WorldWideScience

Sample records for understood emerging evidence

  1. How is evidence to be understood in modern coaching psychology?

    DEFF Research Database (Denmark)

    Spaten, Ole Michael; Løkken, Lillith Olesen

    2015-01-01

    The hunt for evidence in modern coaching psychology could be counter-productive, and possibly lead to a simplified approach to research, practice, searching for “definitive truths”. The article discuss a critical approach to evidence hierarchies, and the prevalent (medical) understanding of evide......The hunt for evidence in modern coaching psychology could be counter-productive, and possibly lead to a simplified approach to research, practice, searching for “definitive truths”. The article discuss a critical approach to evidence hierarchies, and the prevalent (medical) understanding...

  2. Opportunities to preserve forensic evidence in emergency departments.

    Science.gov (United States)

    Peel, Matthew

    2016-11-10

    Victims of violence often seek assistance from emergency departments, so emergency nurses are ideally placed to identify them, and other 'forensic' patients, and protect the evidence that could support any ensuing legal process. Emergency nurses who are trained to identify, collect and preserve forensic evidence can support the identification, elimination and prosecution of suspects. This article gives an overview of forensic evidence, and explains how emergency nurses can preserve and collect samples effectively.

  3. Emerging evidence of hepatitis C virus neuroinvasion.

    Science.gov (United States)

    Laskus, Tomasz; Radkowski, Marek; Adair, Debra M; Wilkinson, Jeffrey; Scheck, Adrienne C; Rakela, Jorge

    2005-10-01

    It has been reported that hepatitis C virus (HCV) infection is associated with cognitive dysfunction, fatigue and depression, which do not correlate with the severity of liver disease and cannot be accounted for by hepatic encephalopathy or drug abuse. There is also emerging evidence that HCV infection can have negative neurocognitive effects in HIV-infected cohorts. Magnetic resonance spectroscopy has suggested the likely existence of a biological basis for these effects. HCV replicative forms have recently been detected in autopsy brain tissue and the infected cells have been identified as CD68-positive (macrophages/microglia). These findings raise the possibility that HCV infection of the brain could be directly related to the reported neuropsychological and cognitive changes. HCV is not strictly hepatotropic, as it can also replicate in leukocytes, including monocytes/macrophages. The latter cells could provide access of HCV into the central nervous system ('Trojan horse' mechanism) in a process similar to that postulated for HIV-1. In support of this hypothetical mechanism come reports showing a close relationship between HCV sequences present in the brain and cerebrospinal fluid and sequences found in lymph nodes and peripheral blood mononuclear cells. However, despite some similarities there is a fundamental difference between HIV-1 and HCV infection as the latter does not progress into AIDS-type dementia.

  4. Pathological Overeating: Emerging Evidence for a Compulsivity Construct.

    Science.gov (United States)

    Moore, Catherine F; Sabino, Valentina; Koob, George F; Cottone, Pietro

    2017-06-01

    Compulsive eating behavior is a transdiagnostic construct that is characteristic of medical and psychiatric conditions such as forms of obesity and eating disorders. Although feeding research is moving toward a better understanding of the proposed addictive properties of food, the components and the mechanisms contributing to compulsive eating are not yet clearly defined or understood. Current understanding highlights three elements of compulsive behavior as it applies to pathological overeating: (1) habitual overeating; (2) overeating to relieve a negative emotional state; and (3) overeating despite aversive consequences. These elements emerge through mechanisms involving pathological habit formation through an aberrant learning process, the emergence of a negative emotional state, and dysfunctions in behavioral control. Dysfunctions in systems within neurocircuitries that comprise the basal ganglia, the extended amygdala, and the prefrontal cortex result in compulsive eating behaviors. Here, we present evidence to relate compulsive eating behavior and addiction and to characterize their underlying neurobiological mechanisms. A major need to improve understanding of compulsive eating through the integration of complex motivational, emotional, and cognitive constructs is warranted.

  5. Poorly Understood Aspects of Striated Muscle Contraction

    Directory of Open Access Journals (Sweden)

    Alf Månsson

    2015-01-01

    Full Text Available Muscle contraction results from cyclic interactions between the contractile proteins myosin and actin, driven by the turnover of adenosine triphosphate (ATP. Despite intense studies, several molecular events in the contraction process are poorly understood, including the relationship between force-generation and phosphate-release in the ATP-turnover. Different aspects of the force-generating transition are reflected in the changes in tension development by muscle cells, myofibrils and single molecules upon changes in temperature, altered phosphate concentration, or length perturbations. It has been notoriously difficult to explain all these events within a given theoretical framework and to unequivocally correlate observed events with the atomic structures of the myosin motor. Other incompletely understood issues include the role of the two heads of myosin II and structural changes in the actin filaments as well as the importance of the three-dimensional order. We here review these issues in relation to controversies regarding basic physiological properties of striated muscle. We also briefly consider actomyosin mutation effects in cardiac and skeletal muscle function and the possibility to treat these defects by drugs.

  6. Emergent Writing in Preschoolers: Preliminary Evidence for a Theoretical Framework

    Science.gov (United States)

    Puranik, Cynthia S.; Lonigan, Christopher J.

    2014-01-01

    Researchers and educators use the term emergent literacy to refer to a broad set of skills and attitudes that serve as foundational skills for acquiring success in later reading and writing; however, models of emergent literacy have generally focused on reading and reading-related behaviors. Hence, the primary aim of this study was to articulate and evaluate a theoretical model of the components of emergent writing. Alternative models of the structure of individual and developmental differences of emergent writing and writing-related skills were examined in 372 preschool children who ranged in age from 3- to 5-years using confirmatory factor analysis. Results from a confirmatory factor analysis provide evidence that these emergent writing skills are best described by three correlated but distinct factors, (a) Conceptual Knowledge, (b) Procedural Knowledge, and (c) Generative Knowledge. Evidence that these three emergent writing factors show different patterns of relations to emergent literacy constructs is presented. Implications for understanding the development of writing and assessment of early writing skills are discussed. PMID:25316955

  7. Emerging Evidence for Platelets as Immune and Inflammatory Effector Cells

    Directory of Open Access Journals (Sweden)

    Matthew Thomas Rondina

    2014-12-01

    Full Text Available While traditionally recognized for their roles in hemostatic pathways, emerging evidence demonstrates that platelets have previously unrecognized, dynamic roles that span the immune continuum. These newly-recognized platelet functions, including the secretion of immune mediators, interactions with endothelial cells, monocytes, and neutrophils, toll-like receptor (TLR mediated responses, and induction of neutrophil extracellular trap (NET formation, bridge thrombotic and inflammatory pathways and contribute to host defense mechanisms against invading pathogens. In this focused review, we highlight several of these emerging aspects of platelet biology and their implications in clinical infectious syndromes.

  8. Health equity in humanitarian emergencies: a role for evidence aid.

    Science.gov (United States)

    Pottie, Kevin

    2015-02-01

    Humanitarian emergencies require a range of planned and coordinated actions: security, healthcare, and, as this article highlights, health equity responses. Health equity is an evidence-based science that aims to address unfair and unjust health inequality outcomes. New approaches are using health equity to guide the development of community programs, equity methods are being used to identify disadvantaged groups that may face health inequities in a humanitarian emergency, and equity is being used to prevent unintended harms and consequences in interventions. Limitations to health equity approaches include acquiring sufficient data to make equity interpretations, integrating disadvantage populations in to the equity approach, and ensuring buy-in from decision-makers. This article uses examples from World Health Organization, Refugee Health Guidelines and Health Impact Assessment to demonstrate the emerging role for health equity in humanitarian emergencies. It is based on a presentation at the Evidence Aid Symposium, on 20 September 2014, at Hyderabad, India. © 2015 Chinese Cochrane Center, West China Hospital of Sichuan University and Wiley Publishing Asia Pty Ltd.

  9. 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.

  10. Donors in Semiconductors - are they Understood in Electronic Era?

    International Nuclear Information System (INIS)

    Dmochowski, Janusz E

    2007-01-01

    The physics of semiconductors and contemporary electronics cannot be understood without impurities. The hydrogen-like shallow donor (and acceptor) state of electron (hole) bound by Coulomb electrostatic force of excess charge of impurity is used to control conductivity of semiconductors and construct semiconductor diodes, transistors and numerous types of semiconductor electronic and optoelectronic devices, including lasers. Recently, surprisingly, the physics of impurity donors appeared to be much reacher. Experimental evidence has been provided for universal existence of other types of electronic states of the same donor impurity: i) mysterious, deep, DX-type state resulting in metastability - slow hysteresis phenomena - understood as two-electron, acceptor-like state of donor impurity, formed upon large lattice distortion or rearrangement around impurity and accompanying capture of second electron, resulting in negative electron correlation energy U; ii) deep, localized, fully symmetric, A1, one-electron donor state of substitutional impurity. The latter state can be formed from the 'ordinary' shallow hydrogen-like state in the process of strong localization of electron by short range, local potential of impurity core, preserving full (A 1 ) symmetry of the substitutional impurity in the host lattice. The 'anticrossing' of the two A 1 (shallow hydrogenic and deep localized) energy levels upon transformation is observed. All types of electronic states of impurity can be universally observed for the same donor impurity and mutual transformation between different states occur upon changing experimental conditions. The knowledge about existence and properties of these n ew , molecular type, donor states in semiconductors seems still await general recognition and positive application in contemporary material and device science and engineering

  11. Stocks for the long run? : Evidence from emerging markets

    NARCIS (Netherlands)

    Spierdijk, Laura; Umar, Zaghum

    2014-01-01

    We estimate the myopic (single-period) and intertemporal hedging (long-run) demand for stocks in 20 growth-leading emerging market economies during the 1999-2012 period. We consider two types of investors: a domestic investor who invests in emerging-market assets only (with returns in local

  12. Improving Evidence on Private Giving in Emerging Economies ...

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

    Despite growing philanthropy in emerging economies, there are significant data gaps on amounts and sources. There is also a lack of research on regulations and policies that support or discourage private giving. This research project will explore philanthropic cooperation in emerging and developing country contexts by ...

  13. Multimarket contact and performance: Evidence from emerging economies

    Directory of Open Access Journals (Sweden)

    Beatriz Domínguez

    2016-10-01

    Full Text Available The organizational structure of multinational enterprises (MNEs is mainly made up of subsidiaries located in emerging and advanced countries. Consequently, they usually compete against the same rivals simultaneously in both emerging and advanced contexts. Multimarket contact (MMC theory analyzes the competitive dynamics that arise in these situations. However, researchers have paid more attention to the consequences of multimarket contact in developed countries than to its effect in emerging countries. To explore the impact of the macroenvironment on the relationship between MMC and performance, we examine how coinciding with multimarket rivals in emerging economies alters the effect of MMC on firm performance. Our research, which is developed with a sample from the mobile telecommunications industry, shows that the presence of MNEs in emerging countries hinders the development of mutual forbearance practices and, therefore, reduces the positive effect of MMC on firm performance.

  14. Determinants of commercial banks’ performance: Evidence from emerging economies

    Directory of Open Access Journals (Sweden)

    Imran Khan

    2017-11-01

    Full Text Available This paper examines the determinants of banks’ performance in emerging economies. Sustainable growth of emerging economies depends on the financial performance of their banks’. The determinants of banks’ performance are, therefore, analyzed through panel econometric techniques over the crisis period of 2008-2014 using data of the top 50 banks from the 10 sampled emerging economies. Both banks’ specific and macroeconomic variables are considered in the analysis. Results reveal that macroeconomic variables like GDP and inflation are significant forces behind high Return on Assets (ROA in emerging economies banks’, however, both negatively influenced the Net Interest Margins (NIM. Among the banks’ specific variables high profitability and NIM are related to high operating costs. This shows that expenses are managed properly in these economies. Further, leverage has a positive impact on both (ROA and (NIM.While reserve requirement has negatively and significantly influence both profitability and net interest margins, which indicates the prominence of central bank’s monetary policy by considering the importance of liquidity for emerging economies commercial banks in economic recovery phase.

  15. Implementing evidence-based practices in an emergency department

    DEFF Research Database (Denmark)

    Kirk, Jeanette W.; Nilsen, Per

    2016-01-01

    of semi-structured interviews. An activity system analysis, as described in the Cultural Historical Activity Theory, was conducted to identify various contradictions that could exist between different parts of the activity system. RESULTS: The main contradiction identified was that guidelines......BACKGROUND: An emergency department is typically a place of high activity where practitioners care for unanticipated presentations, which yields a flow culture so that actions that secure available beds are prioritised by the practitioners. OBJECTIVES: How does the flow culture in an emergency...... department influence nurses' use of a research-based clinical guideline and a nutrition screening routine. METHODS: Ethnographic fieldwork was carried out over three months. The first author followed nurses, medical secretaries and doctors in the emergency department. Data were also collected by means...

  16. Improving Evidence on Private Giving in Emerging Economies ...

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

    Findings to improve private giving This three-year project will: -develop a critical mass of data on philanthropic and other private flows to developing countries from ... enabling environment for philanthropy exists; -promote research uptake and outreach by research teams in emerging economies and by the Centre for Global ...

  17. Psychological Benefits of Regular Physical Activity: Evidence from Emerging Adults

    Science.gov (United States)

    Cekin, Resul

    2015-01-01

    Emerging adulthood is a transitional stage between late adolescence and young adulthood in life-span development that requires significant changes in people's lives. Therefore, identifying protective factors for this population is crucial. This study investigated the effects of regular physical activity on self-esteem, optimism, and happiness in…

  18. Treatment of Graves' hyperthyroidism: evidence-based and emerging modalities

    DEFF Research Database (Denmark)

    Hegedüs, Laszlo

    2009-01-01

    Currently there are three well-established treatment options for hyperthyroid Graves' disease (GD): antithyroid drug therapy with thionamides (ATD), radioactive iodine treatment with (131)I, and thyroid surgery. This article reviews the current evidence so the reader can evaluate advantages...

  19. How Self-Reliance Is Understood: Viewpoints from One Local ...

    African Journals Online (AJOL)

    DrNneka

    Tanzania's 1967 policy of self-reliance (Hultin 1985, p.8). Before looking at the way self-reliance is understood in rural Malawi during a process of development, it may be beneficial to look at some of the tensions between micro and macro forms of development. Leading to Self-Reliance. Development Aid is a term that has ...

  20. How self-reliance is understood: viewpoints from one local ...

    African Journals Online (AJOL)

    How self-reliance is understood: viewpoints from one local community in Malawi. ... model that resists dependence on external aid, empowers community development, and provides opportunities to sustain development activity through local initiative, can be employed to increase social capital leading to sustainable growth.

  1. The genetic epidemiology of diverticulosis and diverticular disease: Emerging evidence

    Science.gov (United States)

    Reichert, Matthias C

    2015-01-01

    Diverticular disease (DD) is one of the most prevalent gastrointestinal disorders. The pathogenesis of diverticulosis and DD is controversially discussed. Current studies call the traditional concept of a fibre-deficient diet causing the development of diverticula into question. Data from two recent twin studies have provided conclusive evidence for a strong genetic component to diverticulosis. Although genomewide association studies have provided new insights into the polygenic architecture of human diseases, genomic research in diverticulosis and DD has just been started. This is an astonishing fact given the high morbidity and mortality of the disease, as well as the substantial economic burden on health care systems. For this review, we provide an update of the molecular pathobiology and summarise recent evidence supporting the hypothesis that distinct, yet unidentified genetic variants contribute to the development of diverticulosis and DD. PMID:26535118

  2. The emergence of the parol evidence rule in English law

    OpenAIRE

    Jarosz, Iwo

    2016-01-01

    Artykuł niniejszy omawia historyczny rozwój parol evidence rule (czyli reguły prawa materialnego zakazującej sądom dopuszczania na okoliczność treści bądź wykładni dokumentu extrinsic evidence, czyli dowodów innych niż sam dokument) w angielskim common law od czasów prawa anglo-normańskiego aż do uchwalenia w 1677 r. Statute of Frauds. Wczesne prawo angielskie charakteryzowała ogólna dopuszczalność takich dowodów. Dokumenty pisemne nie cieszyły się zaufaniem niepiśmiennej społeczności, uważan...

  3. Technical change dynamics. Evidence from the emerging renewable energy technologies

    Energy Technology Data Exchange (ETDEWEB)

    Isoard, S. [Erasme-University of Paris I Pantheon Sorbonne and IPTS-Joint Research Centre, European Commission, World Trade Centre, Isla de la Cartuja s/n, E-41092 Seville (Spain); Soria, A. [Institute for Prospective Technological Studies (IPTS)-Joint Research Centre-European Commission, World Trade Centre, Isla de la Cartuja s/n, E-41092 Seville (Spain)

    2001-11-01

    This paper explores the respective contributions of the effects of learning and returns to scale in the capital costs reduction pattern experienced by renewables. Causality analysis and econometric estimation of learning curves are performed on two emerging renewable energy technologies, namely PV and wind. Learning effects appear as an essential driving force, a result which concurs with the widely acknowledged importance of experience in technical progress inherent to economic growth. The existence of non-constant and flexible returns to scale are further highlighted. Their effect on diffusion dynamics is shown to be potentially considerable, particularly at the outset of innovation deployment. However, returns to scale are suggested to be constant in the long term. Institutional commitment in supporting innovation therefore seems justified, both on the basis of the occurrence of learning effects and diseconomies of scale. These findings appear to be essential to the dynamics of innovation diffusion and market structure.

  4. Urachal tumour: case report of a poorly understood carcinoma

    Directory of Open Access Journals (Sweden)

    Vallarino Luigi

    2009-11-01

    Full Text Available Abstract Background Urachal carcinoma is an uncommon neoplasm associated with poor prognosis. Case presentation A 45-year-old man was admitted with complaints of abdominal pain and pollakisuria. A soft mass was palpable under his navel. TC-scan revealed a 11 × 6 cm tumor, which was composed of a cystic lesion arising from the urachus and a solid mass component at the urinary bladder dome. The tumor was removed surgically. Histological examination detected poor-differentiated adenocarcinoma, which had invaded the urinary bladder. The patient has been followed up without recurrence for 6 months. Conclusion The urachus is the embryological remnant of urogenital sinus and allantois. Involution usually happens before birth and urachus is present as a median umbilical ligament. The pathogenesis of urachal tumours is not fully understood. Surgery is the treatment of choice and role of adjuvant treatment is not clearly understood.

  5. Efficient Market Hypothesis: Some Evidences from Emerging European Forex Markets

    Directory of Open Access Journals (Sweden)

    Anoop S Kumar

    2014-06-01

    Full Text Available This study attempts to analyze the presence of weak form efficiency in the forex markets of a set of select European emerging markets namely Bulgaria, Croatia, Czech Republic, Hungary Poland, Romania, Russia, Slovakia and Slovenia using the monthly NEER data ranging from jan-1994 to Dec-2013. We employ a two step comprehensive methodology where in the first place we test for weak form efficiency using a family of individual and joint variance ratio tests. The results show that while the markets of Croatia, Czech Republic and Bulgaria may be weak form efficient at a shorter lag, the other six markets are not informationally efficient. In the next stage, we estimate a measure of relative efficiency to show the extent to which a market is weak-form inefficient. From the results, it is found that the forex markets of Croatia, Czech Republic and Bulgaria are least weak form inefficient compared to others. The findings of the study are of relevance as it shows that even after roughly two decades of free market economic policies, majority of the forex markets in the area remains informationally inefficient.

  6. Enhanced Recovery After Surgery (ERAS) - The Evidence in Geriatric Emergency Surgery

    DEFF Research Database (Denmark)

    Paduraru, Mihai; Ponchietti, Luca; Casas, Isidro Martinez

    2017-01-01

    . OBJECTIVES: We aimed to determine the feasibility and safety of applying ERAS pathways to emergency elderly surgical patients. METHOD: Two searches were undertaken for ERAS protocols in elderly patients and emergency surgery, in order to gather evidence in relation to ERAS in geriatric emergency patients...... to conventional care. Emergency surgical patients also had fewer postoperative complications with ERAS compared to conventional care. Hospital stay was reduced in 2 out of 3 studies for emergency surgery.Conclusions:ERAS can be safely applied to elderly and emergency patients with a reduction in postoperative......Background: Geriatric surgery is rising and projected to continue at a greater rate. There is already concern about the poor outcomes for the emergency surgery in elderly. How to manage the available resources to improve outcomes in this group of patients is an important object of debate...

  7. Selecting a process paradigm for an emergent disruptive technology: Evidence from the emerging microsystems technology base

    Energy Technology Data Exchange (ETDEWEB)

    Smith, J.H. [Sandia National Labs., Albuquerque, NM (United States). Intelligent Micromachine Dept.; Walsh, S.T. [New Jersey Inst. of Tech., Newark, NJ (United States). School of Industrial Management

    1998-08-01

    Emergent technologies often suffer from a lack of an installed manufacturing base and an obvious dominant manufacturing technique. Firms which base their search for competitive advantage on emergent disruptive technologies must make hard production choices and endure major manufacturing discontinuities. The authors as well as many other firms, are now facing these challenges with the embrace of microsystems technologies. They add to the literature by providing a set of criteria for firms investing in emergent disruptive technologies. Sandia has long been associated as a pioneer in the development of new manufacturing techniques. Microsystems is just the current in a long line of manufacturing technologies that have been considered for mission critical system applications. The authors as well as others, have had to make the hard choice of investing in specific microsystems manufacturing techniques. Important considerations in the technique choice include: the existing internal manufacturing bases, commonality with existing commercial manufacturing infrastructure, current and projected critical performance characteristics, learning curves, the promise to add new but un-thought-of functionally to existing systems, and the anticipated ability to qualify devices built from the technique for mission critical applications.

  8. 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.

  9. Alcohol warning label perceptions: Emerging evidence for alcohol policy.

    Science.gov (United States)

    Al-hamdani, Mohammed; Smith, Steven

    2015-10-03

    Patterns of alcohol and cigarette use and abuse can be considered parallels due to their similar social, biological and epidemiological implications. Therefore, the cross-fertilization of policy research, including health warnings evidence, is justified. The objective of this study was to apply the lessons learned from the tobacco health warnings and plain packaging literature to an alcohol packaging study and test whether labelling alters consumer perceptions. Ninety-two adults were exposed to four labelling conditions of bottles for a famous brand of each of wine, beer and hard liquor. Participants were randomly assigned to one of four labelling conditions: standard, text warning, text and image warning, or text and image warning on a plain bottle. Participants then expressed their product-based (i.e., evaluation of the products) and consumer-based (i.e., evaluation of potential consumers of the products) perceptions in relation to each label condition and were asked to recognize the correct health warning. As expected, participants perceived bottles with warnings less positively as compared to standard bottles in terms of product-based and consumer-based perceptions: plain bottles showed the most consistent statistically significant results, followed by text and image warnings, and then text warnings in pair-wise comparisons with the standard bottles. Some support for the impact of plain packaging on warning recognition was also found. Unlike previous studies, this study reveals that health warnings, if similar to those on cigarette packs, can change consumer-based and product-based perceptions of alcohol products. The study reveals the importance of serious consideration of stringent alcohol warning policy research.

