit resident fish, monitor reservoir and river conditions, and monitor mitigation projects for effectiveness. This project completes urgent and high priority mitigation actions as directed by the Kootenai Subbasin Plan. Montana Fish, Wildlife & Parks (MFWP) uses a combination of techniques to collect physical and biological data within the Kootenai River Basin. These data serve several purposes including: the development and refinement of models used in management of water resources and operation of Libby Dam; investigations into the limiting factors of native fish populations, gathering basic life history information, tracking trends in endangered and threatened species, and the assessment of restoration or management activities designed to restore native fishes and their habitats.

Mitigation for the Construction and Operation of Libby Dam, 2003-2004 Annual Report.

Energy Technology Data Exchange (ETDEWEB)

Dunnigan, James; DeShazer, Jay; Garrow, Larry (Montana Department of Fish, Wildlife and Parks, Libby, MT)

2004-06-01

''Mitigation for the Construction and Operation of Libby Dam'' is part of the Northwest Power and Conservation Council's (NPCC) resident fish and wildlife program. The program was mandated by the Northwest Planning Act of 1980, and is responsible for mitigating for damages to fish and wildlife caused by hydroelectric development in the Columbia River Basin. The objective of Phase I of the project (1983 through 1987) was to maintain or enhance the Libby Reservoir fishery by quantifying seasonal water levels and developing ecologically sound operational guidelines. The objective of Phase II of the project (1988 through 1996) was to determine the biological effects of reservoir operations combined with biotic changes associated with an aging reservoir. The objectives of Phase III of the project (1996 through present) are to implement habitat enhancement measures to mitigate for dam effects, to provide data for implementation of operational strategies that benefit resident fish, monitor reservoir and river conditions, and monitor mitigation projects for effectiveness. This project completes urgent and high priority mitigation actions as directed by the Kootenai Subbasin Plan. Montana FWP uses a combination of diverse techniques to collect a variety of physical and biological data within the Kootenai River Basin. These data serve several purposes including: the development and refinement of models used in management of water resources and operation of Libby Dam; investigations into the limiting factors of native fish populations, gathering basic life history information, tracking trends in endangered, threatened species, and the assessment of restoration or management activities intended to restore native fishes and their habitats.

HYDRAULICS, GRENADA COUNTY, MISSISSIPPI AND INCORPORATED AREAS

Data.gov (United States)

Federal Emergency Management Agency, Department of Homeland Security — Recent developments in digital terrain and geospatial database management technology make it possible to protect this investment for existing and future projects to...

Grenada Digital Elevation Model - 1 arc-second

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — NOAA's National Centers for Environmental Information is building high-resolution digital elevation models (DEMs) for select U.S. coastal regions. These integrated...

Communication of urgent public health messages to urban populations: lessons from the Massachusetts water main break.

Science.gov (United States)

Wang, C Jason; Little, Alison A; Holliman, Jaime Bruce; Ng, Chun Y; Barrero-Castillero, Alejandra; Fu, Chong Min; Zuckerman, Barry; Bauchner, Howard

2011-10-01

To study when and how an urgent public health message about a boil-water order reached an urban population after the Massachusetts water main break. In-person surveys were conducted in waiting areas of clinics and emergency departments at a large urban safety net hospital within 1 week of the event. Of 533 respondents, 97% were aware of the order; 34% of those who lived in affected cities or towns were potentially exposed to contaminated water. Among those who were aware, 98% took action. Respondents first received the message through word of mouth (33%), television (25%), cellular telephone calls (20%), landline calls (10%), and other modes of communication (12%). In multivariate analyses, foreign-born respondents and those who lived outside the city of Boston had a higher risk of exposure to contaminated water. New modes (eg, cellular telephones) were used more commonly by females and younger individuals (ages 18 to 34). Individuals who did not speak English at home were more likely to receive the message through their personal networks. Given the increasing prevalence of cellular telephone use, public officials should encourage residents to register landline and cellular telephone for emergency alerts and must develop creative ways to reach immigrants and non-English-speaking groups quickly via personal networks.

Performance of two strategies for urgent ANCA and anti-GBM analysis in vasculitis.

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de Joode, Anoek A E; Roozendaal, Caroline; van der Leij, Marcel J; Bungener, Laura B; Sanders, Jan Stephan F; Stegeman, Coen A

2014-02-01

In anti-neutrophil cytoplasmic antibodies (ANCA) associated small vessel vasculitis (AAV), rapid testing for ANCA and anti-glomerular basement membrane (GBM) antibodies may be beneficial for therapeutic purpose. We analysed the diagnostic performance of two rapid ANCA and anti-GBM test methods in 260 patients with suspected AAV. Between January 2004 and November 2010, we analysed 260 samples by qualitative Dotblot (Biomedical Diagnostics); retrospective analysis followed with directly coated highly sensitive automated Phadia ELiA and ELiA anti-GBM. Results were related to the final clinical diagnosis and compared with routine capture ELISA. Seventy-four patients had a final diagnosis of AAV (n=62) or anti-GBM disease (n=12). Both Dotblot and ELiA detected all 12 cases of anti-GBM disease; 2 false positive results were found. Dotblot detected ANCA in 56 of 62 AAV patients (sensitivity 90%, NPV 97%), and showed 5 false positives (specificity 97%, PPV 90%). The Phadia ELiA anti-PR3(s) or anti-MPO(s) was positive in 57 of 62 AAV patients (sensitivity 92%, NPV 97%), and had 5 false positives (specificity 97%, PPV 88%). Routine capture ELISA was equally accurate (sensitivity 94%, specificity 97%, PPV 88%, NPV 98%). The Dotblot and Phadia ELiA on anti-GBM, anti-PR3(s) and anti-MPO(s) performed excellently; results were almost identical to routine ELISA. When suspicion of AAV or anti-GBM disease is high and diagnosis is urgently needed, both tests are very powerful for rapid serological diagnosis. Further studies have to confirm the test performances in samples routinely presented for ANCA testing and in follow-up of positive patients. Copyright © 2013 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

An audit of non-urgent general adult referrals to Stikland State Psychiatric Facility

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J Ras

2011-12-01

Full Text Available Objectives. The national Department of Health strongly advocates the strengthening of primary health care systems, and recommendations for appropriate level of care referrals exist. Very few published data on the scope of current ambulatory specialised psychiatric hospital services in South Africa are currently available, making it difficult to assess whether these recommendations are being followed. As a starting point, an audit was conducted to obtain a profile of new non-urgent general adult patients seen at Stikland Hospital with a view to evaluating system needs and demands. Methods. The folders of 103 consecutively seen patients were selected for retrospective review. Patient demographic, referral and assessment information was entered into a single database. Descriptive statistics were compiled with reference to the above variables using SPSS. Results. Overall 58.3% of referrals were from the private sector. More than a third (36.7% of referral letters stated no clear reason for referral and 41.7% no psychiatric diagnosis, and 29.1% of patients were referred without psychotropic medication being started. On assessment 62.1% of patients were found to have a single Axis I diagnosis. Despite virtually no referral letters making any mention of them, substance use disorders (30.1%, personality traits/disorders (35.9% and co-morbid medical illness (36.7% were commonly found on assessment. Conclusions. A significant portion of the patients in our sample could have been managed at primary care level and were referred prematurely. The overall quality of referral letters was poor, and they lacked vital information required for appropriate pre-assessment decision making. Undergraduate training focusing on these skills should be intensified, and consideration should be given to incorporating aspects of our findings into primary health care updates.

Globe report on energy in Central and Easter Europe and the CIS: An urgent need for international cooperation on energy efficiency improvement for sustainable development

International Nuclear Information System (INIS)

Laponche, B.; Baguenier, H.

1998-01-01

In comparison with European Union countries, the countries of Central and Eastern Europe as well as the Confederation of Independent States are characterized by a very high energy intensity i.e. ratio of energy consumption to gross domestic product. The paper deals with most important factors influencing this high energy intensity; variety of situations in different countries affecting the power supplies; an urgent need for energy efficiency policy and cooperation related to sustainable development; the necessary tools for energy efficiency implementation. Main energy data and global indicators are shown in the appendix

ANITA (Advanced Network for Isotope and TArget laboratories) - The urgent need for a European target preparation network

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Schumann, Dorothea; Sibbens, Goedele; Stolarz, Anna; Eberhardt, Klaus; Lommel, Bettina; Stodel, Christelle

2018-05-01

A wide number of research fields in the nuclear sector requires high-quality and well-characterized samples and targets. Currently, only a few laboratories own or have access to the equipment allowing fulfilling such demands. Coordination of activities and sharing resources is therefore mandatory to meet the increasing needs. This very urgent issue has now been addressed by six European target laboratories with an initiative called ANITA (Advanced Network for Isotope and TArget laboratories). The global aim of ANITA is to establish an overarching research infrastructure service for isotope and target production and develop a tight cooperation between the target laboratories in Europe in order to transfer the knowledge and improve the production techniques of well-characterized samples and targets. Moreover, the interaction of the target producers with the users shall be encouraged and intensified to deliver tailor-made targets best-suited to the envisaged experiments. For the realization of this ambitious goal, efforts within the European Commission and strong support by the target-using communities will be necessary. In particular, an appropriate funding instrument has to be found and applied, enabling ANITA to develop from an initiative employed by the interested parties to a real coordination platform.

ERISA failures and the erosion of workers' rights: the urgent need to protect private & public workers' pension and benefits.

Science.gov (United States)

Allen, James P; Bales, Richard A

On March 11, 2011, Governor Scott Walker of Wisconsin signed into law a bill that eliminated most collective bargaining rights for the state's public-sector workers. Many other cash-strapped states followed Wisconsin's lead and introduced or enacted similar restraints on the rights of their workers. Thousands of public workers, whose only means of protecting their rights rested in their ability to collectively bargain, suddenly found their retirement benefits in jeopardy. This truth highlighted the lack of protections for public worker benefits similar to those of the private sector. However, the Employee Retirement Income Security Act, enacted for that purpose, has failed to secure these benefits. This article seeks to provide a broad overview of the crisis facing the pension and benefits system in the United States and offers some possible solutions. More importantly, the goal is to spur discourse on the urgent need to protect the benefits of all workers, public and private.

Duration and predictors of emergency surgical operations - basis for medical management of mass casualty incidents

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Huber-Wagner S

2009-12-01

Full Text Available Abstract Background Hospitals have a critically important role in the management of mass causality incidents (MCI, yet there is little information to assist emergency planners. A significantly limiting factor of a hospital's capability to treat those affected is its surgical capacity. We therefore intended to provide data about the duration and predictors of life saving operations. Methods The data of 20,815 predominantly blunt trauma patients recorded in the Trauma Registry of the German-Trauma-Society was retrospectively analyzed to calculate the duration of life-saving operations as well as their predictors. Inclusion criteria were an ISS ≥ 16 and the performance of relevant ICPM-coded procedures within 6 h of admission. Results From 1,228 patients fulfilling the inclusion criteria 1,793 operations could be identified as life-saving operations. Acute injuries to the abdomen accounted for 54.1% followed by head injuries (26.3%, pelvic injuries (11.5%, thoracic injuries (5.0% and major amputations (3.1%. The mean cut to suture time was 130 min (IQR 65-165 min. Logistic regression revealed 8 variables associated with an emergency operation: AIS of abdomen ≥ 3 (OR 4,00, ISS ≥ 35 (OR 2,94, hemoglobin level ≤ 8 mg/dL (OR 1,40, pulse rate on hospital admission 120/min (OR 1,39, blood pressure on hospital admission Conclusions The mean operation time of 130 min calculated for emergency life-saving surgical operations provides a realistic guideline for the prospective treatment capacity which can be estimated and projected into an actual incident admission capacity. Knowledge of predictive factors for life-saving emergency operations helps to identify those patients that need most urgent operative treatment in case of blunt MCI.

Del teatro de la guerra a la guerra como teatro: algunos aspectos posmodernos de la guerra.

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Richard Harvey Brown.

2002-06-01

Full Text Available Using some examples on the paper that mass media have fulfilled in the military course of the war of Vietnam, Gulf War and invasions to Grenada and Panama, this article presents, from a postmodern position, a reflection on the way in which mass media have turned the war, beyond its political or military effectiveness, in a theatre show.

Medical support to military airborne training and operations.

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Starkey, Kerry J; Lyon, J; Sigman, E; Pynn, H J; Nordmann, G

2018-05-01

Airborne operations enable large numbers of military forces to deploy on the ground in the shortest possible time. This however must be balanced by an increased risk of injury. The aim of this paper is to review the current UK military drop zone medical estimate process, which may help to predict the risk of potential injury and assist in planning appropriate levels of medical support. In spring 2015, a British Airborne Battlegroup (UKBG) deployed on a 7-week overseas interoperability training exercise in the USA with their American counterparts (USBG). This culminated in a 7-day Combined Joint Operations Access Exercise, which began with an airborne Joint Forcible Entry (JFE) of approximately 2100 paratroopers.The predicted number of jump-related injuries was estimated using Parachute Order Number 8 (PO No 8). Such injuries were defined as injuries occurring from the time the paratrooper exited the aircraft until they released their parachute harness on the ground. Overall, a total of 53 (2.5%) casualties occurred in the JFE phase of the exercise, lower than the predicted number of 168 (8%) using the PO No 8 tool. There was a higher incidence of back (30% actual vs 20% estimated) and head injuries (21% actual vs 5% estimated) than predicted with PO No 8. The current method for predicting the incidence of medical injuries after a parachute drop using the PO No 8 tool is potentially not accurate enough for current requirements. Further research into injury rate, influencing factors and injury type are urgently required in order to provide an evidence base to ensure optimal medical logistical and clinical planning for airborne training and operations in the future. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

CORRIGENDUM to The impact of prehabilitation on post-surgical complications in patients undergoing non-urgent cardiovascular surgical intervention: Systematic review and meta-analysis.

Science.gov (United States)

2018-06-01

The impact of prehabilitation on post-surgical complications in patients undergoing non-urgent cardiovascular surgical intervention: Systematic review and meta-analysis by F Marmelo et al. European Journal of Preventive Cardiology January 2018 25: 404-417, DOI: 2016 doi: 10.1177/2047487317752373 The third author's name, affiliation and Funding information were incorrect, the correct details are below: Daniel Moreira-Gonçalves Departamento de Cirurgia e Fisiologia, Faculdade de Medicina, Universidade do Porto, Portugal CIAFEL, Faculdade de Desporto, Universidade do Porto, Portugal Funding D.M.G is supported by an individual fellowship grant from Fundação para a Ciência e Tecnologia (SFRH/BPD/90010/ 2012) This has been corrected in the online article.

Acidente vascular cerebral de etiologia rara com indicação cirúrgica urgente: caso clínico Stroke of a rare etiology with need of urgent surgery: case report

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Ana Vieira Baptista

2012-03-01

Full Text Available Doente de 19 anos com quadro de febre com 8 dias de evolução e posterior instalação súbita de afasia, hemiparésia esquerda e alterações do comportamento. Aumento das proteínas de fase aguda no estudo analítico. TAC e RMN crânio-encefálicas revelaram lesão isquémica temporo-parietal direita. Ecocardiograma excluiu endocardite. Eco-döppler e angio-TAC carotídeo-vertebrais mostraram formação vegetante, móvel com a pulsação cardíaca, na artéria carótida comum direita. Submetido, de urgência, a cirurgia carotídea. Intraoperatoriamente constatou-se a presença de trombo ligeiramente aderente à artéria carótida comum e na dependência de lesão da íntima subjacente, tendo-se procedido à sua exérese e a arteriorrafia primária. Aponta-se como etiologia mais provável do quadro, uma vasculite secundária a infecção por HSV1 (infecção activa ou por Rickettsia conorii.19 years old patient with fever for 8 days associated with sudden aphasia, left hemiparesis and abnormal behavior. Increased acute phase proteins in the analytical study. Head CT scan and MRI revealed a right temporo-parietal ischemic lesion. An echocardiogram excluded endocarditis. Ultrasound and CT angiography scanning of the extracranial cerebral circulation showed a vegetative formation, mobile with the heartbeat, in the right common carotid artery. Submitted, urgently, to carotid surgery. Intraoperatively, a slightly adherent thrombus to the common carotid artery was found and in the dependence of an underlying injury to the intima. The thrombus was ressected and a primary arteriorrhaphy performed. It is pointed out a vasculitis secondary to HSV1 (active infection or to Rickettsia conorii infection as the most likely etiology of the clinic.

Variation in Quality of Urgent Health Care Provided During Commercial Virtual Visits.

Science.gov (United States)

Schoenfeld, Adam J; Davies, Jason M; Marafino, Ben J; Dean, Mitzi; DeJong, Colette; Bardach, Naomi S; Kazi, Dhruv S; Boscardin, W John; Lin, Grace A; Duseja, Reena; Mei, Y John; Mehrotra, Ateev; Dudley, R Adams

2016-05-01

Commercial virtual visits are an increasingly popular model of health care for the management of common acute illnesses. In commercial virtual visits, patients access a website to be connected synchronously-via videoconference, telephone, or webchat-to a physician with whom they have no prior relationship. To date, whether the care delivered through those websites is similar or quality varies among the sites has not been assessed. To assess the variation in the quality of urgent health care among virtual visit companies. This audit study used 67 trained standardized patients who presented to commercial virtual visit companies with the following 6 common acute illnesses: ankle pain, streptococcal pharyngitis, viral pharyngitis, acute rhinosinusitis, low back pain, and recurrent female urinary tract infection. The 8 commercial virtual visit websites with the highest web traffic were selected for audit, for a total of 599 visits. Data were collected from May 1, 2013, to July 30, 2014, and analyzed from July 1, 2014, to September 1, 2015. Completeness of histories and physical examinations, the correct diagnosis (vs an incorrect or no diagnosis), and adherence to guidelines of key management decisions. Sixty-seven standardized patients completed 599 commercial virtual visits during the study period. Histories and physical examinations were complete in 417 visits (69.6%; 95% CI, 67.7%-71.6%); diagnoses were correctly named in 458 visits (76.5%; 95% CI, 72.9%-79.9%), and key management decisions were adherent to guidelines in 325 visits (54.3%; 95% CI, 50.2%-58.3%). Rates of guideline-adherent care ranged from 206 visits (34.4%) to 396 visits (66.1%) across the 8 websites. Variation across websites was significantly greater for viral pharyngitis and acute rhinosinusitis (adjusted rates, 12.8% to 82.1%) than for streptococcal pharyngitis and low back pain (adjusted rates, 74.6% to 96.5%) or ankle pain and recurrent urinary tract infection (adjusted rates, 3.4% to 40

The social relations of bereavement in the Caribbean.

Science.gov (United States)

Marshall, Ronald; Sutherland, Patsy

2008-01-01

The objectives of this article are to discuss the various types of behaviors associated with grief and bereavement, and to examine the relationships, consequences, and outcomes of bereavement practices among the various religious and ethnic groups in the English-speaking Caribbean Islands of Jamaica, Trinidad, Grenada, and Barbados. The rituals associated with death and grief differs across cultures and is greatly influenced by religious beliefs and traditions. How these rituals are played out depend on the culture of origin and level of acculturation of the various groups into mainstream society. In the Caribbean region, expressions of grief represent religious and cultural traditions that may have a significant impact on social relations, particularly in multi-ethnic and multicultural societies. In the English-speaking Caribbean Islands of Jamaica, Trinidad, Grenada, and Barbados, mourning follows the patterns of traditional religious practices which have remained consistent over time. While families and friends may offer social support before and after burial or cremation, the social aspects of bereavement may also have implications for inter-group relations. Insights into bereavement practices and what it holds for ethnic and religious groups in contemporary Caribbean are presented.

Population living in the Red Sea State of Sudan may need urgent intervention to correct the excess dietary iodine intake.

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Izzeldin, H S; Crawford, M A; Jooste, P L

2007-01-01

Both inadequate and high intakes of iodine are associated with thyroid disease and associated abnormalities. Consumption of foods deficient in iodine induces hypothyroidism. Conversely, excessive intake of the nutrient precipitates hyperthyroidism. Iodine deficiency causes impairment of thyroid hormonogenesis resulting in goiter (struma), cretinism which is associated with increased prenatal and infant mortality, deafness, motor disabilities and mental retardation due to damage during fetal and neonatal brain development. We have assessed the iodine status of school children from the locality of Port Sudan, Red Sea State of Eastern Sudan. The primary sources of iodine of the children are mainly iodized salt and rations supplied by local donors and various aid agencies operating in the Sudan. Male and female children (n=141), aged 6 to 12 years (median age 9.8 years), were selected for the survey using a multistage random sampling technique, between May 22 and August 25, 2006. All the children were assessed for urinary iodine and visible goiter. In addition, the iodine content of twenty salt samples was determined using the lodometric titration method and spot test kits. The components of other foods that are routinely consumed by the children and households were noted using a questionnaire form. Urinary iodine concentration exceeded 300 microg/l and 1000 microg/l in 65% and 9.9% of the children, respectively. The highest urinary iodine level was 1470 microg/l. The prevalence of visible goiter was 17%. All the salt samples collected from the schools had more than 150mg potassium iodate per kg of salt. The results of this pilot survey reveal that excessive intake of iodine in children exists in Port Sudan. Inappropriate and unregulated local fortification of salt and lack of monitoring of the imported and donated salt is the primary reason for the excessive intake. There is an urgent need for a regulatory mechanism during the process of iodine fortification and at

Duty of care or a matter of conduct -- can a doctor refuse a person in need of urgent medical attention?

Science.gov (United States)

Dean, Jessica; Mahar, Patrick; Loh, Erwin; Ludlow, Karinne

2013-10-01

Medical practitioners may have their particular skills called upon outside a direct professional context. The responsibilities of medical practitioners outside their defined scope of clinical practice may not be clear to all clinicians. To consider the possible legal consequences of a doctor refusing to assist a person in need of urgent medical attention both in terms of medical negligence and professional misconduct. Where an established clinical relationship does not exist, and a doctor does not wish to render aid, three particular scenarios may arise. A doctor may actively deny being a doctor, passively avoid identifying themselves as a doctor or acknowledge being a doctor, but refuse to render assistance. Aside from any ethical issues, how a doctor chooses to act and represent themselves may lead to different legal ramifications. There exists significant variation in state provisions relating to legal obligations to render aid, which may benefit from review and revision at a national level.

The urgent matter of online pro-eating disorder content and children: clinical practice.

Science.gov (United States)

Custers, Kathleen

2015-04-01

During the last decade, much concern has been expressed about online pro-eating disorder communities (e.g., pro-anorexia websites and blogs) which encourage their users to engage in disordered eating behavior. The aim of the current paper is to reemphasize the importance of pro-eating disorder communities in light of the recent changes in the media landscape. With the increase of social networking sites, pro-anorexia messages have transplanted to more volatile and constantly changing media, such as Snapchat, Twitter, Facebook, Instagram, Pinterest, and many others. Most parents, educators, and health professionals are unaware of the sheer scope and nature of such pro-anorexia messages in these new contexts. The current paper will provide a review of pro-eating disorder websites, overview the effects of such websites on young people's health, examine the emergence of these messages on social media platforms, and highlight a number of guidelines for clinicians and parents. The dissemination of online pro-eating disorder content to different types of social networking sites is becoming an urgent issue. • Existing research on pro-eating disorder websites examines the prevalence and the content of these websites, and the effects of pro-eating disorder content on both clinical (eating disordered individuals) and non-clinical samples (non-eating disordered individuals). • The scope and nature of such anorexia messages is unknown to most adults, and many people (including parents and medical professionals) are insufficiently aware of the ease with which young people access, navigate, and use a wide range of online platforms. • Pro-anorexia messages are no longer limited to websites that can be easily monitored, but instead have been transplanted to more volatile and constantly changing media such as Snapchat, Twitter, Facebook, Pinterest, and Tumblr which makes pro-eating disorder content much more easily accessible. • This paper wants to emphasize the implications

Stroke acute management with urgent risk-factor assessment and improvement (SAMURAI) rt-PA registry. General results and subanalyses

International Nuclear Information System (INIS)

Toyoda, Kazunori; Koga, Masatoshi; Shiokawa, Yoshiaki

2010-01-01

Stroke Acute Management with Urgent Risk-factor Assessment and Improvement [SAMURAI] rt-PA Registry is a multicenter retrospective observational study from 10 Japanese stroke centers. A total of 600 patients (223 women, 72±12 years old) treated with intravenous alteplase (0.6 mg/kg) were studied. Symptomatic intracerebral hemorrhage within 36 hours with ≥4 point-increase from the baseline National Institutes of Health (NIH) Stroke Scale score developed in 8 patients (1.3%, 95% confidence interval (CI) 0.7-2.6%). At 3 months, 199 patients (33.2%, 29.5-37.0%) had a modified Rankin Scale (mRS) score ≤1. Analysis of 399 patients with a premorbid mRS score ≤1 who met the criteria of the European license (≤80 years old, an initial NIHSS score ≤24, etc.) showed that 40.6% (35.9-45.5%) had a 3-month mRS ≤1. In the subanalyses from this registry, early ischemic change on diffusion-weighted imaging assessed by the Alberta Stroke Programme Early CT Score, as well as reduced estimated glomerular filtration rate, was associated with early intracerebral hemorrhage and 3-month outcomes of patients. (author)

Stroke acute management with urgent risk-factor assessment and improvement (SAMURAI) rt-PA registry. General results and subanalyses

Energy Technology Data Exchange (ETDEWEB)

Toyoda, Kazunori; Koga, Masatoshi [National Cerebral and Cardiovascular Center, Suita, Osaka (Japan); Shiokawa, Yoshiaki [Kyorin Univ., School of Medicine, Mitaka, Tokyo (Japan)

2010-11-15

Stroke Acute Management with Urgent Risk-factor Assessment and Improvement [SAMURAI] rt-PA Registry is a multicenter retrospective observational study from 10 Japanese stroke centers. A total of 600 patients (223 women, 72{+-}12 years old) treated with intravenous alteplase (0.6 mg/kg) were studied. Symptomatic intracerebral hemorrhage within 36 hours with {>=}4 point-increase from the baseline National Institutes of Health (NIH) Stroke Scale score developed in 8 patients (1.3%, 95% confidence interval (CI) 0.7-2.6%). At 3 months, 199 patients (33.2%, 29.5-37.0%) had a modified Rankin Scale (mRS) score {<=}1. Analysis of 399 patients with a premorbid mRS score {<=}1 who met the criteria of the European license ({<=}80 years old, an initial NIHSS score {<=}24, etc.) showed that 40.6% (35.9-45.5%) had a 3-month mRS {<=}1. In the subanalyses from this registry, early ischemic change on diffusion-weighted imaging assessed by the Alberta Stroke Programme Early CT Score, as well as reduced estimated glomerular filtration rate, was associated with early intracerebral hemorrhage and 3-month outcomes of patients. (author)

Epilepsy care in the southern Caribbean.

