WorldWideScience

Sample records for review optimising emergency

  1. Computed tomography dose optimisation in cystic fibrosis: A review.

    LENUS (Irish Health Repository)

    Ferris, Helena

    2016-04-28

    Cystic fibrosis (CF) is the most common autosomal recessive disease of the Caucasian population worldwide, with respiratory disease remaining the most relevant source of morbidity and mortality. Computed tomography (CT) is frequently used for monitoring disease complications and progression. Over the last fifteen years there has been a six-fold increase in the use of CT, which has lead to a growing concern in relation to cumulative radiation exposure. The challenge to the medical profession is to identify dose reduction strategies that meet acceptable image quality, but fulfil the requirements of a diagnostic quality CT. Dose-optimisation, particularly in CT, is essential as it reduces the chances of patients receiving cumulative radiation doses in excess of 100 mSv, a dose deemed significant by the United Nations Scientific Committee on the Effects of Atomic Radiation. This review article explores the current trends in imaging in CF with particular emphasis on new developments in dose optimisation.

  2. Numerical optimisation of friction stir welding: review of future challenges

    DEFF Research Database (Denmark)

    Tutum, Cem Celal; Hattel, Jesper Henri

    2011-01-01

    During the last decade, the combination of increasingly more advanced numerical simulation software with high computational power has resulted in models for friction stir welding (FSW), which have improved the understanding of the determining physical phenomena behind the process substantially....... This has made optimisation of certain process parameters possible and has in turn led to better performing friction stir welded products, thus contributing to a general increase in the popularity of the process and its applications. However, most of these optimisation studies do not go well beyond manual...

  3. Review article – Optimisation of exposure parameters for spinal curvature measurements in paediatric radiography

    NARCIS (Netherlands)

    de Haan, Seraphine; Reis, Cláudia; Ndlovu, Junior; Serrenho, Catarina; Akhtar, Ifrah; Garcia, José Antonio; Linde, Daniël; Thorskog, Martine; Franco, Loris; Hogg, Peter

    2015-01-01

    This review aims to identify strategies to optimise radiography practice using digital technologies, for full spine studies on paediatrics focusing particularly on methods used to diagnose and measure severity of spinal curvatures. The literature search was performed on different databases (PubMed,

  4. Emergency food storage for organisations and citizens in New Zealand: results of optimisation modelling.

    Science.gov (United States)

    Nghiem, Nhung; Carter, Mary-Ann; Wilson, Nick

    2012-12-14

    New Zealand (NZ), is a country subject to a wide range of natural disasters, some of which (e.g., floods and storms) may increase in frequency and severity with the effects of climate change. To improve disaster preparations, we aimed to use scenario development and linear programming to identify the lowest-cost foods for emergency storage. We used NZ food price data (e.g., from the Food Price Index) and nutritional data from a NZ food composition database. Different scenarios were modelled in Excel and R along with uncertainty analysis. A collection of low-cost emergency storage foods that meet daily energy requirements for men were identified e.g., at a median purchase cost of NZ$2.21 per day (equivalent to US$1.45) (95% simulation interval = NZ$2.04 to 2.38). In comparison, the cost of such a collection of foods which did not require cooking, was NZ$3.67 per day. While meeting all nutritional recommendations (and not just energy) is far from essential in a disaster setting, if such nutritionally optimised foods are purchased for storage, then the cost would be higher (NZ$7.10 per day). Where a zero level of food spoilage was assumed (e.g., storage by a government agency), the cost of purchasing food for storage was as low as NZ$1.93 per day. It appears to cost very little to purchase basic emergency foods for storage in the current New Zealand setting. The lists of the foods identified could be considered by organisations who participate in disaster relief (civil defence) but also by citizens.

  5. Optimisation of a green gas supply chain : a review

    NARCIS (Netherlands)

    Bekkering, Jan; Broekhuis, A. A.; van Gemert, Wim

    In this review the knowledge status of and future research options on a green gas supply based on biogas production by co-digestion is explored. Applications and developments of the (bio)gas supply in The Netherlands have been considered, whereafter literature research has been done into the several

  6. Optimisation of a green gas supply chain - A review

    NARCIS (Netherlands)

    Bekkering, J.; Broekhuis, A. A.; van Gernert, W. J. T.; van Gemert, W. J. T.

    In this review the Knowledge status of and future research options on a green gas supply based on biogas production by co-digestion is explored. Applications and developments of the (bio)gas supply in The Netherlands have been considered, whereafter literature research has been done into the several

  7. Lost in Optimisation of Water Distribution Systems? A Literature Review of System Design

    Directory of Open Access Journals (Sweden)

    Helena Mala-Jetmarova

    2018-03-01

    Full Text Available Optimisation of water distribution system design is a well-established research field, which has been extremely productive since the end of the 1980s. Its primary focus is to minimise the cost of a proposed pipe network infrastructure. This paper reviews in a systematic manner articles published over the past three decades, which are relevant to the design of new water distribution systems, and the strengthening, expansion and rehabilitation of existing water distribution systems, inclusive of design timing, parameter uncertainty, water quality, and operational considerations. It identifies trends and limits in the field, and provides future research directions. Exclusively, this review paper also contains comprehensive information from over one hundred and twenty publications in a tabular form, including optimisation model formulations, solution methodologies used, and other important details.

  8. Optimisation of a green gas supply chain--a review.

    Science.gov (United States)

    Bekkering, J; Broekhuis, A A; van Gemert, W J T

    2010-01-01

    In this review the knowledge status of and future research options on a green gas supply based on biogas production by co-digestion is explored. Applications and developments of the (bio)gas supply in The Netherlands have been considered, whereafter literature research has been done into the several stages from production of dairy cattle manure and biomass to green gas injection into the gas grid. An overview of a green gas supply chain has not been made before. In this study it is concluded that on installation level (micro-level) much practical knowledge is available and on macro-level knowledge about availability of biomass. But on meso-level (operations level of a green gas supply) very little research has been done until now. Future research should include the modeling of a green gas supply chain on an operations level, i.e. questions must be answered as where to build digesters based on availability of biomass. Such a model should also advise on technology of upgrading depending on scale factors. Future research might also give insight in the usability of mixing (partly upgraded) biogas with natural gas. The preconditions for mixing would depend on composition of the gas, the ratio of gases to be mixed and the requirements on the mixture.

  9. Defining spinal instability and methods of classification to optimise care for patients with malignant spinal cord compression: A systematic review

    International Nuclear Information System (INIS)

    Sheehan, C.

    2016-01-01

    The incidence of Malignant Spinal Cord Compression (MSCC) is thought to be increasing in the UK due to an aging population and improving cancer survivorship. The impact of such a diagnosis requires emergency treatment. In 2008 the National Institute of Clinical Excellence produced guidelines on the management of MSCC which includes a recommendation to assess spinal instability. However, a lack of guidelines to assess spinal instability in oncology patients is widely acknowledged. This can result in variations in the management of care for such patients. A spinal instability assessment can influence optimum patient care (bed rest or encouraged mobilisation) and inform the best definitive treatment modality (surgery or radiotherapy) for an individual patient. The aim of this systematic review is to attempt to identify a consensus definition of spinal instability and methods by which it can be classified. - Highlights: • A lack of guidance on metastatic spinal instability results in variations of care. • Definitions and assessments for spinal instability are explored in this review. • A Spinal Instability Neoplastic Scoring (SINS) system has been identified. • SINS could potentially be adopted to optimise and standardise patient care.

  10. A review of patient dose and optimisation methods in adult and paediatric CT scanning

    International Nuclear Information System (INIS)

    Dougeni, E.; Faulkner, K.; Panayiotakis, G.

    2012-01-01

    Highlights: ► CT scanning frequency has grown with the development of new clinical applications. ► Up to 32-fold dose variation was observed for similar type of procedures. ► Scanning parameters should be optimised for patient size and clinical indication. ► Cancer risks knowledge amongst physicians of certain specialties was poor. ► A significant number of non-indicated CT scans could be eliminated. - Abstract: An increasing number of publications and international reports on computed tomography (CT) have addressed important issues on optimised imaging practice and patient dose. This is partially due to recent technological developments as well as to the striking rise in the number of CT scans being requested. CT imaging has extended its role to newer applications, such as cardiac CT, CT colonography, angiography and urology. The proportion of paediatric patients undergoing CT scans has also increased. The published scientific literature was reviewed to collect information regarding effective dose levels during the most common CT examinations in adults and paediatrics. Large dose variations were observed (up to 32-fold) with some individual sites exceeding the recommended dose reference levels, indicating a large potential to reduce dose. Current estimates on radiation-related cancer risks are alarming. CT doses account for about 70% of collective dose in the UK and are amongst the highest in diagnostic radiology, however the majority of physicians underestimate the risk, demonstrating a decreased level of awareness. Exposure parameters are not always adjusted appropriately to the clinical question or to patient size, especially for children. Dose reduction techniques, such as tube-current modulation, low-tube voltage protocols, prospective echocardiography-triggered coronary angiography and iterative reconstruction algorithms can substantially decrease doses. An overview of optimisation studies is provided. The justification principle is discussed along

  11. Locating helicopter emergency medical service bases to optimise population coverage versus average response time

    NARCIS (Netherlands)

    Garner, A.A. (Alan A.); P.L. van den Berg (Pieter)

    2017-01-01

    textabstractBackground: New South Wales (NSW), Australia has a network of multirole retrieval physician staffed helicopter emergency medical services (HEMS) with seven bases servicing a jurisdiction with population concentrated along the eastern seaboard. The aim of this study was to estimate

  12. Emergency contraception: update and review.

    Science.gov (United States)

    Langston, Aileen

    2010-03-01

    Emergency contraception (EC) is the postcoital method of pregnancy prevention. Three methods of EC are used in the United States: (1) levonorgestrel-only pills, Plan B (Barr Pharmaceuticals, LLC, New Jersey) (2) combined estrogen and progestin pills, and (3) the copper intrauterine device. Used within 120 hours after unprotected sexual intercourse, EC reduces the risk of pregnancy by 60 to 94%. EC is a critical component of medical care for sexual assault survivors, and several states have laws mandating this standard of care. Levonorgestrel-only EC is available to women >or=17 years of age without a prescription. Women who were counseled by their clinician about EC were 11 times more likely to use EC in the following 12 months. Advance provision of EC to women has not been found to decrease rates of unintended pregnancy compared with routine pharmacy access; however, women routinely prefer advance provision. The newly approved by the Food and Drug Administration single-dose EC, Plan B One-Step (Barr Pharmaceuticals, LLC), may affect unintended pregnancy rates among EC users by simplifying use. Thieme Medical Publishers.

  13. Effects of efforts to optimise morbidity and mortality rounds to serve contemporary quality improvement and educational goals: a systematic review.

    Science.gov (United States)

    Smaggus, Andrew; Mrkobrada, Marko; Marson, Alanna; Appleton, Andrew

    2018-01-01

    The quality and safety movement has reinvigorated interest in optimising morbidity and mortality (M&M) rounds. We performed a systematic review to identify effective means of updating M&M rounds to (1) identify and address quality and safety issues, and (2) address contemporary educational goals. Relevant databases (Medline, Embase, PubMed, Education Resource Information Centre, Cumulative Index to Nursing and Allied Health Literature, Healthstar, and Global Health) were searched to identify primary sources. Studies were included if they (1) investigated an intervention applied to M&M rounds, (2) reported outcomes relevant to the identification of quality and safety issues, or educational outcomes relevant to quality improvement (QI), patient safety or general medical education and (3) included a control group. Study quality was assessed using the Medical Education Research Study Quality Instrument and Newcastle-Ottawa Scale-Education instruments. Given the heterogeneity of interventions and outcome measures, results were analysed thematically. The final analysis included 19 studies. We identified multiple effective strategies (updating objectives, standardising elements of rounds and attaching rounds to a formal quality committee) to optimise M&M rounds for a QI/safety purpose. These efforts were associated with successful integration of quality and safety content into rounds, and increased implementation of QI interventions. Consistent effects on educational outcomes were difficult to identify, likely due to the use of methodologies ill-fitted for educational research. These results are encouraging for those seeking to optimise the quality and safety mission of M&M rounds. However, the inability to identify consistent educational effects suggests the investigation of M&M rounds could benefit from additional methodologies (qualitative, mixed methods) in order to understand the complex mechanisms driving learning at M&M rounds. © Article author(s) (or their

  14. The Emergence of Systematic Review in Toxicology.

    Science.gov (United States)

    Stephens, Martin L; Betts, Kellyn; Beck, Nancy B; Cogliano, Vincent; Dickersin, Kay; Fitzpatrick, Suzanne; Freeman, James; Gray, George; Hartung, Thomas; McPartland, Jennifer; Rooney, Andrew A; Scherer, Roberta W; Verloo, Didier; Hoffmann, Sebastian

    2016-07-01

    The Evidence-based Toxicology Collaboration hosted a workshop on "The Emergence of Systematic Review and Related Evidence-based Approaches in Toxicology," on November 21, 2014 in Baltimore, Maryland. The workshop featured speakers from agencies and organizations applying systematic review approaches to questions in toxicology, speakers with experience in conducting systematic reviews in medicine and healthcare, and stakeholders in industry, government, academia, and non-governmental organizations. Based on the workshop presentations and discussion, here we address the state of systematic review methods in toxicology, historical antecedents in both medicine and toxicology, challenges to the translation of systematic review from medicine to toxicology, and thoughts on the way forward. We conclude with a recommendation that as various agencies and organizations adapt systematic review methods, they continue to work together to ensure that there is a harmonized process for how the basic elements of systematic review methods are applied in toxicology. © The Author 2016. Published by Oxford University Press on behalf of the Society of Toxicology.

  15. Simulation optimisation

    International Nuclear Information System (INIS)

    Anon

    2010-01-01

    Over the past decade there has been a significant advance in flotation circuit optimisation through performance benchmarking using metallurgical modelling and steady-state computer simulation. This benchmarking includes traditional measures, such as grade and recovery, as well as new flotation measures, such as ore floatability, bubble surface area flux and froth recovery. To further this optimisation, Outotec has released its HSC Chemistry software with simulation modules. The flotation model developed by the AMIRA P9 Project, of which Outotec is a sponsor, is regarded by industry as the most suitable flotation model to use for circuit optimisation. This model incorporates ore floatability with flotation cell pulp and froth parameters, residence time, entrainment and water recovery. Outotec's HSC Sim enables you to simulate mineral processes in different levels, from comminution circuits with sizes and no composition, through to flotation processes with minerals by size by floatability components, to full processes with true particles with MLA data.

  16. Review of emerging surgical robotic technology.

    Science.gov (United States)

    Peters, Brian S; Armijo, Priscila R; Krause, Crystal; Choudhury, Songita A; Oleynikov, Dmitry

    2018-04-01

    The use of laparoscopic and robotic procedures has increased in general surgery. Minimally invasive robotic surgery has made tremendous progress in a relatively short period of time, realizing improvements for both the patient and surgeon. This has led to an increase in the use and development of robotic devices and platforms for general surgery. The purpose of this review is to explore current and emerging surgical robotic technologies in a growing and dynamic environment of research and development. This review explores medical and surgical robotic endoscopic surgery and peripheral technologies currently available or in development. The devices discussed here are specific to general surgery, including laparoscopy, colonoscopy, esophagogastroduodenoscopy, and thoracoscopy. Benefits and limitations of each technology were identified and applicable future directions were described. A number of FDA-approved devices and platforms for robotic surgery were reviewed, including the da Vinci Surgical System, Sensei X Robotic Catheter System, FreeHand 1.2, invendoscopy E200 system, Flex® Robotic System, Senhance, ARES, the Single-Port Instrument Delivery Extended Research (SPIDER), and the NeoGuide Colonoscope. Additionally, platforms were reviewed which have not yet obtained FDA approval including MiroSurge, ViaCath System, SPORT™ Surgical System, SurgiBot, Versius Robotic System, Master and Slave Transluminal Endoscopic Robot, Verb Surgical, Miniature In Vivo Robot, and the Einstein Surgical Robot. The use and demand for robotic medical and surgical platforms is increasing and new technologies are continually being developed. New technologies are increasingly implemented to improve on the capabilities of previously established systems. Future studies are needed to further evaluate the strengths and weaknesses of each robotic surgical device and platform in the operating suite.

  17. The effect of pharmacist-led interventions in optimising prescribing in older adults in primary care: A systematic review

    Directory of Open Access Journals (Sweden)

    David O Riordan

    2016-06-01

    Full Text Available Objective: To evaluate studies of pharmacist-led interventions on potentially inappropriate prescribing among community-dwelling older adults receiving primary care to identify the components of a successful intervention. Data sources: An electronic search of the literature was conducted using the following databases from inception to December 2015: PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, MEDLINE (through Ovid, Trip, Centre for Reviews and Dissemination databases, Cochrane Database of Systematic Reviews, ISI Web of Science, ScienceDirect, ClinicalTrials.gov, metaRegister of Controlled Trials, ProQuest Dissertations & Theses Database (Theses in Great Britain, Ireland and North America. Review methods: Studies were included if they were randomised controlled trials or quasi-randomised studies involving a pharmacist-led intervention compared to usual/routine care which aimed to reduce potentially inappropriate prescribing in older adults in primary care. Methodological quality of the included studies was independently assessed. Results: A comprehensive literature search was conducted which identified 2193 studies following removal of duplicates. Five studies met the inclusion criteria. Four studies involved a pharmacist conducting a medication review and providing feedback to patients or their family physician. One randomised controlled trial evaluated the effect of a computerised tool that alerted pharmacists when elderly patients were newly prescribed potentially inappropriate medications. Four studies were associated with an improvement in prescribing appropriateness. Conclusion: Overall, this review demonstrates that pharmacist-led interventions may improve prescribing appropriateness in community-dwelling older adults. However, the quality of evidence is low. The role of a pharmacist working as part of a multidisciplinary primary care team requires further investigation to optimise prescribing in this group of

  18. Optimising the Efficacy of Hybrid Academic Teams: Lessons from a Systematic Review Process

    Science.gov (United States)

    Lake, Warren; Wallin, Margie; Boyd, Bill; Woolcott, Geoff; Markopoulos, Christos; Boyd, Wendy; Foster, Alan

    2018-01-01

    Undertaking a systematic review can have many benefits, beyond any theoretical or conceptual discoveries pertaining to the underlying research question. This paper explores the value of utilising a hybrid academic team when undertaking the systematic review process, and shares a range of practical strategies. The paper also comments on how such a…

  19. Using internal and external reviewers can help to optimise neonatal mortality and morbidity conferences.

    Science.gov (United States)

    Assaad, Michael-Andrew; Janvier, Annie; Lapointe, Anie

    2018-02-01

    This study determined whether there was a difference in the conclusions reached by neonatologists in morbidity and mortality conferences based on their level of involvement in a case. All neonatal deaths occurring between August 2014 and September 2015 at the neonatal intensive care unit of Sainte-Justine Hospital, Montreal, Quebec, Canada, were reviewed by internal physicians involved in the case and external physicians who were not. The reviewers were asked to identify positive and negative clinical practice items and provide written recommendations. These were classified into eight categories and compared for each case. During the study, 55 patients died leading to 110 reviews and a total of 590 positive and negative items. Most items were in the communication (25.2%), ethical decision-making (16.7%) and clinical management (14.8%) categories. Both the internal and external reviewers were in agreement 48.5% of the time for positive items and 44.8% for negative items. There were 242 written recommendations, which differed significantly among the internal and external reviewers. Reviews of neonatal deaths by two independent reviewers, internal physicians and external physicians, led to different positive and negative practice items and recommendations. This could allow for a richer discussion and improve recommendations for patient care. ©2017 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

  20. Emerging infections-an increasingly important topic : review by the Emerging Infections Task Force

    NARCIS (Netherlands)

    Petersen, E; Petrosillo, N; Koopmans, M; Stienstra, Y.

    OBJECTIVES: This paper review trends in emerging infections and the need for increased clinical and laboratory surveillance. METHODS: Factors that contributed to the emergence of recent outbreaks have been reviewed. Known, major outbreaks over the past two decades were reviewed. RESULTS: We

  1. A Review of Medical Emergencies in Dental Practice | Uyamadu ...

    African Journals Online (AJOL)

    A Review of Medical Emergencies in Dental Practice. ... are those adverse medical events that may present in the course of dental treatment. ... be available in a dental clinic, outline the prevention and management of such emergencies, ...

  2. Optimising treatment resources for OCD: a review of the evidence base for technology-enhanced delivery.

    Science.gov (United States)

    Lovell, Karina; Bee, Penny

    2011-12-01

    Obsessive-compulsive disorder (OCD) is a chronic and disabling mental health problem. Only a minority of people receive evidence-based psychological treatments, and this deficit has prompted an increasing focus on delivering cognitive behaviour therapy (CBT) in new and innovative ways. To conduct a scoping review of the published evidence base for CBT-based interventions incorporating a health technology in the treatment of OCD. The questions posed by the review were (a) are technology-assisted treatments clinically effective, (b) are patient outcomes durable and (c) are more innovative services deemed acceptable by those individuals who engage in them? Scoping review of published studies using any study design examining CBT interventions incorporating a health technology for OCD. Electronic databases searched included MEDLINE (1966-2010), PsycInfo (1967-2010), EMBASE (1980-2010) and CINAHL databases (1982-2010). Thirteen studies were identified, of these, five used bibliotherapy, five examined computerised CBT (cCBT), two investigated telephone delivered CBT and one evaluated video conferencing. Overall studies were small and methodologically flawed, which precludes definitive conclusions of clinical effectiveness, durability or stakeholder satisfaction. To date the evidence base for technology-enhanced OCD treatments has undergone limited development. Future research should seek to overcome the methodological shortcomings of published work by conducting large-scale trials that incorporate clinical, cost and acceptability outcomes.

  3. The effect of interventions aiming to optimise the prescription of antibiotics in dental care-A systematic review.

    Science.gov (United States)

    Löffler, Christin; Böhmer, Femke

    2017-01-01

    Abundant evidence in dentistry suggests that antibiotics are prescribed despite the existence of guidelines aiming to reduce the development of antibiotic resistance. This review investigated (1) which type of interventions aiming to optimise prescription of antibiotics exist in dentistry, (2) the effect of these interventions and (3) the specific strengths and limitations of the studies reporting on these interventions. Literature search was based on Medline, Embase, Global Health, Cochrane CENTRAL, ClinicalTrials.gov and Current Controlled Trials. Studies with one of the two primary outcomes were included: (1) The number of antibiotics prescribed and/or (2) the accuracy of the prescription, commonly measured as a percentage of adherence to local clinical guidelines. Nine studies met these inclusion criteria. Five studies reported on the prescription of antibiotics in primary dental care and four studies focused on outpatient dental care. Interventions used in primary dental care included a combination of audit, feedback, education, local consensus, dissemination of guidelines and/or academic detailing. Trials in the outpatient setting made use of expert panel discussions, educational feedback on previous acts of prescribing, the dissemination of guidelines and the establishment of internal guidelines. All studies successfully reduced the number of antibiotics prescribed and/or increased the accuracy of the prescription. However, most studies were confounded by a high risk of selection bias, selective outcome reporting and high variance across study groups. In particular, information relating to study design and methodology was insufficient. Only three studies related the prescriptions to the number of patients treated with antibiotics. This systematic review was able to offer conclusions which took the limitations of the investigated studies into account. Unfortunately, few studies could be included and many of these studies were confounded by a low quality of

  4. The effect of interventions aiming to optimise the prescription of antibiotics in dental care-A systematic review.

    Directory of Open Access Journals (Sweden)

    Christin Löffler

    Full Text Available Abundant evidence in dentistry suggests that antibiotics are prescribed despite the existence of guidelines aiming to reduce the development of antibiotic resistance. This review investigated (1 which type of interventions aiming to optimise prescription of antibiotics exist in dentistry, (2 the effect of these interventions and (3 the specific strengths and limitations of the studies reporting on these interventions.Literature search was based on Medline, Embase, Global Health, Cochrane CENTRAL, ClinicalTrials.gov and Current Controlled Trials. Studies with one of the two primary outcomes were included: (1 The number of antibiotics prescribed and/or (2 the accuracy of the prescription, commonly measured as a percentage of adherence to local clinical guidelines.Nine studies met these inclusion criteria. Five studies reported on the prescription of antibiotics in primary dental care and four studies focused on outpatient dental care. Interventions used in primary dental care included a combination of audit, feedback, education, local consensus, dissemination of guidelines and/or academic detailing. Trials in the outpatient setting made use of expert panel discussions, educational feedback on previous acts of prescribing, the dissemination of guidelines and the establishment of internal guidelines. All studies successfully reduced the number of antibiotics prescribed and/or increased the accuracy of the prescription. However, most studies were confounded by a high risk of selection bias, selective outcome reporting and high variance across study groups. In particular, information relating to study design and methodology was insufficient. Only three studies related the prescriptions to the number of patients treated with antibiotics.This systematic review was able to offer conclusions which took the limitations of the investigated studies into account. Unfortunately, few studies could be included and many of these studies were confounded by a low

  5. Observer roles that optimise learning in healthcare simulation education: a systematic review.

    Science.gov (United States)

    O'Regan, Stephanie; Molloy, Elizabeth; Watterson, Leonie; Nestel, Debra

    2016-01-01

    Simulation is widely used in health professional education. The convention that learners are actively involved may limit access to this educational method. The aim of this paper is to review the evidence for learning methods that employ directed observation as an alternative to hands-on participation in scenario-based simulation training. We sought studies that included either direct comparison of the learning outcomes of observers with those of active participants or identified factors important for the engagement of observers in simulation. We systematically searched health and education databases and reviewed journals and bibliographies for studies investigating or referring to observer roles in simulation using mannequins, simulated patients or role play simulations. A quality framework was used to rate the studies. We sought studies that included either direct comparison of the learning outcomes of observers with those of active participants or identified factors important for the engagement of observers in simulation. We systematically searched health and education databases and reviewed journals and bibliographies for studies investigating or referring to observer roles in simulation using mannequins, simulated patients or role play simulations. A quality framework was used to rate the studies. Nine studies met the inclusion criteria. Five studies suggest learning outcomes in observer roles are as good or better than hands-on roles in simulation. Four studies document learner satisfaction in observer roles. Five studies used a tool to guide observers. Eight studies involved observers in the debrief. Learning and satisfaction in observer roles is closely associated with observer tools, learner engagement, role clarity and contribution to the debrief. Learners that valued observer roles described them as affording an overarching view, examination of details from a distance, and meaningful feedback during the debrief. Learners who did not value observer roles

  6. 77 FR 33661 - Review of the Emergency Alert System

    Science.gov (United States)

    2012-06-07

    ... Commission's Review of the Emergency Alert System, Fifth Report and Order (Order). This document is... FEDERAL COMMUNICATIONS COMMISSION 47 CFR Part 11 [EB Docket No. 04-296; FCC 12-7] Review of the Emergency Alert System AGENCY: Federal Communications Commission. ACTION: Final rule; announcement of...

  7. Natural gas market review 2008 - optimising investments and ensuring security in a high-priced environment

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2008-09-18

    Over the last 18 months, natural gas prices have continued to rise steadily in all IEA markets. What are the causes of this steady upward trend? Unprecedented oil and coal prices which have encouraged power generators to switch to gas, together with tight supplies, demand for gas in new markets and delayed investments all played a role. Investment uncertainties, cost increases and delays remain major concerns in most gas markets and are continuing to constitute a threat to long-term security of supply. A massive expansion in LNG production is expected in the short term to 2012, but the lag in LNG investment beyond 2012 is a concern for all gas users in both IEA and non-IEA markets. Despite this tight market context, regional markets continue on their way to globalisation. This tendency seems irreversible, and it impacts even the most independent markets. Price linkages and other interactions between markets are becoming more pronounced. This publication addresses these major developments, assessing investment in natural gas projects (LNG, pipelines, upstream), escalating costs, the activities of international oil and gas companies, and gas demand in the power sector. In addition, the publication includes data and forecasts on OECD and non-OECD regions to 2015 and in-depth reviews of five OECD countries and regions including the European Union. It also provides analysis of 34 non-OECD countries in South America, the Middle East, Africa, and Asia, including a detailed assessment of the outlook for gas in Russia, as well as insights on new technologies to deliver gas to markets.

  8. Review of IAEA documentation on Nuclear and radiological emergency

    International Nuclear Information System (INIS)

    Mukhono, P. M.

    2014-10-01

    The project focuses on the review of IAEA documentation on nuclear or radiological emergencies with main focus on methodology for developing and arrangement for nuclear and radiological emergencies. The main objective of this work is to identify limitations in IAEA documentation on emergency preparedness and response (EPR) and provide recommendation on the main actions needed to fill the gaps identified thus aiding in improvement of emergency preparedness and response to nuclear and radiological accidents. The review of IAEA documentation on nuclear and radiological emergency has been carried out by evaluating various emergency response elements. Several elements for EPR were highlighted covering the safety fundamentals, general safety requirements and EPR methods for development of an effective emergence response capability for nuclear or radiological emergencies. From these issues, the limitations of IAEA documentation on EPR were drawn and recommendations suggested as a means of improving EPR methods. Among them was the need for IAEA consider establishment of follow up and inspection programmes to facilitate implementation of EPR requirements in most developing countries, establishment of programmes that provide platforms for the countries to be motivated to update their system in line with the current status of emergency preparedness, review of the international information exchange aspects of nuclear emergencies in order to improve capabilities to communicate reliable data, information and decisions quickly and effectively among national authorities and their emergency and emergency response centres. (au)

  9. 77 FR 58529 - Submission for OMB Emergency Review

    Science.gov (United States)

    2012-09-21

    ... Total Burden Hours: 28,089 hours. Total Burden Cost (capital/startup): None. Total Burden Cost... date. Therefore, there will be no comment period for this request. Type of Review: Emergency request...

  10. Global Emergency Medicine: A review of the literature from 2017.

    Science.gov (United States)

    Becker, Torben K; Trehan, Indi; Hayward, Alison Schroth; Hexom, Braden J; Kivlehan, Sean M; Lunney, Kevin M; Modi, Payal; Osei-Ampofo, Maxwell; Pousson, Amelia; Cho, Daniel K; Levine, Adam C

    2018-05-23

    The Global Emergency Medicine Literature Review (GEMLR) conducts an annual search of peer-reviewed and gray literature relevant to global emergency medicine (EM) to identify, review, and disseminate the most important new research in this field to a global audience of academics and clinical practitioners. This year, 17,722 articles written in three languages were identified by our electronic search. These articles were distributed among 20 reviewers for initial screening based on their relevance to the field of global EM. Another two reviewers searched the gray literature, yielding an additional 11 articles. All articles that were deemed appropriate by at least one reviewer and approved by their editor underwent formal scoring of overall quality and importance. Two independent reviewers scored all articles. A total of 848 articles met our inclusion criteria and underwent full review. 63% were categorized as emergency care in resource-limited settings, 23% as disaster and humanitarian response, and 14% as emergency medicine development. 21 articles received scores of 18.5 or higher out of a maximum score 20 and were selected for formal summary and critique. Inter-rater reliability testing between reviewers revealed a Cohen's Kappa of 0.344. In 2017, the total number of articles identified by our search continued to increase. Studies and reviews with a focus on infectious diseases, pediatrics, and trauma represented the majority of top-scoring articles. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  11. Global Emergency Medicine: A Review of the Literature From 2016.

    Science.gov (United States)

    Becker, Torben K; Hansoti, Bhakti; Bartels, Susan; Hayward, Alison Schroth; Hexom, Braden J; Lunney, Kevin M; Marsh, Regan H; Osei-Ampofo, Maxwell; Trehan, Indi; Chang, Julia; Levine, Adam C

    2017-09-01

    The Global Emergency Medicine Literature Review (GEMLR) conducts an annual search of peer-reviewed and gray literature relevant to global emergency medicine (EM) to identify, review, and disseminate the most important new research in this field to a global audience of academics and clinical practitioners. This year 13,890 articles written in four languages were identified by our search. These articles were distributed among 20 reviewers for initial screening based on their relevance to the field of global EM. An additional two reviewers searched the gray literature. All articles that were deemed appropriate by at least one reviewer and approved by their editor underwent formal scoring of overall quality and importance. Two independent reviewers scored all articles. A total of 716 articles met our inclusion criteria and underwent full review. Fifty-nine percent were categorized as emergency care in resource-limited settings, 17% as EM development, and 24% as disaster and humanitarian response. Nineteen articles received scores of 18.5 or higher out of a maximum score of 20 and were selected for formal summary and critique. Inter-rater reliability testing between reviewers revealed Cohen's kappa of 0.441. In 2016, the total number of articles identified by our search continued to increase. The proportion of articles in each of the three categories remained stable. Studies and reviews with a focus on infectious diseases, pediatrics, and the use of ultrasound in resource-limited settings represented the majority of articles selected for final review. © 2017 The Authors. Academic Emergency Medicine published by Wiley Periodicals, Inc. on behalf of the Society for Academic Emergency Medicine (SAEM).

  12. Prudency reviews, cash management issues emerge

    International Nuclear Information System (INIS)

    Anon.

    1985-01-01

    Utility management is paying increasing attention to the broadening of regulatory commission prudency reviews to cover operating generating plants as well as those under construction. Utilities can expect a prudency review after a major outage, and should investigate the possibility for legal action against a third party or be prepared to defend itself. The Shoreham nuclear plant serves as a warning to utilities of the need for on-going documentation of cost-benefit analyses conducted during the construction period. Utility managers should demand a prudency standard from their regulators, and minority owners in large projects should make independent prudency findings. There is also a growing need for utilities to develop intelligent strategies for handling excess cash. Methods for handling cash flow include the financial investment, grid refurbishment, dividend payout, decapitalization, and diversification

  13. Review of supplemental oxygen and respiratory support for paediatric emergency care in sub-Saharan Africa

    Directory of Open Access Journals (Sweden)

    Andreas Hansmann

    Full Text Available Introduction: In African countries, respiratory infections and severe sepsis are common causes of respiratory failure and mortality in children under five years of age. Mortality and morbidity in these children could be reduced with adequate respiratory support in the emergency care setting. The purpose of this review is to describe management priorities in the emergency care of critically ill children presenting with respiratory problems. Basic and advanced respiratory support measures are described for implementation according to available resources, work load and skill-levels. Methods: We did a focused search of respiratory support for critically ill children in resource-limited settings over the past ten years, using the search tools PubMed and Google Scholar, the latest WHO guidelines, international ‘Advanced Paediatric Life Support’ guidelines and paediatric critical care textbooks. Results: The implementation of triage and rapid recognition of respiratory distress and hypoxia with pulse oximetry is important to correctly identify critically ill children with increased risk of mortality in all health facilities in resource constrained settings. Basic, effective airway management and respiratory support are essential elements of emergency care. Correct provision of supplemental oxygen is safe and its application alone can significantly improve the outcome of critically ill children. Non-invasive ventilatory support is cost-effective and feasible, with the potential to improve emergency care packages for children with respiratory failure and other organ dysfunctions. Non-invasive ventilation is particularly important in severely under-resourced regions unable to provide intubation and invasive mechanical ventilation support. Malnutrition and HIV-infection are important co-morbid conditions, associated with increased mortality in children with respiratory dysfunction. Discussion: A multi-disciplinary approach is required to optimise

  14. Nuclear emergency planning in Spain. The PLABEN review project

    International Nuclear Information System (INIS)

    Lentijo Lentijo, J. C.; Vila Pena, M.

    2002-01-01

    The international rules and recommendations for nuclear emergency planning and the Spanish experience gained in the management of event with radiological risk have noticed that is necessary to review the planning radiological bases for emergencies in nuclear power plants and to define the planning radiological bases for radiological emergencies that could happen in radioactive facilities or in activities out of the regulatory framework. The paper focuses on CSN actions concerning the Plaben review project related to define the new radiological principles taking into account the current international recommendations for interventions, make a proposal about the organisation and operation of the provincial radiological action group and the national support level for radiological emergency response. (Author) 7 refs

  15. Emerging Technologies Landscape on Education. A review

    Directory of Open Access Journals (Sweden)

    Luis de la Fuente Valentin

    2013-09-01

    Full Text Available This paper presents a desk research that analysed available recent studies in the field of Technology Enhanced Learning. The desk research is focused on work produced in the frame of FP6 and FP7 European programs, in the area of Information and Communication Technologies. It concentrates in technologies that support existing forms of learning, and also in technologies that enhance new learning paradigms. This approach includes already adopted and successfully piloted technologies. The elaboration of the desk research had three main parts: firstly, the collection of documents from CORDIS and other institutions related to TEL research; secondly, the identification of relevant terms appearing in those documents and the elaboration of a thesaurus; and thirdly, a quantitative analysis of each term occurrences. Many of the identified technologies belong to the fields of interactive multimedia, Human-computer Interaction and-or related to recommendation and learning analytics. This study becomes a thorough review of the current state of these fields through the actual development of R&D European projects. This research, will be used as a basis to better understand the evolution of the sector, and to focus future research efforts on these sectors and their application to education.

  16. Emergency psychiatric care for children and adolescents: a literature review.

    Science.gov (United States)

    Janssens, Astrid; Hayen, Sarah; Walraven, Vera; Leys, Mark; Deboutte, Dirk

    2013-09-01

    Over the years, increasing numbers of children and adolescents have sought help for acute psychiatric problems. The responses to this treatment-seeking behavior are heterogeneous in different settings and nations. This review aimed to provide an answer to the questions "which care should be offered to children and adolescents presenting with a psychiatric emergency or crisis and how should it be organized." We committed a literature review to find out if any recommendations can be made regarding the organization of emergency care for children and adolescents with acute mental health problems. The lack of a clear definition of emergencies or urgencies hampered this review; we note the differences between adult and child or adolescent psychiatry. The theoretical models of care found in the literature are built up from several process and structural components, which we describe in greater detail. Furthermore, we review the main service delivery models that exist for children and adolescents. Currently, emergency psychiatric care for children and adolescents is practiced within a wide range of care models. There is no consensus on recommended care or recommended setting for this population. More research is needed to make exact recommendations on the standardization of psychiatric care for young people in emergency settings.

  17. Ectopic Pregnancy and Emergency Contraceptive Pills: A Systematic Review

    Science.gov (United States)

    Cleland, Kelly; Raymond, Elizabeth; Trussell, James; Cheng, Linan; Zhu, Haoping

    2014-01-01

    Objective To evaluate the existing data to estimate the rate of ectopic pregnancy among emergency contraceptive pill treatment failures. Data Sources Our initial reference list was generated from a 2008 Cochrane review of emergency contraception. In August 2009, we searched Biosys Previews, the Cochrane Database of Systematic Reviews, Medline, Global Health Database, Health Source: Popline, and Wanfang Data (a Chinese database). Methods of Study Selection This study included data from 136 studies which followed a defined population of women treated one time with emergency contraceptive pills (either mifepristone or levonorgestrel), and in which the number and location of pregnancies were ascertained. Results Data from each article were abstracted independently by two reviewers. In the studies of mifepristone, 3 out of 494 (0.6%) pregnancies were ectopic; in the levonorgestrel studies, 3 out of 307 (1%) were ectopic. Conclusion The rate of ectopic pregnancy when treatment with emergency contraceptive pills fails does not exceed the rate observed in the general population. Since emergency contraceptive pills are effective in lowering the risk of pregnancy, their use should reduce the chance that an act of intercourse will result in ectopic pregnancy. PMID:20502299

  18. A review of global access to emergency contraception.

    Science.gov (United States)

    Westley, Elizabeth; Kapp, Nathalie; Palermo, Tia; Bleck, Jennifer

    2013-10-01

    Emergency contraception has been known for several decades, and dedicated products have been on the market for close to 20 years. Yet it is unclear whether women, particularly in low-resource countries, have access to this important second-chance method of contraception. To review relevant policies, regulations, and other factors related to access to emergency contraception worldwide. A wide range of gray literature was reviewed, several specific studies were commissioned, and a number of online databases were searched. Several positive policies and regulations are in place: emergency contraception products are registered in the majority of countries around the world, listed in many countries' essential medicines lists, included in widely used guidance, and supported by most donors. Yet analysis of demographic data shows that the majority of women in low-income countries have never heard of emergency contraception, and surveys find that many providers have negative attitudes toward providing emergency contraception. Despite more than a decade of concerted international and country-level efforts to ensure that women have access to emergency contraception, accessibility remains limited. © 2013.

  19. Standard review plan for the review and evaluation of emergency plans for research and test reactors

    International Nuclear Information System (INIS)

    1983-10-01

    This document provides a Standard Review Plan to assure that complete and uniform reviews are made of research and test reactor radiological emergency plans. The report is organized under ten planning standards which correspond to the guidance criteria in American National Standard ANSI/ANS 15.16 - 1982 as endorsed by Revision 1 to Regulatory Guide 2.6. The applicability of the items under each planning standard is indicated by subdivisions of the steady-state thermal power levels at which the reactors are licensed to operate. Standard emergency classes and example action levels for research and test reactors which should initiate these classes are given in an Appendix. The content of the emergency plan is as follows: the emergency plan addresses the necessary provisions for coping with radiological emergencies. Activation of the emergency plan is in response to the emergency action levels. In addition to addressing those severe emergencies that will fall within one of the standard emergency classes, the plan also discusses the necessary provisions to deal with radiological emergencies of lesser severity that can occur within the operations boundary. The emergency plan allows for emergency personnel to deviate from actions described in the plan for unusual or unanticipated conditions

  20. Measles vaccination in humanitarian emergencies: a review of recent practice

    Directory of Open Access Journals (Sweden)

    Watson John

    2011-09-01

    Full Text Available Abstract Background The health needs of children and adolescents in humanitarian emergencies are critical to the success of relief efforts and reduction in mortality. Measles has been one of the major causes of child deaths in humanitarian emergencies and further contributes to mortality by exacerbating malnutrition and vitamin A deficiency. Here, we review measles vaccination activities in humanitarian emergencies as documented in published literature. Our main interest was to review the available evidence focusing on the target age range for mass vaccination campaigns either in response to a humanitarian emergency or in response to an outbreak of measles in a humanitarian context to determine whether the current guidance required revision based on recent experience. Methods We searched the published literature for articles published from January 1, 1998 to January 1, 2010 reporting on measles in emergencies. As definitions and concepts of emergencies vary and have changed over time, we chose to consider any context where an application for either a Consolidated Appeals Process or a Flash Appeal to the UN Central Emergency Revolving Fund (CERF occurred during the period examined. We included publications from countries irrespective of their progress in measles control as humanitarian emergencies may occur in any of these contexts and as such, guidance applies irrespective of measles control goals. Results Of the few well-documented epidemic descriptions in humanitarian emergencies, the age range of cases is not limited to under 5 year olds. Combining all data, both from preventive and outbreak response interventions, about 59% of cases in reports with sufficient data reviewed here remain in children under 5, 18% in 5-15 and 2% above 15 years. In instances where interventions targeted a reduced age range, several reports concluded that the age range should have been extended to 15 years, given that a significant proportion of cases occurred

  1. Tattoos and Piercing: A Review for the Emergency Department Physician

    Directory of Open Access Journals (Sweden)

    William K. Mallon

    2011-05-01

    Full Text Available Tattoos and piercings are increasingly part of everyday life for large sections of the population, and more emergency physicians are seeing these body modifications (BM adorn their patients. In this review we elucidate the most common forms of these BMs, we describe how they may affect both the physical and psychological health of the patient undergoing treatment, and also try to educate around any potential pitfalls in treating associated complications. [West J Emerg Med. 2011;12(4:393–398.

  2. An hypnotic suggestion: review of hypnosis for clinical emergency care.

    Science.gov (United States)

    Iserson, Kenneth V

    2014-04-01

    Hypnosis has been used in medicine for nearly 250 years. Yet, emergency clinicians rarely use it in emergency departments or prehospital settings. This review describes hypnosis, its historical use in medicine, several neurophysiologic studies of the procedure, its uses and potential uses in emergency care, and a simple technique for inducing hypnosis. It also discusses reasons why the technique has not been widely adopted, and suggests methods of increasing its use in emergency care, including some potential research areas. A limited number of clinical studies and case reports suggest that hypnosis may be effective in a wide variety of conditions applicable to emergency medical care. These include providing analgesia for existing pain (e.g., fractures, burns, and lacerations), providing analgesia and sedation for painful procedures (e.g., needle sticks, laceration repair, and fracture and joint reductions), reducing acute anxiety, increasing children's cooperation for procedures, facilitating the diagnosis and treatment of acute psychiatric conditions, and providing analgesia and anxiolysis for obstetric/gynecologic problems. Although it is safe, fast, and cost-effective, emergency clinicians rarely use hypnosis. This is due, in part, to the myths surrounding hypnosis and its association with alternative-complementary medicine. Genuine barriers to its increased clinical use include a lack of assured effectiveness and a lack of training and training requirements. Based on the results of further research, hypnosis could become a powerful and safe nonpharmacologic addition to the emergency clinician's armamentarium, with the potential to enhance patient care in emergency medicine, prehospital care, and remote medical settings. Copyright © 2014 Elsevier Inc. All rights reserved.

  3. Where is the evidence for emergency planning: a scoping review.

    Science.gov (United States)

    Challen, Kirsty; Lee, Andrew C K; Booth, Andrew; Gardois, Paolo; Woods, Helen Buckley; Goodacre, Steve W

    2012-07-23

    Recent terrorist attacks and natural disasters have led to an increased awareness of the importance of emergency planning. However, the extent to which emergency planners can access or use evidence remains unclear. The aim of this study was to identify, analyse and assess the location, source and quality of emergency planning publications in the academic and UK grey literature. We conducted a scoping review, using as data sources for academic literature Embase, Medline, Medline in Process, Psychinfo, Biosis, Science Citation Index, Cinahl, Cochrane library and Clinicaltrials.gov. For grey literature identification we used databases at the Health Protection Agency, NHS Evidence, British Association of Immediate Care Schemes, Emergency Planning College and the Health and Safety Executive, and the websites of UK Department of Health Emergency Planning Division and UK Resilience.Aggregative synthesis was used to analyse papers and documents against a framework based on a modified FEMA Emergency Planning cycle. Of 2736 titles identified from the academic literature, 1603 were relevant. 45% were from North America, 27% were commentaries or editorials and 22% were event reports.Of 192 documents from the grey literature, 97 were relevant. 76% of these were event reports.The majority of documents addressed emergency planning and response. Very few documents related to hazard analysis, mitigation or capability assessment. Although a large body of literature exists, its validity and generalisability is unclear There is little evidence that this potential evidence base has been exploited through synthesis to inform policy and practice. The type and structure of evidence that would be of most value of emergency planners and policymakers has yet to be identified.

  4. Where is the evidence for emergency planning: a scoping review

    Directory of Open Access Journals (Sweden)

    Challen Kirsty

    2012-07-01

    Full Text Available Abstract Background Recent terrorist attacks and natural disasters have led to an increased awareness of the importance of emergency planning. However, the extent to which emergency planners can access or use evidence remains unclear. The aim of this study was to identify, analyse and assess the location, source and quality of emergency planning publications in the academic and UK grey literature. Methods We conducted a scoping review, using as data sources for academic literature Embase, Medline, Medline in Process, Psychinfo, Biosis, Science Citation Index, Cinahl, Cochrane library and Clinicaltrials.gov. For grey literature identification we used databases at the Health Protection Agency, NHS Evidence, British Association of Immediate Care Schemes, Emergency Planning College and the Health and Safety Executive, and the websites of UK Department of Health Emergency Planning Division and UK Resilience. Aggregative synthesis was used to analyse papers and documents against a framework based on a modified FEMA Emergency Planning cycle. Results Of 2736 titles identified from the academic literature, 1603 were relevant. 45% were from North America, 27% were commentaries or editorials and 22% were event reports. Of 192 documents from the grey literature, 97 were relevant. 76% of these were event reports. The majority of documents addressed emergency planning and response. Very few documents related to hazard analysis, mitigation or capability assessment. Conclusions Although a large body of literature exists, its validity and generalisability is unclear There is little evidence that this potential evidence base has been exploited through synthesis to inform policy and practice. The type and structure of evidence that would be of most value of emergency planners and policymakers has yet to be identified.

  5. Review of risk from potential emerging contaminants in UK groundwater

    OpenAIRE

    Stuart, Marianne; Lapworth, Dan; Crane, Emily; Hart, Alwyn

    2012-01-01

    This paper provides a review of the types of emerging organic groundwater contaminants (EGCs) which are beginning to be found in the UK. EGCs are compounds being found in groundwater that were previously not detectable or known to be significant and can come from agricultural, urban and rural point sources. EGCs include nanomaterials, pesticides, pharmaceuticals, industrial compounds, personal care products, fragrances, water treatment by-products, flame retardants and surfactants, as well a...

  6. Tattoos and piercings: a review for the emergency physician.

    Science.gov (United States)

    Urdang, Michael; Mallek, Jennifer T; Mallon, William K

    2011-11-01

    Tattoos and piercings are increasingly part of everyday life for large sections of the population, and more emergency physicians are seeing these body modifications (BM) adorn their patients. In this review we elucidate the most common forms of these BMs, we describe how they may affect both the physical and psychological health of the patient undergoing treatment, and also try to educate around any potential pitfalls in treating associated complications.

  7. Tattoos and Piercings: A Review for the Emergency Physician

    Science.gov (United States)

    Urdang, Michael; Mallek, Jennifer T; Mallon, William K

    2011-01-01

    Tattoos and piercings are increasingly part of everyday life for large sections of the population, and more emergency physicians are seeing these body modifications (BM) adorn their patients. In this review we elucidate the most common forms of these BMs, we describe how they may affect both the physical and psychological health of the patient undergoing treatment, and also try to educate around any potential pitfalls in treating associated complications. PMID:22224126

  8. Beyond Synthesis: Augmenting Systematic Review Procedures with Practical Principles to Optimise Impact and Uptake in Educational Policy and Practice

    Science.gov (United States)

    Green, Chris; Taylor, Celia; Buckley, Sharon; Hean, Sarah

    2016-01-01

    Whilst systematic reviews, meta-analyses and other forms of synthesis are considered amongst the most valuable forms of research evidence, their limited impact on educational policy and practice has been criticised. In this article, we analyse why systematic reviews do not benefit users of evidence more consistently and suggest how review teams…

  9. Systematic Review of the profile of emergency contraception users

    Directory of Open Access Journals (Sweden)

    Maria de Lluc Bauzà Amengual

    2016-01-01

    Full Text Available Abastract Objective: to discern the profile of the Spanish Emergency Contraceptive users (EC. Design: systematic review of contraceptive use in the Spanish population. Data Source: Spanish and international databases, between January 2006 - March 2011. Keywords: Contraceptives, Postcoital pills, emergency contraception, levonorgestrel, data collection. Study selection: original papers, letters to the editor in which stated aims were the description, prediction or measurement of variables related to EC use. Twenty-two papers were retrieved and fourteen were finally selected, all of which were descriptive. Data extraction: manuscripts were evaluated by two independent reviewers. Results: Women requesting EC have ages between 21-24 years, mostly single and university students; declare that they have not previously used EC, and attend an Emergency department, at weekends and within 48 hours following unprotected sexual intercourse. The reason is condom rupture. None of the studies reviewed measured alcohol and other drug consumption, the number of sexual partners, nor any of the studies performed a comparison with a group not using EC. Conclusions: lack of homogeneity and comprehensiveness of studied variables resulted in a limited profile of Spanish EC users. Further studies are needed with a more comprehensive approach if sexual health interventions are to be carried out in possible users.

  10. Computer Based Optimisation Rutines

    DEFF Research Database (Denmark)

    Dragsted, Birgitte; Olsen, Flemmming Ove

    1996-01-01

    In this paper the need for optimisation methods for the laser cutting process has been identified as three different situations. Demands on the optimisation methods for these situations are presented, and one method for each situation is suggested. The adaptation and implementation of the methods...

  11. Optimal Optimisation in Chemometrics

    NARCIS (Netherlands)

    Hageman, J.A.

    2004-01-01

    The use of global optimisation methods is not straightforward, especially for the more difficult optimisation problems. Solutions have to be found for items such as the evaluation function, representation, step function and meta-parameters, before any useful results can be obtained. This thesis aims

  12. Review of phase I and II trials for Wilms' tumour - Can we optimise the search for novel agents?

    DEFF Research Database (Denmark)

    Brok, Jesper; Pritchard-Jones, Kathy; Geller, James I

    2017-01-01

    %) and 13 patients stable disease (6%). None of the included novel biologically targeted therapies emerged as promising interventions, and only conventional chemotherapy was able to induce a complete and partial response. We conclude that early phase trial recruitment of WTs is below expected levels...

  13. Review and expectations of terror attack emergency rescue

    Directory of Open Access Journals (Sweden)

    De-wen WANG

    2012-03-01

    Full Text Available Ten years of anti-terror struggle since the 9/11 event has indicated adequately that terrorism is a global problem and international danger. Likewise, anti-terror emergency rescue is also an important task which will influence the safety and benefit of every country all over the world. This paper reviews the main progress and result of international anti-terror struggle in the last ten years, and also introduces the new characteristic of the international anti-terror activity. Besides that, this paper also brings forward the further consideration about the anti-terror emergency medical rescue and the researches remaining to be carried out. The latter includes: (1 to further perfect the high-efficient medical rescue command organization; (2 to further perfect the emergency medical rescue prearranged scheme; (3 to further perfect the construction of rescue system and rescue base after various types of terror attack; (4 to further promote the anti-terror consciousness in the public, and pay more attention to the prevention and investigation of the psychological disaster; (5 to further carry out the basic investigation on emergency medical rescue after various terror attack injuries (for example the types and characteristics of new injuries, pathophysiology and prevention and treatment of stress-psychological effect induced by terror attack, new high-efficient medical rescue measure and equipments, and so on.

  14. Teamwork Assessment Tools in Obstetric Emergencies: A Systematic Review.

    Science.gov (United States)

    Onwochei, Desire N; Halpern, Stephen; Balki, Mrinalini

    2017-06-01

    Team-based training and simulation can improve patient safety, by improving communication, decision making, and performance of team members. Currently, there is no general consensus on whether or not a specific assessment tool is better adapted to evaluate teamwork in obstetric emergencies. The purpose of this qualitative systematic review was to find the tools available to assess team effectiveness in obstetric emergencies. We searched Embase, Medline, PubMed, Web of Science, PsycINFO, CINAHL, and Google Scholar for prospective studies that evaluated nontechnical skills in multidisciplinary teams involving obstetric emergencies. The search included studies from 1944 until January 11, 2016. Data on reliability and validity measures were collected and used for interpretation. A descriptive analysis was performed on the data. Thirteen studies were included in the final qualitative synthesis. All the studies assessed teams in the context of obstetric simulation scenarios, but only six included anesthetists in the simulations. One study evaluated their teamwork tool using just validity measures, five using just reliability measures, and one used both. The most reliable tools identified were the Clinical Teamwork Scale, the Global Assessment of Obstetric Team Performance, and the Global Rating Scale of performance. However, they were still lacking in terms of quality and validity. More work needs to be conducted to establish the validity of teamwork tools for nontechnical skills, and the development of an ideal tool is warranted. Further studies are required to assess how outcomes, such as performance and patient safety, are influenced when using these tools.

  15. Enhanced Recovery after Emergency Surgery: A Systematic Review.

    Science.gov (United States)

    Paduraru, Mihai; Ponchietti, Luca; Casas, Isidro Martinez; Svenningsen, Peter; Zago, Mauro

    2017-04-01

    To evaluate the current scientific evidence for the applicability, safety and effectiveness of pathways of enhanced recovery after emergency surgery (ERAS). We undertook a search using PubMed and Cochrane databases for ERAS protocols in emergency cases. The search generated 65 titles; after eliminating the papers not meeting search criteria, we selected 4 cohort studies and 1 randomized clinical trial (RCT). Data extracted for analysis consisted of: patient age, type of surgery performed, ERAS elements implemented, surgical outcomes in terms of postoperative complications, mortality, length of stay (LOS) and readmission rate. The number of ERAS items applied was good, ranging from 11 to 18 of the 20 recommended by the ERAS Society. The implementation resulted in fewer postoperative complications. LOS for ES patients was shorter when compared to conventional care. Mortality, specifically reported in three studies, was equal or lower with ERAS. Readmission rates varied widely and were generally higher for the intervention group but without statistical significance. The studies reviewed agreed that ERAS in emergency surgery (ES) was feasible and safe with generally better outcomes. Lower compliance with some of the ERAS items shows the need for the protocol to be adapted to ES patients. More evidence is clearly required as to what can improve outcomes and how this can be formulated into an effective care pathway for the heterogeneous ES patient.

  16. Optimised Renormalisation Group Flows

    CERN Document Server

    Litim, Daniel F

    2001-01-01

    Exact renormalisation group (ERG) flows interpolate between a microscopic or classical theory and the corresponding macroscopic or quantum effective theory. For most problems of physical interest, the efficiency of the ERG is constrained due to unavoidable approximations. Approximate solutions of ERG flows depend spuriously on the regularisation scheme which is determined by a regulator function. This is similar to the spurious dependence on the ultraviolet regularisation known from perturbative QCD. Providing a good control over approximated ERG flows is at the root for reliable physical predictions. We explain why the convergence of approximate solutions towards the physical theory is optimised by appropriate choices of the regulator. We study specific optimised regulators for bosonic and fermionic fields and compare the optimised ERG flows with generic ones. This is done up to second order in the derivative expansion at both vanishing and non-vanishing temperature. An optimised flow for a ``proper-time ren...

  17. Quality Indicators for Evaluating Prehospital Emergency Care: A Scoping Review.

    Science.gov (United States)

    Howard, Ian; Cameron, Peter; Wallis, Lee; Castren, Maaret; Lindstrom, Veronica

    2018-02-01

    Introduction Historically, the quality and performance of prehospital emergency care (PEC) has been assessed largely based on surrogate, non-clinical endpoints such as response time intervals or other crude measures of care (eg, stakeholder satisfaction). However, advances in Emergency Medical Services (EMS) systems and services world-wide have seen their scope and reach continue to expand. This has dictated that novel measures of performance be implemented to compliment this growth. Significant progress has been made in this area, largely in the form of the development of evidence-informed quality indicators (QIs) of PEC. Problem Quality indicators represent an increasingly popular component of health care quality and performance measurement. However, little is known about the development of QIs in the PEC environment. The purpose of this study was to assess the development and characteristics of PEC-specific QIs in the literature. A scoping review was conducted through a search of PubMed (National Center for Biotechnology Information, National Institutes of Health; Bethesda, Maryland USA); EMBase (Elsevier; Amsterdam, Netherlands); CINAHL (EBSCO Information Services; Ipswich, Massachusetts USA); Web of Science (Thomson Reuters; New York, New York USA); and the Cochrane Library (The Cochrane Collaboration; Oxford, United Kingdom). To increase the sensitivity of the literature, a search of the grey literature and review of select websites was additionally conducted. Articles were selected that proposed at least one PEC QI and whose aim was to discuss, analyze, or promote quality measurement in the PEC environment. The majority of research (n=25 articles) was published within the last decade (68.0%) and largely originated within the USA (68.0%). Delphi and observational methodologies were the most commonly employed for QI development (28.0%). A total of 331 QIs were identified via the article review, with an additional 15 QIs identified via the website review. Of

  18. Simulation in Medical School Education: Review for Emergency Medicine

    Directory of Open Access Journals (Sweden)

    Shahram Lotfipour

    2011-05-01

    Full Text Available Medical education is rapidly evolving. With the paradigm shift to small-group didactic sessions and focus on clinically oriented case-based scenarios, simulation training has provided educators a novel way to deliver medical education in the 21st century. The field continues to expand in scope and practice and is being incorporated into medical school clerkship education, and specifically in emergency medicine (EM. The use of medical simulation in graduate medical education is well documented. Our aim in this article is to perform a retrospective review of the current literature, studying simulation use in EM medical student clerkships. Studies have demonstrated the effectiveness of simulation in teaching basic science, clinical knowledge, procedural skills, teamwork, and communication skills. As simulation becomes increasingly prevalent in medical school curricula, more studies are needed to assess whether simulation training improves patient-related outcomes.

  19. Multi-objective evolutionary optimisation for product design and manufacturing

    CERN Document Server

    2011-01-01

    Presents state-of-the-art research in the area of multi-objective evolutionary optimisation for integrated product design and manufacturing Provides a comprehensive review of the literature Gives in-depth descriptions of recently developed innovative and novel methodologies, algorithms and systems in the area of modelling, simulation and optimisation

  20. Developing and Optimising the Use of Logic Models in Systematic Reviews: Exploring Practice and Good Practice in the Use of Programme Theory in Reviews.

    Science.gov (United States)

    Kneale, Dylan; Thomas, James; Harris, Katherine

    2015-01-01

    Logic models are becoming an increasingly common feature of systematic reviews, as is the use of programme theory more generally in systematic reviewing. Logic models offer a framework to help reviewers to 'think' conceptually at various points during the review, and can be a useful tool in defining study inclusion and exclusion criteria, guiding the search strategy, identifying relevant outcomes, identifying mediating and moderating factors, and communicating review findings. In this paper we critique the use of logic models in systematic reviews and protocols drawn from two databases representing reviews of health interventions and international development interventions. Programme theory featured only in a minority of the reviews and protocols included. Despite drawing from different disciplinary traditions, reviews and protocols from both sources shared several limitations in their use of logic models and theories of change, and these were used almost unanimously to solely depict pictorially the way in which the intervention worked. Logic models and theories of change were consequently rarely used to communicate the findings of the review. Logic models have the potential to be an aid integral throughout the systematic reviewing process. The absence of good practice around their use and development may be one reason for the apparent limited utility of logic models in many existing systematic reviews. These concerns are addressed in the second half of this paper, where we offer a set of principles in the use of logic models and an example of how we constructed a logic model for a review of school-based asthma interventions.

  1. Review. Systems for prevention and control of epidemic emergencies

    Directory of Open Access Journals (Sweden)

    Paolo Calistri

    2013-09-01

    Full Text Available The development of early warning systems is fundamental for preventing the spread of infectious diseases. Data collection, however, is a costly activity and it is not possible to implement early warning systems everywhere and for all possible events. Hence, tools helping to improve the focus of surveillance efforts are of paramount importance. Risk assessment methods and other provisional modelling techniques may permit to estimate the probability of introduction and spread of infectious diseases in different geographical areas. Similarly, efficient information systems must be in place to assist the veterinary services in case of epidemic emergencies in order to support the prompt application of control measures for the containment of the infection and the reduction of the magnitude of negative consequences. This review describes two recent approaches to the estimation of the probability of introduction and spread of infectious diseases based on the use of risk maps/spatial modelling and Social Network Analysis (SNA techniques. The review also describes a web application developed in Italy to help official veterinary services to trace animals in case of outbreaks of infectious diseases.

  2. Frequent visitors at the psychiatric emergency room - A literature review.

    Science.gov (United States)

    Schmidt, Manuela

    2018-03-01

    Frequent visitors at the psychiatric emergency room (PER) constitute a small subgroup of patients, yet they are responsible for a disproportionate number of visits and thus claim considerable resources. Their needs are often left unmet and their repetitive visits reflect their dissatisfaction as well as that of PERs' staff. Motivated by these dilemmas, this study systematically reviews the literature about frequent visitors at PER and seeks to answer two questions: What characterizes frequent visitors at PER in the literature? and What characterizes PER in the literature? Based on 29 studies, this paper offers answers to the two questions based on a strength weakness opportunities and threats (SWOT) analysis. The results of the review and subsequent analysis of the literature revealed the multiplicity and complexity of frequent visitors' characteristics and how they appear to converge. Commonalities were more difficult to identify in PER characteristics. In some cases, this happened because the characteristics were poorly described or were context specific. As a result, it was not easy to compare the studies on PER. Based on SWOT and the findings of the analysis, the paper proposes new venues of research and suggests how the field of mental health might develop by taking into account its opportunities and threats.

  3. Emerging desalination technologies for water treatment: a critical review.

    Science.gov (United States)

    Subramani, Arun; Jacangelo, Joseph G

    2015-05-15

    In this paper, a review of emerging desalination technologies is presented. Several technologies for desalination of municipal and industrial wastewater have been proposed and evaluated, but only certain technologies have been commercialized or are close to commercialization. This review consists of membrane-based, thermal-based and alternative technologies. Membranes based on incorporation of nanoparticles, carbon nanotubes or graphene-based ones show promise as innovative desalination technologies with superior performance in terms of water permeability and salt rejection. However, only nanocomposite membranes have been commercialized while others are still under fundamental developmental stages. Among the thermal-based technologies, membrane distillation and adsorption desalination show the most promise for enhanced performance with the availability of a waste heat source. Several alternative technologies have also been developed recently; those based on capacitive deionization have shown considerable improvements in their salt removal capacity and feed water recovery. In the same category, microbial desalination cells have been shown to desalinate high salinity water without any external energy source, but to date, scale up of the process has not been methodically evaluated. In this paper, advantages and drawbacks of each technology is discussed along with a comparison of performance, water quality and energy consumption. Copyright © 2015 Elsevier Ltd. All rights reserved.

  4. Vaccine strategies: Optimising outcomes.

    Science.gov (United States)

    Hardt, Karin; Bonanni, Paolo; King, Susan; Santos, Jose Ignacio; El-Hodhod, Mostafa; Zimet, Gregory D; Preiss, Scott

    2016-12-20

    Successful immunisation programmes generally result from high vaccine effectiveness and adequate uptake of vaccines. In the development of new vaccination strategies, the structure and strength of the local healthcare system is a key consideration. In high income countries, existing infrastructures are usually used, while in less developed countries, the capacity for introducing new vaccines may need to be strengthened, particularly for vaccines administered beyond early childhood, such as the measles or human papillomavirus (HPV) vaccine. Reliable immunisation service funding is another important factor and low income countries often need external supplementary sources of finance. Many regions also obtain support in generating an evidence base for vaccination via initiatives created by organisations including World Health Organization (WHO), the Pan American Health Organization (PAHO), the Agence de Médecine Préventive and the Sabin Vaccine Institute. Strong monitoring and surveillance mechanisms are also required. An example is the efficient and low-cost approaches for measuring the impact of the hepatitis B control initiative and evaluating achievement of goals that have been established in the WHO Western Pacific region. A review of implementation strategies reveals differing degrees of success. For example, in the Americas, PAHO advanced a measles-mumps-rubella vaccine strategy, targeting different population groups in mass, catch-up and follow-up vaccination campaigns. This has had much success but coverage data from some parts of the region suggest that children are still not receiving all appropriate vaccines, highlighting problems with local service infrastructures. Stark differences in coverage levels are also observed among high income countries, as is the case with HPV vaccine implementation in the USA versus the UK and Australia, reflecting differences in delivery settings. Experience and research have shown which vaccine strategies work well and the

  5. Targeted exercise against osteoporosis: A systematic review and meta-analysis for optimising bone strength throughout life

    Directory of Open Access Journals (Sweden)

    Heinonen Ari

    2010-07-01

    Full Text Available Abstract Background Exercise is widely recommended to reduce osteoporosis, falls and related fragility fractures, but its effect on whole bone strength has remained inconclusive. The primary purpose of this systematic review and meta-analysis was to evaluate the effects of long-term supervised exercise (≥6 months on estimates of lower-extremity bone strength from childhood to older age. Methods We searched four databases (PubMed, Sport Discus, Physical Education Index, and Embase up to October 2009 and included 10 randomised controlled trials (RCTs that assessed the effects of exercise training on whole bone strength. We analysed the results by age groups (childhood, adolescence, and young and older adulthood and compared the changes to habitually active or sedentary controls. To calculate standardized mean differences (SMD; effect size, we used the follow-up values of bone strength measures adjusted for baseline bone values. An inverse variance-weighted random-effects model was used to pool the results across studies. Results Our quality analysis revealed that exercise regimens were heterogeneous; some trials were short in duration and small in sample size, and the weekly training doses varied considerably between trials. We found a small and significant exercise effect among pre- and early pubertal boys [SMD, effect size, 0.17 (95% CI, 0.02-0.32], but not among pubertal girls [-0.01 (-0.18 to 0.17], adolescent boys [0.10 (-0.75 to 0.95], adolescent girls [0.21 (-0.53 to 0.97], premenopausal women [0.00 (-0.43 to 0.44] or postmenopausal women [0.00 (-0.15 to 0.15]. Evidence based on per-protocol analyses of individual trials in children and adolescents indicated that programmes incorporating regular weight-bearing exercise can result in 1% to8% improvements in bone strength at the loaded skeletal sites. In premenopausal women with high exercise compliance, improvements ranging from 0.5% to 2.5% have been reported. Conclusions The findings

  6. Behaviour modification interventions to optimise red blood cell transfusion practices: a systematic review and meta-analysis.