  10. Agreement with evidence for tissue Plasminogen Activator use among emergency physicians: a cross-sectional survey.

    Science.gov (United States)

    Grady, Alice M; Bryant, Jamie; Carey, Mariko L; Paul, Christine L; Sanson-Fisher, Rob W; Levi, Christopher R

    2015-06-26

    Emergency department staff play a crucial role in the triage of stroke patients and therefore the capacity to deliver time-dependent treatments such as tissue Plasminogen Activator. This study aimed to identify among emergency physicians, (1) rates of agreement with evidence supporting tissue Plasminogen Activator use in acute stroke care; and (2) individual and hospital factors associated with high agreement with evidence supporting tissue Plasminogen Activator use. Australian fellows and trainees of the Australasian College for Emergency Medicine were invited to complete an online cross-sectional survey assessing perceptions of tissue Plasminogen Activator use in acute stroke. Demographic and hospital characteristics were also collected. 429 Australasian College for Emergency Medicine members responded (13% response rate). Almost half (47.2%) did not agree with any statements regarding the benefits of tissue Plasminogen Activator use for acute stroke. Perceived routine administration of tissue Plasminogen Activator by the head of respondents' emergency department was significantly associated with high agreement with the evidence supporting tissue Plasminogen Activator use in acute stroke. Agreement with evidence supporting tissue Plasminogen Activator use in acute stroke is not high among responding Australian emergency physicians. In order for tissue Plasminogen Activator treatment to become widely accepted and adopted in emergency settings, beliefs and attitudes towards treatment need to be in accordance with clinical practice guidelines.

  11. [Evidence of the validity of the Emergency Severity Index for triage in a general hospital emergency department].

    Science.gov (United States)

    Hernández Ruipérez, Tomás; Leal Costa, César; Adánez Martínez, María de Gracia; García Pérez, Bartolomé; Nova López, Daniel; Díaz Agea, José Luis

    2015-10-01

    To determine whether the Emergency Severity Index (ESI) is valid for triage according to evidence based on classifying real patients in a general referral hospital's emergency department. Observational, cross-sectional descriptive study carried out in the emergency department of Hospital Clínico Universitario Virgen de la Arrixaca in Murcia. Thirty-two nurses used the ESI algorithm to triage 410 patients as they arrived seeking care. The results were compared to a gold standard (a triage expert's opinion, which was later confirmed by an expert committee after discussion, if necessary, of cases for which opinions were not unanimous). We calculated sensitivity, specificity, under- and over-triage rates, as well as descriptive statistics about resource assignment, exitus, patients who left without being seen, destination on discharge, and times. ESI was highly correlated with resources (ρ = -0.717, P < .01) and moderately correlated with destination on discharge (ρ = -0.437, P < .01). Regarding time spent in the department, we found that patients assigned ESI levels 1 and 2 had significantly longer stays, and those assigned ESI levels 4 and 5 had significantly shorter stays (p < 0,001). Interobserver agreement was good or very good, indicating that this triage tool is reliable. This pilot of the ESI triage algorithm in the emergency department of a referral hospital found evidence supporting the system's validity.

  12. Manejo da asma aguda em adultos na sala de emergência: evidências atuais Management of acute asthma in adults in the emergency room: current evidence

    Directory of Open Access Journals (Sweden)

    Paulo de Tarso Roth Dalcin

    2009-01-01

    Full Text Available Asma é uma doença com uma alta prevalência em nosso meio e ao redor do mundo. Embora novas opções terapêuticas tenham sido recentemente desenvolvidas, parece haver um aumento mundial na sua morbidade e mortalidade. Em muitas instituições, as exacerbações asmáticas ainda se constituem em uma emergência médica muito comum. As evidências têm demonstrado que o manejo da asma aguda na sala de emergência concentra decisões cruciais que podem determinar o desfecho desta situação clínica. Nesta revisão, enfocaremos a avaliação e o tratamento do paciente com asma aguda na sala de emergência, descrevendo uma estratégia apropriada para o seu manejo. Serão consideradas as seguintes etapas: diagnóstico, avaliação da gravidade, tratamento, avaliação das complicações, decisão sobre onde se realizará o tratamento adicional e orientações por ocasião da alta da emergência. Espera-se que estas recomendações contribuam para que o médico clínico tome as decisões apropriadas durante o manejo da asma aguda na sala de emergência.Asthma is a disease with high prevalence in our country and worldwide. Although new therapeutic approaches have been developed recently, there seems to be a global increase in morbidity and mortality from asthma. In many institutions, asthma exacerbation is still a common medical emergency. Clinical evidence demonstrates that management of acute asthma in the emergency room entails crucial decisions that could determine the clinical outcome. In this review, the authors focus on assessment and treatment of patients with acute asthma and outline an appropriate management strategy. Diagnosis, severity assessment, treatment, complications, decision about where additional treatment will take place and orientations on discharge from the emergency will be considered. It is expected that these recommendations will help physicians to make the appropriate decisions about care of acute asthma in the emergency

  13. Prevalence of Obesity: A Public Health Problem Poorly Understood

    Directory of Open Access Journals (Sweden)

    Theresa A. Nicklas

    2014-06-01

    Full Text Available This review article discusses the Dietary Guidelines for Americans (DGA in support of a total diet approach to achieving diet and health goals, especially as they relate to the obesity epidemic. However, some scientists and organizations have identified one food, food group, or nutrient as the cause of the obesity epidemic and recommend that simply reducing that food/food group/nutrient will solve the problem. This is simplistic and unlikely to be effective in long term management of the obesity problem. This article also acknowledges discrepancies in the literature and the lack of consensus opinions from systematic reviews. Failure to consider the evidence as a whole can lead to inaccurate reports which may, in turn, adversely influence clinical practice, public policy, and future research. This article also considers where the line should be drawn between individual choice and responsibility and public regulation. Using sugar sweetened beverages as an example, the article considers the lack of a consistent association between added sugars and weight in the literature and calls for policy recommendations that are based on science and emphasizes the need for evidence-based policies rather than policy-based evidence.

  14. Do investors consider composite leading indicators? Time series evidence from emerging countries

    Directory of Open Access Journals (Sweden)

    Mert TOPCU

    2013-09-01

    Full Text Available The nexus between macroeconomic indicators and stock market has been worthy of examination in emerging markets in the recent years. This paper therefore aims to investigate the long run and causal relationship between Composite Leading Indicators (CLI and share prices in the thirteen emerging markets. Findings obtained from the analyses do not provide consistent results across all emerging markets. Empirical evidences of this study indicate that component structure of CLI and financial development level of questioned countries appears to play important role in determining the effectiveness of CLI in investors’ decisions.

  15. Mirror neurons and their function in cognitively understood empathy.

    Science.gov (United States)

    Corradini, Antonella; Antonietti, Alessandro

    2013-09-01

    The current renewal of interest in empathy is closely connected to the recent neurobiological discovery of mirror neurons. Although the concept of empathy has been widely deployed, we shall focus upon one main psychological function it serves: enabling us to understand other peoples' intentions. In this essay we will draw on neuroscientific, psychological, and philosophical literature in order to investigate the relationships between mirror neurons and empathy as to intention understanding. Firstly, it will be explored whether mirror neurons are the neural basis of our empathic capacities: a vast array of empirical results appears to confirm this hypothesis. Secondly, the higher level capacity of reenactive empathy will be examined and the question will be addressed whether philosophical analysis alone is able to provide a foundation for this more abstract level of empathy. The conclusion will be drawn that both empirical evidence and philosophical analysis can jointly contribute to the clarification of the concept of empathy. Copyright © 2013 Elsevier Inc. All rights reserved.

  16. Clinical governance; How been understood, what is needed? Nurses' perspective

    Directory of Open Access Journals (Sweden)

    Homayoun Sadeghi Bazargani

    2015-07-01

    Full Text Available Introduction: Clinical Governance (CG is an overarching concept, using organizational capacity, safeguards high standards of the health services and provides a safe care for patients.  The aim of this research was to study nurses’ perception about Clinical Governance. Materials and Methods: A qualitative study was done with Focus Group Discussions (FGD. Purposeful Sampling was used to select the objectives including 65 participants. Actually 7 FGD’s were held. Content analysis was used to extract the meaningful themes. Results:Nurses believed that patient centeredness and evidence based practice is the core of the CG concept. Also they mentioned that cultural change, staffs training, adequate financial and human resources are required to successfully implementation of CG in hospitals.  Conclusion: Spreading up a shared vision about CG and providing the required infrastructures in hospitals would be facilitate CG initiatives. Proper commitment of the managers and staff participation could lead an effective CG implementation.

  17. Research into Australian emergency services personnel mental health and wellbeing: An evidence map.

    Science.gov (United States)

    Varker, Tracey; Metcalf, Olivia; Forbes, David; Chisolm, Katherine; Harvey, Sam; Van Hooff, Miranda; McFarlane, Alexander; Bryant, Richard; Phelps, Andrea J

    2018-02-01

    Evidence maps are a method of systematically characterising the range of research activity in broad topic areas and are a tool for guiding research priorities. 'Evidence-mapping' methodology was used to quantify the nature and distribution of recent peer-reviewed research into the mental health and wellbeing of Australian emergency services personnel. A search of the PsycINFO, EMBASE and Cochrane Library databases was performed for primary research articles that were published between January 2011 and July 2016. In all, 43 studies of primary research were identified and mapped. The majority of the research focused on organisational and individual/social factors and how they relate to mental health problems/wellbeing. There were several areas of research where very few studies were detected through the mapping process, including suicide, personality, stigma and pre-employment factors that may contribute to mental health outcomes and the use of e-health. No studies were detected which examined the prevalence of self-harm and/or harm to others, bullying, alcohol/substance use, barriers to care or experience of families of emergency services personnel. In addition, there was no comprehensive national study that had investigated all sectors of emergency services personnel. This evidence map highlights the need for future research to address the current gaps in mental health and wellbeing research among Australian emergency services personnel. Improved understanding of the mental health and wellbeing of emergency services personnel, and the factors that contribute, should guide organisations' wellbeing policies and procedures.

  18. Hinkley Point 'C' power station public inquiry: proof of evidence on emergency planning

    International Nuclear Information System (INIS)

    Western, D.J.

    1988-09-01

    A public inquiry has been set up to examine the planning application made by the Central Electricity Generating Board (CEGB) for the construction of a 1200 MW Pressurized Water Reactor power station at Hinkley Point (Hinkley Point ''C'') in the United Kingdom, adjacent to an existing nuclear power station incorporating Magnox and Advanced Gas Cooled reactors. The CEGB evidence to the Inquiry presented here introduces the concept of the Reference Accident as the basis for emergency arrangements. The description which follows of the emergency arrangements at the Hinkley Point site include: the respective responsibilities and their co-ordination of bodies such as the CEGB, external emergency services and government departments; the site emergency organization; practical aspects of the emergency arrangements; and consideration of the extension of the arrangements to a PWR on the same site. Recent developments in emergency planning, such as those arising out of post Chernobyl reviews and the Sizewell ''B'' PWR Inquiry, are taken into account. The conclusion is reached that soundly based emergency arrangements already exist at Hinkley Point which would require relatively minor changes should the proposed PWR be constructed. (UK)

  19. Pediatric orthopedic injuries: evidence-based management in the emergency department [digest].

    Science.gov (United States)

    Lien, Jamie; Pade, Kathryn H

    2017-09-22

    Upper and lower extremity injuries are common in children, with an overall risk of fracture estimated at just under 1 in 5 children. Pediatric bone anatomy and physiology produce age specific injury patterns and conditions that are unique to children, which can make accurate diagnosis difficult for emergency clinicians. This issue reviews the etiology and pathophysiology of child-specific fractures, as well as common injuries of the upper and lower extremities. Evidence-based recommendations for management of pediatric fractures, including appropriate diagnostic studies and treatment, are also discussed. [Points & Pearls is a digest of Pediatric Emergency Medicine Practice].

  20. Targeting carbonic anhydrase to treat diabetic retinopathy: Emerging evidences and encouraging results

    Energy Technology Data Exchange (ETDEWEB)

    Weiwei, Zhang [Department of Endocrinology and Metabolism, HuaShan Hospital, Institute of Endocrinology and Diabetology, Shanghai Medical College, Fudan University, No. 12 Wulumuqi Road, Shanghai 200040 (China); Hu, Renming, E-mail: taylorzww@gmail.com [Department of Endocrinology and Metabolism, HuaShan Hospital, Institute of Endocrinology and Diabetology, Shanghai Medical College, Fudan University, No. 12 Wulumuqi Road, Shanghai 200040 (China)

    2009-12-18

    Diabetic retinopathy (DR) is the leading cause of vision loss among working-age populations in developed countries. Current treatment options are limited to tight glycemic, blood pressure control and destructive laser surgery. Carbonic anhydrases (CAs) are a group of enzymes involving in the rapid conversion of carbon dioxide to bicarbonate and protons. Emerging evidences reveal CA inhibitors hold the promise for the treatment of DR. This article summarizes encouraging results from clinical and animal studies, and reviews the possible mechanisms.

  1. Assessing clinical reasoning in pediatric emergency medicine: validity evidence for a Script Concordance Test.

    Science.gov (United States)

    Carrière, Benoit; Gagnon, Robert; Charlin, Bernard; Downing, Steven; Bordage, Georges

    2009-05-01

    Clinical reasoning is a crucial skill for all residents to acquire during their training. During most patient encounters in pediatric emergency medicine, physicians and trainees are challenged by diagnostic, investigative, and treatment uncertainties. The Script Concordance Test may provide a means to assess reasoning skills in the context of uncertainty in the practice of pediatric emergency medicine. We gathered validity evidence for the use of a pediatric emergency medicine Script Concordance Test to evaluate residents' reasoning skills. A 1-hour test containing 60 questions nested in 38 cases was administered to 53 residents at the end of their pediatric emergency medicine rotation at 1 academic institution. Twelve experienced pediatricians were part of a reference panel to establish the basis for the scoring process. An optimized version of the test, based on positive item discrimination data, contained 30 cases and 50 questions. Scores ranged from 48% to 82%, with a mean score of 69.9 (SD=11.5). The reliability of the optimized test (Cronbach's alpha) was 0.77. Performance on the test increased as the level of experience of the residents increased. The residents considered the Script Concordance Test true to real-life clinical problems and had enough time to complete the test. This pediatric emergency medicine Script Concordance Test was reliable and useful to assess the progression of clinical reasoning during residency training.

  2. What's the Evidence: Self-Assessment Implications for Life-Long Learning in Emergency Medicine.

    Science.gov (United States)

    Wolff, Margaret; Santen, Sally A; Hopson, Laura R; Hemphill, Robin R; Farrell, Susan E

    2017-07-01

    The 2012 Academic Emergency Medicine Consensus Conference, "Education Research in Emergency Medicine: Opportunities, Challenges, and Strategies for Success" noted that emergency medicine (EM) educators often rely on theory and tradition when molding their approaches to teaching and learning, and called on the EM education community to advance the teaching of our specialty through the performance and application of research in teaching and assessment methods, cognitive function, and the effects of education interventions. The purpose of this article was to review the research-based evidence for the effectiveness of self-assessment and to provide suggestions for its use in clinical teaching and practice in EM. This article reviews hypothesis-testing research related to self-assessment behaviors and learning. Evidence indicates that self-assessment is inherently flawed when used in isolation. We review a multi-dimensional approach to informed self-assessment that can serve as the basis for life-long learning and development. Advancing EM education will require that high-quality education research results be translated into actual curricular, pedagogical, assessment, and professional development changes. The informed self-assessment framework is a method that is applicable to teaching and practice in EM. Copyright © 2017 Elsevier Inc. All rights reserved.

  3. Evidence-based management of potassium disorders in the emergency department [digest].

    Science.gov (United States)

    Ashurst, John; Sergent, Shane R; Wagner, Benjamin J; Kim, Jeremy

    2016-11-22

    Hypokalemia and hyperkalemia are the most common electrolyte disorders managed in the emergency department. The diagnosis of these potentially life-threatening disorders is challenging due to the often vague symptomatology a patient may express, and treatment options may be based upon very little data due to the time it may take for laboratory values to return. This review examines the most current evidence with regard to the pathophysiology, diagnosis, and management of potassium disorders. In this review, classic paradigms, such as the use of sodium polystyrene and the routine measurement of serum magnesium, are tested, and an algorithm for the treatment of potassium disorders is discussed. [Points & Pearls is a digest of Emergency Medicine Practice].

  4. Diphtheria, pertussis, and tetanus: evidence-based management of pediatric patients in the emergency department [digest].

    Science.gov (United States)

    Zibners, Lara; Chaudhari, Pradip

    2017-02-22

    Diphtheria, pertussis, and tetanus are potentially deadly bacterial infections that are largely preventable through vaccination, though they remain in the population. This issue reviews the epidemiology, pathophysiology, diagnosis, and current recommended emergency management of these conditions. Disease-specific medications, as well as treatment of the secondary complications, are examined in light of the best current evidence. Resources include obtaining diphtheria antitoxin from the United States Centers for Disease Control and Prevention and best-practice recommendations with regard to testing, involvement of government health agencies, isolation of the patient, and identification and treatment of close contacts. Most importantly, issues regarding vaccination and prevention are highlighted. [Points & Pearls is a digest of Pediatric Emergency Medicine Practice].

  5. Evidence of an emerging digital divide among hospitals that care for the poor.

    Science.gov (United States)

    Jha, Ashish K; DesRoches, Catherine M; Shields, Alexandra E; Miralles, Paola D; Zheng, Jie; Rosenbaum, Sara; Campbell, Eric G

    2009-01-01

    Some hospitals that disproportionately care for poor patients are falling behind in adopting electronic health records (EHRs). Data from a national survey indicate early evidence of an emerging digital divide: U.S. hospitals that provide care to large numbers of poor patients also had minimal use of EHRs. These same hospitals lagged others in quality performance as well, but those with EHR systems seemed to have eliminated the quality gap. These findings suggest that adopting EHRs should be a major policy goal of health reform measures targeting hospitals that serve large populations of poor patients.

  6. Inappropriate emergency laboratory test ordering: defensive or peer evidence shared based medicine?

    Directory of Open Access Journals (Sweden)

    C. Descovich

    2013-05-01

    Full Text Available BACKGROUND The laboratory overuse is widely prevalent in hospital practice, mostly in the emergency care. Reasons for excessive and inappropriate test-ordering include defensive behaviour and fear or uncertainty, lack of experience, the misuse of protocols and guidelines, “routine” and local attitudes, inadequate educational feedback and clinician’s unawareness about the cost of examinations and their related implications. AIM OF THE STUDY AND METHODS The primary target of our working group was to reduce inappropriate ordering on a urgent basis test, implementing further examinations not yet previewed in the hospital panel of the available urgencies, according to the evidence based diagnosis concept. The secondary goal was to indicate strategies of re-engineering of the processes, improving turnaround time in the laboratory management of emergencies. After evaluating, as first intervention, the more reliable sources for practice guidelines, systematic reviews and RCTs, the committee further discussed main topics with in-hospital stakeholders, selected from Emergency, Internal Medicine and Surgery Depts. The working group, in many subsequent audits, tried to obtain a systematic feed back with all involved professionals. RESULTS After reviewing literature’s evidence, the board constrained testing options by defining the basic emergency laboratory panel tests (blood type, hemogram, blood urea nitrogen, plasma creatinine, glucose, sodium, potassium, chloride, osmolarity, CRP, bicarbonate, CPK, creatine phosphokinase-MB, myoglobin, troponin, BNP and NT-proBNP, PT-INR, PTT, D-dimer, beta- HCG, biochemical urinalysis etc.. As final result, the proposed tests reduced the overall number of inappropriate investigations and increased, with newer and updated tests, the available panel for critical patients. DISCUSSION A collegiate review of data reporting, in-hospital deepening of problems and the inter- professional discussion of the evidences

  7. Diphtheria, pertussis, and tetanus: evidence-based management of pediatric patients in the emergency department

    Science.gov (United States)

    Zibners, Lara

    2017-02-01

    Diphtheria, pertussis, and tetanus are potentially deadly bacterial infections that are largely preventable through vaccination, though they remain in the population. This issue reviews the epidemiology, pathophysiology, diagnosis, and current recommended emergency management of these conditions. Disease-specific medications, as well as treatment of the secondary complications, are examined in light of the best current evidence. Resources include obtaining diphtheria antitoxin from the United States Centers for Disease Control and Prevention and best-practice recommendations with regard to testing, involvement of government health agencies, isolation of the patient, and identification and treatment of close contacts. Most importantly, issues regarding vaccination and prevention are highlighted.

  8. The emergency department approach to syncope: evidence-based guidelines and prediction rules.

    Science.gov (United States)

    Kessler, Chad; Tristano, Jenny M; De Lorenzo, Robert

    2010-08-01

    Syncope is a sudden, transient loss of consciousness associated with inability to maintain postural tone followed by spontaneous recovery and return to baseline neurologic status. Global cerebral hypoperfusion is the final pathway common to all presentations of syncope, but this symptom presentation has a broad differential diagnosis. It is important to identify patients whose syncope is a symptom of a potentially life-threatening condition. This article reviews the current status of syncope from the emergency department perspective, focusing on the current evidence behind the various clinical decision rules derived during the past decade. Published by Elsevier Inc.

  9. Delivering patient decision aids on the Internet: definitions, theories, current evidence, and emerging research areas

    Science.gov (United States)

    2013-01-01

    Background In 2005, the International Patient Decision Aids Standards Collaboration identified twelve quality dimensions to guide assessment of patient decision aids. One dimension—the delivery of patient decision aids on the Internet—is relevant when the Internet is used to provide some or all components of a patient decision aid. Building on the original background chapter, this paper provides an updated definition for this dimension, outlines a theoretical rationale, describes current evidence, and discusses emerging research areas. Methods An international, multidisciplinary panel of authors examined the relevant theoretical literature and empirical evidence through 2012. Results The updated definition distinguishes Internet-delivery of patient decision aids from online health information and clinical practice guidelines. Theories in cognitive psychology, decision psychology, communication, and education support the value of Internet features for providing interactive information and deliberative support. Dissemination and implementation theories support Internet-delivery for providing the right information (rapidly updated), to the right person (tailored), at the right time (the appropriate point in the decision making process). Additional efforts are needed to integrate the theoretical rationale and empirical evidence from health technology perspectives, such as consumer health informatics, user experience design, and human-computer interaction. Despite Internet usage ranging from 74% to 85% in developed countries and 80% of users searching for health information, it is unknown how many individuals specifically seek patient decision aids on the Internet. Among the 86 randomized controlled trials in the 2011 Cochrane Collaboration’s review of patient decision aids, only four studies focused on Internet-delivery. Given the limited number of published studies, this paper particularly focused on identifying gaps in the empirical evidence base and

  10. Mother's but not father's education predicts general fluid intelligence in emerging adulthood: Behavioral and neuroanatomical evidence.

    Science.gov (United States)

    Kong, Feng; Chen, Zhencai; Xue, Song; Wang, Xu; Liu, Jia

    2015-11-01

    Lower parental education impairs cognitive abilities of their offspring such as general fluid intelligence dependent on the prefrontal cortex (PFC), but the independent contribution of mother's and father's education is unknown. We used an individual difference approach to test whether mother's and father's education independently affected general fluid intelligence in emerging adulthood at both the behavioral and neural level. Behaviorally, mother's but not father's education accounted for unique variance in general fluid intelligence in emerging adulthood (assessed by the Raven's advanced progressive matrices). Neurally, the whole-brain correlation analysis revealed that the regional gray matter volume (rGMV) in the medial PFC was related to both mother's education and general fluid intelligence but not father's education. Furthermore, after controlling for mother's education, the association between general fluid intelligence and the rGMV in medial PFC was no longer significant, indicating that mother's education plays an important role in influencing the structure of the medial PFC associated with general fluid intelligence. Taken together, our study provides the first behavioral and neural evidence that mother's education is a more important determinant of general cognitive ability in emerging adulthood than father's education. © 2015 Wiley Periodicals, Inc.