Science.gov (United States)

Krauss, Gregory; Sandy, Sherry; Corbin, David O C; Bird-Compton, Jacqueline; Jack, Frances; Nelson, Beverly; Jalonen, Tuula O; Ali, Amza; Fortuné, Taryn; Clarke, Dave; Okolie, Jacqueline; Cervenka, Mackenzie C

2015-10-01

Very little has been reported about the health resources available for patients with epilepsy in the five English-speaking southern Caribbean countries of Trinidad and Tobago, Barbados, Grenada, Saint Vincent and the Grenadines, and Saint Lucia. There is no comprehensive resource describing their health systems, access to specialty care, antiepileptic drug (AED) use, and availability of brain imaging and EEG. The purpose of this study was to profile epilepsy care in these countries as an initial step toward improving the standard of care and identifying gaps in care to guide future policy changes. In each southern Caribbean country, we conducted study visits and interviewed health-care providers, government health ministers, pharmacy directors, hospital medical directors, pharmacists, clinic staff, radiologists, and radiology and EEG technicians. Health-care providers completed extensive epilepsy care surveys. The five countries all have integrated government health systems with clinics and hospitals that provide free or heavily subsidized care and AEDs for patients with epilepsy. Only Trinidad and Tobago and Barbados, however, have neurology specialists. The three smaller countries lack government imaging and EEG facilities. Trinidad had up to one-year waits for public MRI/EEG. Government formularies in Grenada, Saint Vincent and the Grenadines, and Saint Lucia are limited to first-generation AEDs. One or more second-line agents are formulary in Trinidad and Barbados. Nonformulary drugs may be obtained for individual patients in Barbados. Grenada, Saint Lucia, and Saint Vincent and the Grenadines participate in an Organization of Eastern Caribbean States formulary purchasing system, which added levetiracetam following the survey. Newer generic AED formulations with the lowest risks for pregnancy malformation were not in use. In conclusion, patients with epilepsy in the southern Caribbean have excellent access to government clinics and hospitals, but AED choices

Urgent thoracotomy for penetrating chest trauma: analysis of 158 patients of a single center.

Science.gov (United States)

Onat, Serdar; Ulku, Refik; Avci, Alper; Ates, Gungor; Ozcelik, Cemal

2011-09-01

Penetrating injuries to the chest present a frequent and challenging problem, but the majority of these injuries can be managed non-\\operatively. The aim of this study was to describe the incidence of penetrating chest trauma and the ultimate techniques used for operative management, as well as the diagnosis, complications, morbidity and mortality. A retrospective 9-year review of patients who underwent an operative procedure following penetrating chest trauma was performed. The mechanism of injury, gender, age, physiological and outcome parameters, including injury severity score (ISS), chest abbreviated injury scale (AIS) score, lung injury scale score, concomitant injuries, time from admission to operating room, transfusion requirement, indications for thoracotomy, intra-operative findings, operative procedures, length of hospital stay (LOS) and rate of mortality were recorded. A total of 1123 patients who were admitted with penetrating thoracic trauma were investigated. Of these, 158 patients (93 stabbings, 65 gunshots) underwent a thoracotomy within 24 h after the penetrating trauma. There were 146 (92.4%) male and 12 (7.6%) female patients, and their mean age was 25.72 9.33 (range, 15–54) years. The mean LOS was 10.65 8.30 (range, 5–65) days. Patients admitted after a gunshot had a significantly longer LOS than those admitted with a stab wound (gunshot, 13.53 9.92 days; stab wound, 8.76 6.42 days, p chest AIS score (p chest requiring a thoracotomy are uncommon, and lung-sparing techniques have become the most frequently used procedures for lung injuries. The presence of associated abdominal injuries increased the mortality five-fold. Factors that affected mortality were ISS, chest AIS score, SBP, ongoing chest output, blood transfusion volume, diaphragmatic injury and associated abdominal injury.

Working group on unbundling of electricity trade operations 2. A group report; Saehkoeliiketoimintojen eriyttaemistyoeryhmae 2. Tyoeryhmaen mietintoe

Energy Technology Data Exchange (ETDEWEB)

NONE

2000-09-01

The current unbundling of operations in accounts has proved inadequate. No formula or model that could be made binding by provisions have been defined for unbundled accounts. In addition, unbundling can draw a distinct line between commercial activities and network operations, which have assumed various authoritative functions. Against this background, the need for clearer unbundling has become more marked. The working group suggests that the current provisions on unbundling of trade operations should be tightened and that the unbundling should be made clearer especially in terms of allocation of joint costs. For this, the necessary preparations by the authorities should be initiated urgently. At the same time, the working group proposes that network operations should be unbundled from other operations by incorporation or by unbundling them into a separate public utility. The smallest electric utilities should be exempted from the obligation of incorporating network operations. According to the working group, the lower limit could be fixed e.g. at 70 GWh a year. The working group also suggests that the licensees must own the electricity networks they operate. The licensees could not rent their networks from the mother company nor lease them from a financing company. The model proposed by the working group would redress the major problems connected with the supervision of the electricity market. The monopoly, i.e. the electricity network operations, under the supervision of the Electricity Market Authority could thus be unbundled. This would improve the functioning of the market and facilitate the supervision. However, the model would not abolish the tax concession of municipal public utilities in competitive trade operations, production and sale of electricity. The tax concession may affect the competitive situation on the electricity market. (orig.)

REACH MUSC: A telemedicine facilitated network for urgent stroke: initial experience

Directory of Open Access Journals (Sweden)

Robert J. Adams

2012-03-01

Full Text Available REACH MUSC provides stroke consults via the internet in South Carolina. From May 2008 to April 2011 231 patients were treated with intravenous (IV thrombolysis and 369 were transferred to Medical University of South Carolina (MUSC including 42 for intra-arterial revascularization (with or without IV tPA. Medical outcomes and hemorrhage rates, reported elsewhere, were good (Lazaridis et al. 2011, in press. Here we report operational features of REACH MUSC which covers 15 sites with 2,482 beds and 471,875 Emergency Department (ED visits per year. Eight Academic Faculty from MUSC worked with 165 different physicians and 325 different nurses in the conduct of 1085 consults. For the 231 who received tissue plasminogen activator (tPA, time milestones were: Onset to Door: 62 min (mean, 50 (median; Door to REACH Consult: 43 and 33, Consult Request to Consult Start: was 9 and 7 minutes, Consult Start to tPA Decision: 31 and 25 minutes; Decision to Infusion: 20 and 14 minutes, and total Door to Needle: 98 and 87 minutes. The comparable times for the 854 not receiving tPA were: Onset to Door: 140 and 75 minutes; Door to REACH Consult: 61 and 41 minutes; Consult Request to Consult Start 9 and 7 minutes, Consult Start to tPA Decision 27 and 23 minutes. While the consultants respond to consult requests in < 10 minutes, there is a long delay between arrival and Consult request. Tracking of operations indicates if we target shortening Door to Call time and time from tPA decision to start of drug infusion we may be able to improve Door to Needle times to target of < 60 minutes. The large number of individuals involved in the care of these patients, most of whom had no training in REACH usage,will require novel approaches to staff education in ED based operations where turnover is high. Despite these challenges this robust system delivered tPA safely and in a high fraction of patients evaluated using the REACH MUSC system.

Rupturas urgentes em educação Rupturas urgentes en la educación Urgent ruptures in education

Directory of Open Access Journals (Sweden)

Pedro Demo

2010-12-01

Full Text Available Inovar a educação é promessa eterna, porque - segundo se crê - educação é uma das fontes principais de mudança, com o toque ulterior de ser mudança apropriada, aquela mais bem feita. Inspirando-se em Christensen, o texto discute armadilhas da inovação, entre elas: pretender inovar sem inovar-se; buscar controlar o processo de inovação; viver de promessas impossíveis ou de promessas mesquinhas. Os dados sugerem que nosso sistema educacional é inepto: as crianças não aprendem, os professores tendem a ser muito mal formados e mal pagos, a escola está ficando para trás, novas tecnologias não têm chance, e os alunos reclamam cada vez mais. Assim, "reformar" este sistema já não é o caso, porque o sistema já não possui razão suficiente para continuar existindo. Imprescindível seria mudar profundamente, quase começar de novo, em parte para poder estar à altura das necessidades dos alunos em novos tempos, em parte para corresponder aos cuidados pedagógicos da aprendizagem reconhecida crescentemente como desafio continuado. Referência fundamental é o professor, que, afinal, é o agente principal da mudança. Mudar o professor é crucial, porque praticamente todas as mudanças na escola são mudanças docentes. Criticar apenas não basta (nunca basta. É fundamental garantir novas oportunidades.Innovar en el campo de la educación es promesa eterna, porque - según se cree - la educación es una de las fuentes principales de cambio, con el toque ulterior de ser cambio apropiado, el mejor hecho. Inspirándose en Christensen, el texto discute trampas de la innovación, tales como pretender innovar sin innovarse; buscar controlar el proceso de innovación; vivir de promesas imposibles o mezquinas. Los datos sugieren que nuestro sistema educacional es inepto: los niños no aprenden, los maestros o profesores tienden a ser muy mal formados y mal pagados, la escuela está quedándose atrás, nuevas tecnologías no tienen oportunidad y los alumnos se quejan cada vez más. Así, ya no se trata más de "reformar" este sistema, porque el mismo ya no posee razón suficiente para continuar existiendo. Imprescindible sería cambiar profundamente, casi como que empezar de nuevo, en parte para poder estar a la altura de las necesidades de los alumnos en los tiempos actuales, en parte para corresponder a los cuidados pedagógicos del aprendizaje reconocido crecientemente como desafío continuado. El maestro es referencia fundamental, que, al fin de cuentas, es el agente principal del cambio. Transformar al maestro es crucial, porque prácticamente todos los cambios en la escuela son cambios docentes. Sólo criticar no basta (nunca basta. Es fundamental garantizar nuevas oportunidades.To innovate education is an eternal promise, because - as is believed - education is one of the principal sources of change, with the ulterior insight of being the appropriate change, the one better done. Taking inspiration in Christensen, this text discusses innovation traps, of which some are: wanting to innovate without innovating oneself; seeking to control the process of innovation; nurturing impossible or mean promises. Data suggest that our educational system is inappropriate: children do not learn, teachers tend to be very badly trained and very badly remunerated, school is lagging behind, new technologies have no chance, and students complain increasingly. So, "to reform" this system is not the case, since it has no sufficient reason to persist functioning. Indispensable would be to change profoundly, almost beginning anew, partially aiming to be able to cope with the students needs in new times, partially to correspond to pedagogical cares of learning recognized increasingly as continuous challenge. Main reference is the teacher, who, after all, is the main agent changing. To change the teacher is crucial, because practically all changes in school begin with the teachers. To criticize only is not sufficient (it is never sufficient. It is fundamental to guarantee new opportunities.

Syncope: Assessment of risk and an approach to evaluation in the emergency department and urgent care clinic

Directory of Open Access Journals (Sweden)

Baris Akdemir

2015-03-01

Full Text Available Syncope is among the most frequent forms of transient loss of consciousness (TLOC, and is characterized by a relatively brief and self-limited loss of consciousness that by definition is triggered by transient cerebral hypoperfusion. Most often, syncope is caused by a temporary drop of systemic arterial pressure below that required to maintain cerebral function, but brief enough not to cause permanent structural brain injury. Currently, approximately one-third of syncope/collapse patients seen in the emergency department (ED or urgent care clinic are admitted to hospital for evaluation. The primary objective of developing syncope/TLOC risk stratification schemes is to provide guidance regarding the immediate prognostic risk of syncope patients presenting to the ED or clinic; thereafter, based on that risk assessment physicians may be better equipped to determine which patients can be safely evaluated as outpatients, and which require hospital care. In general, the need for hospitalization is determined by several key issues: i the patient's immediate (usually considered 1 week to 1 month mortality risk and risk for physical injury (e.g., falls risk, ii the patient's ability to care for him/herself, and iii whether certain treatments inherently require in-hospital initiation (e.g., pacemaker implantation. However, at present no single risk assessment protocol appears to be satisfactory for universal application, and development of a consensus recommendation is an essential next step.

Operation optimization of a photo-sequencing batch reactor for wastewater treatment: Study on influencing factors and impact on symbiotic microbial ecology.

Science.gov (United States)

Ye, Jianfeng; Liang, Junyu; Wang, Liang; Markou, Giorgos; Jia, Qilong

2018-03-01

Wastewater treatment technology with better energy efficiency and recyclability is in urgent demand. Photo-Sequencing batch reactor (SBR), which introduces microalgae into conventional SBR, is considered to have more potential for resource recycling. In this study, a photo-SBR was evaluated through the manipulation of several key operational parameters, i.e., aeration strength, light supply intensity and time per cycle, and solid retention time (SRT). The algal-bacterial symbiotic system had the potential of removing COD, NH 4 + -N and TN with limited aeration, representing the advantage of energy-saving by low aeration requirement. Maintaining appropriate proportion of microalgae in the symbiotic system is critical for good system performance. Introducing microalgae into conventional SBR has obvious impact on the original microbial ecology. When the concentration of microalgae is too high (>4.60 mg Chl/L), the inhibition on certain phyla of bacteria, e.g., Bacteroidetes and Actinobacteria, would become prominent and not conducive to the stable operation. Copyright © 2017 Elsevier Ltd. All rights reserved.

U.S. Navy Capstone Strategies and Concepts (1981-1990): Strategy, Policy, Concept, and Vision Documents

Science.gov (United States)

2011-12-01

Contra Affair (1988) USS Iowa (BB-61) turret explosion, investigation (1989) US Naval Academy sexual harassment scandal (1989)  Female midshipman...down (1981); Grenada intervention (1983), Lebanon intervention (1982-3); Med hijacker force-down (1985); US assistance to Central American anti...LTG Colin Powell USA Reaction to disastrous USMC intervention in Lebanon (1983)  Forces for Unified Commands memorandum (Feb 1987)  JCS Pub 26

Reserve Component Programs, Fiscal Year 1987.

Science.gov (United States)

1987-01-01

would fight. War- time missions are executed with United States and foreign forces, just as would occur &WV ft Ra RDdNemv cowei hr ~u~, FY M87 Exwutdm...Luxembourg Somalia Bermuda Greece Madagascar South Korea Bolivia Greenland Malaysia Spain Brazil Grenada Marshall Islands Sweden Cameroon Guam Mexico...Major Dell M. Dempsey, USMCR Ecuadoran Military attache in Panama 0 Colonel James V. Dugar, ANGUS * Young, Colonel Ralph R. (USAR) 0 Colonel

The prevalence and virulence characteristics of enteroaggregative Escherichia coli at an urgent-care clinic in the USA: a case-control study.

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Cennimo, David; Abbas, Atif; Huang, David B; Chiang, Tom

2009-04-01

This case-control study examined the prevalence of enteroaggregative Escherichia coli (EAEC), its genes and elicited inflammatory response, and the stool characteristics of adult patients with and without acute diarrhoeal illness presenting to an urgent-care clinic in the USA. A total of 1004 individual stool specimens (253 from patients with acute diarrhoeal illness and 751 from patients without diarrhoeal illness) were collected between 1 June 2003 and 30 June 2008. EAEC was identified as the sole cause of acute diarrhoeal illness in 6 % (n=15) of patients and in 2 % (n=15) without diarrhoeal illness. Control patients (n=15) were similar to case patients (n=15) for age, gender and co-morbidities. The EAEC genes aggR, aap, aat, astA and/or set1A were identified more frequently in case patients compared with control patients (P clinic in the USA and suggest that aggR, aap, aatA, astA and set1A may be markers for virulence.

Evaluación de un modelo de atención quirúrgica urgente en los resultados de eficacia, seguridad y eficiencia en el tratamiento de la apendicitis aguda

OpenAIRE

Pareja Ciuro, Felipe Jose

2016-01-01

Introducción La apendicitis aguda es la urgencia quirúrgica más frecuente de la especialidad. Según las estadísticas mundiales esla causa principal de abdomen agudo quirúrgico y por tanto, sus resultados pueden reflejar en gran medida la calidad de la atención en el ámbito de la cirugía digestiva urgente y podrían ser utilizados como indicador de calidad para evaluar la gestión de las urgencias quirúrgicas. Mediante este estudio queremos evaluar si la existencia de un modelo organizativo ...

Do English NHS Microbiology laboratories offer adequate services for the diagnosis of UTI in children? Healthcare Quality Improvement Partnership (HQIP) Audit of Standard Operational Procedures.

Science.gov (United States)

McNulty, Cliodna A M; Verlander, Neville Q; Moore, Philippa C L; Larcombe, James; Dudley, Jan; Banerjee, Jaydip; Jadresic, Lyda

2015-09-01

The National Institute of Care Excellence (NICE) 2007 guidance CG54, on urinary tract infection (UTI) in children, states that clinicians should use urgent microscopy and culture as the preferred method for diagnosing UTI in the hospital setting for severe illness in children under 3 years old and from the GP setting in children under 3 years old with intermediate risk of severe illness. NICE also recommends that all 'infants and children with atypical UTI (including non-Escherichia coli infections) should have renal imaging after a first infection'. We surveyed all microbiology laboratories in England with Clinical Pathology Accreditation to determine standard operating procedures (SOPs) for urgent microscopy, culture and reporting of children's urine and to ascertain whether the SOPs facilitate compliance with NICE guidance. We undertook a computer search in six microbiology laboratories in south-west England to determine urine submissions and urine reports in children under 3 years. Seventy-three per cent of laboratories (110/150) participated. Enterobacteriaceae that were not E. coli were reported only as coliforms (rather than non-E. coli coliforms) by 61% (67/110) of laboratories. Eighty-eight per cent of laboratories (97/110) provided urgent microscopy for hospital and 54% for general practice (GP) paediatric urines; 61% of laboratories (confidence interval 52-70%) cultured 1 μl volume of urine, which equates to one colony if the bacterial load is 106 c.f.u. l(-1). Only 22% (24/110) of laboratories reported non-E. coli coliforms and provided urgent microscopy for both hospital and GP childhood urines; only three laboratories also cultured a 5 μl volume of urine. Only one of six laboratories in our submission audit had a significant increase in urine submissions and urines reported from children less than 3 years old between the predicted pre-2007 level in the absence of guidance and the 2008 level following publication of the NICE guidance. Less than a

Human factors design of nuclear power plant control rooms including computer-based operator aids

International Nuclear Information System (INIS)

Bastl, W.; Felkel, L.; Becker, G.; Bohr, E.

1983-01-01

The scientific handling of human factors problems in control rooms began around 1970 on the basis of safety considerations. Some recent research work deals with the development of computerized systems like plant balance calculation, safety parameter display, alarm reduction and disturbance analysis. For disturbance analysis purposes it is necessary to homogenize the information presented to the operator according to the actual plant situation in order to supply the operator with the information he most urgently needs at the time. Different approaches for solving this problem are discussed, and an overview is given on what is being done. Other research projects concentrate on the detailed analysis of operators' diagnosis strategies in unexpected situations, in order to obtain a better understanding of their mental processes and the influences upon them when such situations occur. This project involves the use of a simulator and sophisticated recording and analysis methods. Control rooms are currently designed with the aid of mock-ups. They enable operators to contribute their experience to the optimization of the arrangement of displays and controls. Modern control rooms are characterized by increasing use of process computers and CRT (Cathode Ray Tube) displays. A general concept for the integration of the new computerized system and the conventional control panels is needed. The technical changes modify operators' tasks, and future ergonomic work in nuclear plants will need to consider the re-allocation of function between man and machine, the incorporation of task changes in training programmes, and the optimal design of information presentation using CRTs. Aspects of developments in control room design are detailed, typical research results are dealt with, and a brief forecast of the ergonomic contribution to be made in the Federal Republic of Germany is given

The Operation of the Joint Protocol: Theoretical and Practical Implications Revisited

International Nuclear Information System (INIS)

Horbach, N.

2008-01-01

Convention and the 1963 Vienna Convention), is even more urgent in respect of its operation under the revised nuclear liability treaties. Any interpretation making the operation of the Joint Protocol ineffective, distorted or even obsolete as to its main object and purpose, would warrant critical analysis as to its benefits it in practice would provide for its Contracting Parties, considering to join any of the revised treaties. This paper aims to provide an analysis of the legal complications involved in respect of the operation of the Joint Protocol, especially in its interrelation with the revised nuclear liability treaties.(author)

Alcohol consumption and psychological distress in adolescents: a multi-country study.

Science.gov (United States)

Balogun, Olukunmi; Koyanagi, Ai; Stickley, Andrew; Gilmour, Stuart; Shibuya, Kenji

2014-02-01

To examine the association between alcohol use and psychological distress among adolescents in a range of developing countries. Secondary data analysis of the Global School-Based Student Health Survey was conducted using nationally representative data from 12 developing countries: Botswana, Grenada, Indonesia, Kenya, Myanmar, the Philippines, Saint Lucia, Saint Vincent and the Grenadines, the Seychelles, Thailand, Trinidad and Tobago, and Uganda. The surveys were conducted between 2003 and 2008 and involved 32,001 adolescents primarily aged 13-15 years. We used multivariate logistic regression analysis to determine the association between alcohol use and psychological distress. The prevalence of past 30-day alcohol use and lifetime drunkenness varied widely across countries, as did the occurrence of psychological distress (anxiety-induced sleeplessness and/or depression). The risk of psychological distress was significantly higher among adolescents when using alcohol in all countries except Myanmar. In nine of the 12 countries, past 30-day alcohol use was associated with psychological distress, while students who had been drunk at least once in their lifetime had an increased risk of experiencing psychological distress in 11 of the study countries. The high prevalence of alcohol use among adolescents and the strength of the association with psychological distress present a major public health challenge in developing countries. The urgent need to reduce adolescent alcohol use necessitates the implementation of context- and culture-specific strategies that reduce the physical availability of alcohol. Copyright © 2014 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Modified informed consent in a viral seroprevalence study in the Caribbean.

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Cox, Cheryl; Macpherson, CNL

1996-07-01

An unlinked seroprevalence study of HIV and other viruses was conducted on pregnant women on the Caribbean island of Grenada in 1994. Investigators were from both the developed world and the Grenadian Ministry of Health (MOH). There was then no board on Grenada to protect research subjects or review ethical aspects of studies. Nurses from the MOH were asked to verbally inform their patients about the study, and request that patients become subjects of the study and give blood for screening. If consent was given nurses took blood and administered a survey about each subjects' knowledge of HIV transmission routes. Nurses shared a spoken dialect and cultural heritage with prospective subjects and were probably more effective than foreign researchers at informing subjects. Informed consent was obtained with a simplified consent form supplemented with conversation with each prospective research subject. Facilitating discussion between people with common cultural backgrounds helps apply the Western approach to informed consent to communites in the developing world. Researchers must disclose all information to nurses or other mediators, and ensure that nurses disclose as much information as possible to prospective subjects. So modified, informed consent maintains respect for persons and becomes applicable and relevant to various cultures.

Influence of Cultivars and Seed Thermal Treatment on the Development of Fungal Pathogens in Carrot and Onion Plants

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Martin Koudela

2016-01-01

Full Text Available Carrot and onion are vegetables representing an important segment of fresh market. They suffer from serious fungal diseases that can inflict great damage on crops, i.e. alternaria leaf blight, peronospora downy mildew, and botrytis neck rot. The resistance of selected carrot and onion cultivars important for the production of vegetables in the Czech Republic was tested by exposure to targeted infection by the above fungal pathogens. The exposure of eleven carrot cultivars to spores of Alternaria dauci showed that the most resistant and sensitive cultivars were Katrin, Cortina F1, Afalon F1 and Favorit, Tinga, Berlika F1, respectively. A targeted infection of onion cultivars with Botrytis aclada clustered them into three groups: Amfora F1, Bolero, Tosca, Triumf F1 (strong resistance, Avalon, Grenada (medium resistance, Alice, Karmen, Všetana (low resistance. Similar groups were distinguished also after the infection with Peronospora destructor: Avalon, Bolero, Tosca (strong resistance, Alice, Amfora F1, Grenada, Karmen, Triumf F1 (medium resistance,Všetana (low resistance. Hot water treatment of carrot seeds applied after the inoculation with A. dauci decreased the development of the infection 1.3-2.3-fold, whereas the protective effect observed with onion seeds against the infection by P. destructor and B. aclada was lower.