    Science.gov (United States)

    Soril, Lesley J J; Noseworthy, Thomas W; Dowsett, Laura E; Memedovich, Katherine; Holitzki, Hannah M; Lorenzetti, Diane L; Stelfox, Henry Thomas; Zygun, David A; Clement, Fiona M

    2018-05-18

    To assess the impact of behaviour modification interventions to promote restrictive red blood cell (RBC) transfusion practices. Systematic review and meta-analysis. Seven electronic databases were searched to January 2018. Published randomised controlled trials (RCTs) or non-randomised studies examining an intervention to modify healthcare providers' RBC transfusion practice in any healthcare setting were included. The primary outcome was the proportion of patients transfused. Secondary outcomes included the proportion of inappropriate transfusions, RBC units transfused per patient, in-hospital mortality, length of stay (LOS), pretransfusion haemoglobin and healthcare costs. Meta-analysis was conducted using a random-effects model and meta-regression was performed in cases of heterogeneity. Publication bias was assessed by Begg's funnel plot. Eighty-four low to moderate quality studies were included: 3 were RCTs and 81 were non-randomised studies. Thirty-one studies evaluated a single intervention, 44 examined a multimodal intervention. The comparator in all studies was standard of care or historical control. In 33 non-randomised studies, use of an intervention was associated with reduced odds of transfusion (OR 0.63 (95% CI 0.56 to 0.71)), odds of inappropriate transfusion (OR 0.46 (95% CI 0.36 to 0.59)), RBC units/patient weighted mean difference (WMD: -0.50 units (95% CI -0.85 to -0.16)), LOS (WMD: -1.14 days (95% CI -2.12 to -0.16)) and pretransfusion haemoglobin (-0.28 g/dL (95% CI -0.48 to -0.08)). There was no difference in odds of mortality (OR 0.90 (95% CI 0.80 to 1.02)). Protocol/algorithm and multimodal interventions were associated with the greatest decreases in the primary outcome. There was high heterogeneity among estimates and evidence for publication bias. The literature examining the impact of interventions on RBC transfusions is extensive, although most studies are non-randomised. Despite this, pooled analysis of 33 studies revealed

  7. International entrepreneurship research in emerging economies : A critical review and research agenda

    NARCIS (Netherlands)

    Kiss, A.N.; Danis, W.D.; Cavusgil, S.T.

    This article systematically reviews and critically examines international entrepreneurship research in emerging economies (IEEE research), and articulates its importance, timeliness and relevance in consideration of the growing influence of emerging markets in the global economy. A systematic

  8. Optimising Magnetostatic Assemblies

    DEFF Research Database (Denmark)

    Insinga, Andrea Roberto; Smith, Anders

    theorem. This theorem formulates an energy equivalence principle with several implications concerning the optimisation of objective functionals that are linear with respect to the magnetic field. Linear functionals represent different optimisation goals, e.g. maximising a certain component of the field...... approached employing a heuristic algorithm, which led to new design concepts. Some of the procedures developed for linear objective functionals have been extended to non-linear objectives, by employing iterative techniques. Even though most the optimality results discussed in this work have been derived...

  9. Venous Thromboembolism Prevention in Emergency General Surgery: A Review.

    Science.gov (United States)

    Murphy, Patrick B; Vogt, Kelly N; Lau, Brandyn D; Aboagye, Jonathan; Parry, Neil G; Streiff, Michael B; Haut, Elliott R

    2018-05-01

    Venous thromboembolism (VTE) is the most preventable cause of morbidity and mortality in US hospitals, and approximately 2.5% of emergency general surgery (EGS) patients will be diagnosed with a VTE event. Emergency general surgery patients are at increased risk of morbidity and mortality because of the nature of acute surgical conditions and the challenges related to prophylaxis. MEDLINE, Embase, and the Cochrane Database of Collected Reviews were searched from January 1, 1990, through December 31, 2015. Nearly all operatively and nonoperatively treated EGS patients have a moderate to high risk of developing a VTE, and individual risk should be assessed at admission. Pharmacologic prophylaxis in the form of unfractionated or low-molecular-weight heparin should be considered unless an absolute contraindication, such as bleeding, exists. Patients should receive the first dose at admission to the hospital, and administration should continue until discharge without missed doses. Certain patient populations, such as those with malignant tumors, may benefit from prolonged VTE prophylaxis after discharge. Mechanical prophylaxis should be considered in all patients, particularly if pharmacologic prophylaxis is contraindicated. Studies that specifically target improved adherence with VTE prophylaxis in EGS patients suggest that efficacy and quality improvement initiatives should be undertaken from a system and institutional perspective. Operatively and nonoperatively treated EGS patients are at a comparatively high risk of VTE. Despite gaps in existing literature with respect to this increasing patient population, successful best practices can be applied. Best practices include assessment of VTE risk, optimal prophylaxis, and physician, nurse, and patient education regarding the use of mechanical and pharmacologic VTE prophylaxis and institutional policies.

  10. Economic evaluation of emergency obstetric care training: a systematic review.

    Science.gov (United States)

    Banke-Thomas, Aduragbemi; Wilson-Jones, Megan; Madaj, Barbara; van den Broek, Nynke

    2017-12-04

    Training healthcare providers in Emergency Obstetric Care (EmOC) has been shown to be effective in improving their capacity to provide this critical care package for mothers and babies. However, little is known about the costs and cost-effectiveness of such training. Understanding costs and cost-effectiveness is essential in guaranteeing value-for-money in healthcare spending. This study systematically reviewed the available literature on cost and cost-effectiveness of EmOC trainings. Peer-reviewed and grey literature was searched for relevant papers published after 1990. Studies were included if they described an economic evaluation of EmOC training and the training cost data were available. Two reviewers independently searched, screened, and selected studies that met the inclusion criteria, with disagreements resolved by a third reviewer. Quality of studies was assessed using the Consolidated Health Economic Evaluation Reporting Standards statement. For comparability, all costs in local currency were converted to International dollar (I$) equivalents using purchasing power parity conversion factors. The cost per training per participant was calculated. Narrative synthesis was used to summarise the available evidence on cost effectiveness. Fourteen studies (five full and nine partial economic evaluations) met the inclusion criteria. All five and two of the nine partial economic evaluations were of high quality. The majority of studies (13/14) were from low- and middle-income countries. Training equipment, per diems and resource person allowance were the most expensive components. Cost of training per person per day ranged from I$33 to I$90 when accommodation was required and from I$5 to I$21 when training was facility-based. Cost-effectiveness of training was assessed in 5 studies with differing measures of effectiveness (knowledge, skills, procedure cost and lives saved) making comparison difficult. Economic evaluations of EmOC training are limited. There is a

  11. A review of emerging technologies for food refrigeration applications

    International Nuclear Information System (INIS)

    Tassou, S.A.; Lewis, J.S.; Ge, Y.T.; Hadawey, A.; Chaer, I.

    2010-01-01

    Refrigeration has become an essential part of the food chain. It is used in all stages of the chain, from food processing, to distribution, retail and final consumption in the home. The food industry employs both chilling and freezing processes where the food is cooled from ambient to temperatures above 0 deg. C in the former and between -18 deg. C and -35 deg. C in the latter to slow the physical, microbiological and chemical activities that cause deterioration in foods. In these processes mechanical refrigeration technologies are invariably employed that contribute significantly to the environmental impacts of the food sector both through direct and indirect greenhouse gas emissions. To reduce these emissions, research and development worldwide is aimed at both improving the performance of conventional systems and the development of new refrigeration technologies of potentially much lower environmental impacts. This paper provides a brief review of both current state of the art technologies and emerging refrigeration technologies that have the potential to reduce the environmental impacts of refrigeration in the food industry. The paper also highlights research and development needs to accelerate the development and adoption of these technologies by the food sector.

  12. Review of risk from potential emerging contaminants in UK groundwater.

    Science.gov (United States)

    Stuart, Marianne; Lapworth, Dan; Crane, Emily; Hart, Alwyn

    2012-02-01

    This paper provides a review of the types of emerging organic groundwater contaminants (EGCs) which are beginning to be found in the UK. EGCs are compounds being found in groundwater that were previously not detectable or known to be significant and can come from agricultural, urban and rural point sources. EGCs include nanomaterials, pesticides, pharmaceuticals, industrial compounds, personal care products, fragrances, water treatment by-products, flame retardants and surfactants, as well as caffeine and nicotine. Many are relatively small polar molecules which may not be effectively removed by drinking water treatment. Data from the UK Environment Agency's groundwater screening programme for organic pollutants found within the 30 most frequently detected compounds a number of EGCs such as pesticide metabolites, caffeine and DEET. Specific determinands frequently detected include pesticides metabolites, pharmaceuticals including carbamazepine and triclosan, nicotine, food additives and alkyl phosphates. This paper discusses the routes by which these compounds enter groundwater, their toxicity and potential risks to drinking water and the environment. It identifies challenges that need to be met to minimise risk to drinking water and ecosystems. Copyright © 2012. Published by Elsevier B.V.

  13. Emerging contaminants in Indian environmental matrices - A review.

    Science.gov (United States)

    Philip, Jeeva M; Aravind, Usha K; Aravindakumar, Charuvila T

    2018-01-01

    The emergence of issues related to environment from ECs is a topic under serious discussions worldwide in recent years. Indian scenario is not an exception as it is tremendously growing in its rate of production and consumption of compounds belongs to ECs categories. However, a comprehensive documentation on the occurrence of ECs and consequent ARGs as well as their toxic effects on vertebrates on Indian context is still lacking. In the present study, an extensive literature survey was carried out to get an idea on the geographical distribution of ECs in various environmental matrices (water, air, soil, sediment and sludge) and biological samples by dividing the entire subcontinent into six zones based on climatic, geographical and cultural features. A comprehensive assessment of the toxicological effects of ECs and the consequent antibiotic resistant genes has been included. It is found that studies on the screening of ECs are scarce and concentrated in certain geological locations. A total of 166 individual compounds belonging to 36 categories have been reported so far. Pharmaceuticals and drugs occupy the major share in these compounds followed by PFASs, EDCs, PCPs, ASWs and flame retardants. This review throws light on the alarming situation in India where the highest ever reported values of concentrations of some of these compounds are from India. This necessitates a national level monitoring system for ECs in order to assess the magnitude of environmental risks posed by these compounds. Copyright © 2017 Elsevier Ltd. All rights reserved.

  14. Review article: Methodology for the 'rapid review' series on musculoskeletal injuries in the emergency department.

    Science.gov (United States)

    Strudwick, Kirsten; McPhee, Megan; Bell, Anthony; Martin-Khan, Melinda; Russell, Trevor

    2018-02-01

    Musculoskeletal injuries are a common presentation to the ED, with significant costs involved in the management of these injuries, variances in care within the ED and associated morbidity. A series of rapid review papers were completed to guide best practice for the assessment and management of common musculoskeletal injuries presenting to the ED. This paper presents the methodology used across the rapid reviews. PubMed, CINAHL, EMBASE, TRIP and the grey literature, including relevant organisational websites, were searched in 2015. The search was repeated consistently for each topic area (injuries of the foot and ankle, knee, hand and wrist, elbow, shoulder, lumbar spine and cervical spine). English-language primary studies, systematic reviews and guidelines that were published in the last 10 years and addressed acute musculoskeletal injury management were considered for inclusion. Data extraction of each included article was conducted, followed by a quality appraisal. The extracted data from each article was synthesised to group similar evidence together. For each rapid review, the evidence has been organised in a way that a clinician can direct their attention to a specific component of the clinical cycle of care in the ED, such as the assessment, diagnostic tests, management and follow-up considerations from ED. The series of rapid reviews are designed to foster evidence-based practice within the ED, targeting the injuries most commonly presenting. The reviews provide clinicians in EDs with rapid access to the best current evidence, which has been synthesised and organised to assist decision-making. © 2017 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  15. Incentivizing health care behaviors in emerging adults: a systematic review

    Directory of Open Access Journals (Sweden)

    Yu CH

    2016-03-01

    Full Text Available Catherine H Yu,1,2 Giuliana Guarna,1 Pamela Tsao,3 Jude R Jesuthasan,1 Adrian NC Lau,3,4 Ferhan S Siddiqi,1 Julie Anne Gilmour,3 Danyal Ladha,1 Henry Halapy,5 Andrew Advani1–3 1Li Ka Shing Knowledge Institute, St Michael’s Hospital, 2Division of Endocrinology and Metabolism, Department of Medicine, St Michael’s Hospital, University of Toronto, 3Department of Medicine, Faculty of Medicine, University of Toronto, 4Division of Endocrinology, Department of Medicine, University Health Network, 5Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada Purpose: For emerging adults with chronic medical diseases, the transition from pediatric to adult health care is often a time of great upheaval, commonly associated with unhealthy self-management choices, loss to follow-up, and adverse outcomes. We conducted a systematic review to examine the use of incentive strategies to promote positive health-related behaviors in young adults with chronic medical diseases.Methods: The Medline, CINAHL, Embase, PsycInfo, and Cochrane databases were searched through June 2014. Studies of any design where an incentive was used to achieve a target behavior or outcome in a pediatric or emerging adult population (age <30 years with chronic medical conditions including addictions, were included.Results: A total of 26 studies comprising 10,880 patients met our inclusion criteria after screening 10,305 abstracts and 301 full-text articles. Of these studies, 20 examined the effects of behavioral incentives on cigarette smoking or substance abuse, including alcohol; four studies explored behavioral incentives in the setting of HIV or sexual health; and two articles studied individuals with other chronic medical conditions. Seventeen articles reported a statistically significant benefit of the behavioral incentive on one or more outcomes, although only half reported follow-up after the incentive period was terminated.Conclusion: While the majority of

  16. Review article: A systematic review of emergency department incident classification frameworks.

    Science.gov (United States)

    Murray, Matthew; McCarthy, Sally

    2017-10-11

    As in any part of the hospital system, safety incidents can occur in the ED. These incidents arguably have a distinct character, as the ED involves unscheduled flows of urgent patients who require disparate services. To aid understanding of safety issues and support risk management of the ED, a comparison of published ED specific incident classification frameworks was performed. A review of emergency medicine, health management and general medical publications, using Ovid SP to interrogate Medline (1976-2016) was undertaken to identify any type of taxonomy or classification-like framework for ED related incidents. These frameworks were then analysed and compared. The review identified 17 publications containing an incident classification framework. Comparison of factors and themes making up the classification constituent elements revealed some commonality, but no overall consistency, nor evolution towards an ideal framework. Inconsistency arises from differences in the evidential basis and design methodology of classifications, with design itself being an inherently subjective process. It was not possible to identify an 'ideal' incident classification framework for ED risk management, and there is significant variation in the selection of categories used by frameworks. The variation in classification could risk an unbalanced emphasis in findings through application of a particular framework. Design of an ED specific, ideal incident classification framework should be informed by a much wider range of theories of how organisations and systems work, in addition to clinical and human factors. © 2017 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  17. Review article: Staff perception of the emergency department working environment: Integrative review of the literature

    Science.gov (United States)

    Abraham, Louisa; Greenslade, Jaimi; Thom, Ogilvie; Carlstrom, Eric; Wallis, Marianne; Crilly, Julia

    2016-01-01

    Abstract Employees in EDs report increasing role overload because of critical staff shortages, budgetary cuts and increased patient numbers and acuity. Such overload could compromise staff satisfaction with their working environment. This integrative review identifies, synthesises and evaluates current research around staff perceptions of the working conditions in EDs. A systematic search of relevant databases, using MeSH descriptors ED/EDs, Emergency room/s, ER/s, or A&E coupled with (and) working environment, working condition/s, staff perception/s, as well as reference chaining was conducted. We identified 31 key studies that were evaluated using the mixed methods assessment tool (MMAT). These comprised 24 quantitative‐descriptive studies, four mixed descriptive/comparative (non‐randomised controlled trial) studies and three qualitative studies. Studies included varied widely in quality with MMAT scores ranging from 0% to 100%. A key finding was that perceptions of working environment varied across clinical staff and study location, but that high levels of autonomy and teamwork offset stress around high pressure and high volume workloads. The large range of tools used to assess staff perception of working environment limits the comparability of the studies. A dearth of intervention studies around enhancing working environments in EDs limits the capacity to recommend evidence‐based interventions to improve staff morale. © 2016 The Authors. Emergency Medicine Australasia published by John Wiley & Sons Australia, Ltd on behalf of Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine PMID:26784282

  18. 75 FR 52753 - Agency Recordkeeping/Reporting Requirements Under Emergency Review by the Office of Management...

    Science.gov (United States)

    2010-08-27

    ... therefore submitting a revised data collection form for emergency clearance. The definition of subsidized... Recordkeeping/Reporting Requirements Under Emergency Review by the Office of Management and Budget (OMB) Title: TANF Emergency Fund Subsidized Employment Report, Form OFA- 200. OMB No.: New Collection. Description...

  19. 75 FR 32473 - Agency Recordkeeping/Reporting Requirements Under Emergency Review by the Office of Management...

    Science.gov (United States)

    2010-06-08

    ... a TANF Emergency Fund award. The definition of subsidized employment used for this collection is the... Recordkeeping/Reporting Requirements Under Emergency Review by the Office of Management and Budget (OMB) Title: TANF Emergency Fund Subsidized Employment Report, Form OFA 200. OMB No.: New Collection. Description...

  20. Review of current neutron detection systems for emergency response

    Science.gov (United States)

    Mukhopadhyay, Sanjoy; Maurer, Richard; Guss, Paul; Kruschwitz, Craig

    2014-09-01

    Neutron detectors are used in a myriad of applications—from safeguarding special nuclear materials (SNM) to determining lattice spacing in soft materials. The transformational changes taking place in neutron detection and imaging techniques in the last few years are largely being driven by the global shortage of helium-3 (3He). This article reviews the status of neutron sensors used specifically for SNM detection in radiological emergency response. These neutron detectors must be highly efficient, be rugged, have fast electronics to measure neutron multiplicity, and be capable of measuring direction of the neutron sources and possibly image them with high spatial resolution. Neutron detection is an indirect physical process: neutrons react with nuclei in materials to initiate the release of one or more charged particles that produce electric signals that can be processed by the detection system. Therefore, neutron detection requires conversion materials as active elements of the detection system; these materials may include boron-10 (10B), lithium-6 (6Li), and gadollinium-157 (157Gd), to name a few, but the number of materials available for neutron detection is limited. However, in recent years, pulse-shape-discriminating plastic scintillators, scintillators made of helium-4 (4He) under high pressure, pillar and trench semiconductor diodes, and exotic semiconductor neutron detectors made from uranium oxide and other materials have widely expanded the parameter space in neutron detection methodology. In this article we will pay special attention to semiconductor-based neutron sensors. Modern microfabricated nanotubes covered inside with neutron converter materials and with very high aspect ratios for better charge transport will be discussed.

  1. Development and verification for review plan of emergency action level (EAL)

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2013-08-15

    Emergency action levels (EALs) are used as the trigger in order to implement the precautionary protective actions at the nuclear emergency. In this study the framework for applying the EAL in Japan and the process for developing the review plan, such as procedures to review the basis of EAL submitted by the licensee, have been investigated based on the survey for EAL review executed in the United States. In addition, issues to reflect the EAL framework in enhancement of the local government emergency planning and emergency response support system have been investigated. (author)

  2. Serious Games as Experiments for Emergency Management Research : A Review

    NARCIS (Netherlands)

    Van Ruijven, T.W.J.

    2011-01-01

    Serious games and virtual environments are increasingly used for emergency management training and research. The development of these technologies seems to contribute to a solution to some problems in the existing literature on emergency management which is mainly based on case study research.

  3. Optimisation of radiation protection

    International Nuclear Information System (INIS)

    1988-01-01

    Optimisation of radiation protection is one of the key elements in the current radiation protection philosophy. The present system of dose limitation was issued in 1977 by the International Commission on Radiological Protection (ICRP) and includes, in addition to the requirements of justification of practices and limitation of individual doses, the requirement that all exposures be kept as low as is reasonably achievable, taking social and economic factors into account. This last principle is usually referred to as optimisation of radiation protection, or the ALARA principle. The NEA Committee on Radiation Protection and Public Health (CRPPH) organised an ad hoc meeting, in liaison with the NEA committees on the safety of nuclear installations and radioactive waste management. Separate abstracts were prepared for individual papers presented at the meeting

  4. Optimisation by hierarchical search

    Science.gov (United States)

    Zintchenko, Ilia; Hastings, Matthew; Troyer, Matthias

    2015-03-01

    Finding optimal values for a set of variables relative to a cost function gives rise to some of the hardest problems in physics, computer science and applied mathematics. Although often very simple in their formulation, these problems have a complex cost function landscape which prevents currently known algorithms from efficiently finding the global optimum. Countless techniques have been proposed to partially circumvent this problem, but an efficient method is yet to be found. We present a heuristic, general purpose approach to potentially improve the performance of conventional algorithms or special purpose hardware devices by optimising groups of variables in a hierarchical way. We apply this approach to problems in combinatorial optimisation, machine learning and other fields.

  5. Health effects of training laypeople to deliver emergency care in underserviced populations: a systematic review protocol

    OpenAIRE

    Orkin, Aaron M; Curran, Jeffrey D; Fortune, Melanie K; McArthur, Allison; Mew, Emma J; Ritchie, Stephen D; Van de Velde, Stijn; VanderBurgh, David

    2016-01-01

    Introduction The Disease Control Priorities Project recommends emergency care training for laypersons in low-resource settings, but evidence for these interventions has not yet been systematically reviewed. This review will identify the individual and community health effects of educating laypeople to deliver prehospital emergency care interventions in low-resource settings. Methods and analysis This systematic review addresses the following question: in underserviced populations and low-reso...

  6. Urological Emergency Admissions to a Community Hospital: A Review

    Science.gov (United States)

    Atkins, Sam O.

    1983-01-01

    A one-year study was conducted on the impact of emergency admissions to the 125-bed Southwest Community Hospital in Atlanta, Georgia. During the study in 1979, 70 urological emergency room admissions were made, of which 44 (62.8 percent) were males and 26 (37.2 percent) were females. In comparison, 93 admissions were made directly from the private office. The study considered the timeliness of diagnosis and treatment, surgical procedures performed, impact on urological emergency room nursing and medical personnel, physician response to notification, cost containment, and implied legal ramifications and organization structure. Thus, an immediate close scrutiny of urological emergency admission at the nonuniversity affiliated Southwest Community Hospital was permitted. PMID:6876189

  7. Advanced optimisation - coal fired power plant operations

    Energy Technology Data Exchange (ETDEWEB)

    Turney, D.M.; Mayes, I. [E.ON UK, Nottingham (United Kingdom)

    2005-03-01

    The purpose of this unit optimization project is to develop an integrated approach to unit optimisation and develop an overall optimiser that is able to resolve any conflicts between the individual optimisers. The individual optimisers have been considered during this project are: on-line thermal efficiency package, GNOCIS boiler optimiser, GNOCIS steam side optimiser, ESP optimisation, and intelligent sootblowing system. 6 refs., 7 figs., 3 tabs.

  8. Optimisation in radiotherapy II: Programmed and inversion optimisation algorithms

    International Nuclear Information System (INIS)

    Ebert, M.

    1997-01-01

    This is the second article in a three part examination of optimisation in radiotherapy. The previous article established the bases of optimisation in radiotherapy, and the formulation of the optimisation problem. This paper outlines several algorithms that have been used in radiotherapy, for searching for the best irradiation strategy within the full set of possible strategies. Two principle classes of algorithm are considered - those associated with mathematical programming which employ specific search techniques, linear programming type searches or artificial intelligence - and those which seek to perform a numerical inversion of the optimisation problem, finishing with deterministic iterative inversion. (author)

  9. Optimisation of X-ray examinations: General principles and an Irish perspective

    International Nuclear Information System (INIS)

    Matthews, Kate; Brennan, Patrick C.

    2009-01-01

    In Ireland, the European Medical Exposures Directive [Council Directive 97/43] was enacted into national law in Statutory Instrument 478 of 2002. This series of three review articles discusses the status of justification and optimisation of X-ray examinations nationally, and progress with the establishment of Irish diagnostic reference levels. In this second article, literature relating to optimisation issues arising in SI 478 of 2002 is reviewed. Optimisation associated with X-ray equipment and optimisation during day-to-day practice are considered. Optimisation proposals found in published research are summarised, and indicate the complex nature of optimisation. A paucity of current, research-based guidance documentation is identified. This is needed in order to support a range of professional staff in their practical implementation of optimisation.

  10. Optimisation of monochrome images

    International Nuclear Information System (INIS)

    Potter, R.

    1983-01-01

    Gamma cameras with modern imaging systems usually digitize the signals to allow storage and processing of the image in a computer. Although such computer systems are widely used for the extraction of quantitative uptake estimates and the analysis of time variant data, the vast majority of nuclear medicine images is still interpreted on the basis of an observer's visual assessment of a photographic hardcopy image. The optimisation of hardcopy devices is therefore vital and factors such as resolution, uniformity, noise grey scales and display matrices are discussed. Once optimum display parameters have been determined, routine procedures for quality control need to be established; suitable procedures are discussed. (U.K.)

  11. Hantaviruses: an emerging public health threat in India? A review

    Indian Academy of Sciences (India)

    PRAKASH KUMAR

    is to increase awareness of these emerging pathogens and the threats they pose to the public health system. [Chandy S, Abraham P and ..... distribution of the hosts through international shipping routes. The majority of SEOV-related .... Dalrymple J M 1994 Serological relationships among viruses in the Hantavirus genus, ...

  12. Results of the 2010 IGSC Topical Session on Optimisation

    International Nuclear Information System (INIS)

    Bailey, Lucy

    2014-01-01

    topical session reflected the diversity of optimisation goals that may be pursued in the framework of a geological disposal programme. While optimisation of protection, as defined by ICRP, is regarded as a process to keep the magnitude of individual doses, the number of people exposed, and the likelihood of potential exposure as low as reasonably achievable with economic and social factors being taken into account, optimisation can also be seen as a way of increasing the technical quality and robustness of the whole waste management process. An optimal solution means addressing safety requirements whilst balancing other factors such as the need to use resources efficiently, political and acceptance issues and any other boundary conditions imposed by society. It was noted that optimisation variables are not well defined and could be quite programme-specific. However, the discussion showed a lot of agreement and consensus of views. In particular, the summary noted general agreement on the following points: - Optimisation is a process that can be checked and reviewed and needs to be transparent. Optimisation is therefore a learning process, and as such can contribute to building confidence in the safety case by the demonstration of ongoing learning across the organisation. - Optimisation occurs at each stage of the disposal facility development programme, and is therefore forward looking rather than focussed on re-examining past decisions. Optimisation should be about the right way forward at each stage, making the best decisions to move forward from the present situation based on current knowledge and understanding. - Regulators need to be clear about their requirements and these requirements become constraints on the optimisation process, together with any societal constraints that may be applied in certain programmes. Optimisation therefore requires a permanent dialogue between regulator and implementer. - Once the safety objectives (dose/risk targets and other

  13. 76 FR 2198 - Agency Information Collection: Emergency Submission for OMB Review; Comment Request

    Science.gov (United States)

    2011-01-12

    ... organizations; and other stakeholders to reach out, engender trust, reduce stigma, and encourage our Nation's... are experiencing mental health crises and provide confident and trustworthy counseling. To be... Collection: Emergency Submission for OMB Review; Comment Request AGENCY: Veterans Health Administration...

  14. Systematic Review Methodology for the Fatigue in Emergency Medical Services Project

    Science.gov (United States)

    2018-01-11

    Background: Guidance for managing fatigue in the Emergency Medical Services (EMS) setting is limited. The Fatigue in EMS Project sought to complete multiple systematic reviews guided by seven explicit research questions, assemble the best available e...

  15. Use of telehealth in the management of non-critical emergencies in rural or remote emergency departments: a systematic review.

    Science.gov (United States)

    du Toit, Marie; Malau-Aduli, Bunmi; Vangaveti, Venkat; Sabesan, Sabe; Ray, Robin A

    2017-01-01

    Background Telehealth has been used extensively in emergency departments to improve healthcare provision. However, its impact on the management of non-critical emergency presentations within rural and remote emergency department settings has not been adequately explored. The objective of this systematic review is to identify how telehealth has been used to assist in the management of non-critical presentations in rural and remote emergency departments and the outcomes. Methods Articles were identified through database searches of CINAHL, Cochrane, MEDLINE (OVID), Informit and SCOPUS, as well as the screening of relevant article reference and citation lists. To determine how telehealth can assist in the management of non-critical emergencies, information was extracted relating to telehealth programme model, the scope of service and participating health professionals. The outcomes of telehealth programmes were determined by analysing the uptake and usage of telehealth, the impact on altering a diagnosis or management plan as well as patient disposition including patient transfer, discharge, local hospital admission and rates of discharge against medical advice. Results Of the 2532 identified records, 15 were found to match the eligibility criteria and were included in the review. Uptake and usage increased for telehealth programmes predominantly utilised by nursing staff with limited local medical support. Teleconsultation conservatively altered patient diagnosis or management in 18-66% of consultations. Although teleconsultation was associated with increased patient transfer rates, unnecessary transfers were reduced. Simultaneously, an increase in local hospital admission was noted and fewer patients were discharged home. Discharge against medical advice rates were low at 0.9-1.1%. Conclusion The most widely implemented hub-and-spoke telehealth model could be incorporated into existing referral frameworks. Telehealth programmes may assist in reducing unnecessary

  16. Beam position optimisation for IMRT

    International Nuclear Information System (INIS)

    Holloway, L.; Hoban, P.

    2001-01-01

    Full text: The introduction of IMRT has not generally resulted in the use of optimised beam positions because to find the global solution of the problem a time consuming stochastic optimisation method must be used. Although a deterministic method may not achieve the global minimum it should achieve a superior dose distribution compared to no optimisation. This study aimed to develop and test such a method. The beam optimisation method developed relies on an iterative process to achieve the desired number of beams from a large initial number of beams. The number of beams is reduced in a 'weeding-out' process based on the total fluence which each beam delivers. The process is gradual, with only three beams removed each time (following a small number of iterations), ensuring that the reduction in beams does not dramatically affect the fluence maps of those remaining. A comparison was made between the dose distributions achieved when the beams positions were optimised in this fashion and when the beams positions were evenly distributed. The method has been shown to work quite effectively and efficiently. The Figure shows a comparison in dose distribution with optimised and non optimised beam positions for 5 beams. It can be clearly seen that there is an improvement in the dose distribution delivered to the tumour and a reduction in the dose to the critical structure with beam position optimisation. A method for beam position optimisation for use in IMRT optimisations has been developed. This method although not necessarily achieving the global minimum in beam position still achieves quite a dramatic improvement compared with no beam position optimisation and is very efficiently achieved. Copyright (2001) Australasian College of Physical Scientists and Engineers in Medicine

  17. The efficacy of education in emergency-urgency: a review

    Directory of Open Access Journals (Sweden)

    Cristina Cunsolo

    2008-12-01

    Full Text Available After a course of Basic Lift Support, Nurses and Doctors skills retention decline if not used over time. Studies have suggest that methods need to be evaluated and refined to improve practice. A more detailed assessment toll is needed to determine the effectiveness of an educational intervention in providing the best skill acquisition and retention attainable. This review of literature examines factors that enhance retention of knowledge and skill during and after resuscitation training. In order to identify educational strategies that will optimize current practices and suggest the application of the experiential theory of learning to Basic Life Support. The review was undertaken using PUBMED, EMBASE and EBM Reviews – Cochrane Central Register of Controlled Trials. Additional references were also reviewed from the bibliographies and from citation searches on key articles. Those published that identified strategies to enhance the acquisition or retention of cardiopulmonary resuscitation skill and knowledge were included in the review. Review showed that templates should be introduced for research or evaluation of educational interventions designed to improve resuscitation performance. Resuscitation training should be based on in-hospital scenarios and current evidence-based guidelines. Video instruction and new technologies has been shown to improve competence in resuscitation. The research findings suggest the need for an evaluation of the use and effects of cognitive instructional strategies and new technologies in CPR training courses on transfer ok skill and knowledge to practice.

  18. A Systematic Literature Review: Workplace Violence Against Emergency Medical Services Personnel

    OpenAIRE

    Pourshaikhian, Majid; Abolghasem Gorji, Hassan; Aryankhesal, Aidin; Khorasani-Zavareh, Davood; Barati, Ahmad

    2016-01-01

    Context In spite of the high prevalence and consequences of much workplace violence against emergency medical services personnel, this phenomenon has been given insufficient attention. A systematic review can aid the development of guidelines to reduce violence. Objectives The research question addressed by this paper is, “What are the characteristics and findings of studies on workplace violence against emergency medical services...

  19. Automatic optimisation of gamma dose rate sensor networks: The DETECT Optimisation Tool

    DEFF Research Database (Denmark)

    Helle, K.B.; Müller, T.O.; Astrup, Poul

    2014-01-01

    of the EU FP 7 project DETECT. It evaluates the gamma dose rates that a proposed set of sensors might measure in an emergency and uses this information to optimise the sensor locations. The gamma dose rates are taken from a comprehensive library of simulations of atmospheric radioactive plumes from 64......Fast delivery of comprehensive information on the radiological situation is essential for decision-making in nuclear emergencies. Most national radiological agencies in Europe employ gamma dose rate sensor networks to monitor radioactive pollution of the atmosphere. Sensor locations were often...... source locations. These simulations cover the whole European Union, so the DOT allows evaluation and optimisation of sensor networks for all EU countries, as well as evaluation of fencing sensors around possible sources. Users can choose from seven cost functions to evaluate the capability of a given...

  20. 78 FR 11160 - Submission for OMB Emergency Review

    Science.gov (United States)

    2013-02-15

    ... additional human resources available to districts that are implementing the Department of Education's School... Management and Budget (OMB) for review and clearance in accordance with the Paperwork Reduction Act of 1995... over the past several months to develop a strategic partnership that leverages strengths of both...

  1. Parasites and cancer: a review of the emergence of protozoan ...

    African Journals Online (AJOL)

    The role of infectious agents in the formation of cancers has been long established. However the bulk of the emphasis has been on oncogenic DNA viruses and to a lesser extent, bacteria. However,amidst parasites, only a few metazoans have been linked to cancer, and with feeble molecular bases. This review explores the ...

  2. Optimisation of occupational exposure

    International Nuclear Information System (INIS)

    Webb, G.A.M.; Fleishman, A.B.

    1982-01-01

    The general concept of the optimisation of protection of the public is briefly described. Some ideas being developed for extending the cost benefit framework to include radiation workers with full implementation of the ALARA criterion are described. The role of cost benefit analysis in radiological protection and the valuation of health detriment including the derivation of monetary values and practical implications are discussed. Cost benefit analysis can lay out for inspection the doses, the associated health detriment costs and the costs of protection for alternative courses of action. However it is emphasised that the cost benefit process is an input to decisions on what is 'as low as reasonably achievable' and not a prescription for making them. (U.K.)

  3. Review article: Workplace violence in the emergency department: A systematic review and meta analysis.

    Science.gov (United States)

    Nikathil, Shradha; Olaussen, Alexander; Gocentas, Robert A; Symons, Evan; Mitra, Biswadev

    2017-06-01

    Patient or visitor perpetrated workplace violence (WPV) has been reported to be a common occurrence within the ED. No universal definition of violence or recording of such events exists. In addition ED staff are often reluctant to report violent incidents. The true incidence of WPV is therefore unclear. This systematic review aimed to quantify WPV in EDs. The association of WPV to drug and alcohol exposure was explored. The databases MEDLINE, Embase, PsycInfo and the Cochrane Library were searched from their commencement to 10 March 2016. MeSH terms and text words for ED, violence and aggression were combined. A meta-analysis was conducted on the primary outcome variable-proportion of violent patients among total ED presentations. A secondary meta-analysis used studies reporting on proportion of drug and alcohol affected patients occurring within the violent population. The search yielded a total of 8720 records. A total of 7235 were unique and underwent abstract screening. A total of 22 studies were deemed relevant according to inclusion and exclusion criteria. Retrospective study design predominated, analysing mainly security records and incident reports. The rates of violence from individual studies ranged from 1 incident to 172 incidents per 10 000 presentations. The pooled incidence suggests there are 36 violent patients for every 10 000 presentations to the ED (95% confidence interval 0.0030-0.0043). WPV in the ED was commonly reported. There is wide heterogeneity across the study methodology, definitions and rates. More standardised recording and reporting may inform preventive measures and highlight effective management strategies. © 2017 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  4. Standardised approach to optimisation

    International Nuclear Information System (INIS)

    Warren-Forward, Helen M.; Beckhaus, Ronald

    2004-01-01

    Optimisation of radiographic images is said to have been obtained if the patient has achieved an acceptable level of dose and the image is of diagnostic value. In the near future, it will probably be recommended that radiographers measure patient doses and compare them to reference levels. The aim of this paper is to describe a standardised approach to optimisation of radiographic examinations in a diagnostic imaging department. A three-step approach is outlined with specific examples for some common examinations (chest, abdomen, pelvis and lumbar spine series). Step One: Patient doses are calculated. Step Two: Doses are compared to existing reference levels and the technique used compared to image quality criteria. Step Three: Appropriate action is taken if doses are above the reference level. Results: Average entrance surface doses for two rooms were as follows AP Abdomen (6.3mGy and 3.4mGy); AP Lumbar Spine (6.4mGy and 4.1mGy) for AP Pelvis (4.8mGy and 2.6mGy) and PA chest (0.19mGy and 0.20mGy). Comparison with the Commission of the European Communities (CEC) recommended techniques identified large differences in the applied potential. The kVp values in this study were significantly lower (by up to lOkVp) than the CEC recommendations. The results of this study have indicated that there is a need to monitor radiation doses received by patients undergoing diagnostic radiography examinations. Not only has the assessment allowed valuable comparison with International Diagnostic Reference Levels and Radiography Good Practice but has demonstrated large variations in mean doses being delivered from different rooms of the same radiology department. Following the simple 3-step approach advocated in this paper should either provide evidence that department are practising the ALARA principle or assist in making suitable changes to current practice. Copyright (2004) Australian Institute of Radiography

  5. A qualitative study of institutional review board members' experience reviewing research proposals using emergency exception from informed consent.

    Science.gov (United States)

    McClure, Katie B; Delorio, Nicole M; Schmidt, Terri A; Chiodo, Gary; Gorman, Paul

    2007-05-01

    Emergency exception to informed consent regulation was introduced to provide a venue to perform research on subjects in emergency situations before obtaining informed consent. For a study to proceed, institutional review boards (IRBs) need to determine if the regulations have been met. To determine IRB members' experience reviewing research protocols using emergency exception to informed consent. This qualitative research used semistructured telephone interviews of 10 selected IRB members from around the US in the fall of 2003. IRB members were chosen as little is known about their views of exception to consent, and part of their mandate is the protection of human subjects in research. Interview questions focused on the length of review process, ethical and legal considerations, training provided to IRB members on the regulations, and experience using community consultation and notification. Content analysis was performed on the transcripts of interviews. To ensure validity, data analysis was performed by individuals with varying backgrounds: three emergency physicians, an IRB member and a layperson. Respondents noted that: (1) emergency exception to informed consent studies require lengthy review; (2) community consultation and notification regulations are vague and hard to implement; (3) current regulations, if applied correctly, protect human subjects; (4) legal counsel is an important aspect of reviewing exception to informed-consent protocols; and (5) IRB members have had little or no formal training in these regulations, but are able to access materials needed to review such protocols. This preliminary study suggests that IRB members find emergency exception to informed consent studies take longer to review than other protocols, and that community consultation and community notification are the most difficult aspect of the regulations with which to comply but that they adequately protect human subjects.

  6. Port economics, policy and management : review of an emerging research field

    NARCIS (Netherlands)

    Pallis, A.A.; Vitsounis, T.K.; Langen, de P.W.

    2010-01-01

    This paper reviews research in port economics, policy and management during the period 1997-2008. In an increasingly international economy, research interest in ports is gradually emerging. This paper examines the developments, themes and characteristics of this research, by reviewing a

  7. Validity of helicopter emergency medical services dispatch criteria for traumatic injuries: A systematic review

    NARCIS (Netherlands)

    A.N. Ringburg (Akkie); G. de Ronde (Gijs); S. Thomas (Siep); E.M.M. van Lieshout (Esther); P. Patka (Peter); I.B. Schipper (Inger)

    2009-01-01

    textabstractObjective. This review provides an overview of the validity of Helicopter Emergency Medical Services (HEMS) dispatch criteria for severely injured patients. Methods. A systematic literature search was performed. English written and peer-reviewed publications on HEMS dispatch criteria

  8. Emergent Exoplanet Flux: Review of the Spitzer Results

    OpenAIRE

    Deming, Drake

    2008-01-01

    Observations using the Spitzer Space Telescope provided the first detections of photons from extrasolar planets. Spitzer observations are allowing us to infer the temperature structure, composition, and dynamics of exoplanet atmospheres. The Spitzer studies extend from many hot Jupiters, to the hot Neptune orbiting GJ436. Here I review the current status of Spitzer secondary eclipse observations, and summarize the results from the viewpoint of what is robust, what needs more work, and what th...

  9. A review of national gas emergency plans in the European Union

    International Nuclear Information System (INIS)

    Zeniewski, Peter; Bolado-Lavin, Ricardo

    2012-01-01

    The purpose of this paper is to document and review existing national gas emergency plans in the European Union, following the guidelines and requirements set out by the EU's Regulation 994/2010 concerning measures to safeguard security of gas supply. Despite the great deal of attention paid to questions of natural gas security in an increasingly import-dependent European Union, the contingency plans of most of its member states have not been widely published or scrutinized. By reviewing TSO network codes and national legal and regulatory acts, this paper teases out the key similarities and differences between member states' emergency planning frameworks, tools and methods. A gas emergency operational template is subsequently proposed that conforms to EU legislation. This is followed by a discussion of emergency planning in the context of regional cooperation and the liberalizing European gas market. The paper concludes by advocating gas emergency measures which are proportionate to the crisis level, sensitive to the gas demand profile, aware of the regional context, inconsequential to normal market operation, transparent and non-discriminatory during implementation and verifiable during emergencies as well as under normal conditions. - Highlights: ► National gas emergency plans in the EU comprehensively assessed. ► Template for gas emergencies is created to measure conformity to Regulation 994/2010. ► Gas emergency measures are related to regional cooperation and liberal markets.

  10. Advanced manufacturing: optimising the factories of tomorrow

    International Nuclear Information System (INIS)

    Philippon, Patrick

    2013-01-01

    Faced with competition Patrick Philippon - Les Defis du CEA no.179 - April 2013 from the emerging countries, the competitiveness of the industrialised nations depends on the ability of their industries to innovate. This strategy necessarily entails the reorganisation and optimisation of the production systems. This is the whole challenge for 'advanced manufacturing', which relies on the new information and communication technologies. Interactive robotics, virtual reality and non-destructive testing are all technological building blocks developed by CEA, now approved within a cross-cutting programme, to meet the needs of industry and together build the factories of tomorrow. (author)

  11. Topology optimised wavelength dependent splitters

    DEFF Research Database (Denmark)

    Hede, K. K.; Burgos Leon, J.; Frandsen, Lars Hagedorn

    A photonic crystal wavelength dependent splitter has been constructed by utilising topology optimisation1. The splitter has been fabricated in a silicon-on-insulator material (Fig. 1). The topology optimised wavelength dependent splitter demonstrates promising 3D FDTD simulation results....... This complex photonic crystal structure is very sensitive against small fabrication variations from the expected topology optimised design. A wavelength dependent splitter is an important basic building block for high-performance nanophotonic circuits. 1J. S. Jensen and O. Sigmund, App. Phys. Lett. 84, 2022...

  12. Determinants and prevalence of burnout in emergency nurses: a systematic review of 25 years of research.

    Science.gov (United States)

    Adriaenssens, Jef; De Gucht, Véronique; Maes, Stan

    2015-02-01

    Burnout is an important problem in health care professionals and is associated with a decrease in occupational well-being and an increase in absenteeism, turnover and illness. Nurses are found to be vulnerable to burnout, but emergency nurses are even more so, since emergency nursing is characterized by unpredictability, overcrowding and continuous confrontation with a broad range of diseases, injuries and traumatic events. This systematic review aims (1) to explore the prevalence of burnout in emergency nurses and (2) to identify specific (individual and work related) determinants of burnout in this population. A systematic review of empirical quantitative studies on burnout in emergency nurses, published in English between 1989 and 2014. The databases NCBI PubMed, Embase, ISI Web of Knowledge, Informa HealthCare, Picarta, Cinahl and Scielo were searched. Seventeen studies were included in this review. On average 26% of the emergency nurses suffered from burnout. Individual factors such as demographic variables, personality characteristics and coping strategies were predictive of burnout. Work related factors such as exposure to traumatic events, job characteristics and organizational variables were also found to be determinants of burnout in this population. Burnout rates in emergency nurses are high. Job demands, job control, social support and exposure to traumatic events are determinants of burnout, as well as several organizational variables. As a consequence specific action targets for hospital management are formulated to prevent turnover and burnout in emergency nurses. Copyright © 2014 Elsevier Ltd. All rights reserved.

  13. Gastroparesis: a review of current and emerging treatment options

    Directory of Open Access Journals (Sweden)

    Enweluzo C

    2013-09-01

    Full Text Available Chijioke Enweluzo, Fahad AzizHospital Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston Salem, NC, USAAbstract: Gastroparesis is a motility disorder of the stomach causing delay in food emptying from the stomach without any evidence of mechanical obstruction. The majority of cases are idiopathic. Patients need to be diagnosed properly by formal testing, and the evaluation of the severity of the gastroparesis may assist in guiding therapy. Initially, dietary modifications are encouraged, which include frequent and small semisolid-based meals. Promotility medications, like erythromycin, and antiemetics, like prochlorperazine, are offered for symptom relief. In patients who are refractory to pharmacologic treatment, more invasive options, such as intrapyloric botulinum toxin injections, placement of a jejunostomy tube, or implantation of a gastric stimulator, can be considered. Hemin therapy and gastric electric stimulation are emerging treatment options that are still at different stages of research. Regenerative medicine and stem cell-based therapies also hold promise for gastroparesis in the near future.Keywords: Gastroparesis, gastric emptying, gastric electrical stimulation, hemin

  14. Emerging Varieties of Capitalism in Transition Countries: Literature Review

    Directory of Open Access Journals (Sweden)

    Leszczyński Dariusz

    2015-12-01

    Full Text Available The systemic transformation of post-socialist countries from central planning to a market economy was a very complex and unprecedented undertaking. In this study we critically examine three influential classifications proposed by Coates [2000, 2006], Hall and Soskice [2001], and Amable [2003], within the “comparative capitalisms” literature stream, and argue that they are unsuitable for evaluating the progress made by transition economies since 1990. The basis of the criticism stems from timing: these theoretical frameworks were developed primarily to evaluate the growth of advanced and mature capitalist countries. Thus, they fail to capture the unique features of transition economies and the complexity of the transformation process that led to the emergence of different market-based systems. From this vantage point, we discusses and also critique a recent classification developed by Myant and Drahokoupil [2011, 2015], who distinguish five ideal models (i.e. “varieties of capitalism” that have evolved within transition countries. In our conclusion we point to areas within the field that may be explored by future research.

  15. "Not for human consumption": a review of emerging designer drugs.

    Science.gov (United States)

    Musselman, Megan E; Hampton, Jeremy P

    2014-07-01

    Synthetic, or "designer" drugs, are created by manipulating the chemical structures of other psychoactive drugs so that the resulting product is structurally similar but not identical to illegal psychoactive drugs. Originally developed in the 1960s as a way to evade existing drug laws, the use of designer drugs has increased dramatically over the past few years. These drugs are deceptively packaged as "research chemicals," "incense," "bath salts," or "plant food," among other names, with labels that may contain warnings such as "not for human consumption" or "not for sale to minors." The clinical effects of most new designer drugs can be described as either hallucinogenic, stimulant, or opioid-like. They may also have a combination of these effects due to designer side-chain substitutions. The easy accessibility and rapid emergence of new designer drugs have created challenges for health care providers when treating patients presenting with acute toxicity from these substances, many of which can produce significant and/or life-threatening adverse effects. Moreover, the health care provider has no way to verify the contents and/or potency of the agent ingested because it can vary between packages and distributors. Therefore, a thorough knowledge of the available designer drugs, common signs and symptoms of toxicity associated with these agents, and potential effective treatment modalities are essential to appropriately manage these patients. © 2014 Pharmacotherapy Publications, Inc.

  16. Emerging synergy between nanotechnology and implantable biosensors: a review.

    Science.gov (United States)

    Vaddiraju, Santhisagar; Tomazos, Ioannis; Burgess, Diane J; Jain, Faquir C; Papadimitrakopoulos, Fotios

    2010-03-15

    The development of implantable biosensors for continuous monitoring of metabolites is an area of sustained scientific and technological interests. On the other hand, nanotechnology, a discipline which deals with the properties of materials at the nanoscale, is developing as a potent tool to enhance the performance of these biosensors. This article reviews the current state of implantable biosensors, highlighting the synergy between nanotechnology and sensor performance. Emphasis is placed on the electrochemical method of detection in light of its widespread usage and substantial nanotechnology based improvements in various aspects of electrochemical biosensor performance. Finally, issues regarding toxicity and biocompatibility of nanomaterials, along with future prospects for the application of nanotechnology in implantable biosensors, are discussed. (c) 2009 Elsevier B.V. All rights reserved.

  17. Biological Aspects of Emerging Benzothiazoles: A Short Review

    Directory of Open Access Journals (Sweden)

    Ruhi Ali

    2013-01-01

    Full Text Available In recent years heterocyclic compounds analogues and derivatives have attracted wide attention due to their useful biological and pharmacological properties. Benzothiazole is among the usually occurring heterocyclic nuclei in many marine as well as natural plant products. Benzothiazole is a privileged bicyclic ring system with multiple applications. It is known to exhibit a wide range of biological properties including anticancer, antimicrobial, and antidiabetic, anticonvulsant, anti-inflammatory, antiviral, antitubercular activities. A large number of therapeutic agents are synthesized with the help of benzothiazole nucleus. During recent years there have been some interesting developments in the biological activities of benzothiazole derivatives. These compounds have special significance in the field of medicinal chemistry due to their remarkable pharmacological potentialities. This review is mainly an attempt to present the research work reported in the recent scientific literature on different biological activities of benzothiazole compounds.

  18. Optimisation of the Laser Cutting Process

    DEFF Research Database (Denmark)

    Dragsted, Birgitte; Olsen, Flemmming Ove

    1996-01-01

    The problem in optimising the laser cutting process is outlined. Basic optimisation criteria and principles for adapting an optimisation method, the simplex method, are presented. The results of implementing a response function in the optimisation are discussed with respect to the quality as well...

  19. Global nuclear industry views: challenges arising from the evolution of the optimisation principle in radiological protection

    International Nuclear Information System (INIS)

    Saint-Pierre, S.

    2012-01-01

    Over the last few decades, the steady progress achieved in reducing planned exposures of both workers and the public has been admirable in the nuclear sector. However, the disproportionate focus on tiny public exposures and radioactive discharges associated with normal operations came at a high price, and the quasi-denial of a risk of major accident and related weaknesses in emergency preparedness and response came at an even higher price. Fukushima has unfortunately taught us that radiological protection (RP) for emergency and post-emergency situations can be much more than a simple evacuation that lasts 24–48 h, with people returning safely to their homes soon afterwards. On optimisation of emergency and post-emergency exposures, the only ‘show in town’ in terms of international RP policy improvements has been the issuance of the 2007 Recommendations of the International Commission on Radiological Protection (ICRP). However, no matter how genuine these improvements are, they have not been ‘road tested’ on the practical reality of severe accidents. Post-Fukushima, there is a compelling case to review the practical adequacy of key RP notions such as optimisation, evacuation, sheltering, and reference levels for workers and the public, and to amend these notions with a view to making the international RP system more useful in the event of a severe accident. On optimisation of planned exposures, the reality is that, nowadays, margins for further reductions of public doses in the nuclear sector are very small, and the smaller the dose, the greater the extra effort needed to reduce the dose further. If sufficient caution is not exercised in the use of RP notions such as dose constraints, there is a real risk of challenging nuclear power technologies beyond safety reasons. For nuclear new build, it is the optimisation of key operational parameters of nuclear power technologies (not RP) that is of paramount importance to improve their overall efficiency. In

  20. Global nuclear industry views: challenges arising from the evolution of the optimisation principle in radiological protection.

    Science.gov (United States)

    Saint-Pierre, S

    2012-01-01

    Over the last few decades, the steady progress achieved in reducing planned exposures of both workers and the public has been admirable in the nuclear sector. However, the disproportionate focus on tiny public exposures and radioactive discharges associated with normal operations came at a high price, and the quasi-denial of a risk of major accident and related weaknesses in emergency preparedness and response came at an even higher price. Fukushima has unfortunately taught us that radiological protection (RP) for emergency and post-emergency situations can be much more than a simple evacuation that lasts 24-48 h, with people returning safely to their homes soon afterwards. On optimisation of emergency and post-emergency exposures, the only 'show in town' in terms of international RP policy improvements has been the issuance of the 2007 Recommendations of the International Commission on Radiological Protection (ICRP). However, no matter how genuine these improvements are, they have not been 'road tested' on the practical reality of severe accidents. Post-Fukushima, there is a compelling case to review the practical adequacy of key RP notions such as optimisation, evacuation, sheltering, and reference levels for workers and the public, and to amend these notions with a view to making the international RP system more useful in the event of a severe accident. On optimisation of planned exposures, the reality is that, nowadays, margins for further reductions of public doses in the nuclear sector are very small, and the smaller the dose, the greater the extra effort needed to reduce the dose further. If sufficient caution is not exercised in the use of RP notions such as dose constraints, there is a real risk of challenging nuclear power technologies beyond safety reasons. For nuclear new build, it is the optimisation of key operational parameters of nuclear power technologies (not RP) that is of paramount importance to improve their overall efficiency. In pursuing

  1. Turbulence optimisation in stellarator experiments

    Energy Technology Data Exchange (ETDEWEB)

    Proll, Josefine H.E. [Max-Planck/Princeton Center for Plasma Physics (Germany); Max-Planck-Institut fuer Plasmaphysik, Wendelsteinstr. 1, 17491 Greifswald (Germany); Faber, Benjamin J. [HSX Plasma Laboratory, University of Wisconsin-Madison, Madison, WI 53706 (United States); Helander, Per; Xanthopoulos, Pavlos [Max-Planck/Princeton Center for Plasma Physics (Germany); Lazerson, Samuel A.; Mynick, Harry E. [Plasma Physics Laboratory, Princeton University, P.O. Box 451 Princeton, New Jersey 08543-0451 (United States)

    2015-05-01

    Stellarators, the twisted siblings of the axisymmetric fusion experiments called tokamaks, have historically suffered from confining the heat of the plasma insufficiently compared with tokamaks and were therefore considered to be less promising candidates for a fusion reactor. This has changed, however, with the advent of stellarators in which the laminar transport is reduced to levels below that of tokamaks by shaping the magnetic field accordingly. As in tokamaks, the turbulent transport remains as the now dominant transport channel. Recent analytical theory suggests that the large configuration space of stellarators allows for an additional optimisation of the magnetic field to also reduce the turbulent transport. In this talk, the idea behind the turbulence optimisation is explained. We also present how an optimised equilibrium is obtained and how it might differ from the equilibrium field of an already existing device, and we compare experimental turbulence measurements in different configurations of the HSX stellarator in order to test the optimisation procedure.

  2. Optimisation of load control

    International Nuclear Information System (INIS)

    Koponen, P.

    1998-01-01

    Electricity cannot be stored in large quantities. That is why the electricity supply and consumption are always almost equal in large power supply systems. If this balance were disturbed beyond stability, the system or a part of it would collapse until a new stable equilibrium is reached. The balance between supply and consumption is mainly maintained by controlling the power production, but also the electricity consumption or, in other words, the load is controlled. Controlling the load of the power supply system is important, if easily controllable power production capacity is limited. Temporary shortage of capacity causes high peaks in the energy price in the electricity market. Load control either reduces the electricity consumption during peak consumption and peak price or moves electricity consumption to some other time. The project Optimisation of Load Control is a part of the EDISON research program for distribution automation. The following areas were studied: Optimization of space heating and ventilation, when electricity price is time variable, load control model in power purchase optimization, optimization of direct load control sequences, interaction between load control optimization and power purchase optimization, literature on load control, optimization methods and field tests and response models of direct load control and the effects of the electricity market deregulation on load control. An overview of the main results is given in this chapter

  3. Optimisation of load control

    Energy Technology Data Exchange (ETDEWEB)

    Koponen, P [VTT Energy, Espoo (Finland)

    1998-08-01

    Electricity cannot be stored in large quantities. That is why the electricity supply and consumption are always almost equal in large power supply systems. If this balance were disturbed beyond stability, the system or a part of it would collapse until a new stable equilibrium is reached. The balance between supply and consumption is mainly maintained by controlling the power production, but also the electricity consumption or, in other words, the load is controlled. Controlling the load of the power supply system is important, if easily controllable power production capacity is limited. Temporary shortage of capacity causes high peaks in the energy price in the electricity market. Load control either reduces the electricity consumption during peak consumption and peak price or moves electricity consumption to some other time. The project Optimisation of Load Control is a part of the EDISON research program for distribution automation. The following areas were studied: Optimization of space heating and ventilation, when electricity price is time variable, load control model in power purchase optimization, optimization of direct load control sequences, interaction between load control optimization and power purchase optimization, literature on load control, optimization methods and field tests and response models of direct load control and the effects of the electricity market deregulation on load control. An overview of the main results is given in this chapter

  4. SPS batch spacing optimisation

    CERN Document Server

    Velotti, F M; Carlier, E; Goddard, B; Kain, V; Kotzian, G

    2017-01-01

    Until 2015, the LHC filling schemes used the batch spac-ing as specified in the LHC design report. The maximumnumber of bunches injectable in the LHC directly dependson the batch spacing at injection in the SPS and hence onthe MKP rise time.As part of the LHC Injectors Upgrade project for LHCheavy ions, a reduction of the batch spacing is needed. In thisdirection, studies to approach the MKP design rise time of150ns(2-98%) have been carried out. These measurementsgave clear indications that such optimisation, and beyond,could be done also for higher injection momentum beams,where the additional slower MKP (MKP-L) is needed.After the successful results from 2015 SPS batch spacingoptimisation for the Pb-Pb run [1], the same concept wasthought to be used also for proton beams. In fact, thanksto the SPS transverse feed back, it was already observedthat lower batch spacing than the design one (225ns) couldbe achieved. For the 2016 p-Pb run, a batch spacing of200nsfor the proton beam with100nsbunch spacing wasreque...

  5. A Review of the Emerging Field of Underwater Mass Spectrometry

    Directory of Open Access Journals (Sweden)

    Emily Chua

    2016-11-01

    Full Text Available Mass spectrometers are versatile sensor systems, owing to their high sensitivity and ability to simultaneously measure multiple chemical species. Over the last two decades, traditional laboratory-based membrane inlet mass spectrometers have been adapted for underwater use. Underwater mass spectrometry has drastically improved our capability to monitor a broad suite of gaseous compounds (e.g., dissolved atmospheric gases, light hydrocarbons, and volatile organic compounds in the aquatic environment. Here we provide an overview of the progress made in the field of underwater mass spectrometry since its inception in the 1990s to the present. In particular, we discuss the approaches undertaken by various research groups in developing in situ mass spectrometers. We also provide examples to illustrate how underwater mass spectrometers have been used in the field. Finally, we present future trends in the field of in situ mass spectrometry. Most of these efforts are aimed at improving the quality and spatial and temporal scales of chemical measurements in the ocean. By providing up-to-date information on underwater mass spectrometry, this review offers guidance for researchers interested in adapting this technology as well as goals for future progress in the field.

  6. Pseudologia Fantastica in the Emergency Department: A Case Report and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Robyn Thom

    2017-01-01

    Full Text Available Psychiatrists commonly encounter deception in the emergency department. This article presents the case of a patient who presents to the emergency department with an unusual and elaborate web of deceptions along multiple themes including feigning medical illness, multiple losses, and grandiose academic and athletic achievements. We review the clinical characteristics of pseudologia fantastica and discuss how this patient’s constellation of malingering, factitious disorder, and personality disorder suggests this diagnosis.

  7. Emergence

    Directory of Open Access Journals (Sweden)

    Raven John

    2014-07-01

    Full Text Available In this paper I first list a number of areas in which recent research seems to reinforce the need to follow through on activities identified in Simonetta Magari’s article (Magari, Cavaleri 2009. A careful review of research in these areas would lead us into deeply mysterious psychological processes and underline the need to change the most fundamental assumptions on which modern psychology is built. Unfortunately, I am in no position to undertake this review.

  8. Spinal immobilisaton in pre-hospital and emergency care: A systematic review of the literature.

    Science.gov (United States)

    Hood, Natalie; Considine, Julie

    2015-08-01

    Spinal immobilisation has been a mainstay of trauma care for decades and is based on the premise that immobilisation will prevent further neurological compromise in patients with a spinal column injury. The aim of this systematic review was to examine the evidence related to spinal immobilisation in pre-hospital and emergency care settings. In February 2015, we performed a systematic literature review of English language publications from 1966 to January 2015 indexed in MEDLINE and Cochrane library using the following search terms: 'spinal injuries' OR 'spinal cord injuries' AND 'emergency treatment' OR 'emergency care' OR 'first aid' AND immobilisation. EMBASE was searched for keywords 'spinal injury OR 'spinal cord injury' OR 'spine fracture AND 'emergency care' OR 'prehospital care'. There were 47 studies meeting inclusion criteria for further review. Ten studies were case series (level of evidence IV) and there were 37 studies from which data were extrapolated from healthy volunteers, cadavers or multiple trauma patients. There were 15 studies that were supportive, 13 studies that were neutral, and 19 studies opposing spinal immobilisation. There are no published high-level studies that assess the efficacy of spinal immobilisation in pre-hospital and emergency care settings. Almost all of the current evidence is related to spinal immobilisation is extrapolated data, mostly from healthy volunteers. Copyright © 2015 College of Emergency Nursing Australasia Ltd. Published by Elsevier Ltd. All rights reserved.

  9. A supportive architecture for CFD-based design optimisation

    Science.gov (United States)

    Li, Ni; Su, Zeya; Bi, Zhuming; Tian, Chao; Ren, Zhiming; Gong, Guanghong

    2014-03-01

    Multi-disciplinary design optimisation (MDO) is one of critical methodologies to the implementation of enterprise systems (ES). MDO requiring the analysis of fluid dynamics raises a special challenge due to its extremely intensive computation. The rapid development of computational fluid dynamic (CFD) technique has caused a rise of its applications in various fields. Especially for the exterior designs of vehicles, CFD has become one of the three main design tools comparable to analytical approaches and wind tunnel experiments. CFD-based design optimisation is an effective way to achieve the desired performance under the given constraints. However, due to the complexity of CFD, integrating with CFD analysis in an intelligent optimisation algorithm is not straightforward. It is a challenge to solve a CFD-based design problem, which is usually with high dimensions, and multiple objectives and constraints. It is desirable to have an integrated architecture for CFD-based design optimisation. However, our review on existing works has found that very few researchers have studied on the assistive tools to facilitate CFD-based design optimisation. In the paper, a multi-layer architecture and a general procedure are proposed to integrate different CFD toolsets with intelligent optimisation algorithms, parallel computing technique and other techniques for efficient computation. In the proposed architecture, the integration is performed either at the code level or data level to fully utilise the capabilities of different assistive tools. Two intelligent algorithms are developed and embedded with parallel computing. These algorithms, together with the supportive architecture, lay a solid foundation for various applications of CFD-based design optimisation. To illustrate the effectiveness of the proposed architecture and algorithms, the case studies on aerodynamic shape design of a hypersonic cruising vehicle are provided, and the result has shown that the proposed architecture

  10. Adult Status Epilepticus: A Review of the Prehospital and Emergency Department Management

    Science.gov (United States)

    Billington, Michael; Kandalaft, Osama R.; Aisiku, Imoigele P.

    2016-01-01

    Seizures are a common presentation in the prehospital and emergency department setting and status epilepticus represents an emergency neurologic condition. The classification and various types of seizures are numerous. The objectives of this narrative literature review focuses on adult patients with a presentation of status epilepticus in the prehospital and emergency department setting. In summary, benzodiazepines remain the primary first line therapeutic agent in the management of status epilepticus, however, there are new agents that may be appropriate for the management of status epilepticus as second- and third-line pharmacological agents. PMID:27563928

  11. Health effects of training laypeople to deliver emergency care in underserviced populations: a systematic review protocol.