  11. Experience with Event Timing Does not Alter Emergent Timing: Further Evidence for Robustness of Event and Emergent Timing.

    Science.gov (United States)

    Pope, Megan A; Studenka, Breanna E

    2018-02-15

    Although, event and emergent timings are thought of as mutually exclusive, significant correlations between tapping and circle drawing (Baer, Thibodeau, Gralnick, Li, & Penhune, 2013 ; Studenka, Zelaznik, & Balasubramaniam, 2012 ; Zelaznik & Rosenbaum, 2010 ) suggest that emergent timing may not be as robust as once thought. We aimed to test this hypothesis in both a younger (18-25) and older (55-100) population. Participants performed one block of circle drawing as a baseline, then six blocks of tapping, followed by circle drawing. We examined the use of event timing. Our hypothesis that acute experience with event timing would bias an individual to use event timing during an emergent task was not supported. We, instead, support the robustness of event and emergent timing as independent timing modes.

  12. Vitamin D deficiency and anemia risk in children: a review of emerging evidence

    Directory of Open Access Journals (Sweden)

    Uwaezuoke SN

    2017-05-01

    Full Text Available Samuel N Uwaezuoke1,2 1Department of Paediatrics, College of Medicine, University of Nigeria, Nsukka, 2Department of Paediatrics, University of Nigeria Teaching Hospital, Ituku-Ozalla, Nigeria Abstract: There has been renewed scientific interest in the sequelae of vitamin D deficiency, given the emerging evidence on the diverse biologic functions of vitamin D, besides its fundamental role in bone and mineral metabolism. For the past decade, the evidence in the medical literature pointing to a relationship between anemia risk and vitamin D deficiency has been accumulating. This paper critically reviews the current evidence linking vitamin D deficiency to anemia risk in children. The synthesized evidence indicates that the studies, which were preponderantly conducted among the adult population, not only reported a bidirectional relationship between vitamin D deficiency and anemia but also showed a racial effect. In studies conducted among children, similar results were reported. Although the causal association of vitamin D deficiency with anemia risk (especially iron-deficiency anemia remains debatable, the noncalcemic actions of the vitamin and its analogs hold prospects for several novel clinical applications. There is, however, unanimity in many reports suggesting that vitamin D deficiency is directly associated with anemia of chronic disease or inflammation. Despite the advances in unraveling the role of vitamin D in iron homeostasis, further research is still required to validate causality in the relationship between vitamin D deficiency and anemia, as well as to determine its optimal dosing, the ideal recipients for therapeutic intervention, and the preferred analogs to administer. Keywords: calcitriol deficiency, childhood anemia, iron homeostasis, causal link

  13. Stock returns predictability and the adaptive market hypothesis in emerging markets: evidence from India.

    Science.gov (United States)

    Hiremath, Gourishankar S; Kumari, Jyoti

    2014-01-01

    This study addresses the question of whether the adaptive market hypothesis provides a better description of the behaviour of emerging stock market like India. We employed linear and nonlinear methods to evaluate the hypothesis empirically. The linear tests show a cyclical pattern in linear dependence suggesting that the Indian stock market switched between periods of efficiency and inefficiency. In contrast, the results from nonlinear tests reveal a strong evidence of nonlinearity in returns throughout the sample period with a sign of tapering magnitude of nonlinear dependence in the recent period. The findings suggest that Indian stock market is moving towards efficiency. The results provide additional insights on association between financial crises, foreign portfolio investments and inefficiency. G14; G12; C12.

  14. Prioritizing performance measurement for emergency department care: consensus on evidence-based quality of care indicators.

    Science.gov (United States)

    Schull, Michael J; Guttmann, Astrid; Leaver, Chad A; Vermeulen, Marian; Hatcher, Caroline M; Rowe, Brian H; Zwarenstein, Merrick; Anderson, Geoffrey M

    2011-09-01

    The evaluation of emergency department (ED) quality of care is hampered by the absence of consensus on appropriate measures. We sought to develop a consensus on a prioritized and parsimonious set of evidence-based quality of care indicators for EDs. The process was led by a nationally representative steering committee and expert panel (representatives from hospital administration, emergency medicine, health information, government, and provincial quality councils). A comprehensive review of the scientific literature was conducted to identify candidate indicators. The expert panel reviewed candidate indicators in a modified Delphi panel process using electronic surveys; final decisions on inclusion of indicators were made by the steering committee in a guided nominal group process with facilitated discussion. Indicators in the final set were ranked based on their priority for measurement. A gap analysis identified areas where future indicator development is needed. A feasibility study of measuring the final set of indicators using current Canadian administrative databases was conducted. A total of 170 candidate indicators were generated from the literature; these were assessed based on scientific soundness and their relevance or importance. Using predefined scoring criteria in two rounds of surveys, indicators were coded as "retained" (53), "discarded" (78), or "borderline" (39). A final set of 48 retained indicators was selected and grouped in nine categories (patient satisfaction, ED operations, patient safety, pain management, pediatrics, cardiac conditions, respiratory conditions, stroke, and sepsis or infection). Gap analysis suggested the need for new indicators in patient satisfaction, a healthy workplace, mental health and addiction, elder care, and community-hospital integration. Feasibility analysis found that 13 of 48 indicators (27%) can be measured using existing national administrative databases. A broadly representative modified Delphi panel process

  15. Emergency Department Triage Scales and Their Components: A Systematic Review of the Scientific Evidence

    Directory of Open Access Journals (Sweden)

    Jonsson Håkan

    2011-06-01

    Full Text Available Abstract Emergency department (ED triage is used to identify patients' level of urgency and treat them based on their triage level. The global advancement of triage scales in the past two decades has generated considerable research on the validity and reliability of these scales. This systematic review aims to investigate the scientific evidence for published ED triage scales. The following questions are addressed: 1. Does assessment of individual vital signs or chief complaints affect mortality during the hospital stay or within 30 days after arrival at the ED? 2. What is the level of agreement between clinicians' triage decisions compared to each other or to a gold standard for each scale (reliability? 3. How valid is each triage scale in predicting hospitalization and hospital mortality? A systematic search of the international literature published from 1966 through March 31, 2009 explored the British Nursing Index, Business Source Premier, CINAHL, Cochrane Library, EMBASE, and PubMed. Inclusion was limited to controlled studies of adult patients (≥15 years visiting EDs for somatic reasons. Outcome variables were death in ED or hospital and need for hospitalization (validity. Methodological quality and clinical relevance of each study were rated as high, medium, or low. The results from the studies that met the inclusion criteria and quality standards were synthesized applying the internationally developed GRADE system. Each conclusion was then assessed as having strong, moderately strong, limited, or insufficient scientific evidence. If studies were not available, this was also noted. We found ED triage scales to be supported, at best, by limited and often insufficient evidence. The ability of the individual vital signs included in the different scales to predict outcome is seldom, if at all, studied in the ED setting. The scientific evidence to assess interrater agreement (reliability was limited for one triage scale and insufficient or

  16. Emergency Department Triage Scales and Their Components: A Systematic Review of the Scientific Evidence

    Science.gov (United States)

    2011-01-01

    Emergency department (ED) triage is used to identify patients' level of urgency and treat them based on their triage level. The global advancement of triage scales in the past two decades has generated considerable research on the validity and reliability of these scales. This systematic review aims to investigate the scientific evidence for published ED triage scales. The following questions are addressed: 1. Does assessment of individual vital signs or chief complaints affect mortality during the hospital stay or within 30 days after arrival at the ED? 2. What is the level of agreement between clinicians' triage decisions compared to each other or to a gold standard for each scale (reliability)? 3. How valid is each triage scale in predicting hospitalization and hospital mortality? A systematic search of the international literature published from 1966 through March 31, 2009 explored the British Nursing Index, Business Source Premier, CINAHL, Cochrane Library, EMBASE, and PubMed. Inclusion was limited to controlled studies of adult patients (≥15 years) visiting EDs for somatic reasons. Outcome variables were death in ED or hospital and need for hospitalization (validity). Methodological quality and clinical relevance of each study were rated as high, medium, or low. The results from the studies that met the inclusion criteria and quality standards were synthesized applying the internationally developed GRADE system. Each conclusion was then assessed as having strong, moderately strong, limited, or insufficient scientific evidence. If studies were not available, this was also noted. We found ED triage scales to be supported, at best, by limited and often insufficient evidence. The ability of the individual vital signs included in the different scales to predict outcome is seldom, if at all, studied in the ED setting. The scientific evidence to assess interrater agreement (reliability) was limited for one triage scale and insufficient or lacking for all other

  17. Entrepreneurship, Emerging Technologies, Emerging Markets

    NARCIS (Netherlands)

    Thukral, Inderpreet S.; Von Ehr, James; Walsh, Steven Thomas; Groen, Arend J.; van der Sijde, Peter; Adham, Khairul Akmaliah

    2008-01-01

    Academics and practitioners alike have long understood the benefits, if not the risks, of both emerging markets and emerging technologies.Yet it is only recently that foresighted firms have embraced emerging technologies and emerging markets through entrepreneurial activity. Emerging technologies

  18. 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

  19. Adaptive thermogenesis by dietary n-3 polyunsaturated fatty acids: Emerging evidence and mechanisms.

    Science.gov (United States)

    Fan, Rong; Koehler, Karsten; Chung, Soonkyu

    2018-04-19

    Brown/beige fat plays a crucial role in maintaining energy homeostasis through non-shivering thermogenesis in response to cold temperature and excess nutrition (adaptive thermogenesis). Although numerous molecular and genetic regulators have been identified, relatively little information is available regarding thermogenic dietary molecules. Recently, a growing body of evidence suggests that high consumption of n-3 polyunsaturated fatty acids (PUFA) or activation of GPR120, a membrane receptor of n-3 PUFA, stimulate adaptive thermogenesis. In this review, we summarize the emerging evidence that n-3 PUFA promote brown/beige fat formation and highlight the potential mechanisms whereby n-3 PUFA require GPR120 as a signaling platform or act independently. Human clinical trials are revisited in the context of energy expenditure. Additionally, we explore some future perspective that n-3 PUFA intake might be a useful strategy to boost or sustain metabolic activities of brown/beige fat at different lifecycle stages of pregnancy and senescence. Given that a high ratio of n-6/n-3 PUFA intake is associated with the development of obesity and type 2 diabetes, understanding the impact of n-6/n-3 ratio on energy expenditure and adaptive thermogenesis will inform the implementation of a novel nutritional strategy for preventing obesity. Copyright © 2018 Elsevier B.V. All rights reserved.

  20. Validity Evidence for a Serious Game to Assess Performance on Critical Pediatric Emergency Medicine Scenarios.

    Science.gov (United States)

    Gerard, James M; Scalzo, Anthony J; Borgman, Matthew A; Watson, Christopher M; Byrnes, Chelsie E; Chang, Todd P; Auerbach, Marc; Kessler, David O; Feldman, Brian L; Payne, Brian S; Nibras, Sohail; Chokshi, Riti K; Lopreiato, Joseph O

    2018-01-26

    We developed a first-person serious game, PediatricSim, to teach and assess performances on seven critical pediatric scenarios (anaphylaxis, bronchiolitis, diabetic ketoacidosis, respiratory failure, seizure, septic shock, and supraventricular tachycardia). In the game, players are placed in the role of a code leader and direct patient management by selecting from various assessment and treatment options. The objective of this study was to obtain supportive validity evidence for the PediatricSim game scores. Game content was developed by 11 subject matter experts and followed the American Heart Association's 2011 Pediatric Advanced Life Support Provider Manual and other authoritative references. Sixty subjects with three different levels of experience were enrolled to play the game. Before game play, subjects completed a 40-item written pretest of knowledge. Game scores were compared between subject groups using scoring rubrics developed for the scenarios. Validity evidence was established and interpreted according to Messick's framework. Content validity was supported by a game development process that involved expert experience, focused literature review, and pilot testing. Subjects rated the game favorably for engagement, realism, and educational value. Interrater agreement on game scoring was excellent (intraclass correlation coefficient = 0.91, 95% confidence interval = 0.89-0.9). Game scores were higher for attendings followed by residents then medical students (Pc game and written test scores (r = 0.84, P game scores to assess knowledge of pediatric emergency medicine resuscitation.

  1. Emergence Corporate Financial Distressin Emerging Market: Empirical Evidence from Indonesia Stock Exchange(IDX 2004-2008

    Directory of Open Access Journals (Sweden)

    Koes Pranowo

    2011-11-01

    Full Text Available Normal 0 false false false MicrosoftInternetExplorer4 st1\\:*{behavior:url(#ieooui } /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman"; mso-ansi-language:#0400; mso-fareast-language:#0400; mso-bidi-language:#0400;} Financial recovery is the most difficult in financial management. Therefore, this is important to study how a company in financially-distress can survive to rise up to a healthy financial condition (emergence financial distress. The research consists of 200 non financial companies which are listed on Indonesia Stock Exchange (IDX for the period of 2004-2008. This study focuses on management of working capital. How a company fulfill its current liabilities, and its sources in current assets which shall be cashed at the short term period. By using Multinomial logit, we analyzed the probability a financially-distress company rise up to emergence financial distress or stay of the status of financial distress and what are financial indicators affect to a company in the status of Non Financial Distress tend to Financial Distress. Thus, the important thing is to determine financial ratios which can be an indicator to determine of emergence financial distress. We find a positive relationship between Profit, efficiency and emergence financial distress and a negative relationship between leverage and emergence financial distress.   Keywords: Emergence Financial Distress, Indonesia Stock Exchange (IDX, Multinomial Logit JEL Classification Codes: G 3

  2. Addressing intimate partner violence and sexual violence among adolescents: emerging evidence of effectiveness.

    Science.gov (United States)

    Lundgren, Rebecka; Amin, Avni

    2015-01-01

    Intimate partner violence (IPV) and sexual violence (SV) are widespread among adolescents and place them on a lifelong trajectory of violence, either as victims or perpetrators. The aim of this review was to identify effective approaches to prevent adolescent IPV and SV and to identify critical knowledge gaps. The interventions reviewed in this article reflect the global focus on interventions addressing violence perpetrated by men against women in the context of heterosexual relationships. Interventions for girls and boys (10-19 years) were identified through electronic searches for peer-reviewed and gray literature such as reports and research briefs. Studies were excluded if they were published before 1990 or did not disaggregate participants and results by age. Programs were classified as "effective," "emerging," "ineffective," or "unclear" based on the strength of evidence, generalizability of results to developing country settings, and replication beyond the initial pilot. Programs were considered "effective" if they were evaluated with well-designed studies, which controlled for threats to validity through randomization of participants. A review of 142 articles and documents yielded 61 interventions, which aimed to prevent IPV and SV among adolescents. These were categorized as "parenting" (n = 8), "targeted interventions for children and adolescents subjected to maltreatment" (n = 3), "school based" (n = 31; including 10 interventions to prevent sexual assault among university students), "community based" (n = 16), and "economic empowerment" (n = 2). The rigor of the evaluations varies greatly. A good number have relatively weak research designs, short follow-up periods, and low or unreported retention rates. Overall, there is a lack of robust standardized measures for behavioral outcomes. Three promising approaches emerge. First, school-based dating violence interventions show considerable success. However, they have only been implemented in high

  3. Using Medical Student Quality Improvement Projects to Promote Evidence-Based Care in the Emergency Department.

    Science.gov (United States)

    Manning, Michael W; Bean, Eric W; Miller, Andrew C; Templer, Suzanne J; Mackenzie, Richard S; Richardson, David M; Bresnan, Kristin A; Greenberg, Marna R

    2018-01-01

    The Association of American Medical Colleges' (AAMC) initiative for Core Entrustable Professional Activities for Entering Residency includes as an element of Entrustable Professional Activity 13 to "identify system failures and contribute to a culture of safety and improvement." We set out to determine the feasibility of using medical students' action learning projects (ALPs) to expedite implementation of evidence-based pathways for three common patient diagnoses in the emergency department (ED) setting (Atrial fibrillation, congestive heart failure, and pulmonary embolism). These prospective quality improvement (QI) initiatives were performed over six months in three Northeastern PA hospitals. Emergency physician mentors were recruited to facilitate a QI experience for third-year medical students for each project. Six students were assigned to each mentor and given class time and network infrastructure support (information technology, consultant experts in lean management) to work on their projects. Students had access to background network data that revealed potential for improvement in disposition (home) for patients. Under the leadership of their mentors, students accomplished standard QI processes such as performing the background literature search and assessing key stakeholders' positions that were involved in the respective patient's care. Students effectively developed flow diagrams, computer aids for clinicians and educational programs, and participated in recruiting champions for the new practice standard. They met with other departmental clinicians to determine barriers to implementation and used this feedback to help set specific parameters to make clinicians more comfortable with the changes in practice that were recommended. All three clinical practice guidelines were initiated at consummation of the students' projects. After implementation, 86% (38/44) of queried ED providers felt comfortable with medical students being a part of future ED QI

  4. Emerging evidence of the physiological role of hypoxia in mammary development and lactation

    Science.gov (United States)

    2014-01-01

    Hypoxia is a physiological or pathological condition of a deficiency of oxygen supply in the body as a whole or within a tissue. During hypoxia, tissues undergo a series of physiological responses to defend themselves against a low oxygen supply, including increased angiogenesis, erythropoiesis, and glucose uptake. The effects of hypoxia are mainly mediated by hypoxia-inducible factor 1 (HIF-1), which is a heterodimeric transcription factor consisting of α and β subunits. HIF-1β is constantly expressed, whereas HIF-1α is degraded under normal oxygen conditions. Hypoxia stabilizes HIF-1α and the HIF complex, and HIF then translocates into the nucleus to initiate the expression of target genes. Hypoxia has been extensively studied for its role in promoting tumor progression, and emerging evidence also indicates that hypoxia may play important roles in physiological processes, including mammary development and lactation. The mammary gland exhibits an increasing metabolic rate from pregnancy to lactation to support mammary growth, lactogenesis, and lactation. This process requires increasing amounts of oxygen consumption and results in localized chronic hypoxia as confirmed by the binding of the hypoxia marker pimonidazole HCl in mouse mammary gland. We hypothesized that this hypoxic condition promotes mammary development and lactation, a hypothesis that is supported by the following several lines of evidence: i) Mice with an HIF-1α deletion selective for the mammary gland have impaired mammary differentiation and lipid secretion, resulting in lactation failure and striking changes in milk compositions; ii) We recently observed that hypoxia significantly induces HIF-1α-dependent glucose uptake and GLUT1 expression in mammary epithelial cells, which may be responsible for the dramatic increases in glucose uptake and GLUT1 expression in the mammary gland during the transition period from late pregnancy to early lactation; and iii) Hypoxia and HIF-1α increase the

  5. An evidence-based practice approach to improving nursing care of acute stroke in an Australian Emergency Department.

    Science.gov (United States)

    Considine, Julie; McGillivray, Bree

    2010-01-01

    The aim of this study was to improve the emergency nursing care of acute stroke by enhancing the use of evidence regarding prevention of early complications. Preventing complications in the first 24-48 hours decreases stroke-related mortality. Many patients spend considerable part of the first 24 hours following stroke in the Emergency Department therefore emergency nurses play a key role in patient outcomes following stroke. A pre-test/post-test design was used and the study intervention was a guideline for Emergency Department nursing management of acute stroke. The following outcomes were measured before and after guideline implementation: triage category, waiting time, Emergency Department length of stay, time to specialist assessment, assessment and monitoring of vital signs, temperature and blood glucose and venous-thromboembolism and pressure injury risk assessment and interventions. There was significant improvement in triage decisions (21.4% increase in triage category 2, p = 0.009; 15.6% decrease in triage category 4, p = 0.048). Frequency of assessments of respiratory rate (p = 0.009), heart rate (p = 0.022), blood pressure (p = 0.032) and oxygen saturation (p = 0.001) increased. In terms of risk management, documentation of pressure area interventions increased by 28.8% (p = 0.006), documentation of nil orally status increased by 13.8% (ns), swallow assessment prior to oral intake increased by 41.3% (p = 0.003), speech pathology assessment in Emergency Department increased by 6.1% (ns) and there was 93.5 minute decrease in time to speech pathology assessment for admitted patients (ns). An evidence-based guideline can improve emergency nursing care of acute stroke and optimise patient outcomes following stroke. As the continuum of stroke care begins in the Emergency Department, detailed recommendations for evidence-based emergency nursing care should be included in all multidisciplinary guidelines for the management of acute stroke.

  6. Emerging Evidence for MicroRNAs as Regulators of Cancer Stem Cells

    Energy Technology Data Exchange (ETDEWEB)

    Sethi, Aisha [Department of Pathology, Henry Ford Hospital, Detroit, MI 48202 (United States); Sholl, Lynette M., E-mail: lmsholl@partners.org [Department of Pathology, Brigham and Women' s Hospital and Harvard Medical School, Boston, MA 02115 (United States)

    2011-10-24

    Cancer stem cells are defined as a subpopulation of cells within a tumor that are capable of self-renewal and differentiation into the heterogeneous cell lineages that comprise the tumor. Many studies indicate that cancer stem cells may be responsible for treatment failure and relapse in cancer patients. The factors that regulate cancer stem cells are not well defined. MicroRNAs (miRNAs) are small non-coding RNAs that regulate translational repression and transcript degradation. miRNAs play a critical role in embryonic and inducible pluripotent stem cell regulation and emerging evidence supports their role in cancer stem cell evolution. To date, miRNAs have been shown to act either as tumor suppressor genes or oncogenes in driving critical gene expression pathways in cancer stem cells in a wide range of human malignancies, including hematopoietic and epithelial tumors and sarcomas. miRNAs involved in cancer stem cell regulation provide attractive, novel therapeutic targets for cancer treatment. This review attempts to summarize progress to date in defining the role of miRNAs in cancer stem cells.

  7. Zika Virus-associated Ocular and Neurologic Disorders: The Emergence of New Evidence.

    Science.gov (United States)

    Şahiner, Fatih; Siğ, Ali Korhan; Savaşçi, Ümit; Tekin, Kemal; Akay, Fahrettin

    2017-12-01

    It has been approximately 70 years since the discovery of the Zika virus (ZIKV). It had been established that the virus causes mild infections and is confined to Africa and Asia; however, major changes in the clinical and epidemiologic patterns of ZIKV infection have occurred in recent years. The virus has attracted intense interest because of the possible association of several autoimmune and neurodevelopmental disorders. We present a summary of the articles that attempt to explain the ZIKV unknowns and strengthen the association with some disorders that are thought to be related to ZIKV, by describing the discovery milestones from the initial identification of the virus to the present day. New evidence strengthens the association between ZIKV infections and Guillain-Barré syndrome (GBS), microcephaly and various neurodevelopmental and ophthalmologic disorders as a result of numerous new clinical and experimental studies. The World Health Organization declared the end of the "Public Health Emergency of International Concern" in December 2016, but ZIKV and associated consequences remain a significant enduring public health challenge.