Child and Adolescent Emergency and Urgent Mental Health Delivery Through Telepsychiatry: 12-Month Prospective Study.

Science.gov (United States)

Roberts, Nasreen; Hu, Tina; Axas, Nicholas; Repetti, Leanne

2017-10-01

The significant gap between children and adolescents presenting for emergency mental healthcare and the shortage of child and adolescent psychiatrists constitutes a major barrier to timely access for psychiatric assessment for rural and remote areas. Unlike remote areas, urban emergency departments have in-house psychiatric consultation. Telepsychiatry may be a solution to ensure the same service for remote areas. However, there is a paucity of studies on the use of telepsychiatry for child and adolescent emergency consults. Thus, the aim of our study was to (1) assess patient satisfaction with telepsychiatry and (2) compare clinical characteristics and outcome of telepsychiatry with face-to-face emergency child and adolescent assessments. This is a prospective study of telepsychiatry emergency assessments of children and adolescents referred by emergency physicians. The comparison group was age- and gender-matched patients seen for face-to-face urgent assessments. Data were gathered on demographic and clinical variables. Telepsychiatry satisfaction was assessed using a questionnaire. Descriptive statistics and chi-square tests were used to assess group differences for each variable. Logistic regression was used to assess impact of the variables on outcome after the consult. A p value <0.05 was used to determine statistical significance. Sixty (n = 60) assessments were conducted through telepsychiatry in 12 months. Among the telepsychiatry group, Aboriginal patients were over-represented (50% vs. 6.7%, p < 0.001), a higher proportion received a diagnosis of adjustment disorder (22% vs. 8.3%, p = 0.004) or no diagnosis (27% vs. 6.7%, p = 0.004) compared with controls. There was no statistically significant difference between groups on other clinical variables. Patients reported a high degree of satisfaction with telepsychiatry. Telepsychiatry is acceptable to patients and families for safe emergency assessment and follow-up, reducing unnecessary travel

LAS MEDIDAS URGENTES PARA LA REFORMA DEL MERCADO LABORAL: ASPECTOS LABORALES TRAS LA PROMULGACIÓN DE LA LEY 3/2012

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Esperanza Macarena Sierra Benítez

2013-05-01

Full Text Available La situación económica y de crisis en la zona euro obligó al Gobierno, en el año 2010, a iniciar una era de reformas estructurales de gran calado en ámbitos tan importantes como el financiero, y en particular el de la banca. En el ámbito laboral el periodo 2010-2012 se caracteriza por una producción importante de reformas que debería culminar con la Ley 3/2012, de 6 de julio, de medidas urgentes para la reforma laboral, objeto de este trabajo. El estudio contempla también el comienzo de la segunda generación de reformas estructurales, el Real Decreto-ley 4/2013, de 22 de febrero, de medidas de apoyo al emprendedor y de estímulo del crecimiento y de la creación de empleo, para finalizar con una mención al Real Decreto-ley 5/2013, de 15 de marzo, de medidas para favorecer la continuidad de la vida laboral de los trabajadores de mayor edad y promover el envejecimiento activo. Se trata de un comentario que ha atendido fundamentalmente al contenido laboral de la reforma del mercado de trabajo, dejando al margen el de la Seguridad Social, pero incluyendo el RD-ley 20/2012, de 13 de julio, de medidas para garantizar la estabilidad presupuestaria y de fomento de la competitividad. In 2010 the economical situation and the eurozone crisis forced the Spanish Government to commence an era of deep structural reforms in important areas such as finance, with special regard to the banking sector. In the labour sphere the period 2010-2012 is marked by a significant production of reforms that should culminate with the Law 3/2012, of July 6th, on urgent measures for labour reform, which is the aim of this essay. The study also includes the start of a second generation of structural reforms, the Royal Decree-Law 4/2013, of February 22nd, on support measures for entrepreneurs and incentives to growth and employment, and it finishes with a mention to the Royal Decree-Law 5/2013, of March 15th, on measures to keep older workers within the labour market

Use of National Burden to Define Operative Emergency General Surgery.

Science.gov (United States)

Scott, John W; Olufajo, Olubode A; Brat, Gabriel A; Rose, John A; Zogg, Cheryl K; Haider, Adil H; Salim, Ali; Havens, Joaquim M

2016-06-15

Emergency general surgery (EGS) represents 11% of surgical admissions and 50% of surgical mortality in the United States. However, there is currently no established definition of the EGS procedures. To define a set of procedures accounting for at least 80% of the national burden of operative EGS. A retrospective review was conducted using data from the 2008-2011 National Inpatient Sample. Adults (age, ≥18 years) with primary EGS diagnoses consistent with the American Association for the Surgery of Trauma definition, admitted urgently or emergently, who underwent an operative procedure within 2 days of admission were included in the analyses. Procedures were ranked to account for national mortality and complication burden. Among ranked procedures, contributions to total EGS frequency, mortality, and hospital costs were assessed. The data query and analysis were performed between November 15, 2015, and February 16, 2016. Overall procedure frequency, in-hospital mortality, major complications, and inpatient costs calculated per 3-digit International Classification of Diseases, Ninth Revision, Clinical Modification procedure codes. The study identified 421 476 patient encounters associated with operative EGS, weighted to represent 2.1 million nationally over the 4-year study period. The overall mortality rate was 1.23% (95% CI, 1.18%-1.28%), the complication rate was 15.0% (95% CI, 14.6%-15.3%), and mean cost per admission was $13 241 (95% CI, $12 957-$13 525). After ranking the 35 procedure groups by contribution to EGS mortality and morbidity burden, a final set of 7 operative EGS procedures were identified, which collectively accounted for 80.0% of procedures, 80.3% of deaths, 78.9% of complications, and 80.2% of inpatient costs nationwide. These 7 procedures included partial colectomy, small-bowel resection, cholecystectomy, operative management of peptic ulcer disease, lysis of peritoneal adhesions, appendectomy, and laparotomy. Only 7 procedures account

A survey on the technologies and cases for the cognitive models of nuclear power plant operators

International Nuclear Information System (INIS)

Lee, Yong Hee; Chun, Se Woo; Seo, Sang Moon; Lee, Hyun Chul

1993-04-01

To enhance the safety and availability of nuclear power plants, it is necessary to develop the methodologies which can systematically analyze the interrelationships between plant operators and main process systems. Operator congnitive models enable to provide an explicit method to analyze how operator's congitive behavior reacts to the behavior of system changes. However, because no adequate model has been developed up to now, it is difficult to take an effective approach for the review, assessment and improvement of human factors. In this study, we have surveyed the techniques and the cases of operator model development, aiming to develop an operator's model as one of human engineering application methodologies. We have analyzed the cognitive characteristics of decision-making, which is one of the principal factors for modeling, and reviewed the methodologies and implementation thechniques used in the cases of the model development. We investigated the tendencies of the model developments by reviewing ten cases and especially CES, INTEROPS and COSIMO models which have been developed or are under development in nuclear fields. Also, we summarized the cognitive characteristics to be considered in the modeling for the purpose of modeling operator's decision-making. For modeling methodologies, we found a trend of the modeling that is software simulations based on the artificial intelligence technologies, especially focused in knowledge representation methods. Based on the results of our survey, we proposed a development approach and several urgent research subjects. We suggested the development simulation tools which can be applicable to the review, assessment and improvement of human factors, by implementing them as softwares using expert system development tools. The results of this study have been applied to our long-term project named 'The Development of Human Engineering Technologies.' (Author)

A Historical Review and Analysis of Army Physical Readiness Training and Assessment

Science.gov (United States)

2013-03-01

gender; screening weights for 17-20 year old women/men for 60/72” respectively were: 111/132, 190/160. 150. Reynold A. Burrowes , Revolution and Rescue in...Colonel Larry Hicks was responsible for developing the Master Fitness Trainer course (MFT); Director of Doctrine-Lieutenant Colonel Mark Saunders was... Burrowes , Reynold A. Revolution and Rescue in Grenada: an Account of the US Caribbean Invasion. New York: Greenwood Press, 1988. Butts, Edmund. Manual

An integrated program to train local health care providers to meet post-disaster mental health needs Programa integrado para entrenar a proveedores de servicios sanitarios locales a satisfacer las necesidades de salud mental después de un desastre

OpenAIRE

Stan Kutcher; Sonia Chehil; Thorne Roberts

2005-01-01

This paper describes a post-disaster mental health training program developed by the International Section of the Department of Psychiatry at Dalhousie University (Halifax, Canada) and delivered in Grenada after Hurricane Ivan struck the country in September 2004. This train-the-trainer program used an integrated community health model to help local health care providers develop the necessary skills for the identification and evidenced-based treatment of mental disorders occurring after a nat...

Impact of Operative Delay on Sepsis and Mortality in Patients with Acute Diverticulitis

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Robin F. Irons

2017-03-01

Full Text Available Background Ideal operative timing for non-emergent, acute diverticulitis (AD remains unclear. Medical management is initially attempted to convert a high risk urgent surgery to a less morbid elective surgery, or to avoid surgery altogether. A large proportion of patients will fail medical treatment and require colectomy. Objectives To evaluate the effect of operative delay on sepsis and mortality in patients with AD. Methods Patients from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP database who underwent colectomy with a primary diagnosis of diverticulitis between 2005 and 2014 were included. Multiple patient variables were analyzed to see their combined effect on death and sepsis. Patients undergoing surgical intervention on hospital day 0, emergent cases and those with preoperative sepsis were excluded. The impact of operative delay on mortality and sepsis was evaluated using day from admission as the predictor of the primary outcomes. Secondary outcomes included urinary tract infection (UTI, pneumonia (PNA, need for blood transfusion, septic shock, return to the operating room, length of stay (LOS, readmission, wound dehiscence, and surgical site infections (SSI. Frequency of patient variables was recorded and a multiple variable logistic regression analysis was performed to control for possible confounders. Odds ratios (OR with 95% confidence intervals (CI were calculated for primary and secondary outcomes. Results 32,399 patients underwent colectomy for AD on hospital day 1 - 20. Adjusted for other factors, days to operation was found to be a significant predictor for death (OR = 1.038, 95% CI 1.020 - 1.057; P < 0.0001 and sepsis (OR = 1.051, 95% CI, 1.035 - 1.067; P < 0.0001. Each day in which surgical intervention was delayed was associated with a 3.8% increased risk of mortality and 5.1% increased risk of sepsis. Delay of surgery was also associated with an increased risk of blood transfusion

Operation and maintenance of the RA reactor, RA Research reactor. Annual report 1976

International Nuclear Information System (INIS)

Martinc, R.

1976-12-01

During 1976 the Ra reactor was operating for about 30% shorter period than usual. The reason were extraordinary repair activities within regular and investment maintenance as well as repair of failures caused by neglected maintenance during previous 6 years. Delay was caused by unavailability of fuel (2% enriched fuel elements are spent) and the new 80% enriched fuel demanded experimental and theoretical analyses before being introduced into the core. Safety analyses concerned with using 80% enriched fuel both experimental and theoretical were successfully fulfilled. The December 1976 successful experimental campaign can be marked as end of the 17 years period of using 2% enriched fuel and start of the new period of using highly enriched fuel. This is significant not only for the reactor itself but for the users, because it would result in increase of neutron flux by 50% with the increase of costs by only 4%. Demand was submitted for obtaining the final license for transition operating regime with highly enriched fuel which would save at least 2 200 000 dinars. This will enable reactor operation in 1977 and later on, without interruption by 'critical' and other experiments related to new highly enriched fuel. A high number of repair and other urgent activities were fulfilled in order to enable safe operation. Some of these activities were done never before and some were neglected during past 6 years. The most important tasks were: purchase of Al tubes made of special alloy, fabrication and mounting of the fuel channel; overall investigation of reactor vessel leakage; repair of the heavy water pump; exchange of two vertical channels. basic equipment for construction of emergency cooling system was purchased. Hot cells are equipped for independent utilisation [sr

A study on fatigue measurement of operators for human error prevention in NPPs

Energy Technology Data Exchange (ETDEWEB)

Ju, Oh Yeon; Il, Jang Tong; Meiling, Luo; Hee, Lee Young [KAERI, Daejeon (Korea, Republic of)

2012-10-15

The identification and the analysis of individual factor of operators, which is one of the various causes of adverse effects in human performance, is not easy in NPPs. There are work types (including shift), environment, personality, qualification, training, education, cognition, fatigue, job stress, workload, etc in individual factors for the operators. Research at the Finnish Institute of Occupational Health (FIOH) reported that a 'burn out (extreme fatigue)' is related to alcohol dependent habits and must be dealt with using a stress management program. USNRC (U.S. Nuclear Regulatory Commission) developed FFD (Fitness for Duty) for improving the task efficiency and preventing human errors. 'Managing Fatigue' of 10CFR26 presented as requirements to control operator fatigue in NPPs. The committee explained that excessive fatigue is due to stressful work environments, working hours, shifts, sleep disorders, and unstable circadian rhythms. In addition, an International Labor Organization (ILO) developed and suggested a checklist to manage fatigue and job stress. In domestic, a systematic evaluation way is presented by the Final Safety Analysis Report (FSAR) chapter 18, Human Factors, in the licensing process. However, it almost focused on the interface design such as HMI (Human Machine Interface), not individual factors. In particular, because our country is in a process of the exporting the NPP to UAE, the development and setting of fatigue management technique is important and urgent to present the technical standard and FFD criteria to UAE. And also, it is anticipated that the domestic regulatory body applies the FFD program as the regulation requirement so that a preparation for that situation is required. In this paper, advanced researches are investigated to find the fatigue measurement and evaluation methods of operators in a high reliability industry. Also, this study tries to review the NRC report and discuss the causal factors and

A study on fatigue measurement of operators for human error prevention in NPPs

International Nuclear Information System (INIS)

Ju, Oh Yeon; Il, Jang Tong; Meiling, Luo; Hee, Lee Young

2012-01-01

The identification and the analysis of individual factor of operators, which is one of the various causes of adverse effects in human performance, is not easy in NPPs. There are work types (including shift), environment, personality, qualification, training, education, cognition, fatigue, job stress, workload, etc in individual factors for the operators. Research at the Finnish Institute of Occupational Health (FIOH) reported that a 'burn out (extreme fatigue)' is related to alcohol dependent habits and must be dealt with using a stress management program. USNRC (U.S. Nuclear Regulatory Commission) developed FFD (Fitness for Duty) for improving the task efficiency and preventing human errors. 'Managing Fatigue' of 10CFR26 presented as requirements to control operator fatigue in NPPs. The committee explained that excessive fatigue is due to stressful work environments, working hours, shifts, sleep disorders, and unstable circadian rhythms. In addition, an International Labor Organization (ILO) developed and suggested a checklist to manage fatigue and job stress. In domestic, a systematic evaluation way is presented by the Final Safety Analysis Report (FSAR) chapter 18, Human Factors, in the licensing process. However, it almost focused on the interface design such as HMI (Human Machine Interface), not individual factors. In particular, because our country is in a process of the exporting the NPP to UAE, the development and setting of fatigue management technique is important and urgent to present the technical standard and FFD criteria to UAE. And also, it is anticipated that the domestic regulatory body applies the FFD program as the regulation requirement so that a preparation for that situation is required. In this paper, advanced researches are investigated to find the fatigue measurement and evaluation methods of operators in a high reliability industry. Also, this study tries to review the NRC report and discuss the causal factors and management

Market profile and conservation opportunity assessment for large industrial operations in Ontario

International Nuclear Information System (INIS)

Keyes, C.; Balbaa, I.; Cuthbert, D.; Young, D.

2006-01-01

In view of the expected electricity shortages in Ontario, there is an urgent need for not only new supply but also a significant increase in conservation and load shifting efforts. This report presented the results of a study focused on key technology or market areas that presented opportunities for implementation of energy efficient measures. The materials, analytical results, and outcomes of the study could be utilized as a framework for developing future program delivery models. The report provided a comprehensive market analysis for large industrial operations in Ontario. A market profile was presented for the following sectors: mining; pulp and paper; iron and steel; the chemical industry; petroleum refining; motor vehicle, body and parts manufacturing; cement; and food. Opportunities for conservation and demand management were identified. The report also presented an analysis and recommendations for energy conservation demand management and demand response applicable to large industry. Examples of programs in other jurisdictions in Canada as well as the United States were discussed. 34 refs., 7 tabs., 23 figs., 1 appendix.

[Experience in the treatment of patients with STEMI in the frame of urgent PCI Project in Medimurje County].

Science.gov (United States)

Hranilović, Rudolf

2009-02-01

In 2004, the mortality rate of cardiovascular disease in Medimurje County was 53%, with coronary heart disease accounting for 18.2% of cases. The need of organizing a County team for health was recognized. Five health priorities were acknowledged with coronary heart disease on the top of the list. In 2005, Medimurje County was among the first regions outside Zagreb that had launched the Project of urgent percutaneous coronary intervention (PCI) in ST-segment elevation myocardial infarction (STEMI) patients. Internal medicine physicians from the County Hospital received thorough education and printed materials on the issue were distributed to primary care physicians. A media campaign for the general population of the Medimurje County was also prepared. During the first 2 years of the project, the average pain-to-needle time in our patients was less than 4 hours. From the beginning of the project till July 2007, more than 100 patients with STEMI were treated with emergency PCI. There still are issues that have remained unsolved (how to reduce the pain-to-door and door-to-needle time, managing patients in cardiogenic shock, NSTEMI-patients, and presentation of patients with multivessel disease to cardiac surgeons). It is important to carry on with the intensive media campaign as well as with further education of patients, physicians and other health personnel.

De l’urgente nécessité de réformer la gouvernance globale Reframing Global Governance : Apocalypse Soon or Reform !

Directory of Open Access Journals (Sweden)

David Held

2011-03-01

Full Text Available Le réchauffement climatique, la pauvreté ou la menace d’une catastrophe nucléaire comptent parmi les défis majeurs auxquels l’humanité se doit de faire face collectivement en ce début de 21e siècle. Malgré la gravité et l’urgence de la situation, les moyens dont nous disposons pour résoudre de tels problèmes demeurent limités et incomplets. Il est dès lors non seulement essentiel mais aussi urgent de penser comment faire face à de tels enjeux globaux. Les solutions passent par des mécanismes de gouvernance globale et se doivent de répondre aux exigences de solidarité, de démocratie, de justice sociale et d’efficacité politique. Il s’agit notamment d’assurer à chaque personne la possibilité d’influencer les conditions sociales qui façonnent sa vie. Il est donc encore possible d’agir sur le cours des choses, mais si aucune réponse n’est rapidement apportée à ces défis majeurs, le futur de l’humanité risque d’être compromis.Global warming, poverty and the threat of nuclear catastrophe are among the major challenges humanity has to face collectively in this early 21st century. In spite of the seriousness and the urgency of the situation, the means at our disposal to solve such problems remain limited and incomplete. It is therefore not only essential but also urgent to think about how to face these growing global challenges. It requires new mechanisms of global governance and taking steps toward solidarity, democracy, justice and policy effectiveness. Among these key issues is the need to ensure the possibility for each person to influence the social conditions that shape his or her life. Thus, there is still hope that the vital task of reframing global governance may be pursued with an increasing sense of urgency. If this does not happen, the very future of humanity is at risk.

Psychopathology of the General Population Referred by Primary Care Physicians for Urgent Assessment in Psychiatric Hospitals

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Judith McLenan

2016-12-01

Full Text Available Objective: The aim of this study was to evaluate the type, severity and progression of psychiatric pathologies in a sample of 372 outpatients (age range 18–65 years referred by their primary general practitioners (GPs to an Urgent Referral Team (URT based in a psychiatric hospital in Aberdeen, Scotland. This team offers immediate appointments (1- to 7-day delays for rapid assessments and early interventions to the outpatients referred by their primary family doctors.Method: One-sample t-test and z statistic were used for data analysis. From the total population, a convenience sample of 40 people was selected and assessed to evaluate whether follow-up appointments after the first visit could reduce the severity of suicidal ideation, depression and anxiety in the outpatients seen by the URT. A two-sample t-test and a Wilcoxon signed-rank test were used to assess the variations in the scores during the follow-up visits.Results: We found a statistically significant prevalence of depressive disorders, comorbid with anxiety at first presentation in people who were females, white, never married, living with a partner, not studying and not in paid employment. The common presentation of borderline personality disorder and dysthymia in this population underscores its vulnerability to major socioeconomic challenges.Conclusion: The data confirmed the impact that primary care cooperation with psychiatric hospitals can have on the psychiatric system, and as a reflection, on the population’s mental health and well-being. In fact, active cooperation and early diagnosis and intervention will help detect cases at risk in the general population and reduce admissions into hospitals.

[Characteristics of the Chinese human milk banks' operation].

Science.gov (United States)

2017-08-02

Objective: To assess the operation status of human milk banks in the mainland of China. Method: This retrospective study included a consecutive series of 14 human milk banks in the mainland of China from March 2013 to December 2016. The opened date, condition of donated breast milk, characteristics of donors and clinical application of donated breast milk were analyzed. Result: There were 14 human milk banks successively founded in mainland China from March 2013 to December 2016. The number of human milk banks, the amount of donated breast milk, the number of eligible donors and the times of donation had increased each year. Howere, the operation status among these milk banks varied greatly. Among them, one human milk bank has newly opened without relevant data, 6 banks could accept frozen breast milk, and the remaining 7 banks could only collect breast milk by the nurses in the bank. Among the 3 121 eligible donors, 1 404 (45.0%) donated less than 3 times, 2 553 (81.8%) aged 25 to 35 years, 2 828 (90.6%) had term delivery, 2 409 (77.2%) began donation one month after birth, 1 798 (57.6%) were company employees and housewives and 1 891 (60.6%) had bachelor or higher degree. The use of donor breast milk, the number of recipients and the average received amount of breast milk every person varied greatly among these banks. Conclusion: The human milk banking developed quickly in the mainland of China. Howere, the number of donors and the amount of donated breast milk which could not meet the clinical demands should be improved. And it was urgent to establish the standards or guidelines of the human milk banking as soon as possible in China.

A consistent causality-based view on a timed process algebra including urgent interactions

NARCIS (Netherlands)

Katoen, Joost P.; Latella, Diego; Langerak, Romanus; Brinksma, Hendrik; Bolognesi, Tommaso

1998-01-01

This paper discusses a timed variant of a process algebra akin to LOTOS, baptized UPA, in a causality-based setting. Two timed features are incorporated—a delay function which constrains the occurrence time of atomic actions and an urgency operator that forces (local or synchronized) actions to

Effect of operational variables on nitrogen transformations in duckweed stabilization ponds

NARCIS (Netherlands)

Caicedo Berjarano, J.R.

2005-01-01

There is an urgent need to develop and improve low cost technologies for wastewater treatment that are within the economic and technological capabilities of developing countries. Simultaneously treating wastewater and producing duckweed in a pond system is therefore an attractive option to

Aortic root replacement in 372 Marfan patients: evolution of operative repair over 30 years.

Science.gov (United States)

Cameron, Duke E; Alejo, Diane E; Patel, Nishant D; Nwakanma, Lois U; Weiss, Eric S; Vricella, Luca A; Dietz, Harry C; Spevak, Philip J; Williams, Jason A; Bethea, Brian T; Fitton, Torin P; Gott, Vincent L

2009-05-01

We reviewed the evolution of practice and late results of aortic root replacement (ARR) in Marfan syndrome patients at our institution. A retrospective clinical review of Marfan patients undergoing ARR at our institution was performed. Follow-up data were obtained from hospital and office records and from telephone contact with patients or their physicians. Between September 1976 and September 2006, 372 Marfan syndrome patients underwent ARR: 269 had a Bentall composite graft, 85 had valve-sparing ARR, 16 had ARR with homografts, and 2 had ARR with porcine xenografts. In the first 24 years of the study, 85% received a Bentall graft; during the last 8 years, 61% had a valve-sparing procedure. There was no operative or hospital mortality among the 327 patients who underwent elective repair; there were 2 deaths among the 45 patients (4.4%) who underwent emergent or urgent operative repair. There were 74 late deaths (70 Bentalls, 2 homograft, and 2 valve-sparing ARRs). The most frequent causes of late death were dissection or rupture of the residual aorta (10 of 74) and arrhythmia (9 of 74). Of the 85 patients who had a valve-sparing procedure, 40 had a David II remodeling operation; there was 1 late death in this group, and 5 patients required late aortic valve replacement for aortic insufficiency. A David I reimplantation procedure using the De Paulis Valsalva graft has been used exclusively since May 2002. All 44 patients in this last group have 0 to 1+ aortic insufficiency. Prophylactic surgical replacement of the ascending aorta in patients with Marfan syndrome has low operative risk and can prevent aortic catastrophe in most patients. Valve-sparing procedures, particularly using the reimplantation technique with the Valsalva graft, show promise but have not yet proven as durable as the Bentall.