    Science.gov (United States)

    Orkin, Aaron M; Curran, Jeffrey D; Fortune, Melanie K; McArthur, Allison; Mew, Emma J; Ritchie, Stephen D; Van de Velde, Stijn; VanderBurgh, David

    2016-05-18

    The Disease Control Priorities Project recommends emergency care training for laypersons in low-resource settings, but evidence for these interventions has not yet been systematically reviewed. This review will identify the individual and community health effects of educating laypeople to deliver prehospital emergency care interventions in low-resource settings. This systematic review addresses the following question: in underserviced populations and low-resource settings (P), does first aid or emergency care training or education for laypeople (I) confer any individual or community health benefit for emergency health conditions (O), in comparison with no training or other forms of education (C)? We restrict this review to studies reporting quantitatively measurable outcomes, and search 12 electronic bibliographic databases and grey literature sources. A team of expert content and methodology reviewers will conduct title and abstract screening and full-text review, using a custom-built online platform. Two investigators will independently extract methodological variables and outcomes related to patient-level morbidity and mortality and community-level effects on resilience or emergency care capacity. Two investigators will independently assess external validity, selection bias, performance bias, measurement bias, attrition bias and confounding. We will summarise the findings using a narrative approach to highlight similarities and differences between the gathered studies. Formal ethical approval is not required. The results will be disseminated through a peer-reviewed publication and knowledge translation strategy. CRD42014009685. 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/

  12. Improving menstrual hygiene management in emergency contexts: literature review of current perspectives.

    Science.gov (United States)

    VanLeeuwen, Crystal; Torondel, Belen

    2018-01-01

    Management of menstruation in contexts of humanitarian emergencies can be challenging. A lack of empirical research about effective interventions which improve menstrual hygiene management (MHM) among female populations in humanitarian emergencies and a lack of clarity about which sectors within a humanitarian response should deliver MHM interventions can both be attributable to the lack of clear guidance on design and delivery of culturally appropriate MHM intervention in settings of humanitarian emergencies. The objective of this review was to collate, summarize, and appraise existing peer-reviewed and gray literature that describes the current scenario of MHM in emergency contexts in order to describe the breadth and depth of current policies, guidelines, empirical research, and humanitarian aid activities addressing populations' menstrual needs. A structured-search strategy was conducted for peer-reviewed and gray literature to identify studies, published reports, guidelines, and policy papers related to menstrual response in emergency humanitarian contexts. Of the 51 articles included in the review, 16 were peer-reviewed papers and 35 were gray literature. Most of the literature agreed that hardware interventions should focus on the supply of adequate material (not only absorbent material but also other supportive material) and adequate sanitation facilities, with access to water and private space for washing, changing, drying, and disposing menstrual materials. Software interventions should focus on education in the usage of materials to manage menstruation hygienically and education about the female body's biological processes. There was clear agreement that the needs of the target population should be assessed before designing any intervention. Although there is insight about which factors should be included in an effective menstrual hygiene intervention, there is insufficient empirical evidence to establish which interventions are most effective in

  13. Emerging organic contaminants in groundwater : a review of sources, fate and occurrence

    OpenAIRE

    Lapworth, D.J.; Baran, N.; Stuart, M.E.; Ward, R.S.

    2012-01-01

    Emerging organic contaminants (EOCs) detected in groundwater may have adverse effects on human health and aquatic ecosystems. This paper reviews the existing occurrence data in groundwater for a range of EOCs including pharmaceutical, personal care, ‘life-style’ and selected industrial compounds. The main sources and pathways for organic EOCs in groundwater are reviewed, with occurrence data for EOCs in groundwater included from both targeted studies and broad reconnaissance surveys. Nanogram...

  14. A Review of Emerging Technologies for the Detection and Diagnosis of Dental Caries

    Science.gov (United States)

    2016-06-01

    i A REVIEW OF EMERGING TECHNOLOGIES FOR DETECTON AND DIAGNOSIS OF DENTAL CARIES by Walter B. Volinski Jr. Lieutenant... CARIES WALTER B. VOLINSKI JR. DDS, COMPREHENSIVE DEPARTMENT, 2016 Thesis directed by: Ling Ye, DDS, PhD LCDR, DC, USN Department of Dental...diagnosis of dental caries and to compare their efficacy and accuracy to visual, tactile, and radiographic examination. Methods: The technologies reviewed

  15. A review on Zika virus, a re-emerging arbovirus: review article

    Directory of Open Access Journals (Sweden)

    Farshad Khodakhah

    2018-02-01

    Full Text Available Before the recent outbreaks of Zika virus, few people have ever heard of its name. Even virologists had paid little attention to this member of the Flaviviridae family. Hence, up to January 2016, only 269 articles about Zika virus had been indexed in PubMed compared to the 9187 articles related to dengue virus. However, declaration of the World health organization (WHO about the global Zika virus spreading, which has been associated with birth defects and some neurological problems, diverted more attention to this forgotten virus. Afterwards, the virus hit the headlines and became a research interest. Since then, up to 9 August 2017, the number of Zika related articles indexed in PubMed reached to 3214. Zika virus is a re-emerging arbovirus. The First detection of Zika virus was in Uganda in 1947. It belongs to the Flavivirus genus in the Flaviviridae family. Zika can typically cause a mild and self-limiting disease in a healthy person. However, in pregnant women, it might cause birth defects and occasionally it can be associated with peripheral neuropathy such as Guillain-Barre syndrome. Although many research have been conducted to find out the casual link between this virus and these disorders but this relationship is still dim and controversial. Considering its recent epidemics in 2015 and 2016 the geographical distribution of Zika virus seems to expand all over the world progressively. Interaction between virus and vector is dynamic. Variety of competent vectors and adaptability of virus to new arthropod vectors are the two major factors for this process. According to the last report published by WHO, 84 countries/territories in five continents have reported the circulation of Zika virus in their area. In the recent outbreak, WHO regional office in our region (EMRO have reported no case of Zika virus transmission from this region. Nonetheless, because specific and competent vectors exist in some countries, this region has a potential of

  16. Living systematic reviews: an emerging opportunity to narrow the evidence-practice gap.

    Science.gov (United States)

    Elliott, Julian H; Turner, Tari; Clavisi, Ornella; Thomas, James; Higgins, Julian P T; Mavergames, Chris; Gruen, Russell L

    2014-02-01

    The current difficulties in keeping systematic reviews up to date leads to considerable inaccuracy, hampering the translation of knowledge into action. Incremental advances in conventional review updating are unlikely to lead to substantial improvements in review currency. A new approach is needed. We propose living systematic review as a contribution to evidence synthesis that combines currency with rigour to enhance the accuracy and utility of health evidence. Living systematic reviews are high quality, up-to-date online summaries of health research, updated as new research becomes available, and enabled by improved production efficiency and adherence to the norms of scholarly communication. Together with innovations in primary research reporting and the creation and use of evidence in health systems, living systematic review contributes to an emerging evidence ecosystem.

  17. Living systematic reviews: an emerging opportunity to narrow the evidence-practice gap.

    Directory of Open Access Journals (Sweden)

    Julian H Elliott

    2014-02-01

    Full Text Available The current difficulties in keeping systematic reviews up to date leads to considerable inaccuracy, hampering the translation of knowledge into action. Incremental advances in conventional review updating are unlikely to lead to substantial improvements in review currency. A new approach is needed. We propose living systematic review as a contribution to evidence synthesis that combines currency with rigour to enhance the accuracy and utility of health evidence. Living systematic reviews are high quality, up-to-date online summaries of health research, updated as new research becomes available, and enabled by improved production efficiency and adherence to the norms of scholarly communication. Together with innovations in primary research reporting and the creation and use of evidence in health systems, living systematic review contributes to an emerging evidence ecosystem.

  18. Enablers and Barriers to Community Engagement in Public Health Emergency Preparedness: A Literature Review.

    Science.gov (United States)

    Ramsbottom, Anna; O'Brien, Eleanor; Ciotti, Lucrezio; Takacs, Judit

    2018-04-01

    Public health emergency preparedness (PHEP) all too often focusses only on institutional capabilities, including their technical expertise and political influence, while overlooking community capabilities. However, the success of institutional emergency preparedness plans depends upon communities and institutions working together to ensure successful anticipation, response and recovery. Broader community engagement is therefore recommended worldwide. This literature review was carried out to identify enablers and barriers to community and institutional synergies in emergency preparedness. Searches were undertaken across bibliographic databases and grey literature sources. The literature identified was qualitative in nature. A qualitative, 'best fit' framework approach using a pre-existing framework was used to analyse the literature, whereby themes were added and changed as analysis progressed. A working definition of community was identified, based on a 'whole community' approach, inclusive of the whole multitude of stakeholders including community residents and emergency management staff. Given the diversity in community make-up, the types of emergencies that could be faced, the socio-economic, environmental and political range of communities, there are no set practices that will be effective for all communities. The most effective way of engaging communities in emergency preparedness is context-dependent and the review did draw out some important key messages for institutions to consider.

  19. 77 FR 50549 - Agency Information Collection: Emergency Submission for OMB Review (Telehealth in the Parkinson's...

    Science.gov (United States)

    2012-08-21

    ... Collection: Emergency Submission for OMB Review (Telehealth in the Parkinson's Disease Research, Education... needed to improve the care and clinical outcomes of patients with Parkinson's disease. DATES: Comments... Parkinson's Disease Research, Education and Clinical Center (PADRECC): The Key to the Patient-Centered...

  20. A Systematic Review on Recent Advances in mHealth Systems: Deployment Architecture for Emergency Response.

    Science.gov (United States)

    Gonzalez, Enrique; Peña, Raul; Avila, Alfonso; Vargas-Rosales, Cesar; Munoz-Rodriguez, David

    2017-01-01

    The continuous technological advances in favor of mHealth represent a key factor in the improvement of medical emergency services. This systematic review presents the identification, study, and classification of the most up-to-date approaches surrounding the deployment of architectures for mHealth. Our review includes 25 articles obtained from databases such as IEEE Xplore, Scopus, SpringerLink, ScienceDirect, and SAGE. This review focused on studies addressing mHealth systems for outdoor emergency situations. In 60% of the articles, the deployment architecture relied in the connective infrastructure associated with emergent technologies such as cloud services, distributed services, Internet-of-things, machine-to-machine, vehicular ad hoc network, and service-oriented architecture. In 40% of the literature review, the deployment architecture for mHealth considered traditional connective infrastructure. Only 20% of the studies implemented an energy consumption protocol to extend system lifetime. We concluded that there is a need for more integrated solutions specifically for outdoor scenarios. Energy consumption protocols are needed to be implemented and evaluated. Emergent connective technologies are redefining the information management and overcome traditional technologies.

  1. A Systematic Review on Recent Advances in mHealth Systems: Deployment Architecture for Emergency Response

    Directory of Open Access Journals (Sweden)

    Enrique Gonzalez

    2017-01-01

    Full Text Available The continuous technological advances in favor of mHealth represent a key factor in the improvement of medical emergency services. This systematic review presents the identification, study, and classification of the most up-to-date approaches surrounding the deployment of architectures for mHealth. Our review includes 25 articles obtained from databases such as IEEE Xplore, Scopus, SpringerLink, ScienceDirect, and SAGE. This review focused on studies addressing mHealth systems for outdoor emergency situations. In 60% of the articles, the deployment architecture relied in the connective infrastructure associated with emergent technologies such as cloud services, distributed services, Internet-of-things, machine-to-machine, vehicular ad hoc network, and service-oriented architecture. In 40% of the literature review, the deployment architecture for mHealth considered traditional connective infrastructure. Only 20% of the studies implemented an energy consumption protocol to extend system lifetime. We concluded that there is a need for more integrated solutions specifically for outdoor scenarios. Energy consumption protocols are needed to be implemented and evaluated. Emergent connective technologies are redefining the information management and overcome traditional technologies.

  2. 76 FR 81554 - Notice of Information Collection Under Emergency Review: 60-Day Notice of Proposed Information...

    Science.gov (United States)

    2011-12-28

    ... of Population, Refugees, and Migration, Office of Admissions (PRM/A) AGENCY: Department of State... Request: Emergency Review. Originating Office: Bureau of Population, Refugees, and Migration, Office of..., Refugees and Migration. Additional Information: Dated: December 21, 2011. Kelly A. Gauger, Deputy Director...

  3. 78 FR 62638 - Agency Recordkeeping/Reporting Requirements Under Emergency Review by the Office of Management...

    Science.gov (United States)

    2013-10-22

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES Administration for Children and Families Agency Recordkeeping/Reporting Requirements Under Emergency Review by the Office of Management and Budget (OMB) Title: Low Income Home Energy Assistance Program (LIHEAP) Grantee Needs Assessment. OMB No.: New Collection. Description: This information collection is a...

  4. Multidisciplinary team training in a simulation setting for acute abstetric emergencies : a systematic review

    NARCIS (Netherlands)

    Merién, A.E.R.; Ven, van de J.; Mol, B.W.J.; Houterman, S.; Oei, S.G.

    2010-01-01

    OBJECTIVE: To perform a systematic review of the literature on the effectiveness of multidisciplinary teamwork training in a simulation setting for the reduction of medical adverse outcomes in obstetric emergency situations. DATA SOURCES: We searched Medline, Embase, and the Cochrane Library from

  5. Multidisciplinary Team Training in a Simulation Setting for Acute Obstetric Emergencies A Systematic Review

    NARCIS (Netherlands)

    Merién, A. E. R.; van de Ven, J.; Mol, B. W.; Houterman, S.; Oei, S. G.

    2010-01-01

    OBJECTIVE: To perform a systematic review of the literature on the effectiveness of multidisciplinary teamwork training in a simulation setting for the reduction of medical adverse outcomes in obstetric emergency situations. DATA SOURCES: We searched Medline, Embase, and the Cochrane Library from

  6. Mobile Assisted Language Learning: Review of the Recent Applications of Emerging Mobile Technologies

    Science.gov (United States)

    Yang, Jaeseok

    2013-01-01

    As mobile computing technologies have been more powerful and inclusive in people's daily life, the issue of mobile assisted language learning (MALL) has also been widely explored in CALL research. Many researches on MALL consider the emerging mobile technologies have considerable potentials for the effective language learning. This review study…

  7. Thermal performance monitoring and optimisation

    International Nuclear Information System (INIS)

    Sunde, Svein; Berg; Oeyvind

    1998-01-01

    Monitoring of the thermal efficiency of nuclear power plants is expected to become increasingly important as energy-market liberalisation exposes plants to increasing availability requirements and fiercer competition. The general goal in thermal performance monitoring is straightforward: to maximise the ratio of profit to cost under the constraints of safe operation. One may perceive this goal to be pursued in two ways, one oriented towards fault detection and cost-optimal predictive maintenance, and another determined at optimising target values of parameters in response to any component degradation detected, changes in ambient conditions, or the like. Annual savings associated with effective thermal-performance monitoring are expected to be in the order of $ 100 000 for power plants of representative size. A literature review shows that a number of computer systems for thermal-performance monitoring exists, either as prototypes or commercially available. The characteristics and needs of power plants may vary widely, however, and decisions concerning the exact scope, content and configuration of a thermal-performance monitor may well follow a heuristic approach. Furthermore, re-use of existing software modules may be desirable. Therefore, we suggest here the design of a flexible workbench for easy assembly of an experimental thermal-performance monitor at the Halden Project. The suggested design draws heavily on our extended experience in implementing control-room systems featured by assets like high levels of customisation, flexibility in configuration and modularity in structure, and on a number of relevant adjoining activities. The design includes a multi-computer communication system and a graphical user's interface, and aims at a system adaptable to any combination of in-house or end user's modules, as well as commercially available software. (author)

  8. A Review of State Public Health Emergency Declarations in Peru: 2014-2016.

    Science.gov (United States)

    Bambarén, Celso; Alatrista, Maria Del Socorro

    2018-04-01

    Peru has different legal mechanisms of emergency, one of which is the Public Health Emergency that is applicable when: there is high-risk for, or the existence of an outbreak, epidemic, or pandemic; the occurrence of cases of a disease classified as eliminated or eradicated; the occurrence of emerging or re-emerging infectious diseases with high epidemic potential; the occurrence of rapid disseminated epidemics that simultaneously affect more than one department; as well as the existence of an event that affects the continuity of health services. From July 2014 to December 2016, 23 Public Health Emergencies were declared, out of which 57% were in the high-risk or existence of epidemics, 30% were due to some natural or anthropic events that generate a sudden decrease in the operative capacity of health services, and 13% were due to the existence of a rapid spreading epidemic that could affect more than one department in the country. The risk or occurrence of epidemiological outbreaks, mainly of Dengue, was the main cause of emergency declaration. One-hundred and forty million US dollars were allocated to implement the action plans that were part of the declaration, of which 72% was used to keep the operational capacity of health services and 28% to vector and epidemiological control measures. Bambarén C , Alatrista MdS . A review of state public health emergency declarations in Peru: 2014-2016. Prehosp Disaster Med. 2018;33(2):197-200.

  9. Multi-Optimisation Consensus Clustering

    Science.gov (United States)

    Li, Jian; Swift, Stephen; Liu, Xiaohui

    Ensemble Clustering has been developed to provide an alternative way of obtaining more stable and accurate clustering results. It aims to avoid the biases of individual clustering algorithms. However, it is still a challenge to develop an efficient and robust method for Ensemble Clustering. Based on an existing ensemble clustering method, Consensus Clustering (CC), this paper introduces an advanced Consensus Clustering algorithm called Multi-Optimisation Consensus Clustering (MOCC), which utilises an optimised Agreement Separation criterion and a Multi-Optimisation framework to improve the performance of CC. Fifteen different data sets are used for evaluating the performance of MOCC. The results reveal that MOCC can generate more accurate clustering results than the original CC algorithm.

  10. Standard review plan for the review and evaluation of emergency plans for research and test reactors. Technical report

    International Nuclear Information System (INIS)

    Bates, E.F.; Grimes, B.K.; Ramos, S.L.

    1982-05-01

    This document provides a Standard Review Plan for the guidance of the NRC staff to assure that complete and uniform reviews are made of research and test reactor emergency plans. The report is organized under ten planning standards which correspond to the guidance criteria in Draft II of ANSI/ANS 15.16 as endorsed by Revision 1 to Regulatory Guide 2.6. The applicability of the items under each planning standard is indicated by subdivisions of the steady state thermal power levels at which the reactors are licensed to operate. Standard emergency classes and example action levels for research and test reactors which should initiate these classes are given in an Appendix

  11. Isogeometric Analysis and Shape Optimisation

    DEFF Research Database (Denmark)

    Gravesen, Jens; Evgrafov, Anton; Gersborg, Allan Roulund

    of the whole domain. So in every optimisation cycle we need to extend a parametrisation of the boundary of a domain to the whole domain. It has to be fast in order not to slow the optimisation down but it also has to be robust and give a parametrisation of high quality. These are conflicting requirements so we...... will explain how the validity of a parametrisation can be checked and we will describe various ways to parametrise a domain. We will in particular study the Winslow functional which turns out to have some desirable properties. Other problems we touch upon is clustering of boundary control points (design...

  12. The role of teamwork and communication in the emergency department: a systematic review.

    Science.gov (United States)

    Kilner, Emily; Sheppard, Lorraine A

    2010-07-01

    The aim of this study was to develop a systematic review using international research to describe the role of teamwork and communication in the emergency department, and its relevance to physiotherapy practice in the emergency department. Searches were conducted of CINAHL, Academic Search Premier, Scopus, Cochrane, PEDro, Medline, Embase, Amed and PubMed. Selection criteria included full-text English language research papers related to teamwork and/or communication based directly in the emergency department, involvement of any profession in the emergency department, publication in peer-reviewed journals, and related to adult emergency services. Studies were appraised using a validated critical appraisal tool. Fourteen eligible studies, all of mid-range quality, were identified. They demonstrated high levels of staff satisfaction with teamwork training interventions and positive staff attitudes towards the importance of teamwork and communication. There is moderate evidence that the introduction of multidisciplinary teams to the ED may be successful in reducing access block, and physiotherapists may play a role in this. The need for teamwork and communication in the ED is paramount, and their roles are closely linked, with the common significant purposes of improving patient safety, reducing clinical errors, and reducing waiting times. 2009 Elsevier Ltd. All rights reserved.

  13. Games, simulations, and learning in emergency preparedness: a review of the literature.

    Science.gov (United States)

    Olson, Debra K; Hoeppner, Mary M; Scaletta, Kurtis; Peck, Megan; Newkirk, Ryan

    2012-01-01

    Between 2007 and 2011, a comprehensive review of the literature was conducted to identify the usefulness of educational games and simulations in developing and evaluating the competency of public health professionals to prepare for, respond to, and recover from emergencies. This article presents an overview of the literature related to the use of games and simulations in education and training, summarizes key findings, identifies key features of gaming simulation design for educational effectiveness, and suggests that use of these emerging teaching and learning strategies be considered in the development of a comprehensive approach for creating and evaluating competency.

  14. A Systematic Review of Transitional Care for Emerging Adults with Diabetes.

    Science.gov (United States)

    Findley, Mary K; Cha, EunSeok; Wong, Eugene; Faulkner, Melissa Spezia

    2015-01-01

    The prevalence of diabetes and prediabetes in adolescents is increasing. A systematic review of 31 research articles focusing on transitional care for adolescents or emerging adults with diabetes or prediabetes was completed. Studies focused on those with type 1 diabetes, not type 2 diabetes or prediabetes, and were primarily descriptive. Major findings and conclusions include differences in pediatric versus adult care delivery and the importance of structured transitional programs using established recommendations of leading national organizations. Implications include future research on program development, implementation, and evaluation that is inclusive of adolescents and emerging adults, regardless of diabetes type, or prediabetes. Copyright © 2015 Elsevier Inc. All rights reserved.

  15. Improving menstrual hygiene management in emergency contexts: literature review of current perspectives

    Directory of Open Access Journals (Sweden)

    VanLeeuwen C

    2018-04-01

    Full Text Available Crystal VanLeeuwen, Belen Torondel Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK Abstract: Management of menstruation in contexts of humanitarian emergencies can be challenging. A lack of empirical research about effective interventions which improve menstrual hygiene management (MHM among female populations in humanitarian emergencies and a lack of clarity about which sectors within a humanitarian response should deliver MHM interventions can both be attributable to the lack of clear guidance on design and delivery of culturally appropriate MHM intervention in settings of humanitarian emergencies. The objective of this review was to collate, summarize, and appraise existing peer-reviewed and gray literature that describes the current scenario of MHM in emergency contexts in order to describe the breadth and depth of current policies, guidelines, empirical research, and humanitarian aid activities addressing populations’ menstrual needs. A structured-search strategy was conducted for peer-reviewed and gray literature to identify studies, published reports, guidelines, and policy papers related to menstrual response in emergency humanitarian contexts. Of the 51 articles included in the review, 16 were peer-reviewed papers and 35 were gray literature. Most of the literature agreed that hardware interventions should focus on the supply of adequate material (not only absorbent material but also other supportive material and adequate sanitation facilities, with access to water and private space for washing, changing, drying, and disposing menstrual materials. Software interventions should focus on education in the usage of materials to manage menstruation hygienically and education about the female body’s biological processes. There was clear agreement that the needs of the target population should be assessed before designing any intervention. Although there is insight about which factors should be

  16. A Review of Cyber Threats and Defence Approaches in Emergency Management

    Directory of Open Access Journals (Sweden)

    Tuan Vuong

    2013-05-01

    Full Text Available Emergency planners, first responders and relief workers increasingly rely on computational and communication systems that support all aspects of emergency management, from mitigation and preparedness to response and recovery. Failure of these systems, whether accidental or because of malicious action, can have severe implications for emergency management. Accidental failures have been extensively documented in the past and significant effort has been put into the development and introduction of more resilient technologies. At the same time researchers have been raising concerns about the potential of cyber attacks to cause physical disasters or to maximise the impact of one by intentionally impeding the work of the emergency services. Here, we provide a review of current research on the cyber threats to communication, sensing, information management and vehicular technologies used in emergency management. We emphasise on open issues for research, which are the cyber threats that have the potential to affect emergency management severely and for which solutions have not yet been proposed in the literature.

  17. Cogeneration technologies, optimisation and implementation

    CERN Document Server

    Frangopoulos, Christos A

    2017-01-01

    Cogeneration refers to the use of a power station to deliver two or more useful forms of energy, for example, to generate electricity and heat at the same time. This book provides an integrated treatment of cogeneration, including a tour of the available technologies and their features, and how these systems can be analysed and optimised.

  18. For Time-Continuous Optimisation

    DEFF Research Database (Denmark)

    Heinrich, Mary Katherine; Ayres, Phil

    2016-01-01

    Strategies for optimisation in design normatively assume an artefact end-point, disallowing continuous architecture that engages living systems, dynamic behaviour, and complex systems. In our Flora Robotica investigations of symbiotic plant-robot bio-hybrids, we re- quire computational tools...

  19. Nonpharmacological Interventions for Pain Management in Paramedicine and the Emergency Setting: A Review of the Literature

    Directory of Open Access Journals (Sweden)

    Sok Cheon Pak

    2015-01-01

    Full Text Available Paramedicine and the emergency medical services have been moving in the direction of advancing pharmaceutical intervention for the management of pain in both acute and chronic situations. This coincides with other areas of advanced life support and patient management strategies that have been well researched and continue to benefit from the increasing evidence. Even though paramedic practice is firmly focused on pharmacological interventions to alleviate pain, there is emerging evidence proposing a range of nonpharmacological options that can have an important role in pain management. This review highlights literature that suggests that paramedicine and emergency medical services should be considering the application of complementary and alternative therapies which can enhance current practice and reduce the use of pharmacological interventions.

  20. Emergency department interpretation of CT of the brain: a systematic review.

    Science.gov (United States)

    Evans, Lachlan R; Fitzgerald, Mark C; Mitra, Biswadev; Varma, Dinesh

    2017-08-01

    CT of the brain (CTB) is one of the most common radiological investigations performed in the emergency department (ED). Emergency clinicians rely upon this imaging modality to aid diagnosis and guide management. However, their capacity to accurately interpret CTB is unclear. This systematic review aims to determine this capacity and identify the potential need for interventions directed towards improving the ability of emergency clinicians in this important area. A systematic review of the literature was conducted without date restrictions. We searched MEDLINE, EMBASE and Cochrane databases and studies reporting the primary outcome of concordance of CTB interpretation between a non-radiologist and a radiology specialist were identified. Studies were assessed for heterogeneity and a subgroup analysis of pooled data based on medical specialty was carried out to specifically identify the concordance of ED clinicians. The quality of evidence was assessed using the GRADE criteria. There were 21 studies included in this review. Among the included studies, 12 reported on the concordance of emergency clinicians, 5 reported on radiology trainees and 4 on surgeons. Clinical and statistical heterogeneity between studies was high (I 2 =97.8%, perror rate ranging from 0.02 to 0.24. Heterogeneity and the presence of bias limit our confidence in these findings. However, the variance in the interpretation of CTB between emergency clinicians and radiologists suggests that interventions towards improving accuracy may be useful. 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/.

  1. The laparoscopic approach in emergency surgery: A review of the literature

    Directory of Open Access Journals (Sweden)

    Ionut Negoi

    2018-01-01

    Full Text Available The role of laparoscopy in the acute care surgery had significantly increased during the latest years, both as a diagnostic and treatment method of all the upper or lower gastrointestinal pathologies. The objective of the present research is to review the current indications for laparoscopy in bdominal emergencies and to detail the benefits and complications associated with this approach. We have reviewed the relevant literature about this topic published between January 2005 and December 2017, using the PubMed/Medline and Web of Science Core Collection databases. According to the current evidence, we may conclude that the laparoscopic approach is an integral part of the emergency surgery for all the abdominal pathologies. Although laparoscopy requires specialized training and curricula, it brings all the benefits of minimal access in acute care arena.

  2. Review of emerging contaminants in aquatic biota from Latin America: 2002-2016.

    Science.gov (United States)

    Llorca, Marta; Farré, Marinella; Eljarrat, Ethel; Díaz-Cruz, Sílvia; Rodríguez-Mozaz, Sara; Wunderlin, Daniel; Barcelo, Damià

    2017-07-01

    Although it is known that emerging contaminants are widespread all over the globe, there is a gap of information about their distribution in some geographical areas, such as Latin America. The present bibliographic work reviews the available literature about the presence of organic emerging contaminants in Latin American freshwater and marine biota between 2002 and 2016 and includes 23 works from Argentina, Brazil, Chile, Colombia, Mexico, and Nicaragua. In particular, the present review provides an overview of the occurrence of continuously present contaminants such as pharmaceuticals, personal care products, and pyrethroid insecticides, as well as the new groups of persistent organic pollutants, the halogenated flame retardants and the perfluoroalkyl substances. A wide overview is provided, considering not only occurrence data but also effects and potential transfer through the food chain. Environ Toxicol Chem 2017;36:1716-1727. © 2016 SETAC. © 2016 SETAC.

  3. Optimised Dirac operators on the lattice. Construction, properties and applications

    Energy Technology Data Exchange (ETDEWEB)

    Bietenholz, W. [Humboldt-Universitaet, Berlin (Germany). Inst. fuer Physik]|[Deutsches Elektronen-Synchrotron (DESY), Zeuthen (Germany). John von Neumann-Inst. fuer Computing NIC

    2006-11-15

    We review a number of topics related to block variable renormalisation group transformations of quantum fields on the lattice, and to the emerging perfect lattice actions. We first illustrate this procedure by considering scalar fields. Then we proceed to lattice fermions, where we discuss perfect actions for free fields, for the Gross-Neveu model and for a supersymmetric spin model. We also consider the extension to perfect lattice perturbation theory, in particular regarding the axial anomaly and the quark gluon vertex function. Next we deal with properties and applications of truncated perfect fermions, and their chiral correction by means of the overlap formula. This yields a formulation of lattice fermions, which combines exact chiral symmetry with an optimisation of further essential properties. We summarise simulation results for these so-called overlap-hypercube fermions in the two-flavour Schwinger model and in quenched QCD. In the latter framework we establish a link to Chiral Perturbation Theory, both, in the p-regime and in the epsilon-regime. In particular we present an evaluation of the leading Low Energy Constants of the chiral Lagrangian - the chiral condensate and the pion decay constant - from QCD simulations with extremely light quarks. (orig.)

  4. Optimised Dirac operators on the lattice: construction, properties and applications

    International Nuclear Information System (INIS)

    Bietenholz, Wolfgang

    2006-12-01

    We review a number of topics related to block variable renormalisation group transformations of quantum fields on the lattice, and to the emerging perfect lattice actions. We first illustrate this procedure by considering scalar fields. Then we proceed to lattice fermions, where we discuss perfect actions for free fields, for the Gross-Neveu model and for a supersymmetric spin model. We also consider the extension to perfect lattice perturbation theory, in particular regarding the axial anomaly and the quark gluon vertex function. Next we deal with properties and applications of truncated perfect fermions, and their chiral correction by means of the overlap formula. This yields a formulation of lattice fermions, which combines exact chiral symmetry with an optimisation of further essential properties. We summarise simulation results for these so-called overlap-hypercube fermions in the two-flavour Schwinger model and in quenched QCD. In the latter framework we establish a link to Chiral Perturbation Theory, both, in the p-regime and in the e-regime. In particular we present an evaluation of the leading Low Energy Constants of the chiral Lagrangian - the chiral condensate and the pion decay constant - from QCD simulations with extremely light quarks. (author)

  5. Optimised Dirac operators on the lattice. Construction, properties and applications

    International Nuclear Information System (INIS)

    Bietenholz, W.; Deutsches Elektronen-Synchrotron

    2006-11-01

    We review a number of topics related to block variable renormalisation group transformations of quantum fields on the lattice, and to the emerging perfect lattice actions. We first illustrate this procedure by considering scalar fields. Then we proceed to lattice fermions, where we discuss perfect actions for free fields, for the Gross-Neveu model and for a supersymmetric spin model. We also consider the extension to perfect lattice perturbation theory, in particular regarding the axial anomaly and the quark gluon vertex function. Next we deal with properties and applications of truncated perfect fermions, and their chiral correction by means of the overlap formula. This yields a formulation of lattice fermions, which combines exact chiral symmetry with an optimisation of further essential properties. We summarise simulation results for these so-called overlap-hypercube fermions in the two-flavour Schwinger model and in quenched QCD. In the latter framework we establish a link to Chiral Perturbation Theory, both, in the p-regime and in the epsilon-regime. In particular we present an evaluation of the leading Low Energy Constants of the chiral Lagrangian - the chiral condensate and the pion decay constant - from QCD simulations with extremely light quarks. (orig.)

  6. Optimised Dirac operators on the lattice: construction, properties and applications

    Energy Technology Data Exchange (ETDEWEB)

    Bietenholz, Wolfgang [Humbolt-Universitaet zu Berlin (Germany). Inst. fuer Physik; Deutsches Elektronen-Synchrotron (DESY), Zeuthen (Germany). John von Neumann-Inst. fuer Computing (NIC)

    2006-12-15

    We review a number of topics related to block variable renormalisation group transformations of quantum fields on the lattice, and to the emerging perfect lattice actions. We first illustrate this procedure by considering scalar fields. Then we proceed to lattice fermions, where we discuss perfect actions for free fields, for the Gross-Neveu model and for a supersymmetric spin model. We also consider the extension to perfect lattice perturbation theory, in particular regarding the axial anomaly and the quark gluon vertex function. Next we deal with properties and applications of truncated perfect fermions, and their chiral correction by means of the overlap formula. This yields a formulation of lattice fermions, which combines exact chiral symmetry with an optimisation of further essential properties. We summarise simulation results for these so-called overlap-hypercube fermions in the two-flavour Schwinger model and in quenched QCD. In the latter framework we establish a link to Chiral Perturbation Theory, both, in the p-regime and in the e-regime. In particular we present an evaluation of the leading Low Energy Constants of the chiral Lagrangian - the chiral condensate and the pion decay constant - from QCD simulations with extremely light quarks. (author)

  7. An integrative literature review of interventions to reduce violence against emergency department nurses.

    Science.gov (United States)

    Anderson, Linda; FitzGerald, Mary; Luck, Lauretta

    2010-09-01

    To critique the evidence that underpins interventions intended to minimise workplace violence directed against emergency department nurses, to inform researchers and policy makers regarding the design, development, implementation and evaluation of emergency nursing anti-violence and counter-violence interventions. Workplace violence perpetrated against emergency department nurses is at least continuing and at worst increasing. Occupational violence has detrimental effects on job satisfaction, retention and recruitment, and the quality and cost of patient care. An integrated literature review. Searches of the Cochrane Library, CINAHL, MEDLINE and the Joanna Briggs Institute between 1986-May 2007. Included articles were appraised and then synthesised into a narrative summary. Ten primary research studies were included. Interventions were classified as environmental, practices and policies, or skills. While each study has useful information regarding the implementation of interventions, there is no strong evidence for their efficacy. The weight of effort is still directed towards defining the phenomenon rather than addressing solutions. Studies that assessed the efficacy of a single intervention failed to take account of context; and participatory context-driven studies failed to provide generalisable evidence. Concerted multi-site and multi-disciplinary, action-oriented research studies are urgently needed to provide an evidence base for the prevention and mitigation of violence perpetrated against emergency department nurses. The investigation of interventions rather than repeatedly redefining the problem and directing resources into debating semantics or differentiating 'degrees' of violence and aggression is recommended. This review unambiguously identifies the gap in research-based interventions. © 2010 Blackwell Publishing Ltd.

  8. Knowledge translation studies in paediatric emergency medicine: A systematic review of the literature.

    Science.gov (United States)

    Wilson, Catherine L; Johnson, David; Oakley, Ed

    2016-02-01

    Systematic review of knowledge translation studies focused on paediatric emergency care to describe and assess the interventions used in emergency department settings. Electronic databases were searched for knowledge translation studies conducted in the emergency department that included the care of children. Two researchers independently reviewed the studies. From 1305 publications identified, 15 studies of varied design were included. Four were cluster-controlled trials, two patient-level randomised controlled trials, two interrupted time series, one descriptive study and six before and after intervention studies. Knowledge translation interventions were predominantly aimed at the treating clinician, with some targeting the organisation. Studies assessed effectiveness of interventions over 6-12 months in before and after studies, and 3-28 months in cluster or patient level controlled trials. Changes in clinical practice were variable, with studies on single disease and single treatments in a single site showing greater improvement. Evidence for effective methods to translate knowledge into practice in paediatric emergency medicine is fairly limited. More optimal study designs with more explicit descriptions of interventions are needed to facilitate other groups to effectively apply these procedures in their own setting. © 2016 The Authors Journal of Paediatrics and Child Health © 2016 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

  9. Review and assessment of package requirements (yellowcake) and emergency response to transportation accidents

    International Nuclear Information System (INIS)

    1978-10-01

    As a consequence of an accident involving a truck shipment of yellowcake, a joint NRC--DOT study was undertaken to review and assess the regulations and practices related to package integrity and to emergency response to transportation accidents involving low specific activity radioactive materials. Recommendations are made regarding the responsibilities of state and local agencies, carriers, and shippers, and the DOT and NRC regulations

  10. A Review of Lawsuits Related to Point-of-Care Emergency Ultrasound Applications

    Directory of Open Access Journals (Sweden)

    Stolz, Lori

    2014-12-01

    Full Text Available Introduction: New medical technology brings the potential of lawsuits related to the usage of that new technology. In recent years the use of point-of-care (POC ultrasound has increased rapidly in the emergency department (ED. POC ultrasound creates potential legal risk to an emergency physician (EP either using or not using this tool. The aim of this study was to quantify and characterize reported decisions in lawsuits related to EPs performing POC ultrasound. Methods: We conducted a retrospective review of all United States reported state and federal cases in the Westlaw database. We assessed the full text of reported cases between January 2008 and December 2012. EPs with emergency ultrasound fellowship training reviewed the full text of each case. Cases were included if an EP was named, the patient encounter was in the emergency department, the interpretation or failure to perform an ultrasound was a central issue and the application was within the American College of Emergency Physician (ACEP ultrasound core applications. In order to assess deferred risk, cases that involved ultrasound examinations that could have been performed by an EP but were deferred to radiology were included. Results: We identified five cases. All reported decisions alleged a failure to perform an ultrasound study or a failure to perform it in a timely manner. All studies were within the scope of emergency medicine and were ACEP emergency ultrasound core applications. A majority of cases (n=4 resulted in a patient death. There were no reported cases of failure to interpret or misdiagnoses. Conclusion: In a five-year period from January 2008 through December 2012, five malpractice cases involving EPs and ultrasound examinations that are ACEP core emergency ultrasound applications were documented in the Westlaw database. All cases were related to failure to perform an ultrasound study or failure to perform a study in a timely manner and none involved failure to

  11. Optimising growth in phenylketonuria

    DEFF Research Database (Denmark)

    Dokoupil, Katharina; Gokmen-Ozel, Hulya; Lammardo, Anna Maria

    2012-01-01

    populations. We reviewed the literature searching for evidence regarding PKU and growth as well as possible links between dietary management of PKU and growth. The search retrieved only limited evidence on the effect of PKU and its dietary management on growth. Physical development in PKU remains an under....... Protein requirements in dietary management of PKU are met mostly from Phe-free protein substitutes with the intake of natural protein restricted to patient tolerance. Several reports have suggested that growth in early childhood in PKU is sub-optimal, relative to non-PKU control groups or reference...

  12. Frailty in Older Adults Using Pre-hospital Care and the Emergency Department: A Narrative Review.

    Science.gov (United States)

    Goldstein, Judah P; Andrew, Melissa K; Travers, Andrew

    2012-03-01

    Older adults use more health-care services per capita than younger age groups and the older adult population varies greatly in its needs. Evidence suggests that there is a critical distinction between relative frailty and fitness in older adults. Here, we review how frailty is described in the pre-hospital literature and in the broader emergency medicine literature. PubMed was used as the primary database, but was augmented by searches of CINAHL and EMBASE. Articles were included if they focused on patients 60 years and older and implemented a definition of frailty or risk screening tool in the Emergency Medical Services (EMS) or Emergency Department setting. IN THE BROAD CLINICAL LITERATURE, THREE TYPES OF MEASURES CAN BE IDENTIFIED: frailty index measures, frailty scales, and a phenotypic definition. Each offers advantages and disadvantages for the EMS stakeholder. We identified no EMS literature on frailty conceptualization or management, although some risk measures from emergency medicine use terms that overlap with the frailty literature. There is a paucity of research on frailty in the Emergency Medical Services literature. No research was identified that specifically addressed frailty conceptualization or management in EMS patients. There is a compelling need for further research in this area.

  13. A review of emerging non-volatile memory (NVM) technologies and applications

    Science.gov (United States)

    Chen, An

    2016-11-01

    This paper will review emerging non-volatile memory (NVM) technologies, with the focus on phase change memory (PCM), spin-transfer-torque random-access-memory (STTRAM), resistive random-access-memory (RRAM), and ferroelectric field-effect-transistor (FeFET) memory. These promising NVM devices are evaluated in terms of their advantages, challenges, and applications. Their performance is compared based on reported parameters of major industrial test chips. Memory selector devices and cell structures are discussed. Changing market trends toward low power (e.g., mobile, IoT) and data-centric applications create opportunities for emerging NVMs. High-performance and low-cost emerging NVMs may simplify memory hierarchy, introduce non-volatility in logic gates and circuits, reduce system power, and enable novel architectures. Storage-class memory (SCM) based on high-density NVMs could fill the performance and density gap between memory and storage. Some unique characteristics of emerging NVMs can be utilized for novel applications beyond the memory space, e.g., neuromorphic computing, hardware security, etc. In the beyond-CMOS era, emerging NVMs have the potential to fulfill more important functions and enable more efficient, intelligent, and secure computing systems.

  14. When can a woman resume or initiate contraception after taking emergency contraceptive pills? A systematic review.

    Science.gov (United States)

    Salcedo, Jennifer; Rodriguez, Maria I; Curtis, Kathryn M; Kapp, Nathalie

    2013-05-01

    Hormonal emergency contraception can postpone ovulation, making a woman vulnerable to pregnancy later in the same cycle. However, concern exists as to whether concurrently administered emergency contraception pills (ECP) and other hormonal methods of contraception may affect the effectiveness of both medications. A systematic review of the literature using PubMed and the Cochrane databases was performed to identify articles concerning the resumption or initiation of regular contraception within the same cycle as ECP use. We searched for articles in any language, published between 1980 and April 2012 and included all methods of emergency contraception pills available in the USA. The search strategy identified 184 articles in the PubMed and Cochrane databases, of which none met inclusion criteria. The drug manufacturer advises continuation or initiation of routine contraception as soon as possible after use of ulipristal acetate, with concomitant use of a reliable barrier method until next menses. However, a theoretical concern exists that given ulipristal acetate's function as a selective progesterone receptor modulator, coadministration of a progestin could decrease its effectiveness as an emergency contraceptive. Initiation of hormonal contraception following levonorgestrel or the Yuzpe regimen for emergency contraception carries no similar concern for decreased method effectiveness. Copyright © 2013 Elsevier Inc. All rights reserved.

  15. Policy, Practice, and Research Agenda for Emergency Medical Services Oversight: A Systematic Review and Environmental Scan.

    Science.gov (United States)

    Taymour, Rekar K; Abir, Mahshid; Chamberlin, Margaret; Dunne, Robert B; Lowell, Mark; Wahl, Kathy; Scott, Jacqueline

    2018-02-01

    Introduction In a 2015 report, the Institute of Medicine (IOM; Washington, DC USA), now the National Academy of Medicine (NAM; Washington, DC USA), stated that the field of Emergency Medical Services (EMS) exhibits signs of fragmentation; an absence of system-wide coordination and planning; and a lack of federal, state, and local accountability. The NAM recommended clarifying what roles the federal government, state governments, and local communities play in the oversight and evaluation of EMS system performance, and how they may better work together to improve care. This systematic literature review and environmental scan addresses NAM's recommendations by answering two research questions: (1) what aspects of EMS systems are most measured in the peer-reviewed and grey literatures, and (2) what do these measures and studies suggest for high-quality EMS oversight? To answer these questions, a systematic literature review was conducted in the PubMed (National Center for Biotechnology Information, National Institutes of Health; Bethesda, Maryland USA), Web of Science (Thomson Reuters; New York, New York USA), SCOPUS (Elsevier; Amsterdam, Netherlands), and EMBASE (Elsevier; Amsterdam, Netherlands) databases for peer-reviewed literature and for grey literature; targeted web searches of 10 EMS-related government agencies and professional organizations were performed. Inclusion criteria required peer-reviewed literature to be published between 1966-2016 and grey literature to be published between 1996-2016. A total of 1,476 peer-reviewed titles were reviewed, 76 were retrieved for full-text review, and 58 were retained and coded in the qualitative software Dedoose (Manhattan Beach, California USA) using a codebook of themes. Categorizations of measure type and level of application were assigned to the extracted data. Targeted websites were systematically reviewed and 115 relevant grey literature documents were retrieved. A total of 58 peer-reviewed articles met inclusion

  16. Interpretation of optimisation in the context of a disposal facility for long-lived radioactive waste

    International Nuclear Information System (INIS)

    1999-01-01

    Full text: Guidance on the Requirements for Authorisation (the GRA) issued by the Environment Agency for England and Wales requires that all disposals of radioactive waste are undertaken in a manner consistent with four principles for the protection of the public. Among these is a principle of Optimisation, that: 'The radiological detriment to members of the public that may result from the disposal of radioactive waste shall be as low as reasonably achievable, economic and social factors being taken into account'. The principle of optimisation is widely accepted and has been discussed in both UK national policy and guidance and in documents from international organisations. The practical interpretation of optimisation in the context of post-closure safety of radioactive waste repositories is, however, still open to question. In particular, the strategies and procedures that a developer might employ to implement optimisation in the siting and development of a repository, and demonstrate optimisation in a safety case, are not defined. In preparation for its role of regulatory review, the Agency has undertaken a pilot study to explore the possible interpretations of optimisation stemming from the GRA, and to identify possible strategies and procedures that a developer might follow. A review has been undertaken of UK regulatory guidance and related documents, and also international guidance, referring to optimisation in relation to radioactive waste disposal facilities. In addition, diverse examples of the application of optimisation have been identified in the international and UK performance assessment literature. A one-day meeting was organised bringing together Agency staff and technical experts with different experiences and perspectives on the subject of optimisation in the context of disposal facilities for radioactive waste. This meeting identified and discussed key issues and possible approaches to optimisation, and specifically: (1) The meaning of

  17. The efficacy of intrauterine devices for emergency contraception: a systematic review of 35 years of experience

    Science.gov (United States)

    Cleland, Kelly; Zhu, Haoping; Goldstuck, Norman; Cheng, Linan; Trussell, James

    2012-01-01

    BACKGROUND Intrauterine devices (IUDs) have been studied for use for emergency contraception for at least 35 years. IUDs are safe and highly effective for emergency contraception and regular contraception, and are extremely cost-effective as an ongoing method. The objective of this study was to evaluate the existing data to estimate the efficacy of IUDs for emergency contraception. METHODS The reference list for this study was generated from hand searching the reference lists of relevant articles and our own article archives, and electronic searches of several databases: Medline, Global Health, Clinicaltrials.gov, Popline, Wanfang Data (Chinese) and Weipu Data (Chinese). We included studies published in English or Chinese, with a defined population of women who presented for emergency contraception and were provided with an IUD, and in which the number of pregnancies was ascertained and loss to follow-up was clearly defined. Data from each article were abstracted independently by two reviewers. RESULTS The 42 studies (of 274 retrieved) that met our inclusion criteria were conducted in six countries between 1979 and 2011 and included eight different types of IUD and 7034 women. The maximum timeframe from intercourse to insertion of the IUD ranged from 2 days to 10 or more days; the majority of insertions (74% of studies) occurred within 5 days of intercourse. The pregnancy rate (excluding one outlier study) was 0.09%. CONCLUSIONS IUDs are a highly effective method of contraception after unprotected intercourse. Because they are safe for the majority of women, highly effective and cost-effective when left in place as ongoing contraception, whenever clinically feasible IUDs should be included in the range of emergency contraception options offered to patients presenting after unprotected intercourse. This review is limited by the fact that the original studies did not provide sufficient data on the delay between intercourse and insertion of the IUD, parity, cycle day

  18. Report on the emergency evacuation review team on emergency response plans for the Perry and Davis-Besse nuclear power plants

    International Nuclear Information System (INIS)

    Anon.

    1987-01-01

    This book is a report by Ohio's Emergency Evacuation Review Team, at the request of Governor Richard Celeste. The Team concludes that the current emergency response plan for Ohio's reactors is inadequate to protect the public and recommends changes in the current emergency plant requirements. The report also includes a summary of the litigation that has occurred since Celeste withdrew his support for the plans, a list of experts consulted, and sources used to prepare the report. An important document, and a study which every state should undertake

  19. Optimisation in X-ray and Molecular Imaging 2015

    International Nuclear Information System (INIS)

    Baath, Magnus; Hoeschen, Christoph; Mattsson, Soeren; Mansson, Lars Gunnar

    2016-01-01

    This issue of Radiation Protection Dosimetry is based on contributions to Optimisation in X-ray and Molecular Imaging 2015 - the 4. Malmoe Conference on Medical Imaging (OXMI 2015). The conference was jointly organised by members of former and current research projects supported by the European Commission EURATOM Radiation Protection Research Programme, in cooperation with the Swedish Society for Radiation Physics. The conference brought together over 150 researchers and other professionals from hospitals, universities and industries with interests in different aspects of the optimisation of medical imaging. More than 100 presentations were given at this international gathering of medical physicists, radiologists, engineers, technicians, nurses and educational researchers. Additionally, invited talks were offered by world-renowned experts on radiation protection, spectral imaging and medical image perception, thus covering several important aspects of the generation and interpretation of medical images. The conference consisted of 13 oral sessions and a poster session, as reflected by the conference title connected by their focus on the optimisation of the use ionising radiation in medical imaging. The conference included technology-specific topics such as computed tomography and tomosynthesis, but also generic issues of interest for the optimisation of all medical imaging, such as image perception and quality assurance. Radiation protection was covered by e.g. sessions on patient dose benchmarking and occupational exposure. Technically-advanced topics such as modelling, Monte Carlo simulation, reconstruction, classification, and segmentation were seen taking advantage of recent developments of hardware and software, showing that the optimisation community is at the forefront of technology and adapts well to new requirements. These peer-reviewed proceedings, representing a continuation of a series of selected reports from meetings in the field of medical imaging

  20. A multi-disciplinary perspective on emergent and future innovations in peer review.

    Science.gov (United States)

    Tennant, Jonathan P; Dugan, Jonathan M; Graziotin, Daniel; Jacques, Damien C; Waldner, François; Mietchen, Daniel; Elkhatib, Yehia; B Collister, Lauren; Pikas, Christina K; Crick, Tom; Masuzzo, Paola; Caravaggi, Anthony; Berg, Devin R; Niemeyer, Kyle E; Ross-Hellauer, Tony; Mannheimer, Sara; Rigling, Lillian; Katz, Daniel S; Greshake Tzovaras, Bastian; Pacheco-Mendoza, Josmel; Fatima, Nazeefa; Poblet, Marta; Isaakidis, Marios; Irawan, Dasapta Erwin; Renaut, Sébastien; Madan, Christopher R; Matthias, Lisa; Nørgaard Kjær, Jesper; O'Donnell, Daniel Paul; Neylon, Cameron; Kearns, Sarah; Selvaraju, Manojkumar; Colomb, Julien

    2017-01-01

    Peer review of research articles is a core part of our scholarly communication system. In spite of its importance, the status and purpose of peer review is often contested. What is its role in our modern digital research and communications infrastructure? Does it perform to the high standards with which it is generally regarded? Studies of peer review have shown that it is prone to bias and abuse in numerous dimensions, frequently unreliable, and can fail to detect even fraudulent research. With the advent of web technologies, we are now witnessing a phase of innovation and experimentation in our approaches to peer review. These developments prompted us to examine emerging models of peer review from a range of disciplines and venues, and to ask how they might address some of the issues with our current systems of peer review. We examine the functionality of a range of social Web platforms, and compare these with the traits underlying a viable peer review system: quality control, quantified performance metrics as engagement incentives, and certification and reputation. Ideally, any new systems will demonstrate that they out-perform and reduce the biases of existing models as much as possible. We conclude that there is considerable scope for new peer review initiatives to be developed, each with their own potential issues and advantages. We also propose a novel hybrid platform model that could, at least partially, resolve many of the socio-technical issues associated with peer review, and potentially disrupt the entire scholarly communication system. Success for any such development relies on reaching a critical threshold of research community engagement with both the process and the platform, and therefore cannot be achieved without a significant change of incentives in research environments.

  1. Pain Management in the Emergency Department: a Review Article on Options and Methods

    Directory of Open Access Journals (Sweden)

    Ali Abdolrazaghnejad

    2018-06-01

    Full Text Available Context: The aim of this review is to recognizing different methods of analgesia for emergency medicine physicians (EMPs allows them to have various pain relief methods to reduce pain and to be able to use it according to the patient’s condition and to improve the quality of their services. Evidence acquisition: In this review article, the search engines and scientific databases of Google Scholar, Science Direct, PubMed, Medline, Scopus, and Cochrane for emergency pain management methods were reviewed. Among the findings, high quality articles were eventually selected from 2000 to 2018, and after reviewing them, we have conducted a comprehensive comparison of the usual methods of pain control in the emergency department (ED.  Results: For better understanding, the results are reported in to separate subheadings including “Parenteral agents” and “Regional blocks”. Non-opioids analgesics such as nonsteroidal anti-inflammatory drugs (NSAIDs and acetaminophen are commonly used in the treatment of acute pain. However, the relief of acute moderate to severe pain usually requires opioid agents. Considering the side effects of systemic drugs and the restrictions on the use of analgesics, especially opioids, regional blocks of pain as part of a multimodal analgesic strategy can be helpful. Conclusion: This study was designed to investigate and identify the disadvantages and advantages of using each drug to be able to make the right choices in different clinical situations for patients while paying attention to the limitations of the use of these analgesic drugs.

  2. Learning from critical case reviews: emergent themes and their impact on practice.

    Science.gov (United States)

    Crofts, Linda

    2006-12-01

    This paper describes the process of conducting critical case reviews as part of a leadership programme for critical care. Forty-five cases were reviewed over 2 years in five different hospitals and permission was sought from local research ethics committees and research and development committees for the discussions to be treated as research data. Typically the cases presented were patients with complex needs whose trajectory of care had not gone smoothly. Key themes to emerge from the case reviews were: The case reviews themselves were: Communication failures between professional groups, between professional themselves, between staff and families, between wards and departments and between different hospitals. Documentation was also often less than satisfactory. Teams often had problems in working together as a team and different professionals often had different expectations of other members of the team. Individual action may compensate for weaknesses in formal clinical risk system. The case reviews themselves were showcases of the difficulties the health service faces every day and the challenges of communicating effectively. The case reviews provided an effective medium to both resolve those difficulties and model a means through which teams could effectively manage and communicate patient care issues. Furthermore their strength as a learning tool was attributed to team learning as a powerful catalyst for change.

  3. Optimising Comprehensibility in Interlingual Translation

    DEFF Research Database (Denmark)

    Nisbeth Jensen, Matilde

    2015-01-01

    The increasing demand for citizen engagement in areas traditionally belonging exclusively to experts, such as health, law and technology has given rise to the necessity of making expert knowledge available to the general public through genres such as instruction manuals for consumer goods, patien...... the functional text type of Patient Information Leaflet. Finally, the usefulness of applying the principles of Plain Language and intralingual translation for optimising comprehensibility in interlingual translation is discussed....

  4. Emergency department-based interventions for women suffering domestic abuse: a critical literature review.

    Science.gov (United States)

    Ansari, Sereena; Boyle, Adrian

    2017-02-01

    Domestic abuse represents a serious public health and human rights concern. Interventions to reduce the risk of abuse include staff training and standardized documentation improving detection and adherence to referral pathways. Interventional studies have been conducted in primary care, maternity and outpatient settings. Women disclosing abuse in emergency departments differ from women attending other healthcare settings, and it is unclear whether these interventions can be transferred to the emergency care setting. This review examines interventional studies to evaluate the effectiveness of emergency department-based interventions in reducing domestic abuse-related morbidity. Medline, EMBASE, CINAHL, PsycINFO and Cochrane Library were searched, according to prespecified selection criteria. Study quality was assessed using the Jadad scale. Of 273 search results, nine were eligible for review. Interventions involving staff training demonstrated benefits in subjective measures, such as staff knowledge regarding abuse, but no changes in clinical practice, based on detection and referral rates. When staff training was implemented in conjunction with supporting system changes - for example, standardized documentation for assessment and referral - clinically relevant improvements were noted. Interventions centred around staff training are insufficient to bring about improvements in the management and, thus, outcome of patients suffering abuse. Instead, system changes, such as standardized documentation and referral pathways, supported by training, may bring about beneficial changes. It remains uncertain whether surrogate outcomes employed by most studies translate to changes in abuse-related morbidity: the ultimate goal.

  5. Reviewing the History of Pandemic Influenza: Understanding Patterns of Emergence and Transmission

    Science.gov (United States)

    Saunders-Hastings, Patrick R.; Krewski, Daniel

    2016-01-01

    For centuries, novel strains of influenza have emerged to produce human pandemics, causing widespread illness, death, and disruption. There have been four influenza pandemics in the past hundred years. During this time, globalization processes, alongside advances in medicine and epidemiology, have altered the way these pandemics are experienced. Drawing on international case studies, this paper provides a review of the impact of past influenza pandemics, while examining the evolution of our understanding of, and response to, these viruses. This review argues that pandemic influenza is in part a consequence of human development, and highlights the importance of considering outbreaks within the context of shifting global landscapes. While progress in infectious disease prevention, control, and treatment has improved our ability to respond to such outbreaks, globalization processes relating to human behaviour, demographics, and mobility have increased the threat of pandemic emergence and accelerated global disease transmission. Preparedness planning must continue to evolve to keep pace with this heightened risk. Herein, we look to the past for insights on the pandemic experience, underlining both progress and persisting challenges. However, given the uncertain timing and severity of future pandemics, we emphasize the need for flexible policies capable of responding to change as such emergencies develop. PMID:27929449

  6. Compassion Fatigue among Healthcare, Emergency and Community Service Workers: A Systematic Review

    Directory of Open Access Journals (Sweden)

    Fiona Cocker

    2016-06-01

    Full Text Available Compassion fatigue (CF is stress resulting from exposure to a traumatized individual. CF has been described as the convergence of secondary traumatic stress (STS and cumulative burnout (BO, a state of physical and mental exhaustion caused by a depleted ability to cope with one’s everyday environment. Professionals regularly exposed to the traumatic experiences of the people they service, such as healthcare, emergency and community service workers, are particularly susceptible to developing CF. This can impact standards of patient care, relationships with colleagues, or lead to more serious mental health conditions such as posttraumatic stress disorder (PTSD, anxiety or depression. A systematic review of the effectiveness of interventions to reduce CF in healthcare, emergency and community service workers was conducted. Thirteen relevant studies were identified, the majority of which were conducted on nurses (n = 10. Three included studies focused on community service workers (social workers, disability sector workers, while no studies targeting emergency service workers were identified. Seven studies reported a significant difference post-intervention in BO (n = 4 or STS (n = 3. This review revealed that evidence of the effectiveness of CF interventions in at-risk health and social care professions is relatively recent. Therefore, we recommend more research to determine how best to protect vulnerable workers at work to prevent not only CF, but also the health and economic consequences related to the ensuing, and more disabling, physical and mental health outcomes.

  7. TEM turbulence optimisation in stellarators

    Science.gov (United States)

    Proll, J. H. E.; Mynick, H. E.; Xanthopoulos, P.; Lazerson, S. A.; Faber, B. J.

    2016-01-01

    With the advent of neoclassically optimised stellarators, optimising stellarators for turbulent transport is an important next step. The reduction of ion-temperature-gradient-driven turbulence has been achieved via shaping of the magnetic field, and the reduction of trapped-electron mode (TEM) turbulence is addressed in the present paper. Recent analytical and numerical findings suggest TEMs are stabilised when a large fraction of trapped particles experiences favourable bounce-averaged curvature. This is the case for example in Wendelstein 7-X (Beidler et al 1990 Fusion Technol. 17 148) and other Helias-type stellarators. Using this knowledge, a proxy function was designed to estimate the TEM dynamics, allowing optimal configurations for TEM stability to be determined with the STELLOPT (Spong et al 2001 Nucl. Fusion 41 711) code without extensive turbulence simulations. A first proof-of-principle optimised equilibrium stemming from the TEM-dominated stellarator experiment HSX (Anderson et al 1995 Fusion Technol. 27 273) is presented for which a reduction of the linear growth rates is achieved over a broad range of the operational parameter space. As an important consequence of this property, the turbulent heat flux levels are reduced compared with the initial configuration.

  8. EMTALA and patients with psychiatric emergencies: a review of relevant case law.

    Science.gov (United States)

    Lindor, Rachel A; Campbell, Ronna L; Pines, Jesse M; Melin, Gabrielle J; Schipper, Agnes M; Goyal, Deepi G; Sadosty, Annie T

    2014-11-01

    Emergency department (ED) care for patients with psychiatric complaints has become increasingly challenging given recent nationwide declines in available inpatient psychiatric beds. This creates pressure to manage psychiatric patients in the ED or as outpatients and may place providers and institutions at risk for liability under the Emergency Medical Treatment and Labor Act (EMTALA). We describe the patient characteristics, disposition, and legal outcomes of EMTALA cases involving patients with psychiatric complaints. Jury verdicts, settlements, and other litigation involving alleged EMTALA violations related to psychiatric patients between the law's enactment in 1986 and the end of 2012 were collected from 3 legal databases (Westlaw, Lexis, and Bloomberg Law). Details about the patient characteristics, disposition, and reasons for litigation were independently abstracted by 2 trained reviewers onto a standardized data form. Thirty-three relevant cases were identified. Two cases were decided in favor of the plaintiffs, 4 cases were settled, 10 cases had an unknown outcome, and 17 were decided in favor of the defendant institutions. Most patients in these 33 cases were men, had past psychiatric diagnoses, were not evaluated by a psychiatrist, and eventually committed or attempted suicide. The most frequently successful defense used by institutions was to demonstrate that their providers used a standard screening examination and did not detect an emergency medical condition that required stabilization. Lawsuits involving alleged EMTALA violations in the care of ED patients with psychiatric complaints are uncommon and rarely successful. Copyright © 2014 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

  9. Chernobyl is not everywhere. A critical review of emergency preparedness 10 years after Chernobyl

    International Nuclear Information System (INIS)

    Brunner, H.H.

    1996-01-01

    The Chernobyl shock had positive consequences for emergency preparedness. But have the right conclusions been drawn and the lessons really learnt? Some countries which were not ready when Chernobyl happened, have based their new concepts too closely on the Chernobyl scenario and do not seem to realize that a next accident may be completely different. Many concepts and developments are too academic and not adapted to the severe operational requirements of real emergency conditions. The information of the public still shows most of the deficiencies which were the cause of the only real 'catastrophic' consequences of Chernobyl outside the former Soviet Union: the information failure. A critical review of the developments in the various aspects of emergency preparedness, based on international comparisons (a.o. from NEA International Emergency exercise INEX-1 and both NEA and FS Workshops) shows both real improvements and mistakes or weak points and leads to the following positive and negative observations, conclusions and proposals for future action (given in short-hand form due to limited space). (author)

  10. Use of mobile devices in the emergency department: A scoping review.

    Science.gov (United States)

    Dexheimer, Judith W; Borycki, Elizabeth M

    2015-12-01

    Electronic health records are increasingly used in regional health authorities, healthcare systems, hospitals, and clinics throughout North America. The emergency department provides care for urgent and critically ill patients. Over the past several years, emergency departments have become more computerized. Tablet computers and Smartphones are increasingly common in daily use. As part of the computerization trend, we have seen the introduction of handheld computers, tablets, and Smartphones into practice as a way of providing health professionals (e.g. physicians, nurses) with access to patient information and decision support in the emergency department. In this article, we present a scoping review and outline the current state of the research using mobile devices in the emergency departments. Our findings suggest that there is very little research evidence that supports the use of these mobile devices, and more research is needed to better understand and optimize the use of mobile devices. Given the prevalence of handheld devices, it is inevitable that more decision support, charting, and other activities will be performed on these devices. These developments have the potential to improve the quality and timeliness of care but should be thoroughly evaluated. © The Author(s) 2014.

  11. Optimising Impact in Astronomy for Development Projects

    Science.gov (United States)

    Grant, Eli

    2015-08-01

    Positive outcomes in the fields of science education and international development are notoriously difficult to achieve. Among the challenges facing projects that use astronomy to improve education and socio-economic development is how to optimise project design in order to achieve the greatest possible benefits. Over the past century, medical scientists along with statisticians and economists have progressed an increasingly sophisticated and scientific approach to designing, testing and improving social intervention and public health education strategies. This talk offers a brief review of the history and current state of `intervention science'. A similar framework is then proposed for astronomy outreach and education projects, with applied examples given of how existing evidence can be used to inform project design, predict and estimate cost-effectiveness, minimise the risk of unintended negative consequences and increase the likelihood of target outcomes being achieved.

  12. Emerging organic contaminants in groundwater: A review of sources, fate and occurrence

    International Nuclear Information System (INIS)

    Lapworth, D.J.; Baran, N.; Stuart, M.E.; Ward, R.S.

    2012-01-01

    Emerging organic contaminants (EOCs) detected in groundwater may have adverse effects on human health and aquatic ecosystems. This paper reviews the existing occurrence data in groundwater for a range of EOCs including pharmaceutical, personal care, ‘life-style’ and selected industrial compounds. The main sources and pathways for organic EOCs in groundwater are reviewed, with occurrence data for EOCs in groundwater included from both targeted studies and broad reconnaissance surveys. Nanogram-microgram per litre concentrations are present in groundwater for a large range of EOCs as well as metabolites and transformation products and under certain conditions may pose a threat to freshwater bodies for decades due to relatively long groundwater residence times. In the coming decades, more of these EOCs are likely to have drinking water standards, environmental quality standards and/or groundwater threshold values defined, and therefore a better understanding of the spatial and temporal variation remains a priority. - Highlights: ► First review to focus on EOCs in groundwater. ► A large range (n > 180) of EOCs are detected in groundwater. ► Significant concentrations (10 2 –10 4 ng/L) for a range of EOCs, including endocrine disruptors. ► Groundwater EOC occurrence is poorly characterised compared to other freshwater resources. - A large range of emerging organic contaminants are now being detected in groundwater as a result of recent and historical anthropogenic activities.

  13. ATTENTION TO THE EMERGENCY ROOM WITH EMPHASIS ON PRE-HOSPITAL CARE: INTEGRATIVE REVIEW

    Directory of Open Access Journals (Sweden)

    B. S. Santos

    2017-08-01

    Full Text Available The study aims to identify the factors, which influence positively and negatively the implementation of public policies geared to the needs in scope of mobile, found in the publications of brazilian researchers since the implementation of the National Policy of Attention to the Emergency room in Brazil. This is a study of Integrative Literature Review. Composing the basis of methodology, have been used official documents to guide the findings that comprised the conceptual bases of the study and to guide the Integrative Review were used publications that report on the issue in question respecting all steps of the protocol review. The results show the changes in the organizational structure of the Service Mobile Emergency, given the regionalization as something positive for the growth of this service modality and discuss prematurely early articulation between the sectors that make up the public health system in Brazil. In conclusion, the policies of attention to the urgencies, in particular within mobile, have favored beneficially all of the users who require this type of care, in the meantime, make the necessary reflections about this theme in the attempt of a better understanding of the regionalization process and coordination among the municipalities that will offer the mobile care so as to ensure continuity of care through the mechanisms of reference and counter-reference

  14. Ebola Hemorrhagic Fever as a Public Health Emergency of International Concern; a Review Article.

    Science.gov (United States)

    Safari, Saeed; Baratloo, Alireza; Rouhipour, Alaleh; Ghelichkhani, Parisa; Yousefifard, Mahmood

    2015-01-01

    Ebola hemorrhagic fever (EHF) was first reported in 1976 with two concurrent outbreaks of acute viral hemorrhagic fever centered in Yambuku (near the Ebola river), Democratic Republic of Congo, and in Nzara, Sudan. The current outbreak of the Ebola virus was started by reporting the first case in March 2014 in the forest regions of southeastern Guinea. Due to infection rates raising over 13,000% within a 6-month period, Ebola is now considered as a global public health emergency and on August 8(th), 2014 the World Health Organization (WHO) declared the epidemic to be a Public Health Emergency of International Concern. With more than 5000 involved cases and nearly 3000 deaths, this event has turned into the largest and most dangerous Ebola virus outbreak in the world. Based on the above-mentioned, the present article aimed to review the virologic characteristics, transmission, clinical manifestation, diagnosis, treatment, and prevention of Ebola virus disease.