  8. Emerging Evidence for MicroRNAs as Regulators of Cancer Stem Cells

    International Nuclear Information System (INIS)

    Sethi, Aisha; Sholl, Lynette M.

    2011-01-01

    Cancer stem cells are defined as a subpopulation of cells within a tumor that are capable of self-renewal and differentiation into the heterogeneous cell lineages that comprise the tumor. Many studies indicate that cancer stem cells may be responsible for treatment failure and relapse in cancer patients. The factors that regulate cancer stem cells are not well defined. MicroRNAs (miRNAs) are small non-coding RNAs that regulate translational repression and transcript degradation. miRNAs play a critical role in embryonic and inducible pluripotent stem cell regulation and emerging evidence supports their role in cancer stem cell evolution. To date, miRNAs have been shown to act either as tumor suppressor genes or oncogenes in driving critical gene expression pathways in cancer stem cells in a wide range of human malignancies, including hematopoietic and epithelial tumors and sarcomas. miRNAs involved in cancer stem cell regulation provide attractive, novel therapeutic targets for cancer treatment. This review attempts to summarize progress to date in defining the role of miRNAs in cancer stem cells

  9. Poststroke Fatigue: Emerging Evidence and Approaches to Management: A Scientific Statement for Healthcare Professionals From the American Heart Association.

    Science.gov (United States)

    Hinkle, Janice L; Becker, Kyra J; Kim, Jong S; Choi-Kwon, Smi; Saban, Karen L; McNair, Norma; Mead, Gillian E

    2017-07-01

    At least half of all stroke survivors experience fatigue; thus, it is a common cause of concern for patients, caregivers, and clinicians after stroke. This scientific statement provides an international perspective on the emerging evidence surrounding the incidence, prevalence, quality of life, and complex pathogenesis of poststroke fatigue. Evidence for pharmacological and nonpharmacological interventions for management are reviewed, as well as the effects of poststroke fatigue on both stroke survivors and caregivers. © 2017 American Heart Association, Inc.

  10. The genetic architecture of type 2 diabetes pharmacotherapy: the emerging genomic evidence.

    Science.gov (United States)

    Kavvoura, F K; Pappa, M; Evangelou, E; Ntzani, E E

    2014-01-01

    Response to anti-diabetic medications is not always predictable or favourable even in phenotypically similar type-2 diabetes (T2D) cases. This is not only due to patient's compliance and access to care but is also considered to be an effect of idiosyncratic differences among individuals, stemming from the combination of their unique genetic background and environmental exposures. In this systematic review, we aimed to summarise the available evidence on pharmacogenetic and pharmacogenomic studies of oral agents for T2D that are currently in the market and describe the agents studied, the targeted loci in regards to the efficacy and the toxicity profile of the agents included. We included 53 studies published between 2003-2012, which examined the following anti-diabetic classes: sulphonylureas, metformin, metiglinides and thiazolidenediones. There were no published studies on newer agents (e.g. incretin based treatments). Forty-nine studies (92.5%) examined the therapeutic response to oral antiglycaemic agents. Outcomes assessed included changes in metabolic markers (fasting or postprandial blood glucose, fasting or postprandial insulin, HbA1c), Homeostasis Assessment Model (HOMA)-Insulin Resistance (IR) or HOMA-B-cell function (HOMA-B), and time to monotherapy failure. Regarding side effects, hypoglycaemia and TZD-related oedema were the most commonly assessed. In the vast majority of the studies included (n=38, 71.7%), more than one outcomes (n=27, 50.9%) and/or more than one SNPs (n=21, 39.6%) were evaluated in the same publication, but most studies examined one drug (n=50, 94.3%). A considerable number of the proposed genes seem to be related to beta-cell development and function, but there are several genes whose underlying pathway linked to diabetes pharmacotherapy remains poorly understood. Pharmacogenomics are still not in pace with the wealth of information provided by GWAS in the genetics of T2D and related traits and the proposed associations need further

  11. What evidence is there that a physiotherapy service in the emergency department improves health outcomes? A systematic review.

    Science.gov (United States)

    Kilner, Emily

    2011-01-01

    the nature of care delivered in emergency departments has changed due to increased demand. In response, one relatively new change is the introduction of a physiotherapy service. There have been anecdotal reports that this may reduce patient waiting times and lead to more effective use of other health care staff, though it is unclear how such a service affects health outcomes. The objective was to identify the effect an emergency department physiotherapy service has on health outcomes. systematic searches were carried out on the following databases: CINAHL, Medline, Web of Knowledge, Scopus, PEDro, PubMed, Cochrane and Academic Search Premier. Selection criteria included full-text English primary studies published in peer-reviewed journals, investigating physiotherapy services based directly in the emergency department. Papers were appraised using a researcher-developed appraisal of bias tool. eleven eligible primary studies were identified. For most, the likelihood of methodological bias was high or unknown due to inadequate detail provided. Three studies were judged to have introduced little bias. At system and provider levels, there is insufficient evidence to support benefits of an emergency department physiotherapy service. At patient level, there is high-level evidence of benefits in terms of improved pain control and reduced disability in the short term. research evidence does not support the use of physiotherapists in emergency departments. The Royal Society of Medicine Press Ltd 2011.

  12. Do emerging markets matter in the world oil pricing system? Evidence of imported crude by China and India

    International Nuclear Information System (INIS)

    Hong Li; Lin Xiaowen, Sharon

    2011-01-01

    This paper provides empirical evidence on the changing structure of world oil price system by identifying an additional driver-emerging market factor. We choose China and India as a representative of emerging markets to examine if the quantity of crude oil imported by China and India is significant in the existing oil pricing system (. Our data starts from January 2002 and ends in March 2010, which includes the oil shock of 2007-2008. We utilize cointegration and error correction model framework developed by and in the analysis. Our results indicate that demand from emerging markets has become a significant factor in the world oil pricing system since 2003. This result is significant as it lends empirical support to the widely held conjecture that the oil shock of 2007-2008 is a demand-led shock (). Our result also has significant policy implications that go beyond the oil shock. The emerging market factor is there to stay and reflects the changing power between emerging and developed economies in the world economic system as a result of decades of fast economic development in the former. It will certainly influence policy issues related to oil and beyond. - Highlights: → We test the existing oil price modelling with data from 2002-2010. → We find evidence of structural breaks in the world oil pricing model. → We find that emerging market factor is a new driver in the world oil pricing system since 2003. → The emerging market factor lends empirical support to 'consumption-led' conjecture of oil shock. → New factor reflects significant changes of oil demand landscape following shifting economic power.

  13. Postabortion Care: 20 Years of Strong Evidence on Emergency Treatment, Family Planning, and Other Programming Components.

    Science.gov (United States)

    Huber, Douglas; Curtis, Carolyn; Irani, Laili; Pappa, Sara; Arrington, Lauren

    2016-09-28

    Worldwide 75 million women need postabortion care (PAC) services each year following safe or unsafe induced abortions and miscarriages. We reviewed more than 550 studies on PAC published between 1994 and 2013 in the peer-reviewed and gray literature, covering emergency treatment, postabortion family planning, organization of services, and related topics that impact practices and health outcomes, particularly in the Global South. In this article, we present findings from studies with strong evidence that have major implications for programs and practice. For example, vacuum aspiration reduced morbidity, costs, and time in comparison to sharp curettage. Misoprostol 400 mcg sublingually or 600 mcg orally achieved 89% to 99% complete evacuation rates within 2 weeks in multiple studies and was comparable in effectiveness, safety, and acceptability to manual vacuum aspiration. Misoprostol was safely introduced in several PAC programs through mid-level providers, extending services to secondary hospitals and primary health centers. In multiple studies, postabortion family planning uptake before discharge increased by 30-70 percentage points within 1-3 years of strengthening postabortion family planning services; in some cases, increases up to 60 percentage points in 4 months were achieved. Immediate postabortion contraceptive acceptance increased on average from 32% before the interventions to 69% post-intervention. Several studies found that women receiving immediate postabortion intrauterine devices and implants had fewer unintended pregnancies and repeat abortions than those who were offered delayed insertions. Postabortion family planning is endorsed by the professional organizations of obstetricians/gynecologists, midwives, and nurses as a standard of practice; major donors agree, and governments should be encouraged to provide universal access to postabortion family planning. Important program recommendations include offering all postabortion women family planning

  14. Suicidal behavior and antiepileptic drugs in epilepsy: analysis of the emerging evidence

    Directory of Open Access Journals (Sweden)

    Mula M

    2011-06-01

    Full Text Available Marco Mula1, Dale C Hesdorffer21Department of Clinical and Experimental Medicine, Amedeo Avogadro University and Division of Neurology, University Hospital Maggiore della Carità, Novara, Italy; 2Gertrude H Sergievsky Center and Department of Epidemiology, Columbia University, New York, NY, USAAbstract: Two years after the warning issued by the Food and Drug Administration on an increased risk of suicide for people taking antiepileptic drugs (AEDs, a number of pharmacoepidemiologic studies have been published but the scientific community is far from definitive answers. The present paper is aimed at reviewing available evidence on the association between AEDs and suicidal behavior, discussing major variables involved such as the relationship between epilepsy, depression, and suicide and the psychotropic potential of AEDs. All studies published so far show a lack of concordance and are constrained by various methodological limitations. What seems to be established is that mood disorders represent a frequent comorbidity in epilepsy and suicide is a serious complication more frequently encountered in epilepsy rather than in the general population. Moreover, a subgroup of patients appears to be at risk of developing treatment-emergent psychiatric adverse effects of AEDs independently of the specific mechanism of action of the drug. The prior history of suicide attempt, especially preceding the onset of the epilepsy, may represent a key element explaining why what is observed is independent of the specific mechanism of the drug. In general terms, risks associated with stopping, or not even starting, AEDs in epilepsy might well be in excess of the risk of suicide in epilepsy, as deaths due to accident and epilepsy itself may predominate. Clinicians need to pay attention not only to seizure patterns when choosing the appropriate AED but also to a number of different parameters (eg, age, gender, working needs, medical comorbidities, history of

  15. 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].

  16. An Emerging Theory for Evidence Based Information Literacy Instruction in School Libraries, Part 1: Building a Foundation

    Directory of Open Access Journals (Sweden)

    Carol A. Gordon

    2009-06-01

    Full Text Available Objective – Part I of this paper aims to create a framework for an emerging theory of evidence based information literacy instruction. In order to ground this framework in existing theory, a holistic perspective views inquiry as a learning process that synthesizes information searching and knowledge building. An interdisciplinary approach is taken to relate user-centric information behavior theory and constructivist learning theory that supports this synthesis. The substantive theories that emerge serve as a springboard for emerging theory. A second objective of this paper is to define evidence based information literacy instruction by assessing the suitability of performance based assessment and action research as tools of evidence based practice.Methods – An historical review of research grounded in user-centered information behavior theory and constructivist learning theory establishes a body of existing substantive theory that supports emerging theory for evidence based information literacy instruction within an information-to-knowledge approach. A focused review of the literature presents supporting research for an evidence based pedagogy that is performance assessment based, i.e., information users are immersed in real-world tasks that include formative assessments. An analysis of the meaning of action research in terms of its purpose and methodology establishes its suitability for structuring an evidence based pedagogy. Supporting research tests a training model for school librarians and educators which integrates performance based assessment, as well as action research. Results – Findings of an historical analysis of information behavior theory and constructivist teaching practices, and a literature review that explores teaching models for evidence based information literacy instruction, point to two elements of evidence based information literacy instruction: the micro level of information searching behavior and the macro level of

  17. Safety - a Neglected Issue When Introducing Solid Biomass Fuel in Thermal Power Plants? Some Evidence of an Emerging Risk

    DEFF Research Database (Denmark)

    Hedlund, Frank Huess; Astad, John

    2013-01-01

    attention paid to safety and points to evidence of media-shifting-that the 'resolution' of a problem within the environmental domain creates a new problem in the workplace safety domain. The paper argues that biomass pellets qualify as an emerging risk for which proper control strategies have yet......The paper examines recent evidence from Denmark and abroad with climate change projects that aim to reduce global carbon dioxide emissions by converting coal fired thermal power plants to solid biomass fuel. The paper argues that projects appear to be pursued narrow-mindedly with insufficient...

  18. EMERGENCY DEPARTMENT (ED) OVERCROWDING: EVIDENCE-BASED ANSWERS TO FREQUENTLY ASKED QUESTIONS

    OpenAIRE

    RJ Salway; R Valenzuela; JM Shoenberger; WK Mallon; A Viccellio

    2017-01-01

    Overcrowding in emergency departments is a problem in many countries around the world, including the United States and Chile. Emergency department (ED) overcrowding causes problems for patients and staff, including increased waiting times, increased ambulance diversion, increased length of stay, increased medical errors, increased patient mortality, and increased harm to hospitals due to financial losses. This article aims to describe the etiology of ED overcrowding and potential solutions th...

  19. 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....

  20. What is the evidence for the management of patients along the pathway from the emergency department to acute admission to reduce unplanned attendance and admission? An evidence synthesis.

    Science.gov (United States)

    Credé, Sarah H; O'Keeffe, Colin; Mason, Suzanne; Sutton, Anthea; Howe, Emma; Croft, Susan J; Whiteside, Mike

    2017-05-16

    Globally, the rate of emergency hospital admissions is increasing. However, little evidence exists to inform the development of interventions to reduce unplanned Emergency Department (ED) attendances and hospital admissions. The objective of this evidence synthesis was to review the evidence for interventions, conducted during the patient's journey through the ED or acute care setting, to manage people with an exacerbation of a medical condition to reduce unplanned emergency hospital attendance and admissions. A rapid evidence synthesis, using a systematic literature search, was undertaken in the electronic data bases of MEDLINE, EMBASE, CINAHL, the Cochrane Library and Web of Science, for the years 2000-2014. Evidence included in this review was restricted to Randomised Controlled Trials (RCTs) and observational studies (with a control arm) reported in peer-reviewed journals. Studies evaluating interventions for patients with an acute exacerbation of a medical condition in the ED or acute care setting which reported at least one outcome related to ED attendance or unplanned admission were included. Thirty papers met our inclusion criteria: 19 intervention studies (14 RCTs) and 11 controlled observational studies. Sixteen studies were set in the ED and 14 were conducted in an acute setting. Two studies (one RCT), set in the ED were effective in reducing ED attendance and hospital admission. Both of these interventions were initiated in the ED and included a post-discharge community component. Paradoxically 3 ED initiated interventions showed an increase in ED re-attendance. Six studies (1 RCT) set in acute care settings were effective in reducing: hospital admission, ED re-attendance or re-admission (two in an observation ward, one in an ED assessment unit and three in which the intervention was conducted within 72 h of admission). There is no clear evidence that specific interventions along the patient journey from ED arrival to 72 h after admission benefit ED

  1. Altered level of consciousness: evidence-based management in the emergency department [digest].

    Science.gov (United States)

    Song, Joo Lee; Wang, Vincent J; Vazquez, Michelle N

    2017-01-22

    A child who presents to the emergency department with an altered level of consciousness can be clinically unstable and can pose a great diagnostic challenge. The emergency clinician must quickly develop a wide differential of possible etiologies in order to administer potentially life-saving medications or interventions. The history, physical examination, and appropriate diagnostic tests can aid greatly in rapidly narrowing the differential diagnosis. Once initial stabilization, workup, and first-line interventions are completed, most patients who present with unresolved or unidentified altered level of consciousness should be admitted for further evaluation and close monitoring. This issue provides a review of the etiologies of altered level of consciousness as well as guidance for the management and disposition of patients with this condition. [Points & Pearls is a digest of Pediatric Emergency Medicine Practice].

  2. The evidence base of primary research in public health emergency preparedness: a scoping review and stakeholder consultation.

    Science.gov (United States)

    Khan, Yasmin; Fazli, Ghazal; Henry, Bonnie; de Villa, Eileen; Tsamis, Charoula; Grant, Moira; Schwartz, Brian

    2015-04-28

    Effective public health emergency preparedness and response systems are important in mitigating the impact of all-hazards emergencies on population health. The evidence base for public health emergency preparedness (PHEP) is weak, however, and previous reviews have noted a substantial proportion of anecdotal event reports. To investigate the body of research excluding the anecdotal reports and better understand primary and analytical research for PHEP, a scoping review was conducted with two objectives: first, to develop a thematic map focused on primary research; and second, to use this map to inform and guide an understanding of knowledge gaps relevant to research and practice in PHEP. A scoping review was conducted based on established methodology. Multiple databases of indexed and grey literature were searched based on concepts of public health, emergency, emergency management/preparedness and evaluation/evidence. Inclusion and exclusion criteria were applied iteratively. Primary research studies that were evidence-based or evaluative in nature were included in the final group of selected studies. Thematic analysis was conducted for this group. Stakeholder consultation was undertaken for the purpose of validating themes and identifying knowledge gaps. To accomplish this, a purposive sample of researchers and practicing professionals in PHEP or closely related fields was asked to complete an online survey and participate in an in-person meeting. Final themes and knowledge gaps were synthesized after stakeholder consultation. Database searching yielded 3015 citations and article selection resulted in a final group of 58 articles. A list of ten themes from this group of articles was disseminated to stakeholders with the survey questions. Survey findings resulted in four cross-cutting themes and twelve stand-alone themes. Several key knowledge gaps were identified in the following themes: attitudes and beliefs; collaboration and system integration; communication

  3. The impact of internet use on air pollution: Evidence from emerging countries.

    Science.gov (United States)

    Ozcan, Burcu; Apergis, Nicholas

    2018-02-01

    The goal of this study is to analyze the impact of Internet use, employed as a proxy for information and communications technologies (ICTs), on CO 2 emissions. Using a panel of 20 emerging economies spanning the period 1990 to 2015, this paper finds that increased Internet access results in lower levels of air pollution. Moreover, panel causality test results highlight a unidirectional causality running from Internet use to CO 2 emissions. This result also has crucial policy implications for the governments in emerging markets. For instance, increased investment in the ICT sector could be a plausible channel to reduce air pollution level.

  4. The Impact of Ownership Structure on Firm Performance : Evidence From a Large Emerging Market

    NARCIS (Netherlands)

    Douma, S.W.; George, R.; Kabir, M.R.

    2002-01-01

    We examine how ownership structure affects the performance of firms using firm level data from a large emerging market, India.We specifically focus on a previously unexplored phenomenon, namely the differential role played by foreign institutional and foreign corporate shareholders.An examination of

  5. The Inner Working of the Board : Evidence from the Emerging Markets

    NARCIS (Netherlands)

    de Haas, Ralph; Ferreira, Daniel; Kirchmaier, Tom

    2017-01-01

    We survey non-executive directors in emerging markets to obtain detailed information about the inner workings of corporate boards across a variety of institutional settings. We document substantial variation in the structure and conduct of boards as well as in directors’ perceptions about the local

  6. The emerging field of radiomics in esophageal cancer : Current evidence and future potential

    NARCIS (Netherlands)

    van Rossum, Peter S N; Xu, Cai; Fried, David V.; Goense, Lucas; Court, Laurence E.; Lin, Steven H.

    2016-01-01

    'Radiomics' is the name given to the emerging field of extracting additional information from standard medical images using advanced feature analysis. This innovative form of quantitative image analysis appears to have future potential for clinical practice in patients with esophageal cancer by

  7. Exports and Innovation in Emerging Economies : Firm-Level Evidence from South-Africa

    NARCIS (Netherlands)

    Vannoorenberghe, Gonzague

    2015-01-01

    Using a new dataset on the innovation and exports of 500 South African firms, this paper asks whether exports affect rm innovation in the context of an emerging economy. We use a range of particularly attractive features of the dataset. Firms not only report whether they innovated but describe their

  8. Institutions and international investments: Evidence from China and other emerging markets

    NARCIS (Netherlands)

    Zhang, Y.

    2011-01-01

    This thesis empirically investigates the underlying factors that explain the new global trade and investment patterns. At the baseline level, three questions on the globalization process of emerging markets are addressed. First, what is the causal linkage among institutions, external trade and

  9. Can You Multitask? Evidence and Limitations of Task Switching and Multitasking in Emergency Medicine.

    Science.gov (United States)

    Skaugset, L Melissa; Farrell, Susan; Carney, Michele; Wolff, Margaret; Santen, Sally A; Perry, Marcia; Cico, Stephen John

    2016-08-01

    Emergency physicians work in a fast-paced environment that is characterized by frequent interruptions and the expectation that they will perform multiple tasks efficiently and without error while maintaining oversight of the entire emergency department. However, there is a lack of definition and understanding of the behaviors that constitute effective task switching and multitasking, as well as how to improve these skills. This article reviews the literature on task switching and multitasking in a variety of disciplines-including cognitive science, human factors engineering, business, and medicine-to define and describe the successful performance of task switching and multitasking in emergency medicine. Multitasking, defined as the performance of two tasks simultaneously, is not possible except when behaviors become completely automatic; instead, physicians rapidly switch between small tasks. This task switching causes disruption in the primary task and may contribute to error. A framework is described to enhance the understanding and practice of these behaviors. Copyright © 2015 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

  10. Determinants and Dynamics of Business Aspirations : Evidence from Small-scale Entrepreneurs in an Emerging Market

    NARCIS (Netherlands)

    Dalton, Patricio; Rüschenpöhler, Julius; Zia, Bilal

    2018-01-01

    Small-scale entrepreneurs are ubiquitous in emerging market economies, yet very few graduate to become larger businesses. We ask whether such entrepreneurs even aspire to grow, and if so, on which dimensions of the business? What factors influence these aspirations, how realistic are they, and do

  11. Foreign and domestic ownership, business groups, and firm performance: evidence from a large emerging market

    NARCIS (Netherlands)

    Douma, Sytse; George, Rejie; Kabir, Mohammed Rezaul

    2006-01-01

    We adopt a multi-theoretic approach to investigate a previously unexplored phenomenon in extant literature, namely the differential impact of foreign institutional and foreign corporate shareholders on the performance of emerging market firms. We show that the previously documented positive effect

  12. Reverse quality management: developing evidence-based best practices in health emergency management.

    Science.gov (United States)

    Lynch, Tim; Cox, Paul

    2006-01-01

    The British Columbia Ministry of Health's Framework for Core Functions in Public Health was the catalyst that inspired this review of best practices in health emergency management. The fieldwork was conducted in the fall of 2005 between hurricane Katrina and the South Asia earthquake. These tragedies, shown on 24/7 television news channels, provided an eyewitness account of disaster management, or lack of it, in our global village world. It is not enough to just have best practices in place. There has to be a governance structure that can be held accountable. This review of best practices lists actions in support of an emergency preparedness culture at the management, executive, and corporate/governance levels of the organization. The methodology adopted a future quality management approach of the emergency management process to identify the corresponding performance indictors that correlated with practices or sets of practices. Identifying best practice performance indictors needed to conduct a future quality management audit is described as reverse quality management. Best practices cannot be assessed as stand-alone criteria; they are influenced by organizational culture. The defining of best practices was influenced by doubt about defining a practice it is hoped will never be performed, medical staff involvement, leadership, and an appreciation of the resources required and how they need to be managed. Best practice benchmarks are seen as being related more to "measures" of performance defined locally and agreed on by 2 or more parties rather than to achieving industrial standards. Relating practices to performance indicators and then to benchmarks resulted in the development of a Health Emergency Management Best Practices Matrix that lists specific practice in the different phases of emergency management.