Military Post Office Location List (MPOLL)

Science.gov (United States)

1990-02-01

ISLE OF GJ GRENADA IN INDIA GK GUERNSEY 10 BRITISH INDIAN GL GREENLAND OCEAN TERRITORY GO GLORIOSO ISLANDS IP CLIPPERTON ISLAND GP GUADELOUPE IR IRAN GQ...A) BG BANGLADESH BH BELIZE AC ANTIGUA and BARBUDA BL BOLIVIA AF AFGHANISTAN BM BURMA AG ALGERIA BN BENIN AL ALBANIA BP SOLOMON ISLANDS AN ANDORRA BQ...NAVASSA ISLAND AO ANGOLA BR BRAZIL AQ AMERICAN SAMOA BS BASSAS DA INDIA AR ARGENTINA BT BHUTAN AS AUSTRALIA BU BULGARIA AT ASHMORE AND CARTIER

Analysis on the Operation Strategy of the 220kV External Transmission Channel for the Nujiang Power Grid after the Installation of Series Compensation

Science.gov (United States)

Liu, Xiaoxin; Feng, Peilei; Jan, Lisheng; Dai, Xiaozhong; Cai, Pengcheng

2018-01-01

In recent years, Nujiang Prefecture vigorously develop hydropower, the grid structure in the northwest of Yunnan Province is not perfect, which leads to the research and construction of the power grid lags behind the development of the hydropower. In 2015, the company in view of the nu river hydropower dilemma decided to change outside the nu river to send out a passage with series compensation device in order to improve the transmission capacity, the company to the main problems related to the system plan, but not too much in the region distribution network and detailed study. Nujiang power grid has unique structure and properties of the nujiang power grid after respectively, a whole rack respectively into two parts, namely power delivery channels, load power supply, the whole grid occurred fundamental changes, the original strategy of power network is not applicable, especially noteworthy is the main failure after network of independent operation problem, how to avoid the local series, emergency problem is more urgent, very tolerance test area power grid, this paper aims at the analysis of existing data, simulation, provide a reference for respectively after the operation for the stable operation of the power grid.

Short- and Long-Term Stroke Risk after Urgent Management of Transient Ischaemic Attack: The Bologna TIA Clinical Pathway.

Science.gov (United States)

Guarino, Maria; Rondelli, Francesca; Favaretto, Elisabetta; Stracciari, Andrea; Filippini, Massimo; Rinaldi, Rita; Zele, Ivana; Sartori, Michelangelo; Faggioli, Gianluca; Mondini, Susanna; Donti, Andrea; Strocchi, Enrico; Degli Esposti, Daniela; Muscari, Antonio; Veronesi, Maddalena; D'Addato, Sergio; Spinardi, Luca; Faccioli, Luca; Pastore Trossello, Marco; Cirignotta, Fabio

2015-01-01

Rapid management can reduce the short stroke risk after transient ischaemic attack (TIA), but the long-term effect is still little known. We evaluated 3-year vascular outcomes in patients with TIA after urgent care. We prospectively enrolled all consecutive patients with TIA diagnosed by a vascular neurologist and referred to our emergency department (ED). Expedited assessment and best secondary prevention was within 24 h. Endpoints were stroke within 90 days, and stroke, myocardial infarction, and vascular death at 12, 24 and 36 months. Between August 2010 and July 2013, we evaluated 686 patients with suspected TIA; 433 (63%) patients had confirmed TIA. Stroke at 90 days was 2.07% (95% confidence interval (CI), 1.1-3.9) compared with the ABCD2-predicted risk of 9.1%. The long-term stroke risk was 2.6% (95% CI, 1.1-4.2), 3.7% (95% CI, 1.6-5.9) and 4.4% (95% CI, 1.9-6.8) at 12, 24 and 36 months, respectively. The composite outcome of stroke, myocardial infarction, and vascular death was 3.5% (95% CI, 1.7-5.1), 4.9% (95% CI, 2.5-7.4), and 5.6% (95% CI, 2.8-8.3) at 12, 24, and 36 months, respectively. TIA expedited management driven by vascular neurologists was associated with a marked reduction in the expected early stroke risk and low long-term risk of stroke and other vascular events. © 2015 S. Karger AG, Basel.

Impact on Clinical Management of After-Hours Emergent or Urgent Breast Ultrasonography in Patients with Clinically Suspected Breast Abscesses

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Tanya W. Moseley

2018-02-01

Full Text Available Newly diagnosed breast abscesses are generally treated as a medical emergency that may necessitate immediate interventional treatment. At our institution, there is no in-house after-hours coverage for breast ultrasonography. We could find no peer-reviewed studies on the cost-effectiveness or clinical management impact of on-call ultrasound technologist coverage for imaging of breast abscesses. The purposes of this study were to determine the incidence of breast abscess in patients with clinical findings highly suggestive of abscess, identify clinical factors associated with breast abscess in such patients, and determine the impact of after-hours emergent or urgent breast ultrasonography on the clinical management of breast abscesses in both outpatients and inpatients. We retrospectively reviewed 100 after-hours breast ultrasound studies performed at our tertiary care center from 2011 to 2015 for evaluation of a suspected breast abscess. Only 26% of our patients with clinically suspected abscess ultimately had a confirmed abscess. Factors associated with breast abscess were a palpable abnormality and a history of breast surgery within the eight weeks before presentation. After-hours diagnosis of an abscess was associated with after-hours clinical intervention. Of the 74 patients in whom after-hours ultrasound imaging showed no evidence of abscess, only three patients underwent after-hours drainage. Our findings support overnight and weekend breast ultrasound coverage in large tertiary care centers.

Impact on Clinical Management of After-Hours Emergent or Urgent Breast Ultrasonography in Patients with Clinically Suspected Breast Abscesses

Science.gov (United States)

Moseley, Tanya W.; Stanley, Ashley; Wei, Wei; Parikh, Jay R.

2018-01-01

Newly diagnosed breast abscesses are generally treated as a medical emergency that may necessitate immediate interventional treatment. At our institution, there is no in-house after-hours coverage for breast ultrasonography. We could find no peer-reviewed studies on the cost-effectiveness or clinical management impact of on-call ultrasound technologist coverage for imaging of breast abscesses. The purposes of this study were to determine the incidence of breast abscess in patients with clinical findings highly suggestive of abscess, identify clinical factors associated with breast abscess in such patients, and determine the impact of after-hours emergent or urgent breast ultrasonography on the clinical management of breast abscesses in both outpatients and inpatients. We retrospectively reviewed 100 after-hours breast ultrasound studies performed at our tertiary care center from 2011 to 2015 for evaluation of a suspected breast abscess. Only 26% of our patients with clinically suspected abscess ultimately had a confirmed abscess. Factors associated with breast abscess were a palpable abnormality and a history of breast surgery within the eight weeks before presentation. After-hours diagnosis of an abscess was associated with after-hours clinical intervention. Of the 74 patients in whom after-hours ultrasound imaging showed no evidence of abscess, only three patients underwent after-hours drainage. Our findings support overnight and weekend breast ultrasound coverage in large tertiary care centers. PMID:29473859

Impact on Clinical Management of After-Hours Emergent or Urgent Breast Ultrasonography in Patients with Clinically Suspected Breast Abscesses.

Science.gov (United States)

Moseley, Tanya W; Stanley, Ashley; Wei, Wei; Parikh, Jay R

2018-02-23

Newly diagnosed breast abscesses are generally treated as a medical emergency that may necessitate immediate interventional treatment. At our institution, there is no in-house after-hours coverage for breast ultrasonography. We could find no peer-reviewed studies on the cost-effectiveness or clinical management impact of on-call ultrasound technologist coverage for imaging of breast abscesses. The purposes of this study were to determine the incidence of breast abscess in patients with clinical findings highly suggestive of abscess, identify clinical factors associated with breast abscess in such patients, and determine the impact of after-hours emergent or urgent breast ultrasonography on the clinical management of breast abscesses in both outpatients and inpatients. We retrospectively reviewed 100 after-hours breast ultrasound studies performed at our tertiary care center from 2011 to 2015 for evaluation of a suspected breast abscess. Only 26% of our patients with clinically suspected abscess ultimately had a confirmed abscess. Factors associated with breast abscess were a palpable abnormality and a history of breast surgery within the eight weeks before presentation. After-hours diagnosis of an abscess was associated with after-hours clinical intervention. Of the 74 patients in whom after-hours ultrasound imaging showed no evidence of abscess, only three patients underwent after-hours drainage. Our findings support overnight and weekend breast ultrasound coverage in large tertiary care centers.

Evidence-Based Practice Standard Care for Acute Pain Management in Adults With Sickle Cell Disease in an Urgent Care Center.

Science.gov (United States)

Kim, Sunghee; Brathwaite, Ron; Kim, Ook

Vaso-occlusive episodes (VOEs) with sickle cell disease (SCD) require opioid treatment. Despite evidence to support rapid pain management within 30 minutes, care for these patients does not consistently meet this benchmark. This quality improvement study sought to decrease the first analgesic administration time, increase patient satisfaction, and expedite patient flow. A prospective pre-/postevaluation design was used to evaluate outcomes with patients 18 years or older with VOEs in an urgent care (UC) center after implementation of evidence-based practice standard care (EBPSC). A pre- and postevaluation survey of SCD patients' satisfaction with care and analogous surveys of the UC team to assess awareness of EBPSC were used. A retrospective review of the electronic medical records of patients with VOEs compared mean waiting time from triage to the first analgesic administration and the mean length of stay (LOS) over 6 months. Implementing EBPSC decreased the mean time of the first analgesic administration (P = .001), significantly increased patient satisfaction (P = .002), and decreased the mean LOS (P = .010). Implementing EBPSC is a crucial step for improving the management of VOEs and creating a positive patient experience. The intervention enhances the quality of care for the SCD population in a UC center.

Maintenance Issues in Long Term Operation of Nuclear Power Plant

International Nuclear Information System (INIS)

Contri, P.; Bieth, M.; Rieg, C.

2006-01-01

Due to current social and economical framework, in last years many nuclear power plant owners started a program for the Long Term Operation (LTO)/PLEX (Plant Life Extension) of their older nuclear facilities. This process has many nuclear safety implications, other than strategic and political ones. The need for tailoring the available safety assessment tools to such applications has become urgent in recent years and triggered many research actions. The review of regular maintenance and ageing management programs are tools widely used in LTO/PLEX context in many Countries. However, most of these tools are rather general and in many cases they need reshaping in an LTO/PLEX framework before application, with focus to the safety implications of the LTO/PLEX. Many Countries and plants radically modified their maintenance rules towards a condition based approach as a precondition for the implementation of LTO/PLEX programs. In 2004 a network of European Organisations operating Nuclear Power Plants, SENUF, under the coordination of the JRC-IE, carried out an extensive questionnaire on maintenance practice in their facilities aiming at capturing the aspects of the maintenance programs where research is mostly needed. This paper uses some results of the questionnaire, which was not oriented to LTO/PLEX, to draw some conclusions on how the current maintenance programs could support a potential LTO/PLEX, among the other programs running at NPPs. In this sense, it is spin-off of the SENUF WG on maintenance. The paper aims at identifying the technical attributes of the maintenance programs more directly affecting the decision for a long-term safe operation of a nuclear facility, the issues related to their implementation and safety review. The paper includes an analysis of the questionnaire circulated among the SENUF participants and a discussion on the implications of optimised maintenance programs in existing plants. Some examples at WWER plants taken by sources other than

A Survey on Operator Monotonicity, Operator Convexity, and Operator Means

Directory of Open Access Journals (Sweden)

Pattrawut Chansangiam

2015-01-01

Full Text Available This paper is an expository devoted to an important class of real-valued functions introduced by Löwner, namely, operator monotone functions. This concept is closely related to operator convex/concave functions. Various characterizations for such functions are given from the viewpoint of differential analysis in terms of matrix of divided differences. From the viewpoint of operator inequalities, various characterizations and the relationship between operator monotonicity and operator convexity are given by Hansen and Pedersen. In the viewpoint of measure theory, operator monotone functions on the nonnegative reals admit meaningful integral representations with respect to Borel measures on the unit interval. Furthermore, Kubo-Ando theory asserts the correspondence between operator monotone functions and operator means.

Grenada School Nutrition Study: Evidence to Inform Policy | IDRC ...

International Development Research Centre (IDRC) Digital Library (Canada)

The project aims to identify modifiable factors in teens' schools and ... An IDRC delegation will join international delegates and city representatives at the ICLEI World ... Sharing opportunities for innovation in climate change adaptation.

Awareness-of-the-issues investigation about radiological technologist's operating discretionary authority etc

International Nuclear Information System (INIS)

Fukada, Teruaki

2008-01-01

The discretionary range of a radiological technologist and the autonomy on law were investigated by the questionnaire. The degree of satisfaction of work and the domain to lengthen were investigated. Result, the inspection direction change of MRI inspection and the urgent connection at the time of diagnostic imaging unusual discovery is discretion. However, there are no part change and addition of a general photography inspection at discretion. Explanation of the inspection result of a patient is also useless. Moreover, many of troubles are explanation relations, It was much between the doctor or the patient. For the degree of operating satisfactory, definite aim in life is 70 points. There were about 70 points about speciality nature. The degree of discretion has many less than 50 points. On the whole, a female radiological technologist's degree of satisfaction was low. Next, the autonomy of a radiological technologist method was low and many wished a legal revision. Specialization is promoted as a future measure. Diagnostic imaging field advance is lengthened. Improvement in a status of a radiological technologist, Activity fullness of the Japan Association of Radiological Technologists is expected. (author)

Operator theory, operator algebras and applications

CERN Document Server

Lebre, Amarino; Samko, Stefan; Spitkovsky, Ilya

2014-01-01

This book consists of research papers that cover the scientific areas of the International Workshop on Operator Theory, Operator Algebras and Applications, held in Lisbon in September 2012. The volume particularly focuses on (i) operator theory and harmonic analysis (singular integral operators with shifts; pseudodifferential operators, factorization of almost periodic matrix functions; inequalities; Cauchy type integrals; maximal and singular operators on generalized Orlicz-Morrey spaces; the Riesz potential operator; modification of Hadamard fractional integro-differentiation), (ii) operator algebras (invertibility in groupoid C*-algebras; inner endomorphisms of some semi group, crossed products; C*-algebras generated by mappings which have finite orbits; Folner sequences in operator algebras; arithmetic aspect of C*_r SL(2); C*-algebras of singular integral operators; algebras of operator sequences) and (iii) mathematical physics (operator approach to diffraction from polygonal-conical screens; Poisson geo...

Outcomes from peptic ulcer surgery have not benefited from advances in medical therapy.

Science.gov (United States)

Towfigh, Shirin; Chandler, Charles; Hines, Oscar J; McFadden, David W

2002-04-01

Given the advancements in medical treatment of peptic ulcer disease such as Helicobacter pylori eradication and proton-pump inhibitors, we sought to assess their impact on the need for surgical intervention. Patients who underwent peptic ulcer surgery between 1981 and 1998 were evaluated in a retrospective chart review from a tertiary-care hospital (n = 222). The number of operations performed for peptic ulcers decreased annually (24 vs 11.3). Seventy-seven per cent of all cases were done urgently; most were performed for acute perforated ulcers. The overall 30-day mortality rate was 13 per cent, which remained unchanged over the past two decades. The highest mortality rate (82%) was in the transplanted population (n = 11). Our institutional experience demonstrates that despite the lower volume of patients requiring operative management a greater percentage of these patients are presenting with urgent need for surgery. Also despite the aggressive endoscopic management of acutely bleeding ulcers there was no change in the percentage of patients taken to the operating room for uncontrollable hemorrhage. Improvements in medical management of peptic ulcer disease have decreased the surgical volume; nevertheless we show a rising proportion of urgent operations performed annually, and mortality remains high.

RADIOLOGY IN URGENT MEDICINE

Directory of Open Access Journals (Sweden)

Article Editorial

2017-01-01

Full Text Available Интервью с директором Научно-образовательного клинического центра Гибридных технологий лучевой медицины, заведующим кафедрой лучевой диагностики и лучевой терапии Первого МГМУ им. И.М. Сеченова, руководителем отдела томографии Института клинической кардиологии им. А.Л. Мясникова, главным консультантом Главного медицинского управления УД Президента РФ, академиком РАН Сергеем Константиновичем Терновым.

Councils of Urgent Studies

Science.gov (United States)

Cellarius, Richard A.; Platt, John

1972-01-01

Discusses the role of national or international coordinating councils in focusing research on solutions of major human problems. Presents a taxonomy of 25 areas under the major heading: Physical Technology and Engineering; Biotechnology; Behavior and Personal Relations; National Social Structures; World Structure; and Channels of Effectiveness.…

Case-mix analysis and variation in rates of non-surgical treatment of older women with operable breast cancer.

Science.gov (United States)

Morgan, J; Richards, P; Ward, S; Francis, M; Lawrence, G; Collins, K; Reed, M; Wyld, L

2015-08-01

Non-surgical management of older women with oestrogen receptor (ER)-positive operable breast cancer is common in the UK, with up to 40 per cent of women aged over 70 years receiving primary endocrine therapy. Although this may be appropriate for frailer patients, for some it may result in treatment failure, contributing to the poor outcomes seen in this age group. Wide variation in the rates of non-operative management of breast cancer in older women exists across the UK. Case mix may explain some of this variation in practice. Data from two UK regional cancer registries were analysed to determine whether variation in treatment observed between 2002 and 2010 at hospital and clinician level persisted after adjustment for case mix. Expected case mix-adjusted surgery rates were derived by logistic regression using the variables age, proxy Charlson co-morbidity score, deprivation quintile, method of cancer detection, tumour size, stage, grade and node status. Data on 17,129 women aged 70 years or more with ER-positive operable breast cancer were analysed. There was considerable variation in rates of surgery at both hospital and clinician level. Despite adjusting for case mix, this variation persisted at hospital level, although not at clinician level. This study demonstrates variation in selection criteria for older women for operative treatment of early breast cancer, indicating that some older women may be undertreated or overtreated, and may partly explain the inferior disease outcomes in this age group. It emphasizes the urgent need for evidence-based guidelines for treatment selection criteria in older women with breast cancer. © 2015 BJS Society Ltd Published by John Wiley & Sons Ltd.

Effect of urgent treatment of transient ischaemic attack and minor stroke on early recurrent stroke (EXPRESS study): a prospective population-based sequential comparison.

Science.gov (United States)

Rothwell, Peter M; Giles, Matthew F; Chandratheva, Arvind; Marquardt, Lars; Geraghty, Olivia; Redgrave, Jessica N E; Lovelock, Caroline E; Binney, Lucy E; Bull, Linda M; Cuthbertson, Fiona C; Welch, Sarah J V; Bosch, Shelley; Alexander, Faye C; Carasco-Alexander, Faye; Silver, Louise E; Gutnikov, Sergei A; Mehta, Ziyah

2007-10-20

The risk of recurrent stroke is up to 10% in the week after a transient ischaemic attack (TIA) or minor stroke. Modelling studies suggest that urgent use of existing preventive treatments could reduce the risk by 80-90%, but in the absence of evidence many health-care systems make little provision. Our aim was to determine the effect of more rapid treatment after TIA and minor stroke in patients who are not admitted direct to hospital. We did a prospective before (phase 1: April 1, 2002, to Sept 30, 2004) versus after (phase 2: Oct 1, 2004, to March 31, 2007) study of the effect on process of care and outcome of more urgent assessment and immediate treatment in clinic, rather than subsequent initiation in primary care, in all patients with TIA or minor stroke not admitted direct to hospital. The study was nested within a rigorous population-based incidence study of all TIA and stroke (Oxford Vascular Study; OXVASC), such that case ascertainment, investigation, and follow-up were complete and identical in both periods. The primary outcome was the risk of stroke within 90 days of first seeking medical attention, with independent blinded (to study period) audit of all events. Of the 1278 patients in OXVASC who presented with TIA or stroke (634 in phase 1 and 644 in phase 2), 607 were referred or presented direct to hospital, 620 were referred for outpatient assessment, and 51 were not referred to secondary care. 95% (n=591) of all outpatient referrals were to the study clinic. Baseline characteristics and delays in seeking medical attention were similar in both periods, but median delay to assessment in the study clinic fell from 3 (IQR 2-5) days in phase 1 to less than 1 (0-3) day in phase 2 (prisk of recurrent stroke in the patients referred to the study clinic was 10.3% (32/310 patients) in phase 1 and 2.1% (6/281 patients) in phase 2 (adjusted hazard ratio 0.20, 95% CI 0.08-0.49; p=0.0001); there was no significant change in risk in patients treated elsewhere. The

19 CFR 122.49a - Electronic manifest requirement for passengers onboard commercial aircraft arriving in the United...

Science.gov (United States)

2010-04-01

... operations, all-cargo flight operations, and dual flight operations involving the transport of both cargo and... capacity required for normal operation and service of the flight. In addition, the definition of “crew... problem affecting the flight, or to an urgent situation affecting the non-U.S. port of destination that...

Platelet-rich-plasmapheresis for minimising peri-operative allogeneic blood transfusion.

Science.gov (United States)

Carless, Paul A; Rubens, Fraser D; Anthony, Danielle M; O'Connell, Dianne; Henry, David A

2011-03-16

Concerns regarding the safety of transfused blood have generated considerable enthusiasm for the use of technologies intended to reduce the use of allogeneic blood (blood from an unrelated donor). Platelet-rich plasmapheresis (PRP) offers an alternative approach to blood conservation. To examine the evidence for the efficacy of PRP in reducing peri-operative allogeneic red blood cell (RBC) transfusion, and the evidence for any effect on clinical outcomes such as mortality and re-operation rates. We identified studies by searching MEDLINE (1950 to 2009), EMBASE (1980 to 2009), The Cochrane Library (Issue 1, 2009), the Internet (to March 2009) and the reference lists of published articles, reports, and reviews. Controlled parallel group trials in which adult patients, scheduled for non-urgent surgery, were randomised to PRP, or to a control group which did not receive the intervention. Primary outcomes measured were: the number of patients exposed to allogeneic RBC transfusion, and the amount of RBC transfused. Other outcomes measured were: the number of patients exposed to allogeneic platelet transfusions, fresh frozen plasma, and cryoprecipitate, blood loss, re-operation for bleeding, post-operative complications (thrombosis), mortality, and length of hospital stay. Treatment effects were pooled using a random-effects model. Trial quality was assessed using criteria proposed by Schulz et al (Schulz 1995). Twenty-two trials of PRP were identified that reported data for the number of patients exposed to allogeneic RBC transfusion. These trials evaluated a total of 1589 patients. The relative risk (RR) of exposure to allogeneic blood transfusion in those patients randomised to PRP was 0.73 (95%CI 0.59 to 0.90), equating to a relative risk reduction (RRR) of 27% and a risk difference (RD) of 19% (95%CI 10% to 29%). However, significant heterogeneity of treatment effect was observed (p transfused (weighted mean difference [WMD] -0.69, 95%CI -1.93 to 0.56 units). Trials

Your Lung Operation: After Your Operation

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An Analysis of Methodologies and Best Practices for Rapidly Acquiring Technologies to Meet Urgent Warfighter Needs

Science.gov (United States)

2008-03-01

projects are a very small and unique subset of the typical acquisition and S& T programs and require a unique culture, operating environment, and...ll f th th t I’ l l 3 i t b t th ’ d b d I d ’ t k if it’ b h t i t ti l d b f l h t i i o em a ve seen are eve n program managemen , u ere s...Abstract The rapidly changing global security environment that today’s military operates within requires an ever increasing ability to quickly

Survey of Salmonella contamination in chicken layer farms in three Caribbean countries.

Science.gov (United States)

Adesiyun, Abiodun; Webb, Lloyd; Musai, Lisa; Louison, Bowen; Joseph, George; Stewart-Johnson, Alva; Samlal, Sannandan; Rodrigo, Shelly

2014-09-01

This study was conducted to investigate the demography, management, and production practices on layer chicken farms in Trinidad and Tobago, Grenada, and St. Lucia and the frequency of risk factors for Salmonella infection. The frequency of isolation of Salmonella from the layer farm environment, eggs, feeds, hatchery, and imported day-old chicks was determined using standard methods. Of the eight risk factors (farm size, age group of layers, source of day-old chicks, vaccination, sanitation practices, biosecurity measures, presence of pests, and previous disease outbreaks) for Salmonella infection investigated, farm size was the only risk factor significantly associated (P = 0.031) with the prevalence of Salmonella; 77.8% of large farms were positive for this pathogen compared with 33.3 and 26.1% of medium and small farms, respectively. The overall isolation rate of Salmonella from 35 layer farms was 40.0%. Salmonella was isolated at a significantly higher rate (P hatcheries, and airports in this country were negative. Salmonella Anatum, Salmonella group C, and Salmonella Kentucky were the predominant serotypes in Trinidad and Tobago, Grenada, and St. Lucia, respectively. Although Salmonella infections were found in layer birds sampled, table eggs appear to pose minimal risk to consumers. However, the detection of Salmonella -contaminated farm environments and feeds cannot be ignored. Only 2.9% of the isolates belonged to Salmonella Enteritidis, a finding that may reflect the impact of changes in farm management and poultry production in the region.