  15. Ultrasonography of pediatric urogenital emergencies: review of classic and new techniques

    Directory of Open Access Journals (Sweden)

    Masahiro Kitami

    2017-07-01

    Full Text Available Urogenital emergencies are fairly common in the pediatric population, and a timely and correct diagnosis is necessary to avoid possible future infertility. In this field, ultrasonography is essential, as it has the advantages of being radiation-free and readily accessible. In particular, a high-frequency transducer allows precise evaluation of the morphology and vascularity of the scrotum, which is on the surface of the body. Beyond conventional techniques, new advanced imaging techniques have been developed, including elastography and contrast-enhanced ultrasonography. However, several pitfalls remain in the diagnosis of urogenital diseases using ultrasonography. Thus, accurate knowledge and sufficient experience with the technique are essential for making a correct diagnosis. This review provides an overview of pediatric urogenital emergency pathologies and recent ultrasonography techniques.

  16. Ultrasonography of pediatric urogenital emergencies: review of classic and new techniques

    Energy Technology Data Exchange (ETDEWEB)

    Kitami, Masahiro [Dept. of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Sendai (Japan)

    2017-07-15

    Urogenital emergencies are fairly common in the pediatric population, and a timely and correct diagnosis is necessary to avoid possible future infertility. In this field, ultrasonography is essential, as it has the advantages of being radiation-free and readily accessible. In particular, a high-frequency transducer allows precise evaluation of the morphology and vascularity of the scrotum, which is on the surface of the body. Beyond conventional techniques, new advanced imaging techniques have been developed, including elastography and contrast-enhanced ultrasonography. However, several pitfalls remain in the diagnosis of urogenital diseases using ultrasonography. Thus, accurate knowledge and sufficient experience with the technique are essential for making a correct diagnosis. This review provides an overview of pediatric urogenital emergency pathologies and recent ultrasonography techniques.

  17. Active Polymers — Emergent Conformational and Dynamical Properties: A Brief Review

    Science.gov (United States)

    Winkler, Roland G.; Elgeti, Jens; Gompper, Gerhard

    2017-10-01

    Active matter exhibits a wealth of emerging nonequilibrium behaviours. A paradigmatic example is the interior of cells, where active components, such as the cytoskeleton, are responsible for its structural organization and the dynamics of the various components. Of particular interest are the properties of polymers and filaments. The intimate coupling of thermal and active noise, hydrodynamic interactions, and polymer conformations implies the emergence of novel structural and dynamical features. In this article, we review recent theoretical and simulation developments and results for the structural and dynamical properties of polymers exposed to activity. Two- and three-dimensional filaments are considered propelled by different mechanisms such as active Brownian particles or hydrodynamically-coupled force dipoles.

  18. Effect of Task Load Interventions on Fatigue in Emergency Medical Services Personnel and Other Shift Workers: A Systematic Review

    Science.gov (United States)

    2018-01-11

    Modifying the task load of Emergency Medical Services (EMS) personnel may mitigate fatigue, sleep quality and fatigue related risks. A review of the literature addressing task load interventions may benefit EMS administrators as they craft policies r...

  19. A comprehensive review of the literature on epilepsy in selected countries in emerging markets

    Directory of Open Access Journals (Sweden)

    Angalakuditi M

    2011-09-01

    Full Text Available Mallik Angalakuditi1, Nupur Angalakuditi21Georgia State University, Atlanta, GA; 2New York Medical College, Valhalla, NY, USAAims: To perform a systematic literature review of studies in peer reviewed journals on the epidemiology, economics, and treatment patterns of epilepsy in selected countries in emerging markets.Methods: A literature search was performed using relevant search terms to identify articles published from 1999 to 2000 on the epidemiology, economics, and treatment patterns of epilepsy. Studies were identified through electronic Embase®, Cochrane©, MEDLINE®, and PubMed® databases. Manual review of bibliographies allowed for the detection of additional articles.Results: Our search yielded 65 articles. These articles contained information relevant to epidemiology (n = 16, treatment guidelines (n = 4, treatment patterns (n = 33, unmet needs (n = 4, and economics (n = 8. From a patient perspective, patients with less than or equal to two adverse events (AEs while taking anti-epileptic drugs (AEDs had significantly lower annual costs than those having greater than or equal to three AEs, as did patients with fewer seizures. The overall mean annual cost for epilepsy per patient ranged from US$773 in China to US$2646 in Mexico. Prevalence data varied widely and were found for countries including Arab League Members, China, India, and Taiwan. In Turkey, active prevalence rates ranged from 0.08/1000 to 8.5/1000, and in Arab countries, active prevalence ranged from 0.9/1000 in Sudan to 6.5/1000 in Saudi Arabia. Seventeen different AEDs were used in the identified studies. The most common AEDs utilized were phenobarbital (21.7%, valproate (17.5%, and tiagabine (16.4%. In all studies, the use of AEDs resulted in an increase of patients who became seizure free and a reduction in seizure frequency and severity.Conclusion: Few studies have examined the prevalence and incidence of epilepsy in emerging markets and study limitations tend to

  20. Emerging drug targets for Aβ and tau in Alzheimer’s disease: a systematic review

    Science.gov (United States)

    West, Sophie; Bhugra, Praveen

    2015-01-01

    Aims Currently, treatment for Alzheimer’s disease (AD) focuses on the cholinergic hypothesis and provides limited symptomatic effects. Research currently focuses on other factors that are thought to contribute to AD development such as tau proteins and Aβ deposits, and how modification of the associated pathology affects outcomes in patients. This systematic review summarizes and appraises the evidence for the emerging drugs affecting Aβ and tau pathology in AD. Methods A comprehensive, systematic online database search was conducted using the databases ScienceDirect and PubMed to include original research articles. A systematic review was conducted following a minimum set of standards, as outlined by The PRISMA Group 1. Specific inclusion and exclusion criteria were followed and studies fitting the criteria were selected. No human trials were included in this review. In vitro and in vivo AD models were used to assess efficacy to ensure studied agents were emerging targets without large bodies of evidence. Results The majority of studies showed statistically significant improvement (P < 0.05) of Aβ and/or tau pathology, or cognitive effects. Many studies conducted in AD animal models have shown a reduction in Aβ peptide burden and a reduction in tau phosphorylation post-intervention. This has the potential to reduce plaque formation and neuronal degeneration. Conclusions There are many emerging targets showing promising results in the effort to modify the pathological effects associated with AD. Many of the trials also provided evidence of the clinical effects of such drugs reducing pathological outcomes, which was often demonstrated as an improvement of cognition. PMID:25753046

  1. Rapid qualitative research methods during complex health emergencies: A systematic review of the literature.

    Science.gov (United States)

    Johnson, Ginger A; Vindrola-Padros, Cecilia

    2017-09-01

    The 2013-2016 Ebola outbreak in West Africa highlighted both the successes and limitations of social science contributions to emergency response operations. An important limitation was the rapid and effective communication of study findings. A systematic review was carried out to explore how rapid qualitative methods have been used during global heath emergencies to understand which methods are commonly used, how they are applied, and the difficulties faced by social science researchers in the field. We also asses their value and benefit for health emergencies. The review findings are used to propose recommendations for qualitative research in this context. Peer-reviewed articles and grey literature were identified through six online databases. An initial search was carried out in July 2016 and updated in February 2017. The PRISMA checklist was used to guide the reporting of methods and findings. The articles were assessed for quality using the MMAT and AACODS checklist. From an initial search yielding 1444 articles, 22 articles met the criteria for inclusion. Thirteen of the articles were qualitative studies and nine used a mixed-methods design. The purpose of the rapid studies included: the identification of causes of the outbreak, and assessment of infrastructure, control strategies, health needs and health facility use. The studies varied in duration (from 4 days to 1 month). The main limitations identified by the authors were: the low quality of the collected data, small sample sizes, and little time for cross-checking facts with other data sources to reduce bias. Rapid qualitative methods were seen as beneficial in highlighting context-specific issues that need to be addressed locally, population-level behaviors influencing health service use, and organizational challenges in response planning and implementation. Recommendations for carrying out rapid qualitative research in this context included the early designation of community leaders as a point of

  2. Emergency endovascular management of peripheral artery aneurysms and pseudoaneurysms – a review

    Directory of Open Access Journals (Sweden)

    Gillard Jonathan H

    2008-07-01

    Full Text Available Abstract Endovascular stenting has been successfully employed in the management of aortic aneurysms; however, its use in managing peripheral arterial conditions remains questionable. We review the utility of endovascular technique in the management of peripheral arterial conditions like aneurysms, pseudoaneurysms and arterio-venous fistulas in the emergency setting. Though long term data about graft patency rates is not yet available, the endovascular approach appears to be a useful minimally invasive technique in situations where open repair is either difficult or not feasible.

  3. Systematic Review Methodology for the Fatigue in Emergency Medical Services Project.

    Science.gov (United States)

    Patterson, P Daniel; Higgins, J Stephen; Weiss, Patricia M; Lang, Eddy; Martin-Gill, Christian

    2018-02-15

    Guidance for managing fatigue in the Emergency Medical Services (EMS) setting is limited. The Fatigue in EMS Project sought to complete multiple systematic reviews guided by seven explicit research questions, assemble the best available evidence, and rate the quality of that evidence for purposes of producing an Evidence Based Guideline (EBG) for fatigue risk management in EMS operations. We completed seven systematic reviews that involved searches of six databases for literature relevant to seven research questions. These questions were developed a priori by an expert panel and framed in the Population, Intervention, Comparison, and Outcome (PICO) format and pre-registered with PROSPERO. Our target population was defined as persons 18 years of age and older classified as EMS personnel or similar shift worker groups. A panel of experts selected outcomes for each PICO question as prescribed by the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. We pooled findings, stratified by study design (experimental vs. observational) and presented results of each systematic review in narrative and quantitative form. We used meta-analyses of select outcomes to generate pooled effects. We used the GRADE methodology and the GRADEpro software to designate a quality of evidence rating for each outcome. We present the results for each systematic review in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). More than 38,000 records were screened across seven systematic reviews. The median, minimum, and maximum inter-rater agreements (Kappa) between screeners for our seven systematic reviews were 0.66, 0.49, and 0.88, respectively. The median, minimum, and maximum number of records retained for the seven systematic reviews was 13, 1, and 100, respectively. We present key findings in GRADE Evidence Profile Tables in separate publications for each systematic review. We describe a protocol for

  4. Presence and biological effects of emerging contaminants in Llobregat River basin: A review

    International Nuclear Information System (INIS)

    González, Susana; López-Roldán, Ramón; Cortina, Jose-Luis

    2012-01-01

    Llobregat River (North-East Spain) is the most important drinking water source for Barcelona and its surrounding area. As one of the only water sources in the area the river water have been overexploited and effluents from more than 30 urban wastewater treatment plants, industries and agriculture runoffs have been discharged into the river. This article reviews the presence of emerging contaminants published during the last decades, emphasizing on the observed effects on ecosystems caused by the contamination. Pesticides, surfactants, estrogens, pharmaceuticals and personal care products and even abuse drugs are the main groups detected in different studies, reporting alterations in species composition, abundance or biomass and endocrine disruption measured by alterations in enzymatic activity or specific protein production. The information available provides an overview of the river status according to the Water Framework Directive. - The presence of different pollutants (mainly pesticides, pharmaceuticals, surfactants and estrogens) and their biological effects in the Llobregat River are reviewed.

  5. Overcrowding in emergency departments: A review of strategies to decrease future challenges.

    Science.gov (United States)

    Yarmohammadian, Mohammad H; Rezaei, Fatemeh; Haghshenas, Abbas; Tavakoli, Nahid

    2017-01-01

    Emergency departments (EDs) are the most challenging ward with respect to patient delay. The goal of this study is to present strategies that have proven to reduce delay and overcrowding in EDs. In this review article, initial electronic database search resulted in a total of 1006 articles. Thirty articles were included after reviewing full texts. Inclusion criteria were assessments of real patient flows and implementing strategies inside the hospitals. In this study, we discussed strategies of team triage, point-of-care testing, ideal ED patient journey models, streaming, and fast track. Patients might be directed to different streaming channels depending on clinical status and required practitioners. The most comprehensive strategy is ideal ED patient journey models, in which ten interrelated substrategies are provided. ED leaders should apply strategies that provide a continuous care process without deeply depending on external services.

  6. Particle swarm optimisation classical and quantum perspectives

    CERN Document Server

    Sun, Jun; Wu, Xiao-Jun

    2016-01-01

    IntroductionOptimisation Problems and Optimisation MethodsRandom Search TechniquesMetaheuristic MethodsSwarm IntelligenceParticle Swarm OptimisationOverviewMotivationsPSO Algorithm: Basic Concepts and the ProcedureParadigm: How to Use PSO to Solve Optimisation ProblemsSome Harder Examples Some Variants of Particle Swarm Optimisation Why Does the PSO Algorithm Need to Be Improved? Inertia and Constriction-Acceleration Techniques for PSOLocal Best ModelProbabilistic AlgorithmsOther Variants of PSO Quantum-Behaved Particle Swarm Optimisation OverviewMotivation: From Classical Dynamics to Quantum MechanicsQuantum Model: Fundamentals of QPSOQPSO AlgorithmSome Essential ApplicationsSome Variants of QPSOSummary Advanced Topics Behaviour Analysis of Individual ParticlesConvergence Analysis of the AlgorithmTime Complexity and Rate of ConvergenceParameter Selection and PerformanceSummaryIndustrial Applications Inverse Problems for Partial Differential EquationsInverse Problems for Non-Linear Dynamical SystemsOptimal De...

  7. Systematic Reviews Published in Emergency Medicine Journals Do Not Routinely Search Clinical Trials Registries: A Cross-Sectional Analysis.

    Science.gov (United States)

    Keil, Lukas G; Platts-Mills, Timothy F; Jones, Christopher W

    2015-10-01

    Publication bias compromises the validity of systematic reviews. This problem can be addressed in part through searching clinical trials registries to identify unpublished studies. This study aims to determine how often systematic reviews published in emergency medicine journals include clinical trials registry searches. We identified all systematic reviews published in the 6 highest-impact emergency medicine journals between January 1 and December 31, 2013. Systematic reviews that assessed the effects of an intervention were further examined to determine whether the authors described searching a clinical trials registry and whether this search identified relevant unpublished studies. Of 191 articles identified through PubMed search, 80 were confirmed to be systematic reviews. Our sample consisted of 41 systematic reviews that assessed a specific intervention. Eight of these 41 (20%) searched a clinical trials registry. For 4 of these 8 reviews, the registry search identified at least 1 relevant unpublished study. Systematic reviews published in emergency medicine journals do not routinely include searches of clinical trials registries. By helping authors identify unpublished trial data, the addition of registry searches may improve the validity of systematic reviews. Copyright © 2014 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

  8. An Optimisation Approach for Room Acoustics Design

    DEFF Research Database (Denmark)

    Holm-Jørgensen, Kristian; Kirkegaard, Poul Henning; Andersen, Lars

    2005-01-01

    This paper discuss on a conceptual level the value of optimisation techniques in architectural acoustics room design from a practical point of view. It is chosen to optimise one objective room acoustics design criterium estimated from the sound field inside the room. The sound field is modeled...... using the boundary element method where absorption is incorporated. An example is given where the geometry of a room is defined by four design modes. The room geometry is optimised to get a uniform sound pressure....

  9. Feasibility of the use of optimisation techniques to calibrate the models used in a post-closure radiological assessment

    International Nuclear Information System (INIS)

    Laundy, R.S.

    1991-01-01

    This report addresses the feasibility of the use of optimisation techniques to calibrate the models developed for the impact assessment of a radioactive waste repository. The maximum likelihood method for improving parameter estimates is considered in detail, and non-linear optimisation techniques for finding solutions are reviewed. Applications are described for the calibration of groundwater flow, radionuclide transport and biosphere models. (author)

  10. Alcohol and Violence in the Emergency Room: A Review and Perspectives from Psychological and Social Sciences

    Directory of Open Access Journals (Sweden)

    Cheryl Cherpitel

    2013-09-01

    Full Text Available Our objective is to present a focused review of the scientific literature on the effect of alcohol consumption on violence related-injuries assessed in the emergency room (ER and to show how psychological and behavioral sciences could lead to a better understanding of the factors contributing to alcohol-related injuries in the ER. We retrieved published literature through a detailed search in Academic Search Premier, MEDLINE with Full Text PsycARTICLES, Psychology and Behavioral Sciences Collection, PsycINFO, PUBMed and SocINDEX with Full Text for articles related to emergency rooms, medical problems and sociocognitive models addressing alcohol intoxication articles. The first search was conducted in June 2011 and updated until August 2013. Literature shows that compared to uninjured patients; injured ones have a higher probability of: (i having an elevated blood-alcohol concentration upon arrival at the ER; (ii reporting having drunk alcohol during the six hours preceding the event; and (iii suffering from drinking-related consequences that adversely affect their social life. The main neurocognitive and sociocognitive models on alcohol and aggression are also discussed in order to understand the aetiology of violence-related injuries in emergency rooms. Suggestions are made for future research and prevention.

  11. Chemical warfare agent simulants for human volunteer trials of emergency decontamination: A systematic review.

    Science.gov (United States)

    James, Thomas; Wyke, Stacey; Marczylo, Tim; Collins, Samuel; Gaulton, Tom; Foxall, Kerry; Amlôt, Richard; Duarte-Davidson, Raquel

    2018-01-01

    Incidents involving the release of chemical agents can pose significant risks to public health. In such an event, emergency decontamination of affected casualties may need to be undertaken to reduce injury and possible loss of life. To ensure these methods are effective, human volunteer trials (HVTs) of decontamination protocols, using simulant contaminants, have been conducted. Simulants must be used to mimic the physicochemical properties of more harmful chemicals, while remaining non-toxic at the dose applied. This review focuses on studies that employed chemical warfare agent simulants in decontamination contexts, to identify those simulants most suitable for use in HVTs of emergency decontamination. Twenty-two simulants were identified, of which 17 were determined unsuitable for use in HVTs. The remaining simulants (n = 5) were further scrutinized for potential suitability according to toxicity, physicochemical properties and similarities to their equivalent toxic counterparts. Three suitable simulants, for use in HVTs were identified; methyl salicylate (simulant for sulphur mustard), diethyl malonate (simulant for soman) and malathion (simulant for VX or toxic industrial chemicals). All have been safely used in previous HVTs, and have a range of physicochemical properties that would allow useful inference to more toxic chemicals when employed in future studies of emergency decontamination systems. © 2017 Crown Copyright. Journal of Applied Toxicology published by John Wiley & Sons, Ltd.

  12. What are the educational and curriculum needs for emergency medical technicians in Taiwan? A scoping review

    Directory of Open Access Journals (Sweden)

    Chang YT

    2017-09-01

    Full Text Available Yu-Tung Chang,1,2 Kuang-Chau Tsai,2 Brett Williams1 1Department of Community Emergency Health and Paramedic Practice, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Frankston, VIC, Australia; 2Emergency Medicine Department, Far Eastern Memorial Hospital, New Taipei City, Taiwan Purpose: The development of emergency medical services (EMS training in Taiwan is in a transitional phase because of increasing demand for, and advancements in, clinical skill sets. The aim of this study is to review the current literature to compare the key factors of EMS training and education development in different countries in order to provide a new curricula blueprint for the Taiwanese EMS training system.Method: The method follows Arksey and O’Malley’s six stages of scoping review.Results: Five databases were searched for relevant articles: MEDLINE, EMBASE, Allied and Complementary Medicine Database; Education Resources Information Center, and Google Scholar. The initial search of five databases produced 1,230 articles, of which title and abstract screening excluded 1,156 articles. The 74 remaining articles underwent a full-text screening process, which further reduced the number of articles to 22. Researching references and citations produced an additional 23 articles, national curriculum standards produced a further six documents, and one article derived from emergency medical technician (EMT regulation in Taiwan. In total, 52 articles were included in the study, categorized by competency and standards, EMT education and learning environment, curriculum design, and teaching and learning method.Conclusion: This study reviewed international EMS training and education literature and documents to summarize the essential elements for developing an EMS education system: for example, core competencies and standards, education environment, curriculum design, and teaching and learning method. By

  13. A systematic review of patient tracking systems for use in the pediatric emergency department.

    Science.gov (United States)

    Dobson, Ian; Doan, Quynh; Hung, Geoffrey

    2013-01-01

    Patient safety is of great importance in the pediatric emergency department (PED). The combination of acutely and critically ill patients and high patient volumes creates a need for systems to support physicians in making accurate and timely diagnoses. Electronic patient tracking systems can potentially improve PED safety by reducing overcrowding and enhancing security. To enhance our understanding of current electronic tracking technologies, how they are implemented in a clinical setting, and resulting effect on patient care outcomes including patient safety. Nine databases were searched. Two independent reviewers identified articles that contained reference to patient tracking technologies in pediatrics or emergency medicine. Quantitative studies were assessed independently for methodological strength by two reviewers using an external assessment tool. Of 2292 initial articles, 22 were deemed relevant. Seventeen were qualitative, and the remaining five quantitative articles were assessed as being methodologically weak. Existing patient tracking systems in the ED included: infant monitoring/abduction prevention; barcode identification; radiofrequency identification (RFID)- or infrared (IR)-based patient tracking. Twenty articles supported the use of tracking technology to enhance patient safety or improve efficiency. One article failed to support the use of IR patient sensors due to study design flaws. Support exists for the use of barcode-, IR-, and RFID-based patient tracking systems to improve ED patient safety and efficiency. A lack of methodologically strong studies indicates a need for further evidence-based support for the implementation of patient tracking technology in a clinical or research setting. Copyright © 2013 Elsevier Inc. All rights reserved.

  14. Current and emerging concepts in muscle tension dysphonia: a 30-month review.

    Science.gov (United States)

    Altman, Kenneth W; Atkinson, Cory; Lazarus, Cathy

    2005-06-01

    The modern theory of hoarseness is that there are multifactorial etiologies contributing to the voice problem. The hypothesis of this study is that muscle tension dysphonia is multifactorial with various contributing etiologies. This project is a retrospective chart review of all patients seen in the Voice Speech and Language Service and Swallowing Center at our institution with a diagnosis of muscle tension (functional hypertensive) dysphonia over a 30-month period. A literature search and review is also performed regarding current and emerging concepts of muscle tension dysphonia. One hundred fifty subjects were identified (60% female, 40% male, with a mean age of 42.3 years). Significant factors in patient history believed to contribute to abnormal voice production were gastroesophageal reflux in 49%, high stress levels in 18%, excessive amounts of voice use in 63%, and excessive loudness demands on voice use in 23%. Otolaryngologic evaluation was performed in 82% of patients, in whom lesions, significant vocal fold edema, or paralysis/paresis was identified in 52.3%. Speech pathology assessment revealed poor breath support, inappropriately low pitch, and visible cervical neck tension in the majority of patients. Inappropriate intensity was observed in 23.3% of patients. This set of multiple contributing factors is discussed in the context of current and emerging understanding of muscle tension dysphonia. Results confirm multifactorial etiologies contributing to hoarseness in the patients identified with muscle tension dysphonia. An interdisciplinary approach to treating all contributing factors portends the best prognosis.

  15. Optimisation of technical specifications using probabilistic methods

    International Nuclear Information System (INIS)

    Ericsson, G.; Knochenhauer, M.; Hultqvist, G.

    1986-01-01

    During the last few years the development of methods for modifying and optimising nuclear power plant Technical Specifications (TS) for plant operations has received increased attention. Probalistic methods in general, and the plant and system models of probabilistic safety assessment (PSA) in particular, seem to provide the most forceful tools for optimisation. This paper first gives some general comments on optimisation, identifying important parameters and then gives a description of recent Swedish experiences from the use of nuclear power plant PSA models and results for TS optimisation

  16. Layout Optimisation of Wave Energy Converter Arrays

    DEFF Research Database (Denmark)

    Ruiz, Pau Mercadé; Nava, Vincenzo; Topper, Mathew B. R.

    2017-01-01

    This paper proposes an optimisation strategy for the layout design of wave energy converter (WEC) arrays. Optimal layouts are sought so as to maximise the absorbed power given a minimum q-factor, the minimum distance between WECs, and an area of deployment. To guarantee an efficient optimisation......, a four-parameter layout description is proposed. Three different optimisation algorithms are further compared in terms of performance and computational cost. These are the covariance matrix adaptation evolution strategy (CMA), a genetic algorithm (GA) and the glowworm swarm optimisation (GSO) algorithm...

  17. Radiological review of accident and emergency radiographs: A 1-year audit

    International Nuclear Information System (INIS)

    Williams, Stuart M.; Connelly, Daniel J.; Wadsworth, Susan; Wilson, David

    2000-01-01

    AIM: To assess the impact and cost effectiveness of a system of radiological review of accident and emergency (A and E) plain films. MATERIALS AND METHODS: Review documentation was studied retrospectively over a 1-year period. Six hundred and eighty-four actual or suspected errors in the initial radiological interpretation by A and E staff were highlighted by radiologists in training. These selected 'red reports' were then further reviewed by a musculoskeletal radiologist and a more senior member of the A and E team. RESULTS: Three hundred and fifty-one missed or strongly suspected fractures were detected, with ankle, finger and elbow lesions predominating. Other errors included 11 missed chest radiograph abnormalities and 24 A and E false-positives. Radiologists in training tended to over-report abnormalities with an 18% false-positive rate when compared to the subsequent musculoskeletal radiology opinion. Following review, further action was taken by A and E staff in 286 (42.6%) of cases. No operative intervention was required in those patients with a delayed or missed A and E diagnosis. Consideration is given to the cost of providing this form of review and the impact of medico-legal factors. CONCLUSION: Compared with the large numbers of patients seen and radiographed in a busy A and E department, the number of radiological errors was small. There were even fewer changes in management. Despite this, concern over litigation, clinical governance and future work patterns in A and E make this form of review a useful means of risk reduction in a teaching hospital. Williams, S.M. (2000). Clinical Radiology 55, 861-865

  18. Optimisation of the LHCb detector

    CERN Document Server

    Hierck, R H

    2003-01-01

    This thesis describes a comparison of the LHCb classic and LHCb light concept from a tracking perspective. The comparison includes the detector occupancies, the various pattern recognition algorithms and the reconstruction performance. The final optimised LHCb setup is used to study the physics performance of LHCb for the Bs->DsK and Bs->DsPi decay channels. This includes both the event selection and a study of the sensitivity for the Bs oscillation frequency, delta m_s, the Bs lifetime difference, DGamma_s, and the CP parameter gamma-2delta gamma.

  19. Optimisation combinatoire Theorie et algorithmes

    CERN Document Server

    Korte, Bernhard; Fonlupt, Jean

    2010-01-01

    Ce livre est la traduction fran aise de la quatri me et derni re dition de Combinatorial Optimization: Theory and Algorithms crit par deux minents sp cialistes du domaine: Bernhard Korte et Jens Vygen de l'universit de Bonn en Allemagne. Il met l accent sur les aspects th oriques de l'optimisation combinatoire ainsi que sur les algorithmes efficaces et exacts de r solution de probl mes. Il se distingue en cela des approches heuristiques plus simples et souvent d crites par ailleurs. L ouvrage contient de nombreuses d monstrations, concises et l gantes, de r sultats difficiles. Destin aux tudia

  20. A systematic review and overview of health economic evaluations of emergency laparotomy

    Directory of Open Access Journals (Sweden)

    Sohail Bampoe

    2017-11-01

    Full Text Available Abstract Background Little is known about the economic impact of emergency laparotomy (EL surgery in healthcare systems around the world. The aim of this systematic review is to describe the primary resource utilisation, healthcare economic and societal costs of EL in adults in different countries. Methods MEDLINE, EMBASE, ISI Web of Knowledge, Cochrane Central Register Controlled Trials, Cochrane Database of Systematic Reviews and CINAHL were searched for full and partial economic analyses of EL published between 1 January 1991 and 31 December 2015. Quality of studies was assessed using the Consensus on Health Economic Criteria (CHEC checklist. Results Sixteen studies were included from a range of countries. One study was a full economic analysis. Fifteen studies were partial economic evaluations. These studies revealed that emergency abdominal surgery is expensive compared to similar elective surgery when comparing primary resource utilisation costs, with an important societal impact. Most contemporaneous studies indicate that in-hospital costs for EL are in excess of US$10,000 per patient episode, rising substantially when societal costs are considered. Discussion EL is a high-risk and costly procedure with a disproportionate financial burden for healthcare providers, relative to national funding provisions and wider societal cost impact. There is substantial heterogeneity in the methodologies and quality of published economic evaluations of EL; therefore, the true economic costs of EL are yet to be fully defined. Future research should focus on developing strategies to embed health economic evaluations within national programmes aiming to improve EL care, including developing the required measures and infrastructure. Conclusions Emergency laparotomy is expensive, with a significant cost burden to healthcare and systems and society worldwide. Novel strategies for reducing this econmic burden should urgently be explored if greater access to

  1. A systematic review and overview of health economic evaluations of emergency laparotomy.

    Science.gov (United States)

    Bampoe, Sohail; Odor, Peter M; Ramani Moonesinghe, S; Dickinson, Matthew

    2017-01-01

    Little is known about the economic impact of emergency laparotomy (EL) surgery in healthcare systems around the world. The aim of this systematic review is to describe the primary resource utilisation, healthcare economic and societal costs of EL in adults in different countries. MEDLINE, EMBASE, ISI Web of Knowledge, Cochrane Central Register Controlled Trials, Cochrane Database of Systematic Reviews and CINAHL were searched for full and partial economic analyses of EL published between 1 January 1991 and 31 December 2015. Quality of studies was assessed using the Consensus on Health Economic Criteria (CHEC) checklist. Sixteen studies were included from a range of countries. One study was a full economic analysis. Fifteen studies were partial economic evaluations. These studies revealed that emergency abdominal surgery is expensive compared to similar elective surgery when comparing primary resource utilisation costs, with an important societal impact. Most contemporaneous studies indicate that in-hospital costs for EL are in excess of US$10,000 per patient episode, rising substantially when societal costs are considered. EL is a high-risk and costly procedure with a disproportionate financial burden for healthcare providers, relative to national funding provisions and wider societal cost impact. There is substantial heterogeneity in the methodologies and quality of published economic evaluations of EL; therefore, the true economic costs of EL are yet to be fully defined. Future research should focus on developing strategies to embed health economic evaluations within national programmes aiming to improve EL care, including developing the required measures and infrastructure. Emergency laparotomy is expensive, with a significant cost burden to healthcare and systems and society worldwide. Novel strategies for reducing this econmic burden should urgently be explored if greater access to this type of surgery is to be pursued as a global health target. PROSPERO

  2. Optimisation of VSC-HVDC Transmission for Wind Power Plants

    DEFF Research Database (Denmark)

    Silva, Rodrigo Da

    Connection of Wind Power Plants (WPP), typically oshore, using VSCHVDC transmission is an emerging solution with many benefits compared to the traditional AC solution, especially concerning the impact on control architecture of the wind farms and the grid. The VSC-HVDC solution is likely to meet...... more stringent grid codes than a conventional AC transmission connection. The purpose of this project is to analyse how HVDC solution, considering the voltage-source converter based technology, for grid connection of large wind power plants can be designed and optimised. By optimisation, the project...... the robust control technique is applied is compared with the classical proportional-integral (PI) performance, by means of time domain simulation in a point-to-point HVDC connection. The three main parameters in the discussion are the wind power delivered from the offshore wind power plant, the variation...

  3. Emerging (val)ganciclovir resistance during treatment of congenital CMV infection: a case report and review of the literature.

    Science.gov (United States)

    Morillo-Gutierrez, Beatriz; Waugh, Sheila; Pickering, Ailsa; Flood, Terence; Emonts, Marieke

    2017-08-22

    Congenital cytomegalovirus (cCMV) infection is an important illness that is a common cause of hearing loss in newborn infants and a major cause of disability in children. For that reason, treatment of symptomatic patients with either ganciclovir or its pro-drug valganciclovir is recommended. Treatment duration of 6 months has been shown to be more beneficial than shorter courses; however, there is uncertainty regarding emergence of resistance strains, secondary effects and long term sequelae. Here we present a female infant with symptomatic cCMV who was treated from day 5 of life with oral valganciclovir. In spite of close monitoring of her drug levels and increments of her treatment dose according to weight gain, she developed ganciclovir resistance after 4 months of treatment, with increasing viraemia and petechiae. Adherence to treatment was assessed and felt to be good. Clinically, although she had marked developmental delay, she was making steady progress. In view of the development of resistance treatment was stopped at 5 months of age. No secondary effects of ganciclovir were noted during the whole course. There were few cases in the literature reporting resistance to ganciclovir for cCMV before the new recommendations for a 6 months treatment course for this infection were published. As demonstrated in our patient, surveillance with periodic viral loads and drug monitoring are vital to identify emerging resistance and optimise antiviral dosing according to weight gain.

  4. 77 FR 9665 - Submission for OMB Emergency Review; Comment Request: A Multi-Center International Hospital-Based...

    Science.gov (United States)

    2012-02-17

    ... Review; Comment Request: A Multi- Center International Hospital-Based Case-Control Study of Lymphoma in... the Office of Management and Budget (OMB) a request for emergency review and processing this... Hospital- Based Case-Control Study of Lymphoma in Asia (AsiaLymph) (NCI). Type of Information Collection...

  5. Canadian Headache Society systematic review and recommendations on the treatment of migraine pain in emergency settings.

    Science.gov (United States)

    Orr, Serena L; Aubé, Michel; Becker, Werner J; Davenport, W Jeptha; Dilli, Esma; Dodick, David; Giammarco, Rose; Gladstone, Jonathan; Leroux, Elizabeth; Pim, Heather; Dickinson, Garth; Christie, Suzanne N

    2015-03-01

    There is a considerable amount of practice variation in managing migraines in emergency settings, and evidence-based therapies are often not used first line. A peer-reviewed search of databases (MEDLINE, Embase, CENTRAL) was carried out to identify randomized and quasi-randomized controlled trials of interventions for acute pain relief in adults presenting with migraine to emergency settings. Where possible, data were pooled into meta-analyses. Two independent reviewers screened 831 titles and abstracts for eligibility. Three independent reviewers subsequently evaluated 120 full text articles for inclusion, of which 44 were included. Individual studies were then assigned a US Preventive Services Task Force quality rating. The GRADE scheme was used to assign a level of evidence and recommendation strength for each intervention. We strongly recommend the use of prochlorperazine based on a high level of evidence, lysine acetylsalicylic acid, metoclopramide and sumatriptan, based on a moderate level of evidence, and ketorolac, based on a low level of evidence. We weakly recommend the use of chlorpromazine based on a moderate level of evidence, and ergotamine, dihydroergotamine, lidocaine intranasal and meperidine, based on a low level of evidence. We found evidence to recommend strongly against the use of dexamethasone, based on a moderate level of evidence, and granisetron, haloperidol and trimethobenzamide based on a low level of evidence. Based on moderate-quality evidence, we recommend weakly against the use of acetaminophen and magnesium sulfate. Based on low-quality evidence, we recommend weakly against the use of diclofenac, droperidol, lidocaine intravenous, lysine clonixinate, morphine, propofol, sodium valproate and tramadol. © International Headache Society 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  6. Occurrence, fate and transformation of emerging contaminants in water: An overarching review of the field.

    Science.gov (United States)

    Wilkinson, John; Hooda, Peter S; Barker, James; Barton, Stephen; Swinden, Julian

    2017-12-01

    Many of the products and drugs used commonly contain chemical components which may persist through sewage treatment works (STW) and eventually enter the aquatic environment as parent compounds, metabolites, or transformation products. Pharmaceuticals and personal care products (PPCPs) and other emerging contaminants (ECs) have been detected in waters (typically ng/L) as well as more recently bound to sediment and plastic particles (typically ng/g). Despite significant advancement of knowledge since the late 1990s, the fate of these contaminants/transformation products once introduced into the aquatic environment remains relatively unresolved. This review provides a unique focus on the fate of seven major groups of PPCPs/ECs in the aquatic environment, which is frequently not found in similar works which are often compound or topic-specific and limited in background knowledge. Key findings include: a) some replacements for regulation precluded/banned chemicals may be similarly persistent in the environment as those they replace, b) the adsorption of potentially bioactive chemicals to micro- and nanoplastics is a significant topic with risks to aquatic organisms potentially greater than previously thought, and c) micro-/nanoplastics are likely to remain of significant concern for centuries after regulatory limitations on their use become active due to the slow degradation of macro-plastics into smaller components. An interdisciplinary perspective on recent advances in the field is presented here in a unique way which highlights both the principle science and direction of research needed to elucidate the fate and transport patterns of aquatic PPCPs/ECs. Unlike similar reviews, which are often topic-specific, here we aim to present an overarching review of the field with focus on the occurrence, transformation and fate of emerging contaminants. Environmental presence of seven major classes of contaminants (analygesics, antibiotics, antineoplastics, beta

  7. Technology-enhanced simulation in emergency medicine: a systematic review and meta-analysis.

    Science.gov (United States)

    Ilgen, Jonathan S; Sherbino, Jonathan; Cook, David A

    2013-02-01

    Technology-enhanced simulation is used frequently in emergency medicine (EM) training programs. Evidence for its effectiveness, however, remains unclear. The objective of this study was to evaluate the effectiveness of technology-enhanced simulation for training in EM and identify instructional design features associated with improved outcomes by conducting a systematic review. The authors systematically searched MEDLINE, EMBASE, CINAHL, ERIC, PsychINFO, Scopus, key journals, and previous review bibliographies through May 2011. Original research articles in any language were selected if they compared simulation to no intervention or another educational activity for the purposes of training EM health professionals (including student and practicing physicians, midlevel providers, nurses, and prehospital providers). Reviewers evaluated study quality and abstracted information on learners, instructional design (curricular integration, feedback, repetitive practice, mastery learning), and outcomes. From a collection of 10,903 articles, 85 eligible studies enrolling 6,099 EM learners were identified. Of these, 56 studies compared simulation to no intervention, 12 compared simulation with another form of instruction, and 19 compared two forms of simulation. Effect sizes were pooled using a random-effects model. Heterogeneity among these studies was large (I(2) ≥ 50%). Among studies comparing simulation to no intervention, pooled effect sizes were large (range = 1.13 to 1.48) for knowledge, time, and skills and small to moderate for behaviors with patients (0.62) and patient effects (0.43; all p 0.1). Qualitative comparisons of different simulation curricula are limited, although feedback, mastery learning, and higher fidelity were associated with improved learning outcomes. Technology-enhanced simulation for EM learners is associated with moderate or large favorable effects in comparison with no intervention and generally small and nonsignificant benefits in comparison

  8. A Systematic Literature Review: Workplace Violence Against Emergency Medical Services Personnel.

    Science.gov (United States)

    Pourshaikhian, Majid; Abolghasem Gorji, Hassan; Aryankhesal, Aidin; Khorasani-Zavareh, Davood; Barati, Ahmad

    2016-03-01

    In spite of the high prevalence and consequences of much workplace violence against emergency medical services personnel, this phenomenon has been given insufficient attention. A systematic review can aid the development of guidelines to reduce violence. The research question addressed by this paper is, "What are the characteristics and findings of studies on workplace violence against emergency medical services personnel"? A systematic literature review was conducted using online databases (PubMed, Scopus, Google Scholar, and Magiran) with the help of experienced librarians. Inclusion criteria comprised studies in the English or Persian language and researcher's access to the full text. There was no limit to the entry of the study design. Exclusion criteria included lack of access to the full text of the article, studies published in unreliable journals or conferences, and studies in which the results were shared with other medical or relief groups and there was no possibility of breaking down the results. A "Data extraction form" was designed by the researchers based on the goals of the study that included the title and author(s), study method (type, place of study, sample size, sampling method, and data collection/analysis tool), printing location, information related to the frequency of types of violence, characteristics of victims /perpetrators, and related factors. The papers reviewed utilized a variety of locations and environments, methods, and instrument samplings. The majority of the studies were performed using the quantitative method. No intervention study was found. Most studies focused on the prevalence of violence, and their results indicated that exposure to violence was high. The results are presented in six major themes. Workplace violence and injuries incurred from it are extensive throughout the world. The important causes of violence include the shortage of training programs dealing with violence, lack of violence management protocols, and

  9. Optimising resource management in neurorehabilitation.

    Science.gov (United States)

    Wood, Richard M; Griffiths, Jeff D; Williams, Janet E; Brouwers, Jakko

    2014-01-01

    To date, little research has been published regarding the effective and efficient management of resources (beds and staff) in neurorehabilitation, despite being an expensive service in limited supply. To demonstrate how mathematical modelling can be used to optimise service delivery, by way of a case study at a major 21 bed neurorehabilitation unit in the UK. An automated computer program for assigning weekly treatment sessions is developed. Queue modelling is used to construct a mathematical model of the hospital in terms of referral submissions to a waiting list, admission and treatment, and ultimately discharge. This is used to analyse the impact of hypothetical strategic decisions on a variety of performance measures and costs. The project culminates in a hybridised model of these two approaches, since a relationship is found between the number of therapy hours received each week (scheduling output) and length of stay (queuing model input). The introduction of the treatment scheduling program has substantially improved timetable quality (meaning a better and fairer service to patients) and has reduced employee time expended in its creation by approximately six hours each week (freeing up time for clinical work). The queuing model has been used to assess the effect of potential strategies, such as increasing the number of beds or employing more therapists. The use of mathematical modelling has not only optimised resources in the short term, but has allowed the optimality of longer term strategic decisions to be assessed.

  10. Novel and emerging treatments for autism spectrum disorders: a systematic review.

    Science.gov (United States)

    Rossignol, Daniel A

    2009-01-01

    Currently, only one medication (risperidone) is FDA-approved for the treatment of autism spectrum disorders (ASD). Perhaps for this reason, the use of novel, unconventional, and off-label treatments for ASD is common, with up to 74% of children with ASD using these treatments; however, treating physicians are often unaware of this usage. A systematic literature search of electronic scientific databases was performed to identify studies of novel and emerging treatments for ASD, including nutritional supplements, diets, medications, and nonbiological treatments. A grade of recommendation ("Grade") was then assigned to each treatment using a validated evidence-based guideline as outlined in this review: A: Supported by at least 2 prospective randomized controlled trials (RCTs) or 1 systematic review. B: Supported by at least 1 prospective RCT or 2 nonrandomized controlled trials. C: Supported by at least 1 nonrandomized controlled trial or 2 case series. D: Troublingly inconsistent or inconclusive studies or studies reporting no improvements. Potential adverse effects for each treatment were also reviewed. Grade A treatments for ASD include melatonin, acetylcholinesterase inhibitors, naltrexone, and music therapy. Grade B treatments include carnitine, tetrahydrobiopterin, vitamin C, alpha-2 adrenergic agonists, hyperbaric oxygen treatment, immunomodulation and anti-inflammatory treatments, oxytocin, and vision therapy. Grade C treatments for ASD include carnosine, multivitamin/mineral complex, piracetam, polyunsaturated fatty acids, vitamin B6/magnesium, elimination diets, chelation, cyproheptadine, famotidine, glutamate antagonists, acupuncture, auditory integration training, massage, and neurofeedback. The reviewed treatments for ASD are commonly used, and some are supported by prospective RCTs. Promising treatments include melatonin, antioxidants, acetylcholinesterase inhibitors, naltrexone, and music therapy. All of the reviewed treatments are currently considered

  11. Early economic evaluation of emerging health technologies: protocol of a systematic review

    Science.gov (United States)

    2014-01-01

    Background The concept of early health technology assessment, discussed well over a decade, has now been collaboratively implemented by industry, government, and academia to select and expedite the development of emerging technologies that may address the needs of patients and health systems. Early economic evaluation is essential to assess the value of emerging technologies, but empirical data to inform the current practice of early evaluation is limited. We propose a systematic review of early economic evaluation studies in order to better understand the current practice. Methods/design This protocol describes a systematic review of economic evaluation studies of regulated health technologies in which the evaluation is conducted prior to regulatory approval and when the technology effectiveness is not well established. Included studies must report an economic evaluation, defined as the comparative analysis of alternatives with respect to their associated costs and health consequences, and must evaluate some regulated health technology such as pharmaceuticals, biologics, high-risk medical devices, or biomarkers. We will conduct the literature search on multiple databases, including MEDLINE, EMBASE, the Centre for Reviews and Dissemination Databases, and EconLit. Additional citations will be identified via scanning reference lists and author searching. We suspect that many early economic evaluation studies are unpublished, especially those conducted for internal use only. Additionally, we use a chain-referral sampling approach to identify authors of unpublished studies who work in technology discovery and development, starting out with our contact lists and authors who published relevant studies. Citation screening and full-text review will be conducted by pairs of reviewers. Abstracted data will include those related to the decision context and decision problem of the early evaluation, evaluation methods (e.g., data sources, methods, and assumptions used to

  12. A review of factors affecting patient satisfaction with nurse led triage in emergency departments.

    Science.gov (United States)

    Rehman, Salma Abdul; Ali, Parveen Azam

    2016-11-01

    To determine the factors that affect patient satisfaction with nurse-led-triage in EDs using a systematic review. Nurses' involvement in the triage services provided in the Emergency Department has been an integral part of practice for several decades in some countries. Although studies exploring patient satisfaction with nurse-led ED triage exist, no systematic review of this evidence is available. MEDLINE, CINAHL, PsycInfo, EMBASE, the Cochrane Library, Joanna Briggs Library and Google Scholar were searched (January 1980-June 2013). Eighteen studies that met the inclusion criteria were reviewed. Factors that affect patient satisfaction with nurse-led-triage include nurses' abilities to provide patient centred care, communication skills, nurses' caring abilities, concern for the patient and competence in diagnosing and treating the health problem. Other factors include availability and visibility of nurses, provision of appropriate health related information in a jargon-free language, nurses' ability to answer questions, and an ability to provide patients with an opportunity to ask questions. There is continued scope for nurse-led-triage services in the ED. Patients are generally satisfied with the service provided by nurses in EDs and report a willingness to see the same professional again in the future if needed. Copyright © 2015 Elsevier Ltd. All rights reserved.

  13. Epidemiological review of scorpion stings in Qatar. The need for regional management guidelines in emergency departments.

    Science.gov (United States)

    Alkahlout, Baha H; Abid, Muhammad M; Kasim, Mohammad M; Haneef, Shumaila M

    2015-07-01

    To review the epidemiology of scorpion sting in Qatar, to explore both the clinical significance, and the role of the emergency department (ED) in the management of such cases. In this retrospective study, we reviewed the records of all scorpion sting cases presented to the ED of Hamad General Hospital, Doha, Qatar between October 2010 and May 2013. A total of 111 cases of scorpion stings were reviewed, 81 (72.9%) were males and 30 (27.1%) were females, with a mean age of 38 years. Localized pain was the most frequent presenting complaint (89 [80.2%]), whereas localized redness (44 [39.6%]) and swelling (38 [34.2%]) were the most common clinical signs. Abroug's classification was used, and all cases  were found to be class I. All patients received symptomatic treatment and were sent home. Scorpion sting problem in Qatar has a low clinical significance. Data from such studies should be utilized to create more specific (local) management guidelines, which should be more efficient with more rational utilization of ED resources.

  14. Occurrence, fate and transformation of emerging contaminants in water: An overarching review of the field

    International Nuclear Information System (INIS)

    Wilkinson, John; Hooda, Peter S.; Barker, James; Barton, Stephen; Swinden, Julian

    2017-01-01

    Many of the products and drugs used commonly contain chemical components which may persist through sewage treatment works (STW) and eventually enter the aquatic environment as parent compounds, metabolites, or transformation products. Pharmaceuticals and personal care products (PPCPs) and other emerging contaminants (ECs) have been detected in waters (typically ng/L) as well as more recently bound to sediment and plastic particles (typically ng/g). Despite significant advancement of knowledge since the late 1990s, the fate of these contaminants/transformation products once introduced into the aquatic environment remains relatively unresolved. This review provides a unique focus on the fate of seven major groups of PPCPs/ECs in the aquatic environment, which is frequently not found in similar works which are often compound or topic-specific and limited in background knowledge. Key findings include: a) some replacements for regulation precluded/banned chemicals may be similarly persistent in the environment as those they replace, b) the adsorption of potentially bioactive chemicals to micro- and nanoplastics is a significant topic with risks to aquatic organisms potentially greater than previously thought, and c) micro-/nanoplastics are likely to remain of significant concern for centuries after regulatory limitations on their use become active due to the slow degradation of macro-plastics into smaller components. An interdisciplinary perspective on recent advances in the field is presented here in a unique way which highlights both the principle science and direction of research needed to elucidate the fate and transport patterns of aquatic PPCPs/ECs. Unlike similar reviews, which are often topic-specific, here we aim to present an overarching review of the field with focus on the occurrence, transformation and fate of emerging contaminants. Environmental presence of seven major classes of contaminants (analygesics, antibiotics, antineoplastics, beta

  15. 'BRICS without straw'? A systematic literature review of newly emerging economies' influence in global health.

    Science.gov (United States)

    Harmer, Andrew; Xiao, Yina; Missoni, Eduardo; Tediosi, Fabrizio

    2013-04-15

    Since 2010, five newly emerging economies collectively known as 'BRICS' (Brazil, India, Russia, China and South Africa) have caught the imagination, and scholarly attention, of political scientists, economists and development specialists. The prospect of a unified geopolitical bloc, consciously seeking to re-frame international (and global) health development with a new set of ideas and values, has also, if belatedly, begun to attract the attention of the global health community. But what influence, if any, do the BRICS wield in global health, and, if they do wield influence, how has that influence been conceptualized and recorded in the literature? We conducted a systematic literature review in (March-December 2012) of documents retrieved from the databases EMBASE, PubMed/Medline, Global Health, and Google Scholar, and the websites of relevant international organisations, research institutions and philanthropic organisations. The results were synthesised using a framework of influence developed for the review from the political science literature. Our initial search of databases and websites yielded 887 documents. Exclusion criteria narrowed the number of documents to 71 journal articles and 23 reports. Two researchers using an agreed set of inclusion criteria independently screened the 94 documents, leaving just 7 documents. We found just one document that provided sustained analysis of the BRICS' collective influence; the overwhelming tendency was to describe individual BRICS countries influence. Although influence was predominantly framed by BRICS countries' material capability, there were examples of institutional and ideational influence - particularly from Brazil. Individual BRICS countries were primarily 'opportunity seekers' and region mobilisers but with potential to become 'issue leaders' and region organisers. Though small in number, the written output on BRICS influence in global health has increased significantly since a similar review conducted in

  16. Visual grading characteristics and ordinal regression analysis during optimisation of CT head examinations.

    Science.gov (United States)

    Zarb, Francis; McEntee, Mark F; Rainford, Louise

    2015-06-01

    To evaluate visual grading characteristics (VGC) and ordinal regression analysis during head CT optimisation as a potential alternative to visual grading assessment (VGA), traditionally employed to score anatomical visualisation. Patient images (n = 66) were obtained using current and optimised imaging protocols from two CT suites: a 16-slice scanner at the national Maltese centre for trauma and a 64-slice scanner in a private centre. Local resident radiologists (n = 6) performed VGA followed by VGC and ordinal regression analysis. VGC alone indicated that optimised protocols had similar image quality as current protocols. Ordinal logistic regression analysis provided an in-depth evaluation, criterion by criterion allowing the selective implementation of the protocols. The local radiology review panel supported the implementation of optimised protocols for brain CT examinations (including trauma) in one centre, achieving radiation dose reductions ranging from 24 % to 36 %. In the second centre a 29 % reduction in radiation dose was achieved for follow-up cases. The combined use of VGC and ordinal logistic regression analysis led to clinical decisions being taken on the implementation of the optimised protocols. This improved method of image quality analysis provided the evidence to support imaging protocol optimisation, resulting in significant radiation dose savings. • There is need for scientifically based image quality evaluation during CT optimisation. • VGC and ordinal regression analysis in combination led to better informed clinical decisions. • VGC and ordinal regression analysis led to dose reductions without compromising diagnostic efficacy.

  17. Evolutionary programming for neutron instrument optimisation

    Energy Technology Data Exchange (ETDEWEB)

    Bentley, Phillip M. [Hahn-Meitner Institut, Glienicker Strasse 100, D-14109 Berlin (Germany)]. E-mail: phillip.bentley@hmi.de; Pappas, Catherine [Hahn-Meitner Institut, Glienicker Strasse 100, D-14109 Berlin (Germany); Habicht, Klaus [Hahn-Meitner Institut, Glienicker Strasse 100, D-14109 Berlin (Germany); Lelievre-Berna, Eddy [Institut Laue-Langevin, 6 rue Jules Horowitz, BP 156, 38042 Grenoble Cedex 9 (France)

    2006-11-15

    Virtual instruments based on Monte-Carlo techniques are now integral part of novel instrumentation development and the existing codes (McSTAS and Vitess) are extensively used to define and optimise novel instrumental concepts. Neutron spectrometers, however, involve a large number of parameters and their optimisation is often a complex and tedious procedure. Artificial intelligence algorithms are proving increasingly useful in such situations. Here, we present an automatic, reliable and scalable numerical optimisation concept based on the canonical genetic algorithm (GA). The algorithm was used to optimise the 3D magnetic field profile of the NSE spectrometer SPAN, at the HMI. We discuss the potential of the GA which combined with the existing Monte-Carlo codes (Vitess, McSTAS, etc.) leads to a very powerful tool for automated global optimisation of a general neutron scattering instrument, avoiding local optimum configurations.

  18. Evolutionary programming for neutron instrument optimisation

    International Nuclear Information System (INIS)

    Bentley, Phillip M.; Pappas, Catherine; Habicht, Klaus; Lelievre-Berna, Eddy

    2006-01-01

    Virtual instruments based on Monte-Carlo techniques are now integral part of novel instrumentation development and the existing codes (McSTAS and Vitess) are extensively used to define and optimise novel instrumental concepts. Neutron spectrometers, however, involve a large number of parameters and their optimisation is often a complex and tedious procedure. Artificial intelligence algorithms are proving increasingly useful in such situations. Here, we present an automatic, reliable and scalable numerical optimisation concept based on the canonical genetic algorithm (GA). The algorithm was used to optimise the 3D magnetic field profile of the NSE spectrometer SPAN, at the HMI. We discuss the potential of the GA which combined with the existing Monte-Carlo codes (Vitess, McSTAS, etc.) leads to a very powerful tool for automated global optimisation of a general neutron scattering instrument, avoiding local optimum configurations

  19. Management of pediatric central nervous system emergencies: a review for general radiologists.

    Science.gov (United States)

    Rebollo Polo, M

    2016-05-01

    To review the most common and most important diseases and disorders of the central nervous system (CNS) in pediatric emergencies, discussing the indications for different imaging tests in each context. In pediatric patients, acute neurologic symptoms (seizures, deteriorating level of consciousness, focal neurologic deficits, etc.) can appear in diverse clinical situations (trauma, child abuse, meningoencephalitis, ischemia…). It is important to decide on the most appropriate neuroimaging diagnostic algorithm for each situation and age group, as well as to know the signs of the most typical lesions that help us in the etiological differential diagnosis. Pediatric patients' increased vulnerability to ionizing radiation and the possible need for sedation in studies that require more time are factors that should be taken into account when indicating an imaging test. It is essential to weigh the risks and benefits for the patient and to avoid unnecessary studies. Copyright © 2016 SERAM. Published by Elsevier España, S.L.U. All rights reserved.

  20. Review and Implementation of the Emerging CCSDS Recommended Standard for Multispectral and Hyperspectral Lossless Image Coding

    Science.gov (United States)

    Sanchez, Jose Enrique; Auge, Estanislau; Santalo, Josep; Blanes, Ian; Serra-Sagrista, Joan; Kiely, Aaron

    2011-01-01

    A new standard for image coding is being developed by the MHDC working group of the CCSDS, targeting onboard compression of multi- and hyper-spectral imagery captured by aircraft and satellites. The proposed standard is based on the "Fast Lossless" adaptive linear predictive compressor, and is adapted to better overcome issues of onboard scenarios. In this paper, we present a review of the state of the art in this field, and provide an experimental comparison of the coding performance of the emerging standard in relation to other state-of-the-art coding techniques. Our own independent implementation of the MHDC Recommended Standard, as well as of some of the other techniques, has been used to provide extensive results over the vast corpus of test images from the CCSDS-MHDC.

  1. Evidence-based review and appraisal of the use of droperidol in the emergency department

    Directory of Open Access Journals (Sweden)

    Pei-Chun Lai

    2018-01-01

    Full Text Available Droperidol is a short-acting, potent dopamine D2 antagonist that can pass through the blood–brain barrier. A black box warning was issued for droperidol by the United States Food and Drug Administration in 2001 because of a risk of development of torsades de pointes induced by QT prolongation. Many experts feel that the incidence of arrhythmia is overestimated, and low-dose droperidol is almost always used by anesthesiologists for postoperative nausea and vomiting. In this review, we used evidence-based analysis to appraise high-quality studies with a low risk of bias published after 2001 on the use of droperidol in the emergency department (ED. Droperidol appears not only efficacious but also safe to treat patients with nausea/vomiting, acute psychosis, and migraine in the ED. For these conditions, droperidol may be an option for shared decision-making.

  2. A systematic review of community-based interventions for emerging zoonotic infectious diseases in Southeast Asia

    Science.gov (United States)

    Halton, Kate; Sarna, Mohinder; Barnett, Adrian; Leonardo, Lydia; Graves, Nicholas

    2013-01-01

    Executive Summary Background Southeast Asia has been at the epicentre of recent epidemics of emerging and re-emerging zoonotic diseases. Community-based surveillance and control interventions have been heavily promoted but the most effective interventions have not been identified. Objectives This review evaluated evidence for the effectiveness of community-based surveillance interventions at monitoring and identifying emerging infectious disease; the effectiveness of community-based control interventions at reducing rates of emerging infectious disease; and contextual factors that influence intervention effectiveness. Inclusion criteria Participants Communities in Brunei, Cambodia, Indonesia, Laos, Malaysia, Myanmar, the Philippines, Singapore, Thailand and Viet Nam. Types of intervention(s) Non-pharmaceutical, non-vaccine, and community-based surveillance or prevention and control interventions targeting rabies, Nipah virus, dengue, SARS or avian influenza. Types of outcomes Primary outcomes: measures: of infection or disease; secondary outcomes: measures of intervention function. Types of studies Original quantitative studies published in English. Search strategy Databases searched (1980 to 2011): PubMed, CINAHL, ProQuest, EBSCOhost, Web of Science, Science Direct, Cochrane database of systematic reviews, WHOLIS, British Development Library, LILACS, World Bank (East Asia), Asian Development Bank. Methodological quality Two independent reviewers critically appraised studies using standard Joanna Briggs Institute instruments. Disagreements were resolved through discussion. Data extraction A customised tool was used to extract quantitative data on intervention(s), populations, study methods, and primary and secondary outcomes; and qualitative contextual information or narrative evidence about interventions. Data synthesis Data was synthesised in a narrative summary with the aid of tables. Meta-analysis was used to statistically pool quantitative results. Results

  3. Short-Range Noncontact Sensors for Healthcare and Other Emerging Applications: A Review

    Directory of Open Access Journals (Sweden)

    Changzhan Gu

    2016-07-01

    Full Text Available Short-range noncontact sensors are capable of remotely detecting the precise movements of the subjects or wirelessly estimating the distance from the sensor to the subject. They find wide applications in our day lives such as noncontact vital sign detection of heart beat and respiration, sleep monitoring, occupancy sensing, and gesture sensing. In recent years, short-range noncontact sensors are attracting more and more efforts from both academia and industry due to their vast applications. Compared to other radar architectures such as pulse radar and frequency-modulated continuous-wave (FMCW radar, Doppler radar is gaining more popularity in terms of system integration and low-power operation. This paper reviews the recent technical advances in Doppler radars for healthcare applications, including system hardware improvement, digital signal processing, and chip integration. This paper also discusses the hybrid FMCW-interferometry radars and the emerging applications and the future trends.

  4. Calcium polysulphide, its applications and emerging risk of environmental pollution-a review article.

    Science.gov (United States)

    Dahlawi, Saad Mohammed; Siddiqui, Samreen

    2017-01-01

    Easy availability, preparation technique, and economic value make calcium polysulphide (CaS x ) a very useful inorganic chemical for various field and industrial applications. In this article, disparate applications of CaS x solution have been reviewed to suggest potential and future consolidation. This article also encompasses the physiochemical properties and production of CaS x solution, with critical appraisal on research focusing on CaS x application in agriculture industries and removal of potentially toxic elements (PTEs) from the environment. The kinetics of CaS x , technical issues associated with optimization of its dosage and environmental fate is also discussed in detail. This study covers almost all of the peer-reviewed research that has been performed since 1914. Some of the critiques in this article include the lack of integration between the exposure effect and the efficiency of treatment method, effects of oxidizing environments on the long-term performance of CaS x solution, and kinetics of CaS x solution with the PTEs. The working model of CaS x with PTEs is still system dependent, and therefore cannot be used with other applications. The kinetics of CaS x is described in detail with various phase stoichiometric reactions. Environmental fate is discussed based on applications, government reports, peer-reviewed articles and kinetics of CaS x , which provides a clear picture of emerging contaminants in the environment in relation to the insect resistance and ecotoxicology. Real time, lab based research articles are needed to identify toxicity limits of CaS x in environment in order to describe its effective permissible limit in environmental system. This review article provides a risk assessment of environmental pollution by CaS x based on its physicochemical characteristic, stoichiometry, kinetics, field, and industrial applications.

  5. Exploring the psychological health of emergency dispatch centre operatives: a systematic review and narrative synthesis

    Directory of Open Access Journals (Sweden)

    Sarah E. Golding

    2017-10-01

    Full Text Available Background The study objective was to investigate and synthesize available evidence relating to the psychological health of Emergency Dispatch Centre (EDC operatives, and to identify key stressors experienced by EDC operatives. Methods Eight electronic databases (Embase, PubMed, Medline, CINAHL, PsycInfo, PsycArticles, The Psychology and Behavioural Sciences Collection, and Google Scholar were searched. All study designs were included, and no date limits were set. Studies were included if they were published in English, and explored the psychological health of any EDC operatives, across fire, police, and emergency medical services. Studies were excluded if they related solely to other emergency workers, such as police officers or paramedics. Methodological quality of included studies was assessed using checklists adapted from the Critical Appraisal Skills Programme. A narrative synthesis was conducted, using thematic analysis. Results A total of 16 articles were included in the review. Two overarching themes were identified during the narrative synthesis: ‘Organisational and Operational Factors’ and ‘Interactions with Others’. Stressors identified included being exposed to traumatic calls, lacking control over high workload, and working in under-resourced and pressured environments. Lack of support from management and providing an emotionally demanding service were additional sources of stress. Peer support and social support from friends and family were helpful in managing work-related stress. Discussion EDC operatives experience stress as a result of their work, which appears to be related to negative psychological health outcomes. Future research should explore the long-term effects of this stress, and the potential for workplace interventions to alleviate the negative impacts on psychological health. PROSPERO Registration Number CRD42014010806.

  6. Exploring the psychological health of emergency dispatch centre operatives: a systematic review and narrative synthesis.

    Science.gov (United States)

    Golding, Sarah E; Horsfield, Claire; Davies, Annette; Egan, Bernadette; Jones, Martyn; Raleigh, Mary; Schofield, Patricia; Squires, Allison; Start, Kath; Quinn, Tom; Cropley, Mark

    2017-01-01

    The study objective was to investigate and synthesize available evidence relating to the psychological health of Emergency Dispatch Centre (EDC) operatives, and to identify key stressors experienced by EDC operatives. Eight electronic databases (Embase, PubMed, Medline, CINAHL, PsycInfo, PsycArticles, The Psychology and Behavioural Sciences Collection, and Google Scholar) were searched. All study designs were included, and no date limits were set. Studies were included if they were published in English, and explored the psychological health of any EDC operatives, across fire, police, and emergency medical services. Studies were excluded if they related solely to other emergency workers, such as police officers or paramedics. Methodological quality of included studies was assessed using checklists adapted from the Critical Appraisal Skills Programme. A narrative synthesis was conducted, using thematic analysis. A total of 16 articles were included in the review. Two overarching themes were identified during the narrative synthesis: 'Organisational and Operational Factors' and 'Interactions with Others'. Stressors identified included being exposed to traumatic calls, lacking control over high workload, and working in under-resourced and pressured environments. Lack of support from management and providing an emotionally demanding service were additional sources of stress. Peer support and social support from friends and family were helpful in managing work-related stress. EDC operatives experience stress as a result of their work, which appears to be related to negative psychological health outcomes. Future research should explore the long-term effects of this stress, and the potential for workplace interventions to alleviate the negative impacts on psychological health. CRD42014010806.

  7. A Step-by-Step Framework on Discrete Events Simulation in Emergency Department; A Systematic Review.

    Science.gov (United States)

    Dehghani, Mahsa; Moftian, Nazila; Rezaei-Hachesu, Peyman; Samad-Soltani, Taha

    2017-04-01

    To systematically review the current literature of simulation in healthcare including the structured steps in the emergency healthcare sector by proposing a framework for simulation in the emergency department. For the purpose of collecting the data, PubMed and ACM databases were used between the years 2003 and 2013. The inclusion criteria were to select English-written articles available in full text with the closest objectives from among a total of 54 articles retrieved from the databases. Subsequently, 11 articles were selected for further analysis. The studies focused on the reduction of waiting time and patient stay, optimization of resources allocation, creation of crisis and maximum demand scenarios, identification of overcrowding bottlenecks, investigation of the impact of other systems on the existing system, and improvement of the system operations and functions. Subsequently, 10 simulation steps were derived from the relevant studies after an expert's evaluation. The 10-steps approach proposed on the basis of the selected studies provides simulation and planning specialists with a structured method for both analyzing problems and choosing best-case scenarios. Moreover, following this framework systematically enables the development of design processes as well as software implementation of simulation problems.

  8. Improving medical students' knowledge of genetic disease: a review of current and emerging pedagogical practices.

    Science.gov (United States)

    Wolyniak, Michael J; Bemis, Lynne T; Prunuske, Amy J

    2015-01-01

    Genetics is an essential subject to be mastered by health professional students of all types. However, technological advances in genomics and recent pedagogical research have changed the way in which many medical training programs teach genetics to their students. These advances favor a more experience-based education focused primarily on developing student's critical thinking skills. In this review, we examine the current state of genetics education at both the preclinical and clinical levels and the ways in which medical and pedagogical research have guided reforms to current and emerging teaching practices in genetics. We discover exciting trends taking place in which genetics is integrated with other scientific disciplines both horizontally and vertically across medical curricula to emphasize training in scientific critical thinking skills among students via the evaluation of clinical evidence and consultation of online databases. These trends will produce future health professionals with the skills and confidence necessary to embrace the new tools of medical practice that have emerged from scientific advances in genetics, genomics, and bioinformatics.