  13. High quality of evidence is uncommon in Cochrane systematic reviews in Anaesthesia, Critical Care and Emergency Medicine.

    Science.gov (United States)

    Conway, Aaron; Conway, Zachary; Soalheira, Kathleen; Sutherland, Joanna

    2017-12-01

    The association between the quality of evidence in systematic reviews and authors' conclusions regarding the effectiveness of interventions relevant to anaesthesia has not been examined. The objectives of this study were: to determine the proportion of systematic reviews in which the authors made a conclusive statement about the effect of an intervention; to describe the quality of evidence derived from outcomes in reviews that used the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) working group system for grading the quality of evidence; and to identify review characteristics associated with conclusiveness. Cross-sectional analysis of Cochrane systematic reviews from the Anaesthesia, Critical Care and Emergency Review Group was undertaken. The Cochrane webpage was used to identify reviews for inclusion (http://.ace.cochrane.org/). New and updated versions of systematic reviews published up to 17 September 2015 were eligible. Protocols for systematic reviews were excluded. A total of 159 reviews were included. GRADE was used in 103 reviews (65%). Of these, high-level evidence for the primary outcome was identified in 11 reviews (10%). The main reasons that quality of evidence for the primary outcome was downgraded were risk of bias (n = 44; 43%) and imprecision (n = 36; 35%). Authors of 47% (n = 75) of the total number of reviews made conclusive statements about the effects of interventions. Independent predictors of conclusiveness in the subgroup of reviews with GRADE assessments were quality of evidence for the primary outcome (odds ratio 2.03; 95% confidence interval: [1.18 to 3.52] and an increasing number of studies included in reviews (OR 1.05; 95% CI: [1.01 to 1.09]). It was common for conclusive statements to be made about the effects of interventions despite evidence for the primary outcome being rated less than high quality. Improving methodological quality of trials would have the greatest impact on improving the

  14. Market Structure, Financial Dependence and Industrial Growth: Evidence from the Banking Industry in Emerging Asian Economies.

    Science.gov (United States)

    Khan, Habib Hussain; Ahmad, Rubi Binit; Gee, Chan Sok

    2016-01-01

    In this study, we examine the role of market structure for growth in financially dependent industries from 10 emerging Asian economies over the period of 1995-2011. Our approach departs from existing studies in that we apply four alternative measures of market structure based on structural and non-structural approaches and compare their outcomes. Results indicate that higher bank concentration may slow down the growth of financially dependent industries. Bank competition on the other hand, allows financially dependent industries to grow faster. These findings are consistent across a number of sensitivity checks such as alternative measures of financial dependence, institutional factors (including property rights, quality of accounting standards and bank ownership), and endogeneity consideration. In sum, our study suggests that financially dependent industries grow more in more competitive/less concentrated banking systems. Therefore, regulatory authorities need to be careful while pursuing a consolidation policy for banking sector in emerging Asian economies.

  15. ARE SMALL-FIRM CLUSTERS EMERGENT PHENOMENA? EVIDENCE FROM ZIMBABWE’S SMALL FURNITURE- MANUFACTURING FIRMS

    Directory of Open Access Journals (Sweden)

    Godfrey MUPONDA

    2014-07-01

    Full Text Available The purpose of this study was to explore the reasons behind the rapid growth and apparent dynamism of Zimbabwe’s small-firm industrial clusters. The hypothesis behind the study was that these small-firm clusters are emergent phenomena. The study analysed the capital utilisation techniques of small firms located in a large industrial cluster in order to determine the factors that lead to the collective efficiency of such firms. The study found that, in comparison with large, stock exchange-listed firms, the cluster environment enables the small firm to operate from a relatively small capital base and also to use its capital more efficiently in creating revenues and profits. The individual firm does not have to invest its capital in a large assets base as this is done by a specialised group of firms within the cluster. Thus, the cluster has the characteristics of an emergent phenomenon.

  16. Emergency management of blunt chest trauma in children: an evidence-based approach.

    Science.gov (United States)

    Pauzé, Denis R; Pauzé, Daniel K

    2013-11-01

    Pediatric trauma is commonly encountered in the emergency department, and trauma to the head, chest, and abdomen may be a source of significant morbidity and mortality. As children have unique thoracic anatomical and physiological properties, they may present with diagnostic challenges that the emergency clinician must be aware of. This review examines the effects of blunt trauma to the pediatric chest, as well as its relevant etiologies and associated mortality. Diagnostic and treatment options for commonly encountered injuries such as pulmonary contusions, rib fractures, and pneumothoraces are examined. Additionally, this review discusses rarely encountered--yet highly lethal--chest wall injuries such as blunt cardiac injuries, commotio cordis, nonaccidental trauma, and aortic injuries.

  17. IMPACT OF INFLATION ON PER CAPITA INCOME IN EMERGING ECONOMIES: EVIDENCE FROM BRICS NATIONS

    Directory of Open Access Journals (Sweden)

    Khalid Ashraf CHISTI

    2015-12-01

    Full Text Available In this paper an attempt has been made to analyse the impact of Inflation on per capita income of emerging economies. In order to achieve the objective of the study the researchers have taken five major emerging countries of the world which are the members of BRICS. For the purpose of analysis, the data of thirteen years has been taken from 1999 to 2011. After employing the regression model, the results confirm that independent variable (inflation does not statistically influence the dependent variable (Per Capita Income in three countries which are India, Brazil and South Africa. However, in the other two countries (China and Russia the findings affirm the independent variable (Inflation does statistically influence the dependent variable (Per Capita Income.Therefore, it can be concluded that a change in the inflation rate can not necessarily bring a change in the per capita income of a country.

  18. Market Structure, Financial Dependence and Industrial Growth: Evidence from the Banking Industry in Emerging Asian Economies

    Science.gov (United States)

    Khan, Habib Hussain; Ahmad, Rubi Binit; Gee, Chan Sok

    2016-01-01

    In this study, we examine the role of market structure for growth in financially dependent industries from 10 emerging Asian economies over the period of 1995–2011. Our approach departs from existing studies in that we apply four alternative measures of market structure based on structural and non-structural approaches and compare their outcomes. Results indicate that higher bank concentration may slow down the growth of financially dependent industries. Bank competition on the other hand, allows financially dependent industries to grow faster. These findings are consistent across a number of sensitivity checks such as alternative measures of financial dependence, institutional factors (including property rights, quality of accounting standards and bank ownership), and endogeneity consideration. In sum, our study suggests that financially dependent industries grow more in more competitive/less concentrated banking systems. Therefore, regulatory authorities need to be careful while pursuing a consolidation policy for banking sector in emerging Asian economies. PMID:27490847

  19. Does bank competition and diversification lead to greater stability? Evidence from emerging markets

    Directory of Open Access Journals (Sweden)

    Mohammed Amidu

    2013-07-01

    Full Text Available This paper investigates how the level of competition affects diversification and stability using a sample of 978 banks in 55 emerging and developing countries over an eight year period 2000–2007. We shed further light on the competition-stability nexus by examining the complex interaction between three key variables: the degree of bank market power, diversification and stability. The core finding is that competition increases stability as diversification across and within both interest and non-interest income generating activities of banks increases. Our analysis identifies revenue diversification as a channel through which competition affects bank insolvency risk in emerging countries. The results are robust to an array of controls including alternative methodology, variable specifications and the regulatory environments that banks operate in.

  20. Investor sentiment, optimism and excess stock market returns. Evidence from emerging markets

    OpenAIRE

    Karolina Daszynska-Zygadlo; Aleksandra Szpulak; Adam Szyszka

    2014-01-01

    We test the existence of a contemporaneous relationship between sentiment/optimism indexes and returns at the aggregate market level in eight emerging markets, namely: Brazil, China, India, Mexico, Poland, Republic of South Africa, Russia and Turkey. We use sentiment and optimism Thomson Reuters MarketPsych Indexes that are based on scanning media coverage for relevant text reflecting particular moods and opinions. We find that there is a positive relationship between investor sentiment index...

  1. The Value of Institutions for Financial Markets; Evidence From Emerging Markets

    OpenAIRE

    Thomas Stratmann; Bernardin Akitoby

    2009-01-01

    This paper investigates the value of political institutions for financial markets, using panel data from emerging market countries. We test the hypothesis that changes in political institutions, such as improvements in democratic rights and increased government accountability, have a direct effect on sovereign interest rate spreads. We find that financial markets value institutions over and above the economic and fiscal outcomes these institutions shape. Democracy and accountability generally...

  2. Why is the wage share falling in emerging economies? Industry level evidence

    OpenAIRE

    Guschanski, Alexander; Onaran, Özlem

    2017-01-01

    This article presents an econometric analysis of the wage share in seven emerging economies. We focus on the effect of globalisation, captured by participation in global value chains and financial integration, indicators of bargaining power of labour and technological change on the wage share. We use input-output tables that allow us to obtain detailed measures of global value chain participation, and sectoral data to distinguish the effect on high- and low-skilled workers and within manufact...

  3. Performance Effects of Stakeholder Interaction in Emerging Economies: Evidence from Brazil

    Directory of Open Access Journals (Sweden)

    Rodrigo Bandeira-de-Mello

    2011-07-01

    Full Text Available Firm survival in emerging economies is often related to having access to valuable resources that are in stakeholders‟ hands. However, the literature on strategy in emerging economies provides scant information on the efficiency of acquiring stakeholder resources and its effect on firm performance. We investigated the stakeholder interaction effects on performance of domestic firms competing in an emerging market (Wright, Filatotchev, Hoskisson, & Peng, 2005 from a contractual perspective (Williamson, 1985. We argue that interacting stakeholders in a contractual set yield synergistic governance structures that allow firms more efficient access to external resources. Using a sample of 267 firms in Brazil (secondary data, we explored different patterns in stakeholder contracting with community, government, top management, and employees. A three-stage analysis process was devised: cluster analysis, general linear model estimation and verification tests. Results suggest that stakeholder interaction has a positive impact on firm performance. The conjoint effect of government and community contracts was found to yield superior firm performance as they provide a basic structure for contracting with other interacting stakeholders.

  4. Do foreign portfolio flows increase risk in emerging stock markets? Evidence from six Latin American countries 1999-2008

    Directory of Open Access Journals (Sweden)

    Diego A. Agudelo

    2011-03-01

    Full Text Available Foreign portfolio flows have been blamed for causing instability in emerging markets, especially during financial crises. This study measured the effect of foreign capital flows on volatility and exposure to world market risk in the six largest Latin American stock markets: Argentina, Brazil, Colombia, Chile, Mexico and Peru, for around 10 years including the 2008 World financial crisis. This will test whether these flows cause instability for those markets and increase their exposure to international stock market returns. A proprietary database, from Emerging Portoflio.com and time series models, both univariate (ARCH-GARCH and multivariate (VAR, are used to estimate the effect foreign portfolio flows on the risk variables and the causality of these effects. We found no strong evidence to support the hypothesis that foreign flows cause instability in the Latin American stock markets, in spite of some evidence of causing price pressure. Instead, the evidence points to a strong dependence of market returns on international stock and foreign exchange markets, both in means and in volatility, instrumental to transmit crisis to those markets.

  5. Emerging Evidence for Instructional Practice: Repeated Viewings of Sign Language Models

    Science.gov (United States)

    Beal-Alvarez, Jennifer S.; Huston, Sandra G.

    2014-01-01

    Current initiatives in education, such as No Child Left Behind and the National Common Core Standards movement, call for the use of evidence-based practices, or those instructional practices that are supported by documentation of their effectiveness related to student learning outcomes, including students with special needs. While hearing loss is…

  6. An Emerging Theory for Evidence Based Information Literacy Instruction in School Libraries, Part 2: Building a Culture of Inquiry

    Directory of Open Access Journals (Sweden)

    Carol A. Gordon

    2009-09-01

    Full Text Available Objective – The purpose of this paper is to articulate a theory for the use of action research as a tool of evidence based practice for information literacy instruction in school libraries. The emerging theory is intended to capture the complex phenomenon of information skills teaching as it is embedded in school curricula. Such a theory is needed to support research on the integrated approach to teaching information skills and knowledge construction within the framework of inquiry learning. Part 1 of this paper, in the previous issue, built a foundation for emerging theory, which established user‐centric information behavior and constructivist learning theory as the substantive theory behind evidence based library instruction in schools. Part 2 continues to build on the Information Search Process and Guided Inquiry as foundational to studying the information‐to‐knowledge connection and the concepts of help and intervention characteristic of 21st century school library instruction.Methods – This paper examines the purpose and methodology of action research as a tool of evidence based instruction. This is accomplished through the explication of three components of theory‐building: paradigm, substantive research, and metatheory. Evidence based practice is identified as the paradigm that contributes values and assumptions about school library instruction. It establishes the role of evidence in teaching and learning, linking theory and practice. Action research, as a tool of evidence based practice is defined as the synthesis of authentic learning, or performance‐based assessment practices that continuously generate evidence throughout the inquiry unit of instruction and traditional data collection methods typically used in formal research. This paper adds social psychology theory from Lewin’s work, which contributes methodology from Gestalt psychology, field theory, group dynamics, and change theory. For Lewin the purpose of action

  7. Does the Political Environment Affect Inflows of Foreign Direct Investment? Evidence from Emerging Markets

    Directory of Open Access Journals (Sweden)

    Michal Mádr

    2015-01-01

    Full Text Available The main aim of the paper is to identify and quantify the influence of the political environment on the inflows of foreign direct investment in emerging markets. The paper defines emerging markets as Middle Income Countries according to the evaluation of the World Bank. Our sample of countries contains 78 states. The reference period focuses on the period of 1996–2012 due to data availability. The evaluation of the political environment is based on three dimensions: the quality of democracy, political instability and the level of corruption, which are related to three subcomponents of the concept, Governance Matters, provided by the World Bank. The paper distinguishes between two types of political instability omitted in thematic literature, elite and non-elite. The former represents non-violent instability (minority governments, tension related to the holding of elections while the latter deals with violent forms of instability (civil wars, coups, ethnic and religious riots. The paper uses panel data regression analysis for the purpose of identification and quantification. The research uses fixed effects model with a cluster option. According to the results, the influence of the political environment on FDI is not entirely unequivocal in emerging markets; nevertheless, there is a statistically significant dimension – political instability (both parts. The quality of democracy and the level of corruption are significant only in some cases. The paper combines indicators frequently occurring in empirical literature (the Corruption Perception Index, Freedom in the World, Governance Matters with alternative proxies (the Herfindahl Index Government, the Political Terror Scale, the State Fragility Index, which seem to be a perspective for a future research.

  8. No Evidence for Phylostratigraphic Bias Impacting Inferences on Patterns of Gene Emergence and Evolution.

    Science.gov (United States)

    Domazet-Lošo, Tomislav; Carvunis, Anne-Ruxandra; Albà, M Mar; Šestak, Martin Sebastijan; Bakaric, Robert; Neme, Rafik; Tautz, Diethard

    2017-04-01

    Phylostratigraphy is a computational framework for dating the emergence of DNA and protein sequences in a phylogeny. It has been extensively applied to make inferences on patterns of genome evolution, including patterns of disease gene evolution, ontogeny and de novo gene origination. Phylostratigraphy typically relies on BLAST searches along a species tree, but new simulation studies have raised concerns about the ability of BLAST to detect remote homologues and its impact on phylostratigraphic inferences. Here, we re-assessed these simulations. We found that, even with a possible overall BLAST false negative rate between 11-15%, the large majority of sequences assigned to a recent evolutionary origin by phylostratigraphy is unaffected by technical concerns about BLAST. Where the results of the simulations did cast doubt on previously reported findings, we repeated the original analyses but now excluded all questionable sequences. The originally described patterns remained essentially unchanged. These new analyses strongly support phylostratigraphic inferences, including: genes that emerged after the origin of eukaryotes are more likely to be expressed in the ectoderm than in the endoderm or mesoderm in Drosophila, and the de novo emergence of protein-coding genes from non-genic sequences occurs through proto-gene intermediates in yeast. We conclude that BLAST is an appropriate and sufficiently sensitive tool in phylostratigraphic analysis that does not appear to introduce significant biases into evolutionary pattern inferences. © The Author 2017. Published by Oxford University Press on behalf of the Society for Molecular Biology and Evolution.

  9. Trade Openness and Bank Risk-Taking Behavior: Evidence from Emerging Economies

    Directory of Open Access Journals (Sweden)

    Badar Nadeem Ashraf

    2017-07-01

    Full Text Available In this paper, we examine the impact of trade openness on bank risk-taking behavior. Using a panel dataset of 291 banks from 37 emerging countries over the period from 1998 to 2012, we find that higher trade openness decreases bank risk-taking. The results are robust when we use alternative bank risk-taking proxies and alternative estimation methods. We argue that trade openness provides diversification opportunities to banks in lending activities, which decrease overall bank risk. Further to this end, we observe that higher trade openness helps domestic banks to smooth out income volatility and decreases the impact of a financial crisis on banks.

  10. The causal dynamics between coal consumption and growth: Evidence from emerging market economies

    International Nuclear Information System (INIS)

    Apergis, Nicholas; Payne, James E.

    2010-01-01

    This study examines the relationship between coal consumption and economic growth for 15 emerging market economies within a multivariate panel framework over the period 1980-2006. The heterogeneous panel cointegration results indicate there is a long-run equilibrium relationship between real GDP, coal consumption, real gross fixed capital formation, and the labor force. While in the long-run both real gross fixed capital formation and the labor force have a significant positive impact on real GDP, coal consumption has a significant negative impact. The panel causality tests show bidirectional causality between coal consumption and economic growth in both the short- and long-run. (author)

  11. How operating room efficiency is understood in a surgical team: a qualitative study.

    Science.gov (United States)

    Arakelian, Erebouni; Gunningberg, Lena; Larsson, Jan

    2011-02-01

    Building surgical teams is one attempt to ensure the health-care system becomes more efficient, but how is 'efficiency' understood or interpreted? The aim was to study how organized surgical team members and their leaders understood operating room efficiency. Qualitative study. A 1100-bed Swedish university hospital. Eleven participants, nine team members from the same team and their two leaders were interviewed. The analysis was performed according to phenomenography, a research approach that aims to discover variations in peoples' understanding of a phenomenon. Seven ways of understanding operating room efficiency were identified: doing one's best from one's prerequisites, enjoying work and adjusting it to the situation, interacting group performing parallel tasks, working with minimal resources to produce desired results, fast work with preserved quality, long-term effects for patient care and a relative concept. When talking about the quality and benefits of delivered care, most team members invoked the patient as the central focus. Despite seven ways of understanding efficiency between the team members, they described their team as efficient. The nurses and assistant nurses were involved in the production and discussed working in a timely manner more than the leaders. The seven ways of understanding operating room efficiency appear to represent both organization-oriented and individual-oriented understanding of that concept in surgical teams. The patient is in focus and efficiency is understood as maintaining quality of care and measuring benefits of care for the patients.

  12. Extreme value theory in emerging markets: Evidence from the Montenegrin stock exchange

    Directory of Open Access Journals (Sweden)

    Cerović Julija

    2015-01-01

    Full Text Available The concept of Value at Risk(VaR estimates the maximum loss of a financial position at a given time for a given probability. This paper considers the adequacy of the methods that are the basis of extreme value theory in the Montenegrin emerging market before and during the global financial crisis. In particular, the purpose of the paper is to investigate whether the peaks-over-threshold method outperforms the block maxima method in evaluation of Value at Risk in emerging stock markets such as the Montenegrin market. The daily return of the Montenegrin stock market index MONEX20 is analyzed for the period January 2004 - February 2014. Results of the Kupiec test show that the peaks-over-threshold method is significantly better than the block maxima method, but both methods fail to pass the Christoffersen independence test and joint test due to the lack of accuracy in exception clustering when measuring Value at Risk. Although better, the peaks-over-threshold method still cannot be treated as an accurate VaR model for the Montenegrin frontier stock market.

  13. Genomic Evidence for the Emergence and Evolution of Pathogenicity and Niche Preferences in the Genus Campylobacter

    Science.gov (United States)

    Iraola, Gregorio; Pérez, Ruben; Naya, Hugo; Paolicchi, Fernando; Pastor, Eugenia; Valenzuela, Sebastián; Calleros, Lucía; Velilla, Alejandra; Hernández, Martín; Morsella, Claudia

    2014-01-01

    The genus Campylobacter includes some of the most relevant pathogens for human and animal health; the continuous effort in their characterization has also revealed new species putatively involved in different kind of infections. Nowadays, the available genomic data for the genus comprise a wide variety of species with different pathogenic potential and niche preferences. In this work, we contribute to enlarge this available information presenting the first genome for the species Campylobacter sputorum bv. sputorum and use this and the already sequenced organisms to analyze the emergence and evolution of pathogenicity and niche preferences among Campylobacter species. We found that campylobacters can be unequivocally distinguished in established and putative pathogens depending on their repertory of virulence genes, which have been horizontally acquired from other bacteria because the nonpathogenic Campylobacter ancestor emerged, and posteriorly interchanged between some members of the genus. Additionally, we demonstrated the role of both horizontal gene transfers and diversifying evolution in niche preferences, being able to distinguish genetic features associated to the tropism for oral, genital, and gastrointestinal tissues. In particular, we highlight the role of nonsynonymous evolution of disulphide bond proteins, the invasion antigen B (CiaB), and other secreted proteins in the determination of niche preferences. Our results arise from assessing the previously unmet goal of considering the whole available Campylobacter diversity for genome comparisons, unveiling notorious genetic features that could explain particular phenotypes and set the basis for future research in Campylobacter biology. PMID:25193310

  14. From Closed to Open Innovation in Emerging Economies: Evidence from the Chemical Industry in Brazil

    Directory of Open Access Journals (Sweden)

    Elisa Thomas

    2018-03-01

    Full Text Available In this article, we examine how firms in an emerging economy perform research and development (R&D activities in regards to the concept of open innovation. Most literature on open innovation shows multinational knowledge-intensive firms with well-established R&D processes mainly in developed countries. Searching for management contributions for firms in emerging economies, we qualitatively analyzed two chemical firms in Southern Brazil that have different profiles and are representative samples of typical firms in the region. Our results show that firms did not fully exploit the potential benefits brought by open innovation, even when complete opening was not the main goal. The firms were similar concerning interactions with partners and stages where relationships occur. The generation of ideas was an open activity performed both by firms and by clients, and interactions with universities were getting stronger. On the other hand, intellectual property has not been used as means of profiting from innovation activities. Our main finding refers to the internal mediation of relationships with partners. R&D teams rarely contact external organizations directly; instead, they leave such interactions to other departments within their firms. Relationships with clients are mediated through technical and commercial departments, and interactions with suppliers are intermediated by the supply staff.