Genomic analysis of diversity, population structure, virulence, and antimicrobial resistance in Klebsiella pneumoniae, an urgent threat to public health

Science.gov (United States)

Holt, Kathryn E.; Wertheim, Heiman; Zadoks, Ruth N.; Baker, Stephen; Whitehouse, Chris A.; Dance, David; Jenney, Adam; Connor, Thomas R.; Hsu, Li Yang; Severin, Juliëtte; Brisse, Sylvain; Cao, Hanwei; Wilksch, Jonathan; Gorrie, Claire; Schultz, Mark B.; Edwards, David J.; Nguyen, Kinh Van; Nguyen, Trung Vu; Dao, Trinh Tuyet; Mensink, Martijn; Minh, Vien Le; Nhu, Nguyen Thi Khanh; Schultsz, Constance; Kuntaman, Kuntaman; Newton, Paul N.; Moore, Catrin E.; Strugnell, Richard A.; Thomson, Nicholas R.

2015-01-01

Klebsiella pneumoniae is now recognized as an urgent threat to human health because of the emergence of multidrug-resistant strains associated with hospital outbreaks and hypervirulent strains associated with severe community-acquired infections. K. pneumoniae is ubiquitous in the environment and can colonize and infect both plants and animals. However, little is known about the population structure of K. pneumoniae, so it is difficult to recognize or understand the emergence of clinically important clones within this highly genetically diverse species. Here we present a detailed genomic framework for K. pneumoniae based on whole-genome sequencing of more than 300 human and animal isolates spanning four continents. Our data provide genome-wide support for the splitting of K. pneumoniae into three distinct species, KpI (K. pneumoniae), KpII (K. quasipneumoniae), and KpIII (K. variicola). Further, for K. pneumoniae (KpI), the entity most frequently associated with human infection, we show the existence of >150 deeply branching lineages including numerous multidrug-resistant or hypervirulent clones. We show K. pneumoniae has a large accessory genome approaching 30,000 protein-coding genes, including a number of virulence functions that are significantly associated with invasive community-acquired disease in humans. In our dataset, antimicrobial resistance genes were common among human carriage isolates and hospital-acquired infections, which generally lacked the genes associated with invasive disease. The convergence of virulence and resistance genes potentially could lead to the emergence of untreatable invasive K. pneumoniae infections; our data provide the whole-genome framework against which to track the emergence of such threats. PMID:26100894

Spontaneous perforation of the bladder in a patient operated for a lung abscess: a case report

Directory of Open Access Journals (Sweden)

Velizar Hadzhiminev

2018-04-01

Full Text Available We present a rare case of a spontaneous perforation of the bladder in a female patient who underwent thoracic operation. A 45 year-old female patient with no other comorbidities was admitted to the department of thoracic and abdominal surgery of University hospital “Sveti Georgi” with clinical, laboratory and image findings of right lung abscess. A right thoracotomy was performed, a large lung abscess was found and upper right bilobectomy was performed. On the day of her discharge she complained of a sudden abdominal pain, ballooning of the abdomen, nausea and vomiting. The ultrasonography showed a free fluid in the peritoneal cavity. An urgent laparotomy was performed, a perforation of the bladder was found, resection of the necrotic part of the wall and two layer suture of the bladder were performed by urologist. Postoperatively, we had multiple complications. Tuberculosis was considered as one of the most likely diagnosis but was subsequently rejected. The patient was discharged after 70 days of hospital stay in a good health condition.

John Dumbrell, Rethinking the Vietnam War.

OpenAIRE

Gratale, Joseph Michael

2015-01-01

Since the conclusion of the Vietnam War in the early 1970s, the USA has been involved in a number of wars and military interventions throughout the world.  From the US invasion of Grenada in 1983 and the Persian Gulf War of 1991, to the US wars in Afghanistan and Iraq in the early 21st century, the USA has found a variety of justifications and rationales in pursuing its national interests through the implementation of war.  In spite of the frequency and impacts of US military interventions ov...

Collaborative Monitoring of Production and Costs of Timber Harvest Operations in the Brazilian Amazon

Directory of Open Access Journals (Sweden)

Benno Pokorny

2005-06-01

Full Text Available Timber companies and policy makers in the Brazilian Amazon urgently need financial information on forest management. Results from a few experiments, case studies, and surveys have been groundbreaking, but are insufficient. A strategic partnership between timber companies and research organizations is needed to generate additional information. This paper presents a tool for monitoring production and costs of forest operations to facilitate such collaboration. The tool provides useful information for companies and, at the same time, generates reliable data for research. Selected results are presented on production, capacity, and costs to demonstrate the usefulness of the information that can be generated. These results are based on the first 2 years of implementation by a company in the State of Pará, Brazil. This pilot project confirmed that the tool is simple and relevant. Its successful implementation requires significant investment, and will be applicable only to companies interested in changing from conventional logging to reduced-impact logging, especially those seeking Forest Stewardship Council certification. Successful implementation of the tool will also depend on it generating readily understood and highly relevant results for the companies, and receiving extensive support during the first 2 years.

Conduct of operations: establishing operational focus and setting operational standards

International Nuclear Information System (INIS)

Lane, L.; McGuigan, K.

1998-01-01

Due to the nature of our business, we have often tended to focus on the technological aspects of the nuclear industry. The focus of this paper is directed towards the importance of addressing the people skills, attitudes, and 'culture' within, and surrounding, our facilities as key areas of improvement. Within Ontario Hydro Nuclear (OLIN) we have developed the terminology 'event free' operation and 'event free' culture. 'Event Free' recognizes errors as a part of human performance. 'Event Free' takes into account human weaknesses, and provides tools (such as standards) to manage, control, and mitigate errors. In essence, 'Event Free' encompasses two concepts: 1. Prevent errors from occurring; 2. If an error is made, catch it before it can affect safe operation of the facility, learn from the error, and ensure that it does not happen again. In addressing these business realities, Ontario Hydro has identified a number of key support mechanisms and corresponding performance standards that are essential for achieving operating excellence and an 'event free' business culture. This paper will discuss two operational aspects of an 'event free' culture, the first being a set of expectations to enhance the culture, and the second an example of cultural change: 1. Operating Standards - establishing clear expectations for human performance in operating staff; 2. Operational Focus - the understanding that, as a nuclear worker, you should consider every task, activity, in fact everything you do in this business, for the potential to affect safe and reliable operation of a nuclear facility. Note that although the term 'Operational' appears in the title, this concept applies to every individual in the nuclear business, from the cleaner, to the Board of Directors, to the external supplier. (author)

Your Lung Operation: After Your Operation

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Your Lung Operation: After Your Operation

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Your Lung Operation: After Your Operation

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Full Text Available ... You Want to Be a Surgeon Resident Resources Teaching Resources Online Guide to Choosing a Surgical Residency ... After Your Operation Your Discharge and Recovery Complete Video After Your Operation Guidance for after the operation ...

Your Lung Operation: After Your Operation

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Full Text Available ... Liability Surgeons as Advocates Surgeons and Bundled Payment Models Surgeons as Institutional Employees Our Changing Health Care ... Lung Operation After Your Operation Your Discharge and Recovery Complete Video After Your Operation Guidance for after ...

Your Lung Operation: After Your Operation

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Full Text Available ... Safety Resources About the Patient Education Program The Recovery Room Choosing Wisely Educational Programs Educational Programs Educational ... Lung Operation After Your Operation Your Discharge and Recovery Complete Video After Your Operation Guidance for after ...

Claims of operators, non-operators and third parties arising from oil and gas operations

International Nuclear Information System (INIS)

Block, R.W.; Semadeni, T.

1999-01-01

There has come a resurgence in the number of companies involved in the oil and gas industry seeking protection from their creditors because of the recent weakness in commodity prices. Because most operations in this industry are conducted jointly, a single insolvency can lead to a toppling of other participants in the joint venture and beyond. The problem is to minimize one's losses if other members of the joint venture become insolvent. An examination is included of some remedies which may be available to operators, non-operators and third parties when faced with an insolvent oil and gas participant. The remedies which may be available to the non-operator that is owed moneys by its operator are discussed. The remedies that the operator has against its non-operators, with an emphasis on the nature of the operator's lien and the right of set-off, are described. A brief review is included of some of the remedies that might be available to a third party as against the operators and non-operators. Some s uggestions are included for directors, bankers, third parties, non-operators and operators

Operator-assisted planning and execution of proximity operations subject to operational constraints

Science.gov (United States)

Grunwald, Arthur J.; Ellis, Stephen R.

1991-01-01

Future multi-vehicle operations will involve multiple scenarios that will require a planning tool for the rapid, interactive creation of fuel-efficient trajectories. The planning process must deal with higher-order, non-linear processes involving dynamics that are often counter-intuitive. The optimization of resulting trajectories can be difficult to envision. An interaction proximity operations planning system is being developed to provide the operator with easily interpreted visual feedback of trajectories and constraints. This system is hosted on an IRIS 4D graphics platform and utilizes the Clohessy-Wiltshire equations. An inverse dynamics algorithm is used to remove non-linearities while the trajectory maneuvers are decoupled and separated in a geometric spreadsheet. The operator has direct control of the position and time of trajectory waypoints to achieve the desired end conditions. Graphics provide the operator with visualization of satisfying operational constraints such as structural clearance, plume impingement, approach velocity limits, and arrival or departure corridors. Primer vector theory is combined with graphical presentation to improve operator understanding of suggested automated system solutions and to allow the operator to review, edit, or provide corrective action to the trajectory plan.

Applied Operations Research: Operator's Assistant

Science.gov (United States)

Cole, Stuart K.

2015-01-01

NASA operates high value critical equipment (HVCE) that requires trouble shooting, periodic maintenance and continued monitoring by Operations staff. The complexity HVCE and information required to maintain and trouble shoot HVCE to assure continued mission success as paper is voluminous. Training on new HVCE is commensurate with the need for equipment maintenance. LaRC Research Directorate has undertaken a proactive research to support Operations staff by initiation of the development and prototyping an electronic computer based portable maintenance aid (Operator's Assistant). This research established a goal with multiple objectives and a working prototype was developed. The research identified affordable solutions; constraints; demonstrated use of commercial off the shelf software; use of the US Coast Guard maintenance solution; NASA Procedure Representation Language; and the identification of computer system strategies; where these demonstrations and capabilities support the Operator, and maintenance. The results revealed validation against measures of effectiveness and overall proved a substantial training and capability sustainment tool. The research indicated that the OA could be deployed operationally at the LaRC Compressor Station with an expectation of satisfactorily results and to obtain additional lessons learned prior to deployment at other LaRC Research Directorate Facilities. The research revealed projected cost and time savings.

Using fractional order method to generalize strengthening generating operator buffer operator and weakening buffer operator

OpenAIRE

Wu, L.; Liu, S.; Yang, Yingjie

2016-01-01

Traditional integer order buffer operator is extended to fractional order buffer operator, the corresponding relationship between the weakening buffer operator and the strengthening buffer operator is revealed. Fractional order buffer operator not only can generalize the weakening buffer operator and the strengthening buffer operator, but also realize tiny adjustment of buffer effect. The effectiveness of GM(1,1) with the fractional order buffer operator is validated by six cases.

Prevalence of operator fatigue in winter maintenance operations.

Science.gov (United States)

Camden, Matthew C; Medina-Flintsch, Alejandra; Hickman, Jeffrey S; Bryce, James; Flintsch, Gerardo; Hanowski, Richard J

2018-02-02

Similar to commercial motor vehicle drivers, winter maintenance operators are likely to be at an increased risk of becoming fatigued while driving due to long, inconsistent shifts, environmental stressors, and limited opportunities for sleep. Despite this risk, there is little research concerning the prevalence of winter maintenance operator fatigue during winter emergencies. The purpose of this research was to investigate the prevalence, sources, and countermeasures of fatigue in winter maintenance operations. Questionnaires from 1043 winter maintenance operators and 453 managers were received from 29 Clear Road member states. Results confirmed that fatigue was prevalent in winter maintenance operations. Over 70% of the operators and managers believed that fatigue has a moderate to significant impact on winter maintenance operations. Approximately 75% of winter maintenance operators reported to at least sometimes drive while fatigued, and 96% of managers believed their winter maintenance operators drove while fatigued at least some of the time. Furthermore, winter maintenance operators and managers identified fatigue countermeasures and sources of fatigue related to winter maintenance equipment. However, the countermeasures believed to be the most effective at reducing fatigue during winter emergencies (i.e., naps) were underutilized. For example, winter maintenance operators reported to never use naps to eliminate fatigue. These results indicated winter maintenance operations are impacted by operator fatigue. These results support the increased need for research and effective countermeasures targeting winter maintenance operator fatigue. Copyright © 2018 Elsevier Ltd. All rights reserved.

Heat transfer operators associated with quantum operations

International Nuclear Information System (INIS)

Aksak, C; Turgut, S

2011-01-01

Any quantum operation applied on a physical system is performed as a unitary transformation on a larger extended system. If the extension used is a heat bath in thermal equilibrium, the concomitant change in the state of the bath necessarily implies a heat exchange with it. The dependence of the average heat transferred to the bath on the initial state of the system can then be found from the expectation value of a Hermitian operator, which is named as the heat transfer operator (HTO). The purpose of this paper is to investigate the relation between the HTOs and the associated quantum operations. Since any given quantum operation on a system can be realized by different baths and unitaries, many different HTOs are possible for each quantum operation. On the other hand, there are also strong restrictions on the HTOs which arise from the unitarity of the transformations. The most important of these is the Landauer erasure principle. This paper is concerned with the question of finding a complete set of restrictions on the HTOs that are associated with a given quantum operation. An answer to this question has been found only for a subset of quantum operations. For erasure operations, these characterizations are equivalent to the generalized Landauer erasure principle. For the case of generic quantum operations, however, it appears that the HTOs obey further restrictions which cannot be obtained from the entropic restrictions of the generalized Landauer erasure principle.

Effectiveness of operation tools developed by KEKB operators

International Nuclear Information System (INIS)

Sugino, K.; Satoh, Y.; Kitabayashi, T.

2004-01-01

The main tasks of KEKB (High Energy Accelerator Research Organization B-physics) operators are beam tuning and injection, operation logging, monitoring of accelerator conditions and safety management. New beam tuning methods are frequently applied to KEKB in order to accomplish high luminosity. In such a situation, various operation tools have been developed by the operators to realize efficient operation. In this paper, we describe effectiveness of tools developed by the operators. (author)

Regulation for delivery of subsidies for urgent safety measures for atomic power generating facilities

International Nuclear Information System (INIS)

1981-01-01

This rule is established under the provisions of the law for the proper enforcement of subsidy budgets and the ordinance for the execution of this law and to practice these provisions. It is applied to the delivery of subsidies for the expenses of the measures taken beforehand for the security of inhabitants in the surrounding areas of atomic power generating facilities in the emergency time of hazard or the danger of the occurrence of hazard by such facilities. Basic terms are defined, such as atomic power generating facilities and others, prefecture concerned, cities, towns and villages concerned, emergency communication network arrangement business, emergency medical facility arrangement business, business of holding hazard prevention course and expected date of beginning operation. Directors of ministries and agencies concerned deliver, if necessary, to prefectures concerned subsidies for all or a part of the expenses needed for the businesses of emergency communication network arrangement, emergency medical facility arrangement and holding hazard prevention course. The terms of delivery and the amounts of subsidies vary according to the kinds of businesses. Prefectures which intend to apply for the delivery of subsidies shall file to the director of the ministry or agency concerned the specified application attaching the operation plans of businesses and the general explanation of atomic power generating facilities, etc. The decision and conditions of delivery, reports on the situations and results of businesses and other related matters are defined, respectively. (Okada, K.)

Operating room data management: improving efficiency and safety in a surgical block.

Science.gov (United States)

Agnoletti, Vanni; Buccioli, Matteo; Padovani, Emanuele; Corso, Ruggero M; Perger, Peter; Piraccini, Emanuele; Orelli, Rebecca Levy; Maitan, Stefano; Dell'amore, Davide; Garcea, Domenico; Vicini, Claudio; Montella, Teresa Maria; Gambale, Giorgio

2013-03-11

European Healthcare Systems are facing a difficult period characterized by increasing costs and spending cuts due to economic problems. There is the urgent need for new tools which sustain Hospitals decision makers work. This project aimed to develop a data recording system of the surgical process of every patient within the operating theatre. The primary goal was to create a practical and easy data processing tool to give hospital managers, anesthesiologists and surgeons the information basis to increase operating theaters efficiency and patient safety. The developed data analysis tool is embedded in an Oracle Business Intelligence Environment, which processes data to simple and understandable performance tachometers and tables. The underlying data analysis is based on scientific literature and the projects teams experience with tracked data. The system login is layered and different users have access to different data outputs depending on their professional needs. The system is divided in the tree profile types Manager, Anesthesiologist and Surgeon. Every profile includes subcategories where operators can access more detailed data analyses. The first data output screen shows general information and guides the user towards more detailed data analysis. The data recording system enabled the registration of 14.675 surgical operations performed from 2009 to 2011. Raw utilization increased from 44% in 2009 to 52% in 2011. The number of high complexity surgical procedures (≥120 minutes) has increased in certain units while decreased in others. The number of unscheduled procedures performed has been reduced (from 25% in 2009 to 14% in 2011) while maintaining the same percentage of surgical procedures. The number of overtime events decreased in 2010 (23%) and in 2011 (21%) compared to 2009 (28%) and the delays expressed in minutes are almost the same (mean 78 min). The direct link found between the complexity of surgical procedures, the number of unscheduled procedures

Review of operational aids for nuclear plant operators

International Nuclear Information System (INIS)

Kisner, R.A.

1983-01-01

Many approaches are being explored to improve the safety of nuclear plant operations. One approach is to supply high-quality, relevant information by means of computer-based diagnostic systems to assist plant operators in performing their operational and safety-related roles. The evaluation of operational aids to ensure safe plant operations is a necessary function of NRC. This work has two purposes: to collect limited data on a diversity of operational aids, and to provide a method for evaluating the safety implications of the functions of proposed operational aids. After a discussion of the method evaluation now under study, this paper outlines this data collection to date

Malnutrition in older adults - urgent need for action: a plea for improving the nutritional situation of older adults.

Science.gov (United States)

Volkert, Dorothee

2013-01-01

During the past decades, malnutrition has attracted increasing scientific attention and is by now regarded as a true geriatric syndrome characterized by multifactorial causality, identified by symptoms and accompanied by frailty, disability and poor outcome. This viewpoint summarizes our present knowledge and the usual current handling of malnutrition in older people and highlights the urgent need for action in this field. Age-related changes in the complex system of appetite regulation, resulting in the so-called anorexia of aging, predispose older adults to a decrease in food intake which may lead to malnutrition, if additional risk factors like health or social problems occur. Consequently, malnutrition is widespread in the older population, notably in those who are institutionalized. Despite the fact that effective interventions are available, prevention and treatment of malnutrition do not currently receive appropriate attention. As an important first step towards better awareness, screening for malnutrition should become a mandatory integral part of the comprehensive geriatric assessment. Furthermore, practical local guidelines should be implemented in all geriatric hospital wards and nursing homes in order to improve nutritional care in the daily routine. Important to note is that reasonable nutritional management is not possible without qualified staff in adequate numbers allowing appropriate individual nutritional care. Regarding future research, studies at the cellular, metabolic and clinical levels and the linking of information from different research approaches are required to better understand the transition from good nutritional health and independence of old people to malnutrition, functional impairment and poor health. In parallel to well-designed observational and intervention studies, standardized documentation of nutritional information in daily routine would enable the uniform collection of data for research as well as for political decisions

Critical success factors for international travel fairs, using the Taipei International Travel Fair as an example

OpenAIRE

I.-Ying Chang

2014-01-01

The travel industry has experienced operating difficulties because of the intense competition within the industry, difficulties in developing new products as well as the overly transparent and continuously increasing operating cost that reduces the profit margin. As a result, it is urgent that the business operating bottleneck be overcome and some strategies be implemented. These include dumping the conventional operating model, reducing basic operating costs, increasing the profit margin, an...

Nonlocal Operational Calculi for Dunkl Operators

Directory of Open Access Journals (Sweden)

Ivan H. Dimovski

2009-03-01

Full Text Available The one-dimensional Dunkl operator $D_k$ with a non-negative parameter $k$, is considered under an arbitrary nonlocal boundary value condition. The right inverse operator of $D_k$, satisfying this condition is studied. An operational calculus of Mikusinski type is developed. In the frames of this operational calculi an extension of the Heaviside algorithm for solution of nonlocal Cauchy boundary value problems for Dunkl functional-differential equations $P(D_ku = f$ with a given polynomial $P$ is proposed. The solution of these equations in mean-periodic functions reduces to such problems. Necessary and sufficient condition for existence of unique solution in mean-periodic functions is found.

Necrotizing fasciitis: an urgent diagnosis

Energy Technology Data Exchange (ETDEWEB)

Paz Maya, Silvia; Dualde Beltran, Delfina [Hospital Clinico Universitario de Valencia, Valencia (Spain); Lemercier, Pierre; Leiva-Salinas, Carlos [Hospital Politecnico y Universitario La Fe, Valencia (Spain)

2014-05-15

Necrotizing fasciitis (NF) is a rare, life-threatening soft-tissue infection and a medical and surgical emergency, with increasing incidence in the last few years. It is characterized by a rapidly spreading, progressive necrosis of the deep fascia and subcutaneous tissue. Necrotizing fasciitis is often underestimated because of the lack of specific clinical findings in the initial stages of the disease. Many adjuncts such as laboratory findings, bedside tests - e.g., the ''finger test'' or biopsy - and imaging tests have been described as being helpful in the early recognition of the disease. Imaging is very useful to confirm the diagnosis, but also to assess the extent of the disorder, the potential surgical planning, and the detection of underlying etiologies. The presence of gas within the necrotized fasciae is characteristic, but may be lacking. The main finding is thickening of the deep fasciae due to fluid accumulation and reactive hyperemia, best seen on magnetic resonance imaging. (orig.)

Some urgent problems of radiopulmonology

International Nuclear Information System (INIS)

Vinner, M.G.

1986-01-01

3-stage diagnosis and appropriate organizational structure has been proposed. The main emphasis is laid on a high quality of tomographic and bronchographic investigation at the first stage in polyclinic and hospital X-ray rooms. Roentgenologists' responsibilities in a pulmonological center (the 2nd stage of diagnosis) and radiosurgical hospital (the 3rd stage) were distinguished. Radiosurgical methods are used at the 3rd stage. Tomography, bronchography and transthoracic puncture are the main diagnosicmethods in radiopulmonology. It is desirable that roentgenologists in a pulmonological center and radiosurgical hospital should master apart from transthoracic puncture bronchofibroscopy performed under local anesthesia and X-ray TV control. The authors have put forward ideas of overcoming difficulties in the diagnosis of disseminated, common and rare pulmonary diseases, of the necessity of drawing together X-ray departments for this purpose

[Antibiotic resistance: measures urgently needed].

NARCIS (Netherlands)

Kluytmans, J.; Vandenbroucke-Grauls, C.M.; Meer, J.W.M. van der

2010-01-01

Antimicrobial resistance is increasing rapidly and there are hardly any new antimicrobial agents to be expected in the coming years. The number of patients affected by extended spectrum beta-lactamase producing organisms (ESBLs) is rising and there are strong indications that this is caused in part

Urgent need of a doctor

CERN Multimedia

2003-01-01

GENEVE PATIENT NOT FIT TO BE MOVED: Call your family doctor Or: SOS MEDECINS (24H/24H) 022 748-49-50 Or: ASSOC. MEDECINS DE GENEVE (07H-23H) 022 322-20-20 PATIENT CAN BE MOVED: • HOPITAL CANTONAL 24 Micheli du Crest 022 372-33-11 / 022 382-33-11 URGENCES PEDIATRIQUES 30 Bd de la Cluse 022 382-45-55 MATERNITY 24 Micheli du Crest 022 382-68-16 / 022 382-33-11 CLINIQUE OPHTALMOLOGIQUE 22 Alcide Jentzer 022 382-84-00 • HOPITAL DE LA TOUR Meyrin 022 719-61-11 EMERGENCIES ADULTES Meyrin 022 719-66-80 EMERGENCIES: AMBULANCES (GENEVE AND VAUD) 144 FIRE BRIGADE CERN 022 767-44-44 FIRE BRIGADE 118 POLICE 117 CENTRE ANTI-POISON (24H/24H): 01-251-51-51 EUROPEAN EMERGENCY CALL: 112 FRANCE PATIENT NOT FIT TO BE MOVED: Call your family doctor (or 15) PATIENT CAN BE MOVED: • HOPITAL DE ST. JULIEN rue Amédée VIII de Savoie 04-50-49-65-65 EMERGENCIES rue Amédée VIII de Savoie 04-50-49-65-83 MATERNITY r...

Urgent Need of a Doctor

CERN Multimedia

2004-01-01

GENEVE PATIENT NOT FIT TO BE MOVED: Call your family doctor Or: SOS MEDECINS (24H/24H) 022 748-49-50 Or: ASSOC. MEDECINS DE GENEVE (07H-23H) 022 322-20-20 PATIENT CAN BE MOVED: • HOPITAL CANTONAL 24 Micheli du Crest 022 372-33-11 / 022 382-33-11 PAEDIATRIC EMERGENCIES 30 Bd de la Cluse 022 382-45-55 MATERNITY 24 Micheli du Crest 022 382-68-16 / 022 382-33-11 CLINIQUE OPHTALMOLOGY 22 Alcide Jentzer 022 382-84-00 • HOPITAL DE LA TOUR Meyrin 022 719-61-11 EMERGENCIES ADULTS Meyrin 022 719-66-80 EMERGENCIES: AMBULANCE (GENEVE AND VAUD) 144 FIRE BRIGADE 118 FIRE BRIGADE CERN 022 767-44-44 POLICE 117 ANTI POISON CENTRE (24H/24H) 01-251-51-51 EUROPEAN EMERGENCY CALL  112 FRANCE PATIENT NOT FIT TO BE MOVED: Call your family doctor (or 15) PATIENT CAN BE MOVED: • HOPITAL DE ST. JULIEN Rue Amédée VIII de Savoie 04-50-49-65-65 EMERGENCIES Rue Amédée VIII de Savoie 04.50-49-65-83 MATERNITY Rue Am&...