  9. Improving medical students' knowledge of genetic disease: a review of current and emerging pedagogical practices

    Directory of Open Access Journals (Sweden)

    Wolyniak MJ

    2015-10-01

    Full Text Available Michael J Wolyniak,1 Lynne T Bemis,2 Amy J Prunuske2 1Department of Biology, Hampden-Sydney College, Hampden-Sydney, VA, 2Department of Biomedical Sciences, University of Minnesota Medical School, Duluth, MN, USA Abstract: Genetics is an essential subject to be mastered by health professional students of all types. However, technological advances in genomics and recent pedagogical research have changed the way in which many medical training programs teach genetics to their students. These advances favor a more experience-based education focused primarily on developing student's critical thinking skills. In this review, we examine the current state of genetics education at both the preclinical and clinical levels and the ways in which medical and pedagogical research have guided reforms to current and emerging teaching practices in genetics. We discover exciting trends taking place in which genetics is integrated with other scientific disciplines both horizontally and vertically across medical curricula to emphasize training in scientific critical thinking skills among students via the evaluation of clinical evidence and consultation of online databases. These trends will produce future health professionals with the skills and confidence necessary to embrace the new tools of medical practice that have emerged from scientific advances in genetics, genomics, and bioinformatics. Keywords: genetics education, medical genetics, pedagogical practice, active learning, problem-based learning

  10. Improving medical students’ knowledge of genetic disease: a review of current and emerging pedagogical practices

    Science.gov (United States)

    Wolyniak, Michael J; Bemis, Lynne T; Prunuske, Amy J

    2015-01-01

    Genetics is an essential subject to be mastered by health professional students of all types. However, technological advances in genomics and recent pedagogical research have changed the way in which many medical training programs teach genetics to their students. These advances favor a more experience-based education focused primarily on developing student’s critical thinking skills. In this review, we examine the current state of genetics education at both the preclinical and clinical levels and the ways in which medical and pedagogical research have guided reforms to current and emerging teaching practices in genetics. We discover exciting trends taking place in which genetics is integrated with other scientific disciplines both horizontally and vertically across medical curricula to emphasize training in scientific critical thinking skills among students via the evaluation of clinical evidence and consultation of online databases. These trends will produce future health professionals with the skills and confidence necessary to embrace the new tools of medical practice that have emerged from scientific advances in genetics, genomics, and bioinformatics. PMID:26604852

  11. Tumefactive multiple sclerosis requiring emergency craniotomy: case report and literature review.

    Science.gov (United States)

    Munarriz, Pablo M; Castaño-Leon, Ana M; Martinez-Perez, Rafael; Hernandez-Lain, Aurelio; Ramos, Ana; Lagares, Alfonso

    2013-01-01

    Multiple sclerosis (MS) is a demyelinating disease of the central nervous system, characterized by focal neurological dysfunction with a relapsing and remitting course. Tumor-like presentation of MS (or "tumefactive"/"pseudotumoral" presentation) has been described before with a certain frequency; it consists of a large single plaque (>2cm) with presence of edema and mass effect and it is hard to distinguish from a brain tumor. However, we present a very rare case of a 53-year-old woman with a right temporal mass that turned out to be a MS plaque, who deteriorated within hours (brain herniation with loss of consciousness and unilateral mydriasis) and required an emergency craniotomy. We also present a review of the literature. It appears that only 4 cases of emergency craniotomy/craniectomy required in a patient with a tumor-like MS plaque have been reported before. Copyright © 2012 Sociedad Española de Neurocirugía. Published by Elsevier España. All rights reserved.

  12. Review of the ecotoxicological effects of emerging contaminants to soil biota.

    Science.gov (United States)

    Gomes, Ana R; Justino, Celine; Rocha-Santos, Teresa; Freitas, Ana C; Duarte, Armando C; Pereira, Ruth

    2017-08-24

    In recent years, emerging contaminants (e.g. pesticides and their metabolites, pharmaceuticals, personal and house care products, life-style compounds, food additives, industrial products and wastes, as well as nanomaterials) have become a problem to the environment. In fact, the cumulative use of a panoply of chemical substances in agriculture, industrial activities, in our homes and in health care services has led to their recent appearance in detectable levels in soils, surface, and groundwater resources, with unpredictable consequences for these ecosystems. Few data exist regarding the toxicity and potential for bioaccumulation in biota. When available, data were obtained only for some representatives of the main groups of chemical substances, and for a limited number of species, following non-standard protocols. This makes difficult the calculation of predicted no effect concentrations (PNEC) and the existence of sufficient data to set limits for their release into the environment. This is particularly concerning for the soil compartment, since only recently the scientific community, regulators, and the public have realised the importance of protecting this natural resource and its services to guarantee the sustainability of terrestrial ecosystems and human well-being. In this context, this review paper aims to identify the major groups of soil emerging contaminants, their sources, pathways and receptors, and in parallel to analyse existing ecotoxicological data for soil biota.

  13. Management protocols for status epilepticus in the pediatric emergency room: systematic review article

    Directory of Open Access Journals (Sweden)

    Cheuk C. Au

    Full Text Available Abstract Objective: This systematic review of national or regional guidelines published in English aimed to better understand variance in pre-hospital and emergency department treatment of status epilepticus. Sources: Systematic search of national or regional guidelines (January 2000 to February 2017 contained within PubMed and Google Scholar databases, and article reference lists. The search keywords were status epilepticus, prolonged seizure, treatment, and guideline. Summary of findings: 356 articles were retrieved and 13 were selected according to the inclusion criteria. In all six pre-hospital guidelines, the preferred route of medication administration was to use alternatives to the intravenous route: all recommended buccal and intranasal midazolam; three also recommended intramuscular midazolam, and five recommended using rectal diazepam. All 11 emergency department guidelines described three phases in therapy. Intravenous medication, by phase, was indicated as such: initial phase - ten/11 guidelines recommended lorazepam, and eight/11 recommended diazepam; second phase - most (ten/11 guidelines recommended phenytoin, but other options were phenobarbital (nine/11, valproic acid (six/11, and either fosphenytoin or levetiracetam (each four/11; third phase - four/11 guidelines included the choice of repeating second phase therapy, whereas the other guidelines recommended using a variety of intravenous anesthetic agents (thiopental, midazolam, propofol, and pentobarbital. Conclusions: All of the guidelines share a similar framework for management of status epilepticus. The choice in route of administration and drug type varied across guidelines. Hence, the adoption of a particular guideline should take account of local practice options in health service delivery.

  14. Priority Substances and Emerging Organic Pollutants in Portuguese Aquatic Environment: A Review.

    Science.gov (United States)

    Ribeiro, Cláudia; Ribeiro, Ana Rita; Tiritan, Maria Elizabeth

    Aquatic environments are among the most noteworthy ecosystems regarding chemical pollution due to the anthropogenic pressure. In 2000, the European Commission implemented the Water Framework Directive, with the aim of progressively reducing aquatic chemical pollution of the European Union countries. Therefore, the knowledge about the chemical and ecological status is imperative to determine the overall quality of water bodies. Concerning Portugal, some studies have demonstrated the presence of pollutants in the aquatic environment but an overall report is not available yet. The aim of this paper is to provide a comprehensive review about the occurrence of priority substances included in the Water Framework Directive and some classes of emerging organic pollutants that have been found in Portuguese aquatic environment. The most frequently studied compounds comprise industrial compounds, natural and synthetic estrogens, phytoestrogens, phytosterols, pesticides, pharmaceuticals and personal care products. Concentration of these pollutants ranged from few ng L(-1) to higher values such as 30 μg L(-1) for industrial compounds in surface waters and up to 106 μg L(-1) for the pharmaceutical ibuprofen in wastewaters. Compounds already banned in Europe such as atrazine, alkylphenols and alkylphenol polyethoxylates are still found in surface waters, nevertheless their origin is still poorly understood. Beyond the contamination of the Portuguese aquatic environment by priority substances and emerging organic pollutants, this review also highlights the need of more research on other classes of pollutants and emphasizes the importance of extending this research to other locations in Portugal, which have not been investigated yet.

  15. Critical care clinician perceptions of factors leading to Medical Emergency Team review.

    Science.gov (United States)

    Currey, Judy; Allen, Josh; Jones, Daryl

    2018-03-01

    The introduction of rapid response systems has reduced the incidence of in-hospital cardiac arrest; however, many instances of clinical deterioration are unrecognised. Afferent limb failure is common and may be associated with unplanned intensive care admissions, heightened mortality and prolonged length of stay. Patients reviewed by a Medical Emergency Team are inherently vulnerable with a high in-hospital mortality. To explore perceptions of intensive care unit (ICU) staff who attend deteriorating acute care ward patients regarding current problems, barriers and potential solutions to recognising and responding to clinical deterioration that culminates in a Medical Emergency Team review. A descriptive exploratory design was used. Registered intensive care nurses and medical staff (N=207) were recruited during a professional conference using purposive sampling for experience in attending deteriorating patients. Written response surveys were used to address the study aim. Data were analysed using content analysis. Four major themes were identified: Governance, Teamwork, Clinical Care Delivery and End of Life Care. Participants perceived there was a lack of sufficient and senior staff with the required theoretical knowledge; and inadequate assessment and critical thinking skills for anticipating, recognising and responding to clinical deterioration. Senior doctors were perceived to inappropriately manage End of Life Care issues and displayed Teamwork behaviours rendering ward clinicians feeling fearful and intimidated. A lack of System and Clinical Governance hindered identification of clinical deterioration. To improve patient safety related to recognising and responding to clinical deterioration, suboptimal care due to professionals' knowledge, skills and behaviours need addressing, along with End of Life Care and Governance. Copyright © 2017 Australian College of Critical Care Nurses Ltd. All rights reserved.

  16. Dose optimisation in computed radiography

    International Nuclear Information System (INIS)

    Schreiner-Karoussou, A.

    2005-01-01

    After the installation of computed radiography (CR) systems in three hospitals in Luxembourg a patient dose survey was carried out for three radiographic examinations, thorax, pelvis and lumbar spine. It was found that the patient doses had changed in comparison with the patient doses measured for conventional radiography in the same three hospitals. A close collaboration between the manufacturers of the X-ray installations, the CR imaging systems and the medical physicists led to the discovery that the speed class with which each radiographic examination was to be performed, had been ignored, during installation of the digital imaging systems. A number of procedures were carried out in order to calibrate and program the X-ray installations in conjunction with the CR systems. Following this optimisation procedure, a new patient dose survey was carried out for the three radiographic examinations. It was found that patient doses for the three hospitals were reduced. (authors)

  17. Optimising costs in WLCG operations

    CERN Document Server

    Pradillo, Mar; Flix, Josep; Forti, Alessandra; Sciabà, Andrea

    2015-01-01

    The Worldwide LHC Computing Grid project (WLCG) provides the computing and storage resources required by the LHC collaborations to store, process and analyse the 50 Petabytes of data annually generated by the LHC. The WLCG operations are coordinated by a distributed team of managers and experts and performed by people at all participating sites and from all the experiments. Several improvements in the WLCG infrastructure have been implemented during the first long LHC shutdown to prepare for the increasing needs of the experiments during Run2 and beyond. However, constraints in funding will affect not only the computing resources but also the available effort for operations. This paper presents the results of a detailed investigation on the allocation of the effort in the different areas of WLCG operations, identifies the most important sources of inefficiency and proposes viable strategies for optimising the operational cost, taking into account the current trends in the evolution of the computing infrastruc...

  18. Emerging Endoscopic and Photodynamic Techniques for Bladder Cancer Detection and Surveillance

    Directory of Open Access Journals (Sweden)

    Prashant Patel

    2011-01-01

    Full Text Available This review provides an overview of emerging techniques, namely, photodynamic diagnosis (PDD, narrow band imaging (NBI, Raman spectroscopy, optical coherence tomography, virtual cystoscopy, and endoscopic microscopy for its use in the diagnosis and surveillance of bladder cancer. The technology, clinical evidence and future applications of these approaches are discussed with particular emphasis on PDD and NBI. These approaches show promise to optimise cystoscopy and transurethral resection of bladder tumours.

  19. Promoting public health legal preparedness for emergencies: review of current trends and their relevance in light of the Ebola crisis

    OpenAIRE

    Cohen, Odeya; Feder-Bubis, Paula; Bar-Dayan, Yaron; Adini, Bruria

    2015-01-01

    Background: Public health legal preparedness (PHLP) for emergencies is a core component of the health system response. However, the implementation of health legal preparedness differs between low- and middle-income countries (LMIC) and developed countries.Objective: This paper examines recent trends regarding public health legal preparedness for emergencies and discusses its role in the recent Ebola outbreak.Design: A rigorous literature review was conducted using eight electronic databases a...

  20. New and emerging contraceptives: a state-of-the-art review

    Directory of Open Access Journals (Sweden)

    Bahamondes L

    2014-02-01

    Full Text Available Luis Bahamondes, M Valeria Bahamondes Human Reproduction Unit, Department of Obstetrics and Gynaecology, Faculty of Medical Sciences, University of Campinas and National Institute of Hormones and Women's Health, Campinas, SP, Brazil Background: The first hormonal contraceptive was introduced onto the market in several countries 50 years ago; however, the portfolio of contraceptive methods remains restricted with regards to their steroid composition, their cost, and their ability to satisfy the requirements of millions of women/couples in accordance with their different reproductive intentions, behaviors, cultures, and settings. Methods: A literature review was conducted using Medline, Embase, and Current Contents databases, up to September 1, 2013 to identify publications reporting new contraceptives in development using combinations of the search terms: contraception, contraceptives, oral contraceptives, patch, vaginal ring, implants, intrauterine contraceptives, and emergency contraception (EC. Also, several experts in the field were also consulted to document ongoing projects on contraception development. Additionally, the Clinicaltrial.gov website was searched for ongoing studies on existing contraceptive methods and new and emerging female contraceptives developed over the past 5 years. Information was also obtained from the pharmaceutical industry. Results: Early sexual debut and late menopause means that women may require contraception for up to 30 years. Although oral, injectable, vaginal, transdermal, subdermal, and intrauterine contraceptives are already available, new contraceptives have been developed in an attempt to reduce side effects and avoid early discontinuation, and to fulfill women's different requirements. Research efforts are focused on replacing ethinyl-estradiol with natural estradiol to reduce thrombotic events. In addition, new, less androgenic progestins are being introduced and selective progesterone receptor

  1. Emerging surface characterization techniques for carbon steel corrosion: a critical brief review

    Science.gov (United States)

    Dwivedi, D.; Lepkova, K.; Becker, T.

    2017-03-01

    Carbon steel is a preferred construction material in many industrial and domestic applications, including oil and gas pipelines, where corrosion mitigation using film-forming corrosion inhibitor formulations is a widely accepted method. This review identifies surface analytical techniques that are considered suitable for analysis of thin films at metallic substrates, but are yet to be applied to analysis of carbon steel surfaces in corrosive media or treated with corrosion inhibitors. The reviewed methods include time of flight-secondary ion mass spectrometry, X-ray absorption spectroscopy methods, particle-induced X-ray emission, Rutherford backscatter spectroscopy, Auger electron spectroscopy, electron probe microanalysis, near-edge X-ray absorption fine structure spectroscopy, X-ray photoemission electron microscopy, low-energy electron diffraction, small-angle neutron scattering and neutron reflectometry, and conversion electron Moessbauer spectrometry. Advantages and limitations of the analytical methods in thin-film surface investigations are discussed. Technical parameters of nominated analytical methods are provided to assist in the selection of suitable methods for analysis of metallic substrates deposited with surface films. The challenges associated with the applications of the emerging analytical methods in corrosion science are also addressed.

  2. Emerging sexually transmitted viral infections: 1. Review of Ebola virus disease.

    Science.gov (United States)

    Caswell, Rachel J; Manavi, Kaveh

    2017-11-01

    This is the first in a series of articles reviewing four viral infections, Ebola virus, Zika virus, human T-cell lymphotropic virus, type 1 and hepatitis C virus, with an emphasis on recent advances in our understanding of their sexual transmission. With current day speed and ease of travel it is important for staff in sexual healthcare services to know and understand these infections when patients present to them and also to be able to advise those travelling to endemic regions. Following the recent resurgence in West Africa, this first article looks at Ebola virus disease (EVD). EVD has a high mortality rate and, of note, has been detected in the semen of those who have cleared the virus from their blood and have clinically recovered from the disease. As the result of emerging data, the WHO now recommends safe sex practices for all male survivors of EVD for 12 months after the onset of the disease or after having had two consecutive negative tests of semen specimens for the virus. This review provides an up-to-date summary of what is currently known about EVD and its implications for sexual health practice.

  3. Entrepreneur-related constructs explaining the emergence of born global firms: A Systematic Literature Review

    Directory of Open Access Journals (Sweden)

    Elena Pawęta

    2016-02-01

    Full Text Available Objective: The paper is aimed at structuring entrepreneur-related constructs and building a conceptual framework that can serve as a foundation for future international entrepreneurship research and theory building. Research Design & Methods: The author conducted the systematic literature review of 94 empirical studies and conceptual papers on the entrepreneur-related determinants of early internationalization in the international management journals in the years 1966 – 2015. Findings: This article discusses and groups the existing knowledge on entrepreneur-related determinants of born globals successful international performance. The major theoretical contribution of the study is the conceptual framework of the main entrepreneur-level determinants of rapid internationalization. Implications & Recommendations: The results of the study are exploratory and there is a need in validating the theoretical framework through an advanced quantitative study. Future research might try to integrate the reviewed entrepreneur-related constructs with organizational characteristics and external characteristics which determine born globals emergence. Contribution & Value added: This paper provides the conceptual framework that groups entrepreneur-related constructs into 6 main constructs which can enrich future international entrepreneurship research.

  4. Emerging applications of nanotechnology for diagnosis and therapy of disease: a review.

    Science.gov (United States)

    Bayford, Richard; Rademacher, Tom; Roitt, Ivan; Wang, Scarlet Xiaoyan

    2017-07-24

    Nanotechnology is of increasing interest in the fields of medicine and physiology over recent years. Its application could considerably improve disease detection and therapy, and although the potential is considerable, there are still many challenges that need to be addressed before it is accepted in routine clinical use. This review focuses on emerging applications that nanotechnology could enhance or provide new approaches in diagnoses and therapy. The main focus of recent research centres on targeted therapies and enhancing imaging; however, the introduction of nanomaterial into the human body must be controlled, as there are many issues with possible toxicity and long-term effects. Despite these issues, the potential for nanotechnology to provide new methods of combating cancer and other disease conditions is considerable. There are still key challenges for researchers in this field, including the means of delivery and targeting in the body to provide effective treatment for specific disease conditions. Nanoparticles are difficult to measure due to their size and physical properties; hence there is still a great need to improve physiological measurement methods in the field to ascertain how effective their use is in the human subject. This review is a brief snapshot into the fast changing research field of measurement and physiological links to nanoparticle use and its potential in the future.

  5. A review of existing and emerging digital technologies to combat the global trade in fake medicines.

    Science.gov (United States)

    Mackey, Tim K; Nayyar, Gaurvika

    2017-05-01

    The globalization of the pharmaceutical supply chain has introduced new challenges, chief among them, fighting the international criminal trade in fake medicines. As the manufacture, supply, and distribution of drugs becomes more complex, so does the need for innovative technology-based solutions to protect patients globally. Areas covered: We conducted a multidisciplinary review of the science/health, information technology, computer science, and general academic literature with the aim of identifying cutting-edge existing and emerging 'digital' solutions to combat fake medicines. Our review identified five distinct categories of technology including mobile, radio frequency identification, advanced computational methods, online verification, and blockchain technology. Expert opinion: Digital fake medicine solutions are unifying platforms that integrate different types of anti-counterfeiting technologies as complementary solutions, improve information sharing and data collection, and are designed to overcome existing barriers of adoption and implementation. Investment in this next generation technology is essential to ensure the future security and integrity of the global drug supply chain.

  6. Management protocols for status epilepticus in the pediatric emergency room: systematic review article.

    Science.gov (United States)

    Au, Cheuk C; Branco, Ricardo G; Tasker, Robert C

    This systematic review of national or regional guidelines published in English aimed to better understand variance in pre-hospital and emergency department treatment of status epilepticus. Systematic search of national or regional guidelines (January 2000 to February 2017) contained within PubMed and Google Scholar databases, and article reference lists. The search keywords were status epilepticus, prolonged seizure, treatment, and guideline. 356 articles were retrieved and 13 were selected according to the inclusion criteria. In all six pre-hospital guidelines, the preferred route of medication administration was to use alternatives to the intravenous route: all recommended buccal and intranasal midazolam; three also recommended intramuscular midazolam, and five recommended using rectal diazepam. All 11 emergency department guidelines described three phases in therapy. Intravenous medication, by phase, was indicated as such: initial phase - ten/11 guidelines recommended lorazepam, and eight/11 recommended diazepam; second phase - most (ten/11) guidelines recommended phenytoin, but other options were phenobarbital (nine/11), valproic acid (six/11), and either fosphenytoin or levetiracetam (each four/11); third phase - four/11 guidelines included the choice of repeating second phase therapy, whereas the other guidelines recommended using a variety of intravenous anesthetic agents (thiopental, midazolam, propofol, and pentobarbital). All of the guidelines share a similar framework for management of status epilepticus. The choice in route of administration and drug type varied across guidelines. Hence, the adoption of a particular guideline should take account of local practice options in health service delivery. Copyright © 2017 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.

  7. The role of Victorian emergency nurses in the collection and preservation of forensic evidence: a review of the literature.

    Science.gov (United States)

    McGillivray, Bree

    2005-04-01

    Emergency Departments (ED) are providing care for increasing numbers of patients who present as a result of criminal or interpersonal violence and patients may be victims, suspects or perpetrators. As a result, the role of emergency nurses in the recognition, collection and preservation of forensic evidence is increasing. There is little published literature about the role and responsibilities of emergency nurses regarding the collection and preservation of evidence in the state of Victoria and this is complicated by a lack of department and organisation policy and the need for more specific educational preparation of emergency nurses in this area. While it is well accepted that the primary focus of nursing care will always be the physical and emotional care of the patient, the increasing importance of the role of emergency nurses in the recognition and collection of forensic evidence in Victoria is now being recognized and the need for education of emergency nurses in this area understood. This paper reviews the literature related to the recognition, collection and preservation, of forensic materials in EDs by emergency nurses in the state of Victoria and discusses the role of emergency nurses in Victoria in caring for patients who present as victims of violence and in whom the collection and preservation of forensic evidence is required.

  8. Review of off-site emergency preparedness and response plan of Indian NPPs based on experience of Fukushima nuclear accident

    International Nuclear Information System (INIS)

    Singh, Hukum; Dash, M.; Shukla, Vikas; Vijayan, P.; Krishnamurthy, P.R.

    2012-01-01

    Nuclear power plants in India are designed, constructed and operated based on the principle of the highest priority to nuclear safety. To deal with any unlikely situation of radiological emergency, the emergency preparedness and response plans are ensured to be in place at all NPPs prior to their commissioning. These plans are periodically reviewed and tested by conducting emergency exercise with the participation of various agencies such as Nuclear Power Corporation of India Limited, NDMA, district authorities, regulatory body and general public. On March 11, 2011 an earthquake of magnitude 9.0 hit the Fukushima Dai-ichi and Dai-ni followed by tsunami waves of height 15 meters above reference sea level. This resulted in large scale release of radioactive material from Fukushima Dai-ichi NPS. This led to the evacuation of a large number of people from the areas surrounding the affected nuclear power plants. The event was rated as level 7 event in International Nuclear Event Scale (INES). The event also revealed the challenges in handling radiological emergency situation in adverse environmental conditions, The experience of managing radiological emergency situation during Fukushima nuclear accident provides opportunities to review and improve emergency preparedness and response programme. The present paper presents the chronology of the emergency situation, challenges faced and handled in Fukushima. Even though the possibility of a Fukushima type nuclear accident in India is very remote due to the low probability of a high intensity earthquake followed by tsunami at NPP sites, the efforts needs to be initiated from the regulatory point of view for an effective Nuclear and Radiological Emergency Preparedness and Response Plans. The Emergency Preparedness and Response Plans of NPP sites were reviewed in the light of unique challenges of accident at Fukushima. It is realized that multi unit events are the realities that must be addressed as part of Emergency

  9. Review of off-site emergency preparedness and response plan of Indian NPPs based on experience of Fukushima nuclear accident

    Energy Technology Data Exchange (ETDEWEB)

    Singh, Hukum; Dash, M.; Shukla, Vikas; Vijayan, P.; Krishnamurthy, P.R., E-mail: vshukla@aerb.gov.in [Operating Plants Safety Division, Atomic Energy Regulatory Board, Mumbai (India)

    2012-07-01

    Nuclear power plants in India are designed, constructed and operated based on the principle of the highest priority to nuclear safety. To deal with any unlikely situation of radiological emergency, the emergency preparedness and response plans are ensured to be in place at all NPPs prior to their commissioning. These plans are periodically reviewed and tested by conducting emergency exercise with the participation of various agencies such as Nuclear Power Corporation of India Limited, NDMA, district authorities, regulatory body and general public. On March 11, 2011 an earthquake of magnitude 9.0 hit the Fukushima Dai-ichi and Dai-ni followed by tsunami waves of height 15 meters above reference sea level. This resulted in large scale release of radioactive material from Fukushima Dai-ichi NPS. This led to the evacuation of a large number of people from the areas surrounding the affected nuclear power plants. The event was rated as level 7 event in International Nuclear Event Scale (INES). The event also revealed the challenges in handling radiological emergency situation in adverse environmental conditions, The experience of managing radiological emergency situation during Fukushima nuclear accident provides opportunities to review and improve emergency preparedness and response programme. The present paper presents the chronology of the emergency situation, challenges faced and handled in Fukushima. Even though the possibility of a Fukushima type nuclear accident in India is very remote due to the low probability of a high intensity earthquake followed by tsunami at NPP sites, the efforts needs to be initiated from the regulatory point of view for an effective Nuclear and Radiological Emergency Preparedness and Response Plans. The Emergency Preparedness and Response Plans of NPP sites were reviewed in the light of unique challenges of accident at Fukushima. It is realized that multi unit events are the realities that must be addressed as part of Emergency

  10. Optimising preterm nutrition: present and future

    LENUS (Irish Health Repository)

    Brennan, Ann-Marie

    2016-04-01

    The goal of preterm nutrition in achieving growth and body composition approximating that of the fetus of the same postmenstrual age is difficult to achieve. Current nutrition recommendations depend largely on expert opinion, due to lack of evidence, and are primarily birth weight based, with no consideration given to gestational age and\\/or need for catch-up growth. Assessment of growth is based predominately on anthropometry, which gives insufficient attention to the quality of growth. The present paper provides a review of the current literature on the nutritional management and assessment of growth in preterm infants. It explores several approaches that may be required to optimise nutrient intakes in preterm infants, such as personalising nutritional support, collection of nutrient intake data in real-time, and measurement of body composition. In clinical practice, the response to inappropriate nutrient intakes is delayed as the effects of under- or overnutrition are not immediate, and there is limited nutritional feedback at the cot-side. The accurate and non-invasive measurement of infant body composition, assessed by means of air displacement plethysmography, has been shown to be useful in assessing quality of growth. The development and implementation of personalised, responsive nutritional management of preterm infants, utilising real-time nutrient intake data collection, with ongoing nutritional assessments that include measurement of body composition is required to help meet the individual needs of preterm infants.

  11. Primary care patients in the emergency department: who are they? A review of the definition of the 'primary care patient' in the emergency department.

    Science.gov (United States)

    Bezzina, Andrew J; Smith, Peter B; Cromwell, David; Eagar, Kathy

    2005-01-01

    To review the definition of 'primary care' and 'inappropriate' patients in ED and develop a generally acceptable working definition of a 'primary care' presentation in ED. A Medline review of articles on primary care in ED and the definitions used. A total of 34 reviewed papers contained a proposed definition or comment on the definition for potential 'primary care', 'general practice', or 'inappropriate' patients in ED. A representative definition was developed premised on the common factors in these papers: low urgency/acuity--triage categories four or five in the Australasian Triage Scale, self-referred--by definition, patients referred by general practitioner/community primary medical services are not primary care cases because a primary care service has referred them on, presenting for a new episode of care (i.e. not a planned return because planned returns are not self-referred), unlikely to be admitted (in the opinion of Emergency Nurse interviewers) or ultimately not admitted. This definition can be applied either prospectively or retrospectively, depending on the purpose. Appropriateness must be considered in light of a legitimate role for ED in primary care and the balance of resources between primary care and emergency medicine in local settings.

  12. Combining simulation and multi-objective optimisation for equipment quantity optimisation in container terminals

    OpenAIRE

    Lin, Zhougeng

    2013-01-01

    This thesis proposes a combination framework to integrate simulation and multi-objective optimisation (MOO) for container terminal equipment optimisation. It addresses how the strengths of simulation and multi-objective optimisation can be integrated to find high quality solutions for multiple objectives with low computational cost. Three structures for the combination framework are proposed respectively: pre-MOO structure, integrated MOO structure and post-MOO structure. The applications of ...

  13. Improvement of Emergency Management Mechanism of Public Health Crisis in Rural China: A Review Article.

    Science.gov (United States)

    Hu, Jiaxiang; Chen, Chao; Kuai, Tingting

    2018-02-01

    With the rapid development of social economy in China, various public health emergencies frequently occur. Such emergencies cause a serious threat to human health and public safety, especially in rural China. Owing to flaws in emergency management mechanism and policy, the government is not capable to effectively deal with public health emergencies. Therefore, this study aimed to discuss the path to improve the emergency management mechanism for public health emergency in rural China. This study was conducted in 2017 to detect the emergency management mechanism of public health crisis (EMMPHC) in Rural China. Data were collected using the following keywords: Rural China, public health emergency, emergency management mechanism, organization mechanism, operation mechanism in the databases of PubMed, Scopus, Web of Science, and CNKI. EMMPHC in rural China can be enhanced from the following three aspects. First, a permanent institution for rural emergency management with public health management function is established. Second, the entire process of emergency management mechanism, including the stages of pre-disaster, disaster, and post-disaster, is improved. Finally, investment in rural public health is increased, and an adequate reserve system for emergency resources is formed. The new path of EMMPHC in rural China can effectively help the local government accomplish the dispatch capability in public health emergency, and it has important research significance for the protection of public health and social stability of residents in rural China.

  14. Emerging trends in biosensing using stripping voltammetric detection of metal-containing nanolabels – A review

    Energy Technology Data Exchange (ETDEWEB)

    Kokkinos, Christos; Economou, Anastasios, E-mail: aeconomo@chem.uoa.gr

    2017-04-08

    Over the last years, nanomaterials have found many applications in the development of electrochemical biosensors. Among other functions, metal nanoparticles (NPs) and quantum dots (QDs) (semiconducting nanocrystals composed of metal salts) are increasingly being used as voltammetric labels in affinity biosensing. Labeling is based on the attachment of the label(s) on the target biomolecules or on a biorecognition reporting probe. After an appropriate specific affinity interaction between the target and the reporting probe, the metallic nanolabels are converted to the respective cations which are quantified by a voltammetric technique. The very use of metal-containing nanoprobes as labels provides a first amplification step since each nanoprobe can release a very significant number of detectable cations. When anodic stripping voltammetry (ASV) (in which a preconcentration step precedes the actual voltammetric scan) is further employed as the detection format, ultra-sensitive bioassays can be developed. The present paper reviews the emerging trends in affinity biosensing using ASV detection of metal-containing nanolabels. It provides a critical discussion of recent developments in ASV transduction and electrodes, novel strategies for signal enhancement, approaches for multiplexed detection as well as fluidics, paper-based and lab-on-a-chip devices. - Highlights: • This paper reviews the use of ASV for affinity biosensing with metal-containing nanolabels. • Both metal nanoparticles and quantum dots applications are considered. • Transducers and new electrode materials are covered. • Signal enhancement and multiplexing strategies are discussed. • Sensor arrays, paper-based, fluidic and lab-on-chip applications are described.

  15. Factors associated with imaging overuse in the emergency department: A systematic review.

    Science.gov (United States)

    Tung, Monica; Sharma, Ritu; Hinson, Jeremiah S; Nothelle, Stephanie; Pannikottu, Jean; Segal, Jodi B

    2018-02-01

    Emergency departments (ED) are sites of prevalent imaging overuse; however, determinants that drive imaging in this setting are not well-characterized. We systematically reviewed the literature to summarize the determinants of imaging overuse in the ED. We searched MEDLINE® and Embase® from January 1998 to March 2017. Studies were included if they were written in English, contained original data, pertained to a U.S. population, and identified a determinant associated with overuse of imaging in the ED. Twenty relevant studies were included. Fourteen evaluated computerized tomography (CT) scanning in patents presenting to a regional ED who were then transferred to a level 1 trauma center; incomplete transfer of data and poor image quality were the most frequently described reasons for repeat scanning. Unnecessary pre-transfer scanning or repeated scanning after transfer, in multiple studies, was highest among older patients, those with higher Injury Severity Scores (ISS) and those being transferred further. Six studies explored determinants of overused imaging in the ED in varied conditions, with overuse greater in older patients and those having more comorbid diseases. Defensive imaging reportedly influenced physician behavior. Less integration of services across the health system also predisposed to overuse of imaging. The literature is heterogeneous with surprisingly few studies of determinants of imaging in minor head injury or of spine imaging. Older patient age and higher ISS were the most consistently associated with ED imaging overuse. This review highlights the need for precise definitions of overuse of imaging in the ED. Copyright © 2017 Elsevier Inc. All rights reserved.

  16. Layout Optimisation of Wave Energy Converter Arrays

    Directory of Open Access Journals (Sweden)

    Pau Mercadé Ruiz

    2017-08-01

    Full Text Available This paper proposes an optimisation strategy for the layout design of wave energy converter (WEC arrays. Optimal layouts are sought so as to maximise the absorbed power given a minimum q-factor, the minimum distance between WECs, and an area of deployment. To guarantee an efficient optimisation, a four-parameter layout description is proposed. Three different optimisation algorithms are further compared in terms of performance and computational cost. These are the covariance matrix adaptation evolution strategy (CMA, a genetic algorithm (GA and the glowworm swarm optimisation (GSO algorithm. The results show slightly higher performances for the latter two algorithms; however, the first turns out to be significantly less computationally demanding.

  17. Topology optimisation of natural convection problems

    DEFF Research Database (Denmark)

    Alexandersen, Joe; Aage, Niels; Andreasen, Casper Schousboe

    2014-01-01

    This paper demonstrates the application of the density-based topology optimisation approach for the design of heat sinks and micropumps based on natural convection effects. The problems are modelled under the assumptions of steady-state laminar flow using the incompressible Navier-Stokes equations...... coupled to the convection-diffusion equation through the Boussinesq approximation. In order to facilitate topology optimisation, the Brinkman approach is taken to penalise velocities inside the solid domain and the effective thermal conductivity is interpolated in order to accommodate differences...... in thermal conductivity of the solid and fluid phases. The governing equations are discretised using stabilised finite elements and topology optimisation is performed for two different problems using discrete adjoint sensitivity analysis. The study shows that topology optimisation is a viable approach...

  18. Topology Optimisation for Coupled Convection Problems

    DEFF Research Database (Denmark)

    Alexandersen, Joe

    This thesis deals with topology optimisation for coupled convection problems. The aim is to extend and apply topology optimisation to steady-state conjugate heat transfer problems, where the heat conduction equation governs the heat transfer in a solid and is coupled to thermal transport...... in a surrounding uid, governed by a convection-diffusion equation, where the convective velocity field is found from solving the isothermal incompressible steady-state Navier-Stokes equations. Topology optimisation is also applied to steady-state natural convection problems. The modelling is done using stabilised...... finite elements, the formulation and implementation of which was done partly during a special course as prepatory work for this thesis. The formulation is extended with a Brinkman friction term in order to facilitate the topology optimisation of fluid flow and convective cooling problems. The derived...

  19. Benchmarks for dynamic multi-objective optimisation

    CSIR Research Space (South Africa)

    Helbig, M

    2013-06-01

    Full Text Available When algorithms solve dynamic multi-objective optimisation problems (DMOOPs), benchmark functions should be used to determine whether the algorithm can overcome specific difficulties that can occur in real-world problems. However, for dynamic multi...

  20. Credit price optimisation within retail banking

    African Journals Online (AJOL)

    2014-02-14

    Feb 14, 2014 ... cost based pricing, where the price of a product or service is based on the .... function obtained from fitting a logistic regression model .... Note that the proposed optimisation approach below will allow us to also incorporate.

  1. Cyanide intoxication as part of smoke inhalation--a review on diagnosis and treatment from the emergency perspective

    DEFF Research Database (Denmark)

    Lawson-Smith, Pia; Jansen, Erik C; Hyldegaard, Ole

    2011-01-01

    This paper reviews the current literature on smoke inhalation injuries with special attention to the effects of hydrogen cyanide. It is assumed that cyanide poisoning is still an overlooked diagnosis in fire victims. Treatment against cyanide poisoning in the emergency setting should be given based...

  2. Risk factors for emergence and progression of scoliosis in children with severe cerebral palsy : a systematic review

    NARCIS (Netherlands)

    Loeters, Marianne J. B.; Maathuis, Carel G. B.; Hadders-Algra, Mijna

    Aim Scoliosis is a frequently occurring and serious complication of severe cerebral palsy (CP). This systematic review aims to the assess the risk factors associated with the emergence and progression of scoliosis in children with CP functioning at level IV or V of the Gross Motor Function

  3. User perspectives in public transport timetable optimisation

    DEFF Research Database (Denmark)

    Jensen, Jens Parbo; Nielsen, Otto Anker; Prato, Carlo Giacomo

    2014-01-01

    The present paper deals with timetable optimisation from the perspective of minimising the waiting time experienced by passengers when transferring either to or from a bus. Due to its inherent complexity, this bi-level minimisation problem is extremely difficult to solve mathematically, since tim...... on the large-scale public transport network in Denmark. The timetable optimisation approach yielded a yearly reduction in weighted waiting time equivalent to approximately 45 million Danish kroner (9 million USD)....

  4. Methodological principles for optimising functional MRI experiments

    International Nuclear Information System (INIS)

    Wuestenberg, T.; Giesel, F.L.; Strasburger, H.

    2005-01-01

    Functional magnetic resonance imaging (fMRI) is one of the most common methods for localising neuronal activity in the brain. Even though the sensitivity of fMRI is comparatively low, the optimisation of certain experimental parameters allows obtaining reliable results. In this article, approaches for optimising the experimental design, imaging parameters and analytic strategies will be discussed. Clinical neuroscientists and interested physicians will receive practical rules of thumb for improving the efficiency of brain imaging experiments. (orig.) [de

  5. Optimisation: how to develop stake holder involvement

    International Nuclear Information System (INIS)

    Weiss, W.

    2003-01-01

    The Precautionary Principle is an internationally recognised approach for dealing with risk situations characterised by uncertainties and potential irreversible damages. Since the late fifties, ICRP has adopted this prudent attitude because of the lack of scientific evidence concerning the existence of a threshold at low doses for stochastic effects. The 'linear, no-threshold' model and the 'optimisation of protection' principle have been developed as a pragmatic response for the management of the risk. The progress in epidemiology and radiobiology over the last decades have affirmed the initial assumption and the optimisation remains the appropriate response for the application of the precautionary principle in the context of radiological protection. The basic objective of optimisation is, for any source within the system of radiological protection, to maintain the level of exposure as low as reasonably achievable, taking into account social and economical factors. Methods tools and procedures have been developed over the last two decades to put into practice the optimisation principle with a central role given to the cost-benefit analysis as a means to determine the optimised level of protection. However, with the advancement in the implementation of the principle more emphasis was progressively given to good practice, as well as on the importance of controlling individual levels of exposure through the optimisation process. In the context of the revision of its present recommendations, the Commission is reenforcing the emphasis on protection of the individual with the adoption of an equity-based system that recognizes individual rights and a basic level of health protection. Another advancement is the role that is now recognised to 'stakeholders involvement' in the optimisation process as a mean to improve the quality of the decision aiding process for identifying and selecting protection actions considered as being accepted by all those involved. The paper

  6. Review of the emerging role of optical polarimetry in characterization of pathological myocardium.

    Science.gov (United States)

    Ahmad, Iftikhar

    2017-10-01

    Myocardial infarction (MI), a cause of significant morbidity and mortality, is typically followed by microstructural alterations where the necrotic myocardium is steadily replaced with a collagen scar. Engineered remodeling of the fibrotic scar via stem cell regeneration has been shown to improve/restore the myocardium function after MI. Nevertheless, the heterogeneous nature of the scar patch may impair the myocardial electrical integrity, leading to the formation of arrhythmogenesis. Radiofrequency ablation (RFA) offers an effective treatment for focal arrhythmias where local heating generated via electric current at specific spots in the myocardium ablate the arrhythmogenic foci. Characterization of these myocardial pathologies (i.e., infarcted, stem cell regenerated, and RFA-ablated myocardial tissues) is of potential clinical importance. Optical polarimetry, the use of light to map and characterize the polarization signatures of a sample, has emerged as a powerful imaging tool for structural characterization of myocardial tissues, exploiting the underlying highly fibrous tissue nature. This study aims to review the recent progress in optical polarimetry pertaining to the characterization of myocardial pathologies while describing the underlying biological rationales that give rise to the optical imaging contrast in various pathologies of the myocardium. Future possibilities of and challenges to optical polarimetry in cardiac imaging clinics are also discussed. (2017) COPYRIGHT Society of Photo-Optical Instrumentation Engineers (SPIE).

  7. Capnography in the Emergency Department: A Review of Uses, Waveforms, and Limitations.

    Science.gov (United States)

    Long, Brit; Koyfman, Alex; Vivirito, Michael A

    2017-12-01

    Capnography has many uses in the emergency department (ED) and critical care setting, most commonly cardiac arrest and procedural sedation. This review evaluates several indications concerning capnography beyond cardiac arrest and procedural sedation in the ED, as well as limitations and specific waveforms. Capnography includes the noninvasive measurement of CO 2 , providing information on ventilation, perfusion, and metabolism in intubated and spontaneously breathing patients. Since the 1990s, capnography has been utilized extensively for cardiac arrest and procedural sedation. Qualitative capnography includes a colorimetric device, changing color on the amount of CO 2 present. Quantitative capnography provides a numeric value (end-tidal CO 2 ), and capnography most commonly includes a waveform as a function of time. Conditions in which capnography is informative include cardiac arrest, procedural sedation, mechanically ventilated patients, and patients with metabolic acidemia. Patients with seizure, trauma, and respiratory conditions, such as pulmonary embolism and obstructive airway disease, can benefit from capnography, but further study is needed. Limitations include use of capnography in conditions with mixed pathophysiology, patients with low tidal volumes, and equipment malfunction. Capnography should be used in conjunction with clinical assessment. Capnography demonstrates benefit in cardiac arrest, procedural sedation, mechanically ventilated patients, and patients with metabolic acidemia. Further study is required in patients with seizure, trauma, and respiratory conditions. It should only be used in conjunction with other patient factors and clinical assessment. Published by Elsevier Inc.

  8. Emerging techniques for assisting and accelerating food freezing processes: A review of recent research progresses.

    Science.gov (United States)

    Cheng, Lina; Sun, Da-Wen; Zhu, Zhiwei; Zhang, Zi

    2017-03-04

    Freezing plays an important role in food preservation and the emergence of rapid freezing technologies can be highly beneficial to the food industry. This paper reviews some novel food freezing technologies, including high-pressure freezing (HPF), ultrasound-assisted freezing (UAF), electrically disturbed freezing (EF) and magnetically disturbed freezing (MF), microwave-assisted freezing (MWF), and osmo-dehydro-freezing (ODF). HPF and UAF can initiate ice nucleation rapidly, leading to uniform distribution of ice crystals and the control of their size and shape. Specifically, the former is focused on increasing the degree of supercooling, whereas the latter aims to decrease it. Direct current electric freezing (DC-EF) and alternating current electric freezing (AC-EF) exhibit different effects on ice nucleation. DC-EF can promote ice nucleation and AC-EF has the opposite effect. Furthermore, ODF has been successfully used for freezing various vegetables and fruit. MWF cannot control the nucleation temperature, but can decrease supercooling degree, thus decreasing the size of ice crystals. The heat and mass transfer processes during ODF have been investigated experimentally and modeled mathematically. More studies should be carried out to understand the effects of these technologies on food freezing process.

  9. New and emerging technologies for the treatment of inherited retinal diseases: a horizon scanning review.

    Science.gov (United States)

    Smith, J; Ward, D; Michaelides, M; Moore, A T; Simpson, S

    2015-09-01

    The horizon scanning review aimed to identify new and emerging technologies in development that have the potential to slow or stop disease progression and/or reverse sight loss in people with inherited retinal diseases (IRDs). Potential treatments were identified using recognized horizon scanning methods. These included a combination of online searches using predetermined search terms, suggestions from clinical experts and patient and carer focus groups, and contact with commercial developers. Twenty-nine relevant technologies were identified. These included 9 gene therapeutic approaches, 10 medical devices, 5 pharmacological agents, and 5 regenerative and cell therapies. A further 11 technologies were identified in very early phases of development (typically phase I or pre-clinical) and were included in the final report to give a complete picture of developments 'on the horizon'. Clinical experts and patient and carer focus groups provided helpful information and insights, such as the availability of specialised services for patients, the potential impacts of individual technologies on people with IRDs and their families, and helped to identify additional relevant technologies. This engagement ensured that important areas of innovation were not missed. Most of the health technologies identified are still at an early stage of development and it is difficult to estimate when treatments might be available. Further, well designed trials that generate data on efficacy, applicability, acceptability, and costs of the technologies, as well as the long-term impacts for various conditions are required before these can be considered for adoption into routine clinical practice.

  10. Emerging contaminants in surface waters in China—a short review

    International Nuclear Information System (INIS)

    Yang, Guang; Zhang, Guangming; Fan, Maohong

    2014-01-01

    Emerging contaminants (ECs) have drawn attention to many countries due to their persistent input and potential threat to human health and the environment. This article reviews the current contamination sources and their status for surface waters in China. The contamination levels of ECs in surface waters are in the range ng L −1 to μg L −1 in China, apparently about the same as the situation in other countries. ECs enter surface water via runoff, drainage, rainfall, and wastewater treatment effluent. The frequency of occurrence of ECs increased rapidly from 2006 to 2011; a significant reason is the production and consumption of pharmaceuticals and personal care products. As for the distribution of EC pollution in China, the frequency of occurrence of ECs in eastern regions is higher than in western regions. A majority of EC studies have focused on surface waters of the Haihe River and Pearl River watersheds due to their highly developed industries and intense human activity. Legislative and administrative regulation of ECs is lacking in China. To remove ECs, a number of technologies, such as absorption by activated carbon, membrane filtration technology, and advanced oxidation processes, have been researched. (letter)

  11. A scientometric review of emerging trends and new developments in agricultural ecological compensation.

    Science.gov (United States)

    He, Ke; Zhang, Junbiao; Wang, Xueting; Zeng, Yangmei; Zhang, Lu

    2018-05-08

    Agricultural ecological compensation has drawn an increasingly broad range of interest since early 1990s. In recent years, the volume of the literature grows rapidly. As a result, a systematic review of the diverse research field and its current trends becomes essential. This paper surveys the literature of agricultural ecological compensation between 1990 and 2016. Specifically, by employing CiteSpace information visualization software, we firstly identified the research hotspots and evolution path and then illustrated the frontier and developing trend of the domain in core and broader perspectives. It is found that the focus of the academic community has always been researches on the theoretical policy and application of the payment for agro-ecosystem services, agricultural ecological compensation based on contingent valuation method, and ecological compensation of farmland landscape and organic food production as well as willingness to accept/pay for land use and ecological protection. Meanwhile, we also found that, in recent years, qualitative research has received more and more attention in the field of agricultural ecological compensation, since global warming, agricultural carbon emissions, and other emerging environmental issues have aroused widespread concern of the people around the world. Moreover, we believed that more and more scholars will employ case study methodology to analyze agricultural ecological compensation in specific systems, regions, or circumstances in the future.

  12. Epidemiology of Mental Health Attendances at Emergency Departments: Systematic Review and Meta-Analysis.

    Directory of Open Access Journals (Sweden)

    Helen Barratt

    Full Text Available The characteristics of Emergency Department (ED attendances due to mental or behavioural health disorders need to be described to enable appropriate development of services. We aimed to describe the epidemiology of mental health-related ED attendances within health care systems free at the point of access, including clinical reason for presentation, previous service use, and patient sociodemographic characteristics.Systematic review and meta-analysis of observational studies describing ED attendances by patients with common mental health conditions.18 studies from seven countries met eligibility criteria. Patients attending due to mental or behavioural health disorders accounted for 4% of ED attendances; a third were due to self-harm or suicidal ideation. 58.1% of attendees had a history of psychiatric illness and up to 58% were admitted. The majority of studies were single site and of low quality so results must be interpreted cautiously.Prevalence studies of mental health-related ED attendances are required to enable the development of services to meet specific needs.

  13. A review of palivizumab and emerging therapies for respiratory syncytial virus.

    Science.gov (United States)

    Shadman, Kristin A; Wald, Ellen R

    2011-11-01

    Respiratory syncytial virus (RSV) is an important pathogen in children and adults; however, current treatment options are primarily supportive. Palivizumab, the only approved specific monoclonal antibody for RSV is used prophylactically to reduce morbidity in a select population of high-risk children. The development and current use of palivizumab; the potential role of palivizumab as preventive therapy in patients with cystic fibrosis, asthma and compromised immune systems; and explores the limited research in which palivizumab has been used for treatment of RSV. The modified recommendations for the use of palivizumab espoused by the American Academy of Pediatrics and research on the cost-effectiveness of this product are presented. In addition, the authors discuss the development of enhanced monoclonal antibodies including motavizumab, which was recently denied FDA approval for preventative therapy. The authors explore the historical and current efforts to develop a vaccine targeting RSV. The current status of antiviral drug development is also reviewed. The literature search included RSV-Ig, palivizumab, and emerging drugs and vaccines for the treatment of RSV as keywords and titles from 1997 to 2011. Although there are potential drugs and vaccines in development to prevent or reduce the effects of RSV infection, palivizumab remains the only licensed product to reduce the severity of disease in high-risk pediatric patients.

  14. Quality indicators for the assessment and management of pain in the emergency department: a systematic review.

    Science.gov (United States)

    Stang, Antonia Schirmer; Hartling, Lisa; Fera, Cassandra; Johnson, David; Ali, Samina

    2014-01-01

    Evidence indicates that pain is undertreated in the emergency department (ED). The first step in improving the pain experience for ED patients is to accurately and systematically assess the actual care being provided. Identifying gaps in the assessment and treatment of pain and improving patient outcomes requires relevant, evidence-based performance measures. To systematically review the literature and identify quality indicators specific to the assessment and management of pain in the ED. Four major bibliographical databases were searched from January 1980 to December 2010, and relevant journals and conference proceedings were manually searched. Original research that described the development or collection of data on one or more quality indicators relevant to the assessment or management of pain in the ED was included. The search identified 18,078 citations. Twenty-three articles were included: 15 observational (cohort) studies; three before-after studies; three audits; one quality indicator development study; and one survey. Methodological quality was moderate, with weaknesses in the reporting of study design and methodology. Twenty unique indicators were identified, with the majority (16 of 20) measuring care processes. Overall, 91% (21 of 23) of the studies reported indicators for the assessment or management of presenting pain, as opposed to procedural pain. Three of the studies included children; however, none of the indicators were developed specifically for a pediatric population. Gaps in the existing literature include a lack of measures reflecting procedural pain, patient outcomes and the pediatric population. Future efforts should focus on developing indicators specific to these key areas.

  15. Emerging contaminants in surface waters in China—a short review

    Science.gov (United States)

    Yang, Guang; Fan, Maohong; Zhang, Guangming

    2014-07-01

    Emerging contaminants (ECs) have drawn attention to many countries due to their persistent input and potential threat to human health and the environment. This article reviews the current contamination sources and their status for surface waters in China. The contamination levels of ECs in surface waters are in the range ng L-1 to μg L-1 in China, apparently about the same as the situation in other countries. ECs enter surface water via runoff, drainage, rainfall, and wastewater treatment effluent. The frequency of occurrence of ECs increased rapidly from 2006 to 2011; a significant reason is the production and consumption of pharmaceuticals and personal care products. As for the distribution of EC pollution in China, the frequency of occurrence of ECs in eastern regions is higher than in western regions. A majority of EC studies have focused on surface waters of the Haihe River and Pearl River watersheds due to their highly developed industries and intense human activity. Legislative and administrative regulation of ECs is lacking in China. To remove ECs, a number of technologies, such as absorption by activated carbon, membrane filtration technology, and advanced oxidation processes, have been researched.

  16. Review on drivers, trends and emerging issues of the food wastage in China

    Directory of Open Access Journals (Sweden)

    Lin MA,Wei QIN,Tara GARNETT,Fusuo ZHANG

    2015-06-01

    Full Text Available China has successfully achieved food self-sufficiency over the past 50 years, however, with large inputs and losses. To meet the challenge of feeding a growing population with limited resources, many studies have explored options for improving productivity and efficiency of the food production. However, there have been few studies into the potential of reducing food loss along the whole food production-consumption chain. Here we review the literature on food waste in China. We briefly analyze (1 the drivers that influence levels of food waste in the food chain, (2 examine trends in the volumes and types of food wasted at different stages in the food chain, (3 assess the environmental and resource consequences of food waste in the food chain, and (4 evaluate the policy and stakeholder responses to the emerging challenges. It is concluded that reducing food loss and meeting food security in China requires a coherent institutional structure that promotes the synergistic outcomes of research, policy and education. Suggested key actions include (1 improving machinery and facility for sowing, harvesting, transportation and storage, which can reduce food loss by up to 50%, and (2 improving food waste recycling management, based on coupled food production and consumption systems.

  17. Wound healing effects of dipeptidyl peptidase-4 inhibitors: An emerging concept in management of diabetic foot ulcer-A review.

    Science.gov (United States)

    Saboo, Apoorva; Rathnayake, Ayeshmanthe; Vangaveti, Venkat N; Malabu, Usman H

    2016-01-01

    Dipeptidyl peptidase-4 (DPP-4) inhibitors have a well-known effect on glycaemic control in patients with diabetes but little is known on their wound healing role in this group of population. This paper reviews the effects of DPP-4 inhibitors on wound healing of diabetic foot ulcers. Published data on effects and mechanism of DDP-4 inhibitors on wound healing were derived from Medline, PubMed and Google Scholar search of English language literature from 1994 to 2014 using the key words such as "DPP-4 inhibitors", "endothelial healing" "diabetes" and "chronic ulcers". DPP-4 inhibitors show a potential benefit in processes of wound healing in diabetic chronic foot ulcers. The enzyme inhibitors promote recruitment of endothelial progenitor cells and allow the final scaffolding of wounds. Furthermore DPP-4 inhibitors augment angiogenesis and have widespread effects on optimising the immune response to persistent hypoxia in chronic diabetes wounds. DPP-4 inhibitors show promise in the local wound healing of diabetic foot ulcers in addition to its already established glycaemic control. In the light of high rate of amputations due to non-healing ulcers with profound psychological and economical liability, more investigations on the usefulness of DPP-4 inhibitors in the high risk diabetes population are needed. Copyright © 2015 Diabetes India. Published by Elsevier Ltd. All rights reserved.

  18. Dose optimisation in single plane interstitial brachytherapy

    DEFF Research Database (Denmark)

    Tanderup, Kari; Hellebust, Taran Paulsen; Honoré, Henriette Benedicte

    2006-01-01

    patients,       treated for recurrent rectal and cervical cancer, flexible catheters were       sutured intra-operatively to the tumour bed in areas with compromised       surgical margin. Both non-optimised, geometrically and graphically       optimised CT -based dose plans were made. The overdose index...... on the       regularity of the implant, such that the benefit of optimisation was       larger for irregular implants. OI and HI correlated strongly with target       volume limiting the usability of these parameters for comparison of dose       plans between patients. CONCLUSIONS: Dwell time optimisation significantly......BACKGROUND AND PURPOSE: Brachytherapy dose distributions can be optimised       by modulation of source dwell times. In this study dose optimisation in       single planar interstitial implants was evaluated in order to quantify the       potential benefit in patients. MATERIAL AND METHODS: In 14...

  19. Predicting geriatric falls following an episode of emergency department care: a systematic review.

    Science.gov (United States)

    Carpenter, Christopher R; Avidan, Michael S; Wildes, Tanya; Stark, Susan; Fowler, Susan A; Lo, Alexander X

    2014-10-01

    Falls are the leading cause of traumatic mortality in geriatric adults. Despite recent multispecialty guideline recommendations that advocate for proactive fall prevention protocols in the emergency department (ED), the ability of risk factors or risk stratification instruments to identify subsets of geriatric patients at increased risk for short-term falls is largely unexplored. This was a systematic review and meta-analysis of ED-based history, physical examination, and fall risk stratification instruments with the primary objective of providing a quantitative estimate for each risk factor's accuracy to predict future falls. A secondary objective was to quantify ED fall risk assessment test and treatment thresholds using derived estimates of sensitivity and specificity. A medical librarian and two emergency physicians (EPs) conducted a medical literature search of PUBMED, EMBASE, CINAHL, CENTRAL, DARE, the Cochrane Registry, and Clinical Trials. Unpublished research was located by a hand search of emergency medicine (EM) research abstracts from national meetings. Inclusion criteria for original studies included ED-based assessment of pre-ED or post-ED fall risk in patients 65 years and older with sufficient detail to reproduce contingency tables for meta-analysis. Original study authors were contacted for additional details when necessary. The Quality Assessment Tool for Diagnostic Accuracy Studies (QUADAS-2) was used to assess individual study quality for those studies that met inclusion criteria. When more than one qualitatively similar study assessed the same risk factor for falls at the same interval following an ED evaluation, then meta-analysis was performed using Meta-DiSc software. The primary outcomes were sensitivity, specificity, and likelihood ratios for fall risk factors or risk stratification instruments. Secondary outcomes included estimates of test and treatment thresholds using the Pauker method based on accuracy, screening risk, and the

  20. Discussion on Implementation of ICRP Recommendations Concerning Reference Levels and Optimisation

    International Nuclear Information System (INIS)

    2013-02-01

    International Commission on Radiological Protection (ICRP) Publication 103, 'The 2007 Recommendations of the International Commission on Radiological Protection', issued in 2007, defines emergency exposure situations as unexpected situations that may require the implementation of urgent protective actions and perhaps longer term protective actions. The ICRP continues to recommend optimisation and the use of reference levels to ensure an adequate degree of protection in regard to exposure to ionising radiation in emergency exposure situations. Reference levels represent the level of dose or risk above which it is judged to be inappropriate to plan to allow exposures to occur and for which protective actions should therefore be planned and optimised. National authorities are responsible for establishing reference levels. The Expert Group on the Implementation of New International Recommendations for Emergency Exposure Situations (EGIRES) performed a survey to analyse the established processes for optimisation of the protection strategy for emergency exposure situations and for practical implementation of the reference level concept in several member states of the Nuclear Energy Agency (NEA). The EGIRES collected information on several national optimisation strategy definitions, on optimisation of protection for different protective actions, and also on optimisation of urgent protective actions. In addition, national criteria for setting reference levels, their use, and relevant processes, including specific triggers and dosimetric quantifies in setting reference levels, are focus points that the EGIRES also evaluated. The analysis of national responses to this 2011 survey shows many differences in the interpretation and application of the established processes and suggests that most countries are still in the early stages of implementing these processes. Since 2011, national authorities have continued their study of the ICRP recommendations to incorporate them into

  1. A review of precipitation and temperature control on seedling emergence and establishment for ponderosa and lodgepole pine forest regeneration

    Science.gov (United States)

    Petrie, Matthew; Wildeman, A.M.; Bradford, John B.; Hubbard, R.M.; Lauenroth, W.K.

    2016-01-01

    The persistence of ponderosa pine and lodgepole pine forests in the 21st century depends to a large extent on how seedling emergence and establishment are influenced by driving climate and environmental variables, which largely govern forest regeneration. We surveyed the literature, and identified 96 publications that reported data on dependent variables of seedling emergence and/or establishment and one or more independent variables of air temperature, soil temperature, precipitation and moisture availability. Our review suggests that seedling emergence and establishment for both species is highest at intermediate temperatures (20 to 25 °C), and higher precipitation and higher moisture availability support a higher percentage of seedling emergence and establishment at daily, monthly and annual timescales. We found that ponderosa pine seedlings may be more sensitive to temperature fluctuations whereas lodgepole pine seedlings may be more sensitive to moisture fluctuations. In a changing climate, increasing temperatures and declining moisture availability may hinder forest persistence by limiting seedling processes. Yet, only 23 studies in our review investigated the effects of driving climate and environmental variables directly. Furthermore, 74 studies occurred in a laboratory or greenhouse, which do not often replicate the conditions experienced by tree seedlings in a field setting. It is therefore difficult to provide strong conclusions on how sensitive emergence and establishment in ponderosa and lodgepole pine are to these specific driving variables, or to investigate their potential aggregate effects. Thus, the effects of many driving variables on seedling processes remain largely inconclusive. Our review stresses the need for additional field and laboratory studies to better elucidate the effects of driving climate and environmental variables on seedling emergence and establishment for ponderosa and lodgepole pine.

  2. A systematic review of effectiveness and safety of different regimens of levonorgestrel oral tablets for emergency contraception.

    Science.gov (United States)

    Shohel, Mohammad; Rahman, Mohammad Mahfuzur; Zaman, Asif; Uddin, Mir Muhammad Nasir; Al-Amin, Md Mamun; Reza, Hasan Mahmud

    2014-04-04

    Unintended pregnancy is a complex phenomenon which raise to take an emergency decision. Low contraceptive prevalence and high user failure rates are the leading causes of this unexpected situation. High user failure rates suggest the vital role of emergency contraception to prevent unplanned pregnancy. Levonorgestrel - a commonly used progestin for emergency contraception. However, little is known about its pharmacokinetics and optimal dose for use. Hence, there is a need to conduct a systematic review of the available evidences. Randomized, double-blind trials were sought, evaluating healthy women with regular menstrual cycles, who requested emergency contraception within 72 h of unprotected coitus, to one of three regimens: 1.5 mg single dose levonorgestrel, two doses of 0.75 mg levonorgestrel given 12 h apart or two doses of 0.75 mg levonorgestrel given 24 h apart. The primary outcome was unintended pregnancy; other outcomes were side-effects and timing of next menstruation. Every trial under consideration successfully established the contraceptive effectiveness of levonorgestrel for preventing unintended pregnancy. Moreover, a single dose of levonorgestrel 1.5 mg for emergency contraception supports its safety and efficacy profile. If two doses of levonorgestrel 0.75 mg are intended for administration, the second dose can positively be taken 12-24 h after the first dose without compromising its contraceptive efficacy. The main side effect was frequent menstrual irregularities. No serious adverse events were reported. The review shows that, emergency contraceptive regimen of single-dose levonorgestrel is not inferior in efficacy to the two-dose regimen. All the regimens studied were very efficacious for emergency contraception and prevented a high proportion of pregnancies if taken within 72 h of unprotected coitus. Single levonorgestrel dose (1.5 mg) can substitute two 0.75 mg doses 12 or 24 h apart. With either regimen, the earlier the treatment is given

  3. Transient ischemic attack: reviewing the evolution of the definition, diagnosis, risk stratification, and management for the emergency physician.

    Science.gov (United States)

    Siket, Matthew S; Edlow, Jonathan A

    2012-08-01

    A transient ischemic attack (TIA) is an episode of reversible neurologic deficit caused by temporary focal central nervous system hypoperfusion. TIA is a medical emergency. Because patients with TIA in the emergency department (ED) have a high risk for stroke within the next 48 hours, it is imperative for the clinician to recognize this golden opportunity to prevent a disabling stroke. This article reviews our conceptual understanding of TIA, its definition, diagnosis, ways to stratify stroke risk, the acute management and disposition in the ED, and the potential future role of diagnostic biomarkers. Copyright © 2012 Elsevier Inc. All rights reserved.

  4. Natural history of treatment-emergent central sleep apnea on positive airway pressure: A systematic review.

    Science.gov (United States)

    Nigam, Gaurav; Riaz, Muhammad; Chang, Edward T; Camacho, Macario

    2018-01-01

    Treatment-emergent central sleep apnea (TECSA) is observed in some patients when they are treated with positive airway pressure (PAP) after significant resolution of the preexisting obstructive events in patients with obstructive sleep apnea. The objective of this study was to systematically review the literature for studies describing the natural history of TECSA. PubMed, Medline, Scopus, Web of Science, and Cochran Library databases were searched through June 29, 2017. Five studies were identified that discussed the natural history of TECSA. TECSA developed in 3.5%-19.8% of PAP-treated patients. Treatment-persistent central sleep apnea (TPCSA), representing protracted periods of PAP therapy-related central apneas, was noted in 14.3%-46.2% of patients with TECSA. Delayed-TECSA (D-TECSA) represents an anomalous TECSA entity appearing weeks to months after initial PAP therapy. D-TECSA was observed in 0.7%-4.2% of OSA patients undergoing PAP treatment (after at least 1 month). In patients with TECSA, a higher apnea-hypopnea index (AHI) and central apnea index at their baseline study or a higher residual AHI at their titration study may be associated with an increased likelihood of conversion to TPCSA. Overall, TECSA developed in 3.5%-19.8% of PAP-treated patients with OSA. The vast majority will experience complete resolution of central apneas over a few weeks to months. Unfortunately, about a third of patients with TECSA may continue to exhibit persistence of central sleep apnea on reevaluation. A small proportion may experience D-TECSA after few weeks to several months of initial exposure to PAP therapy.

  5. Screening injured children for physical abuse or neglect in emergency departments: a systematic review.

    Science.gov (United States)

    Woodman, J; Lecky, F; Hodes, D; Pitt, M; Taylor, B; Gilbert, Ruth

    2010-03-01

    Screening markers are used in emergency departments (EDs) to identify children who should be assessed for possible physical abuse and neglect. We conducted three systematic reviews evaluating age, repeat attendance and injury type as markers for physical abuse or neglect in injured children attending EDs. We included studies comparing markers in physically abused or neglected children and non-abused injured children attending ED or hospital. We calculated likelihood ratios (LRs) for age group, repeat attendance and injury type (head injury, bruises, fractures, burns or other). Given the low prevalence of abuse or neglect, we considered that an LR of 10 or more would be clinically useful. All studies were poor quality. Infancy increased the risk of physical abuse or neglect in severely injured or admitted children (LRs 7.7-13.0, 2 studies) but was not strongly associated in children attending the ED (LR 1.5, 95% CI: 0.9, 2.8; one study). Repeat attendance did not substantially increase the risk of abuse or neglect and may be confounded by chronic disease and socio-economic status (LRs 0.8-3.9, 3 studies). One study showed no evidence that the type of injury substantially increased the risk of physical abuse or neglect in severely injured children. There was no evidence that any of the markers (infancy, type of injury, repeated attendance) were sufficiently accurate (i.e. LR >or= 10) to screen injured children in the ED to identify those requiring paediatric assessment for possible physical abuse or neglect. Clinicians should be aware that among injured children at ED a high proportion of abused children will present without these characteristics and a high proportion of non-abused children will present with them. Information about age, injury type and repeat attendances should be interpreted in this context.