  15. Evidence of spread of the emerging infectious disease, finch trichomonosis, by migrating birds.

    Science.gov (United States)

    Lawson, Becki; Robinson, Robert A; Neimanis, Aleksija; Handeland, Kjell; Isomursu, Marja; Agren, Erik O; Hamnes, Inger S; Tyler, Kevin M; Chantrey, Julian; Hughes, Laura A; Pennycott, Tom W; Simpson, Vic R; John, Shinto K; Peck, Kirsi M; Toms, Mike P; Bennett, Malcolm; Kirkwood, James K; Cunningham, Andrew A

    2011-06-01

    Finch trichomonosis emerged in Great Britain in 2005 and led to epidemic mortality and a significant population decline of greenfinches, Carduelis chloris and chaffinches, Fringilla coelebs, in the central and western counties of England and Wales in the autumn of 2006. In this article, we show continued epidemic spread of the disease with a pronounced shift in geographical distribution towards eastern England in 2007. This was followed by international spread to southern Fennoscandia where cases were confirmed at multiple sites in the summer of 2008. Sequence data of the ITS1/5.8S/ITS2 ribosomal region and part of the small subunit (SSU) rRNA gene showed no variation between the British and Fennoscandian parasite strains of Trichomonas gallinae. Epidemiological and historical ring return data support bird migration as a plausible mechanism for the observed pattern of disease spread, and suggest the chaffinch as the most likely primary vector. This finding is novel since, although intuitive, confirmed disease spread by migratory birds is very rare and, when it has been recognised, this has generally been for diseases caused by viral pathogens. We believe this to be the first documented case of the spread of a protozoal emerging infectious disease by migrating birds.

  16. Forward-Looking Beta Estimates:Evidence from an Emerging Market

    OpenAIRE

    Onour, Ibrahim

    2008-01-01

    Results in this paper support evidence of time-varying beta coefficients for five sectors in Kuwait Stock Market. The paper indicates banks, food, and service sectors exhibit relatively wider range of variation compared to industry and real estate sectors. Results of time-varying betas invalidate the standard application of Capital Asset Pricing model that assumes constant beta. In terms of risk exposure, banks and industrial sectors reflect higher risk as their average betas exceed the mark...

  17. Evident?

    DEFF Research Database (Denmark)

    Plant, Peter

    2012-01-01

    Quality assurance and evidence in career guidance in Europe are often seen as self-evident approaches, but particular interests lie behind......Quality assurance and evidence in career guidance in Europe are often seen as self-evident approaches, but particular interests lie behind...

  18. OIL MARKET, NUCLEAR ENERGY CONSUMPTION AND ECONOMIC GROWTH: EVIDENCE FROM EMERGING ECONOMIES

    Directory of Open Access Journals (Sweden)

    Hanan Naser

    2014-04-01

    Full Text Available This paper empirically examines the relationship between oil consumption, nuclear energy consumption, oil price and economic growth in four emerging economies (Russia, China, South Korea, and India over the period from 1965 to 2010. Applying a modified version of the granger causality test developed by Toda and Yamamoto, we find that the level of world crude oil prices (WTI plays a crucial role in determining the economic growth in the investigated countries. The results suggest that there is a unidirectional causality running from real GDP to oil consumption in China and South Korea, while bidirectional relationship between oil consumption and real GDP growth appears in India. Furthermore, the results propose that while nuclear energy stimulates economic growth in both South Korea and India, the rapid increase in China economic growth requires additional usage of nuclear energy.

  19. Medical Management of Endometriosis: Emerging Evidence Linking Inflammation to Disease Pathophysiology

    Science.gov (United States)

    Bruner-Tran, Kaylon L.; Herington, Jennifer L.; Duleba, Antoni J.; Taylor, Hugh S.; Osteen, Kevin G.

    2013-01-01

    Progesterone action normally mediates the balance between anti-inflammatory and pro-inflammatory processes throughout the female reproductive tract. However, in women with endometriosis, endometrial progesterone resistance, characterized by alterations in progesterone responsive gene and protein expression, is now considered a central element in disease pathophysiology. Recent studies additionally suggest that the peritoneal microenvironment of endometriosis patients exhibits altered physiological characteristics that may further promote inflammation-driven disease development and progression. Within this review, we summarize our current understanding of the pathogenesis of endometriosis with an emphasis on the role that inflammation plays in generating not only the progesterone-resistant eutopic endometrium but also a peritoneal microenvironment that may contribute significantly to disease establishment. Viewing endometriosis from the emerging perspective that a progesterone resistant endometrium and an immunologically compromised peritoneal microenvironment are biologically linked risk factors for disease development provides a novel mechanistic framework to identify new therapeutic targets for appropriate medical management. PMID:23598784

  20. Accelerated Internationalization in Emerging Markets: Empirical Evidence from Brazilian Technology-Based Firms

    Directory of Open Access Journals (Sweden)

    Fernanda Ferreira Ribeiro

    2014-04-01

    Full Text Available This paper offers an analysis into the external factors influencing the accelerated internationalization of technology-based firms (TBFs in the context of an emerging country, Brazil. This type of firm is typically called born global and has been reported mainly in high technology sectors and from developed countries. A survey was applied to small and medium Brazilian TBFs. Logistic regression was used to test the research hypotheses. The results suggest that new and small Brazilian technology-based firms, which followed an accelerated internationalization process, are most likely to be integrated into a global production chain. Results also show that TBFs which take more than five years to enter the international market, benefit more from the location in an innovation habitat, the partnerships in the home country, and the pro-internationalization government policies. Therefore, this research contributes to a better understanding of the phenomenon and points to new perspectives of studies.

  1. Spectropolarimetric Evidence for a Siphon Flow along an Emerging Magnetic Flux Tube

    Energy Technology Data Exchange (ETDEWEB)

    Requerey, Iker S.; Cobo, B. Ruiz [Instituto de Astrofísica de Canarias, Vía Láctea s/n, E-38205 La Laguna, Tenerife (Spain); Iniesta, J. C. Del Toro; Suárez, D. Orozco [Instituto de Astrofísica de Andalucía (CSIC), Apdo. de Correos 3004, E-18080 Granada (Spain); Rodríguez, J. Blanco [Grupo de Astronomía y Ciencias del Espacio, Universidad de Valencia, E-46980 Paterna, Valencia (Spain); Solanki, S. K.; Barthol, P.; Gandorfer, A.; Gizon, L.; Hirzberger, J.; Riethmüller, T. L.; Noort, M. van [Max-Planck-Institut für Sonnensystemforschung, Justus-von-Liebig-Weg 3, D-37077 Göttingen (Germany); Schmidt, W. [Kiepenheuer-Institut für Sonnenphysik, Schöneckstr. 6, D-79104 Freiburg (Germany); Pillet, V. Martínez [National Solar Observatory, 3665 Discovery Drive, Boulder, CO 80303 (United States); Knölker, M., E-mail: iker@iac.es [High Altitude Observatory, National Center for Atmospheric Research, P.O. Box 3000, Boulder, CO 80307-3000 (United States)

    2017-03-01

    We study the dynamics and topology of an emerging magnetic flux concentration using high spatial resolution spectropolarimetric data acquired with the Imaging Magnetograph eXperiment on board the sunrise balloon-borne solar observatory. We obtain the full vector magnetic field and the line of sight (LOS) velocity through inversions of the Fe i line at 525.02 nm with the SPINOR code. The derived vector magnetic field is used to trace magnetic field lines. Two magnetic flux concentrations with different polarities and LOS velocities are found to be connected by a group of arch-shaped magnetic field lines. The positive polarity footpoint is weaker (1100 G) and displays an upflow, while the negative polarity footpoint is stronger (2200 G) and shows a downflow. This configuration is naturally interpreted as a siphon flow along an arched magnetic flux tube.

  2. Relationship between oil prices, interest rate, and unemployment. Evidence from an emerging market

    International Nuclear Information System (INIS)

    Dogrul, H. Guensel; Soytas, Ugur

    2010-01-01

    While the interrelation between oil price changes, economic activity and employment is an important issue that has been studied mainly for developed countries, little attention has been devoted to inquiries on fluctuations in the price of crude oil and its impact on employment for small open economies. Adopting an efficiency wage model for equilibrium employment that does not require any assumptions regarding labor supply, this paper contributes to the literature by investigating the causality between unemployment and two input prices, namely energy (crude oil) and capital (real interest rate) in an emerging market, Turkey for the period 2005:01-2009:08. Applying a relatively new technique, the Toda-Yamamoto procedure, we find that the real price of oil and interest rate improve the forecasts of unemployment in the long run. This finding supports the hypothesis that labor is a substitute factor of production for capital and energy. (author)

  3. Is repeat use of emergency contraception common among pharmacy clients? Evidence from Kenya.

    Science.gov (United States)

    Keesbury, Jill; Morgan, Gwendolyn; Owino, Benter

    2011-04-01

    As emergency contraception (EC) becomes more widely available in African pharmacies, public concern in many countries has emerged over perceived "repeat use" of the method. This study examines issues of repeat use in Kenya, a country where women almost exclusively obtain EC from pharmacies. Interviews were conducted with all clients who purchased EC from private pharmacies located in five urban areas across Kenya. Over a period of 5 days, a total of 182 male and female EC purchasers were interviewed. χ(2) tests were used to determine the statistical significance of differences between repeat and nonrepeat users. The majority (58%) of respondents had purchased EC at least twice in the past 1 month. All women interviewed reported purchasing EC a mean of 3.8 times in the 6 months prior to the survey. Those who purchased EC at least twice in the past 1 month were significantly more likely to hold misperceptions about EC's efficacy or side effects. Two thirds of all users reported having a chance to ask questions at the pharmacy, although one quarter felt that they did not receive adequate information. This study indicates that many of the women surveyed, particularly those who had sex on an infrequent basis, chose to use EC as a regular family planning method. Among these women, it also indicates the need for better information on EC's efficacy and side effects. Such information-sharing could take place within pharmacies, although interventions must not undermine the core benefits of pharmacy access: convenience and confidentiality. Copyright © 2011 Elsevier Inc. All rights reserved.

  4. DETERMINANTS OF GROWTH IN FRANCHISING CONTRACTS IN EMERGING MARKETS; EVIDENCES FROM TURKEY

    Directory of Open Access Journals (Sweden)

    Sitki Sonmezer

    2012-02-01

    Full Text Available This study aims to examine the franchise sector and determine the significant factors that contribute to an increase in the number of franchiser’s contracts in Turkey. Secondary data is used from the Turkish Franchise Association and multivariate regression models are run for each sector. Our models explain the change in the number of franchise contracts with R2’s varying between .6577 and .7549. We provide evidence that success factors in increasing the number of contracts change depending on the sector firms operating in and contracts may be designed thusly to pursue success.

  5. Estimating Short run and Long run Coefficients of Fundamentals Factors with Growth and Momentum Factor: Evidence from Emerging Markets

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    Adnan Shoaib

    2016-12-01

    Full Text Available This study examines the long term relationship of risk premium and fundamental factors in emerging stock markets of China, India and Pakistan keeping in view leading contribution of Fama and French (1992 and Carhart (1997 models. Contrary to the macroeconomic multifactor models, this study incorporates firm-specific risk factors related to the market premium; size (SMB, value (HML, momentum (WML and growth (UMD as determinants of risk premium. The firm-specific growth factor is incorporated based on evidence from Ho, Strange, and Piesse (2008 by employing (UMD which is based on assets to market equity of the firm. Sample of 1198 companies from the three emerging markets for the period of 2001-2013 depicts market risk premium as the leading factor affecting risk premium in Indian and the Pakistani markets. Results reveal market momentum being high enough to overestimate coefficients in the short run. However, the relationship is stabilized and adjusted in the long run. Chinese markets, where all the risk factors seem to play their role to determine risk premium, are relatively much stable and grown-up and clearly represent maturity of the Chinese markets. Distinction between the short run and long run might be useful for the investors of the three emerging economies. According to the principle of high risk associated with high returns, small value happens to deliver higher returns with higher volatility. The growth stocks outperform value stocks in these economies.

  6. Laying a Firm Foundation: Embedding Evidence-Based Emergent Literacy Practices Into Early Intervention and Preschool Environments.

    Science.gov (United States)

    Terrell, Pamela; Watson, Maggie

    2018-04-05

    As part of this clinical forum on curriculum-based intervention, the goal of this tutorial is to share research about the importance of language and literacy foundations in natural environments during emergent literacy skill development, from infancy through preschool. Following an overview of intervention models in schools by Powell (2018), best practices at home, in child care, and in preschool settings are discussed. Speech-language pathologists in these settings will be provided a toolbox of best emergent literacy practices. A review of published literature in speech-language pathology, early intervention, early childhood education, and literacy was completed. Subsequently, an overview of the impact of early home and preschool literacy experiences are described. Research-based implementation of best practice is supported with examples of shared book reading and child-led literacy embedded in play within the coaching model of early intervention. Finally, various aspects of emergent literacy skill development in the preschool years are discussed. These include phonemic awareness, print/alphabet awareness, oral language skills, and embedded/explicit literacy. Research indicates that rich home literacy environments and exposure to rich oral language provide an important foundation for the more structured literacy environments of school. Furthermore, there is a wealth of evidence to support a variety of direct and indirect intervention practices in the home, child care, and preschool contexts to support and enhance all aspects of oral and written literacy. Application of this "toolbox" of strategies should enable speech-language pathologists to address the prevention and intervention of literacy deficits within multiple environments during book and play activities. Additionally, clinicians will have techniques to share with parents, child care providers, and preschool teachers for evidence-based literacy instruction within all settings during typical daily

  7. Tracking the emergence of the consonant bias in visual-word recognition: evidence with developing readers.

    Science.gov (United States)

    Soares, Ana Paula; Perea, Manuel; Comesaña, Montserrat

    2014-01-01

    Recent research with skilled adult readers has consistently revealed an advantage of consonants over vowels in visual-word recognition (i.e., the so-called "consonant bias"). Nevertheless, little is known about how early in development the consonant bias emerges. This work aims to address this issue by studying the relative contribution of consonants and vowels at the early stages of visual-word recognition in developing readers (2(nd) and 4(th) Grade children) and skilled adult readers (college students) using a masked priming lexical decision task. Target words starting either with a consonant or a vowel were preceded by a briefly presented masked prime (50 ms) that could be the same as the target (e.g., pirata-PIRATA [pirate-PIRATE]), a consonant-preserving prime (e.g., pureto-PIRATA), a vowel-preserving prime (e.g., gicala-PIRATA), or an unrelated prime (e.g., bocelo -PIRATA). Results revealed significant priming effects for the identity and consonant-preserving conditions in adult readers and 4(th) Grade children, whereas 2(nd) graders only showed priming for the identity condition. In adult readers, the advantage of consonants was observed both for words starting with a consonant or a vowel, while in 4(th) graders this advantage was restricted to words with an initial consonant. Thus, the present findings suggest that a Consonant/Vowel skeleton should be included in future (developmental) models of visual-word recognition and reading.

  8. The nervous system and metabolic dysregulation: emerging evidence converges on ketogenic diet therapy

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    David N. Ruskin

    2012-03-01

    Full Text Available A link between metabolism and brain function is clear. Since ancient times, epileptic seizures were noted as treatable with fasting, and historical observations of the therapeutic benefits of fasting on epilepsy were confirmed nearly 100 years ago. Shortly thereafter a high-fat, low-carbohydrate ketogenic diet debuted as a therapy to reduce seizures. This strict regimen could mimic the metabolic effects of fasting while allowing adequate caloric intake for ongoing energy demands. Today, ketogenic diet therapy, which forces predominantly ketone-based rather than glucose-based metabolism, is now well-established as highly successful in reducing seizures. More recently, cellular metabolic dysfunction in the nervous system has been recognized as existing side-by-side with nervous system disorders - although often with much less obvious cause-and-effect as the relationship between fasting and seizures. Rekindled interest in metabolic and dietary therapies for brain disorders complements new insight into their mechanisms and broader implications. Here we describe the emerging relationship between a ketogenic diet and adenosine as a way to reset brain metabolism and neuronal activity and disrupt a cycle of dysfunction. We also provide an overview of the effects of a ketogenic diet on cognition and recent data on the effects of a ketogenic diet on pain, and explore the relative time course quantified among hallmark metabolic changes, altered neuron function and altered animal behavior assessed after diet administration. We predict continued applications of metabolic therapies in treating dysfunction including and beyond the nervous system.

  9. Value-at-risk estimation with wavelet-based extreme value theory: Evidence from emerging markets

    Science.gov (United States)

    Cifter, Atilla

    2011-06-01

    This paper introduces wavelet-based extreme value theory (EVT) for univariate value-at-risk estimation. Wavelets and EVT are combined for volatility forecasting to estimate a hybrid model. In the first stage, wavelets are used as a threshold in generalized Pareto distribution, and in the second stage, EVT is applied with a wavelet-based threshold. This new model is applied to two major emerging stock markets: the Istanbul Stock Exchange (ISE) and the Budapest Stock Exchange (BUX). The relative performance of wavelet-based EVT is benchmarked against the Riskmetrics-EWMA, ARMA-GARCH, generalized Pareto distribution, and conditional generalized Pareto distribution models. The empirical results show that the wavelet-based extreme value theory increases predictive performance of financial forecasting according to number of violations and tail-loss tests. The superior forecasting performance of the wavelet-based EVT model is also consistent with Basel II requirements, and this new model can be used by financial institutions as well.

  10. Investor’s Sentiments and Stock Market Volatility: an empirical evidence from emerging stock market

    Directory of Open Access Journals (Sweden)

    Mobeen Ur Rehman

    2013-05-01

    Full Text Available The concept of efficient market hypothesis has prevailed the financial markets for a long time which says that the prices of the securities reflect all available information. This approach was mainly followed by the rational investors but with the passage of time, the concept of behavioral finance emerged due to some of the major global financial crashes. This concept states that there are investors trading in the market making decisions on the basis of sentiments not on any fundamental information. Such class of traders is called the noise traders and they are mainly responsible for any disruption in the returns of the securities. In this paper we will try to find whether these sentiments of the investors affect the returns of the securities listed on the Karachi stock exchange. We will use the investor sentiment index that uses the six proxies the data on which has been collected mainly from the Karachi stock exchange. Volatility of the stock market returns will be calculated and regressed with the sentimental equation discussed above as the independent variable. This study will help us to find out the extent to which these sentiments influence the stock market returns in weak form efficient market and also it will help us to identify the presence of such irrational noise traders in our financial market.

  11. The Nervous System and Metabolic Dysregulation: Emerging Evidence Converges on Ketogenic Diet Therapy

    Science.gov (United States)

    Ruskin, David N.; Masino, Susan A.

    2012-01-01

    A link between metabolism and brain function is clear. Since ancient times, epileptic seizures were noted as treatable with fasting, and historical observations of the therapeutic benefits of fasting on epilepsy were confirmed nearly 100 years ago. Shortly thereafter a high fat, low-carbohydrate ketogenic diet (KD) debuted as a therapy to reduce seizures. This strict regimen could mimic the metabolic effects of fasting while allowing adequate caloric intake for ongoing energy demands. Today, KD therapy, which forces predominantly ketone-based rather than glucose-based metabolism, is now well-established as highly successful in reducing seizures. Cellular metabolic dysfunction in the nervous system has been recognized as existing side-by-side with nervous system disorders – although often with much less obvious cause-and-effect as the relationship between fasting and seizures. Rekindled interest in metabolic and dietary therapies for brain disorders complements new insight into their mechanisms and broader implications. Here we describe the emerging relationship between a KD and adenosine as a way to reset brain metabolism and neuronal activity and disrupt a cycle of dysfunction. We also provide an overview of the effects of a KD on cognition and recent data on the effects of a KD on pain, and explore the relative time course quantified among hallmark metabolic changes, altered neuron function and altered animal behavior assessed after diet administration. We predict continued applications of metabolic therapies in treating dysfunction including and beyond the nervous system. PMID:22470316

  12. Structural analysis and evidence for dynamic emergence of Bacillus anthracis S-layer networks.

    Science.gov (United States)

    Couture-Tosi, Evelyne; Delacroix, Hervé; Mignot, Tâm; Mesnage, Stéphane; Chami, Mohamed; Fouet, Agnès; Mosser, Gervaise

    2002-12-01

    Surface layers (S-layers), which form the outermost layers of many Bacteria and Archaea, consist of protein molecules arranged in two-dimensional crystalline arrays. Bacillus anthracis, a gram-positive, spore-forming bacterium, responsible for anthrax, synthesizes two abundant surface proteins: Sap and EA1. Regulatory studies showed that EA1 and Sap appear sequentially at the surface of the parental strain. Sap and EA1 can form arrays. The structural parameters of S-layers from mutant strains (EA1(-) and Sap(-)) were determined by computer image processing of electron micrographs of negatively stained regular S-layer fragments or deflated whole bacteria. Sap and EA1 projection maps were calculated on a p1 symmetry basis. The unit cell parameters of EA1 were a = 69 A, b = 83 A, and gamma = 106 degrees, while those of Sap were a = 184 A, b = 81 A, and gamma = 84 degrees. Freeze-etching experiments and the analysis of the peripheral regions of the cell suggested that the two S-layers have different settings. We characterized the settings of each network at different growth phases. Our data indicated that the scattered emergence of EA1 destabilizes the Sap S-layer.

  13. Increasing convergence between imagined and executed movement across development: evidence for the emergence of movement representations.

    Science.gov (United States)

    Caeyenberghs, Karen; Wilson, Peter H; van Roon, Dominique; Swinnen, Stephan P; Smits-Engelsman, Bouwien C M

    2009-04-01

    Motor imagery (MI) has become a principal focus of interest in studies on brain and behavior. However, changes in MI across development have received virtually no attention so far. In the present study, children (N = 112, 6 to 16 years old) performed a new, computerized Virtual Radial Fitts Task (VRFT) to determine their MI ability as well as the age-related confluence between performance in executed and imagined movement conditions. Participants aimed at five targets, which were positioned along radial axes from a central target circle. The targets differed in width (2.5, 5, 10, 20 or 40 mm), resulting in an index of difficulty (ID) that varied from 6.9 to 2.9 bits. Performance was indexed by the linear relationship between ID and Movement Time (MT). The findings showed that executed task performance was slower than imagined performance. Moreover, conformance to Fitts' Law during executed movement performance was obtained from a very young age. Most importantly, correlations between imagined and executed movements were low in the young participants but gradually increased across age. These age-related changes in MI are hypothesized to reflect the children's emerging ability to represent internal models for prospective actions, consistent with the gradual unfolding of feedforward control processes.

  14. Asbestos exposure and health hazards: a global emergency, Epidemiological evidence and denial theories

    Directory of Open Access Journals (Sweden)

    Francesca Zazzara

    2013-01-01

    Full Text Available On June 3rd 2013, in Turin, Italy, the Swiss industrialist Schmidheiny has been sentenced to 18 years imprisonment for intentional disaster for 3,000 asbestos-linked tumours in Italian workers at cement multinational Eternit. The indiscriminate use of asbestos, however, continues worldwide. Although many studies have shown that asbestos is associated with an increased risk of mortality and morbidity, denial theories were spread over time, showing how the logic of profit governs the production of asbestos. We examined the history of the epidemiological evidence of asbestos related risks and, second, the main sources of exposure in Italy and in the world, occupational, non-occupational, and post-disaster exposure (as occurred after L’Aquila earthquake in April 2009. The theme of inequality and social justice is ever so alarming in the fight against asbestos and its lobbies.