Urgent Need of a Doctor

CERN Multimedia

2004-01-01

GENEVE PATIENT NOT FIT TO BE MOVED: Call your family doctor Or: SOS MEDECINS (24H/24H) 022 748-49-50 Or: ASSOC. MEDECINS DE GENEVE (07H-23H) 022 322-20-20 PATIENT CAN BE MOVED: • HOPITAL CANTONAL 24 Micheli du Crest 022 372-33-11 / 022 382-33-11 PAEDIATRIC EMERGENCIES 30 Bd de la Cluse 022 382-45-55 MATERNITY 24 Micheli du Crest 022 382-68-16 / 022 382-33-11 CLINIQUE OPHTALMOLOGY 22 Alcide Jentzer 022 382-84-00 • HOPITAL DE LA TOUR Meyrin 022 719-61-11 EMERGENCIES ADULTS Meyrin 022 719-66-80 EMERGENCIES: AMBULANCE (GENEVE AND VAUD) 144 FIRE BRIGADE 118 FIRE BRIGADE CERN 022 767-44-44 POLICE 117 ANTI POISON CENTRE (24H/24H) 01-251-51-51 EUROPEAN EMERGENCY CALL  112 FRANCE PATIENT NOT FIT TO BE MOVED: Call your family doctor (or 15) PATIENT CAN BE MOVED: • HOPITAL DE ST. JULIEN Rue Amédée VIII de Savoie 04-50-49-65-65 EMERGENCIES Rue Amédée VIII de Savoie 04.50-49-65-83 MATERNITY Rue Am...

Urgent need of a doctor

CERN Document Server

2003-01-01

GENEVE PATIENT NOT FIT TO BE MOVED: Call your family doctor Or : SOS MEDECINS (24H/24H) 022 748-49-50 Or : ASSOC. MEDECINS DE GENEVE (07H-23H) 022 322-20-20 PATIENT CAN BE MOVED: HOPITAL CANTONAL 24 Micheli du Crest 022 372-33-11 / 022 382-33-11 EMERGENCIES PEDIATRIQUES 30 Bd de la Cluse 022 382-45-55 MATERNITY 24 Micheli du Crest 022 382-68-16 / 022 382-33-11 CLINIQUE OPHTALMOLOGIQUE 22 Alcide Jentzer 022 382-84-00 HOPITAL DE LA TOUR Meyrin 022 719-61-11 EMERGENCIES ADULTS Meyrin 022 719-66-80 EMERGENCIES: AMBULANCES (GENEVE ET VAUD) 144 FIRE BRIGADE CERN 022 767-44-44 FIRE BRIGADE 118 POLICE 117 CENTRE ANTI-POISON 24H/24H: 01-251-51-51 EUROPEAN EMERGENCY CALL : 112 FRANCE PATIENT NOT FIT TO BE MOVED: Call your family doctor (or 15) PATIENT CAN BE MOVED: HOPITAL DE ST. JULIEN rue Amédée VIII de Savoie 04-50-49-65-65 EMERGENCIES rue Amédée VIII de Savoie 04-50-49-65-83 MATERNITY rue Amédée VIII de Savoie 04-50-49-66-07 HOPITAL D'ANNEMASSE 1...

URGENT NEED OF A DOCTOR

CERN Multimedia

2003-01-01

GENEVE PATIENT NOT FIT TO BE MOVED: Call your family doctor Or: SOS MEDECINS (24H/24H) 022 748-49-50 Or: ASSOC. MEDECINS DE GENEVE (07H-23H) 022 322-20-20 PATIENT CAN BE MOVED: HOPITAL CANTONAL 24 Micheli du Crest 022 372-33-11 / 022 382-33-11 EMERGENCIES PEDIATRIQUES 30 Bd de la Cluse 022 382-45-55 MATERNITY 24 Micheli du Crest 022 382-68-16 / 022 382-33-11 CLINIQUE OPHTALMOLOGIQUE 22 Alcide Jentzer 022 382-84-00 HOPITAL DE LA TOUR Meyrin 022 719-61-11 EMERGENCIES ADULTES Meyrin 022 719-66-80 EMERGENCIES: AMBULANCES (GENEVE ET VAUD) 144 FIRE BRIGADE CERN 022 767-44-44 FIRE BRIGADE 118 POLICE 117 CENTRE ANTI-POISON: 24H/24H 01-251-51-51 EUROPEAN EMERGENCY CALL: 112 FRANCE PATIENT NOT FIT TO BE MOVED: Call your family doctor (or 15) PATIENT CAN BE MOVED: HOPITAL DE ST. JULIEN rue Amédée VIII de Savoie 04-50-49-65-65 EMERGENCIES rue Amédée VIII de Savoie 04-50-49-65-83 MATERNITY rue Amédée VIII de Savoie 04-50-49-66-07 HOPITAL D'ANNEMASSE 17 r...

URGENT NEED OF A DOCTOR

CERN Document Server

2003-01-01

GENEVE PATIENT NOT FIT TO BE MOVED: Call your family doctor Or : SOS MEDECINS (24H/24H) 022 748-49-50 Or : ASSOC. MEDECINS DE GENEVE (07H-23H) 022 322-20-20 PATIENT CAN BE MOVED: HOPITAL CANTONAL 24 Micheli du Crest 022 372-33-11 / 022 382-33-11 EMERGENCIES PEDIATRIQUES 30 Bd de la Cluse 022 382-45-55 MATERNITY 24 Micheli du Crest 022 382-68-16 / 022 382-33-11 CLINIQUE OPHTALMOLOGIQUE 22 Alcide Jentzer 022 382-84-00 HOPITAL DE LA TOUR Meyrin 022 719-61-11 EMERGENCIES ADULTES Meyrin 022 719-66-80 EMERGENCIES: AMBULANCES (GENEVE ET VAUD) 144 FIRE BRIGADE CERN 022 767-44-44 FIRE BRIGADE 118 POLICE 117 CENTRE ANTI-POISON: 24H/24H 01-251-51-51 EUROPEAN EMERGENCY CALL: 112 FRANCE PATIENT NOT FIT TO BE MOVED: Call your family doctor (or 15) PATIENT CAN BE MOVED: HOPITAL DE ST. JULIEN rue Amédée VIII de Savoie 04-50-49-65-65 EMERGENCIES rue Amédée VIII de Savoie 04-50-49-65-83 MATERNITY rue Amédée VIII de Savoie 04-50-49-66-07 HOPITAL D'ANNEMASSE 17 rue du Jura, Ambilly 04-50-87-47-47 EMERGENCIES 17 rue...

URGENT NEED OF A DOCTOR

CERN Multimedia

2002-01-01

GENEVA PATIENT NOT FIT TO BE MOVED: Call your family doctor  Or SOS MEDECINS (24H/24H) Or ASSOC. MEDECINS DE GENEVE (7H-23H) 022 748-49-50 022 322-20-20 PATIENT CAN BE MOVED: HOPITAL CANTONAL 24 Micheli du Crest  022 372-33-11 / 022 382-33-11 URGENCES PEDIATRIQUES  30 Bd de la Cluse  022 382-45-55  MATERNITY 24 Micheli du Crest  022 382-68-16 / 022 382-33-11 CLINIQUE OPHTALMOLOGIQUE 22 Alcide Jentzer  022 382-84-00 HOPITAL DE LA TOUR  Meyrin  022 719-61-11 URGENCES ADULTES  Meyrin  022 719-66-80  URGENCES : AMBULANCE (GENEVE ET VAUD) : 144 FIRE BRIGADE CERN 767-44-44  FIRE BRIGADE 118 POLICE 117 CENTRE ANTI-POISON 24H/24H  01-251-51-510 APPEL D'URGENCE EUROPEEN 112 FRANCE PATIENT NOT FIT TO BE MOVED: Call your family doctor (ou­or 15) PATIENT CAN BE MOVED: HOPITAL DE ST. JULIEN  Rue Amédée VIII de Savoie&a...

Urgent problems at small x

International Nuclear Information System (INIS)

Landshoff, P. V.

1999-01-01

Regge theory provides an excellent fit to small-x structure-function data from Q 2 = 0 right up to the highest available values, but it also teaches us that conventional approaches to perturbative evolution are incorrect

Urgent request on avian influenza

DEFF Research Database (Denmark)

More, Simon J.; Bicout, Dominique; Bøtner, Anette

2016-01-01

HPAI H5N8 is currently causing an epizootic in Europe, infecting many poultry holdings as well as captive and wild bird species in more than ten countries. Given the clear clinical manifestation, passive surveillance is considered the most effective means of detecting infected wild and domestic b...

Between Urgent and Lifelong Matters

DEFF Research Database (Denmark)

From, Ditte-Marie

2017-01-01

This article addresses the learner perspective on doing overweight by listening to 39 Danish overweight children aged 8 to 13 years old. In accordance with the existing critique of the ‘obesity epidemic’ and medico-scientific discourses around food and exercise, this article explores how new heal...

Evaluation of hexachlorocyclohexane contamination from the last lindane production plant operating in India.

Science.gov (United States)

Jit, Simran; Dadhwal, Mandeep; Kumari, Hansi; Jindal, Swati; Kaur, Jasvinder; Lata, Pushp; Niharika, Neha; Lal, Devi; Garg, Nidhi; Gupta, Sanjay Kumar; Sharma, Pooja; Bala, Kiran; Singh, Ajaib; Vijgen, John; Weber, Roland; Lal, Rup

2011-05-01

α-Hexachlorocyclohexane (HCH), β-HCH, and lindane (γ-HCH) were listed as persistent organic pollutants by the Stockholm Convention in 2009 and hence must be phased out and their wastes/stockpiles eliminated. At the last operating lindane manufacturing unit, we conducted a preliminary evaluation of HCH contamination levels in soil and water samples collected around the production area and the vicinity of a major dumpsite to inform the design of processes for an appropriate implementation of the Convention. Soil and water samples on and around the production site and a major waste dumpsite were measured for HCH levels. All soil samples taken at the lindane production facility and dumpsite and in their vicinity were contaminated with an isomer pattern characteristic of HCH production waste. At the dumpsite surface samples contained up to 450 g kg(-1) Σ HCH suggesting that the waste HCH isomers were simply dumped at this location. Ground water in the vicinity and river water was found to be contaminated with 0.2 to 0.4 mg l(-1) of HCH waste isomers. The total quantity of deposited HCH wastes from the lindane production unit was estimated at between 36,000 and 54,000 t. The contamination levels in ground and river water suggest significant run-off from the dumped HCH wastes and contamination of drinking water resources. The extent of dumping urgently needs to be assessed regarding the risks to human and ecosystem health. A plan for securing the waste isomers needs to be developed and implemented together with a plan for their final elimination. As part of the assessment, any polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/PCDF) generated during HCH recycling operations need to be monitored.

Synergy, a co-operative innovation for joint operations

International Nuclear Information System (INIS)

Todd, C.; Feuchtwanger, T.; Moberg, R.; Lesser, L.

1993-01-01

Industry cooperation in the operation of the large Swan Hills oil field in western Alberta is described. Declining production and increasing costs required innovative approaches to field operation. Traditional operation involved one operator making the majority of decisions with funding controlled by numerous non-operating joint owners, and can suffer from interaction problems due to the inherenty competitive nature of the petroleum industry. The new mode of operation stresses trust, cooperation, teamwork, resource sharing, and continuous improvement. The synergy involves sharing best practices, information, knowledge and expertise, combining resources, and standardizing procedures and specifications. The new mode of operation has resulted in an improved performance of up to 15%. The cooperation lessons learnt at Swan Hills may have broad application across the petroleum industry. 6 refs., 6 figs

Dual-Electrical-Port Control of Cascaded Doubly-Fed Induction Machine for EV/HEV Applications

DEFF Research Database (Denmark)

Han, Peng; Cheng, Ming; Chen, Zhe

2017-01-01

that of the power machine in singly-fed operation mode, and only a half of that of the power machine in doubly-fed operation mode, which shows the urgent need for torque density enhancement of brushless doubly-fed machines for electric vehicle/hybrid electric vehicle applications. Computer simulations...

Does Operational Risk Disclosure Quality Increase Operating Cash Flows?

Directory of Open Access Journals (Sweden)

Haitham Nobanee

2017-12-01

Full Text Available This study aims to measure the degree of operational risk disclosure and examine its impact on operating cash flow of banks listed on the UAE Abu Dhabi Stock Exchange (ADX and Dubai Financial Market (DFM during the period 2003-2016. The authors conducted content analysis of the annual reports to measure the degree of operational risk disclosure. In addition, they used dynamic panel data regressions to analyze the impact of operational risk disclosure on the operating cash flow generated by the banks. The results show a low degree of operational risk disclosure for all UAE banks, both Islamic and conventional. In addition, the results show no association between the levels of disclosure of operational risk and cash flow for all banks, conventional and Islamic. Operational risk disclosure of Islamic banks has not been examined by any prior researchers. In addition, this paper examines the potential impact of operational risk disclosure on the operating cash flow generated by the banks.

Manejo anestésico para la cirugía urgente traumatológica en miembro superior en una gestante de 23 semanas: rol del bloqueo ecoguiado del plexo braquial mediante abordaje infraclavicular. Reporte de caso

OpenAIRE

Guerrero-Domínguez, Rosana; López-Herrera-Rodríguez, Daniel; Fernández-López, Jesús; Luengo, Ángeles; Jiménez, Ignacio

2014-01-01

Describimos el tratamiento anestésico de una mujer de 34 años en su 23 semana de gestación con una lesión vascular y tendinosa de antebrazo que requirió una reparación quirúrgica urgente. El bloqueo nervioso del plexo braquial evita el riesgo potencial de intubación fallida y de broncoaspiración, además de reducir la exposición fetal a fármacos potencialmente teratógenos. Mientras sea posible una técnica anestésica regional, debería ser usada. Si es inevitable una anestesia general, se requie...

Operator programs and operator processes

NARCIS (Netherlands)

Bergstra, J.A.; Walters, P.

2003-01-01

We define a notion of program which is not a computer program but an operator program: a detailed description of actions performed and decisions taken by a human operator (computer user) performing a task to achieve a goal in a simple setting consisting of that user, one or more computers and a

Pediatric Bulbar and Posterior Urethral Injuries: Operative Outcomes and Long-Term Follow-Up.

Science.gov (United States)

Trachta, Jan; Moravek, Jiri; Kriz, Jan; Padr, Radek; Skaba, Richard

2016-02-01

The aim of this study was to analyze complications and outcomes of end-to-end urethral anastomosis performed for posttraumatic bulbar strictures or posterior urethral injuries in pediatric patients. The records of 15 boys, age 18 years and below, admitted to our tertiary trauma center with urethral injuries from 1989 to 2014 were reviewed retrospectively. Out of these 15 boys, 7 were excluded (2 for iatrogenic trauma, 2 for minor straddle injuries who were not operated on, 2 for incomplete records, and 1 lost to follow-up) and 8 analyzed patients were operated for bulbar or posterior urethral injury. The mean follow-up after the operation was 4.5 years (range 0.5-10). To obtain up-to-date follow-up information, all the analyzed patients were contacted by a letter and telephone in January 2015 and asked about lower urinary tract or erectile dysfunction (ED) using the International Index of Erectile Function-5 questionnaire. Mean age at the time of injury was 12.3 years (range 5-17). Four patients with pelvic fracture had complete posterior urethra disruption, three patients after straddle injury developed obliterating stricture of the bulbar urethra and one patient had torn his bulbar urethra apart by a sharp hook. Except for the immediate exploration of the open perineal wound, all patients were operated via perineal approach 1 to 6 months after initial suprapubic catheter insertion. Five patients needed a cystotomy to identify the proximal urethral stump by a probe, and two patients had partial pubectomy to gain urethral length. Postoperative complications included stricture in anastomosis in six patients (all reoperated, four more than once including attempts of endoscopic internal urethrotomy). Six days after surgery, one patient developed massive external bleeding around a permanent urinary catheter due to a posttraumatic ruptured arterial aneurysm that was later stopped by urgent angiography and coil insertion. After discharge, three patients had transient

From EGEE Operations Portal towards EGI Operations Portal

Science.gov (United States)

Cordier, Hélène; L'Orphelin, Cyril; Reynaud, Sylvain; Lequeux, Olivier; Loikkanen, Sinikka; Veyre, Pierre

Grid operators in EGEE have been using a dedicated dashboard as their central operational tool, stable and scalable for the last 5 years despite continuous upgrade from specifications by users, monitoring tools or data providers. In EGEE-III, recent regionalisation of operations led the Operations Portal developers to conceive a standalone instance of this tool. We will see how the dashboard reorganization paved the way for the re-engineering of the portal itself. The outcome is an easily deployable package customized with relevant information sources and specific decentralized operational requirements. This package is composed of a generic and scalable data access mechanism, Lavoisier; a renowned php framework for configuration flexibility, Symfony and a MySQL database. VO life cycle and operational information, EGEE broadcast and Downtime notifications are next for the major reorganization until all other key features of the Operations Portal are migrated to the framework. Features specifications will be sketched at the same time to adapt to EGI requirements and to upgrade. Future work on feature regionalisation, on new advanced features or strategy planning will be tracked in EGI- Inspire through the Operations Tools Advisory Group, OTAG, where all users, customers and third parties of the Operations Portal are represented from January 2010.

Transforming Junior Leader Development: Developing the Next Generation of Pentathletes

National Research Council Canada - National Science Library

Haynes, Kenneth G

2007-01-01

.... The convergence of Full Spectrum Operations, Network Centric Warfare, and Krulak's "Three Block War" have facilitated an urgent need for junior leaders that are more capable, adaptive, and mature...

Role of communication systems in coordinating supervising anesthesiologists' activities outside of operating rooms.

Science.gov (United States)

Smallman, Bettina; Dexter, Franklin; Masursky, Danielle; Li, Fenghua; Gorji, Reza; George, Dave; Epstein, Richard H

2013-04-01

Theoretically, communication systems have the potential to increase the productivity of anesthesiologists supervising anesthesia providers. We evaluated the maximal potential of communication systems to increase the productivity of anesthesia care by enhancing anesthesiologists' coordination of care (activities) among operating rooms (ORs). At hospital A, data for 13,368 pages were obtained from files recorded in the internal alphanumeric text paging system. Pages from the postanesthesia care unit were processed through a numeric paging system and thus not included. At hospital B, in a different US state, 3 of the authors categorized each of 898 calls received using the internal wireless audio system (Vocera(®)). Lower and upper 95% confidence limits for percentages are the values reported. At least 45% of pages originated from outside the ORs (e.g., 20% from holding area) at hospital A and at least 56% of calls (e.g., 30% administrative) at hospital B. In contrast, requests from ORs for urgent presence of the anesthesiologist were at most 0.2% of pages at hospital A and 1.8% of calls at hospital B. Approximately half of messages to supervising anesthesiologists are for activity originating outside the ORs being supervised. To use communication tools to increase anesthesia productivity on the day of surgery, their use should include a focus on care coordination outside ORs (e.g., holding area) and among ORs (e.g., at the control desk).

Prospective evaluation of stress myocardial perfusion imaging for pre-operative cardiac risk assessment

International Nuclear Information System (INIS)

Byrne, A.J.; Rowe, C.C.; Flannery, G.

2002-01-01

Full text: A prospective evaluation of patients who underwent stress myocardial perfusion imaging (MPI) to assess preoperative cardiac risk was undertaken. At the time of the scan patients were classified into 4 Clinical Risk groups (CR) based on known clinical data. On completion of the scan, the patient was then categorised into 4 Scan based Risk groups (SR), incorporating size of perfusion deficit, single versus multi-vessel disease and ejection fraction. Surgery at Austin and Repatriation Medical Centre within 6 months of scan and complications were identified using the hospital medical database. Major early cardiac events coded were death (cardiac related), myocardial infarction, unstable angina, acute pulmonary oedema, cardiac arrest, and urgent revascularisation. 208 patients have reached 6 months post-MPI scan. Of these 119 (57%) were identified as having surgery. Of the Scan Risk groups, 63% of normal, 57% of increased, and 47% of high and very high groups have had surgery. An abnormal scan is associated with a three-fold risk of cardiac complication (3.5% vs 11.3%). This is lower than most previous reports and may be due to higher representation of low risk surgical procedures (14% in this series), improved peri-operative care and/or the test result influence on management (suggested by decreasing surgical rate as SR estimate rose). Copyright (2002) The Australian and New Zealand Society of Nuclear Medicine Inc

Your Lung Operation: After Your Operation

Medline Plus

Full Text Available ... Careers at ACS Careers at ACS About ACS Career Types Working at ACS ... ( 0 ) Cart Donate American College of Surgeons Education Patients and Family Skills Programs Your Lung Operation Your Lung Operation DVD ...

Your Lung Operation: After Your Operation

Medline Plus

Full Text Available ... to Participate Resources Webinars for Young Surgeons YFA E-News YFA Advocacy Essay Contest Resident and Associate ... ACS Leader International Exchange Scholar Program Resources RAS E-News Medical Students Operation Giving Back Operation Giving ...

Elementary operators on self-adjoint operators

Science.gov (United States)

Molnar, Lajos; Semrl, Peter

2007-03-01

Let H be a Hilbert space and let and be standard *-operator algebras on H. Denote by and the set of all self-adjoint operators in and , respectively. Assume that and are surjective maps such that M(AM*(B)A)=M(A)BM(A) and M*(BM(A)B)=M*(B)AM*(B) for every pair , . Then there exist an invertible bounded linear or conjugate-linear operator and a constant c[set membership, variant]{-1,1} such that M(A)=cTAT*, , and M*(B)=cT*BT, .

Operator bosonization on Riemann surfaces: new vertex operators

International Nuclear Information System (INIS)

Semikhatov, A.M.

1989-01-01

A new formalism is proposed for the construction of an operator theory of generalized ghost systems (bc theories of spin J) on Riemann surfaces (loop diagrams of the theory of closed strings). The operators of the bc system are expressed in terms of operators of the bosonic conformal theory on a Riemann surface. In contrast to the standard bosonization formulas, which have meaning only locally, operator Baker-Akhiezer functions, which are well defined globally on a Riemann surface of arbitrary genus, are introduced. The operator algebra of the Baker-Akhiezer functions generates explicitly the algebraic-geometric τ function and correlation functions of bc systems on Riemann surfaces

Operating systems

CERN Document Server

Tsichritzis, Dionysios C; Rheinboldt, Werner

1974-01-01

Operating Systems deals with the fundamental concepts and principles that govern the behavior of operating systems. Many issues regarding the structure of operating systems, including the problems of managing processes, processors, and memory, are examined. Various aspects of operating systems are also discussed, from input-output and files to security, protection, reliability, design methods, performance evaluation, and implementation methods.Comprised of 10 chapters, this volume begins with an overview of what constitutes an operating system, followed by a discussion on the definition and pr

Operational calculus

CERN Document Server

Boehme, Thomas K

1987-01-01

Operational Calculus, Volume II is a methodical presentation of operational calculus. An outline of the general theory of linear differential equations with constant coefficients is presented. Integral operational calculus and advanced topics in operational calculus, including locally integrable functions and convergence in the space of operators, are also discussed. Formulas and tables are included.Comprised of four sections, this volume begins with a discussion on the general theory of linear differential equations with constant coefficients, focusing on such topics as homogeneous and non-ho

[Bentall operation combined with total arch replacement and stented elephant trunk implantation for serious Debakey I aortic dissecting aneurysm].

Science.gov (United States)

Gu, Tian-Xiang; Wang, Chun; Zhang, Yu-Hai

2008-12-01

To summarize the clinical experience of Bentall operation combined with total arch replacement and stented elephant trunk implantation for serious Debakey I aortic dissecting aneurysm. Twelve patients with serious Debakey I aortic dissecting aneurysm underwent surgical treatment from January 2005 to December 2007. There were 10 male and 2 female with the mean age of (40.1 +/- 9.5) years old. There were acute aortic dissection in 9 cases, chronic aortic dissection in 3 cases. The inner diameter of aorta was (5.3 +/- 1.8) cm. There were Marfan syndrome in 4 cases, aortic regurgitation in all cases, severely persistent chest pain in 9 cases, acute left heart failure in 8 cases, and cardiac tamponade in 4 cases. Bentall operations combined with total arch replacement and stented elephant trunk implantation were performed by using deep hypothermic circulatory arrest and antegrade selective cerebral perfusion in all cases. Urgent surgery underwent in 9 cases. The mean interval between the onset of aortic dissection and the accomplishment of surgery was (41.0 +/- 15.9) hours. Cardiopulmonary bypass time was (191 +/- 26) min, average cross clamp time was (134 +/- 31) min, and average deep hypothermic circulatory arrest time was (50.0 +/- 14.5) min. One patient died in hospital. The time stayed in ICU was 3 to 27 d. Mental disorder in 6 cases, hemi-paralysis in 1 case, amputation in 1 case, hemorrhage of anastomosis in 1 case, hemorrhage of alimentary tract in 1 case, and pleural effusion in 4 cases were recorded. Eleven cases were followed-up for 8 weeks to 36 months. There were no bending of the stents and no obstruction in the vascular prosthesis.No re-operation was needed. One case died 6 months postoperatively. Bentall operation combined with total arch replacement and stented elephant trunk implantation is safe and effective for serious Debakey I aortic dissecting aneurysm, while good organs protection and consummate cardiopulmonary bypass were taken.