  6. Past speculations of the future: a review of the methods used for forecasting emerging health technologies.

    Science.gov (United States)

    Doos, Lucy; Packer, Claire; Ward, Derek; Simpson, Sue; Stevens, Andrew

    2016-03-10

    Forecasting can support rational decision-making around the introduction and use of emerging health technologies and prevent investment in technologies that have limited long-term potential. However, forecasting methods need to be credible. We performed a systematic search to identify the methods used in forecasting studies to predict future health technologies within a 3-20-year timeframe. Identification and retrospective assessment of such methods potentially offer a route to more reliable prediction. Systematic search of the literature to identify studies reported on methods of forecasting in healthcare. People are not needed in this study. The authors searched MEDLINE, EMBASE, PsychINFO and grey literature sources, and included articles published in English that reported their methods and a list of identified technologies. Studies reporting methods used to predict future health technologies within a 3-20-year timeframe with an identified list of individual healthcare technologies. Commercially sponsored reviews, long-term futurology studies (with over 20-year timeframes) and speculative editorials were excluded. 15 studies met our inclusion criteria. Our results showed that the majority of studies (13/15) consulted experts either alone or in combination with other methods such as literature searching. Only 2 studies used more complex forecasting tools such as scenario building. The methodological fundamentals of formal 3-20-year prediction are consistent but vary in details. Further research needs to be conducted to ascertain if the predictions made were accurate and whether accuracy varies by the methods used or by the types of technologies identified. 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/

  7. Managing Terrorism or Accidental Nuclear Errors, Preparing for Iodine-131 Emergencies: A Comprehensive Review

    Directory of Open Access Journals (Sweden)

    Eric R. Braverman

    2014-04-01

    Full Text Available Chernobyl demonstrated that iodine-131 (131I released in a nuclear accident can cause malignant thyroid nodules to develop in children within a 300 mile radius of the incident. Timely potassium iodide (KI administration can prevent the development of thyroid cancer and the American Thyroid Association (ATA and a number of United States governmental agencies recommend KI prophylaxis. Current pre-distribution of KI by the United States government and other governments with nuclear reactors is probably ineffective. Thus we undertook a thorough scientific review, regarding emergency response to 131I exposures. We propose: (1 pre-distribution of KI to at risk populations; (2 prompt administration, within 2 hours of the incident; (3 utilization of a lowest effective KI dose; (4 distribution extension to at least 300 miles from the epicenter of a potential nuclear incident; (5 education of the public about dietary iodide sources; (6 continued post-hoc analysis of the long-term impact of nuclear accidents; and (7 support for global iodine sufficiency programs. Approximately two billion people are at risk for iodine deficiency disorder (IDD, the world’s leading cause of preventable brain damage. Iodide deficient individuals are at greater risk of developing thyroid cancer after 131I exposure. There are virtually no studies of KI prophylaxis in infants, children and adolescents, our target population. Because of their sensitivity to these side effects, we have suggested that we should extrapolate from the lowest effective adult dose, 15–30 mg or 1–2 mg per 10 pounds for children. We encourage global health agencies (private and governmental to consider these critical recommendations.

  8. Randomized controlled trials of simulation-based interventions in Emergency Medicine: a methodological review.

    Science.gov (United States)

    Chauvin, Anthony; Truchot, Jennifer; Bafeta, Aida; Pateron, Dominique; Plaisance, Patrick; Yordanov, Youri

    2018-04-01

    The number of trials assessing Simulation-Based Medical Education (SBME) interventions has rapidly expanded. Many studies show that potential flaws in design, conduct and reporting of randomized controlled trials (RCTs) can bias their results. We conducted a methodological review of RCTs assessing a SBME in Emergency Medicine (EM) and examined their methodological characteristics. We searched MEDLINE via PubMed for RCT that assessed a simulation intervention in EM, published in 6 general and internal medicine and in the top 10 EM journals. The Cochrane Collaboration risk of Bias tool was used to assess risk of bias, intervention reporting was evaluated based on the "template for intervention description and replication" checklist, and methodological quality was evaluated by the Medical Education Research Study Quality Instrument. Reports selection and data extraction was done by 2 independents researchers. From 1394 RCTs screened, 68 trials assessed a SBME intervention. They represent one quarter of our sample. Cardiopulmonary resuscitation (CPR) is the most frequent topic (81%). Random sequence generation and allocation concealment were performed correctly in 66 and 49% of trials. Blinding of participants and assessors was performed correctly in 19 and 68%. Risk of attrition bias was low in three-quarters of the studies (n = 51). Risk of selective reporting bias was unclear in nearly all studies. The mean MERQSI score was of 13.4/18.4% of the reports provided a description allowing the intervention replication. Trials assessing simulation represent one quarter of RCTs in EM. Their quality remains unclear, and reproducing the interventions appears challenging due to reporting issues.

  9. A Review of Cyber Threats and Defence Approaches in Emergency Management

    OpenAIRE

    Tuan Vuong; Diane Gan; George Loukas

    2013-01-01

    Emergency planners, first responders and relief workers increasingly rely on computational and communication systems that support all aspects of emergency management, from mitigation and preparedness to response and recovery. Failure of these systems, whether accidental or because of malicious action, can have severe implications for emergency management. Accidental failures have been extensively documented in the past and significant effort has been put into the development and introduction ...

  10. Optimisation of Storage for Concentrated Solar Power Plants

    Directory of Open Access Journals (Sweden)

    Luigi Cirocco

    2014-12-01

    Full Text Available The proliferation of non-scheduled generation from renewable electrical energy sources such concentrated solar power (CSP presents a need for enabling scheduled generation by incorporating energy storage; either via directly coupled Thermal Energy Storage (TES or Electrical Storage Systems (ESS distributed within the electrical network or grid. The challenges for 100% renewable energy generation are: to minimise capitalisation cost and to maximise energy dispatch capacity. The aims of this review article are twofold: to review storage technologies and to survey the most appropriate optimisation techniques to determine optimal operation and size of storage of a system to operate in the Australian National Energy Market (NEM. Storage technologies are reviewed to establish indicative characterisations of energy density, conversion efficiency, charge/discharge rates and costings. A partitioning of optimisation techniques based on methods most appropriate for various time scales is performed: from “whole of year”, seasonal, monthly, weekly and daily averaging to those best suited matching the NEM bid timing of five minute dispatch bidding, averaged on the half hour as the trading settlement spot price. Finally, a selection of the most promising research directions and methods to determine the optimal operation and sizing of storage for renewables in the grid is presented.

  11. Living systematic reviews: an emerging opportunity to narrow the evidence-practice gap.

    OpenAIRE

    Julian H Elliott; Tari Turner; Ornella Clavisi; James Thomas; Julian P T Higgins; Chris Mavergames; Russell L Gruen

    2014-01-01

    The current difficulties in keeping systematic reviews up to date leads to considerable inaccuracy, hampering the translation of knowledge into action. Incremental advances in conventional review updating are unlikely to lead to substantial improvements in review currency. A new approach is needed. We propose living systematic review as a contribution to evidence synthesis that combines currency with rigour to enhance the accuracy and utility of health evidence. Living systematic reviews are ...

  12. Optimisation of Investment Resources at Small Enterprises

    Directory of Open Access Journals (Sweden)

    Shvets Iryna B.

    2014-03-01

    Full Text Available The goal of the article lies in the study of the process of optimisation of the structure of investment resources, development of criteria and stages of optimisation of volumes of investment resources for small enterprises by types of economic activity. The article characterises the process of transformation of investment resources into assets and liabilities of the balances of small enterprises and conducts calculation of the structure of sources of formation of investment resources in Ukraine at small enterprises by types of economic activity in 2011. On the basis of the conducted analysis of the structure of investment resources of small enterprises the article forms main groups of criteria of optimisation in the context of individual small enterprises by types of economic activity. The article offers an algorithm and step-by-step scheme of optimisation of investment resources at small enterprises in the form of a multi-stage process of management of investment resources in the context of increase of their mobility and rate of transformation of existing resources into investments. The prospect of further studies in this direction is development of a structural and logic scheme of optimisation of volumes of investment resources at small enterprises.

  13. Motives for self-referral to the emergency department: a systematic review of the literature

    NARCIS (Netherlands)

    Kraaijvanger, N.; Leeuwen, H. van; Rijpsma, D.; Edwards, M.J.

    2016-01-01

    BACKGROUND: In several western countries patients' use of Emergency Departments (EDs) is increasing. A substantial number of patients is self-referred, but does not need emergency care. In order to have more influence on unnecessary self-referral, it is essential to know why patients visit the ED

  14. Thigh infection and subcutaneous emphysema: an emergency, review of literature and case discussion.

    LENUS (Irish Health Repository)

    Thakral, R

    2011-06-01

    Thigh infection associated with local emphysematous signs on presentation to the emergency room should alert the medical staff at once of potential complication associated with it. The infection may be associated with underlying bowel pathology and has a high mortality rate. Hence, emergency treatment should be instituted. We discuss a case with this uncommon presentation, treatment administered and relevant literature.

  15. Development of an optimised 1:1 physiotherapy intervention post first-time lumbar discectomy: a mixed-methods study

    Science.gov (United States)

    Rushton, A; White, L; Heap, A; Heneghan, N; Goodwin, P

    2016-01-01

    Objectives To develop an optimised 1:1 physiotherapy intervention that reflects best practice, with flexibility to tailor management to individual patients, thereby ensuring patient-centred practice. Design Mixed-methods combining evidence synthesis, expert review and focus groups. Setting Secondary care involving 5 UK specialist spinal centres. Participants A purposive panel of clinical experts from the 5 spinal centres, comprising spinal surgeons, inpatient and outpatient physiotherapists, provided expert review of the draft intervention. Purposive samples of patients (n=10) and physiotherapists (n=10) (inpatient/outpatient physiotherapists managing patients with lumbar discectomy) were invited to participate in the focus groups at 1 spinal centre. Methods A draft intervention developed from 2 systematic reviews; a survey of current practice and research related to stratified care was circulated to the panel of clinical experts. Lead physiotherapists collaborated with physiotherapy and surgeon colleagues to provide feedback that informed the intervention presented at 2 focus groups investigating acceptability to patients and physiotherapists. The focus groups were facilitated by an experienced facilitator, recorded in written and tape-recorded forms by an observer. Tape recordings were transcribed verbatim. Data analysis, conducted by 2 independent researchers, employed an iterative and constant comparative process of (1) initial descriptive coding to identify categories and subsequent themes, and (2) deeper, interpretive coding and thematic analysis enabling concepts to emerge and overarching pattern codes to be identified. Results The intervention reflected best available evidence and provided flexibility to ensure patient-centred care. The intervention comprised up to 8 sessions of 1:1 physiotherapy over 8 weeks, starting 4 weeks postsurgery. The intervention was acceptable to patients and physiotherapists. Conclusions A rigorous process informed an

  16. Systematic review of frequent users of emergency departments in non-US hospitals: state of the art.

    Science.gov (United States)

    van Tiel, Sofie; Rood, Pleunie P M; Bertoli-Avella, Aida M; Erasmus, Vicky; Haagsma, Juanita; van Beeck, Ed; Patka, Peter; Polinder, Suzanne

    2015-10-01

    This review focuses on frequent users (FUs) of the emergency department (ED). Elucidation of the characteristics of frequent ED users will help to improve healthcare services. A systematic review of the literature (from 1999 onwards) on frequent ED users in non-US hospitals was performed. Twenty-two studies were included. FUs are responsible for a wide variety of 1-31% of ED visits depending on the FU definition used. They have a mean age between 40 and 50 years and are older than nonfrequent users. Chronic physical and mental diseases seem to be the main reasons for frequent ED visits. In terms of social characteristics, lacking a partner is more frequently reported among FUs in some studies. The absence of a universal definition for FUs complicates the determination of the burden on emergency healthcare services. FUs are a heterogeneous group of patients with genuine medical needs and high consumption of other healthcare services.

  17. TH-C-BRC-02: A Review of Emerging Technologies in Robotic SRS/SBRT Delivery

    Energy Technology Data Exchange (ETDEWEB)

    Wang, L. [Stanford University Cancer Center (United States)

    2016-06-15

    deliver highly conformal radiosurgery treatments to multiple targets simultaneously via a single isocenter to replace the conventional multi-iso multi-plan treatments. It becomes important to understand the advantages and limitations of this technique, and the pitfalls for implementing this technique in clinical practice. The planning process of single-iso multi-target MAT will be described, and its plan quality and delivery efficiency will be compared with multi-iso plans. The QA process for verifying such complex plans will be illustrated, and pitfalls in imaging and patient set up will be discussed. Overall, this session will focus on the following areas: 1) Update on the emerging technology in current SRS/SBRT delivery. 2) New developments in treatment planning and Quality Assurance program. 3) Imaging guidance and motion management. Learning Objectives: To understand the SRS/SBRT principles and its clinical applications, and gain knowledge on the emerging technologies in SRS/SBRT. To review planning concepts and useful tips in treatment planning. To learn about the imaging guidance procedures and the quality assurance program in SRS/SBRT. National Institutes of Health, Varian Medical System; L. Ren, The presenter is funded by National Institutes of Health and Varian Medical System.

  18. TH-C-BRC-02: A Review of Emerging Technologies in Robotic SRS/SBRT Delivery

    International Nuclear Information System (INIS)

    Wang, L.

    2016-01-01

    deliver highly conformal radiosurgery treatments to multiple targets simultaneously via a single isocenter to replace the conventional multi-iso multi-plan treatments. It becomes important to understand the advantages and limitations of this technique, and the pitfalls for implementing this technique in clinical practice. The planning process of single-iso multi-target MAT will be described, and its plan quality and delivery efficiency will be compared with multi-iso plans. The QA process for verifying such complex plans will be illustrated, and pitfalls in imaging and patient set up will be discussed. Overall, this session will focus on the following areas: 1) Update on the emerging technology in current SRS/SBRT delivery. 2) New developments in treatment planning and Quality Assurance program. 3) Imaging guidance and motion management. Learning Objectives: To understand the SRS/SBRT principles and its clinical applications, and gain knowledge on the emerging technologies in SRS/SBRT. To review planning concepts and useful tips in treatment planning. To learn about the imaging guidance procedures and the quality assurance program in SRS/SBRT. National Institutes of Health, Varian Medical System; L. Ren, The presenter is funded by National Institutes of Health and Varian Medical System.

  19. Promoting public health legal preparedness for emergencies: review of current trends and their relevance in light of the Ebola crisis.

    Science.gov (United States)

    Cohen, Odeya; Feder-Bubis, Paula; Bar-Dayan, Yaron; Adini, Bruria

    2015-01-01

    Public health legal preparedness (PHLP) for emergencies is a core component of the health system response. However, the implementation of health legal preparedness differs between low- and middle-income countries (LMIC) and developed countries. This paper examines recent trends regarding public health legal preparedness for emergencies and discusses its role in the recent Ebola outbreak. A rigorous literature review was conducted using eight electronic databases as well as Google Scholar. The results encompassed peer-reviewed English articles, reports, theses, and position papers dating from 2011 to 2014. Earlier articles concerning regulatory actions were also examined. The importance of PHLP has grown during the past decade and focuses mainly on infection-disease scenarios. Amid LMICs, it mostly refers to application of international regulations, whereas in developed states, it focuses on independent legislation and creation of conditions optimal to promoting an effective emergency management. Among developed countries, the United States' utilisation of health legal preparedness is the most advanced, including the creation of a model comprising four elements: law, competencies, information, and coordination. Only limited research has been conducted in this field to date. Nevertheless, in both developed and developing states, studies that focused on regulations and laws activated in health systems during emergencies, identified inconsistency and incoherence. The Ebola outbreak plaguing West Africa since 2014 has global implications, challenges and paralleling results, that were identified in this review. The review has shown the need to broaden international regulations, to deepen reciprocity between countries, and to consider LMICs health capacities, in order to strengthen the national health security. Adopting elements of the health legal preparedness model is recommended.

  20. Promoting public health legal preparedness for emergencies: review of current trends and their relevance in light of the Ebola crisis

    Directory of Open Access Journals (Sweden)

    Odeya Cohen

    2015-10-01

    Full Text Available Background: Public health legal preparedness (PHLP for emergencies is a core component of the health system response. However, the implementation of health legal preparedness differs between low- and middle-income countries (LMIC and developed countries. Objective: This paper examines recent trends regarding public health legal preparedness for emergencies and discusses its role in the recent Ebola outbreak. Design: A rigorous literature review was conducted using eight electronic databases as well as Google Scholar. The results encompassed peer-reviewed English articles, reports, theses, and position papers dating from 2011 to 2014. Earlier articles concerning regulatory actions were also examined. Results: The importance of PHLP has grown during the past decade and focuses mainly on infection–disease scenarios. Amid LMICs, it mostly refers to application of international regulations, whereas in developed states, it focuses on independent legislation and creation of conditions optimal to promoting an effective emergency management. Among developed countries, the United States’ utilisation of health legal preparedness is the most advanced, including the creation of a model comprising four elements: law, competencies, information, and coordination. Only limited research has been conducted in this field to date. Nevertheless, in both developed and developing states, studies that focused on regulations and laws activated in health systems during emergencies, identified inconsistency and incoherence. The Ebola outbreak plaguing West Africa since 2014 has global implications, challenges and paralleling results, that were identified in this review. Conclusions: The review has shown the need to broaden international regulations, to deepen reciprocity between countries, and to consider LMICs health capacities, in order to strengthen the national health security. Adopting elements of the health legal preparedness model is recommended.

  1. Promoting public health legal preparedness for emergencies: review of current trends and their relevance in light of the Ebola crisis

    Science.gov (United States)

    Cohen, Odeya; Feder-Bubis, Paula; Bar-Dayan, Yaron; Adini, Bruria

    2015-01-01

    Background Public health legal preparedness (PHLP) for emergencies is a core component of the health system response. However, the implementation of health legal preparedness differs between low- and middle-income countries (LMIC) and developed countries. Objective This paper examines recent trends regarding public health legal preparedness for emergencies and discusses its role in the recent Ebola outbreak. Design A rigorous literature review was conducted using eight electronic databases as well as Google Scholar. The results encompassed peer-reviewed English articles, reports, theses, and position papers dating from 2011 to 2014. Earlier articles concerning regulatory actions were also examined. Results The importance of PHLP has grown during the past decade and focuses mainly on infection–disease scenarios. Amid LMICs, it mostly refers to application of international regulations, whereas in developed states, it focuses on independent legislation and creation of conditions optimal to promoting an effective emergency management. Among developed countries, the United States’ utilisation of health legal preparedness is the most advanced, including the creation of a model comprising four elements: law, competencies, information, and coordination. Only limited research has been conducted in this field to date. Nevertheless, in both developed and developing states, studies that focused on regulations and laws activated in health systems during emergencies, identified inconsistency and incoherence. The Ebola outbreak plaguing West Africa since 2014 has global implications, challenges and paralleling results, that were identified in this review. Conclusions The review has shown the need to broaden international regulations, to deepen reciprocity between countries, and to consider LMICs health capacities, in order to strengthen the national health security. Adopting elements of the health legal preparedness model is recommended. PMID:26449204

  2. Limited evidence for intranasal fentanyl in the emergency department and the prehospital setting--a systematic review

    DEFF Research Database (Denmark)

    Hansen, Morten Sejer; Dahl, Jørgen Berg

    2013-01-01

    The intranasal (IN) mode of application may be a valuable asset in non-invasive pain management. Fentanyl demonstrates pharmacokinetic and pharmacodynamic properties that are desirable in the management of acute pain, and IN fentanyl may be of value in the prehospital setting. The aim...... of this systematic review was to evaluate the current evidence for the use of IN fentanyl in the emergency department (ED) and prehospital setting....

  3. Emerging Roles of Women in the National Food Security Campaign of the Federal Government of Nigeria: A Review

    OpenAIRE

    Ademilua, O.S; Adeeko, A; Gbotoso, O.A; Akomolafe, A.M; Ishola, O.O

    2017-01-01

    The issue of food security in Nigeria is of national concern as it affects young and old, male and female. The review assessed the emerging roles of women and their contributions to food security in Nigeria. Specifically, it explained the concept of food security, identified the specific roles of women in food security and identified factors affecting women participation in national food security. Food security is a situation that exist when all people at all times, have physical, social and ...

  4. Multicriteria Optimisation in Logistics Forwarder Activities

    Directory of Open Access Journals (Sweden)

    Tanja Poletan Jugović

    2007-05-01

    Full Text Available Logistics forwarder, as organizer and planner of coordinationand integration of all the transport and logistics chains elements,uses adequate ways and methods in the process of planningand decision-making. One of these methods, analysed inthis paper, which could be used in optimisation of transportand logistics processes and activities of logistics forwarder, isthe multicriteria optimisation method. Using that method, inthis paper is suggested model of multicriteria optimisation of logisticsforwarder activities. The suggested model of optimisationis justified in keeping with method principles of multicriteriaoptimization, which is included in operation researchmethods and it represents the process of multicriteria optimizationof variants. Among many different processes of multicriteriaoptimization, PROMETHEE (Preference Ranking OrganizationMethod for Enrichment Evaluations and Promcalc& Gaia V. 3.2., computer program of multicriteria programming,which is based on the mentioned process, were used.

  5. Noise aspects at aerodynamic blade optimisation projects

    International Nuclear Information System (INIS)

    Schepers, J.G.

    1997-06-01

    The Netherlands Energy Research Foundation (ECN) has often been involved in industrial projects, in which blade geometries are created automatic by means of numerical optimisation. Usually, these projects aim at the determination of the aerodynamic optimal wind turbine blade, i.e. the goal is to design a blade which is optimal with regard to energy yield. In other cases, blades have been designed which are optimal with regard to cost of generated energy. However, it is obvious that the wind turbine blade designs which result from these optimisations, are not necessarily optimal with regard to noise emission. In this paper an example is shown of an aerodynamic blade optimisation, using the ECN-program PVOPT. PVOPT calculates the optimal wind turbine blade geometry such that the maximum energy yield is obtained. Using the aerodynamic optimal blade design as a basis, the possibilities of noise reduction are investigated. 11 figs., 8 refs

  6. A qualitative systematic review of the reasons for parental attendance at the emergency department with children presenting with minor illness.

    Science.gov (United States)

    Butun, Ahmet; Hemingway, Pippa

    2018-01-01

    Over 5 million children attend the Emergency Department (ED) annually in England with an ever-increasing paediatric emergency caseload echoed globally. Approximately 60% of children present with illness and the majority have non-urgent illness creating burgeoning pressures on children's ED and this crisis resonates globally. To date no qualitative systematic review exists that focuses on the parental reasons for childhood attendance at the ED in this sub-group. To identify parental reasons for attending ED for their children presenting with minor illness. A qualitative systematic review was conducted against inclusion/exclusion criteria. Five electronic databases and key journals were searched in June 2015. 471 studies were identified and following study selection, 4 qualitative studies were included. Nine themes were identified e.g. dissatisfaction with family medical services, perceived advantages of ED and 'child suffering' with novel and insightful sub-themes of 'hereditary anxiety', 'taking it off our hands', ED as a 'magical place'. This novel qualitative systematic review examined parental attendance presenting with childhood minor illness of interest to emergency care reformers and clinicians. ED attendance is complex and multifactorial but parents provide vital insight to ED reformers on parental reasons for ED attendance in this sub-group. Copyright © 2017 Elsevier Ltd. All rights reserved.

  7. Topology Optimisation of Wireless Sensor Networks

    Directory of Open Access Journals (Sweden)

    Thike Aye Min

    2016-01-01

    Full Text Available Wireless sensor networks are widely used in a variety of fields including industrial environments. In case of a clustered network the location of cluster head affects the reliability of the network operation. Finding of the optimum location of the cluster head, therefore, is critical for the design of a network. This paper discusses the optimisation approach, based on the brute force algorithm, in the context of topology optimisation of a cluster structure centralised wireless sensor network. Two examples are given to verify the approach that demonstrate the implementation of the brute force algorithm to find an optimum location of the cluster head.

  8. Radiological procedures: Quality criteria and dose optimisation: French status

    International Nuclear Information System (INIS)

    Grenier, Ph.; Marshall-Depommier, E.; Bourguignon, M.; Beauvais-March, H.; Valero, M.; Lacronique, J.F.; Frijal, G.

    2001-01-01

    The Council Directive 97/43/Euratom of June 30 1997 on health protection of individuals against the dangers of ionising radiation in relation to medical exposure has come into force on May, 13 th 2000. French health directorate has entrusted the 'Office de Protection contre les Rayonnements Ionisants (OPRI)' together with the 'Societe Francaise de Radiologie' (SFR) to implement article 6 related to radiological procedures, in order to bring into operation the principle of optimisation. The most frequent diagnostic radiology and interventional procedures (120 protocols) have been standardised in writing. Corresponding patient dosimetry has been determined from measurements on site, calculations and literature review. The criteria for optimisation have been highlighted for each protocols. With the help of the French Society of Medical Physicists (SFPM), measurements are being collected on a large scale in France. Then, knowing more precisely the patient dosimetry of each protocol, referral criteria will be reviewed and prioritised to implement the principle of justification. The authors will present and explain the chosen methodology (methodology of the Accreditation and Evaluation in Health Agency: ANAES) for completing this two years workload program, and will demonstrate clinical examples as well. (author)

  9. The social media manifesto: a comprehensive review of the impact of social media on emergency management.

    Science.gov (United States)

    Crowe, Adam

    2011-02-01

    Over the past five years, social media have impacted emergency management and disaster response in numerous ways. The emergency management professional must begin to accept this impact not as an arbitrary consequence of an uncontrolled disaster, but rather as a tool to help coordinate, manage and facilitate a safe and expected response during emergencies and disasters. This paper will explain the power and purpose of social media as well as how social media systems have equalised capabilities for all levels and sizes of government. Moreover, this paper will also highlight the social media systems that are being used as operational tools as well as what the future holds. Lastly, common implementation challenges will be discussed through a look at systematic approaches to applying social media in emergency management as a positive and valuable tool.

  10. Severe traumatic brain injury in children: an evidence-based review of emergency department management [digest].

    Science.gov (United States)

    Morrissey, Kirsten; Fairbrother, Hilary; Vazquez, Michelle N

    2016-10-22

    More than 1.7 million traumatic brain injuries occur in adults and children each year in the United States, with approximately 30% occurring in children aged digest of Pediatric Emergency Medicine Practice].

  11. Commercial Airline In-Flight Emergency: Medical Student Response and Review of Medicolegal Issues.

    Science.gov (United States)

    Bukowski, Josh H; Richards, John R

    2016-01-01

    As the prevalence of air travel increases, in-flight medical emergencies occur more frequently. A significant percentage of these emergencies occur when there is no certified physician, nurse, or paramedic onboard. During these situations, flight crews might enlist the help of noncertified passengers, such as medical students, dentists, or emergency medical technicians in training. Although Good Samaritan laws exist, many health care providers are unfamiliar with the limited legal protections and resources provided to them after responding to an in-flight emergency. A 78-year-old woman lost consciousness and became pulseless onboard a commercial aircraft. No physician was available. A medical student responded and coordinated care with the flight crew, ground support physician, and other passengers. After receiving a packet (4 g) of sublingual sucrose and 1 L i.v. crystalloid, the patient regained pulses and consciousness. The medical student made the decision not to divert the aircraft based on the patient's initial response to therapy and, 45 min later, the patient had normal vital signs. Upon landing, she was met and taken by paramedics to the nearest emergency department for evaluation of her collapse. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Emergency physicians are the most qualified to assist in-flight emergencies, but they might not be aware of the medicolegal risks involved with in-flight care, the resources available, and the role of the flight crew in liability and decision making. This case, which involved a medical student who was not given explicit protection under Good Samaritan laws, illustrates the authority of the flight crew during these events and highlights areas of uncertainty in the legislation for volunteer medical professionals. Copyright © 2016 Elsevier Inc. All rights reserved.

  12. Parametric studies and optimisation of pumped thermal electricity storage

    International Nuclear Information System (INIS)

    McTigue, Joshua D.; White, Alexander J.; Markides, Christos N.

    2015-01-01

    Highlights: • PTES is modelled by cycle analysis and a Schumann-style model of the thermal stores. • Optimised trade-off surfaces show a flat efficiency vs. energy density profile. • Overall roundtrip efficiencies of around 70% are not inconceivable. - Abstract: Several of the emerging technologies for electricity storage are based on some form of thermal energy storage (TES). Examples include liquid air energy storage, pumped heat energy storage and, at least in part, advanced adiabatic compressed air energy storage. Compared to other large-scale storage methods, TES benefits from relatively high energy densities, which should translate into a low cost per MW h of storage capacity and a small installation footprint. TES is also free from the geographic constraints that apply to hydro storage schemes. TES concepts for electricity storage rely on either a heat pump or refrigeration cycle during the charging phase to create a hot or a cold storage space (the thermal stores), or in some cases both. During discharge, the thermal stores are depleted by reversing the cycle such that it acts as a heat engine. The present paper is concerned with a form of TES that has both hot and cold packed-bed thermal stores, and for which the heat pump and heat engine are based on a reciprocating Joule cycle, with argon as the working fluid. A thermodynamic analysis is presented based on traditional cycle calculations coupled with a Schumann-style model of the packed beds. Particular attention is paid to the various loss-generating mechanisms and their effect on roundtrip efficiency and storage density. A parametric study is first presented that examines the sensitivity of results to assumed values of the various loss factors and demonstrates the rather complex influence of the numerous design variables. Results of an optimisation study are then given in the form of trade-off surfaces for roundtrip efficiency, energy density and power density. The optimised designs show a

  13. Transmit Power Optimisation in Wireless Network

    Directory of Open Access Journals (Sweden)

    Besnik Terziu

    2011-09-01

    Full Text Available Transmit power optimisation in wireless networks based on beamforming have emerged as a promising technique to enhance the spectrum efficiency of present and future wireless communication systems. The aim of this study is to minimise the access point power consumption in cellular networks while maintaining a targeted quality of service (QoS for the mobile terminals. In this study, the targeted quality of service is delivered to a mobile station by providing a desired level of Signal to Interference and Noise Ratio (SINR. Base-stations are coordinated across multiple cells in a multi-antenna beamforming system. This study focuses on a multi-cell multi-antenna downlink scenario where each mobile user is equipped with a single antenna, but where multiple mobile users may be active simultaneously in each cell and are separated via spatial multiplexing using beamforming. The design criteria is to minimize the total weighted transmitted power across the base-stations subject to SINR constraints at the mobile users. The main contribution of this study is to define an iterative algorithm that is capable of finding the joint optimal beamformers for all basestations, based on a correlation-based channel model, the full-correlation model. Among all correlated channel models, the correlated channel model used in this study is the most accurate, giving the best performance in terms of power consumption. The environment here in this study is chosen to be Non-Light of- Sight (NLOS condition, where a signal from a wireless transmitter passes several obstructions before arriving at a wireless receiver. Moreover there are many scatterers local to the mobile, and multiple reflections can occur among them before energy arrives at the mobile. The proposed algorithm is based on uplink-downlink duality using the Lagrangian duality theory. Time-Division Duplex (TDD is chosen as the platform for this study since it has been adopted to the latest technologies in Fourth

  14. Application of Surpac and Whittle Software in Open Pit Optimisation ...

    African Journals Online (AJOL)

    Application of Surpac and Whittle Software in Open Pit Optimisation and Design. ... This paper studies the Surpac and Whittle software and their application in designing an optimised pit. ... EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT

  15. (MBO) algorithm in multi-reservoir system optimisation

    African Journals Online (AJOL)

    A comparative study of marriage in honey bees optimisation (MBO) algorithm in ... A practical application of the marriage in honey bees optimisation (MBO) ... to those of other evolutionary algorithms, such as the genetic algorithm (GA), ant ...

  16. Extending Particle Swarm Optimisers with Self-Organized Criticality

    DEFF Research Database (Denmark)

    Løvbjerg, Morten; Krink, Thiemo

    2002-01-01

    Particle swarm optimisers (PSOs) show potential in function optimisation, but still have room for improvement. Self-organized criticality (SOC) can help control the PSO and add diversity. Extending the PSO with SOC seems promising reaching faster convergence and better solutions.......Particle swarm optimisers (PSOs) show potential in function optimisation, but still have room for improvement. Self-organized criticality (SOC) can help control the PSO and add diversity. Extending the PSO with SOC seems promising reaching faster convergence and better solutions....

  17. Understanding management and support for domestic violence and abuse within emergency departments: A systematic literature review from 2000-2015.

    Science.gov (United States)

    Hinsliff-Smith, Kathryn; McGarry, Julie

    2017-12-01

    To identify, review and critically evaluate published empirical studies concerned with the prevalence, management and support for survivors of domestic violence and abuse who present at emergency department. Domestic violence and abuse is a global phenomenon with a wealth of studies that explore the different aspects of the issue including the economic, social and health effects on survivors and on society as a whole. Emergency department is widely recognised as one healthcare facility where domestic violence and abuse survivors will often disclose domestic violence and abuse. In the UK, National Institute of Clinical Excellence produced guidelines in 2014 requiring all sectors of health care and those they work alongside to recognise support and manage survivors of domestic violence and abuse. Whilst there is an increasing body of research on domestic violence and abuse, limited synthesised work has been conducted in the context of domestic violence and abuse within emergency department. This review encompasses empirical studies conducted in emergency department for screening interventions, management and support for domestic violence and abuse patients including prevalence. This review included studies that included emergency department staff, emergency department service users and domestic violence and abuse survivors. A systematic approach across five electronic bibliographic databases found 35 studies meeting the inclusion criteria published between 2000-2015. From the 35 studies, four descriptive overarching themes were identified (i) prevalence of domestic violence and abuse in emergency department, (ii) use of domestic violence and abuse screening tools and emergency department interventions, (iii) current obstacles for staff working in emergency department and (iv) emergency department users and survivor perspectives. Having knowledgeable and supportive emergency department staff can have a positive benefit for the longer-term health of the domestic

  18. Operational Radiological Protection and Aspects of Optimisation

    International Nuclear Information System (INIS)

    Lazo, E.; Lindvall, C.G.

    2005-01-01

    Since 1992, the Nuclear Energy Agency (NEA), along with the International Atomic Energy Agency (IAEA), has sponsored the Information System on Occupational Exposure (ISOE). ISOE collects and analyses occupational exposure data and experience from over 400 nuclear power plants around the world and is a forum for radiological protection experts from both nuclear power plants and regulatory authorities to share lessons learned and best practices in the management of worker radiation exposures. In connection to the ongoing work of the International Commission on Radiological Protection (ICRP) to develop new recommendations, the ISOE programme has been interested in how the new recommendations would affect operational radiological protection application at nuclear power plants. Bearing in mind that the ICRP is developing, in addition to new general recommendations, a new recommendation specifically on optimisation, the ISOE programme created a working group to study the operational aspects of optimisation, and to identify the key factors in optimisation that could usefully be reflected in ICRP recommendations. In addition, the Group identified areas where further ICRP clarification and guidance would be of assistance to practitioners, both at the plant and the regulatory authority. The specific objective of this ISOE work was to provide operational radiological protection input, based on practical experience, to the development of new ICRP recommendations, particularly in the area of optimisation. This will help assure that new recommendations will best serve the needs of those implementing radiation protection standards, for the public and for workers, at both national and international levels. (author)

  19. Optimisation of surgical care for rectal cancer

    NARCIS (Netherlands)

    Borstlap, W.A.A.

    2017-01-01

    Optimisation of surgical care means weighing the risk of treatment related morbidity against the patients’ potential benefits of a surgical intervention. The first part of this thesis focusses on the anaemic patient undergoing colorectal surgery. Hypothesizing that a more profound haemoglobin

  20. On optimal development and becoming an optimiser

    NARCIS (Netherlands)

    de Ruyter, D.J.

    2012-01-01

    The article aims to provide a justification for the claim that optimal development and becoming an optimiser are educational ideals that parents should pursue in raising their children. Optimal development is conceptualised as enabling children to grow into flourishing persons, that is persons who

  1. Particle Swarm Optimisation with Spatial Particle Extension

    DEFF Research Database (Denmark)

    Krink, Thiemo; Vesterstrøm, Jakob Svaneborg; Riget, Jacques

    2002-01-01

    In this paper, we introduce spatial extension to particles in the PSO model in order to overcome premature convergence in iterative optimisation. The standard PSO and the new model (SEPSO) are compared w.r.t. performance on well-studied benchmark problems. We show that the SEPSO indeed managed...

  2. OPTIMISATION OF COMPRESSIVE STRENGTH OF PERIWINKLE ...

    African Journals Online (AJOL)

    In this paper, a regression model is developed to predict and optimise the compressive strength of periwinkle shell aggregate concrete using Scheffe's regression theory. The results obtained from the derived regression model agreed favourably with the experimental data. The model was tested for adequacy using a student ...

  3. An efficient optimisation method in groundwater resource ...

    African Journals Online (AJOL)

    DRINIE

    2003-10-04

    Oct 4, 2003 ... theories developed in the field of stochastic subsurface hydrology. In reality, many ... Recently, some researchers have applied the multi-stage ... Then a robust solution of the optimisation problem given by Eqs. (1) to (3) is as ...

  4. Water distribution systems design optimisation using metaheuristics ...

    African Journals Online (AJOL)

    The topic of multi-objective water distribution systems (WDS) design optimisation using metaheuristics is investigated, comparing numerous modern metaheuristics, including several multi-objective evolutionary algorithms, an estimation of distribution algorithm and a recent hyperheuristic named AMALGAM (an evolutionary ...

  5. Optimisation of efficiency of axial fans

    NARCIS (Netherlands)

    Kruyt, Nicolaas P.; Pennings, P.C.; Faasen, R.

    2014-01-01

    A three-stage research project has been executed to develop ducted axial-fans with increased efficiency. In the first stage a design method has been developed in which various conflicting design criteria can be incorporated. Based on this design method, an optimised design has been determined

  6. Thermodynamic optimisation of a heat exchanger

    NARCIS (Netherlands)

    Cornelissen, Rene; Hirs, Gerard

    1999-01-01

    The objective of this paper is to show that for the optimal design of an energy system, where there is a trade-off between exergy saving during operation and exergy use during construction of the energy system, exergy analysis and life cycle analysis should be combined. An exergy optimisation of a

  7. Self-optimising control of sewer systems

    DEFF Research Database (Denmark)

    Mauricio Iglesias, Miguel; Montero-Castro, Ignacio; Mollerup, Ane Loft

    2013-01-01

    . The definition of an optimal performance was carried out by through a two-stage optimisation (stochastic and deterministic) to take into account both the overflow during the current rain event as well as the expected overflow, given the probability of a future rain event. The methodology is successfully applied...

  8. A multi-disciplinary perspective on emergent and future innovations in peer review [version 3; referees: 2 approved

    Directory of Open Access Journals (Sweden)

    Jonathan P. Tennant

    2017-11-01

    Full Text Available Peer review of research articles is a core part of our scholarly communication system. In spite of its importance, the status and purpose of peer review is often contested. What is its role in our modern digital research and communications infrastructure? Does it perform to the high standards with which it is generally regarded? Studies of peer review have shown that it is prone to bias and abuse in numerous dimensions, frequently unreliable, and can fail to detect even fraudulent research. With the advent of web technologies, we are now witnessing a phase of innovation and experimentation in our approaches to peer review. These developments prompted us to examine emerging models of peer review from a range of disciplines and venues, and to ask how they might address some of the issues with our current systems of peer review. We examine the functionality of a range of social Web platforms, and compare these with the traits underlying a viable peer review system: quality control, quantified performance metrics as engagement incentives, and certification and reputation. Ideally, any new systems will demonstrate that they out-perform and reduce the biases of existing models as much as possible. We conclude that there is considerable scope for new peer review initiatives to be developed, each with their own potential issues and advantages. We also propose a novel hybrid platform model that could, at least partially, resolve many of the socio-technical issues associated with peer review, and potentially disrupt the entire scholarly communication system. Success for any such development relies on reaching a critical threshold of research community engagement with both the process and the platform, and therefore cannot be achieved without a significant change of incentives in research environments.

  9. Perfluorooctanoic acid (PFOA), an emerging drinking water contaminant: a critical review of recent literature.

    Science.gov (United States)

    Post, Gloria B; Cohn, Perry D; Cooper, Keith R

    2012-07-01

    well-studied drinking water contaminants, the human dose-response curve for several effects appears to be steepest at the lower exposure levels, including the general population range, with no apparent threshold for some endpoints. There is concordance in animals and humans for some effects, while humans and animals appear to react differently for other effects such as lipid metabolism. PFOA was classified as "likely to be carcinogenic in humans" by the USEPA Science Advisory Board. In animal studies, developmental effects have been identified as more sensitive endpoints for toxicity than carcinogenicity or the long-established hepatic effects. Notably, exposure to an environmentally relevant drinking water concentration caused adverse effects on mammary gland development in mice. This paper reviews current information relevant to the assessment of PFOA as an emerging drinking water contaminant. This information suggests that continued human exposure to even relatively low concentrations of PFOA in drinking water results in elevated body burdens that may increase the risk of health effects. Copyright © 2012 Elsevier Inc. All rights reserved.

  10. An Evidence Framework for Off-Patent Pharmaceutical Review (EFOR) for Health Technology Assessment in Emerging Markets.

    Science.gov (United States)

    Brixner, Diana; Kaló, Zoltán; Maniadakis, Nikos; Kim, Kyoo; Wijaya, Kalman

    2018-03-29

    This article introduces an Evidence Framework for Off-Patent Pharmaceutical Review (EFOR), which establishes value-based criteria in a template that manufacturers use to provide evidence showing how their products meet those criteria. Health authorities in emerging markets can then use the evidence presented in the EFOR to evaluate off-patent pharmaceuticals (OPPs) in a consistent, transparent, and evidence-based manner to support policy decisions, including pricing, reimbursement, formulary listing, and drug procurement. A literature search found no multi-criteria evidence framework for evaluating OPPs in emerging markets. An International Outcomes Research Board (IORB) of academia and industry experts conducted extensive research, meetings, and workshops to define high-priority criteria to incorporate into an evidence-based health technology assessment (HTA) tool using the multi-criteria decision analysis (MCDA) technique. The resulting framework was further tailored for country-specific needs in workshops in three emerging countries (Kazakhstan, Vietnam, and Indonesia). The IORB defined nine criteria four categories (Product, Manufacturing, Service, and Value Assessment), which OPP manufacturers can use to provide evidence for reimbursement and health policy decision making. Then the IORB developed the EFOR as a base case document, which can be adapted and used as a template by health authorities in emerging countries. Emerging countries have a significant need for an HTA tool that balances affordability with accurate evidence showing the value differentiation of OPPs. The value attributes in this setting often are different from those in developed markets, which emphasize new products and have high regulation and manufacturing standards. The EFOR is an easy-to-use, adaptable framework that emerging countries can use to increase the consistency, transparency, and effectiveness of drug decision making. The open source EFOR is available as Supplemental Materials

  11. Does outcome feedback make you a better emergency physician? A systematic review and research framework proposal.

    Science.gov (United States)

    Lavoie, Curtis F; Schachter, Howard; Stewart, Aviva T; McGowan, Jessie

    2009-11-01

    The organization of emergency medical care limits the ability of emergency physicians to know the outcomes of most of their patients after the patients leave the emergency department. This lack of outcome feedback may hinder the practice of emergency medicine (EM) by preventing "calibration" of the decision tools of practitioners. We sought to determine what is currently known about outcome feedback in EM, including its incidence, impact and modifiers. We searched the following databases: PreMEDLINE, MEDLINE, EMBASE, CINAHL, CENTRAL, PsycINFO, DARE, Health Technology Assessment Database and AMED. We performed manual searches on abstract databases, reference lists, various health information and research websites, and nonindexed journals. Selection entailed a 2-step screening pro cess to exclude articles not pertaining to outcome feedback in EM. Our search yielded 1128 bibliographic records, from which screening identified 7 relevant reports: 5 surveys, 1 system level evaluation and 1 intervention trial. All studies were found to have "inadequate" or "unable to assess" reporting and study quality. Systems for outcome feedback to EM residents have been increasingly available since 1984, though they are perceived to be inadequate. Commonly used mechanisms for outcome feedback include automatic routing of discharge summaries, case conferences for admitted patients and telephone calls to patients or families for discharged patients. With respect to attending emergency physicians, no conclusions or clinical recommendations can be made given the level of available evidence. The potential importance of outcome feedback remains, at this time, underevaluated. We propose a research framework, and hypothesize that increasing outcome feedback would increase emergency physician diagnostic accuracy, therapeutic outcomes, clinical efficiency and job satisfaction. Future research in this area should include surveys and focus groups, as well as simulated or real-world intervention

  12. Physical health and wellbeing of emerging and young adults with mental illness: an integrative review of international literature.

    Science.gov (United States)

    McCloughen, Andrea; Foster, Kim; Huws-Thomas, Michelle; Delgado, Cynthia

    2012-06-01

    Physical health in people with mental illness is often compromised. Chronic physical conditions and disease risk factors occur at higher rates than in the general population. Although substantial research exists regarding mental-physical comorbidities in middle to older-aged adults and mental illness consequential to childhood physical illness, research addressing physical health in young people/emerging adults of 16-24 years with primary mental illnesses is minimal. Health problems often track from youth to adulthood, indicating a need to better recognize and understand the overall health of young people with mental illness. This paper reports findings from an integrative review of published research investigating physical health of emerging/young adults with mental illness. A total of 18 research papers were systematically analysed. The review found that comorbid mental-physical illness/conditions were evident across a wide age span. Specific physical health problems, including pain, gastrointestinal, and respiratory disorders, were apparent in those 16 years to those in their mid-late 20s, and/or with first episode psychosis. Lifestyle risk factors for cardiometabolic disorders occurred with some frequency and originated prior to adulthood. These findings highlight the need for targeted health screening and illness prevention strategies for emerging/young adults with mental health problems and draws attention to the need for young people to be supported in their health-care behaviours. © 2012 The Authors. International Journal of Mental Health Nursing © 2012 Australian College of Mental Health Nurses Inc.

  13. Optimising Shovel-Truck Fuel Consumption using Stochastic ...

    African Journals Online (AJOL)

    Optimising the fuel consumption and truck waiting time can result in significant fuel savings. The paper demonstrates that stochastic simulation is an effective tool for optimising the utilisation of fossil-based fuels in mining and related industries. Keywords: Stochastic, Simulation Modelling, Mining, Optimisation, Shovel-Truck ...

  14. Design of optimised backstepping controller for the synchronisation ...

    Indian Academy of Sciences (India)

    Ehsan Fouladi

    2017-12-18

    Dec 18, 2017 ... for the proposed optimised method compared to PSO optimised controller or any non-optimised backstepping controller. Keywords. Colpitts oscillator; backstepping controller; chaos synchronisation; shark smell algorithm; particle .... The velocity model is based on the gradient of the objective function, tilting ...

  15. Efficient topology optimisation of multiscale and multiphysics problems

    DEFF Research Database (Denmark)

    Alexandersen, Joe

    The aim of this Thesis is to present efficient methods for optimising high-resolution problems of a multiscale and multiphysics nature. The Thesis consists of two parts: one treating topology optimisation of microstructural details and the other treating topology optimisation of conjugate heat...

  16. EMERGING SCIENCE: EPA'S ORD SUPPORTS REGIONAL HAZE PROGRAM; POSTERS FROM BOSC REVIEW AND SCIENCE FORUM

    Science.gov (United States)

    A series of presentations from EPA's Board of Science Councilors review in April 2005 and the Science Forum in May 2005 are being made available to the Regional Planning Organization conference on June 9-10, 2005. Attendees will be able to review the materials during the confere...

  17. Patient information, education and self-management in bronchiectasis: facilitating improvements to optimise health outcomes.

    Science.gov (United States)

    Hester, Katy L M; Newton, Julia; Rapley, Tim; De Soyza, Anthony

    2018-05-22

    Bronchiectasis is an incurable lung disease characterised by irreversible airway dilatation. It causes symptoms including chronic productive cough, dyspnoea, and recurrent respiratory infections often requiring hospital admission. Fatigue and reductions in quality of life are also reported in bronchiectasis. Patients often require multi-modal treatments that can be burdensome, leading to issues with adherence. In this article we review the provision of, and requirement for, education and information in bronchiectasis. To date, little research has been undertaken to improve self-management in bronchiectasis in comparison to other chronic conditions, such as COPD, for which there has been a wealth of recent developments. Qualitative work has begun to establish that information deficit is one of the potential barriers to self-management, and that patients feel having credible information is fundamental when learning to live with and manage bronchiectasis. Emerging research offers some insights into ways of improving treatment adherence and approaches to self-management education; highlighting ways of addressing the specific unmet information needs of patients and their families who are living with bronchiectasis. We propose non-pharmacological recommendations to optimise patient self-management and symptom recognition; with the aim of facilitating measurable improvements in health outcomes for patients with bronchiectasis.

  18. Optimising secondary prevention in the acute period following a TIA of ischaemic origin.

    Science.gov (United States)

    Heron, Neil

    2016-01-01

    Transient ischaemic attacks (TIAs) are highly prevalent conditions, with at least 46 000 people per year in the UK having a TIA for the first time. TIAs are a warning that the patient is at risk of further vascular events and the 90-day risk of vascular events following a TIA, excluding events within the first week after diagnosis when the risk is highest, can be as high as 18%. Immediate assessment of patients with TIA, either at accident and emergency, general practice and/or TIA clinics, is therefore required to address secondary prevention and prevent further vascular events. This article addresses the need for optimising secondary prevention in the acute period following a TIA of ischaemic origin to reduce the risk of further vascular events as per recent Cochrane review advice and presents a novel project, Stroke Prevention Rehabilitation Intervention Trial of Exercise (SPRITE), to do this. One novel way to tackle vascular risk factors and promote secondary prevention in patients with TIA could be to adapt a cardiac rehabilitation programme for these patients. SPRITE, a feasibility and pilot study (ClinicalTrials.gov Identifier: NCT02712385) funded by the National Institute for Health Research, is attempting to adapt a home-based cardiac rehabilitation programme, 'The Healthy Brain Rehabilitation Manual', for use in the acute period following a TIA. The use of cardiac rehabilitation programmes post-TIA requires further research, particularly within the primary care setting.

  19. Emerging and Reemerging Neglected Tropical Diseases: a Review of Key Characteristics, Risk Factors, and the Policy and Innovation Environment

    Science.gov (United States)

    Liang, Bryan A.; Cuomo, Raphael; Hafen, Ryan; Brouwer, Kimberly C.; Lee, Daniel E.

    2014-01-01

    SUMMARY In global health, critical challenges have arisen from infectious diseases, including the emergence and reemergence of old and new infectious diseases. Emergence and reemergence are accelerated by rapid human development, including numerous changes in demographics, populations, and the environment. This has also led to zoonoses in the changing human-animal ecosystem, which are impacted by a growing globalized society where pathogens do not recognize geopolitical borders. Within this context, neglected tropical infectious diseases have historically lacked adequate attention in international public health efforts, leading to insufficient prevention and treatment options. This subset of 17 infectious tropical diseases disproportionately impacts the world's poorest, represents a significant and underappreciated global disease burden, and is a major barrier to development efforts to alleviate poverty and improve human health. Neglected tropical diseases that are also categorized as emerging or reemerging infectious diseases are an even more serious threat and have not been adequately examined or discussed in terms of their unique risk characteristics. This review sets out to identify emerging and reemerging neglected tropical diseases and explore the policy and innovation environment that could hamper or enable control efforts. Through this examination, we hope to raise awareness and guide potential approaches to addressing this global health concern. PMID:25278579

  20. Quantification of burnout in emergency nurses: A systematic review and meta-analysis.

    Science.gov (United States)

    Li, Hong; Cheng, Bin; Zhu, Xiao Ping

    2018-01-17

    Previous studies showed increased levels of absenteeism, drug abuse, depression, and symptoms allied with burnout in emergency nurses. This meta-analysis aimed to quantify the three dimensions of burnout in emergency nurses and estimate the proportion of nurses who experience higher than tolerable levels of burnout. A systematic search was conducted on PubMed, Scielo, Xueshu Baidu and Informa databases with a cut-off time between 1997 and 2017 to retrieve published papers in any language that had estimated the burnout levels in emergency nurses by using MBI scale. We identified a total of 11 eligible studies. The total mean estimate was moderate for emotional exhaustion (25.552), but clearly trending towards higher level, whereas depersonalization (10.383) and lack of personal accomplishment (30.652) showed higher burnouts levels. The proportion of emergency nurses suffering from high emotional exhaustion, high depersonalization, and low personal accomplishment was 40.5%, 44.3%, and 42.7%, respectively. Burnout is detrimental to achieving high-quality healthcare services and causes a loss of productivity. It is high time for nursing leader and management personnel to identify appropriate measures to counteract burnout. Copyright © 2017 Elsevier Ltd. All rights reserved.

  1. Emergency presentation of cystic lymphangioma of the colon: A case report and literature review

    Directory of Open Access Journals (Sweden)

    Luca Lepre

    2016-01-01

    Conclusion: The interest in our case lies in the relatively rare diagnosis of colon lymphangioma and how the cardinal sign was anemia, which may be due to the serosanguineous cystic contents of lymphangiomatosis from the internal bleeding and can cause fatal complications that require emergency surgery.

  2. Tools for 'safety netting' in common paediatric illnesses: A systematic review in emergency care

    NARCIS (Netherlands)

    E. De Vos-Kerkhof (Evelien); D.H.F. Geurts (Dorien); M. Wiggers (Mariska); H.A. Moll (Henriëtte); R. Oostenbrink (Rianne)

    2016-01-01

    textabstractContext Follow-up strategies after emergency department (ED) discharge, alias safety netting, is often based on the gut feeling of the attending physician. Objective To systematically identify evaluated safetynetting strategies after ED discharge and to describe determinants of

  3. 78 FR 50136 - Notice of Information Collection Under Emergency Review: Medical History and Examination for...

    Science.gov (United States)

    2013-08-16

    ...: Medical History and Examination for Foreign Service DS-1843 and DS-1622 ACTION: Notice of request for... methods: Web: Persons with access to the Internet may use the Federal Docket Management System (FDMS) to... History and Examination for Foreign Service. OMB Control Number: 1405-0068. Type of Request: Emergency...

  4. 77 FR 66075 - Agency Information Collection Activities; Emergency Clearance Submission for Expedited OMB Review...

    Science.gov (United States)

    2012-11-01

    ... Ethics. [FR Doc. 2012-26101 Filed 10-31-12; 8:45 am] BILLING CODE 6345-03-P ... OFFICE OF GOVERNMENT ETHICS Agency Information Collection Activities; Emergency Clearance... 201-A Ethics in Government Act Access Form AGENCY: Office of Government Ethics (OGE). ACTION...

  5. Suspected total spinal in patient having emergent Caesarean section, a case report and literature review

    Directory of Open Access Journals (Sweden)

    H. Virgin, MD

    2016-01-01

    Concluiosn: To perform spinal anaesthesia for emergent Caesarean in patients having an epidural for labour pain is a feasible option and should be considered in category 2–3 section. The dose for a convert spinal block should be assessed on an individual basis and reasonably reduced.

  6. The Technology Review 10: Emerging Technologies that Will Change the World.

    Science.gov (United States)

    Technology Review, 2001

    2001-01-01

    Identifies 10 emerging areas of technology that will soon have a profound impact on the economy and on how people live and work: brain-machine interfaces; flexible transistors; data mining; digital rights management; biometrics; natural language processing; microphotonics; untangling code; robot design; and microfluidics. In each area, one…

  7. Strategic Review Process for an Accountable Care Organization and Emerging Accountable Care Best Practices.

    Science.gov (United States)

    Conway, Sarah J; Himmelrich, Sarah; Feeser, Scott A; Flynn, John A; Kravet, Steven J; Bailey, Jennifer; Hebert, Lindsay C; Donovan, Susan H; Kachur, Sarah G; Brown, Patricia M C; Baumgartner, William A; Berkowitz, Scott A

    2018-02-02

    Accountable Care Organizations (ACOs), like other care entities, must be strategic about which initiatives they support in the quest for higher value. This article reviews the current strategic planning process for the Johns Hopkins Medicine Alliance for Patients (JMAP), a Medicare Shared Savings Program Track 1 ACO. It reviews the 3 focus areas for the 2017 strategic review process - (1) optimizing care coordination for complex, at-risk patients, (2) post-acute care, and (3) specialty care integration - reviewing cost savings and quality improvement opportunities, associated best practices from the literature, and opportunities to leverage and advance existing ACO and health system efforts in each area. It then reviews the ultimate selection of priorities for the coming year and early thoughts on implementation. After the robust review process, key stakeholders voted to select interventions targeted at care coordination, post-acute care, and specialty integration including Part B drug and imaging costs. The interventions selected incorporate a mixture of enhancing current ACO initiatives, working collaboratively and synergistically on other health system initiatives, and taking on new projects deemed targeted, cost-effective, and manageable in scope. The annual strategic review has been an essential and iterative process based on performance data and informed by the collective experience of other organizations. The process allows for an evidence-based strategic plan for the ACO in pursuit of the best care for patients.

  8. Fractures in sport: Optimising their management and outcome

    Science.gov (United States)

    Robertson, Greg AJ; Wood, Alexander M

    2015-01-01

    Fractures in sport are a specialised cohort of fracture injuries, occurring in a high functioning population, in which the goals are rapid restoration of function and return to play with the minimal symptom profile possible. While the general principles of fracture management, namely accurate fracture reduction, appropriate immobilisation and timely rehabilitation, guide the treatment of these injuries, management of fractures in athletic populations can differ significantly from those in the general population, due to the need to facilitate a rapid return to high demand activities. However, despite fractures comprising up to 10% of all of sporting injuries, dedicated research into the management and outcome of sport-related fractures is limited. In order to assess the optimal methods of treating such injuries, and so allow optimisation of their outcome, the evidence for the management of each specific sport-related fracture type requires assessment and analysis. We present and review the current evidence directing management of fractures in athletes with an aim to promote valid innovative methods and optimise the outcome of such injuries. From this, key recommendations are provided for the management of the common fracture types seen in the athlete. Six case reports are also presented to illustrate the management planning and application of sport-focussed fracture management in the clinical setting. PMID:26716081

  9. Infrastructure optimisation via MBR retrofit: a design guide.

    Science.gov (United States)

    Bagg, W K

    2009-01-01

    Wastewater management is continually evolving with the development and implementation of new, more efficient technologies. One of these is the Membrane Bioreactor (MBR). Although a relatively new technology in Australia, MBR wastewater treatment has been widely used elsewhere for over 20 years, with thousands of MBRs now in operation worldwide. Over the past 5 years, MBR technology has been enthusiastically embraced in Australia as a potential treatment upgrade option, and via retrofit typically offers two major benefits: (1) more capacity using mostly existing facilities, and (2) very high quality treated effluent. However, infrastructure optimisation via MBR retrofit is not a simple or low-cost solution and there are many factors which should be carefully evaluated before deciding on this method of plant upgrade. The paper reviews a range of design parameters which should be carefully evaluated when considering an MBR retrofit solution. Several actual and conceptual case studies are considered to demonstrate both advantages and disadvantages. Whilst optimising existing facilities and production of high quality water for reuse are powerful drivers, it is suggested that MBRs are perhaps not always the most sustainable Whole-of-Life solution for a wastewater treatment plant upgrade, especially by way of a retrofit.

  10. Systematic Review and Meta-analysis of the Effects of Caffeine in Fatigued Shift Workers: Implications for Emergency Medical Services Personnel

    Science.gov (United States)

    2018-01-11

    Background: Emergency Medical Services (EMS) workers may experience fatigue as a consequence of shift work. We reviewed the literature to determine the impact of caffeine as a countermeasure to fatigue in EMS personnel and related shift workers. Meth...

  11. Effect of Fatigue Training on Safety, Fatigue, and Sleep in Emergency Medical Services Personnel and Other Shift Workers: A Systematic Review and Meta-Analysis

    Science.gov (United States)

    2018-01-11

    Background: Fatigue training may be an effective way to mitigate fatigue-related risk. We aimed to critically review and synthesize existing literature on the impact of fatigue training on fatigue-related outcomes for Emergency Medical Services (EMS)...

  12. Reliability and Validity of Survey Instruments to Measure Work-Related Fatigue in the Emergency Medical Services Setting: A Systematic Review

    Science.gov (United States)

    2018-01-11

    Background: This study sought to systematically search the literature to identify reliable and valid survey instruments for fatigue measurement in the Emergency Medical Services (EMS) occupational setting. Methods: A systematic review study design wa...

  13. Shorter Versus Longer Shift Durations to Mitigate Fatigue and Fatigue-Related Risks in Emergency Medical Services Personnel and Related Shift Workers: A Systematic Review

    Science.gov (United States)

    2018-01-11

    Background: This study comprehensively reviewed the literature on the impact of shorter versus longer shifts on critical and important outcomes for Emergency Medical Services (EMS) personnel and related shift worker groups. Methods: Six databases (e....

  14. National Systematic Legal Review of State Policies on Emergency Medical Services Licensure Levels' Authority to Administer Opioid Antagonists.

    Science.gov (United States)

    Kinsman, Jeremiah M; Robinson, Kathy

    2018-02-27

    Previous research conducted in November 2013 found there were a limited number of states and territories in the United States (US) that authorize emergency medical technicians (EMTs) and emergency medical responders (EMRs) to administer opioid antagonists. Given the continued increase in the number of opioid-related overdoses and deaths, many states have changed their policies to authorize EMTs and EMRs to administer opioid antagonists. The goal of this study is to provide an updated description of policy on EMS licensure levels' authority to administer opioid antagonists for all 50 US states, the District of Columbia (DC), and the Commonwealth of Puerto Rico (PR). State law and scopes of practice were systematically reviewed using a multi-tiered approach to determine each state's legally-defined EMS licensure levels and their authority to administer an opioid antagonist. State law, state EMS websites, and state EMS scope of practice documents were identified and searched using Google Advanced Search with Boolean Search Strings. Initial results of the review were sent to each state office of EMS for review and comment. As of September 1, 2017, 49 states and DC authorize EMTs to administer an opioid antagonist. Among the 40 US jurisdictions (39 states and DC) that define the EMR or a comparable first responder licensure level in state law, 37 states and DC authorize their EMRs to administer an opioid antagonist. Paramedics are authorized to administer opioid antagonists in all 50 states, DC, and PR. All 49 of the US jurisdictions (48 states and DC) that define the advanced emergency medical technician (AEMT) or a comparable intermediate EMS licensure level in state law authorize their AEMTs to administer an opioid antagonist. 49 out of 52 US jurisdictions (50 states, DC, and PR) authorize all existing levels of EMS licensure levels to administer an opioid antagonist. Expanding access to this medication can save lives, especially in communities that have limited

  15. Information Technology in New Zealand: Review of Emerging Social Trends, Current Issues, and Policies

    OpenAIRE

    Erturk, Emre; Fail, Derwyn

    2015-01-01

    This paper discusses the general state of information technology in New Zealand society, current issues, and policies. It is a qualitative study that reviews recent scholarly articles, periodicals, and surveys in order to create an understanding of some of the information technology issues and trends in New Zealand. After reviewing previous research, it assesses the potential existence and nature of a 'digital divide' in New Zealand society whilst also evaluating possible strategic responses ...

  16. Emergency Risk Communication: Lessons Learned from a Rapid Review of Recent Gray Literature on Ebola, Zika, and Yellow Fever.

    Science.gov (United States)

    Toppenberg-Pejcic, Deborah; Noyes, Jane; Allen, Tomas; Alexander, Nyka; Vanderford, Marsha; Gamhewage, Gaya

    2018-03-20

    A rapid review of gray literature from 2015 to 2016 was conducted to identify the lessons learned for emergency risk communication from recent outbreaks of Ebola, Zika, and yellow fever. Gray literature databases and key websites were searched and requests for documents were posted to expert networks. A total of 83 documents met inclusion criteria, 68 of which are cited in this report. This article focuses on the 3 questions, out of 12 posed by World Health Organization as part of a Guideline development process, dealing most directly with communicating risk during health emergencies: community engagement, trust building, and social media. Documents were evaluated for credibility using an Authority, Accuracy, Coverage, Objectivity, Date, Significance (AACODS) checklist? and if the document contained a study, a method-specific tool was applied. A rapid content analysis of included sources was undertaken with relevant text either extracted verbatim or summarized and mapped against the questions. A database subset was created for each question and citations were assigned to the subset(s) for which they contained relevant information. Multiple designations per document were common. Database subsets were used to synthesize the results into a coherent narrative. The gray literature strongly underlines the central importance of local communities. A one-size-fits-all approach does not work. For maximum effectiveness, local communities need to be involved with and own emergency risk communication processes, preferably well before an emergency occurs. Social media can open new avenues for communication, but is not a general panacea and should not be viewed as a replacement for traditional modes of communication. In general, the gray literature indicates movement toward greater recognition of emergency risk communication as a vitally important element of public health.

  17. Sex as a Biological Variable in Emergency Medicine Research and Clinical Practice: A Brief Narrative Review

    Directory of Open Access Journals (Sweden)

    Alyson J. McGregor

    2017-10-01

    Full Text Available The National Institutes of Health recently highlighted the significant role of sex as a biological variable (SABV in research design, outcome and reproducibility, mandating that this variable be accounted for in all its funded research studies. This move has resulted in a rapidly increasing body of literature on SABV with important implications for changing the clinical practice of emergency medicine (EM. Translation of this new knowledge to the bedside requires an understanding of how sex-based research will ultimately impact patient care. We use three case-based scenarios in acute myocardial infarction, acute ischemic stroke and important considerations in pharmacologic therapy administration to highlight available data on SABV in evidence-based research to provide the EM community with an important foundation for future integration of patient sex in the delivery of emergency care as gaps in research are filled.

  18. Emergency contraception. Widely available and effective but disappointing as a public health intervention: a review.

    Science.gov (United States)

    2015-04-01

    Emergency contraception (EC) prevents pregnancy after unprotected sex or contraceptive failure. Use of EC has increased markedly in countries where a product is available over the counter, yet barriers to availability and use remain. Although effective in clinical trials, it has not yet been possible to show a public health benefit of EC in terms of reduction of unintended pregnancy rates. Selective progesterone receptor modulators developed as emergency contraceptives offer better effectiveness than levonorgestrel, but still EC is less effective than use of ongoing regular contraception. Methods which inhibit ovulation whenever they are taken or which act after ovulation to prevent implantation and strategies to increase the uptake of effective ongoing contraception after EC use would prevent more pregnancies. © The Author 2015. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  19. Rapid assessment of health needs in mass emergencies: review of current concepts and methods.

    Science.gov (United States)

    Guha-Sapir, D

    1991-01-01

    The increase in the number of natural disasters and their impact on population is of growing concern to countries at risk and agencies involved in health and humanitarian action. The numbers of persons killed or disabled as a result of earthquakes, cyclones, floods and famines have reached record levels in the last decade. Population density, rampant urbanization and climatic changes have brought about risk patterns that are exposing larger and larger sections of populations in developing countries to life-threatening natural disasters. Despite substantial spending on emergency relief, the approaches to relief remain largely ad hoc and amateurish, resulting generally in inappropriate and/or delayed action. In recent years, mass emergencies of the kind experienced in Bangladesh or the Sahelian countries have highlighted the importance of rapid assessment of health needs for better allocation of resources and relief management. As a result, the development of techniques for rapid assessment of health needs has been identified as a priority for effective emergency action. This article sketches the health context of disasters in terms of mortality and morbidity patterns; it describes initial assessment techniques currently used and their methodological biases and constraints; it also discusses assessment needs which vary between different types of disasters and the time frame within which assessments are undertaken. Earthquakes, cyclones, famines, epidemics or refugees all have specific risk profiles and emergency conditions which differ for each situation. Vulnerability to mortality changes according to age and occupation, for earthquakes and famines. These risk factors then have significant implications for the design of rapid assessment protocols and checklists. Experiences from the field in rapid survey techniques and estimation of death rates are discussed, with emphasis on the need for a reliable denominator even for the roughest assessment. Finally, the

  20. Chemical warfare agent simulants for human volunteer trials of emergency decontamination: A systematic review

    OpenAIRE

    James, Thomas; Wyke, Stacey; Marczylo, Tim; Collins, Samuel; Gaulton, Tom; Foxall, Kerry; Amlôt, Richard; Duarte‐Davidson, Raquel

    2017-01-01

    Abstract Incidents involving the release of chemical agents can pose significant risks to public health. In such an event, emergency decontamination of affected casualties may need to be undertaken to reduce injury and possible loss of life. To ensure these methods are effective, human volunteer trials (HVTs) of decontamination protocols, using simulant contaminants, have been conducted. Simulants must be used to mimic the physicochemical properties of more harmful chemicals, while remaining ...