  15. Emergence of Wealth Inequality in China: Evidence from Rural Household Survey, 1986 -2000

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    Kyeongwon Yoo

    2003-12-01

    Full Text Available Based on relatively recent household survey data (1986 2000 in rural China, this paper analyzes the composition and inequality in non-land wealth. We first document the evolution of rural households wealth during the sample period. Our results show that the housing assets have played a dominant role in their wealth composition although the share of the assets tends to decrease during the period. We also observe that financial and fixed assets have become relatively important in their wealth composition. Based on various inequality measures we are able to provide consistent evidence that the inequality of wealth distribution has worsened in rural China. We find that financial asset holdings appear to have significant unequalizing effect on the total non-land wealth distribution, mostly due to the growing differential in rural non-farm opportunities.

  16. Asbestos exposure and health hazards: a global emergency, Epidemiological evidence and denial theories

    Directory of Open Access Journals (Sweden)

    Francesca Zazzara

    2013-11-01

    Full Text Available On June 3rd 2013, in Turin, Italy, the Swiss industrialist Schmidheiny has been sentenced to 18 years imprisonment for intentional disaster for 3,000 asbestos-linked tumours in Italian workers at cement multinational Eternit. The indiscriminate use of asbestos, however, continues worldwide. Although many studies have shown that asbestos is associated with an increased risk of mortality and morbidity, denial theories were spread over time, showing how the logic of profit governs the production of asbestos. We examined the history of the epidemiological evidence of asbestos related risks and, second, the main sources of exposure in Italy and in the world, occupational, non-occupational, and post-disaster exposure (as occurred after L’Aquila earthquake in April 2009. The theme of inequality and social justice is ever so alarming in the fight against asbestos and its lobbies.

  17. Sports injuries in Victoria, 2012-13 to 2014-15: evidence from emergency department records.

    Science.gov (United States)

    Fernando, D Tharanga; Berecki-Gisolf, Janneke; Finch, Caroline F

    2018-04-02

    To report the incidence of presentations to emergency departments (EDs) in Victoria for sport- and active recreation-related injuries; to establish which sports have the highest rates of injury per participant; to assess the effects of age and sport type on the rate of serious sport injury (resulting in admission to hospital). Retrospective analysis of 171 541 ED presentations to 38 Victorian hospitals, 2012-13 to 2014-15. Sports- and active recreation-related injuries in people aged 5 years or more were identified from coded data and by text searches. Population rates of injuries by sport and ranking of sports by per participant injury rates (for people aged 15 years or more); proportions of presenting patients subsequently admitted to hospital (serious sport injuries) (for people aged 5 years or more). During 2012-13 to 2014-15, there were 171 541 presentations to EDs with sports-related injuries. Sports most commonly associated with presentation by people aged 15 years or more were Australian football, motor sports, and cycling/BMX; the highest per participant injury rates (people aged 15 or more) were for motor sports, rugby, and skateboarding/inline hockey/roller sports. 11% of ED patients aged 5 years or more were subsequently admitted to hospital; the odds of admission were highest for those with injuries from motor sports, horse riding, or cycling/BMX. Assessing sports injury rates corrected for participation rates and evaluating the relative severity of injuries is important for monitoring safety. Our findings can assist decisions about which sports should be the focus of injury prevention efforts.

  18. Content-Based Instruction Understood in Terms of Connectionism and Constructivism

    Science.gov (United States)

    Lain, Stephanie

    2016-01-01

    Despite the number of articles devoted to the topic of content-based instruction (CBI), little attempt has been made to link the claims for CBI to research in cognitive science. In this article, I review the CBI model of foreign language (FL) instruction in the context of its close alignment with two emergent frameworks in cognitive science:…

  19. Congenital Vomer Agenesis: A Rare and Poorly Understood Condition Revealed by Cone Beam CT.

    Science.gov (United States)

    Yan, David Jun; Lenoir, Vincent; Chatelain, Sibylle; Stefanelli, Salvatore; Becker, Minerva

    2018-02-10

    Isolated congenital vomer agenesis is a very rare and poorly understood condition. In the context of dental work-up by cone-beam computed tomography (CBCT), the explored volume of the facial bones occasionally reveals incidental abnormalities. We report the case of a 13-year old Caucasian female who underwent CBCT for the pre-treatment evaluation of primary failure of tooth eruption affecting the permanent right upper and inferior molars. CBCT depicted a large defect of the postero-inferior part of the nasal septum without associated soft tissue abnormality and without cranio-facial malformation or cleft palate. In the absence of a history of trauma, chronic inflammatory sinonasal disease, neoplasia and drug abuse, a posterior nasal septum defect warrants the diagnosis of vomer agenesis. A discussion of this condition and of salient CBCT features is provided.

  20. Poorly understood and often miscategorized congenital umbilical cord hernia: an alternative repair method.

    Science.gov (United States)

    İnce, E; Temiz, A; Ezer, S S; Gezer, H Ö; Hiçsönmez, A

    2017-06-01

    Umbilical cord hernia is poorly understood and often miscategorized as "omphalocele minor". Careless clamping of the cord leads to iatrogenic gut injury in the situation of umbilical cord hernia. This study aimed to determine the characteristics and outcomes of umbilical cord hernias. We also highlight an alternative repair method for umbilical cord hernias. We recorded 15 cases of umbilical cord hernias over 10 years. The patients' data were retrospectively reviewed, and preoperative preparation of the newborn, gestational age, birth weight, other associated malformations, surgical technique used, enteral nutrition, and length of hospitalization were recorded. This study included 15 neonates with umbilical cord hernias. The mean gestational age at the time of referral was 38.2 ± 2.1 umbilical cord hernia, the body folds develop normally and form the umbilical ring. The double purse-string technique is easy to apply and produces satisfactory cosmetic results in neonates with umbilical cord hernias.

  1. Fragmentary evidence of great-earthquake subsidence during holocene emergence, Valdivia estuary, South Central Chile

    Science.gov (United States)

    Nelson, A.R.; Kashima, K.; Bradley, L.A.

    2009-01-01

    A reconnaissance of Holocene stratigraphy beneath fringing marshes of the Valdivia estuary, where an M 9.5 earthquake caused 1-2 m of regional coseismic subsidence in 1960, shows only fragmentary evidence of prehistoric coseismic subsidence. In most of the 150 hand-driven cores that were examined, a distinct unconformity separates 0.5-1.5 m of late Holocene tidal and floodplain mud, peat, and sand from underlying middle Holocene subtidal mud and sand. At the Las Coloradas site, where stratigraphy is best preserved, two A horizons of marsh and meadow soils abruptly overlain by sand and mud probably record coseismic subsidence shortly followed by tsunamis. The amount of subsidence during the earthquakes proved difficult to reconstruct with a diatom transfer function because of differences between modern and fossil diatom assemblages. Maximum 14C ages on macrofossils from the two A horizons at the Las Coloradas site of 1.7-1.3 ka and 2.7-1.7 ka allow correlation of the younger horizon with either of two of six 14C-dated A horizons buried by tsunami sand or post-tsunami tidal sand 200 km to the south at Maull??n, and with a lake-wide mass wasting event in Lago Puyehue, 100 km to the southeast. Tidal records of prehistoric coseismic subsidence at Valdivia are scarce because of a sea-level fall of 3-8 m over the past 6000 years, erosion of marsh and meadow soils during subsidence-induced flooding of the estuary, and largely complete land-level recovery during cycles of coseismic subsidence and postseismic uplift.

  2. Treatment of Anabolic-Androgenic Steroid Dependence: Emerging Evidence and Its Implications

    Science.gov (United States)

    Kanayama, Gen; Brower, Kirk J.; Wood, Ruth I.; Hudson, James I.; Pope, Harrison G.

    2010-01-01

    Currently, few users of anabolic-androgenic steroids (AAS) seek substance-abuse treatment. But this picture may soon change substantially, because illicit AAS use did not become widespread until the 1980s, and consequently the older members of this AAS-using population—those who initiated AAS as youths in the 1980s—are only now reaching middle age. Members of this group, especially those who have developed AAS dependence, may therefore be entering the age of risk for cardiac and psychoneuroendocrine complications sufficient to motivate them for substance-abuse treatment. We suggest that this treatment should address at least three etiologic mechanisms by which AAS dependence might develop. First, individuals with body-image disorders such as “muscle dysmorphia” may become dependent on AAS for their anabolic effects; these body-image disorders may respond to psychological therapies or pharmacologic treatments. Second, AAS suppress the male hypothalamic-pituitary-gonadal axis via their androgenic effects, potentially causing hypogonadism during AAS withdrawal. Men experiencing prolonged dysphoric effects or frank major depression from hypogonadism may desire to resume AAS, thus contributing to AAS dependence. AAS-induced hypogonadism may require treatment with human chorionic gonadotropin or clomiphene to reactivate neuroendocrine function, and may necessitate antidepressant treatments in cases of depression inadequately responsive to endocrine therapies alone. Third, human and animal evidence indicates that AAS also possess hedonic effects, which likely promote dependence via mechanisms shared with classical addictive drugs, especially opioids. Indeed, the opioid antagonist naltrexone blocks AAS dependence in animals. By inference, pharmacological and psychosocial treatments for human opioid dependence might also benefit AAS-dependent individuals. PMID:20188494

  3. Treatment of anabolic-androgenic steroid dependence: Emerging evidence and its implications.

    Science.gov (United States)

    Kanayama, Gen; Brower, Kirk J; Wood, Ruth I; Hudson, James I; Pope, Harrison G

    2010-06-01

    Currently, few users of anabolic-androgenic steroids (AAS) seek substance abuse treatment. But this picture may soon change substantially, because illicit AAS use did not become widespread until the 1980s, and consequently the older members of this AAS-using population - those who initiated AAS as youths in the 1980s - are only now reaching middle age. Members of this group, especially those who have developed AAS dependence, may therefore be entering the age of risk for cardiac and psychoneuroendocrine complications sufficient to motivate them for substance abuse treatment. We suggest that this treatment should address at least three etiologic mechanisms by which AAS dependence might develop. First, individuals with body image disorders such as "muscle dysmorphia" may become dependent on AAS for their anabolic effects; these body image disorders may respond to psychological therapies or pharmacological treatments. Second, AAS suppress the male hypothalamic-pituitary-gonadal axis via their androgenic effects, potentially causing hypogonadism during AAS withdrawal. Men experiencing prolonged dysphoric effects or frank major depression from hypogonadism may desire to resume AAS, thus contributing to AAS dependence. AAS-induced hypogonadism may require treatment with human chorionic gonadotropin or clomiphene to reactivate neuroendocrine function, and may necessitate antidepressant treatments in cases of depression inadequately responsive to endocrine therapies alone. Third, human and animal evidence indicates that AAS also possess hedonic effects, which likely promote dependence via mechanisms shared with classical addictive drugs, especially opioids. Indeed, the opioid antagonist naltrexone blocks AAS dependence in animals. By inference, pharmacological and psychosocial treatments for human opioid dependence might also benefit AAS-dependent individuals. Copyright (c) 2010 Elsevier Ireland Ltd. All rights reserved.

  4. On the early emergence of reverse transcription: theoretical basis and experimental evidence

    Science.gov (United States)

    Lazcano, A.; Valverde, V.; Hernandez, G.; Gariglio, P.; Fox, G. E.; Oro, J.

    1992-01-01

    Reverse transcriptase (RT) was first discovered as an essential catalyst in the biological cycle of retroviruses. However, in the past years evidence has accumulated showing that RTs are involved in a surprisingly large number of RNA-mediated transpositional events that include both viral and nonviral genetic entities. Although it is probable that some RT-bearing genetic elements like the different types of AIDS viruses and the mammalian LINE family have arisen in recent geological times, the possibility that reverse transcription first took place in the early Archean is supported by (1) the hypothesis that RNA preceded DNA as cellular genetic material; (2) the existence of homologous regions of the subunit tau of the E. coli DNA polymerase III with the simian immunodeficiency virus RT, the hepatitis B virus RT, and the beta' subunit of the E. coli RNA polymerase (McHenry et al. 1988); (3) the presence of several conserved motifs, including a 14-amino-acid segment that consists of an Asp-Asp pair flanked by hydrophobic amino acids, which are found in all RTs and in most cellular and viral RNA polymerases. However, whether extant RTs descend from the primitive polymerase involved in the RNA-to-DNA transition remains unproven. Substrate specificity of the AMV and HIV-1 RTs can be modified in the presence of Mn2+, a cation which allows them to add ribonucleotides to an oligo (dG) primer in a template-dependent reaction. This change in specificity is comparable to that observed under similar conditions in other nucleic acid polymerases. This experimentally induced change in RT substrate specificity may explain previous observations on the misincorporation of ribonucleotides by the Maloney murine sarcoma virus RT in the minus and plus DNA of this retrovirus (Chen and Temin 1980). Our results also suggest that HIV-infected macrophages and T-cell cells may contain mixed polynucleotides containing both ribo- and deoxyribonucleotides. The evolutionary significance of these

  5. Testing biochemistry revisited: how in vivo metabolism can be understood from in vitro enzyme kinetics.

    Directory of Open Access Journals (Sweden)

    Karen van Eunen

    Full Text Available A decade ago, a team of biochemists including two of us, modeled yeast glycolysis and showed that one of the most studied biochemical pathways could not be quite understood in terms of the kinetic properties of the constituent enzymes as measured in cell extract. Moreover, when the same model was later applied to different experimental steady-state conditions, it often exhibited unrestrained metabolite accumulation.Here we resolve this issue by showing that the results of such ab initio modeling are improved substantially by (i including appropriate allosteric regulation and (ii measuring the enzyme kinetic parameters under conditions that resemble the intracellular environment. The following modifications proved crucial: (i implementation of allosteric regulation of hexokinase and pyruvate kinase, (ii implementation of V(max values measured under conditions that resembled the yeast cytosol, and (iii redetermination of the kinetic parameters of glyceraldehyde-3-phosphate dehydrogenase under physiological conditions.Model predictions and experiments were compared under five different conditions of yeast growth and starvation. When either the original model was used (which lacked important allosteric regulation, or the enzyme parameters were measured under conditions that were, as usual, optimal for high enzyme activity, fructose 1,6-bisphosphate and some other glycolytic intermediates tended to accumulate to unrealistically high concentrations. Combining all adjustments yielded an accurate correspondence between model and experiments for all five steady-state and dynamic conditions. This enhances our understanding of in vivo metabolism in terms of in vitro biochemistry.

  6. The market of human organs: a window into a poorly understood global business.

    Science.gov (United States)

    Surman, O S; Saidi, R; Purtilo, R; Simmerling, M; Ko, D; Burke, T F

    2008-03-01

    The global demand for human organs has set the stage for an exploding and poorly understood global business in human organs. Whenever there is demand for a product, the opportunity for business arises. The form that a business takes is dependent on a complex network of inputs and outputs, each affecting the others. Historically, the details of any specific market are drastically underestimated. Nowhere is this truer than in the market of human organs. The drivers, which propel the "goods" of human organs, form a flourishing business. Critical analysis is essential to understanding of the supply and demand sides and to determine the role of government in regulating the industry. Governmental groups have dismissed formation of a regulated market for organ sales. The concept is nonetheless a topic of active discussion, motivated by the suffering of patients in need of organs and exploitation of the victims of human trafficking. Ethical principles have been invoked on each side of the ensuing debate. Theory in the absence of sufficient data is shaky ground for enactment of new policy. The Aristotelian concept of "practical wisdom" and the pragmatism of William James illuminate the importance of scientific investigation as guide to policy formation. How will stakeholders benefit or lose? What impact might be anticipated in regard to organized medicine's social contract? What can we learn about cross-cultural differences and their effect on the global landscape?

  7. How spirituality is understood and taught in New Zealand medical schools.

    Science.gov (United States)

    Lambie, D; Egan, R; Walker, S; MacLeod, R

    2015-02-01

    The objective of this research was to explore how spirituality is currently understood and taught in New Zealand Medical Schools. A mixed methods study was carried out involving interviews (n = 14) and a survey (n = 73). The first stage of the study involved recorded semi-structured interviews of people involved in curriculum development from the Dunedin School of Medicine (n = 14); which then informed a cross-sectional self-reported electronic survey (n = 73). The results indicate that spirituality is regarded by many involved in medical education in New Zealand as an important part of healthcare that may be taught in medical schools, but also that there is little consensus among this group as to what the topic is about. These findings provide a basis for further discussion about including spirituality in medical curricula, and in particular indicate a need to develop a shared understanding of what 'spirituality' means and how it can be taught appropriately. As a highly secular country, these New Zealand findings are significant for medical education in other secular Western countries. Addressing spirituality with patients has been shown to positively impact a range of health outcomes, but how spirituality is taught in medical schools is still developing across the globe.

  8. The vulnerability of family caregivers in relation to vulnerability as understood by nurses.

    Science.gov (United States)

    Sarvimäki, Anneli; Stenbock-Hult, Bettina; Sundell, Eija; Oesch-Börman, Christine

    2017-03-01

    In Finland, the care of older persons is shifting from institutional care to family care. Research shows that family caregivers experience their situation much in the same way as professional nurses. The nurses' experiences have been studied in terms of vulnerability, and the same perspective could deepen our understanding of family caregivers' experiences. The aim of this study was to gain knowledge of the vulnerability of older caregivers taking care of an ageing family member. The research questions were as follows: How do family caregivers experience vulnerability? How do their experiences relate to vulnerability as understood by nurses? The study was done as a secondary analysis of focus group interviews on the experiences and daily life of older family caregivers. Four caregivers had taken part in monthly interviews during a period of 10 months. The interviews were analysed by deductive and inductive content analysis. The results showed that the caregivers saw caregiving as part of being human. They experienced a variety of feelings and moral agony and were harmed physically, mentally and socially. They showed courage, protected themselves and recognised that being a caregiver also was a source of maturing and developing. These results corresponded with the nurses' understanding of vulnerability. Shame, the experience of duty as a burden, worry and loneliness were themes that were found only among the family caregivers. The use of a matrix may have restricted the analysis, but using it in an unconstrained way allowed for new themes to be created. The results indicate a common humanness and vulnerability in professional and family caregiving. They also show that family caregivers need more support both from society and professionals. © 2016 Nordic College of Caring Science.

  9. The development and evaluation of an evidence-based guideline programme to improve care in a paediatric emergency department.

    Science.gov (United States)

    Akenroye, Ayobami T; Stack, Anne M

    2016-02-01

    Care guidelines can improve the quality of care by making current evidence available in a concise format. Emergency departments (EDs) are an ideal site for guidelines given the wide variety of presenting conditions and treating providers, and the need for timely decision making. We designed a programme for guideline development and implementation and evaluated its impact in an ED. The setting was an urban paediatric ED with an annual volume of 60 000. Common and/or high-risk conditions were identified for guideline development. Following implementation of the guidelines, their impact on effectiveness of care, patient outcomes, efficiency and equitability of care was assessed using a web-based provider survey and performance on identified metrics. Variation in clinical care between providers was assessed using funnel plots. Eleven (11) guidelines were developed and implemented. 3 years after the initiation of the programme, self-reported adherence to recommendations was high (95% for physicians and 89% for nurses). 97% of physicians and 92% of nurses stated that the programme improved the quality of care in the ED. For some guidelines, provider-to-provider care practice variation was reduced significantly. We found reduced disparity in imaging when assessing one guideline. There were also reductions in utilisation of diagnostic tests or therapies. As a balancing measure, the percentage of patients with any of the guideline conditions who returned to the ED within 72 h of discharge did not change from before to after guideline initiation. Overall, 80% of physician and 56% of nurse respondents rated the guideline programme at the highest value. A programme for guideline development and implementation helped to improve efficiency, and standardise and eliminate disparities in emergency care without jeopardising patient outcomes. 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/

  10. The rationale for use of Ulipristal Acetate as first line in emergency contraception: biological and clinical evidence.

    Science.gov (United States)

    Glasier, Anna

    2014-10-01

    Ulipristal acetate (UPA) was licensed as an emergency contraceptive (EC) in Europe in 2009. By the end of May 2013, over 1.4 million courses had been used. The rationale for using UPA for EC in favor of the much more commonly used levonorgestrel (LNG) is based on data on efficacy, safety and side effects. In two large clinical trials among women presenting for EC up to 120 hours after unprotected sex, UPA was as effective as LNG at preventing pregnancy. When the two trials were combined in a meta analysis UPA was superior, almost halving the risk of pregnancy compared with LNG. Biomedical studies have shown that UPA inhibits or delays ovulation more effectively than LNG at a stage of the cycle when the risk of pregnancy is highest. Safety and side effects: UPA and LNG have similar side effect profiles and to date no serious adverse events have been attributed to use of UPA for EC. Data on pregnancies conceived in association with UPA use are reassuring. There is no evidence for teratogenesis or for any increased risk of ectopic pregnancy or miscarriage. Use of UPA will remain limited until it is available without a doctor's prescription.

  11. A prospective multiple case study of the impact of emerging scientific evidence on established colorectal cancer screening programs: a study protocol.