Spatial Operations

Directory of Open Access Journals (Sweden)

Anda VELICANU

2010-09-01

Full Text Available This paper contains a brief description of the most important operations that can be performed on spatial data such as spatial queries, create, update, insert, delete operations, conversions, operations on the map or analysis on grid cells. Each operation has a graphical example and some of them have code examples in Oracle and PostgreSQL.

Operation planning device

International Nuclear Information System (INIS)

Watanabe, Takashi; Odakawa, Naoto; Erikuchi, Makoto; Okada, Masayuki; Koizumi, Atsuhiko.

1996-01-01

The device of the present invention provides a device suitable for monitoring a reactor core state and operation replanning in terms of reactor operation. Namely, (1) an operation result difference judging means judges that replanning is necessary when the operation results deviates from the operation planning, (2) an operation replanning rule data base storing means stores a deviation key which shows various kinds of states where the results deviate from the planning and a rule for replanning for returning to the operation planning on every deviating key, (3) an operation replanning means forms a new operation planning in accordance with the rule which is retrieved based on the deviation key, (4) an operation planning optimizing rule data base storing means evaluates the reformed planning and stores it on every evaluation item, (5) an operation planning optimization means correct the operation planning data so as to be optimized when the evaluation of the means (4) is less than a reference value, and (6) an operation planning display means edits adaptable operation planning data and the result of the evaluation and displays them. (I.S.)

Operational amplifiers

CERN Document Server

Dostal, Jiri

1993-01-01

This book provides the reader with the practical knowledge necessary to select and use operational amplifier devices. It presents an extensive treatment of applications and a practically oriented, unified theory of operational circuits.Provides the reader with practical knowledge necessary to select and use operational amplifier devices. Presents an extensive treatment of applications and a practically oriented, unified theory of operational circuits

Operational circular No. 1 (Rev. 1) – Operational circulars

CERN Multimedia

HR Department

2011-01-01

Operational Circular No. 1 (Rev. 1) is applicable to members of the personnel and other persons concerned. Operational Circular No. 1 (Rev. 1) entitled "Operational circulars", approved following discussion at the Standing Concertation Committee meeting on 4 May 2011, is available on the intranet site of the Human Resources Department: https://hr-docs.web.cern.ch/hr-docs/opcirc/opcirc.asp It cancels and replaces Operational Circular No. 1 entitled "Operational Circulars” of December 1996. This new version clarifies, in particular, that operational circulars do not necessarily arise from the Staff Rules and Regulations, and the functional titles have been updated to bring them into line with the current CERN organigram. Department Head Office  

Systemic Operational Design: Enhancing the Joint Operation Planning Process

National Research Council Canada - National Science Library

Delacruz, Victor J

2007-01-01

Operational level commanders and their staffs require relevant and current joint doctrine that articulates the critical function of operational design and its role in the Joint Operation Planning Process (JOPP...

Cumulative incidence for wait-list death in relation to length of queue for coronary-artery bypass grafting: a cohort study

Directory of Open Access Journals (Sweden)

Levy Adrian R

2006-08-01

Full Text Available Abstract Background In deciding where to undergo coronary-artery bypass grafting, the length of surgical wait lists is often the only information available to cardiologists and their patients. Our objective was to compare the cumulative incidence for death on the wait list according to the length of wait lists at the time of registration for the operation. Methods The study cohort included 8966 patients who registered to undergo isolated coronary-artery bypass grafting (82.4% men; 71.9% semi-urgent; 22.4% non-urgent. The patients were categorized according to wait-list clearance time at registration: either "1 month or less" or "more than 1 month". Cumulative incidence for wait-list death was compared between the groups, and the significance of difference was tested by means of regression models. Results Urgent patients never registered on a wait list with a clearance time of more than 1 month. Semi-urgent patients registered on shorter wait lists more often than non-urgent patients (79.1% vs. 44.7%. In semi-urgent and non-urgent patients, the observed proportion of wait-list deaths by 52 weeks was lower in category "1 month or less" than in category "more than 1 month" (0.8% [49 deaths] vs. 1.6% [39 deaths], P P Conclusion Long wait lists for coronary-artery bypass grafting are associated with increased probability that a patient dies before surgery. Physicians who advise patients where to undergo cardiac revascularization should consider the risk of pre-surgical death that is associated with the length of a surgical wait list.

1H NMR study of fermented cocoa (Theobroma cacao L.) beans.

Science.gov (United States)

Caligiani, Augusta; Acquotti, Domenico; Cirlini, Martina; Palla, Gerardo

2010-12-08

This study reports for the first time the metabolic profile of cocoa (Theobroma cacao L.) beans using the (1)H NMR technique applied to polar extracts of fermented cocoa beans. The simultaneous detection and quantification of amino acids, polyalcohols, organic acids, sugars, methylxanthines, catechins, and phenols were obtained by assigning the major signals of the spectra for different varieties of cocoa beans (Forastero, Criollo, and Trinitario) from different countries (Ecuador, Ghana, Grenada, and Trinidad). The data set obtained, representative of all classes of soluble compounds of cocoa, was useful to characterize the fermented cocoa beans as a function of the variety and geographic origin.

3D GIS spatial operation based on extended Euler operators

Science.gov (United States)

Xu, Hongbo; Lu, Guonian; Sheng, Yehua; Zhou, Liangchen; Guo, Fei; Shang, Zuoyan; Wang, Jing

2008-10-01

The implementation of 3 dimensions spatial operations, based on certain data structure, has a lack of universality and is not able to treat with non-manifold cases, at present. ISO/DIS 19107 standard just presents the definition of Boolean operators and set operators for topological relationship query, and OGC GeoXACML gives formal definitions for several set functions without implementation detail. Aiming at these problems, based mathematical foundation on cell complex theory, supported by non-manifold data structure and using relevant research in the field of non-manifold geometry modeling for reference, firstly, this paper according to non-manifold Euler-Poincaré formula constructs 6 extended Euler operators and inverse operators to carry out creating, updating and deleting 3D spatial elements, as well as several pairs of supplementary Euler operators to convenient for implementing advanced functions. Secondly, we change topological element operation sequence of Boolean operation and set operation as well as set functions defined in GeoXACML into combination of extended Euler operators, which separates the upper functions and lower data structure. Lastly, we develop underground 3D GIS prototype system, in which practicability and credibility of extended Euler operators faced to 3D GIS presented by this paper are validated.

Enfermedad ectasiante de la aorta abdominal: Morbilidad y mortalidad

Directory of Open Access Journals (Sweden)

Lilia E Chércoles Cazate

1996-06-01

Full Text Available Se presentó la experiencia de 10 años de trabajo (1983 a 1992, durante los cuales se atendieron 388 pacientes en el Hospital Provincial Docente "Saturnino Lora" de Santiago de Cuba, con el diagnóstico principal o asociado de aneurisma de la aorta abdominal. En el período analizado ingresaron en angiología y cirugía vascular 98 pacientes, 176 en medicina y 8 en otros servicios. Fallecieron a su llegada al cuerpo de guardia 106 por rotura del aneurisma o disección aórtica. Predominó el sexo masculino y la procedencia urbana. La hipertensión arterial fue la afección asociada más frecuente en los operados y la cardiopatía isquémica en los no operados. En los operados electivos, la complicación inmediata que más ocurrencia tuvo fue la trombosis de una rama de la prótesis y en los urgentes el sangramiento; mientras que en las mediatas, los operados electivos presentaron bronconeumonía y en los urgentes, anemia e íleo paralíticoThe experience of ten years of work (1983-1992 was presented. During that period, 388 patients with the main of associated diagnosis of abdominal aortic aneurysm were managed at the "Saturnino Lora" Provincial Educational Hospital, at Santiago de Cuba. In the decade analyzed, 98 patients entered in angiology and vascular surgery, 176 patients entered in medicine, and 8 in other services. In arriving to the emergency room, 106 subjects deceased due to aneurystic rupture or aortic dissection. Masculine sex and urban origin were prevailing. Arterial hypertension was the disease most frequently associated in the operated patients, and ischemic cardiac disease, among the non operated. In the elective operated patients, the immediate complication with the highest occurrence was the thrombosis of a branch of the prosthesis, and bleeding in the urgent cases, while in the mediate complications, the elective operated patients presented bronchopneumonia, and the urgent cases had anemia and paralytic ileus

On the operational mechanism of industrial technology innovation strategic alliance in Ningbo%宁波市产业技术创新联盟运行机制选择策略

Institute of Scientific and Technical Information of China (English)

李建花

2012-01-01

Industrial technology innovation alliance is an innovative combination mechanism.The building of industrial technology innovation alliance in Ningbo has been more than three years,but the effectiveness of operation and innovation is not obvious.It is an urgent need to strengthen the building of institutional mechanisms become.The paper analyzes the development and problems in industrial technology innovation strategic alliance in Ningbo,and puts forwards some strategic operation mechanism in Ningbo.%产业技术创新联盟是一种创新的产学研结合机制,宁波市产业技术创新联盟建设已经过3年多的时间,但运行与创新成效并不明显,亟需加强体制机制建设。通过对宁波市产业技术创新战略联盟发展现状和运行中存在的问题分析,提出宁波市产业技术创新战略联盟运行机制的构建策略。

Examination of Operation Quality for High-frequent Railway Operation

DEFF Research Database (Denmark)

Landex, Alex; Kaas, Anders H.

2009-01-01

take the first train in their direction. The article examines four different approaches to examine operation quality for high-frequent operation that are based on the experiences of the passengers. These approaches are the service frequency of the operation, travel time extension, a combination......The examination of operation quality for high-frequent operation requires other approaches than the typical evaluation of punctuality (trains on time) and reliability (operated trains). This is because passengers in high-frequent railway systems do not necessarily notice train delays as they just...... of the service frequency and travel time approaches, and passenger delays. The service frequency and travel time approaches are simple measurements with low complexity and complement each other. Therefore, the article recommends combining the service frequency and travel time approaches to get a more accurate...

Headache-attributed burden and its impact on productivity and quality of life in Russia: structured healthcare for headache is urgently needed.

Science.gov (United States)

Ayzenberg, I; Katsarava, Z; Sborowski, A; Chernysh, M; Osipova, V; Tabeeva, G; Steiner, T J

2014-05-01

The study evaluated headache-attributed burden and its impact on productivity and quality of life (QoL) in Russia. Its purpose was to support recommendations for change. A countrywide population-based random sample of 2725 biologically unrelated adults (aged 18-65 years) in 35 cities and nine rural areas of Russia were interviewed in a door-to-door survey. The structured questionnaire enquired into symptom burden, functional disability, lost productive time and QoL (applying the WHOQoL-8 question set), as well as willingness to pay (WTP) for adequate headache treatment, if it were available. Mean lost paid-work days due to headache in the previous 3 months were 1.9 ± 4.2, and mean lost household work days were 3.4 ± 5.7. The estimated annual indirect cost of primary headache disorders was USD 22.8 billion, accounting for 1.75% of gross domestic product. QoL was reduced by all types of primary headaches. According to WHOQoL-8, it was significantly lower in those with headache on ≥15 days/month than in those with episodic headache (24.7 ± 4.6 vs. 28.1 ± 5.0; P < 0.05) and lower in those with migraine than in those with tension-type headache (TTH) (27.1 ± 4.9 vs. 28.8 ± 5.0; P < 0.05). Average WTP for adequate headache treatment was RUB 455 ± 494 per month (median RUB 300), a sum sufficient in most cases, and correlated with illness severity (higher for headache on ≥15 days/month than for migraine, and for migraine than for TTH). Headache is common, burdensome and costly in Russia and, manifestly, poorly mitigated by existing healthcare. Structured healthcare services for headache need to be urgently put in place. © 2014 The Author(s) European Journal of Neurology © 2014 EFNS.

[Pre-operation evaluation and intra-operation management of cochlear implantation].

Science.gov (United States)

Zhang, Dao-xing; Hu, Bao-hua; Xiao, Yu-li; Shi, Bo-ning

2004-10-01

To summarize pre-operation evaluation experiences in cochlear implantation. Performing auditory evaluation and image analysis seriously in 158 severe hearing loss or total deaf cases before cochlear implantation, comparing their performance with the findings during and post operation. Among the total 158 cases, 116 cases with normal structure, 42 cases with the abnormal findings of the inner or middle ear. Stapedial gusher happened in 6 cases, 1 case was not predicted before operation. Except 1 case with serious malformation, the findings of other 157 cases in operation were consistent with the pre-operation evaluation. We helped all patients reconstruct auditory conduction with cochlear implantation, and the average hearing level up to 37.6 dB SPL. Performing image analysis seriously before operation and planning for operation according to HRCT can do great help to cochlear implantation. The operation under the HRCT instruction has less complications.

Operating experience feedback report - Solenoid-operated valve problems

International Nuclear Information System (INIS)

Ornstein, H.L.

1991-02-01

This report highlights significant operating events involving observed or potential common-mode failures of solenoid-operated valves (SOVs) in US plants. These events resulted in degradation or malfunction of multiple trains of safety systems as well as of multiple safety systems. On the basis of the evaluation of these events, the Office for Analysis and Evaluation of Operational Data (AEOD) of the US Nuclear Regulatory Commission (NRC) concludes that the problems with solenoid-operated valves are an important issue that needs additional NRC and industry attention. This report also provides AEOD's recommendations for actions to reduce the occurrence of SOV common-mode failures. 115 refs., 7 figs., 2 tabs

Year 2000 Computing Challenge: Leadership and Partnerships Results in Limited Rollover Disruptions

National Research Council Canada - National Science Library

2000-01-01

Because of its urgent nature and the potentially devastating impact it could have had on critical government operations, in February 1997 we designated the Year 2000 problem a high-risk area for the federal government...

The impact of surgery and anesthesia on post-operative cognitive decline and Alzheimer's disease development: biomarkers and preventive strategies.

Science.gov (United States)

Kapila, Ayush K; Watts, Helena R; Wang, Tianlong; Ma, Daqing

2014-01-01

Alzheimer's disease (AD) is a major social and clinical burden in the elderly, affecting 5% of people aged over 65 and 20% aged over 80. Despite improved management, a cure has not been found and hence analysis of predisposing factors to identify preventive strategies has become increasingly important. Surgery and anesthesia have been proposed to increase the incidence of post-operative cognitive decline (POCD) and AD. This is hypothesized to be the result of a malignant neuroinflammatory response and subsequent synaptic impairment in the elderly and susceptible individuals. As a result, strategies are being explored to prevent surgery and anesthesia induced cognitive impairment. Whereas previously the diagnosis of AD was primarily dependent on clinical examination, biomarkers such as inflammatory cytokines, amyloid-β, and tau deposition in the cerebrospinal fluid have received increased attention. Nonetheless, AD is currently still treated symptomatically with acetylcholinesterase inhibitors and NMDA antagonists to improve cholinergic transmission and prevent glutamatergic excitotoxicity. Therapeutic success is, however, often not achieved, since these treatment methods do not address the ongoing neuroinflammatory processes and hence novel therapeutic and protective strategies are urgently needed. This review provides an insight into the current understanding of age-related cognitive impairment post-surgery and reflects on novel markers of AD pathogeneses exploring their use as targets for treatment. It gives a summary of recent efforts in preventing and treating POCD or AD with regards to the choice and depth of anesthesia, surgical strategy, and peri-operative medication, and discusses the mechanism of action and therapeutic prospects of novel agents.

Hanaro operation

International Nuclear Information System (INIS)

Lee, Ji Bok; Jeon, Byung Jin; Kwack, Byung Ho

1997-01-01

HANARO was configurated its first operating core in 1995. Long term operation test was conducted up to 3-1 cycle during 1996, in order to investigate the reactor characteristics due to fuel depletion and additional fuel loading. Now HANARO has accumulated 168.4 days of total operation time and 2,687.5 MWD of total thermal output. Reactor analysis, producing operation datum and its validation with test, periodic inspection and maintenance of the facility are continuously conducted for safe operation of the HANARO. Conducted the verification tests for installed utilization facilities, and successfully performed the radiation emergency drill. The shutdown report of TRIGA Mark II and III was submitted to MOST, and decommissioning will be started from 1997. (author). 70 tabs., 50 figs., 27 refs

Survey of Operators Knowledge of Operation and Maintenance of ...

African Journals Online (AJOL)

Result showed that the machine failures encountered during operations were as a result of poor management, inadequate maintenance practices, and lack of spare parts, obsoleteness, overloading, careless operations and poor storage of machine after use. Recommendations were therefore given to improve the operation ...

HFETR operation management

International Nuclear Information System (INIS)

Liu Rong; Yang Shuchun; Peng Jun; Zhou Shoukang

2003-01-01

Experiences and work methods with High Flux Engineering Test Reactor (HFETR) operation are introduced, which have been accumulated in a long period of operation, in the aspects as reactor operation, test, maintenance, operator training and incident management. It's clear that the safety operation of HFETR has been ensured, and the methods are valid. (authors)

Spacecraft operations

CERN Document Server

Sellmaier, Florian; Schmidhuber, Michael

2015-01-01

The book describes the basic concepts of spaceflight operations, for both, human and unmanned missions. The basic subsystems of a space vehicle are explained in dedicated chapters, the relationship of spacecraft design and the very unique space environment are laid out. Flight dynamics are taught as well as ground segment requirements. Mission operations are divided into preparation including management aspects, execution and planning. Deep space missions and space robotic operations are included as special cases. The book is based on a course held at the German Space Operation Center (GSOC).

Advanced operation strategy for feed-and-bleed operation in an OPR1000

International Nuclear Information System (INIS)

Kim, Bo Gyung; Yoon, Ho Joon; Kim, Jaewhan; Kang, Hyun Gook

2016-01-01

Highlights: • Advanced operating strategy covers all necessary conditions for F&B operation. • Advanced operating strategy identifies the urgency of F&B operation. • An advanced operating strategy for F&B operation is developed using a decision tree. • Human error probability is re-estimated based on a thermohydraulic analysis and K-HRA method. • An advanced operation strategy provides indications under various plant situations. - Abstract: When the secondary side is unavailable in a pressurized water reactor (PWR), heat from the core will accumulate in the primary side causing core damage. In this situation a heat removal mechanism called feed-and-bleed operation (F&B operation) must be used, which is a process of directly cooling the primary reactor cooling system (RCS). However, conventional operation strategy in emergency operating procedures (EOPs) does not cover all possible conditions to initiate F&B operation. If the EOP informs on the urgency of F&B operation, operators will be able to more clearly make decisions regarding F&B operation initiation. In order to cover all possible scenarios for F&B operation and systematically inform its urgency, an advanced operating strategy using a decision tree is developed in this study. The plant condition can be classified according to failure of secondary side, RCS pressure condition, injectable inventory to RCS, and remaining core inventory. RCS pressure, core level, and RCS temperature are representative indicators which provide information regarding the initiation of F&B operation. Indicators can be selected based on their detectability and quantification, and a decision tree is developed according to combinations of indicators. To estimate the effects of the advanced operation strategy, human error probability (HEP) of F&B operation is re-estimated based on a thermohydraulic analysis. The available time for operators to initiate F&B operation is also re-estimated to obtain more realistic data. This

Operator-based metric for nuclear operations automation assessment

Energy Technology Data Exchange (ETDEWEB)

Zacharias, G.L.; Miao, A.X.; Kalkan, A. [Charles River Analytics Inc., Cambridge, MA (United States)] [and others

1995-04-01

Continuing advances in real-time computational capabilities will support enhanced levels of smart automation and AI-based decision-aiding systems in the nuclear power plant (NPP) control room of the future. To support development of these aids, we describe in this paper a research tool, and more specifically, a quantitative metric, to assess the impact of proposed automation/aiding concepts in a manner that can account for a number of interlinked factors in the control room environment. In particular, we describe a cognitive operator/plant model that serves as a framework for integrating the operator`s information-processing capabilities with his procedural knowledge, to provide insight as to how situations are assessed by the operator, decisions made, procedures executed, and communications conducted. Our focus is on the situation assessment (SA) behavior of the operator, the development of a quantitative metric reflecting overall operator awareness, and the use of this metric in evaluating automation/aiding options. We describe the results of a model-based simulation of a selected emergency scenario, and metric-based evaluation of a range of contemplated NPP control room automation/aiding options. The results demonstrate the feasibility of model-based analysis of contemplated control room enhancements, and highlight the need for empirical validation.

Operational challenges in diagnosing multi-drug resistant TB and initiating treatment in Andhra Pradesh, India.

Directory of Open Access Journals (Sweden)

Sarabjit S Chadha

Full Text Available BACKGROUND: Revised National TB Control Programme (RNTCP, Andhra Pradesh, India. There is limited information on whether MDR-TB suspects are identified, undergo diagnostic assessment and are initiated on treatment according to the programme guidelines. OBJECTIVES: To assess i using the programme definition, the number and proportion of MDR-TB suspects in a large cohort of TB patients on first-line treatment under RNTCP ii the proportion of these MDR-TB suspects who underwent diagnosis for MDR-TB and iii the number and proportion of those diagnosed as MDR-TB who were successfully initiated on treatment. METHODS: A retrospective cohort analysis, by reviewing RNTCP records and reports, was conducted in four districts of Andhra Pradesh, India, among patients registered for first line treatment during October 2008 to December 2009. RESULTS: Among 23,999 TB patients registered for treatment there were 559 (2% MDR-TB suspects (according to programme definition of which 307 (55% underwent diagnosis and amongst these 169 (55% were found to be MDR-TB. Of the MDR-TB patients, 112 (66% were successfully initiated on treatment. Amongst those eligible for MDR-TB services, significant proportions are lost during the diagnostic and treatment initiation pathway due to a variety of operational challenges. The programme needs to urgently address these challenges for effective delivery and utilisation of the MDR-TB services.

Operative Start Time Does Not Affect Post-Operative Infection Risk.

Science.gov (United States)

Guidry, Christopher A; Davies, Stephen W; Willis, Rhett N; Dietch, Zachary C; Shah, Puja M; Sawyer, Robert G

2016-10-01

Surgical care is delivered 24 h a day at most institutions. Alarmingly, some authors have found that certain operative start times are associated with greater morbidity and mortality rates. This effect has been noted in both the public and private sector. Although some of these differences may be related to process, they may also be caused by the human circadian rhythm and corresponding changes in host defenses. We hypothesized that the time of day of an operation would impact the frequency of certain post-operative outcomes significantly. Cases at a single tertiary-care center reported to the American College of Surgeons National Surgical Quality Improvement Program over a 10-year period were identified. Operative start times were divided into six-hour blocks, with 6 am to noon serving as the reference. Standard univariable techniques were applied. Multivariable logistic regression with mixed effects modeling then was used to determine the relation between operative start times and infectious outcomes, controlling for surgeon clustering. Statistical significance was set at p operative infectious complication. Seventy percent of these infections (n = 1,506) were surgical site infections. On univariable analysis considering all cases, nighttime and evening operations had higher rates of post-operative infections than those in performed during the day (9.1% from 6 am to noon; 9.7% from noon to 6 pm; 14.8% from 6 pm to midnight; and 14.4% from midnight to 6 am; p operative start time was not associated with the risk of post-operative infection, even when emergency cases were considered independently. Our data suggest that operative start times have no correlation with post-operative infectious complications. Further work is required to identify the source of the time-dependent outcome variability observed in previous studies.

Feynman's Operational Calculi: Spectral Theory for Noncommuting Self-adjoint Operators

International Nuclear Information System (INIS)

Jefferies, Brian; Johnson, Gerald W.; Nielsen, Lance

2007-01-01

The spectral theorem for commuting self-adjoint operators along with the associated functional (or operational) calculus is among the most useful and beautiful results of analysis. It is well known that forming a functional calculus for noncommuting self-adjoint operators is far more problematic. The central result of this paper establishes a rich functional calculus for any finite number of noncommuting (i.e. not necessarily commuting) bounded, self-adjoint operators A 1 ,..., A n and associated continuous Borel probability measures μ 1 , ?, μ n on [0,1]. Fix A 1 ,..., A n . Then each choice of an n-tuple (μ 1 ,...,μ n ) of measures determines one of Feynman's operational calculi acting on a certain Banach algebra of analytic functions even when A 1 , ..., A n are just bounded linear operators on a Banach space. The Hilbert space setting along with self-adjointness allows us to extend the operational calculi well beyond the analytic functions. Using results and ideas drawn largely from the proof of our main theorem, we also establish a family of Trotter product type formulas suitable for Feynman's operational calculi

Co-Operative Advances in Behavioral Health and Performance Research and Operations

Science.gov (United States)

VanderArk, Stephen T.; Leveton, Lauren B.