  1. Review of Considerations, Management, and Treatment of Medical Emergencies During Commercial Flight

    Science.gov (United States)

    2017-04-01

    MedAire, from Banner Good Samaritan Hospital, Phoenix, AZ; Stat-MD, from the University of Pittsburgh Hospital, Pittsburgh, PA; and The First Call, from...COMMON MEDICAL EMERGENCIES IN FLIGHT: THE FLIGHT ENVIRONMENT Air travel has become quite the luxurious mode of transportation in the past few...pH, known as the Bohr effect [12]. As the hydrogen ion concentration is increased, indicated by a decrease in pH, the oxyhemoglobin dissociation curve

  2. Safety and effectiveness data for emergency contraceptive pills among women with obesity: a systematic review.

    Science.gov (United States)

    Jatlaoui, Tara C; Curtis, Kathryn M

    2016-12-01

    This study aims to determine whether emergency contraceptive pills (ECPs) are less safe and effective for women with obesity compared with those without obesity. We searched PubMed for articles through November 2015 regarding the safety and effectiveness of ECPs [ulipristal acetate (UPA), levonorgestrel (LNG) and combined estrogen and progestin] among obese users. We assessed study quality using the United States Preventive Services Task Force evidence grading system. We identified four pooled secondary analyses (quality: poor to fair), two of which examined UPA and three examined LNG formulations. Three analyses pooled overlapping data from a total of three primary studies and demonstrated significant associations between obesity and risk of pregnancy after ECP use. One analysis reported a 4-fold increased risk of pregnancy among women with obesity (BMI≥30kg/m 2 ) compared with women within normal/underweight categories (BMIcontraception; at weights less than 75 kg, the rate of pregnancy was less than 2%. Two analyses examining UPA suggested an approximate 2-fold increased risk of pregnancy among women with obesity compared with either normal/underweight women or nonobese (BMIemergency contraception options in order for them to understand their options, to receive advanced supplies of emergency contraception as needed and to understand how to access an emergency copper intrauterine device if desired. Copyright © 2016. Published by Elsevier Inc.

  3. Economic growth, urbanization, globalization, and the risks of emerging infectious diseases in China: A review.

    Science.gov (United States)

    Wu, Tong; Perrings, Charles; Kinzig, Ann; Collins, James P; Minteer, Ben A; Daszak, Peter

    2017-02-01

    Three interrelated world trends may be exacerbating emerging zoonotic risks: income growth, urbanization, and globalization. Income growth is associated with rising animal protein consumption in developing countries, which increases the conversion of wild lands to livestock production, and hence the probability of zoonotic emergence. Urbanization implies the greater concentration and connectedness of people, which increases the speed at which new infections are spread. Globalization-the closer integration of the world economy-has facilitated pathogen spread among countries through the growth of trade and travel. High-risk areas for the emergence and spread of infectious disease are where these three trends intersect with predisposing socioecological conditions including the presence of wild disease reservoirs, agricultural practices that increase contact between wildlife and livestock, and cultural practices that increase contact between humans, wildlife, and livestock. Such an intersection occurs in China, which has been a "cradle" of zoonoses from the Black Death to avian influenza and SARS. Disease management in China is thus critical to the mitigation of global zoonotic risks.

  4. Real-time optimisation of the Hoa Binh reservoir, Vietnam

    DEFF Research Database (Denmark)

    Richaud, Bertrand; Madsen, Henrik; Rosbjerg, Dan

    2011-01-01

    -time optimisation. First, the simulation-optimisation framework is applied for optimising reservoir operating rules. Secondly, real-time and forecast information is used for on-line optimisation that focuses on short-term goals, such as flood control or hydropower generation, without compromising the deviation...... in the downstream part of the Red River, and at the same time to increase hydropower generation and to save water for the dry season. The real-time optimisation procedure further improves the efficiency of the reservoir operation and enhances the flexibility for the decision-making. Finally, the quality......Multi-purpose reservoirs often have to be managed according to conflicting objectives, which requires efficient tools for trading-off the objectives. This paper proposes a multi-objective simulation-optimisation approach that couples off-line rule curve optimisation with on-line real...

  5. Acoustic Resonator Optimisation for Airborne Particle Manipulation

    Science.gov (United States)

    Devendran, Citsabehsan; Billson, Duncan R.; Hutchins, David A.; Alan, Tuncay; Neild, Adrian

    Advances in micro-electromechanical systems (MEMS) technology and biomedical research necessitate micro-machined manipulators to capture, handle and position delicate micron-sized particles. To this end, a parallel plate acoustic resonator system has been investigated for the purposes of manipulation and entrapment of micron sized particles in air. Numerical and finite element modelling was performed to optimise the design of the layered acoustic resonator. To obtain an optimised resonator design, careful considerations of the effect of thickness and material properties are required. Furthermore, the effect of acoustic attenuation which is dependent on frequency is also considered within this study, leading to an optimum operational frequency range. Finally, experimental results demonstrated good particle levitation and capture of various particle properties and sizes ranging to as small as 14.8 μm.

  6. Techno-economic optimisation of energy systems

    International Nuclear Information System (INIS)

    Mansilla Pellen, Ch.

    2006-07-01

    The traditional approach currently used to assess the economic interest of energy systems is based on a defined flow-sheet. Some studies have shown that the flow-sheets corresponding to the best thermodynamic efficiencies do not necessarily lead to the best production costs. A method called techno-economic optimisation was proposed. This method aims at minimising the production cost of a given energy system, including both investment and operating costs. It was implemented using genetic algorithms. This approach was compared to the heat integration method on two different examples, thus validating its interest. Techno-economic optimisation was then applied to different energy systems dealing with hydrogen as well as electricity production. (author)

  7. Pre-operative optimisation of lung function

    Directory of Open Access Journals (Sweden)

    Naheed Azhar

    2015-01-01

    Full Text Available The anaesthetic management of patients with pre-existing pulmonary disease is a challenging task. It is associated with increased morbidity in the form of post-operative pulmonary complications. Pre-operative optimisation of lung function helps in reducing these complications. Patients are advised to stop smoking for a period of 4–6 weeks. This reduces airway reactivity, improves mucociliary function and decreases carboxy-haemoglobin. The widely used incentive spirometry may be useful only when combined with other respiratory muscle exercises. Volume-based inspiratory devices have the best results. Pharmacotherapy of asthma and chronic obstructive pulmonary disease must be optimised before considering the patient for elective surgery. Beta 2 agonists, inhaled corticosteroids and systemic corticosteroids, are the main drugs used for this and several drugs play an adjunctive role in medical therapy. A graded approach has been suggested to manage these patients for elective surgery with an aim to achieve optimal pulmonary function.

  8. Weightbearing Computed Tomography of the Foot and Ankle: Emerging Technology Topical Review.

    Science.gov (United States)

    Barg, Alexej; Bailey, Travis; Richter, Martinus; de Cesar Netto, Cesar; Lintz, François; Burssens, Arne; Phisitkul, Phinit; Hanrahan, Christopher J; Saltzman, Charles L

    2018-03-01

    In the last decade, cone-beam computed tomography technology with improved designs allowing flexible gantry movements has allowed both supine and standing weight-bearing imaging of the lower extremity. There is an increasing amount of literature describing the use of weightbearing computed tomography in patients with foot and ankle disorders. To date, there is no review article summarizing this imaging modality in the foot and ankle. Therefore, we performed a systematic literature review of relevant clinical studies targeting the use of weightbearing computed tomography in diagnosis of patients with foot and ankle disorders. Furthermore, this review aims to offer insight to those with interest in considering possible future research opportunities with use of this technology. Level V, expert opinion.

  9. Optimised dipper fine tunes shovel performance

    Energy Technology Data Exchange (ETDEWEB)

    Fiscor, S.

    2005-06-01

    Joint efforts between mine operators, OEMs, and researchers yields unexpected benefits from dippers for shovels for coal, oil, or hardrock mining that can now be tailored to meet site-specific conditions. The article outlines a process being developed by CRCMining and P & H MIning Equipment to optimise the dipper that involves rapid prototyping and scale modelling of the dipper and the mine conditions. Scale models have been successfully field tested. 2 photos.

  10. Public transport optimisation emphasising passengers’ travel behaviour.

    OpenAIRE

    Jensen, Jens Parbo; Nielsen, Otto Anker; Prato, Carlo Giacomo

    2015-01-01

    Passengers in public transport complaining about their travel experiences are not uncommon. This might seem counterintuitive since several operators worldwide are presenting better key performance indicators year by year. The present PhD study focuses on developing optimisation algorithms to enhance the operations of public transport while explicitly emphasising passengers’ travel behaviour and preferences. Similar to economic theory, interactions between supply and demand are omnipresent in ...

  11. ATLAS software configuration and build tool optimisation

    Science.gov (United States)

    Rybkin, Grigory; Atlas Collaboration

    2014-06-01

    ATLAS software code base is over 6 million lines organised in about 2000 packages. It makes use of some 100 external software packages, is developed by more than 400 developers and used by more than 2500 physicists from over 200 universities and laboratories in 6 continents. To meet the challenge of configuration and building of this software, the Configuration Management Tool (CMT) is used. CMT expects each package to describe its build targets, build and environment setup parameters, dependencies on other packages in a text file called requirements, and each project (group of packages) to describe its policies and dependencies on other projects in a text project file. Based on the effective set of configuration parameters read from the requirements files of dependent packages and project files, CMT commands build the packages, generate the environment for their use, or query the packages. The main focus was on build time performance that was optimised within several approaches: reduction of the number of reads of requirements files that are now read once per package by a CMT build command that generates cached requirements files for subsequent CMT build commands; introduction of more fine-grained build parallelism at package task level, i.e., dependent applications and libraries are compiled in parallel; code optimisation of CMT commands used for build; introduction of package level build parallelism, i. e., parallelise the build of independent packages. By default, CMT launches NUMBER-OF-PROCESSORS build commands in parallel. The other focus was on CMT commands optimisation in general that made them approximately 2 times faster. CMT can generate a cached requirements file for the environment setup command, which is especially useful for deployment on distributed file systems like AFS or CERN VMFS. The use of parallelism, caching and code optimisation significantly-by several times-reduced software build time, environment setup time, increased the efficiency of

  12. The current regulatory requirements on optimisation and BAT in Sweden in the context of geological disposal

    International Nuclear Information System (INIS)

    Dverstorp, B.

    2010-01-01

    Bjorn Dverstorp, Swedish Radiation Safety authority (SSM) presented 'The current regulatory requirements on optimisation and BAT in Sweden in the context of geological disposal'. In Sweden, a nuclear waste repository will be evaluated according to both to general environmental legislation (the Environmental Code, SFS, 1998:808) and according to more specific requirements in the Act on Nuclear Activities (SFS, 1984:3) and the Radiation Protection Act (SFS, 1988:220). The evaluations according to these laws will be carried out according to two separate, but coordinated, legal-review and decision-making processes. This will be a basis for the siting process. Although the requirements on BAT and siting in the Environmental Code apply to radiological protection, they aim at a broader system optimisation. The more specific requirements on optimisation and BAT of radiological protection of geological disposal systems are given in the regulations associated with the Radiation Protection Act. The Swedish radiation protection regulations (SSM, 2009) comprise three corner stones: a risk target, environmental protection goals and the use of optimisation and BAT. In SSM' s guidance optimisation is defined as a means to reduce risk, guided by the results of risk calculations. In case of a conflict between BAT and optimisation, measures satisfying BAT should have priority. Application of optimisation and BAT on different timescales are described as well as for human intrusion scenarios. B. Dverstorp explained that because of uncertainties in the long term there is a need for additional arguments in the safety case in support of decision making. It is in this context that the requirements on optimisation and BAT should be seen as supplementary to the risk target, in providing evidence that the developer has taken into consideration, as far as reasonably possible, measures and options for reducing future doses and risks. Both principles focus on the proponent's work on developing

  13. Emerging mHealth and eHealth interventions for serious mental illness: a review of the literature.

    Science.gov (United States)

    Naslund, John A; Marsch, Lisa A; McHugo, Gregory J; Bartels, Stephen J

    2015-01-01

    Serious mental illness (SMI) is one of the leading causes of disability worldwide. Emerging mobile health (mHealth) and eHealth interventions may afford opportunities for reaching this at-risk group. To review the evidence on using emerging mHealth and eHealth technologies among people with SMI. We searched MEDLINE, PsychINFO, CINAHL, Scopus, Cochrane Central, and Web of Science through July 2014. Only studies which reported outcomes for mHealth or eHealth interventions, defined as remotely delivered using mobile, online, or other devices, targeting people with schizophrenia, schizoaffective disorder, or bipolar disorder, were included. Forty-six studies spanning 12 countries were included. Interventions were grouped into four categories: (1) illness self-management and relapse prevention; (2) promoting adherence to medications and/or treatment; (3) psychoeducation, supporting recovery, and promoting health and wellness; and (4) symptom monitoring. The interventions were consistently found to be highly feasible and acceptable, though clinical outcomes were variable but offered insight regarding potential effectiveness. Our findings confirm the feasibility and acceptability of emerging mHealth and eHealth interventions among people with SMI; however, it is not possible to draw conclusions regarding effectiveness. Further rigorous investigation is warranted to establish effectiveness and cost benefit in this population.

  14. Apneic oxygenation reduces the incidence of hypoxemia during emergency intubation: A systematic review and meta-analysis.

    Science.gov (United States)

    Pavlov, Ivan; Medrano, Sofia; Weingart, Scott

    2017-08-01

    Apneic oxygenation has been advocated for the prevention of hypoxemia during emergency endotracheal intubation. Because of conflicting results from recent trials, the efficacy of apneic oxygenation remains unclear. We performed a systematic review and meta-analysis to investigate the effect of apneic oxygenation on the incidence of clinically significant hypoxemia during emergency endotracheal intubation. MEDLINE, EMBASE, and PubMed databases were searched without language and time restrictions for studies of apneic oxygenation performed in a critical care setting. Meta-analysis was conducted with a random-effect model, and according to intention-to-treat allocation wherever applicable. Subgroup analyses were performed to ensure the robustness of findings across various clinical outcomes. Eight studies (n=1953) were included in the meta-analysis. The pooled absolute risk of clinically significant hypoxemia was 27.6% in the usual care group and 19.1% in the apneic oxygenation group, without any heterogeneity across studies (I 2 =0%; p=0.42). Apneic oxygenation reduced the relative risk of hypoxemia by 30% (95% confidence interval 0.59 to 0.82). There was a trend toward lower mortality in the apneic oxygenation group (relative risk of death 0.77; 95% confidence interval 0.59 to 1.02). Apneic oxygenation significantly reduces the incidence of hypoxemia during emergency endotracheal intubation. These findings support the inclusion of apneic oxygenation in everyday clinical practice. Copyright © 2017 Elsevier Inc. All rights reserved.

  15. Is the emergence of fungal resistance to medical triazoles related to their use in the agroecosystems? A mini review

    Directory of Open Access Journals (Sweden)

    Aícha Daniela Ribas e Ribas

    Full Text Available Abstract Triazole fungicides are used broadly for the control of infectious diseases of both humans and plants. The surge in resistance to triazoles among pathogenic populations is an emergent issue both in agriculture and medicine. The non-rational use of fungicides with site-specific modes of action, such as the triazoles, may increase the risk of antifungal resistance development. In the medical field, the surge of resistant fungal isolates has been related to the intensive and recurrent therapeutic use of a limited number of triazoles for the treatment and prophylaxis of many mycoses. Similarities in the mode of action of triazole fungicides used in these two fields may lead to cross-resistance, thus expanding the spectrum of resistance to multiple fungicides and contributing to the perpetuation of resistant strains in the environment. The emergence of fungicide-resistant isolates of human pathogens has been related to the exposure to fungicides used in agroecosystems. Examples include species of cosmopolitan occurrence, such as Fusarium and Aspergillus, which cause diseases in both plants and humans. This review summarizes the information about the most important triazole fungicides that are largely used in human clinical therapy and agriculture. We aim to discuss the issues related to fungicide resistance and the recommended strategies for preventing the emergence of triazole-resistant fungal populations capable of spreading across environments.

  16. A review of the role of emerging environmental contaminants in the development of breast cancer in women

    Directory of Open Access Journals (Sweden)

    Shabana Siddique

    2016-12-01

    Full Text Available The incidence of breast cancer is on a rise worldwide; it is a disease having a complex etiology. Besides genetics, environmental and other lifestyle factors play a role in the development of the disease. There has been a keen interest in studying associations between breast cancer and exposures to emerging environmental chemicals, which mimic estrogens or influence estrogen levels and signaling in the human body. The common consequence of an endocrine disrupting chemical exposure is that it may have an impact on breast cancer etiology by stimulating formation as well as progression of breast cancer. Exposures to selected emerging environmental contaminants such as alkylphenols (APs, bisphenol A (BPA, parabens, perfluoroalkyl substances (PFASs, phthalates, polybrominated diphenyl ethers (PBDEs, synthetic musks and triclosan, and their probable role in breast cancer development are reviewed. Studies evaluated include the experimental in vitro and in vivo studies as well as human population based studies. In vitro and in vivo evidences indicate that a number of emerging environmental contaminants may play a role in the initiation and/or progression of breast cancer. Although exposures have been assessed in some human populations, breast and other cancer risks associated with these exposures are largely unknown. Efforts should be focussed on the evaluation of these environmental exposures in human populations and their interactions with each other and other genetic and lifestyle risk factors.

  17. The Evaluation and Management of Rocky Mountain Spotted Fever in the Emergency Department: a Review of the Literature.

    Science.gov (United States)

    Gottlieb, Michael; Long, Brit; Koyfman, Alex

    2018-07-01

    Rocky Mountain spotted fever (RMSF) is potentially deadly and can present subtly with signs and symptoms overlapping with other clinical conditions. Delayed diagnosis can be fatal. This review provides an evidence-based summary of the current data for the evaluation and management of RMSF in the emergency department. RMSF occurs through transmission of Rickettsia rickettsii by an infected tick. Exposure in the United States occurs most commonly from April to September, and high-risk locations include wooded, shrubby, or grassy areas. Approximately half of patients with infection do not recall tick exposure. Symptoms can include fever, headache, photophobia, malaise, myalgias, and a petechial rash that begins on the wrists and ankles and spreads to the trunk. Rash may not occur in ≤15% of patients, and the classic triad of fever, headache, and rash is also not definitive. Laboratory evaluation may demonstrate hyponatremia, anemia, thrombocytopenia, abnormal liver enzymes, and elevated coagulation tests. Antibody testing can be helpful, but these results are not typically available to the emergency clinician. Doxycycline is the treatment of choice in adults, children, and pregnant patients. Patients should be advised about prevention strategies and effective techniques for removing ticks. RMSF is a potentially deadly disease that requires prompt recognition and management. Focused history, physical examination, and testing are important in the diagnosis of this disease. Understanding the clinical features, diagnostic tools, and proper treatment can assist emergency clinicians in the management of RMSF. Published by Elsevier Inc.

  18. Natural Erosion of Sandstone as Shape Optimisation.

    Science.gov (United States)

    Ostanin, Igor; Safonov, Alexander; Oseledets, Ivan

    2017-12-11

    Natural arches, pillars and other exotic sandstone formations have always been attracting attention for their unusual shapes and amazing mechanical balance that leave a strong impression of intelligent design rather than the result of a stochastic process. It has been recently demonstrated that these shapes could have been the result of the negative feedback between stress and erosion that originates in fundamental laws of friction between the rock's constituent particles. Here we present a deeper analysis of this idea and bridge it with the approaches utilized in shape and topology optimisation. It appears that the processes of natural erosion, driven by stochastic surface forces and Mohr-Coulomb law of dry friction, can be viewed within the framework of local optimisation for minimum elastic strain energy. Our hypothesis is confirmed by numerical simulations of the erosion using the topological-shape optimisation model. Our work contributes to a better understanding of stochastic erosion and feasible landscape formations that could be found on Earth and beyond.

  19. Exploration of automatic optimisation for CUDA programming

    KAUST Repository

    Al-Mouhamed, Mayez

    2014-09-16

    © 2014 Taylor & Francis. Writing optimised compute unified device architecture (CUDA) program for graphic processing units (GPUs) is complex even for experts. We present a design methodology for a restructuring tool that converts C-loops into optimised CUDA kernels based on a three-step algorithm which are loop tiling, coalesced memory access and resource optimisation. A method for finding possible loop tiling solutions with coalesced memory access is developed and a simplified algorithm for restructuring C-loops into an efficient CUDA kernel is presented. In the evaluation, we implement matrix multiply (MM), matrix transpose (M-transpose), matrix scaling (M-scaling) and matrix vector multiply (MV) using the proposed algorithm. We present the analysis of the execution time and GPU throughput for the above applications, which favourably compare to other proposals. Evaluation is carried out while scaling the problem size and running under a variety of kernel configurations. The obtained speedup is about 28-35% for M-transpose compared to NVIDIA Software Development Kit, 33% speedup for MV compared to general purpose computation on graphics processing unit compiler, and more than 80% speedup for MM and M-scaling compared to CUDA-lite.

  20. Exploration of automatic optimisation for CUDA programming

    KAUST Repository

    Al-Mouhamed, Mayez; Khan, Ayaz ul Hassan

    2014-01-01

    © 2014 Taylor & Francis. Writing optimised compute unified device architecture (CUDA) program for graphic processing units (GPUs) is complex even for experts. We present a design methodology for a restructuring tool that converts C-loops into optimised CUDA kernels based on a three-step algorithm which are loop tiling, coalesced memory access and resource optimisation. A method for finding possible loop tiling solutions with coalesced memory access is developed and a simplified algorithm for restructuring C-loops into an efficient CUDA kernel is presented. In the evaluation, we implement matrix multiply (MM), matrix transpose (M-transpose), matrix scaling (M-scaling) and matrix vector multiply (MV) using the proposed algorithm. We present the analysis of the execution time and GPU throughput for the above applications, which favourably compare to other proposals. Evaluation is carried out while scaling the problem size and running under a variety of kernel configurations. The obtained speedup is about 28-35% for M-transpose compared to NVIDIA Software Development Kit, 33% speedup for MV compared to general purpose computation on graphics processing unit compiler, and more than 80% speedup for MM and M-scaling compared to CUDA-lite.

  1. Optimisation and symmetry in experimental radiation physics

    International Nuclear Information System (INIS)

    Ghose, A.

    1988-01-01

    The present monograph is concerned with the optimisation of geometric factors in radiation physics experiments. The discussions are essentially confined to those systems in which optimisation is equivalent to symmetrical configurations of the measurement systems. They include, measurements of interaction cross section of diverse types, determination of polarisations, development of detectors with almost ideal characteristics, production of radiations with continuously variable energies and development of high efficiency spectrometers etc. The monograph is intended for use by experimental physicists investigating primary interactions of radiations with matter and associated technologies. We have illustrated the various optimisation procedures by considering the cases of the so-called ''14 MeV'' on d-t neutrons and gamma rays with energies less than 3 MeV. Developments in fusion technology are critically dependent on the availability accurate cross sections of nuclei for fast neutrons of energies at least as high as d-t neutrons. In this monograph we have discussed various techniques which can be used to improve the accuracy of such measurements and have also presented a method for generating almost monoenergetic neutrons in the 8 MeV to 13 MeV energy range which can be used to measure cross sections in this sparingly investigated region

  2. Occurrence and fate of emerging contaminants in municipal wastewater treatment plants from different geographical regions-a review.

    Science.gov (United States)

    Tran, Ngoc Han; Reinhard, Martin; Gin, Karina Yew-Hoong

    2018-04-15

    Emerging contaminants, such as antibiotics, pharmaceuticals, personal care products, hormones, and artificial sweeteners, are recognized as new classes of water contaminants due to their proven or potential adverse effects on aquatic ecosystems and human health. This review provides comprehensive data on the occurrence of 60 emerging contaminants (ECs) in influent, treated effluent, sludge, and biosolids in wastewater treatment plants (WWTPs). In particular, data on the occurrence of ECs in the influents and effluents of WWTPs are systematically summarized and categorized according to geographical regions (Asia, Europe, and North America). The occurrence patterns of ECs in raw influent and treated effluents of WWTPs between geographical regions were compared and evaluated. Concentrations of most ECs in raw influent in Asian region tend to be higher than those in European and North American countries. Many antibiotics were detected in the influents and effluents of WWTPs at concentrations close to or exceeding the predicted no-effect concentrations (PNECs) for resistance selection. The efficacy of EC removal by sorption and biodegradation during wastewater treatment processes are discussed in light of kinetics and parameters, such as sorption coefficients (K d ) and biodegradation constants (k biol ), and physicochemical properties (i.e. log K ow and pK a ). Commonly used sampling and monitoring strategies are critically reviewed. Analytical research needs are identified, and novel investigative approaches for future monitoring studies are proposed. Copyright © 2017 Elsevier Ltd. All rights reserved.

  3. Recent Trends in Salmonella Outbreaks and Emerging Technology for Biocontrol of Salmonella Using Phages in Foods: A Review.

    Science.gov (United States)

    Oh, Jun-Hyun; Park, Mi-Kyung

    2017-12-28

    Salmonella is one of the principal causes of foodborne outbreaks. As traditional control methods have shown less efficacy against emerging Salmonella serotypes or antimicrobialresistant Salmonella , new approaches have been attempted. The use of lytic phages for the biocontrol of Salmonella in the food industry has become an attractive method owing to the many advantages offered by the use of phages as biocontrol agents. Phages are natural alternatives to traditional antimicrobial agents; they have proven effective in the control of bacterial pathogens in the food industry, which has led to the development of different phage products. The treatment with specific phages in the food industry can prevent the decay of products and the spread of bacterial diseases, and ultimately promotes safe environments for animal and plant food production, processing, and handling. After an extensive investigation of the current literature, this review focuses predominantly on the efficacy of phages for the successful control of Salmonella spp. in foods. This review also addresses the current knowledge on the pathogenic characteristics of Salmonella , the prevalence of emerging Salmonella outbreaks, the isolation and characterization of Salmonella -specific phages, the effectiveness of Salmonella -specific phages as biocontrol agents, and the prospective use of Salmonella -specific phages in the food industry.

  4. Cosmetic Ingredients as Emerging Pollutants of Environmental and Health Concern. A Mini-Review

    Directory of Open Access Journals (Sweden)

    Claudia Juliano

    2017-04-01

    Full Text Available Cosmetic and personal care products are used in huge quantities throughout the world; as a result of their regular use, they are continuously released into the environment in very large amounts. Many of these products are biologically active and are characterized by persistence and bioaccumulation potential, posing a threat to ecosystem and human health. On the basis of the most recent scientific literature available on this subject, this paper provides an overview of some cosmetic ingredients that are considered environmental emerging pollutants of particular concern such as UV filters, some preservatives (parabens, triclosan, and microplastics.

  5. Emergence delirium

    DEFF Research Database (Denmark)

    Munk, Louise; Andersen, Lars Peter Holst; Gögenur, Ismail

    2013-01-01

    Emergence delirium (ED) is a well-known phenomenon in the postoperative period. However, the literature concerning this clinical problem is limited. This review evaluates the literature with respect to epidemiology and risk factors. Treatment strategies are discussed. The review concludes...

  6. Emergency care of reptiles.

    Science.gov (United States)

    Boyer, T H

    1998-09-01

    Common reptile emergencies are reviewed in this article and the fundamentals of emergency care are provided. Important points include obtaining a complete history and husbandry review, physical examination, diagnostic tests, fluid support, anesthetics, and antibiotics.

  7. Adherence to guidelines and protocols in the prehospital and emergency department setting : A systematic review

    NARCIS (Netherlands)

    Theo van Achterberg; S. Meijer; M. Verhofstad; Joke Mintjes; Lilian Vloet

    2011-01-01

    A gap between guidelines or protocols and clinical practice often exists, which may result in patients not receiving appropriate care. Therefore, the objectives of this systematic review were (1) to give an overview of professionals’ adherence to (inter)national guidelines and protocols in the

  8. Adherence to guidelines and protocols in the prehospital and emergency care setting: a systematic review

    NARCIS (Netherlands)

    Ebben, R.H.A.; Vloet, L.C.M.; Verhofstad, M.H.J.; Meijer, S.; Groot, J. de; Achterberg, T. van

    2013-01-01

    A gap between guidelines or protocols and clinical practice often exists, which may result in patients not receiving appropriate care. Therefore, the objectives of this systematic review were (1) to give an overview of professionals' adherence to (inter)national guidelines and protocols in the

  9. Emergent Characteristics of Effective Cross-Cultural Research: A Review of the Literature

    Science.gov (United States)

    Sullivan, Christopher; Cottone, R. Rocco

    2010-01-01

    This article identifies characteristics of effective research done in cross-cultural environments; reviews the literature in the years following the publication of Oyserman, Coon, and Kemmelmeier's (2002) seminal article, challenging the basis for the description of cultures as individualistic or collectivistic; and summarizes major issues…

  10. Review of an emerging research field 'spin-orbit torques'

    International Nuclear Information System (INIS)

    Kurebayashi, Hidekazu

    2015-01-01

    This Review will provide a landscape of the recent development of one of spintronics sub-fields, so-called 'spin orbit torques'. This new class of spin torques, arising from the relativistic spin-orbit interaction in solid states, has gained a great deal of academic interest from relevant scientists and technologists. (author)

  11. The emergence of research on teachers' professional identity : a review of literature from 1988 to 2000

    NARCIS (Netherlands)

    Beijaard, D.; Meijer, P.C.; Verloop, N.; Craig, C.J.; Meijer, P.C.; Broeckmans, J.

    2013-01-01

    The studies considered in this review of research on teachers’ professional identity until 2004 can be divided into three categories: (a) studies in which the focus was on teachers’ professional identity formation; (b) studies in which the focus was on the identification of characteristics of

  12. 76 FR 72712 - Agency Emergency Processing Under the Office of Management and Budget Review; Submission for...

    Science.gov (United States)

    2011-11-25

    ... Management and Budget Review; Comment Request; Food and Drug Administration Food Safety Modernization Act...., Office of Information Management, Food and Drug Administration, 1350 Piccard Dr., PI50-400B, Rockville... DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration [Docket No. FDA-2011-N-0841...

  13. Emerging optical techniques in advanced cystoscopy for bladder cancer diagnosis: A review of the current literature

    NARCIS (Netherlands)

    Cauberg Evelyne, C. C.; de La Rosette, Jean J. M. C. H.; de Reijke, Theo M.

    2011-01-01

    The current standard for the diagnosis and followup of bladder cancer remains white light cystoscopy, despite its well-known limitations. The aim of this paper is to review the current literature on three optical diagnostics that have been developed to improve the performance of white light

  14. Emergency transportation interventions for reducing adverse pregnancy outcomes in low- and middle-income countries: a systematic review protocol.

    Science.gov (United States)

    Ehiri, John; Alaofè, Halimatou; Asaolu, Ibitola; Chebet, Joy; Esu, Ekpereonne; Meremikwu, Martin

    2018-04-25

    Transportation interventions seek to decrease delay in reaching a health facility for emergency obstetric care and are, thus, believed to contribute to reductions in such adverse pregnancy and childbirth outcomes as maternal deaths, stillbirths, and neonatal mortality in low- and middle-income countries (LMICs). However, there is limited empirical evidence to support this hypothesis. The objective of the proposed review is to summarize and critically appraise evidence regarding the effect of emergency transportation interventions on outcomes of labor and delivery in LMICs. The following databases will be searched from inception to March 31, 2018: MEDLINE/PubMed, EMBASE, Web of Science, EBSCO (PsycINFO and CINAHL), the Cochrane Pregnancy and Child Birth Group's Specialized Register, and the Cochrane Central Register of Controlled Trials. We will search for studies in the grey literature through Google and Google Scholar. We will solicit unpublished reports from such relevant agencies as United Nations Fund for Population Activities (UNFPA), the World Health Organization (WHO), the United Nations Children's Fund (UNICEF), the United States Agency for International Development (USAID), and the United Kingdom Department for International Development (DfID) among others. Data generated from the search will be managed using Endnote Version 7. We will perform quantitative data synthesis if studies are homogenous in characteristics and provide adequate outcome data for meta-analysis. Otherwise, data will be synthesized, using the narrative synthesis approach. Among the many barriers that women in LMICs face in accessing life-saving interventions during labor and delivery, lack of access to emergency transportation is particularly important. This review will provide a critical summary of evidence regarding the impact of transportation interventions on outcomes of pregnancy and childbirth in LMICs. PROSPERO CRD42017080092.

  15. Optimisation structurelle des systemes energetiques

    Science.gov (United States)

    Saloux, Etienne

    The development of renewable energies is growing over the last decade to face environmental issues due to the world fossil fuel consumption increase. These energies are highly involved in houses and commercial buildings and numerous systems have been proposed to meet their energy demand. Therefore, improving both efficiency and use of systems, i.e. improving energy management, appears essential to limit the ecological footprint of humanity on the planet. However, system integration yields a very complex problem to be solved due to the large number of units and theirs technology, size, working conditions and interconnections. This situation highlights the lack of systematic analysis for comparing integrated system performance and for correctly pointing out their potential. As a result, the objective of this thesis is to develop and to present such a method, in other words the structural optimization of energy systems. It will be helpful to choose the optimal equipment by identifying all the possibilities of system arrangements and for comparing their performance. Combinations have then been subjected to environmental (climate), structural (available area) and economical constrains while assessment criteria have considered both energy, economic and ecological aspects. For that reason, as well as energy and economic analyses, the exergy concept has also been applied to the equipment. Nevertheless, the high degree of complexity of integrated systems and the tedious numerical calculations make the resolution by using standard software very difficult. It is clear that the whole optimization project would be considerable and the aim is to develop models and optimization tools. First of all, an exhaustive review of energy equipment including photovoltaic panels, solar collectors, heat pumps and thermal energy storage systems, has been performed. Afterwards, energy and exergy models have been developed and tested for two specific energy scenarios: a) a solar assisted heat

  16. Emergence of influenza viruses with zoonotic potential: open issues which need to be addressed. A review.

    Science.gov (United States)

    Capua, Ilaria; Munoz, Olga

    2013-07-26

    The real and perceived impact of influenza infections in animals has changed dramatically over the last 10 years, due mainly to the better understanding of the public health implications of avian and swine influenza viruses. On a number of occasions in the last decade avian-to-human transmissions of H5, H7 and H9 virus subtypes have occurred, and the first influenza pandemic of the new millennium occurred as a result of the emergence and spread of a virus from pigs. Although the mechanisms that allow influenza viruses to jump from one host species to another are not fully understood, several genetic signatures linked to the crossing of species barriers have been identified. This has led to a re-evaluation of the importance of understanding these viruses in the animal reservoir, to the extent that millions of euros have been invested in surveillance, research and capacity building worldwide. This has resulted in an enhanced collaboration with our medical counterparts, leading to many discoveries that will contribute to an understanding of the complex mechanisms that lead to the emergence of a pandemic virus. Copyright © 2013 Elsevier B.V. All rights reserved.

  17. Ethics review of studies during public health emergencies - the experience of the WHO ethics review committee during the Ebola virus disease epidemic.

    Science.gov (United States)

    Alirol, Emilie; Kuesel, Annette C; Guraiib, Maria Magdalena; de la Fuente-Núñez, Vânia; Saxena, Abha; Gomes, Melba F

    2017-06-26

    Between 2013 and 2016, West Africa experienced the largest ever outbreak of Ebola Virus Disease. In the absence of registered treatments or vaccines to control this lethal disease, the World Health Organization coordinated and supported research to expedite identification of interventions that could control the outbreak and improve future control efforts. Consequently, the World Health Organization Research Ethics Review Committee (WHO-ERC) was heavily involved in reviews and ethics discussions. It reviewed 24 new and 22 amended protocols for research studies including interventional (drug, vaccine) and observational studies. WHO-ERC provided the reviews within on average 6 working days. The WHO-ERC often could not provide immediate approval of protocols for reasons which were not Ebola Virus Disease specific but related to protocol inconsistencies, missing information and complex informed consents. WHO-ERC considerations on Ebola Virus Disease specific issues (benefit-risk assessment, study design, exclusion of pregnant women and children from interventional studies, data and sample sharing, collaborative partnerships including international and local researchers and communities, community engagement and participant information) are presented. To accelerate study approval in future public health emergencies, we recommend: (1) internally consistent and complete submissions with information documents in language participants are likely to understand, (2) close collaboration between local and international researchers from research inception, (3) generation of template agreements for data and sample sharing and use during the ongoing global consultations on bio-banks, (4) formation of Joint Scientific Advisory and Data Safety Review Committees for all studies linked to a particular intervention or group of interventions, (5) formation of a Joint Ethics Review Committee with representatives of the Ethics Committees of all institutions and countries involved to

  18. The emergent role of digital technologies in the Circular Economy: A review

    DEFF Research Database (Denmark)

    Pagoropoulos, Aris; Pigosso, Daniela Cristina Antelmi; McAloone, Tim C.

    2017-01-01

    Digital technologies have enabled the formulation of multiple Product Service-Systems (PSS) with considerable economic, environmental and societal benefits. One of the most promising paradigms, which is inspired by business models and value propositions that have already been described in the PSS....... The study concludes by identifying research gaps, reflecting on the application of digital technologies in the field of PSS and proposing suggestions for future research....... literature, is the concept of Circular Economy. Circular Economy is characterized as an economy that is restorative and regenerative by design and is attracting significant attention from researchers and policy makers alike. In light of the recent proliferation of digital technologies such as Big Data...... and the Internet of Things, this article attempts to identify how can digital technologies support the transition to Circular Economy. This article conducted a systematic review of the literature based on a review protocol, in an effort to evaluate the application of key digital technologies in Circular Economy...

  19. Does levonorgestrel emergency contraceptive have a post-fertilization effect? A review of its mechanism of action.

    Science.gov (United States)

    Peck, Rebecca; Rella, Walter; Tudela, Julio; Aznar, Justo; Mozzanega, Bruno

    2016-02-01

    Recent studies have identified that levonorgestrel administered orally in emergency contraception (LNG-EC) is only efficacious when taken before ovulation. However, the drug does not consistently prevent follicular rupture or impair sperm function. The present systematic review is performed to analyze and more precisely define the extent to which pre-fertilization mechanisms of action may explain the drug's efficacy in pregnancy avoidance. We also examine the available evidence to determine if pre-ovulatory drug administration may be associated with post-fertilization effects. The mechanism of action of LNG-EC is reviewed. The drug has no ability to alter sperm function at doses used in vivo and has limited ability to suppress ovulation. Our analysis estimates that the drug's ovulatory inhibition potential could prevent less than 15 percent of potential conceptions, thus making a pre-fertilization mechanism of action significantly less likely than previously thought. Luteal effects (such as decreased progesterone, altered glycodelin levels, and shortened luteal phase) present in the literature may suggest a pre-ovulatory induced post-fertilization drug effect. Plan B is the most widely used emergency contraceptive available. It is important for patients and physicians to clearly understand the drug's mechanism of action (MOA). The drug was originally thought to work by preventing fertilization. Recent research has cast doubt on this. Our review of the research suggests that it could act in a pre-fertilization capacity, and we estimate that it could prevent ovulation in only 15 percent or less of cases. The drug has no ability to alter sperm function and limited ability to suppress ovulation. Further, data suggest that when administered pre-ovulation, it may have a post-fertilization MOA.

  20. Emerging surface characterization techniques for carbon steel corrosion: a critical brief review

    OpenAIRE

    Dwivedi, D.; Lepkova, K.; Becker, T.

    2017-01-01

    Carbon steel is a preferred construction material in many industrial and domestic applications, including oil and gas pipelines, where corrosion mitigation using film-forming corrosion inhibitor formulations is a widely accepted method. This review identifies surface analytical techniques that are considered suitable for analysis of thin films at metallic substrates, but are yet to be applied to analysis of carbon steel surfaces in corrosive media or treated with corrosion inhibitors. The rev...

  1. Entrepreneur-related constructs explaining the emergence of born global firms: A Systematic Literature Review

    OpenAIRE

    Elena Pawęta

    2016-01-01

    Objective: The paper is aimed at structuring entrepreneur-related constructs and building a conceptual framework that can serve as a foundation for future international entrepreneurship research and theory building. Research Design & Methods: The author conducted the systematic literature review of 94 empirical studies and conceptual papers on the entrepreneur-related determinants of early internationalization in the international management journals in the years 1966 – 2015. Findings...

  2. Evacuation and Sheltering of Hospitals in Emergencies: A Review of International Experience

    OpenAIRE

    Bagaria, Jayshree; Heggie, Caroline; Abrahams, Jonathan; Murray, Virginia

    2017-01-01

    Abstract Objective: A scoping exercise to establish how common hospital evacuations are, identify hospital evacuation policies and review case studies to identify trig-gers, processes and challenges involved in the evacuation of hospitals globally. Design: A systematic search of PubMed and disaster agency online resources, search of grey literature and media reports. Results: This study showed that hospitals are vulnerable to both natural and man made disasters and that hospital evacuations d...

  3. Reviewing current and emerging antiemetics for chemotherapy-induced nausea and vomiting prophylaxis.

    Science.gov (United States)

    Natale, James J

    2015-01-01

    This review provides background information on chemotherapy-induced nausea and vomiting (CINV) classification and pathophysiology and reviews various antiemetic agents for CINV prophylaxis, including corticosteroids, serotonin receptor antagonists (5-HT3 RAs), tachykinin NK1 receptor antagonists (NK1 RAs), and olanzapine. Other less commonly used agents are briefly discussed. Practical considerations are reviewed as well, including emetogenicity of chemotherapeutic regimens, patient-specific risk factors for CINV, principles of CINV management, health economics outcome research, and quality of life. Available data on the newly FDA-approved antiemetic combination netupitant/palonosetron (NEPA) is also reviewed. Prevention of CINV is an important goal in managing patients with cancer and is especially difficult with respect to nausea and delayed CINV. Corticosteroids are a mainstay of CINV prophylaxis and are usually given in combination with other therapies. The 5-HT3 RA palonosetron has shown increased efficacy over other agents in the same class for prevention of delayed emesis with moderately emetogenic chemotherapy and NK1 RAs improve emesis prevention in combination with 5-HT3 RAs and dexamethasone. Olanzapine has shown efficacy for CINV prophylaxis and the treatment of breakthrough CINV. The new combination therapy, NEPA, has been shown to be efficacious for the prevention of acute, delayed, and overall CINV. Risk factors that have been identified for CINV include gender, age, and alcohol intake. It is important to assess the emetogenicity of chemotherapy regimens as well as the potential impact of patient risk factors in order to provide adequate prophylaxis. Acute and delayed CINV are severe, burdensome side effects of chemotherapy; however, new data on prevention and the discovery of new agents can further improve CINV control.

  4. Emerging models for mobilizing family support for chronic disease management: a structured review.

    Science.gov (United States)

    Rosland, Ann-Marie; Piette, John D

    2010-03-01

    We identify recent models for programmes aiming to increase effective family support for chronic illness management and self-care among adult patients without significant physical or cognitive disabilities. We then summarize evidence regarding the efficacy for each model identified. Structured review of studies published in medical and psychology databases from 1990 to the present, reference review, general Web searches and conversations with family intervention experts. Review was limited to studies on conditions that require ongoing self-management, such as diabetes, chronic heart disease and rheumatologic disease. Programmes with three separate foci were identified: (1) Programmes that guide family members in setting goals for supporting patient self-care behaviours have led to improved implementation of family support roles, but have mixed success improving patient outcomes. (2) Programmes that train family in supportive communication techniques, such as prompting patient coping techniques or use of autonomy supportive statements, have successfully improved patient symptom management and health behaviours. (3) Programmes that give families tools and infrastructure to assist in monitoring clinical symptoms and medications are being conducted, with no evidence to date on their impact on patient outcomes. The next generation of programmes to improve family support for chronic disease management incorporate a variety of strategies. Future research can define optimal clinical situations for family support programmes, the most effective combinations of support strategies, and how best to integrate family support programmes into comprehensive models of chronic disease care.

  5. Citation Analysis for the Modern Instructor: An Integrated Review of Emerging Research

    Directory of Open Access Journals (Sweden)

    Chris Piotrowski

    2013-07-01

    Full Text Available While online instructors may be versed in conducting e-Research (Hung, 2012; Thelwall, 2009, today’s faculty are probably less familiarized with the rapidly advancing fields of bibliometrics and informetrics. One key feature of research in these areas is Citation Analysis, a rather intricate operational feature available in modern indexes such as Web of Science, Scopus, Google Scholar, and PsycINFO. This paper reviews the recent extant research on bibliometrics within the context of citation analysis. Particular focus is on empirical studies, review essays, and critical commentaries on citation-based metrics across interdisciplinary academic areas. Research that relates to the interface between citation analysis and applications in higher education is discussed. Some of the attributes and limitations of citation operations of contemporary databases that offer citation searching or cited reference data are presented. This review concludes that: a citation-based results can vary largely and contingent on academic discipline or specialty area, b databases, that offer citation options, rely on idiosyncratic methods, coverage, and transparency of functions, c despite initial concerns, research from open access journals is being cited in traditional periodicals, and d the field of bibliometrics is rather perplex with regard to functionality and research is advancing at an exponential pace. Based on these findings, online instructors would be well served to stay abreast of developments in the field.

  6. A Review of the Emerging Markets Literature: Context, Concepts and Future Research

    DEFF Research Database (Denmark)

    Nielsen, Ulrik B.; Hannibal, Martin; Larsen, Nathalie Nørregaard

    Emerging Markets (EM) has been the focus of numerous studies. Even though the EM category has been heavily debated and has been the focus of a substantial and ever-growing body of research, the elements used to define and characterize EMs are still found to be inconsistent. Through a systematic...... of the existing EM literature, which is currently dominated by studies involving China and India. Secondly, we identify the seminal contributions based on cross-references in the EM field and citations in international business literature in general. Thirdly, we elaborate on the definitional elements of the most...... dominant definitions and characterizations in the extant EM literature. As a final step these are used to develop an organizing framework for future research. Finally, based on our findings we suggest avenues of future research and managerial implications are presented....

  7. Must we review printed lab reports without checking them? A prospective analysis of emergency department practice.

    LENUS (Irish Health Repository)

    McCabe, A

    2012-04-01

    This study investigated if results of haematology and biochemistry laboratory tests, carried out at the point of care in our Emergency Department, are checked by the clinician who ordered the test, mitigating the requirement to check printed reports later. Five hundred and nineteen (519) laboratory reports were examined for significant abnormal results and documentation in clinical notes. Thirty percent (30%, n = 158) of these met the inclusion criteria for \\'significantly abnormal\\' laboratory results. Of the 158 significantly abnormal results, 34.8% (n = 55) were not documented in the ED clinical case notes. No patient was discharged inappropriately. Our study suggests it is safe to stop routinely rechecking printed biochemistry and haematology laboratory reports in our department.

  8. Vasovagal reflex emergency caused by Riedel's thyroiditis: A case report and review of the literature.

    Science.gov (United States)

    Cai, Wei; Kang, Hua; Hai, Tao

    2016-01-01

    Riedel's thyroiditis is a rare type of chronic thyroiditis, associated with fibroinflammatory process and invasion into surrounding tissues, leading to compressive symptoms. A 45-year-old man had a left thyroid mass, presenting with hypotension and bradycardia many times. He was diagnosed with vasovagal reflex caused by cervical vessel compression due to a thyroid lesion. We performed the emergency operation, and most of the left thyroid was removed to relieve the compression on cervical vessels. The result of pathology proved to be Riedel's thyroiditis. The vasovagal reflex did not occur any more during the 28-month follow up, except on the 3(rd) day after the surgery. Six months after the thyroidectomy, the patient was found to have retroperitoneal fibrosis, diagnosed by biopsy during a laparotomy for biliary disease. Riedel's thyroiditis can lead to a vasovagal episode and might not be a primary thyroid disease but rather a manifestation of the systemic disorder, multifocal fibrosclerosis. Copyright © 2013. Published by Elsevier Taiwan.

  9. Emerging Viral Infections in Sub-Saharan Africa and the Developing Nervous System: A Mini Review.

    Science.gov (United States)

    Kakooza-Mwesige, Angelina; Mohammed, Abdul H; Kristensson, Krister; Juliano, Sharon L; Lutwama, Julius J

    2018-01-01

    The global public health concern is heightened over the increasing number of emerging viruses, i.e., newly discovered or previously known that have expanded into new geographical zones. These viruses challenge the health-care systems in sub-Saharan Africa (SSA) countries from which several of them have originated and been transmitted by insects worldwide. Some of these viruses are neuroinvasive, but have been relatively neglected by neuroscientists. They may provide experiments by nature to give a time window for exposure to a new virus within sizeable, previously non-infected human populations, which, for instance, enables studies on potential long-term or late-onset effects on the developing nervous system. Here, we briefly summarize studies on the developing brain by West Nile, Zika, and Chikungunya viruses, which are mosquito-borne and have spread worldwide out of SSA. They can all be neuroinvasive, but their effects vary from malformations caused by prenatal infections to cognitive disturbances following perinatal or later infections. We also highlight Ebola virus, which can leave surviving children with psychiatric disturbances and cause persistent infections in the non-human primate brain. Greater awareness within the neuroscience community is needed to emphasize the menace evoked by these emerging viruses to the developing brain. In particular, frontline neuroscience research should include neuropediatric follow-up studies in the field on long-term or late-onset cognitive and behavior disturbances or neuropsychiatric disorders. Studies on pathogenetic mechanisms for viral-induced perturbations of brain maturation should be extended to the vulnerable periods when neurocircuit formations are at peaks during infancy and early childhood.

  10. Utilisation of helicopter emergency medical services in the early medical response to major incidents: a systematic literature review.

    Science.gov (United States)

    Johnsen, Anne Siri; Fattah, Sabina; Sollid, Stephen J M; Rehn, Marius

    2016-02-09

    This systematic review identifies, describes and appraises the literature describing the utilisation of helicopter emergency medical services (HEMS) in the early medical response to major incidents. Early prehospital phase of a major incident. Systematic literature review performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, the Web of Science, PsycINFO, Scopus, Cinahl, Bibsys Ask, Norart, Svemed and UpToDate were searched using phrases that combined HEMS and 'major incidents' to identify when and how HEMS was utilised. The identified studies were subjected to data extraction and appraisal. The database search identified 4948 articles. Based on the title and abstract, the full text of 96 articles was obtained; of these, 37 articles were included in the review, and an additional five were identified by searching the reference lists of the 37 articles. HEMS was used to transport medical and rescue personnel to the incident and to transport patients to the hospital, especially when the infrastructure was damaged. Insufficient air traffic control, weather conditions, inadequate landing sites and failing communication were described as challenging in some incidents. HEMS was used mainly for patient treatment and to transport patients, personnel and equipment in the early medical management of major incidents, but the optimal utilisation of this specialised resource remains unclear. This review identified operational areas with improvement potential. A lack of systematic indexing, heterogeneous data reporting and weak methodological design, complicated the identification and comparison of incidents, and more systematic reporting is needed. CRD42013004473. 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/

  11. A review paper on offline inspection of finished and semi-finished products and emerging research directions

    Directory of Open Access Journals (Sweden)

    Babar Ramzan Muhammad

    2016-01-01

    Full Text Available Organizations want to focus on product quality along with productivity to get their competitive advantage in global market. In order to achieve this aim, quality management system and its different aspects are becoming more valuable than before. This study has considered quality control and its activities with specific focus on offline inspection. The objective of this study is to provide a literature review that identifies different models and methodologies, developed for offline inspection under different manufacturing and inspection conditions. This review is based on research work accepted by international journals and published in the years from 2000 to 2016. These studies are classified into six groups on the basis of their research objectives, model developed, adopted methodologies, and research outcomes. This review paper also gives а brief look at the offline inspection to propose future research opportunities and emerging trends. The proposed research directions can be helpful in developing new models or modifying the existing models to improve the performance of offline inspection.

  12. The Third Annual Deep Brain Stimulation Think Tank: A Review of Emerging Issues and Technologies

    Directory of Open Access Journals (Sweden)

    P. Justin eRossi

    2016-04-01

    Full Text Available This review summarizes the most contemporary clinical, electrophysiological, imaging, and computational work on DBS for the treatment of neurological and neuropsychiatric disease. Significant innovations of the past year are emphasized; these advances were presented at the 3rd Annual Deep Brain Stimulation Think Tank. The Think Tank’s contributors represent a unique multidisciplinary ensemble of expert neurologists, neurosurgeons, neuropsychologists, psychiatrists, scientists, engineers, and members of industry. Presentations and discussions covered a broad range of topics, including policy and advocacy considerations for the future of DBS, connectomic approaches to DBS targeting, developments in electrophysiology and related strides toward responsive DBS systems, and recent developments in sensor and device technologies.

  13. The effectiveness of community-based loan funds for transport during obstetric emergencies in developing countries: a systematic review.

    Science.gov (United States)

    Nwolise, Chidiebere Hope; Hussein, Julia; Kanguru, Lovney; Bell, Jacqueline; Patel, Purvi

    2015-09-01

    Scarcity and costs of transport have been implicated as key barriers to accessing care when obstetric emergencies occur in community settings. Community-based loans have been used to increase utilization of health facilities and potentially reduce maternal mortality by providing funding at community level to provide emergency transport. This review aimed to provide evidence of the effect of community-based loan funds on utilization of health facilities and reduction of maternal mortality in developing countries. Electronic databases of published literature and websites were searched for relevant literature using a pre-defined set of search terms, inclusion and exclusion criteria. Screening of titles, abstracts and full-text articles were done by at least two reviewers independently. Quality assessment was carried out on the selected papers. Data related to deliveries and obstetric complications attended at facilities, maternal deaths and live births were extracted to measure and compare the effects of community-based loan funds using odds ratios (ORs) and reductions in maternal mortality ratio. Forest plots are presented where possible. The results of the review show that groups where community-based loan funds were implemented (alongside other interventions) generally recorded increases in utilization of health facilities for deliveries, with ORs of 3.5 (0.97-15.48) and 3.55 (1.56-8.05); and an increase in utilization of emergency obstetric care with ORs of 2.22 (0.51-10.38) and 3.37 (1.78-6.37). Intervention groups also experienced a positive effect on met need for complications and a reduction in maternal mortality. There is some evidence to suggest that community-based loan funds as part of a multifaceted intervention have positive effects. Conclusions are limited by challenges of study design and bias. Further studies which strengthen the evidence of the effects of loan funds, and mechanism for their functionality, are recommended. Published by Oxford

  14. ‘BRICS without straw’? A systematic literature review of newly emerging economies’ influence in global health

    Science.gov (United States)

    2013-01-01

    Background Since 2010, five newly emerging economies collectively known as ‘BRICS’ (Brazil, India, Russia, China and South Africa) have caught the imagination, and scholarly attention, of political scientists, economists and development specialists. The prospect of a unified geopolitical bloc, consciously seeking to re-frame international (and global) health development with a new set of ideas and values, has also, if belatedly, begun to attract the attention of the global health community. But what influence, if any, do the BRICS wield in global health, and, if they do wield influence, how has that influence been conceptualized and recorded in the literature? Methods We conducted a systematic literature review in (March-December 2012) of documents retrieved from the databases EMBASE, PubMed/Medline, Global Health, and Google Scholar, and the websites of relevant international organisations, research institutions and philanthropic organisations. The results were synthesised using a framework of influence developed for the review from the political science literature. Results Our initial search of databases and websites yielded 887 documents. Exclusion criteria narrowed the number of documents to 71 journal articles and 23 reports. Two researchers using an agreed set of inclusion criteria independently screened the 94 documents, leaving just 7 documents. We found just one document that provided sustained analysis of the BRICS’ collective influence; the overwhelming tendency was to describe individual BRICS countries influence. Although influence was predominantly framed by BRICS countries’ material capability, there were examples of institutional and ideational influence - particularly from Brazil. Individual BRICS countries were primarily ‘opportunity seekers’ and region mobilisers but with potential to become ‘issue leaders’ and region organisers. Conclusion Though small in number, the written output on BRICS influence in global health has

  15. Methods for Optimisation of the Laser Cutting Process

    DEFF Research Database (Denmark)

    Dragsted, Birgitte

    This thesis deals with the adaptation and implementation of various optimisation methods, in the field of experimental design, for the laser cutting process. The problem in optimising the laser cutting process has been defined and a structure for at Decision Support System (DSS......) for the optimisation of the laser cutting process has been suggested. The DSS consists of a database with the currently used and old parameter settings. Also one of the optimisation methods has been implemented in the DSS in order to facilitate the optimisation procedure for the laser operator. The Simplex Method has...... been adapted in two versions. A qualitative one, that by comparing the laser cut items optimise the process and a quantitative one that uses a weighted quality response in order to achieve a satisfactory quality and after that maximises the cutting speed thus increasing the productivity of the process...

  16. Removal of heavy metals from emerging cellulosic low-cost adsorbents: a review

    Science.gov (United States)

    Malik, D. S.; Jain, C. K.; Yadav, Anuj K.

    2017-09-01

    Heavy metal pollution is a major problems in the environment. The impact of toxic metal ions can be minimized by different technologies, viz., chemical precipitation, membrane filtration, oxidation, reverse osmosis, flotation and adsorption. But among them, adsorption was found to be very efficient and common due to the low concentration of metal uptake and economically feasible properties. Cellulosic materials are of low cost and widely used, and very promising for the future. These are available in abundant quantity, are cheap and have low or little economic value. Different forms of cellulosic materials are used as adsorbents such as fibers, leaves, roots, shells, barks, husks, stems and seed as well as other parts also. Natural and modified types of cellulosic materials are used in different metal detoxifications in water and wastewater. In this review paper, the most common and recent materials are reviewed as cellulosic low-cost adsorbents. The elemental properties of cellulosic materials are also discussed along with their cellulose, hemicelluloses and lignin contents.

  17. A Targeted Review of the Neurobiology and Genetics of Behavioral Addictions: An Emerging Area of Research

    Science.gov (United States)

    Leeman, Robert F.; Potenza, Marc N.

    2013-01-01

    This review summarizes neurobiological and genetic findings in behavioral addictions, draws parallels with findings pertaining to substance use disorders and offers suggestions for future research. Articles concerning brain function, neurotransmitter activity and family history/genetics findings for behavioral addictions involving gambling, internet use, video game playing, shopping, kleptomania and sexual activity were reviewed. Behavioral addictions involve dysfunction in several brain regions, particularly the frontal cortex and striatum. Findings from imaging studies incorporating cognitive tasks have arguably been more consistent than cue-induction studies. Early results suggest white and gray matter differences. Neurochemical findings suggest roles for dopaminergic and serotonergic systems, but results from clinical trials seem more equivocal. While limited, family history/genetic data support heritability for pathological gambling and that those with behavioral addictions are more likely to have a close family member with some form of psychopathology. Parallels exist between neurobiological and genetic/family history findings in substance and non-substance addictions, suggesting that compulsive engagement in these behaviors may constitute addictions. Findings to date are limited, particularly for shopping, kleptomania and sexual behavior. Genetic understandings are at an early stage. Future research directions are offered. PMID:23756286

  18. Invasive Trichosporon Infection: A systematic review on a re-emerging fungal pathogen

    Directory of Open Access Journals (Sweden)

    João Nobrega De Almeida Júnior

    2016-10-01

    Full Text Available Objectives: This review aimed to better depict the clinical features and address the issue of therapeutic management of Trichosporon deep-seated infections.Methods: We comprehensively reviewed the cases of invasive Trichosporon infection reported in the literature from 1994 (date of taxonomic modification to 2015. Data from antifungal susceptibility testing (AST studies were also analyzed. Results: Two hundred and three cases were retained and split into four groups: hemopathy (n=79, other immunodeficiency conditions (n =41, miscellaneous (n=58 and newborns (n=25. Trichosporon asahii was the main causative species (46.7% and may exhibit cross-resistance to different antifungal classes. The unfavorable outcome rate was at 44.3%. By multivariate analysis, breakthrough infection (OR 2.45 was associated with unfavorable outcome, whilst the use of an azole-based therapy improved the prognosis (OR 0.16. Voriconazole-based treatment was associated with favorable outcome in hematological patients (73.6% vs. 41.8%; p=0.016. Compiled data from AST demonstrated that (i T. asahii exhibits the highest MICs to amphotericin B and (ii voriconazole has the best in vitro efficacy against clinical isolates of Trichosporon spp. Conclusions: Trichosporon infection is not only restricted to hematological patients. Analysis of compiled data from AST and clinical outcome support the use of voriconazole as first line therapy.

  19. An author's guide to publication ethics: a review of emerging standards in biomedical journals.

    Science.gov (United States)

    Roberts, Jason

    2009-04-01

    Universal definitions of ethical issues related to medical publishing have remained somewhat elusive. Training in the art of writing for medical journals is inconsistent and most commonly informal, involving collaborative efforts between mentors and students. This approach inadvertently may perpetuate erroneous assumptions as to what constitutes acceptable behavior. In contrast to instruction on composition, ethical considerations related to the publication of a paper are likely to receive little attention. Even so, consequent to the ever-increasing scrutiny from the media and government agencies, journals are recognizing the need for greater transparency in peer review and are thus more inclined to enforce ethical standards. Understanding that some apparent ethical contraventions are the result of confusion or a lack of knowledge, some journals are assuming the responsibility of educating their community about ethical issues in publishing. This paper reviews the key ethical issues (eg, authorship criteria, conflicts of interest, redundant publication, data access and biases in data reporting, image manipulation) that authors should consider before submitting a manuscript. It also surveys some of the policies of the most highly cited clinical medical journals. In the future, authors can anticipate that their submissions will be required to meet an expanding array of ethical standards.

  20. A targeted review of the neurobiology and genetics of behavioural addictions: an emerging area of research.

    Science.gov (United States)

    Leeman, Robert F; Potenza, Marc N

    2013-05-01

    This review summarizes neurobiological and genetic findings in behavioural addictions, draws parallels with findings pertaining to substance use disorders, and offers suggestions for future research. Articles concerning brain function, neurotransmitter activity, and family history and (or) genetic findings for behavioural addictions involving gambling, Internet use, video game playing, shopping, kleptomania, and sexual activity were reviewed. Behavioural addictions involve dysfunction in several brain regions, particularly the frontal cortex and striatum. Findings from imaging studies incorporating cognitive tasks have arguably been more consistent than cue-induction studies. Early results suggest white and grey matter differences. Neurochemical findings suggest roles for dopaminergic and serotonergic systems, but results from clinical trials seem more equivocal. While limited, family history and genetic data support heritability for pathological gambling and that people with behavioural addictions are more likely to have a close family member with some form of psychopathology. Parallels exist between neurobiological and genetic and family history findings in substance and nonsubstance addictions, suggesting that compulsive engagement in these behaviours may constitute addictions. To date, findings are limited, particularly for shopping, kleptomania, and sexual behaviour. Genetic understandings are at an early stage. Future research directions are offered.

  1. The Emerging Wireless Body Area Network on Android Smartphones: A Review

    Science.gov (United States)

    Puspitaningayu, P.; Widodo, A.; Yundra, E.

    2018-01-01

    Our society now has driven us into an era where almost everything can be digitally monitored and controlled including the human body. The growth of wireless body area network (WBAN), as a specific scope of sensor networks which mounted or attached to human body also developing rapidly. It allows people to monitor their health and several daily activities. This study is intended to review the trend of WBAN especially on Android, one of the most popular smartphone platforms. A systematic literature review is concerned to the following parameters: the purpose of the device and/or application, the type of sensors, the type of Android device, and its connectivity. Most of the studies were more concern to healthcare or medical monitoring systems: blood pressure, electro cardiograph, tremor detection, etc. On the other hand, the rest of them aimed for activity tracker, environment sensing, and epidemic control. After all, those studies shown that not only Android can be a powerful platform to process data from various sensors but also smartphones can be a good alternative to develop WBANs for medical and other daily applications.

  2. Process water treatment in Canada's oil sands industry : 2 : a review of emerging technologies

    International Nuclear Information System (INIS)

    Allen, E.W.

    2008-01-01

    This review was conducted to identify candidate treatment technologies for treating oil sands process water. The oil sands industry in Canada uses large volumes of fresh water in order to extract bitumen deposits. The development of process water treatment technologies has become a critical issue for the industry, particularly as oil sand production is expected to triple in the next decade. However, treatment technologies must be adapted to consider the fouling potential of bitumens and fine clays as well as the effect of alkaline process water on treatment performance. The review included developments in chemical modifications to membranes and adsorbents designed to improve pollutant removal and reduce fouling; hybridization technologies designed to enhance the biological treatment of toxic feedwaters; recent advances in photocatalytic oxidation technologies for organic compounds; and new designs for large-scale treatment wetlands for polluted waste waters. It was concluded that major knowledge gaps must be optimized and preliminary studies must be conducted in order to understand how the treatment technologies will be affected by the chemical and physical characteristics of oil sands process water. 188 refs., 8 tabs

  3. An empirical study on website usability elements and how they affect search engine optimisation

    Directory of Open Access Journals (Sweden)

    Eugene B. Visser

    2011-03-01

    Full Text Available The primary objective of this research project was to identify and investigate the website usability attributes which are in contradiction with search engine optimisation elements. The secondary objective was to determine if these usability attributes affect conversion. Although the literature review identifies the contradictions, experts disagree about their existence.An experiment was conducted, whereby the conversion and/or traffic ratio results of an existing control website were compared to a usability-designed version of the control website,namely the experimental website. All optimisation elements were ignored, thus implementing only usability. The results clearly show that inclusion of the usability attributes positively affect conversion,indicating that usability is a prerequisite for effective website design. Search engine optimisation is also a prerequisite for the very reason that if a website does not rank on the first page of the search engine result page for a given keyword, then that website might as well not exist. According to this empirical work, usability is in contradiction to search engine optimisation best practices. Therefore the two need to be weighed up in terms of importance towards search engines and visitors.

  4. Epidemiological Pattern of Injuries in Iran; a Nationwide Review of Seven Million Emergency Department Admissions

    Directory of Open Access Journals (Sweden)

    Mohammad Haji Aghajani

    2016-12-01

    Full Text Available Introduction: Globally, it is estimated that around 5.8 million people die annually as result of injuries, which causes 10% of all deaths and 16% of disability adjusted life years lost worldwide. This study aimed to determine the epidemiology of injuries in emergency departments in Iran.Method: This cross sectional study was carried out using national injury surveillance data registry from 21 March 2009 to 20 March 2014.Results: 7,176,344 patients with the mean age of 27.5 ± 17.8 years were registered to 657 EDs (70.6% male. Road Traffic Crash (RTC was the most common cause of injury (31.0% followed by hit (28.2% and fall (10.1%. While roads were the commonest place of injuries, 34.0% of patients have been injured at home. More than 90% of injuries were unintentional. Assault and suicide attempt were causes of injury in 5.6% and 3.9% of patients, respectively.Conclusion:This paper addresses where prevention measures are most urgently needed and offers insights which could be useful for injury prevention programs in Iran and other developing countries.

  5. Effect of Delivery and Episiotomy on the Emergence of Urinary Incontinence in Women: Review of Literature

    Science.gov (United States)

    Živković, Krešimir; Živković, Nikica; Župić, Tomislav; Hodžić, Damir; Mandić, Vjekoslav; Orešković, Slavko

    2016-12-01

    Episiotomy is obstetric procedure during which the incision extends the vestibule of the vagina during the second stage of labor. Episiotomy was extensively spread with gradual increase of rates in the first half of the 20th century and was performed medio-laterally in all nulliparous women with the idea to protect fetal head from trauma and pelvic floor from injuries. However, reports claiming that episiotomy had no such benefits were published. It was shown that routine medio-lateral episiotomy did not protect against the appearance of urinary incontinence after vaginal delivery, while the risk of anal incontinence could be increased. The role of episiotomy in development of pelvic floor dysfunction remains quite unclear. Due to the mentioned reason, restricted episiotomy approach should be accepted. The origin of stress incontinence during pregnancy is controversial and not definitely scientifically proven. Pregnancy per se and older age at first delivery may have impact on the onset of pelvic floor dysfunction. Urinary incontinence in pregnancy increases the risk of later urinary incontinence, both postpartum and later in life. Vaginal delivery is just one of the potential risk factors for development of urinary incontinence. Mechanical pressure by fetus on the pelvic floor structures, limited denervation of the pelvic floor and soft tissue damage during delivery are some of explanations for the onset of stress urinary incontinence. On the other hand, cesarean delivery might not be protective against emergence of urinary incontinence. Further research in this field is needed.

  6. Emergency planning lessons learned from a review of past major radiological accidents

    International Nuclear Information System (INIS)

    Stephan, J.G.; Selby, J.M.; Martin, J.B.; Moeller, D.W.; Vallario, E.J.

    1988-01-01

    In examining a range of nuclear accidents from the 1950s to the present that were reported in the literature, the authors have identified a number of contributing factors which affected human judgement during these events. One common thread found in a large number of accidents is the time of occurrence; a second is the adequacy of emergency training. The data show that events, whether severe accidents or operational incidents, appear to occur more frequently during off-normal hours such as the early morning shift, weekends, or holidays. Accidents seldom occur during the day shift when the full management team and senior operations personnel are present. As a result, those facility employees most expert in coping with the situation may not be available, and the normal chain of command may be disrupted. At several nuclear power plants, it was also observed that new or less experienced technicians are often assigned to night shifts. The lack of experienced human resources and the pressure of an accident situation can have an adverse impact on individuals who are faced with making important decisions

  7. Digital chest tomosynthesis: the 2017 updated review of an emerging application

    Science.gov (United States)

    Ferrari, Arianna; Bertolaccini, Luca; Solli, Piergiorgio; Di Salvia, Paola Oriana

    2018-01-01

    Lung cancer is the leading cause of cancer death and second most common cancer among both men and women, but most of them are detected when patients become symptomatic and in late-stage. Chest radiography (CR) is a basic technique for the investigation of lung cancer and has the benefit of convenience and low radiation dose, but detection of malignancy is often difficult. The introduction of computed tomography (CT) for screening has increased the proportion of lung cancer detected but with higher exposure dose and higher costs. Digital chest tomosynthesis (DCT), a tomographic technique, may offer an alternative to CT. DCT uses a conventional radiograph tube, a flat-panel detector, a computer-controlled tube mover and reconstruction algorithms to produce section images. It shows promise in the detection of potentially malignant lung nodules, with higher sensibility than CR, and is emerging as a low-dose and low-cost alternative to CT to improve treatment decisions. In fact, an increasing number of researchers are showing that tomosynthesis could have a role in the detection of lung cancer, in addition to its present role in breast screening. However, DCT offers some limitations, such as limited depth resolution, which may explain the difficulty in detecting pathologies in the subpleural region and the occurrence of artefacts from medical devices. Once solved these limitations and once more studies supporting its use will be available, DCT could become the first-line lung cancer screening tool among patients at considerable risk of lung cancer. PMID:29666814

  8. Social media and outbreaks of emerging infectious diseases: A systematic review of literature.

    Science.gov (United States)

    Tang, Lu; Bie, Bijie; Park, Sung-Eun; Zhi, Degui

    2018-04-05

    The public often turn to social media for information during emerging infectious diseases (EIDs) outbreaks. This study identified the major approaches and assessed the rigors in published research articles on EIDs and social media. We searched 5 databases for published journal articles on EIDs and social media. We then evaluated these articles in terms of EIDs studied, social media examined, theoretical frameworks, methodologic approaches, and research findings. Thirty articles were included in the analysis (published between January 1, 2010, and March 1, 2016). EIDs that received most scholarly attention were H1N1 (or swine flu, n = 15), Ebola virus (n = 10), and H7N9 (or avian flu/bird flu, n = 2). Twitter was the most often studied social media (n = 17), followed by YouTube (n = 6), Facebook (n = 6), and blogs (n = 6). Three major approaches in this area of inquiry are identified: (1) assessment of the public's interest in and responses to EIDs, (2) examination of organizations' use of social media in communicating EIDs, and (3) evaluation of the accuracy of EID-related medical information on social media. Although academic studies of EID communication on social media are on the rise, they still suffer from a lack of theorization and a need for more methodologic rigor. Copyright © 2018 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  9. Mechanism of action of ulipristal acetate for emergency contraception: a systematic review

    Directory of Open Access Journals (Sweden)

    Elena eRosato

    2016-01-01

    Full Text Available SUMMARYUlipristal acetate (UPA is now recommended as first choice hormonal Emergency Contraception (EC, due to its higher efficacy and similar safety compared to Levonogestrel - EC. Even though all trials demonstrated that the first mechanism of action is inhibition of ovulation, some authors still postulate that a post fertilization effect is also possible, raising the alert on medication and fostering the ethical debate.A Medline database search was performed in order to find recent articles related to UPA’s effects on ovulation, on fallopian tube and on endometrium. We also analyzed the effects on sperm function and pregnancy. All studies conclude that UPA is effective in inhibition of ovulation even when administered shortly before LH peak. The effects on fallopian tube are unclear: according to some authors UPA inhibits ciliar beat through an agonistic effect on progesterone receptors, according to others it antagonizes the progesterone-induced ciliar beat decrease. Concerning the action on endometrium and on embryo implantation most of the studies concluded that low dose UPA used for EC has no significant effect on the decrease of endometrial thickness and on embryo’s attachment, but these results are still matter of debate. Finally recent evidence suggests that UPA modulates human sperm functions while it has no effect on established pregnancy. To date the majority of the evidence concur in excluding a post-fertilization effect of UPA, even though more studies are needed to clarify its mechanism of action.

  10. Fecal Microbiota Transplantation: A Review of Emerging Indications Beyond Relapsing Clostridium difficile Toxin Colitis.

    Science.gov (United States)

    Jung Lee, Woo; Lattimer, Lakshmi D N; Stephen, Sindu; Borum, Marie L; Doman, David B

    2015-01-01

    The symbiotic relationship between gut microbiota and humans has been forged over many millennia. This relationship has evolved to establish an intimate partnership that we are only beginning to understand. Gut microbiota were once considered pathogenic, but the concept of gut microbiota and their influence in human health is undergoing a major paradigm shift, as there is mounting evidence of their impact in the homeostasis of intestinal development, metabolic activities, and the immune system. The disruption of microbiota has been associated with many gastrointestinal and nongastrointestinal diseases, and the reconstitution of balanced microbiota has been postulated as a potential therapeutic strategy. Fecal microbiota transplantation (FMT), a unique method to reestablish a sustained balance in the disrupted microbiota of diseased intestine, has demonstrated great success in the treatment of recurrent Clostridium difficile infection and has gained increasing acceptance in clinical use. The possibility of dysfunctional micro-biota playing a causative role in other gastrointestinal and nongas-trointestinal diseases, therefore, has also been raised, and there are an increasing number of studies supporting this hypothesis. FMT is emerging as a feasible therapeutic option for several diseases; however, its efficacy remains in question, given the lack of clinical trial data. Altering microbiota with FMT holds great promise, but much research is needed to further define FMT's therapeutic role and optimize the microbiota delivery system.

  11. Mechatronic System Design Based On An Optimisation Approach

    DEFF Research Database (Denmark)

    Andersen, Torben Ole; Pedersen, Henrik Clemmensen; Hansen, Michael Rygaard

    The envisaged objective of this paper project is to extend the current state of the art regarding the design of complex mechatronic systems utilizing an optimisation approach. We propose to investigate a novel framework for mechatronic system design. The novelty and originality being the use...... of optimisation techniques. The methods used to optimise/design within the classical disciplines will be identified and extended to mechatronic system design....

  12. Analysis and optimisation of heterogeneous real-time embedded systems

    DEFF Research Database (Denmark)

    Pop, Paul; Eles, Petru; Peng, Zebo

    2005-01-01

    . The success of such new design methods depends on the availability of analysis and optimisation techniques. Analysis and optimisation techniques for heterogeneous real-time embedded systems are presented in the paper. The authors address in more detail a particular class of such systems called multi...... of application messages to frames. Optimisation heuristics for frame packing aimed at producing a schedulable system are presented. Extensive experiments and a real-life example show the efficiency of the frame-packing approach....

  13. Analysis and optimisation of heterogeneous real-time embedded systems

    DEFF Research Database (Denmark)

    Pop, Paul; Eles, Petru; Peng, Zebo

    2006-01-01

    . The success of such new design methods depends on the availability of analysis and optimisation techniques. Analysis and optimisation techniques for heterogeneous real-time embedded systems are presented in the paper. The authors address in more detail a particular class of such systems called multi...... of application messages to frames. Optimisation heuristics for frame packing aimed at producing a schedulable system are presented. Extensive experiments and a real-life example show the efficiency of the frame-packing approach....

  14. Carbon dioxide poisoning: a literature review of an often forgotten cause of intoxication in the emergency department.

    Science.gov (United States)

    Permentier, Kris; Vercammen, Steven; Soetaert, Sylvia; Schellemans, Christian

    2017-12-01

    The goal of this article was to provide an overview of the literature available on carbon dioxide intoxication. Articles were included based on their focus on medical or physiological effects of carbon dioxide. Studies related to decompression sickness were excluded. Mechanisms of carbon dioxide poising (both as an asphyxiant and as a toxicant) were described. Our review suggested that precautions are needed when handling dry ice or while working in confined spaces. Pre-hospital responders also need to pay attention for the possible diagnosis of CO 2 intoxication for their own safety. When confronted with a victim, he/she should be removed from the dangerous area as fast as possible and oxygen should be administered. Without adequate treatment, victims may show acute reduced cognitive performance, respiratory failure, and circulatory arrest. Therefore, carbon dioxide poisoning is a rare but not to miss diagnosis in the emergency department.

  15. Innovative Ingredients and Emerging Technologies for Controlling Ice Recrystallization, Texture, and Structure Stability in Frozen Dairy Desserts: A Review.

    Science.gov (United States)

    Soukoulis, Christos; Fisk, Ian

    2016-11-17

    Over the past decade, ice cream manufacturers have developed a strong understanding of the functionality of key ingredients and processing, developing effective explanations for the link between structure forming agents, stability mechanisms, and perceived quality. Increasing demand for products perceived as healthier/more natural with minimal processing has identified a number of new tools to improve quality and storage stability of frozen dairy desserts. Ingredients such as dietary fiber, polysaccharides, prebiotics, alternate sweeteners, fat sources rich in unsaturated fatty acids and ice strucsturing proteins (ISP) have been successfully applied as cryoprotective, texturizing, and structuring agents. Emerging minimal processing technologies including hydrostatic pressure processing, ultrasonic or high pressure assisted freezing, low temperature extrusion and enzymatically induced biopolymers crosslinking have been evaluated for their ability to improve colloidal stability, texture and sensory quality. It is therefore timely for a comprehensive review.

  16. Flotation process control optimisation at Prominent Hill

    International Nuclear Information System (INIS)

    Lombardi, Josephine; Muhamad, Nur; Weidenbach, M.

    2012-01-01

    OZ Minerals' Prominent Hill copper- gold concentrator is located 130 km south east of the town of Coober Pedy in the Gawler Craton of South Australia. The concentrator was built in 2008 and commenced commercial production in early 2009. The Prominent Hill concentrator is comprised of a conventional grinding and flotation processing plant with a 9.6 Mtpa ore throughput capacity. The flotation circuit includes six rougher cells, an IseMill for regrinding the rougher concentrate and a Jameson cell heading up the three stage conventional cell cleaner circuit. In total there are four level controllers in the rougher train and ten level controllers in the cleaning circuit for 18 cells. Generic proportional — integral and derivative (PID) control used on the level controllers alone propagated any disturbances downstream in the circuit that were generated from the grinding circuit, hoppers, between cells and interconnected banks of cells, having a negative impact on plant performance. To better control such disturbances, FloatStar level stabiliser was selected for installation on the flotation circuit to account for the interaction between the cells. Multivariable control was also installed on the five concentrate hoppers to maintain consistent feed to the cells and to the IsaMill. An additional area identified for optimisation in the flotation circuit was the mass pull rate from the rougher cells. FloatStar flow optimiser was selected to be installed subsequent to the FloatStar level stabiliser. This allowed for a unified, consistent and optimal approach to running the rougher circuit. This paper describes the improvement in the stabilisation of the circuit achieved by the FloatStar level stabiliser by using the interaction matrix between cell level controllers and the results and benefits of implementing the FloatStar flow optimiser on the rougher train.

  17. Effectiveness of Interventions to Decrease Image Ordering for Low Back Pain Presentations in the Emergency Department: A Systematic Review.

    Science.gov (United States)

    Liu, Chaocheng; Desai, Shashwat; Krebs, Lynette D; Kirkland, Scott W; Keto-Lambert, Diana; Rowe, Brian H

    2018-01-08

    Low back pain (LBP) is an extremely frequent reason for patients to present to an emergency department (ED). Despite evidence against the utility of imaging, simple and advanced imaging (i.e., computed tomography [CT], magnetic resonance imaging) for patients with LBP has become increasingly frequent in the ED. The objective of this review was to identify and examine the effectiveness of interventions aimed at reducing image ordering in the ED for LBP patients. A protocol was developed a priori, following the PRISMA guidelines, and registered with PROSPERO. Six bibliographic databases (including MEDLINE, EMBASE, EBM Reviews, SCOPUS, CINAHL, and Dissertation Abstracts) and the gray literature were searched. Comparative studies assessing interventions that targeted image ordering in the ED for adult patients with LBP were eligible for inclusion. Two reviewers independently screened study eligibility and completed data extraction. Study quality was completed independently by two reviewers using the before-after quality assessment checklist, with a third-party mediator resolving any differences. Due to a limited number of studies and significant heterogeneity, only a descriptive analysis was performed. The search yielded 603 unique citations of which a total of five before-after studies were included. Quality assessment identified potential biases relating to comparability between the pre- and postintervention groups, reliable assessment of outcomes, and an overall lack of information on the intervention (i.e., time point, description, intervention data collection). The type of interventions utilized included clinical decision support tools, clinical practice guidelines, a knowledge translation initiative, and multidisciplinary protocols. Overall, four studies reported a decrease in the relative percentage change in imaging in a specific image modality (22.7%-47.4%) following implementation of the interventions; however, one study reported a 35% increase in patient

  18. The genetics of multiple sclerosis: review of current and emerging candidates

    Science.gov (United States)

    Muñoz-Culla, Maider; Irizar, Haritz; Otaegui, David

    2013-01-01

    Multiple sclerosis (MS) is a complex disease in which environmental, genetic, and epigenetic factors determine the risk of developing the disease. The human leukocyte antigen region is the strongest susceptibility locus linked to MS, but it does not explain the whole heritability of the disease. To find other non-human leukocyte antigen loci associated with the disease, high-throughput genotyping, sequencing, and gene-expression studies have been performed, producing a valuable quantity of information. An overview of the genomic and expression studies is provided in this review, as well as microRNA-expression studies, highlighting the importance of combining all the layers of information in order to elucidate the causes or pathological mechanisms occurring in the disease. Genetics in MS is a promising field that is presumably going to be very productive in the next decade understanding the cross talk between all the factors contributing to the development of MS. PMID:24019748

  19. The structure and emerging trends of construction safety management research: a bibliometric review.

    Science.gov (United States)

    Liang, Huakang; Zhang, Shoujian; Su, Yikun

    2018-03-29

    Recently, construction safety management (CSM) practices and systems have become important topics for stakeholders to take care of human resources. However, few studies have attempted to map the global research on CSM. A comprehensive bibliometric review was conducted in this study based on multiple methods. In total, 1172 CSM-related papers from the Web of Science Core Collection database were examined. The analyses focused on publication year, country-institute, publication source, author and research topics. The results indicated that the USA, China, Australia and the UK took leading positions in CSM research. Two branches of journals were identified, namely the branch of engineering science and that of safety science and social science. Additionally, seven themes together with 28 specific topics were detected to allow researchers to track the main structure and temporal evolution of CSM research. Finally, the main research trends and potential research directions were discussed to guide the future research.

  20. Evidence Aid: Using Systematic Reviews to Improve Access to Evidence for Humanitarian Emergencies

    Directory of Open Access Journals (Sweden)

    Mike Clarke

    2017-10-01

    Full Text Available Evidence Aid is an international initiative to improve access to reliable evidence that will help people and organisations make well-informed decisions about interventions, actions and strategies in the disaster setting. It focuses on systematic reviews as the most reliable source of research evidence, maximising the power of existing research, avoiding undue emphasis on single studies and reducing the waste associated with research that is ignored or not accessible to decision makers. Evidence Aid is knowledge champion for influencers of the humanitarian sector, including funders, policy makers, NGOs, and humanitarian professionals. Evidence Aid was established by members of the Cochrane Collaboration after the Indian Ocean tsunami of December 2004. It provides access to information relevant to disaster risk reduction, planning, response, recovery, resilience and rehabilitation. This presentation will discuss the need for Evidence Aid, and describes its activities.Find out more about Mike.

  1. Augmented Reality in Neurosurgery: A Review of Current Concepts and Emerging Applications.

    Science.gov (United States)

    Guha, Daipayan; Alotaibi, Naif M; Nguyen, Nhu; Gupta, Shaurya; McFaul, Christopher; Yang, Victor X D

    2017-05-01

    Augmented reality (AR) superimposes computer-generated virtual objects onto the user's view of the real world. Among medical disciplines, neurosurgery has long been at the forefront of image-guided surgery, and it continues to push the frontiers of AR technology in the operating room. In this systematic review, we explore the history of AR in neurosurgery and examine the literature on current neurosurgical applications of AR. Significant challenges to surgical AR exist, including compounded sources of registration error, impaired depth perception, visual and tactile temporal asynchrony, and operator inattentional blindness. Nevertheless, the ability to accurately display multiple three-dimensional datasets congruently over the area where they are most useful, coupled with future advances in imaging, registration, display technology, and robotic actuation, portend a promising role for AR in the neurosurgical operating room.

  2. Evaluation of emergency department performance - a systematic review on recommended performance and quality-in-care measures.

    Science.gov (United States)

    Sørup, Christian Michel; Jacobsen, Peter; Forberg, Jakob Lundager

    2013-08-09

    Evaluation of emergency department (ED) performance remains a difficult task due to the lack of consensus on performance measures that reflects high quality, efficiency, and sustainability. To describe, map, and critically evaluate which performance measures that the published literature regard as being most relevant in assessing overall ED performance. Following the PRISMA guidelines, a systematic literature review of review articles reporting accentuated ED performance measures was conducted in the databases of PubMed, Cochrane Library, and Web of Science. Study eligibility criteria includes: 1) the main purpose was to discuss, analyse, or promote performance measures best reflecting ED performance, 2) the article was a review article, and 3) the article reported macro-level performance measures, thus reflecting an overall departmental performance level. A number of articles addresses this study's objective (n = 14 of 46 unique hits). Time intervals and patient-related measures were dominant in the identified performance measures in review articles from US, UK, Sweden and Canada. Length of stay (LOS), time between patient arrival to initial clinical assessment, and time between patient arrivals to admission were highlighted by the majority of articles. Concurrently, "patients left without being seen" (LWBS), unplanned re-attendance within a maximum of 72 hours, mortality/morbidity, and number of unintended incidents were the most highlighted performance measures that related directly to the patient. Performance measures related to employees were only stated in two of the 14 included articles. A total of 55 ED performance measures were identified. ED time intervals were the most recommended performance measures followed by patient centeredness and safety performance measures. ED employee related performance measures were rarely mentioned in the investigated literature. The study's results allow for advancement towards improved performance measurement and

  3. Efficacy of hospital in the home services providing care for patients admitted from emergency departments: an integrative review.

    Science.gov (United States)

    Varney, Jane; Weiland, Tracey J; Jelinek, George

    2014-06-01

    Increases in emergency department (ED) demand may compromise patient outcomes, leading not only to overcrowding in the ED, increased ED waiting times and increased ED length of stay, but also compromising patient safety; the risk of adverse events is known to rise in the presence of overcrowding. Hospital in the home (HiTH) services may offer one means of reducing ED demand. This integrative review sought to assess the efficacy of admission-avoidance HiTH services that admit patients directly from the ED. Papers published between 1995 and 2013 were identified through searches of Medline, CINAHL and Google. English-language studies that assessed the efficacy of a HiTH service and that recruited at least one-third of the participants directly from the ED were included in the review. A HiTH service was considered one that provided health professional support to patients at home for a time-limited period, thus avoiding the need for hospitalization. Twenty-two articles met the inclusion criteria for this review. The interventions were diverse in terms of the clinical interventions delivered, the range and intensity of health professional input and the conditions treated. The studies included in the review found no effect on clinical outcomes, rates of adverse events or complications, although patient satisfaction and costs were consistently and favourably affected by HiTH treatment. Given evidence suggesting that HiTH services which recruit patients directly from the ED contribute to cost-savings, greater patient satisfaction and safety and efficacy outcomes that are at least equivalent to those associated with hospital-based care, the expansion of such programmes might therefore be considered a priority for policy makers.

  4. Diagnosis and management of food allergies: new and emerging options: a systematic review

    Directory of Open Access Journals (Sweden)

    O’Keefe AW

    2014-10-01

    Full Text Available Andrew W O'Keefe,1,2 Sarah De Schryver,1 Jennifer Mill,3 Christopher Mill,3 Alizee Dery,1 Moshe Ben-Shoshan1 1Division of Pediatric Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada; 2Department of Pediatrics, Faculty of Medicine, Memorial University of Newfoundland, St John's, NL, Canada; 3Division of Clinical Epidemiology, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada Abstract: It is reported that 6% of children and 3% of adults have food allergies, with studies suggesting increased prevalence worldwide over the last few decades. Despite this, our diagnostic capabilities and techniques for managing patients with food allergies remain limited. We have conducted a systematic review of literature published within the last 5 years on the diagnosis and management of food allergies. While the gold standard for diagnosis remains the double-blind, placebo-controlled food challenge, this assessment is resource intensive and impractical in most clinical situations. In an effort to reduce the need for the double-blind, placebo-controlled food challenge, several risk-stratifying tests are employed, namely skin prick testing, measurement of serum-specific immunoglobulin E levels, component testing, and open food challenges. Management of food allergies typically involves allergen avoidance and carrying an epinephrine autoinjector. Clinical research trials of oral immunotherapy for some foods, including peanut, milk, egg, and peach, are under way. While oral immunotherapy is promising, its readiness for clinical application is controversial. In this review, we assess the latest studies published on the above diagnostic and management modalities, as well as novel strategies in the diagnosis and management of food allergy. Keywords: skin prick testing, oral challenge, specific IgE, component testing, oral immunotherapy, epinephrine

  5. Bladder Cancer in HIV-infected Adults: An Emerging Issue? Case-Reports and Systematic Review.

    Directory of Open Access Journals (Sweden)

    Sylvain Chawki

    Full Text Available Non-AIDS-related malignancies now represent a frequent cause of death among HIV-infected patients. Albeit bladder cancer is one of the most common malignancies worldwide, it has been rarely reported among HIV-infected patients. We wished to assess the prevalence and characteristics of bladder cancer in HIV-infected patients.We conducted a single center retrospective study from 1998 to 2013 in a university hospital in Paris. Cases of bladder cancer among HIV-infected patients were identified using the electronic records of the hospital database and of the HIV-infected cohort. Patient characteristics and outcomes were retrieved from patients charts. A systematic review of published cases of bladder cancers in patients with HIV-infection was also performed.During the study period we identified 15 HIV-infected patients (0.2% of the cohort with a bladder cancer. Patients were mostly men (73% and smokers (67%, with a median age of 56 years at cancer diagnosis. Bladder cancer was diagnosed a median of 14 years after HIV-infection. Most patients were on ART (86% with median current and nadir CD4 cell counts of 506 and 195 cells/mm3, respectively. Haematuria (73% was the most frequent presenting symptom and HPV-associated lesions were seen in 6/10 (60% patients. Histopathology showed transitional cell carcinoma in 80% and a high proportion of tumors with muscle invasion (47% and high histologic grade (73%. One-year survival rate was 74.6%. The systematic review identified 13 additional cases of urothelial bladder cancers which shared similar features.Bladder cancers in HIV-infected patients remain rare but may occur in relatively young patients with a low nadir CD4 cell count, have aggressive pathological features and can be fatal.

  6. How can we identify patients with delirium in the emergency department?: A review of available screening and diagnostic tools.

    Science.gov (United States)

    Tamune, Hidetaka; Yasugi, Daisuke

    2017-09-01

    Delirium is a widespread and serious but under-recognized problem. Increasing evidence argues that emergency health care providers need to assess the mental status of the patient as the "sixth vital sign". A simple, sensitive, time-efficient, and cost-effective tool is needed to identify delirium in patients in the emergency department (ED); however, a stand-alone measurement has not yet been established despite previous studies partly because the differential diagnosis of dementia and delirium superimposed on dementia (DSD) is too difficult to achieve using a single indicator. To fill up the gap, multiple aspects of a case should be assessed including inattention and arousal. For instance, we proposed the 100 countdown test as an effective means of detecting inattention. Further dedicated studies are warranted to shed light on the pathophysiology and better management of dementia, delirium and/or "altered mental status". We reviewed herein the clinical questions and controversies concerning delirium in an ED setting. Copyright © 2017 Elsevier Inc. All rights reserved.

  7. Risk based test interval and maintenance optimisation - Application and uses

    International Nuclear Information System (INIS)

    Sparre, E.

    1999-10-01

    The project is part of an IAEA co-ordinated Research Project (CRP) on 'Development of Methodologies for Optimisation of Surveillance Testing and Maintenance of Safety Related Equipment at NPPs'. The purpose of the project is to investigate the sensitivity of the results obtained when performing risk based optimisation of the technical specifications. Previous projects have shown that complete LPSA models can be created and that these models allow optimisation of technical specifications. However, these optimisations did not include any in depth check of the result sensitivity with regards to methods, model completeness etc. Four different test intervals have been investigated in this study. Aside from an original, nominal, optimisation a set of sensitivity analyses has been performed and the results from these analyses have been compared to the original optimisation. The analyses indicate that the result of an optimisation is rather stable. However, it is not possible to draw any certain conclusions without performing a number of sensitivity analyses. Significant differences in the optimisation result were discovered when analysing an alternative configuration. Also deterministic uncertainties seem to affect the result of an optimisation largely. The sensitivity of failure data uncertainties is important to investigate in detail since the methodology is based on the assumption that the unavailability of a component is dependent on the length of the test interval

  8. Improving Vector Evaluated Particle Swarm Optimisation by incorporating nondominated solutions.

    Science.gov (United States)

    Lim, Kian Sheng; Ibrahim, Zuwairie; Buyamin, Salinda; Ahmad, Anita; Naim, Faradila; Ghazali, Kamarul Hawari; Mokhtar, Norrima

    2013-01-01

    The Vector Evaluated Particle Swarm Optimisation algorithm is widely used to solve multiobjective optimisation problems. This algorithm optimises one objective using a swarm of particles where their movements are guided by the best solution found by another swarm. However, the best solution of a swarm is only updated when a newly generated solution has better fitness than the best solution at the objective function optimised by that swarm, yielding poor solutions for the multiobjective optimisation problems. Thus, an improved Vector Evaluated Particle Swarm Optimisation algorithm is introduced by incorporating the nondominated solutions as the guidance for a swarm rather than using the best solution from another swarm. In this paper, the performance of improved Vector Evaluated Particle Swarm Optimisation algorithm is investigated using performance measures such as the number of nondominated solutions found, the generational distance, the spread, and the hypervolume. The results suggest that the improved Vector Evaluated Particle Swarm Optimisation algorithm has impressive performance compared with the conventional Vector Evaluated Particle Swarm Optimisation algorithm.

  9. Improving Vector Evaluated Particle Swarm Optimisation by Incorporating Nondominated Solutions

    Directory of Open Access Journals (Sweden)

    Kian Sheng Lim

    2013-01-01

    Full Text Available The Vector Evaluated Particle Swarm Optimisation algorithm is widely used to solve multiobjective optimisation problems. This algorithm optimises one objective using a swarm of particles where their movements are guided by the best solution found by another swarm. However, the best solution of a swarm is only updated when a newly generated solution has better fitness than the best solution at the objective function optimised by that swarm, yielding poor solutions for the multiobjective optimisation problems. Thus, an improved Vector Evaluated Particle Swarm Optimisation algorithm is introduced by incorporating the nondominated solutions as the guidance for a swarm rather than using the best solution from another swarm. In this paper, the performance of improved Vector Evaluated Particle Swarm Optimisation algorithm is investigated using performance measures such as the number of nondominated solutions found, the generational distance, the spread, and the hypervolume. The results suggest that the improved Vector Evaluated Particle Swarm Optimisation algorithm has impressive performance compared with the conventional Vector Evaluated Particle Swarm Optimisation algorithm.

  10. Nontraumatic hypotension and shock in the emergency department and the prehospital setting, prevalence, etiology, and mortality: a systematic review.

    Directory of Open Access Journals (Sweden)

    Jon Gitz Holler

    Full Text Available Acute patients presenting with hypotension in the prehospital or emergency department (ED setting are in need of focused management and knowledge of the epidemiology characteristics might help the clinician. The aim of this review was to address prevalence, etiology and mortality of nontraumatic hypotension (SBP ≤ 90 mmHg with or without the presence of shock in the prehospital and ED setting.We performed a systematic literature search up to August 2013, using Medline, Embase, Cinahl, Dare and The Cochrane Library. The analysis and eligibility criteria were documented according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA-guidelines and The Cochrane Collaboration. No restrictions on language, publication date, or status were imposed. We used the Newcastle-Ottawa quality assessment scale (NOS-scale and the Strengthening the Reporting of Observational studies in Epidemiology (STROBE-statement to assess the quality.Six observational studies were considered eligible for analysis based on the evaluation of 11,880 identified papers. Prehospital prevalence of hypotension was 19.5/1000 emergency medicine service (EMS contacts, and the prevalence of hypotensive shock was 9.5-19/1000 EMS contacts with an inhospital mortality of shock between 33 to 52%. ED prevalence of hypotension was 4-13/1000 contacts with a mortality of 12%. Information on mortality, prevalence and etiology of shock in the ED was limited. A meta-analysis was not feasible due to substantial heterogeneity between studies.There is inadequate evidence to establish concise estimates of the characteristics of nontraumatic hypotension and shock in the ED or in the prehospital setting. The available studies suggest that 2% of EMS contacts present with nontraumatic hypotension while 1-2% present with shock. The inhospital mortality of prehospital shock is 33-52%. Prevalence of hypotension in the ED is 1% with an inhospital mortality of 12%. Prevalence

  11. Optimising end of generation of Magnox reactors

    International Nuclear Information System (INIS)

    Hall, D.; Hopper, E.D.A.

    2014-01-01

    Designing, justifying and gaining regulatory approval for optimised, terminal fuel cycles for the last 4 of the 13 strong Magnox Fleet is described, covering: - constraints set by the plant owner's integrated closure plan, opportunities for innovative fuel cycles while preserving flexibility to respond to business changes; - methods of collectively determining best options for each site; - selected strategies including lower fuel element retention and inter-reactor transfer of fuel; - the required work scope, its technical, safety case and resource challenges and how they were met; - achieving additional electricity generation worth in excess of Pound 1 b from 4 sites (a total of 8 reactors); - the keys to success. (authors)

  12. Biorefinery plant design, engineering and process optimisation

    DEFF Research Database (Denmark)

    Holm-Nielsen, Jens Bo; Ehimen, Ehiazesebhor Augustine

    2014-01-01

    Before new biorefinery systems can be implemented, or the modification of existing single product biomass processing units into biorefineries can be carried out, proper planning of the intended biorefinery scheme must be performed initially. This chapter outlines design and synthesis approaches...... applicable for the planning and upgrading of intended biorefinery systems, and includes discussions on the operation of an existing lignocellulosic-based biorefinery platform. Furthermore, technical considerations and tools (i.e., process analytical tools) which could be applied to optimise the operations...... of existing and potential biorefinery plants are elucidated....

  13. Specification, Verification and Optimisation of Business Processes

    DEFF Research Database (Denmark)

    Herbert, Luke Thomas

    is extended with stochastic branching, message passing and reward annotations which allow for the modelling of resources consumed during the execution of a business process. Further, it is shown how this structure can be used to formalise the established business process modelling language Business Process...... fault tree analysis and the automated optimisation of business processes by means of an evolutionary algorithm. This work is motivated by problems that stem from the healthcare sector, and examples encountered in this field are used to illustrate these developments....

  14. Topology Optimisation for Coupled Convection Problems

    DEFF Research Database (Denmark)

    Alexandersen, Joe; Andreasen, Casper Schousboe; Aage, Niels

    stabilised finite elements implemented in a parallel multiphysics analysis and optimisation framework DFEM [1], developed and maintained in house. Focus is put on control of the temperature field within the solid structure and the problems can therefore be seen as conjugate heat transfer problems, where heat...... conduction governs in the solid parts of the design domain and couples to convection-dominated heat transfer to a surrounding fluid. Both loosely coupled and tightly coupled problems are considered. The loosely coupled problems are convection-diffusion problems, based on an advective velocity field from...

  15. Cost optimisation studies of high power accelerators

    Energy Technology Data Exchange (ETDEWEB)

    McAdams, R.; Nightingale, M.P.S.; Godden, D. [AEA Technology, Oxon (United Kingdom)] [and others

    1995-10-01

    Cost optimisation studies are carried out for an accelerator based neutron source consisting of a series of linear accelerators. The characteristics of the lowest cost design for a given beam current and energy machine such as power and length are found to depend on the lifetime envisaged for it. For a fixed neutron yield it is preferable to have a low current, high energy machine. The benefits of superconducting technology are also investigated. A Separated Orbit Cyclotron (SOC) has the potential to reduce capital and operating costs and intial estimates for the transverse and longitudinal current limits of such machines are made.

  16. Dermatologic emergencies

    Directory of Open Access Journals (Sweden)

    M.P. Simón Díaz

    2016-01-01

    Full Text Available Dermatologic emergencies represent about 8–20% of the diseases seen in the Emergency Department of hospitals. It is often a challenge for primary care physicians to differentiate mundane skin ailments from more serious, life threatening conditions that require immediate intervention. In this review we included the following conditions: Stevens-Johnson syndrome/toxic epidermal necrosis, pemphigus vulgaris, toxic shock syndrome, fasciitis necrotising, angioedema/urticaria, meningococcemia, Lyme disease and Rocky Mountain spotted fever.

  17. The ASCAT soil moisture product. A Review of its specifications, validation results, and emerging applications

    Energy Technology Data Exchange (ETDEWEB)

    Wagner, Wolfgang; Hahn, Sebastian; Kidd, Richard [Vienna Univ. of Technology (Austria). Dept. of Geodesy and Geoinformation] [and others

    2013-02-15

    Many physical, chemical and biological processes taking place at the land surface are strongly influenced by the amount of water stored within the upper soil layers. Therefore, many scientific disciplines require soil moisture observations for developing, evaluating and improving their models. One of these disciplines is meteorology where soil moisture is important due to its control on the exchange of heat and water between the soil and the lower atmosphere. Soil moisture observations may thus help to improve the forecasts of air temperature, air humidity and precipitation. However, until recently, soil moisture observations had only been available over a limited number of regional soil moisture networks. This has hampered scientific progress as regards the characterisation of land surface processes not just in meteorology but many other scientific disciplines as well. Fortunately, in recent years, satellite soil moisture data have increasingly become available. One of the freely available global soil moisture data sets is derived from the backscatter measurements acquired by the Advanced Scatterometer (ASCAT) that is a C-band active microwave remote sensing instrument flown on board of the Meteorological Operational (METOP) satellite series. ASCAT was designed to observe wind speed and direction over the oceans and was initially not foreseen for monitoring soil moisture over land. Yet, as argued in this review paper, the characteristics of the ASCAT instrument, most importantly its wavelength (5.7 cm), its high radiometric accuracy, and its multiple-viewing capabilities make it an attractive sensor for measuring soil moisture. Moreover, given the operational status of ASCAT, and its promising long-term prospects, many geoscientific applications might benefit from using ASCAT soil moisture data. Nonetheless, the ASCAT soil moisture product is relatively complex, requiring a good understanding of its properties before it can be successfully used in applications. To

  18. The ASCAT Soil Moisture Product: A Review of its Specifications, Validation Results, and Emerging Applications

    Directory of Open Access Journals (Sweden)

    Wolfgang Wagner

    2013-02-01

    Full Text Available Many physical, chemical and biological processes taking place at the land surface are strongly influenced by the amount of water stored within the upper soil layers. Therefore, many scientific disciplines require soil moisture observations for developing, evaluating and improving their models. One of these disciplines is meteorology where soil moisture is important due to its control on the exchange of heat and water between the soil and the lower atmosphere. Soil moisture observations may thus help to improve the forecasts of air temperature, air humidity and precipitation. However, until recently, soil moisture observations had only been available over a limited number of regional soil moisture networks. This has hampered scientific progress as regards the characterisation of land surface processes not just in meteorology but many other scientific disciplines as well. Fortunately, in recent years, satellite soil moisture data have increasingly become available. One of the freely available global soil moisture data sets is derived from the backscatter measurements acquired by the Advanced Scatterometer (ASCAT that is a C-band active microwave remote sensing instrument flown on board of the Meteorological Operational (METOP satellite series. ASCAT was designed to observe wind speed and direction over the oceans and was initially not foreseen for monitoring soil moisture over land. Yet, as argued in this review paper, the characteristics of the ASCAT instrument, most importantly its wavelength (5.7 cm, its high radiometric accuracy, and its multiple-viewing capabilities make it an attractive sensor for measuring soil moisture. Moreover, given the operational status of ASCAT, and its promising long-term prospects, many geoscientific applications might benefit from using ASCAT soil moisture data. Nonetheless, the ASCAT soil moisture product is relatively complex, requiring a good understanding of its properties before it can be successfully used in

  19. Implementation of VGB recommendations for optimisation of the VGB Human Factors System, results

    International Nuclear Information System (INIS)

    Toepner, H.

    1999-01-01

    A major objective of the review and adjustment activities was to incorporate a more holistic approach in the VGB Human Factors System for optimisation of the man-machine interface, so as to take into account in addition to ergonomic and work flow aspects all other competences in an NPP with an influence on the human performance, frequency of occurrence, or probability of occurrence, of human errors in operation. (orig./CB) [de

  20. An empirical study on website usability elements and how they affect search engine optimisation

    OpenAIRE

    Eugene B. Visser; Melius Weideman

    2011-01-01

    The primary objective of this research project was to identify and investigate the website usability attributes which are in contradiction with search engine optimisation elements. The secondary objective was to determine if these usability attributes affect conversion. Although the literature review identifies the contradictions, experts disagree about their existence.An experiment was conducted, whereby the conversion and/or traffic ratio results of an existing control website were compared...

  1. Eosinophilic Esophagitis (EoE: an emerging disease in childhood - Review of diagnostic and management strategies

    Directory of Open Access Journals (Sweden)

    Jorge Amil Dias

    2014-11-01

    Full Text Available Eosinophilic esophagitis (EoE is a chronic immune/antigen mediated inflammatory disease of the esophagus. It comprises a separate entity of increasing incidence and prevalence in children and adults. The disease is characterized by histological evidence of dense esophageal tissue eosinophilia in the presence of a variety of upper GI symptoms including vomiting, dysphagia, food impaction and odynophagia. Cornerstone of treatment is dietary intervention and/or the off-label use of swallowed topical corticosteroids. New drug therapies are under investigation. In this review we focus on the diagnostic approach and the currently available treatment strategies. Keywords: Eosinophilic esophagitis, oral viscous budesonide, fluticasone propionate, oral steroids, amino acid-based formula, empiric elimination diet, targeted elimination dietKey points:1.A trial with antisecretory medication is necessary to exclude GERD and PPI-responsive esophageal eosinophilia and to fulfil the diagnostic criteria of EoE. 2.Elimination diet and/or off-label use of topical corticosteroids are effective measures for treating EoE. 3.Elimination diet is the first line treatment in atopic children. 4.Systemic corticosteroids are reserved for patients with severe disease requiring immediate relief, or when other treatments have failed. 5.Cromolyn sodium (sodium cromoglycate and leukotriene receptor antagonists, are not currently recommended for treating EoE, due to lack of solid evidence of benefit.6.Immunosuppressive drugs and biologics have shown some value but effect has been limited and therefore not yet recommended as standard therapy.

  2. Emerging nanotechnology based strategies for diagnosis and therapeutics of urinary tract infections: A review.

    Science.gov (United States)

    Kumar, M S; Das, A P

    2017-11-01

    At present, various diagnostic and therapeutic approaches are available for urinary tract infections. But, still the quest for development of more rapid, accurate and reliable approach is an unending process. The pathogens, especially uropathogens are adapting to new environments and antibiotics day by day rapidly. Therefore, urinary tract infections are evolving as hectic and difficult to eradicate, increasing the economic burden to the society. The technological advances should be able to compete the adaptability characteristics of microorganisms to combat their growth in new environments and thereby preventing their infections. Nanotechnology is at present an extensively developing area of immense scientific interest since it has diverse potential applications in biomedical field. Nanotechnology may be combined with cellular therapy approaches to overcome the limitations caused by conventional therapeutics. Nanoantibiotics and drug delivery using nanotechnology are currently growing areas of research in biomedical field. Recently, various categories of antibacterial nanoparticles and nanocarriers for drug delivery have shown their potential in the treatment of infectious diseases. Nanoparticles, compared to conventional antibiotics, are more beneficial in terms of decreasing toxicity, prevailing over resistance and lessening costs. Nanoparticles present long term therapeutic effects since they are retained in body for relatively longer periods. This review focuses on recent advances in the field of nanotechnology, principally emphasizing diagnostics and therapeutics of urinary tract infections. Copyright © 2017 Elsevier B.V. All rights reserved.

  3. Emergency and disaster preparedness for chronically ill patients: a review of recommendations

    Directory of Open Access Journals (Sweden)

    Tomio J

    2014-12-01

    Full Text Available Jun Tomio,1 Hajime Sato2 1Department of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; 2Department of Health Policy and Technology Assessment, National Institute of Public Health, Wako, Japan Abstract: Recent disasters, especially those in developed countries, have highlighted the importance of disaster preparedness measures for chronic diseases. A number of surviving patients experienced the exacerbation of a chronic illness, such as hypertension, diabetes, cancer, and chronic respiratory diseases, due to disaster-related stress, interruption of care, or both; for some patients, these exacerbations resulted in death. Here, we review reports from recent disasters in developed countries and summarize the recommendations for disaster preparedness of chronically ill patients. A considerable number of recommendations based on the lessons learned from recent disasters have been developed, and they provide practical and essential steps to prevent treatment interruption during and after a disaster. To improve preparedness efforts, we suggest that health care providers should be aware of the following three suggestions: 1 recommendations should be evidence-based; 2 recommendations should contain consistent messages; and 3 recommendations should be feasible. Keywords: disaster, chronic illness, preparedness

  4. A review on oral liquid as an emerging technology in controlled drug delivery system.

    Science.gov (United States)

    Torne, Sangmesh Raosaheb; Sheela, Angappan; Sarada, N C

    2017-12-03

    The oral liquid drug delivery system (OLDDS) remains as the primary choice of dosage form, though challenging, for the pharmaceutical scientists. In the last two decades, Oral Liquid Controlled Release (OLCR) formulation has gained a lot of attention because of its advantages over the conventional dosage forms. The world of nanotechnology has paved multiple ways to administer the drug through oral cavity in liquid dosage form with an additional advantage of control over the release. In the current study, the various approaches towards the same have been discussed comprehensively to understand the different mechanisms of OLCR. This review also emphasizes on the existing techniques and the developments that have been made to improve on its efficacy including various formulation related factors. It also provides valuable insights into the role of polymers in the development of OLCR formulation that can be used in the management of Gastroesophageal reflux disease (GERD). Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

  5. A review of mild traumatic brain injury diagnostics: current perspectives, limitations, and emerging technology.

    Science.gov (United States)

    Cook, Glen A; Hawley, Jason S

    2014-10-01

    Mild traumatic brain injury (mTBI) or concussion is a common battlefield and in-garrison injury caused by transmission of mechanical forces to the head. The energy transferred in such events can cause structural and/or functional changes in the brain that manifest as focal neurological, cognitive, or behavioral dysfunction. Current diagnostic criteria for mTBI are highly limited, variable, and based on subjective self-report. The subjective nature of the symptoms, both in quantity and quality, together with their large overlap in other physical and behavioral maladies, limit the clinician's ability to accurately diagnose, treat, and make prognostic decisions after such injuries. These diagnostic challenges are magnified in an operational environment as well. The Department of Defense has invested significant resources into improving the diagnostic tools and accuracy for mTBI. This focus has been to supplement the clinician's examination with technology that is better able to objectify brain dysfunction after mTBI. Through this review, we discuss the current state of three promising technologies--soluble protein biomarkers, advanced neuroimaging, and quantitative electroencephalography--that are of particular interest within military medicine. Reprint & Copyright © 2014 Association of Military Surgeons of the U.S.

  6. Validating the Remotely Sensed Geography of Crime: A Review of Emerging Issues

    Directory of Open Access Journals (Sweden)

    Alice B. Kelly

    2014-12-01

    Full Text Available This paper explores the existing literature on the active detection of crimes using remote sensing technologies. The paper reviews sixty-one studies that use remote sensing to actively detect crime. Considering the serious consequences of misidentifying crimes or sites of crimes (e.g., opening that place and its residents up to potentially needless intrusion, intimidation, surveillance or violence, the authors were surprised to find a lack of rigorous validation of the remote sensing methods utilized in these studies. In some cases, validation was not mentioned, while in others, validation was severely hampered by security issues, rough terrain and weather conditions. The paper also considers the potential hazards of the use of Google Earth to identify crimes and criminals. The paper concludes by considering alternate, “second order” validation techniques that could add vital context and understanding to remotely sensed images in a law enforcement context. With this discussion, the authors seek to initiate a discussion on other potential “second order” validation techniques, as well as on the exponential growth of surveillance in our everyday lives.

  7. Perinatally acquired HIV infection in adolescents from sub-Saharan Africa: a review of emerging challenges.

    Science.gov (United States)

    Lowenthal, Elizabeth D; Bakeera-Kitaka, Sabrina; Marukutira, Tafireyi; Chapman, Jennifer; Goldrath, Kathryn; Ferrand, Rashida A

    2014-07-01

    Worldwide, more than three million children are infected with HIV, 90% of whom live in sub-Saharan Africa. As the HIV epidemic matures and antiretroviral treatment is scaled up, children with HIV are reaching adolescence in large numbers. The growing population of adolescents with perinatally acquired HIV infection living within this region presents not only unprecedented challenges but also opportunities to learn about the pathogenesis of HIV infection. In this Review, we discuss the changing epidemiology of paediatric HIV and the particular features of HIV infection in adolescents in sub-Saharan Africa. Longstanding HIV infection acquired when the immune system is not developed results in distinctive chronic clinical complications that cause severe morbidity. As well as dealing with chronic illness, HIV-infected adolescents have to confront psychosocial issues, maintain adherence to drugs, and learn to negotiate sexual relationships, while undergoing rapid physical and psychological development. Context-specific strategies for early identification of HIV infection in children and prompt linkage to care need to be developed. Clinical HIV care should integrate age-appropriate sexual and reproductive health and psychological, educational, and social services. Health-care workers will need to be trained to recognise and manage the needs of these young people so that the increasing numbers of children surviving to adolescence can access quality care beyond specialist services at low-level health-care facilities. Copyright © 2014 Elsevier Ltd. All rights reserved.

  8. The genetics of multiple sclerosis: review of current and emerging candidates

    Directory of Open Access Journals (Sweden)

    Muñoz-Culla M

    2013-08-01

    Full Text Available Maider Muñoz-Culla,1,2 Haritz Irizar,1,2 David Otaegui1,2 1Multiple Sclerosis Unit, Instituto Biodonostia, San Sebastián, Spain; 2Red Española de Esclerosis Múltiple (REEM, Barcelona, Spain Abstract: Multiple sclerosis (MS is a complex disease in which environmental, genetic, and epigenetic factors determine the risk of developing the disease. The human leukocyte antigen region is the strongest susceptibility locus linked to MS, but it does not explain the whole heritability of the disease. To find other non-human leukocyte antigen loci associated with the disease, high-throughput genotyping, sequencing, and gene-expression studies have been performed, producing a valuable quantity of information. An overview of the genomic and expression studies is provided in this review, as well as microRNA-expression studies, highlighting the importance of combining all the layers of information in order to elucidate the causes or pathological mechanisms occurring in the disease. Genetics in MS is a promising field that is presumably going to be very productive in the next decade understanding the cross talk between all the factors contributing to the development of MS. Keywords: multiple sclerosis, genetics, gene expression, microRNA

  9. Emerging role of apelin as a therapeutic target in cancer: a patent review.

    Science.gov (United States)

    Rayalam, Srujana; Della-Fera, Mary A; Kasser, Thomas; Warren, William; Baile, Clifton A

    2011-09-01

    Since tumors cannot grow or spread without forming new blood vessels, inhibiting angiogenesis is an excellent approach for the treatment of cancer. Further, inhibitors of angiogenesis have mild side effects since they act on endothelial cells, which eliminate the possibility of developing resistance or tolerance in tumor cells, unlike that seen with chemotherapy drugs. The anti-vascular endothelial growth factor (VEGF) monoclonal antibody bevacizumab acts by preventing new blood vessel formation in solid tumors and is approved by FDA to treat colorectal, lung, breast, glioblastoma and kidney cancers. The registration of this drug and its ongoing success in the clinic has validated the targeting of angiogenesis as an important approach to the treatment of solid tumors. Apelin is a novel angiogenic factor and recent studies indicate that apelin promotes angiogenesis, lymphangiogenesis and tumor growth in vivo and the angiogenic potential of apelin is similar to that of VEGF. Also, apelin expression is upregulated and has been shown to be associated with clinical outcome in certain human cancers. Thus, inhibition of apelin activity might lead to a new class of anti-angiogenesis drugs which should be more efficacious than those currently on the market due to their ability to be both anti-angiogenic as well as anti-lymphangiogenic. There are very few patents on the angiogenic effects of apelin and this review article focuses on these patented claims related to inhibiting apelin signaling and sheds more light on how blocking apelin signaling might open doors to a new class of angiogenic inhibitors.

  10. A Review of Emerging Technologies for the Management of Diabetes Mellitus.

    Science.gov (United States)

    Zarkogianni, Konstantia; Litsa, Eleni; Mitsis, Konstantinos; Wu, Po-Yen; Kaddi, Chanchala D; Cheng, Chih-Wen; Wang, May D; Nikita, Konstantina S

    2015-12-01

    High prevalence of diabetes mellitus (DM) along with the poor health outcomes and the escalated costs of treatment and care poses the need to focus on prevention, early detection and improved management of the disease. The aim of this paper is to present and discuss the latest accomplishments in sensors for glucose and lifestyle monitoring along with clinical decision support systems (CDSSs) facilitating self-disease management and supporting healthcare professionals in decision making. A critical literature review analysis is conducted focusing on advances in: 1) sensors for physiological and lifestyle monitoring, 2) models and molecular biomarkers for predicting the onset and assessing the progress of DM, and 3) modeling and control methods for regulating glucose levels. Glucose and lifestyle sensing technologies are continuously evolving with current research focusing on the development of noninvasive sensors for accurate glucose monitoring. A wide range of modeling, classification, clustering, and control approaches have been deployed for the development of the CDSS for diabetes management. Sophisticated multiscale, multilevel modeling frameworks taking into account information from behavioral down to molecular level are necessary to reveal correlations and patterns indicating the onset and evolution of DM. Integration of data originating from sensor-based systems and electronic health records combined with smart data analytics methods and powerful user centered approaches enable the shift toward preventive, predictive, personalized, and participatory diabetes care. The potential of sensing and predictive modeling approaches toward improving diabetes management is highlighted and related challenges are identified.

  11. Novel and emergent sandfly-borne phleboviruses in Asia Minor: a systematic review.

    Science.gov (United States)

    Ergunay, Koray; Ayhan, Nazli; Charrel, Remi N

    2017-03-01

    Sandfly-transmitted phleboviruses are globally spread agents causing febrile diseases and central nervous system infections. The activity of pathogenic phleboviruses, as well as several novel strains, has been reported from Turkey, a transboundary country connecting Asia, Europe, and Africa with suitable habitats for sandflies. This study overviews all published data on phleboviruses from Turkey and evaluates the impact from the virological, epidemiological, and public health perspectives. A systematic review of Web-based global and local resources was performed. Comparison and phylogenetic analyses of particular phlebovirus sequences were also undertaken. Through the evaluation of 1693 international and regional entries, 31 manuscripts providing data on case reports or outbreaks, serological surveillance, animal infections and exposure, virus characterization, vector surveillance, and/or diagnostics were accessed. Detailed information on 5 novel phleboviruses completely or partially characterized during 2008-2015 as well as on clinical and epidemiological features of major phleboviruses established as human pathogens such as Toscana virus and sandfly fever Sicilian virus has been compiled. The ongoing activity of these agents, as indicated by consistently reported symptomatic cases and confirmed exposure in vertebrates including humans, was noted. The circulation in the Anatolian peninsula of phleboviruses with surprising diversity as well as distinct virus species is documented. Specific phlebovirus strains constitute a public health threat for local populations and travelers and must be considered in the diagnostic workup of clinically compatible cases. Human health impact and epidemiological aspects of certain viruses require further investigation via intensive surveillance. Copyright © 2016 John Wiley & Sons, Ltd.

  12. Emergency preparedness

    International Nuclear Information System (INIS)

    1997-01-01

    In 1996 the Nuclear Regulatory Authority of the Slovak Republic (NRA SR) continued in systematic development of its activities in the field of emergency planning according to the concept adopted by the Authority and according to the concept for building Emergency headquarters (EH) adopted after establishing of Emergency Response Centre (ERC). Major efforts were focused not only on building up a quality EH, but also tasks associated with completion and incorporation of ERC into emergency planning and emergency managing. An important role in building ERC was played by international missions. Significant position among these missions was taken by missions from Great Britain, which in the past years made a significant contribution to building up ERC. These missions focused on review of newly created standard procedures, preparation and implementation of first emergency exercises of the EH. The emergency exercises in which NRA SR took place in 1996 are reviewed. In order to make the co-operation of the Authority with the selected Army units of SR more effective in solving extraordinary situations in nuclear energy, an agreement was signed between NRA SR and the Headquarters of the Army of SR, which will help significantly to the objective

  13. Emerging role of HPV self-sampling in cervical cancer screening for hard-to-reach women: Focused literature review.

    Science.gov (United States)

    Madzima, Tina R; Vahabi, Mandana; Lofters, Aisha

    2017-08-01

    To provide a focused critical review of the literature on the acceptability, feasibility, and uptake of human papillomavirus (HPV) self-sampling among hard-to-reach women. A focused search to obtain relevant literature published in English between 1997 and 2015 was done using PubMed and EMBASE using search terms including HPV self-test or HPV self-sample or HPV kit in combination with acceptability or feasibility . Only studies that focused on never-screened or underscreened populations were included in this review. Human papillomavirus self-sampling was found to be highly acceptable and feasible among these hard-to-reach women across most studies. Mailing of self-sampling kits has been shown to increase participation among hard-to reach women. Some concerns remain regarding adherence to further follow-up among high-risk women with positive test results for HPV after screening. There is a strong body of evidence to support the usefulness of HPV self-sampling in increasing participation of hard-to-reach women in screening programs (level I evidence). Convenience, privacy, ease of use, and, likely, cost-effectiveness of HPV self-sampling are driving forces in its emerging role in cervical cancer screening among hard-to-reach women. Key barriers to participation could be addressed by overcoming disparities in HPV-related knowledge and perceptions about cervical cancer screening. Copyright© the College of Family Physicians of Canada.

  14. Direct emergence of the dorsospinal artery from the aorta and spinal cord blood supply. Case reports and literature review

    International Nuclear Information System (INIS)

    Siclari, Francesca; Fasel, Jean H.D.; Gailloud, Philippe

    2006-01-01

    Direct emergence of a dorsospinal artery from the aorta is a rare anatomic variant, of which a total of seven cases have been reported. This report offers an additional angiographic observation and reviews the literature. Two observations of common intercostal trunks documented during spinal angiography are described. In the first observation, the common intercostal trunk provided complete blood supply to two adjacent vertebral levels (T11 and T12). In other words, the trunk included an intercostal branch and a dorsospinal branch for each level. In the second observation, the common intercostal trunk provided an intercostal branch for each level (T9 and T10), but only one dorsospinal branch (T10). An isolated dorsospinal artery (DA) originated separately from the aorta at the T9 level, and provided a significant contribution to the anterior spinal axis. The two reported cases illustrate the concept of ''complete'' versus ''incomplete'' common intercostal trunks. In instances where an incomplete trunk is documented, a separate DA originating directly from the aorta must be looked for. A review of the literature indicates a tendency for isolated DAs to participate in the blood supply to the spinal cord. (orig.)

  15. HVAC system optimisation-in-building section

    Energy Technology Data Exchange (ETDEWEB)

    Lu, L.; Cai, W.; Xie, L.; Li, S.; Soh, Y.C. [School of Electrical and Electronic Engineering, Nanyang Technological University, Singapore (Singapore)

    2004-07-01

    This paper presents a practical method to optimise in-building section of centralised Heating, Ventilation and Air-Conditioning (HVAC) systems which consist of indoor air loops and chilled water loops. First, through component characteristic analysis, mathematical models associated with cooling loads and energy consumption for heat exchangers and energy consuming devices are established. By considering variation of cooling load of each end user, adaptive neuro-fuzzy inference system (ANFIS) is employed to model duct and pipe networks and obtain optimal differential pressure (DP) set points based on limited sensor information. A mix-integer nonlinear constraint optimization of system energy is formulated and solved by a modified genetic algorithm. The main feature of our paper is a systematic approach in optimizing the overall system energy consumption rather than that of individual component. A simulation study for a typical centralized HVAC system is provided to compare the proposed optimisation method with traditional ones. The results show that the proposed method indeed improves the system performance significantly. (author)

  16. Optimisation of milling parameters using neural network

    Directory of Open Access Journals (Sweden)

    Lipski Jerzy

    2017-01-01

    Full Text Available The purpose of this study was to design and test an intelligent computer software developed with the purpose of increasing average productivity of milling not compromising the design features of the final product. The developed system generates optimal milling parameters based on the extent of tool wear. The introduced optimisation algorithm employs a multilayer model of a milling process developed in the artificial neural network. The input parameters for model training are the following: cutting speed vc, feed per tooth fz and the degree of tool wear measured by means of localised flank wear (VB3. The output parameter is the surface roughness of a machined surface Ra. Since the model in the neural network exhibits good approximation of functional relationships, it was applied to determine optimal milling parameters in changeable tool wear conditions (VB3 and stabilisation of surface roughness parameter Ra. Our solution enables constant control over surface roughness parameters and productivity of milling process after each assessment of tool condition. The recommended parameters, i.e. those which applied in milling ensure desired surface roughness and maximal productivity, are selected from all the parameters generated by the model. The developed software may constitute an expert system supporting a milling machine operator. In addition, the application may be installed on a mobile device (smartphone, connected to a tool wear diagnostics instrument and the machine tool controller in order to supply updated optimal parameters of milling. The presented solution facilitates tool life optimisation and decreasing tool change costs, particularly during prolonged operation.

  17. Noise aspects at aerodynamic blade optimisation projects

    Energy Technology Data Exchange (ETDEWEB)

    Schepers, J.G. [Netherlands Energy Research Foundation, Petten (Netherlands)

    1997-12-31

    This paper shows an example of an aerodynamic blade optimisation, using the program PVOPT. PVOPT calculates the optimal wind turbine blade geometry such that the maximum energy yield is obtained. Using the aerodynamic optimal blade design as a basis, the possibilities of noise reduction are investigated. The aerodynamic optimised geometry from PVOPT is the `real` optimum (up to the latest decimal). The most important conclusion from this study is, that it is worthwhile to investigate the behaviour of the objective function (in the present case the energy yield) around the optimum: If the optimum is flat, there is a possibility to apply modifications to the optimum configuration with only a limited loss in energy yield. It is obvious that the modified configurations emits a different (and possibly lower) noise level. In the BLADOPT program (the successor of PVOPT) it will be possible to quantify the noise level and hence to assess the reduced noise emission more thoroughly. At present the most promising approaches for noise reduction are believed to be a reduction of the rotor speed (if at all possible), and a reduction of the tip angle by means of low lift profiles, or decreased twist at the outboard stations. These modifications were possible without a significant loss in energy yield. (LN)

  18. The "rectosigmoid brake": Review of an emerging neuromodulation target for colorectal functional disorders.

    Science.gov (United States)

    Lin, Anthony Y; Dinning, Phil G; Milne, Tony; Bissett, Ian P; O'Grady, Gregory

    2017-07-01

    The regulation of gastrointestinal motility encompasses several overlapping mechanisms including highly regulated and coordinated neurohormonal circuits. Various feedback mechanisms or "brakes" have been proposed. While duodenal, jejunal, and ileal brakes are well described, a putative distal colonic brake is less well defined. Despite the high prevalence of colonic motility disorders, there is little knowledge of colonic motility owing to difficulties with organ access and technical difficulties in recording detailed motor patterns along its entire length. The motility of the colon is not under voluntary control. A wide range of motor patterns is seen, with long intervals of intestinal quiescence between them. In addition, the use of traditional manometric catheters to record contractile activity of the colon has been limited by the low number of widely spaced sensors, which has resulted in the misinterpretation of colonic motor patterns. The recent advent of high-resolution (HR) manometry is revolutionising the understanding of gastrointestinal motor patterns. It has now been observed that the most common motor patterns in the colon are repetitive two to six cycles per minute (cpm) propagating events in the distal colon. These motor patterns are prominent soon after a meal, originate most frequently in the rectosigmoid region, and travel in the retrograde direction. The distal prominence and the origin of these motor patterns raise the possibility of them serving as a braking mechanism, or the "rectosigmoid brake," to limit rectal filling. This review aims to describe what is known about the "rectosigmoid brake," including its physiological and clinical significance and potential therapeutic applications. © 2017 John Wiley & Sons Australia, Ltd.

  19. Pharmaceuticals as emerging contaminants and their removal from water. A review.

    Science.gov (United States)

    Rivera-Utrilla, José; Sánchez-Polo, Manuel; Ferro-García, María Ángeles; Prados-Joya, Gonzalo; Ocampo-Pérez, Raúl

    2013-10-01

    The main objective of this study was to conduct an exhaustive review of the literature on the presence of pharmaceutical-derived compounds in water and on their removal. The most representative pharmaceutical families found in water were described and related water pollution issues were analyzed. The performances of different water treatment systems in the removal of pharmaceuticals were also summarized. The water treatment technologies were those based on conventional systems (chlorine, chlorine dioxide, wastewater treatment plants), adsorption/bioadsorption on activated carbon (from lotus stalks, olive-waste cake, coal, wood, plastic waste, cork powder waste, peach stones, coconut shell, rice husk), and advanced oxidation processes by means of ozonation (O₃, O₃/H₂O₂, O₃/activated carbon, O₃/biological treatment), photooxidation (UV, UV/H₂O₂, UV/K₂S₂O₈, UV/TiO₂, UV/H₂O₂/TiO₂, UV/TiO₂/activated carbon, photo-Fenton), radiolysis (e-Beam, ⁶⁰Co, ¹³⁷Cs. Additives used: H₂O₂, SO₃²⁻, HCO₃⁻, CH₃₋OH, CO₃²⁻, or NO₃⁻), and electrochemical processes (Electrooxidation without and with active chlorine generation). The effect of these treatments on pharmaceutical compounds and the advantages and disadvantages of different methodologies used were described. The most important parameters of the above water treatment systems (experimental conditions, removal yield, pharmaceutical compound mineralization, TOC removal, toxicity evolution) were indicated. The key publications on pharmaceutical removal from water were summarized. Copyright © 2013 Elsevier Ltd. All rights reserved.

  20. Retrospective and emergency dosimetry in response to radiological incidents and nuclear mass-casualty events: A review

    International Nuclear Information System (INIS)

    Bailiff, I.K.; Sholom, S.; McKeever, S.W.S.

    2016-01-01

    This paper reviews recent research on the application of the physical dosimetry techniques of electron paramagnetic resonance (EPR) and luminescence (optically stimulated luminescence, OSL, and thermoluminescence, TL) to determine radiation dose following catastrophic, large-scale radiological events. Such data are used in dose reconstruction to obtain estimates of dose due to the exposure to external sources of radiation, primarily gamma radiation, by individual members of the public and by populations. The EPR and luminescence techniques have been applied to a wide range of radiological studies, including nuclear bomb detonation (e.g., Hiroshima and Nagasaki), nuclear power plant accidents (e.g., Chernobyl), radioactive pollution (e.g., Mayak plutonium facility), and in the future could include terrorist events involving the dispersal of radioactive materials. In this review we examine the application of these techniques in ‘emergency’ and ‘retrospective’ modes of operation that are conducted on two distinct timescales. For emergency dosimetry immediate action to evaluate dose to individuals following radiation exposure is required to assess deterministic biological effects and to enable rapid medical triage. Retrospective dosimetry, on the other hand, contributes to the reconstruction of doses to populations and individuals following external exposure, and contributes to the long-term study of stochastic processes and the consequential epidemiological effects. Although internal exposure, via ingestion of radionuclides for example, can be a potentially significant contributor to dose, this review is confined to those dose components arising from exposure to external radiation, which in most studies is gamma radiation. The nascent emergency dosimetry measurement techniques aim to perform direct dose evaluations for individuals who, as members of the public, are most unlikely to be carrying a dosimeter issued for radiation monitoring purposes in the event