2011-01-01

In organizations that engage in both operations and applied research, with operational needs guiding research questions and research informing improved operations, the ideal goal is a synergy of ideas and information. In reality, this ideal synergy is often lacking. Real-time operational needs driving day-to-day decisions, lack of communication, lag time in getting research advances plugged into operations can cause both areas to suffer from this gap between operations and research. At Johnson Space Center, the Behavior Health and Performance group (BHP) strives to bridge this gap by following a Human Research Program framework: Expectations of future operational needs identify the knowledge gaps; the gaps in turn guide research leading to a product that is transitioned into operations. Thus, the direction those of us in research take is in direct response to current and future needs of operations. Likewise, those of us in operations actively seek knowledge that is supported by evidence-based research. We make an ongoing effort to communicate across the research and operations gap by working closely with each other and making a conscious effort to keep each other informed. The objective of the proposed panel discussion is to demonstrate through the following presentations the results of a successful collaboration between research and operations and to provide ASMA members with more practical knowledge and strategies for building these bridges to serve our field of practice well. The panel will consist of six presenters from BHP operations, internal BHP research, and external research instigated by BHP who together represent the entire BHP Research Transition to Operations Framework

Nuclear units operating improvement by using operating experience

International Nuclear Information System (INIS)

Rotaru, I.; Bilegan, I.C.

1997-01-01

The paper presents how the information experience can be used to improve the operation of nuclear units. This areas include the following items: conservative decision making; supervisory oversight; teamwork; control room distraction; communications; expectations and standards; operator training and fundamental knowledge, procedure quality and adherence; plant status awareness. For each of these topics, the information illustrate which are the principles, the lessons learned from operating experience and the most appropriate exemplifying documents. (authors)

Operating System Security

CERN Document Server

Jaeger, Trent

2008-01-01

Operating systems provide the fundamental mechanisms for securing computer processing. Since the 1960s, operating systems designers have explored how to build "secure" operating systems - operating systems whose mechanisms protect the system against a motivated adversary. Recently, the importance of ensuring such security has become a mainstream issue for all operating systems. In this book, we examine past research that outlines the requirements for a secure operating system and research that implements example systems that aim for such requirements. For system designs that aimed to

Operator entanglement of two-qubit joint unitary operations revisited: Schmidt number approach

Energy Technology Data Exchange (ETDEWEB)

Xia, Hui-Zhi; Li, Chao; Yang, Qing; Yang, Ming, E-mail: mingyang@ahu.edu.cn [Key Laboratory of Opto-electronic Information Acquisition and Manipulation, Ministry of Education, School of Physics and Material Science, Anhui University Hefei (China); Cao, Zhuo-Liang [School of Electronic Information Engineering, Hefei Normal University (China)

2012-08-15

The operator entanglement of two-qubit joint unitary operations is revisited. The Schmidt number, an important attribute of a two-qubit unitary operation, may have connection with the entanglement measure of the unitary operator. We find that the entanglement measure of a two-qubit unitary operators is classified by the Schmidt number of the unitary operators. We also discuss the exact relation between the operator entanglement and the parameters of the unitary operator. (author)

Construction of vertex operators using operator formalism techniques

International Nuclear Information System (INIS)

Gato, B.; Massachusetts Inst. of Tech., Cambridge

1989-01-01

We derive vertex operators in oscillator form as an application of the conserved charges method developed by Vafa for the operator formalism in higher genus Riemann surfaces. This construction proves to be clear, direct and valid for the bosonic and fermionic strings as wells as for twisted strings on orbifolds. We discuss the method and construct vertex operators for the bosonic string moving on Z N orbifolds and for the fermionic string in the NSR formulation. (orig.)

Endoscopic retrograde cholangiopancreatography and endoscopic ...

African Journals Online (AJOL)

1991-01-05

Jan 5, 1991 ... stone pancreatitis was adopted by the Department of Surgery .... severe chronic obstructive airways disease, of which she died 3 years later. Patients ... urgent ERCP and ES versus conventional treatment (i.e. non- operative ...

Seminar 1. Joint Military Operations. Application of the Operational Reserve

National Research Council Canada - National Science Library

Copp, A

1997-01-01

.... As a means of achieving decisive effect at the operational level of war, the operational reserve should be considered an operational function and should be addressed as both a planning element...

Difficult airway management with bonfils fiberscope in case of emergency: acute abdomen with ileus.

Science.gov (United States)

Maldini, Branka; Novotny, Zdenko; Letica-Brnadić, Renata; Brkljacić, Ana; Bartolek, Dubravka

2012-09-01

This clinical report describes an emergency case of a 49-year-old man, ASA E III status, with clinical symptoms of acute abdomen and ileus, who was scheduled for urgent surgery. Predictors of difficult intubation (Mallampati test Class III, short thyro-mental (management decided on one attempt of Bonfils fiberoptic intubation as primary intervention and urgent tracheotomy, if needed, as secondary intervention. Immediately after assuming supine position on the operating table, the patient lost consciousness and cardiac arrest developed. Successful intubation with oxygenation was followed by cardiopulmonary resuscitation. Upon stabilization of the patient's vital functions, urgent surgery was performed. In the emergency case presented, we succeeded quickly to secure the airway with Bonfils fiberoptic intubation, which allowed for appropriate oxygenation and starting resuscitation. The high risk of the possible aspiration was avoided by timely provision of airway in the experienced anesthetist's hands.

A Study on the Operator Decision Support for Feed-and-Bleed Operation

International Nuclear Information System (INIS)

Kim, Bo Gyung; Kim, Sang Ho; Kang, Hyun Gook; Yoon, Ho Joon

2014-01-01

In the case of a combined accident that includes a failure of the secondary cooling system, it is difficult for operators to recognize the necessity of an feed and bleed (F and B) operation because a lot of parameters and alarms should be checked before a decision, and operators may spend a considerable amount of time arriving at the entry for a proper emergency operating procedure that contains the procedure for an F and B operation. Therefore, a clear identification of the success boundary of an F and B operation would help operators in their decision-making when a combined accident that includes a secondary cooling system failure occurs. This study will provide a useful guideline for the initiation of an F and B operation for operators. Cooling the RCS after a scram is one of the most important safety functions for preventing core damage. To support the operator in decision making whether to initiate the F and B operation, plant conditions requiring the initiation of an F and B operation were identified. Plant conditions are affected by the steam generator inventory, RCS inventory, core inventory, and safety injection availability. The combination of accident types, component availabilities, and the initiation time of an F and B operation affect the success of the F and B operation. Operators need clear information about the RCS condition when the steam generators, the RCS's main residual heat removal mechanism, become unavailable. When this happens, the initiation of an F and B operation becomes necessary. As the number of the state increases, the necessity of an F and B operation increases. Especially, the operator should initiate an F and B operation when the RCS condition enters State 3 for Type 1 incidents or State 3-2 for Type 2 incidents. The results of this study may be useful in providing information regarding the necessity and effects of an F and B operation in a quantitative manner. In particular, in the case of a combined accident including a

Tables of Products of Tensor Operators and Stevens Operators

DEFF Research Database (Denmark)

Lindgård, Per-Anker

1975-01-01

Numerical tables of products of tensor (Racah) operators, Rl,m(J), and Stevens operators Olm(J), working within a J-multiplet are given as a function of X=J(J+1). Examples of the use of the tables, such as the calculation of commutation relations and thermal averages are given.......Numerical tables of products of tensor (Racah) operators, Rl,m(J), and Stevens operators Olm(J), working within a J-multiplet are given as a function of X=J(J+1). Examples of the use of the tables, such as the calculation of commutation relations and thermal averages are given....

Operational Design for Peace Enforcement: Lessons for the Operational Staff

National Research Council Canada - National Science Library

Neumann, Michael

2004-01-01

U.S. involvement in Somalia serves as a useful case study of the unique challenges an operational staff may face when applying operational design to the planning and execution of a peace enforcement operation. U.S...

Urgent aspects of radiodiagnosis in traumatology

International Nuclear Information System (INIS)

Novikov, V.P.

1981-01-01

Problems of X-ray examination of osteoarticular system in traumas are considered. An assessment is given of such methods of radiodiagnosis as tomography, microphotometry, angiography, arthrography, electroradiography and etc. The problems of standardization of X-ray examinations in traumatology permits to avoid, unnecessary examinations and errors in diagnosis are discussed [ru

Atomic energy today: An urgent dilemma

International Nuclear Information System (INIS)

Coronado, G.

1997-01-01

This article compiles the trajectory of the nuclear energy, in different countries of the world, since 1939. It also makes reference to the nuclear accidents that have happened in the past. It contains information of other applications of the nuclear energy, such as: the atomic industry of energetic production and alternatives to the nuclear energy [es

IN URGENT NEED OF A DOCTOR

CERN Multimedia

Medical Service

2002-01-01

GENEVA EMERGENCY SERVICES GENEVA AND VAUD 144 FIRE BRIGADE 118 POLICE 117 CERN FIREMEN 767-44-44 ANTI-POISONS CENTRE Open 24h/24h 01-251-51-51 Patient not fit to be moved, call family doctor, or: GP AT HOME, open 24h/24h 748-49-50 Association Of Geneva Doctors Emergency Doctors at home 07h-23h 322 20 20 Patient fit to be moved: HOPITAL CANTONAL CENTRAL 24 Micheli-du-Crest 372-33-11 ou 382-33-11 EMERGENCIES 382-33-11 ou 372-33-11 CHILDREN'S HOSPITAL 6 rue Willy-Donzé 372-33-11 MATERNITY 32 bvd.de la Cluse 382-68-16 ou 382-33-11 OPHTHALMOLOGY 22 Alcide Jentzer 382-33-11 ou 372-33-11 MEDICAL CENTRE CORNAVIN 1-3 rue du Jura 345 45 50 HOPITAL DE LA TOUR Meyrin EMERGENCIES 719-61-11 URGENCES PEDIATRIQUES 719-61-00 LA TOUR MEDICAL CENTRE 719-74-00 European Emergency Call 112 FRANCE EMERGENCY SERVICES 15 FIRE BRIGADE 18 POLICE 17 CERN FIREMEN AT HOME 00-41-22-767-44-44 ANTI-POISONS CENTRE Open 24h/24h 04-72-11-69-11 All doctors will come to your home. Cal...

Urgent advice on lumpy skin disease

DEFF Research Database (Denmark)

Nielsen, Søren Saxmose

2016-01-01

of the entire susceptible population in regions at risk for LSDV introduction or affected by LSDV in order to minimise the number of outbreaks, and high animal- and farm-level vaccination coverage should be achieved. Farmers and veterinarians should be trained in the clinical identification of LSD in order...

Operational symmetries basic operations in physics

CERN Document Server

Saller, Heinrich

2017-01-01

This book describes the endeavour to relate the particle spectrum with representations of operational electroweak spacetime, in analogy to the atomic spectrum as characterizing representations of hyperbolic space. The spectrum of hyperbolic position space explains the properties of the nonrelativistic atoms; the spectrum of electroweak spacetime is hoped to explain those of the basic interactions and elementary particles. In this book, the theory of operational symmetries is developed from the numbers, from Plato’s and Kepler’s symmetries over the simple Lie groups to their applications in nonrelativistic, special relativistic and general relativistic quantum theories with the atomic spectrum for hyperbolic position and, in first attempts, the particle spectrum for electroweak spacetime. The standard model of elementary particles and interactions is characterized by a symmetry group. In general, as initiated by Weyl and stressed by Heisenberg, quantum theory can be built as a theory of operation groups an...

Modeling operators' emergency response time for chemical processing operations.

Science.gov (United States)

Murray, Susan L; Harputlu, Emrah; Mentzer, Ray A; Mannan, M Sam

2014-01-01

Operators have a crucial role during emergencies at a variety of facilities such as chemical processing plants. When an abnormality occurs in the production process, the operator often has limited time to either take corrective actions or evacuate before the situation becomes deadly. It is crucial that system designers and safety professionals can estimate the time required for a response before procedures and facilities are designed and operations are initiated. There are existing industrial engineering techniques to establish time standards for tasks performed at a normal working pace. However, it is reasonable to expect the time required to take action in emergency situations will be different than working at a normal production pace. It is possible that in an emergency, operators will act faster compared to a normal pace. It would be useful for system designers to be able to establish a time range for operators' response times for emergency situations. This article develops a modeling approach to estimate the time standard range for operators taking corrective actions or following evacuation procedures in emergency situations. This will aid engineers and managers in establishing time requirements for operators in emergency situations. The methodology used for this study combines a well-established industrial engineering technique for determining time requirements (predetermined time standard system) and adjustment coefficients for emergency situations developed by the authors. Numerous videos of workers performing well-established tasks at a maximum pace were studied. As an example, one of the tasks analyzed was pit crew workers changing tires as quickly as they could during a race. The operations in these videos were decomposed into basic, fundamental motions (such as walking, reaching for a tool, and bending over) by studying the videos frame by frame. A comparison analysis was then performed between the emergency pace and the normal working pace operations

Operational limits and conditions and operating procedures for research reactors. Safety guide

International Nuclear Information System (INIS)

2008-01-01

This publication provides practical guidance on all important aspects of developing, formulating and presenting the operational limits and conditions as well as the operating procedures for research reactors. It covers the concept of operational limits and conditions, their content, and the responsibilities of the operating organization with respect to their establishment, modification, documentation and compliance. The guidance also covers the training of operating personnel on performing periodic testing, established by the operational limits and conditions, and operating procedures

Operational behaviour of a reactor normal operation and disturbances

International Nuclear Information System (INIS)

Geyer, K.H.

1982-01-01

During normal operation, the following topics are dealt with: primary and secondary coolant circuits - full load operation - start-up and shutdown - steady state part load diagramm. During disturbances and incidents, the following procedures are discussed: identification and detection of the events - automatic actions - manual actions of the operator - provided indications - explanation of actuated systems - basic information of reactor protection system. (RW)

Condition Monitoring Of Operating Pipelines With Operational Modal Analysis Application

Directory of Open Access Journals (Sweden)

Mironov Aleksey

2015-12-01

Full Text Available In the petroleum, natural gas and petrochemical industries, great attention is being paid to safety, reliability and maintainability of equipment. There are a number of technologies to monitor, control, and maintain gas, oil, water, and sewer pipelines. The paper focuses on operational modal analysis (OMA application for condition monitoring of operating pipelines. Special focus is on the topicality of OMA for definition of the dynamic features of the pipeline (frequencies and mode shapes in operation. The research was conducted using two operating laboratory models imitated a part of the operating pipeline. The results of finite-element modeling, identification of pipe natural modes and its modification under the influence of virtual failure are discussed. The work considers the results of experimental research of dynamic behavior of the operating pipe models using one of OMA techniques and comparing dynamic properties with the modeled data. The study results demonstrate sensitivity of modal shape parameters to modification of operating pipeline technical state. Two strategies of pipeline repair – with continuously condition-based monitoring with proposed technology and without such monitoring, was discussed. Markov chain reliability models for each strategy were analyzed and reliability improvement factor for proposed technology of monitoring in compare with traditional one was evaluated. It is resumed about ability of operating pipeline condition monitoring by measuring dynamic deformations of the operating pipe and OMA techniques application for dynamic properties extraction.

Separable quadratic stochastic operators

International Nuclear Information System (INIS)

Rozikov, U.A.; Nazir, S.

2009-04-01

We consider quadratic stochastic operators, which are separable as a product of two linear operators. Depending on properties of these linear operators we classify the set of the separable quadratic stochastic operators: first class of constant operators, second class of linear and third class of nonlinear (separable) quadratic stochastic operators. Since the properties of operators from the first and second classes are well known, we mainly study the properties of the operators of the third class. We describe some Lyapunov functions of the operators and apply them to study ω-limit sets of the trajectories generated by the operators. We also compare our results with known results of the theory of quadratic operators and give some open problems. (author)

A low-cost and reliable technique to monitor the spread of an invasive seagrass in the Caribbean Sea

Science.gov (United States)

Jobsis, D.; Wyllie-Echeverria, S.

2016-02-01

In 2002 the seagrass Halophila stipulacea was observed in Grenada in the Eastern Caribbean Sea. Since then this invasive species has spread northward through the Lesser Antilles and Leeward Islands into the US Virgin Islands. There are native Halophila species as well as other seagrass species in Eastern Caribbean therefore it is essential to accurately identify H. stipulacea before an invasion event is reported. Moreover, because the consequences of H. stipulaceapresence and spread are not known in many locations, after accurate identification is made it is also important to map patch expansion as a first step in process studies designed to determine impact. We now report a low-cost (GoPro video camera placed inside underwater housing, a weighted towfish and a GPS tracking device. The camera, set in the time-lapse mode, is fixed to the towfish; Afterward using a series of straight line transects, our array is towed at low speeds while synched to GPS. The accuracy of an underwater video system is based on knowing the accurate position of seagrass on the seafloor during filming (Norris et al. 1997). After sampling images and their associated GPS coordinates are imported to a spreadsheet and coded such that H. stipulaceais related to a known position on the bottom. With this system we produce accurate maps that specifically identify H. stipulacea patches, regardless of water depth, on the seafloor. During our poster presentation we will show a series of images from 2015 sampling and display mapping results. Since the 2002 sighting in Grenada, H. stipulaceae has spread northward to nineteen Eastern Caribbean Islands (Williette et al 2014). Our technique will allow those charged with protecting natural resources to track the spread of this invasion and potentially provide an early warning system for islands nations not yet invaded.

Operator training

International Nuclear Information System (INIS)

Wirstad, J.

1983-12-01

The traditional operator job is changing, which among other things has generated a need for better job training. Surprisingly increased process automation has lead to increased operator qualifications, i.e. basic job training but also up-date and rehearsal training within certain fixed intervals. There are several, similar models for instructional system development available in the literature. One model which is of special interest integrates Operator Training development and Man-Machine Interfaces development. The extent to which Systematic Operator Training has been implemented varies with branches and companies. The nuclear power branch is given as an example in the report. This branch probably represents something better than the average among the process industries.(author)

Operational Efficiency And Customer Satisfaction of Restaurants: Basis For Business Operation Enhancement

Directory of Open Access Journals (Sweden)

Annie Gay Barlan-Espino

2017-02-01

Full Text Available Restaurants’ primary objective is to provide comfort and satisfaction to guest without compromising the operational efficiency of the business. This research aimed to determine the operational efficiency and customer satisfaction of restaurants as a basis for business operation enhancement. Specifically to determine the operational efficiency of the restaurant in terms of kitchen operations and dining operations and the level of customer satisfaction of the restaurant business in terms of: Product, Policies, People, Processes and Proactivity as well as the problems encountered by the restaurant in their operation and customer service. Descriptive research design was used with managers and customers as respondents of the study. It was concluded that majority of the restaurants are operating for more than a year with sufficient number of employees having enough seating capacity that accommodate large volume of customers. Restaurants are efficient on the aspect of kitchen and dining operations and sometimes encountered problems. Customers are satisfied in terms of 5 P’s. It was found out that there is no significant difference in the operational efficiency of restaurant when grouped according to profile variables. An action plan for continuous business operation enhancement on operational efficiency and customer satisfaction was proposed.

Pre-operative assessment and post-operative care in elective shoulder surgery.

Science.gov (United States)

Akhtar, Ahsan; Macfarlane, Robert J; Waseem, Mohammad

2013-01-01

Pre-operative assessment is required prior to the majority of elective surgical procedures, primarily to ensure that the patient is fit to undergo surgery, whilst identifying issues that may need to be dealt with by the surgical or anaesthetic teams. The post-operative management of elective surgical patients begins during the peri-operative period and involves several health professionals. Appropriate monitoring and repeated clinical assessments are required in order for the signs of surgical complications to be recognised swiftly and adequately. This article examines the literature regarding pre-operative assessment in elective orthopaedic surgery and shoulder surgery, whilst also reviewing the essentials of peri- and post-operative care. The need to recognise common post-operative complications early and promptly is also evaluated, along with discussing thromboprophylaxis and post-operative analgesia following shoulder surgery.

Building New Competition Law Regimes

International Development Research Centre (IDRC) Digital Library (Canada)

The new administration had no choice but to devise a set of urgent economic ..... have involved pursuing chambers of business operating in markets such as tourist ...... In 1969, Bolivia, Chile, Colombia, Ecuador and Peru joined together in the ...

CASE STUDY: China — Bridging the Gap between Scientists and ...

International Development Research Centre (IDRC) Digital Library (Canada)

... neatly printed card giving details of the type and origin of the items laid out there. ... and are responsible for post-harvest operations, seed selection and storage, ... current separated and conflicting situation, is urgently needed to address the ...

International co-operation

International Nuclear Information System (INIS)

1998-01-01

In this part the are reviewed: Co-operation with IAEA; Participation of the Slovakia on the 41 st session of the General Conference; The comprehensive Nuclear-Test-Ban Treaty Organization; Co-operation with the Organization for Economic Co-operation and Development; co-operation with the European Commission; Fulfillment of obligations resulting from the international contracting documents

Operating room management and operating room productivity: the case of Germany.

Science.gov (United States)

Berry, Maresi; Berry-Stölzle, Thomas; Schleppers, Alexander

2008-09-01

We examine operating room productivity on the example of hospitals in Germany with independent anesthesiology departments. Linked to anesthesiology group literature, we use the ln(Total Surgical Time/Total Anesthesiologists Salary) as a proxy for operating room productivity. We test the association between operating room productivity and different structural, organizational and management characteristics based on survey data from 87 hospitals. Our empirical analysis links improved operating room productivity to greater operating room capacity, appropriate scheduling behavior and management methods to realign interests. From this analysis, the enforcing jurisdiction and avoiding advance over-scheduling appear to be the implementable tools for improving operating room productivity.

THE REALITY OF OPERATIONAL ENVIRONMENT IN MILITARY OPERATIONS

Directory of Open Access Journals (Sweden)

Milan PODHOREC

2012-01-01

Full Text Available The strategic and operational environment affecting national security is complex, multifaceted and variable. Even in the long term, it will be characterized by high dynamics of changes, the growing diversity of players and increasingly complex interdependence of security trends and factors. Threats, risks and their sources are often difficult to localize and nowadays have mostly non-state and transnational character. Many of the specific threats and their impacts are difficult to predict. It all adds up to a further blurring of distinctions between internal and external national security. The operating environment consists of a set of factors arising from the nature of an area where the operation is carried out or will be. Operating environment is also formed by the character of a potential enemy, possibilities of effecting technological and informational areas and further by terrain, climatic conditions and level of own forces and coalition forces.

76 FR 58565 - Proposed Information Collection (Operation Enduring Freedom/Operation Iraqi Freedom Seriously...

Science.gov (United States)

2011-09-21

... (Operation Enduring Freedom/ Operation Iraqi Freedom Seriously Injured/Ill Service Member Veteran Worksheet... solicits comments on information provided to Operation Enduring Freedom/Operation Iraqi Freedom veterans... information technology. Title: Operation Enduring Freedom/Operation Iraqi Freedom Seriously Injured/Ill...

Operator theory

CERN Document Server

2015-01-01

A one-sentence definition of operator theory could be: The study of (linear) continuous operations between topological vector spaces, these being in general (but not exclusively) Fréchet, Banach, or Hilbert spaces (or their duals). Operator theory is thus a very wide field, with numerous facets, both applied and theoretical. There are deep connections with complex analysis, functional analysis, mathematical physics, and electrical engineering, to name a few. Fascinating new applications and directions regularly appear, such as operator spaces, free probability, and applications to Clifford analysis. In our choice of the sections, we tried to reflect this diversity. This is a dynamic ongoing project, and more sections are planned, to complete the picture. We hope you enjoy the reading, and profit from this endeavor.

Basic operator theory

CERN Document Server

Gohberg, Israel

2001-01-01

rii application of linear operators on a Hilbert space. We begin with a chapter on the geometry of Hilbert space and then proceed to the spectral theory of compact self adjoint operators; operational calculus is next presented as a nat­ ural outgrowth of the spectral theory. The second part of the text concentrates on Banach spaces and linear operators acting on these spaces. It includes, for example, the three 'basic principles of linear analysis and the Riesz­ Fredholm theory of compact operators. Both parts contain plenty of applications. All chapters deal exclusively with linear problems, except for the last chapter which is an introduction to the theory of nonlinear operators. In addition to the standard topics in functional anal­ ysis, we have presented relatively recent results which appear, for example, in Chapter VII. In general, in writ­ ing this book, the authors were strongly influenced by re­ cent developments in operator theory which affected the choice of topics, proofs and exercises. One ...

76 FR 72243 - Proposed Information Collection (Operation Enduring Freedom/Operation Iraqi Freedom Veterans...

Science.gov (United States)

2011-11-22

... (Operation Enduring Freedom/ Operation Iraqi Freedom Veterans Health Needs Assessment) Activity; Comment... Operation Enduring Freedom/ Operation Iraqi Freedom veterans and their families. DATES: Written comments and...: Operation Enduring Freedom/Operation Iraqi Freedom Veterans Health Needs Assessment, VA Form 10-21091. OMB...

Space station operations management

Science.gov (United States)

Cannon, Kathleen V.

1989-01-01

Space Station Freedom operations management concepts must be responsive to the unique challenges presented by the permanently manned international laboratory. Space Station Freedom will be assembled over a three year period where the operational environment will change as significant capability plateaus are reached. First Element Launch, Man-Tended Capability, and Permanent Manned Capability, represent milestones in operational capability that is increasing toward mature operations capability. Operations management concepts are being developed to accomodate the varying operational capabilities during assembly, as well as the mature operational environment. This paper describes operations management concepts designed to accomodate the uniqueness of Space Station Freedoom, utilizing tools and processes that seek to control operations costs.