    Science.gov (United States)

    Geddie, Hannah; Dobrow, Mark J; Hoch, Jeffrey S; Rabeneck, Linda

    2012-06-01

    Health-policy decision making is a complex and dynamic process, for which strong evidentiary support is required. This includes scientifically produced research, as well as information that relates to the context in which the decision takes place. Unlike scientific evidence, this "contextual evidence" is highly variable and often includes information that is not scientifically produced, drawn from sources such as political judgement, program management experience and knowledge, or public values. As the policy decision-making process is variable and difficult to evaluate, it is often unclear how this heterogeneous evidence is identified and incorporated into "evidence-based policy" decisions. Population-based colorectal cancer screening poses an ideal context in which to examine these issues. In Canada, colorectal cancer screening programs have been established in several provinces over the past five years, based on the fecal occult blood test (FOBT) or the fecal immunochemical test. However, as these programs develop, new scientific evidence for screening continues to emerge. Recently published randomized controlled trials suggest that the use of flexible sigmoidoscopy for population-based screening may pose a greater reduction in mortality than the FOBT. This raises the important question of how policy makers will address this evidence, given that screening programs are being established or are already in place. This study will examine these issues prospectively and will focus on how policy makers monitor emerging scientific evidence and how both scientific and contextual evidence are identified and applied for decisions about health system improvement. This study will employ a prospective multiple case study design, involving participants from Ontario, Alberta, Manitoba, Nova Scotia, and Quebec. In each province, data will be collected via document analysis and key informant interviews. Documents will include policy briefs, reports, meeting minutes, media

  12. Vitamin D Status and the Host Resistance to Infections: What It Is Currently (Not) Understood.

    Science.gov (United States)

    Lang, Pierre Olivier; Aspinall, Richard

    2017-05-01

    Vitamin D is increasingly thought to play a role in regulating immunity. This comprehensive review updates the current understanding regarding ways in which we believe that vitamin D regulates responsiveness of the immune system and how serum status modulates the host defense against pathogens. The literature was searched by using PubMed and Scopus with the following key words: vitamin D, immunity, innate and adaptive immunity, infectious disease, and vaccine response. Vitamin D deficiency remains a major public health concern worldwide. The overall body of evidence confirms that vitamin D plays an important role in modulating the immune response to infections. Epidemiologic studies suggest a clear association between vitamin D deficiency and susceptibility to various pathogens. However, translation of vitamin D use into the clinic as a means of controlling infections is fraught with methodologic and epidemiologic challenges. The recent discovery of alternative activation pathways, different active forms of vitamin D, and possible interaction with non-vitamin D receptors provide further complications to an already complex interaction between vitamin D and the immune system. Moreover, it has become apparent that the individual responsiveness to supplementation is more dynamic than presumed from the static assessment of 25-hydroxy vitamin D status. Furthermore, the epigenetic response at the level of the individual to environmental changes and lifestyle or health conditions provides greater variation than those resulting from vitamin D receptor polymorphisms. To understand the future of vitamin D with respect to clinical applications in the prevention and better control of infectious diseases, it is necessary to determine all aspects of vitamin D metabolism, as well as the mechanisms by which active forms interact with the immune system globally. For the most part, we are unable to identify tissue-specific applications of supplementation except for those subjects at

  13. How Global Education Is Understood and to What Extent It Is Implemented in One Educator Preparation Program

    Science.gov (United States)

    Amewu-Sirleaf, Lydia Valentina

    2015-01-01

    This mixed method study investigated the overarching question "how global education is understood and implemented in an educator preparation program in a Colorado university". The sub-questions used to answer the research question are: (1) How is global education/perspective understood and implemented by the faculty; (2) How do students…

  14. Reviewing the Purpose of Education and Challenges Faced in Implementing Sound Pedagogical Practices in the Presence of Emerging Evidence from Neuroscience

    Science.gov (United States)

    Watagodakumbura, Chandana

    2015-01-01

    The field of neuroscience has been evolving constantly and at a rapid pace in the recent past. Consequently, neuroscientists have put forth a wealth of knowledge in relation learning and education in general. In this context, how can we as educators benefit from the emerging evidence from neuroscience so that we can take a significant step forward…

  15. A prospective multiple case study of the impact of emerging scientific evidence on established colorectal cancer screening programs: a study protocol

    Directory of Open Access Journals (Sweden)

    Geddie Hannah

    2012-06-01

    Full Text Available Abstract Background Health-policy decision making is a complex and dynamic process, for which strong evidentiary support is required. This includes scientifically produced research, as well as information that relates to the context in which the decision takes place. Unlike scientific evidence, this “contextual evidence” is highly variable and often includes information that is not scientifically produced, drawn from sources such as political judgement, program management experience and knowledge, or public values. As the policy decision-making process is variable and difficult to evaluate, it is often unclear how this heterogeneous evidence is identified and incorporated into “evidence-based policy” decisions. Population-based colorectal cancer screening poses an ideal context in which to examine these issues. In Canada, colorectal cancer screening programs have been established in several provinces over the past five years, based on the fecal occult blood test (FOBT or the fecal immunochemical test. However, as these programs develop, new scientific evidence for screening continues to emerge. Recently published randomized controlled trials suggest that the use of flexible sigmoidoscopy for population-based screening may pose a greater reduction in mortality than the FOBT. This raises the important question of how policy makers will address this evidence, given that screening programs are being established or are already in place. This study will examine these issues prospectively and will focus on how policy makers monitor emerging scientific evidence and how both scientific and contextual evidence are identified and applied for decisions about health system improvement. Methods This study will employ a prospective multiple case study design, involving participants from Ontario, Alberta, Manitoba, Nova Scotia, and Quebec. In each province, data will be collected via document analysis and key informant interviews. Documents will include

  16. Educating Through Exploration: Emerging Evidence for Improved Learning Outcomes Using a New Theory of Digital Learning Design

    Science.gov (United States)

    Anbar, Ariel; Center for Education Through eXploration

    2018-01-01

    Advances in scientific visualization and public access to data have transformed science outreach and communication, but have yet to realize their potential impacts in the realm of education. Computer-based learning is a clear bridge between visualization and education that benefits students through adaptative personalization and enhanced access. Building this bridge requires close partnerships among scientists, technologists, and educators.The Infiniscope project fosters such partnerships to produce exploration-driven online learning experiences that teach basic science concepts using a combination of authentic space science narratives, data, and images, and a personalized guided inquiry approach. Infiniscope includes a web portal to host these digital learning experiences, as well as a teaching network of educators using and modifying these experiences. Infiniscope experiences are built around a new theory of digital learning design that we call “education through exploration” (ETX) developed during the creation of successful online, interactive science courses offered at ASU and other institutions. ETX builds on the research-based practices of active learning and guided inquiry to provide a set of design principles that aim to develop higher order thinking skills in addition to understanding of content. It is employed in these experiences by asking students to solve problems and actively discover relationships, supported by an intelligent tutoring system which provides immediate, personalized feedback and scaffolds scientific thinking and methods. The project is led by ASU’s School of Earth and Space Exploration working with learning designers in the Center for Education Through eXploration, with support from NASA’s Science Mission Directorate as part of the NASA Exploration Connection program.We will present an overview of ETX design, the Infinscope project, and emerging evidence of effectiveness.

  17. If Channel as an Emerging Therapeutic Target for Cardiovascular Diseases: A Review of Current Evidence and Controversies

    Directory of Open Access Journals (Sweden)

    Hayelom G. Mengesha

    2017-11-01

    Full Text Available In 2015, non-communicable diseases accounted for 39.5 million (70% of the total 56.4 million deaths that occurred globally, of which 17.7 million (45% were due to cardiovascular diseases. An elevated heart rate is considered to be one of the independent predictors and markers of future cardiovascular diseases. A variety of experimental and epidemiological studies have found that atherosclerosis, heart failure, coronary artery disease, stroke, and arrhythmia are linked to elevated heart rate. Although there are established drugs to reduce the heart rate, these drugs have undesirable side effects. Hence, the development of new drugs that selectively inhibit the heart rate is considered necessary. In the search for such drugs, almost four decades ago the If channel, also known as the “funny channel,” emerged as a novel site for the selective inhibition of heart rate. These If channels, with a mixed sodium and potassium inward current, have been identified in the sinoatrial node of the heart, which mediates the slow diastolic depolarization of the pacemaker of the spontaneous rhythmic cells. The hyperpolarization-activated cyclic nucleotide-gated (HCN subfamily is primarily articulated in the heart and neurons that are encoded by a family of four genes (HCN1-4 and they identify the funny channel. Of these, HCN-4 is the principal protein in the sinoatrial node. Currently, funny channel inhibition is being targeted for the treatment and prevention of cardiovascular diseases such as atherosclerosis and stroke. A selective If channel inhibitor named ivabradine was discovered for clinical use in treating heart failure and coronary artery disease. However, inconsistencies regarding the clinical effects of ivabradine have been reported in the literature, suggesting the need for a rigorous analysis of the available evidence. The objective of this review is therefore to assess the current advances in targeting the If channel associated with ivabradine

  18. Successfully integrating aged care services: A review of the evidence and tools emerging from a long-term care program

    Directory of Open Access Journals (Sweden)

    Michael J. Stewart

    2013-02-01

    decline and handicap levels, and improving feelings of empowerment and satisfaction with care provided. The research also demonstrated benefits to the health system, including a more appropriate use of emergency rooms, and decreased consultations with medical specialists. Discussion: Reviewing the body of research reveals the importance of both designing programs with an eye to local context, and building in flexibility allowing the program to be adapted to changing circumstances.  Creating partnerships between policy designers, project implementers, and academic teams is an important element in achieving these goals. Partnerships are also valuable for achieving effective monitoring and evaluation, and support to "evidence-based" policy-making processes. Despite a shared electronic health record being a key component of the service model, there was an under-investigation of the impact this technology on facilitating and enabling integration and the outcomes achieved. Conclusions: PRISMA provides evidence of the benefits that can arise from integrating care for older persons, particularly in terms of increased feelings of personal empowerment, and improved client satisfaction with the care provided. Taken alongside other integrated care experiments, PRISMA provides further evidentiary support to policy makers pursuing integrated care programs. The scale and scope of the research body highlights the long-term and complex nature of program evaluations, but underscores the benefits of evaluation, review and subsequent adaptation of programs. The role of information technology in supporting integration of services is likely to substantially expand in the future and the potential this technology offers should be investigated and harnessed. Background: Providing efficient and effective aged care services is one of the greatest public policy concerns currently facing governments. Increasing the integration of care services has the potential to provide many benefits including

  19. BET 2: Poor evidence on whether teaching cognitive debiasing, or cognitive forcing strategies, lead to a reduction in errors attributable to cognition in emergency medicine students or doctors.

    Science.gov (United States)

    Oliver, Govind; Oliver, Gopal; Body, Rick

    2017-08-01

    A short review was carried out to see if teaching cognitive forcing strategies reduces cognitive error in the practice of emergency medicine. Two relevant papers were found using the described search strategy. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are tabulated. There is currently little evidence that teaching cognitive forcing strategies reduces cognitive error in the practice of emergency medicine. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  20. Does Gender Moderate the Relations Between Externalizing Behavior and Key Emergent Literacy Abilities? Evidence From a Longitudinal Study.

    Science.gov (United States)

    Allan, Nicholas P; Joye, Shauna W; Lonigan, Christopher J

    2017-05-01

    There is a significant negative relation between externalizing behavior and emergent literacy skills among preschool children. The purpose of this study was to examine the impact of gender on the predictive relation of externalizing behavior and emergent literacy in a group of 178 preschool children (mean age = 48.50 months, SD = 3.66; 48% boys). Externalizing behaviors predicted emergent literacy over time. Distinct patterns of predictive associations dependent on gender were found. Girls with higher levels of externalizing behaviors experienced less change in their vocabulary skills compared with the vocabulary change shown by girls with lower levels of these problem behaviors. The results suggest that early identification programs that include externalizing behavior problems and their relation with emergent literacy development should account for potential gender differences. A theoretical framework in which girls with behavior problems receive less opportunity for vocabulary acquisition is presented.

  1. Identifying an evidence-based model of therapy for the pre-hospital emergency management of supraventricular tachycardia

    OpenAIRE

    Smith, Gavin

    2017-01-01

    This thesis provides a comprehensive reporting of the work undertaken to identify evidence supporting pre-hospital management of supraventricular tachycardia (SVT), delivering an evidence base for paramedic treatment of these patients. The literature search identified absences in evidence supporting therapies used within existing clinical guidelines. The vagal manoeuvres, the simplest and least invasive therapy to employ in the stable patient, were insufficiently evidenced regarding technique...

  2. What's the Evidence: A Review of the One-Minute Preceptor Model of Clinical Teaching and Implications for Teaching in the Emergency Department.

    Science.gov (United States)

    Farrell, Susan E; Hopson, Laura R; Wolff, Margaret; Hemphill, Robin R; Santen, Sally A

    2016-09-01

    The 2012 Academic Emergency Medicine Consensus Conference, "Education Research in Emergency Medicine: Opportunities, Challenges, and Strategies for Success" noted that emergency medicine (EM) educators often rely on theory and tradition in molding their approaches to teaching and learning, and called on the EM education community to advance the teaching of our specialty through the performance and application of research in teaching and assessment methods, cognitive function, and the effects of education interventions. The purpose of this article is to review the research-based evidence for the effectiveness of the one-minute preceptor (OMP) teaching method, and to provide suggestions for its use in clinical teaching and learning in EM. This article reviews hypothesis-testing education research related to the use of the OMP as a pedagogical method applicable to clinical teaching. Evidence indicates that the OMP prompts the teaching of higher level concepts, facilitates the assessment of students' knowledge, and prompts the provision of feedback. Students indicate satisfaction with this method of clinical case-based discussion teaching. Advancing EM education will require that high quality education research results be translated into actual curricular, pedagogical, assessment, and professional development changes. The OMP is a pedagogical method that is applicable to teaching in the emergency department. Copyright © 2016 Elsevier Inc. All rights reserved.

  3. Evidence to Support Oxygen Guidelines for Children with Emergency Signs in Developing Countries: A Systematic Review and Physiological and Mechanistic Analysis.

    Science.gov (United States)

    Tosif, Shidan; Duke, Trevor

    2017-10-01

    There are currently no evidence-based oxygen saturation targets for treating children with life-threatening conditions. We reviewed evidence of SpO2 targets for oxygen therapy in children with emergency signs as per WHO Emergency Triage Assessment and Treatment guidelines. We systematically searched for physiological data and international guidelines that would inform a safe approach. Our findings suggest that in children with acute lung disease who do not require resuscitation, a threshold SpO2 for commencing oxygen of 90% will provide adequate oxygen delivery. Although there is no empirical evidence regarding oxygen saturation to target in children with emergency signs from developing countries, a SpO2 of ≥ 94% during resuscitation may help compensate for common situations of reduced oxygen delivery. In children who do not require resuscitation or are stable post resuscitation with only lung disease, a lower limit of SpO2 for commencing oxygen of 90% will provide adequate oxygen delivery and save resources. © The Author [2017]. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  4. A review on prevention and treatment of post-orthodontic white spot lesions - evidence-based methods and emerging technologies

    DEFF Research Database (Denmark)

    Bergstrand, Fredrik; Twetman, Svante

    2011-01-01

    The aim of this paper was to update the evidence for primary and secondary prevention (treatment) of white spot lesions (WSL) adjacent to fixed orthodontic appliances.......The aim of this paper was to update the evidence for primary and secondary prevention (treatment) of white spot lesions (WSL) adjacent to fixed orthodontic appliances....

  5. A Decision Model for Emergency Warehouse Location Based on a Novel Stochastic MCDA Method: Evidence from China

    Directory of Open Access Journals (Sweden)

    Junkang He

    2017-01-01

    Full Text Available China is one of the disaster-prone countries in the world. Constructing a rapid and effective relief logistic system is important for disaster-responding at country level. Strategic prepositioning of emergency items, especially the decision of appropriate emergency warehouses location, has significant impacts on rapid disaster response to ensure sufficient relief supplies. The emergency warehouse location decision is a complex problem, where a wide variety of criteria need to be considered and the preference information of decision makers (DMs may be imprecise or even absent. In this paper, we identify key effectiveness-oriented criteria used to evaluate the alternative emergency warehouse locations and make an attempt to propose a new multicriteria ranking method to solve the problem of inaccurate or uncertain weight information based on stochastic pairwise dominant relations and the pruning procedure of ELECTRE-II method. The proposed method extends the conventional ELECTRE-II method by incorporating inaccurate information and broadens its application to emergency warehouse location field. The feasibility and applicability of the proposed method are illustrated with a simulated example.

  6. An analysis of the macroeconomic conditions required for SME lending: Evidence from Turkey and other emerging market countries

    Directory of Open Access Journals (Sweden)

    Jenkins Hatice

    2017-01-01

    Full Text Available Providing small and medium enterprises (SMEs with access to external finance has been a major concern for many governments and international organizations for three decades. In recent years the experiences of emerging market countries suggest that a paradigm shift is taking place in SME finance. Particularly in fast-growing emerging market countries such as Turkey, banks are increasingly targeting SMEs as a new line of banking business. This research analyzes how macroeconomic factors have contributed to increased commercial bank lending to SMEs in six emerging market countries: Turkey, Argentina, Brazil, Mexico, Chile, and Poland. Based on time series and panel data analysis, we find that a high GDP growth rate and increased competition in the banking sector have contributed to increased banking sector credit to SMEs. The findings also reveal that curbing the high inflation rate and reducing government domestic borrowing have significantly encouraged bank lending to the SME segment.

  7. Does volatility spillover among stock markets varies from normal to turbulent periods? Evidence from emerging markets of Asia

    Directory of Open Access Journals (Sweden)

    Khalil Jebran

    2017-01-01

    Full Text Available This study investigates the volatility spillover effect among Asian emerging markets in pre and post 2007 financial crisis period. The sample includes five emerging markets of Asia named; China, Pakistan, Hong Kong, Sri Lanka, and India. The asymmetric volatility spillover among the stock markets is examined using an extended EGARCH model. The results highlight certain interesting key findings. We find bidirectional volatility spillover between stock markets of India and Sri Lanka in both sub-periods. However the volatility spillover is bidirectional between stock markets of Hong Kong and India; Pakistan and India in pre-crisis period, while in stock markets of Sri Lanka and Pakistan in post-crisis period. The integration of emerging markets of Asia has important implications for investors and policy makers.

  8. Reducing rural maternal mortality and the equity gap in northern Nigeria: the public health evidence for the Community Communication Emergency Referral strategy

    Directory of Open Access Journals (Sweden)

    Aradeon SB

    2016-03-01

    Full Text Available Susan B Aradeon,1 Henry V Doctor2 1Freelance International Consultant (Social and Behavioral Change Communication, Aventura, FL, USA; 2Department of Information, Evidence and Research, Regional Office for the Eastern Mediterranean, World Health Organization, Nasr City, Cairo, Egypt Abstract: The Sustainable Development Goal (SDG maternal mortality target risks being underachieved like its Millennium Development Goal (MDG predecessor. The MDG skilled birth attendant (SBA strategy proved inadequate to end preventable maternal deaths for the millions of rural women living in resource-constrained settings. This equity gap has been successfully addressed by integrating a community-based emergency obstetric care strategy into the intrapartum care SBA delivery strategy in a large scale, northern Nigerian health systems strengthening project. The Community Communication Emergency Referral (CCER strategy catalyzes community capacity for timely evacuations to emergency obstetric care facilities instead of promoting SBA deliveries in environments where SBA availability and accessibility will remain inadequate for the near and medium term. Community Communication is an innovative, efficient, equitable, and culturally appropriate community mobilization approach that empowers low- and nonliterate community members to become the communicators. For the CCER strategy, this community mobilization approach was used to establish and maintain emergency maternal care support structures. Public health evidence demonstrates the success of integrating the CCER strategy into the SBA strategy and the practicability of this combined strategy at scale. In intervention sites, the maternal mortality ratio reduced by 16.8% from extremely high levels within 4 years. Significantly, the CCER strategy contributed to saving one-third of the lives saved in the project sites, thereby maximizing the effectiveness of the SBAs and upgraded emergency obstetric care facilities. Pre- and

  9. How is palliative care understood in the context of dementia? Results from a massive open online course.

    Science.gov (United States)

    McInerney, Fran; Doherty, Kathleen; Bindoff, Aidan; Robinson, Andrew; Vickers, James

    2017-11-01

    A palliative approach to the care of people with dementia has been advocated, albeit from an emergent evidence base. The person-centred philosophy of palliative care resonates with the often lengthy trajectory and heavy symptom burden of this terminal condition. To explore participants' understanding of the concept of palliative care in the context of dementia. The participant population took an online course in dementia. The participant population took a massive open online course on 'Understanding Dementia' and posted answers to the question: 'palliative care means …' We extracted these postings and analysed them via the dual methods of topic modelling analysis and thematic analysis. A total of 1330 participants from three recent iterations of the Understanding Dementia Massive Open Online Course consented to their posts being used. Participants included those caring formally or informally for someone living with dementia as well as those with a general interest in dementia Results: Participants were found to have a general awareness of palliative care, but saw it primarily as terminal care, focused around the event of death and specialist in nature. Comfort was equated with pain management only. Respondents rarely overtly linked palliative care to dementia. A general lack of palliative care literacy, particularly with respect to dementia, was demonstrated by participants. Implications for dementia care consumers seeking palliative care and support include recognition of the likely lack of awareness of the relevance of palliative care to dementia. Future research could access online participants more directly about their understandings/experiences of the relationship between palliative care and dementia.

  10. Prosody Signals the Emergence of Intentional Communication in the First Year of Life: Evidence from Catalan-Babbling Infants

    Science.gov (United States)

    Esteve-Gibert, Nuria; Prieto, Pilar

    2013-01-01

    There is considerable debate about whether early vocalizations mimic the target language and whether prosody signals emergent intentional communication. A longitudinal corpus of four Catalan-babbling infants was analyzed to investigate whether children use different prosodic patterns to distinguish communicative from investigative vocalizations…

  11. Evidence for the Convergence Model: The Emergence of Highly Pathogenic Avian Influenza (H5N1 in Viet Nam.

    Directory of Open Access Journals (Sweden)

    Sumeet Saksena

    Full Text Available Building on a series of ground breaking reviews that first defined and drew attention to emerging infectious diseases (EID, the 'convergence model' was proposed to explain the multifactorial causality of disease emergence. The model broadly hypothesizes disease emergence is driven by the co-incidence of genetic, physical environmental, ecological, and social factors. We developed and tested a model of the emergence of highly pathogenic avian influenza (HPAI H5N1 based on suspected convergence factors that are mainly associated with land-use change. Building on previous geospatial statistical studies that identified natural and human risk factors associated with urbanization, we added new factors to test whether causal mechanisms and pathogenic landscapes could be more specifically identified. Our findings suggest that urbanization spatially combines risk factors to produce particular types of peri-urban landscapes with significantly higher HPAI H5N1 emergence risk. The work highlights that peri-urban areas of Viet Nam have higher levels of chicken densities, duck and geese flock size diversities, and fraction of land under rice or aquaculture than rural and urban areas. We also found that land-use diversity, a surrogate measure for potential mixing of host populations and other factors that likely influence viral transmission, significantly improves the model's predictability. Similarly, landscapes where intensive and extensive forms of poultry production overlap were found at greater risk. These results support the convergence hypothesis in general and demonstrate the potential to improve EID prevention and control by combing geospatial monitoring of these factors along with pathogen surveillance programs.

  12. THE RELATIONSHIP BETWEEN DIVERSIFICATION STRATEGY AND FIRM PERFORMANCE IN DEVELOPED AND EMERGING ECONOMY CONTEXTS: EVIDENCE FROM TURKEY, ITALY AND NETHERLANDS

    Directory of Open Access Journals (Sweden)

    Onur Akpinar

    2016-09-01

    Full Text Available The aim of this study is to determine whether there is a difference between types of diversification and performance comparing Turkey, Italy and Netherlands. There are studies with the conclusion that the indicators of the relationship between diversification strategies and firm performance of developed countries differ from the indicators of developing countries. The data of 166 firms in Netherlands, 265 firms in Italy and 128 firms in Turkey were analyzed. The data of 2007-2011 was used in the research. Return on Assets (ROA and Return on Sales (ROS for financial performance and Entropy Index for diversification were used. According to the results, there is no correlation between total entropy and a performance criterion ROA and ROS in Italy and Netherlands. On the other hand, in Turkey, it is understood that there is a low-level positive correlation between total entropy and firm performance.

  13. The emergency room at the Rotunda Hospital: evidence of an improving service over the past 3 years.

    LENUS (Irish Health Repository)

    Talukdar, S

    2014-12-01

    This is a retrospective review of the Rotunda Hospital Emergency Room (ER) documentation with respect to attendances for a 4-month period (August-November) in both 2009 and 2012. The aim was to quantify the workload and assess the quality of care offered to patients attending the ER over the two time periods and to highlight any improvements in care after changes were implemented following the initial 2009 review.

  14. Migrants and emerging public health issues in a globalized world: threats, risks and challenges, an evidence-based framework.

    Science.gov (United States)

    Gushulak, Bd; Weekers, J; Macpherson, Dw

    2009-01-01

    International population mobility is an underlying factor in the emergence of public health threats and risks that must be managed globally. These risks are often related, but not limited, to transmissible pathogens. Mobile populations can link zones of disease emergence to lowprevalence or nonendemic areas through rapid or high-volume international movements, or both. Against this background of human movement, other global processes such as economics, trade, transportation, environment and climate change, as well as civil security influence the health impacts of disease emergence. Concurrently, global information systems, together with regulatory frameworks for disease surveillance and reporting, affect organizational and public awareness of events of potential public health significance. International regulations directed at disease mitigation and control have not kept pace with the growing challenges associated with the volume, speed, diversity, and disparity of modern patterns of human movement. The thesis that human population mobility is itself a major determinant of global public health is supported in this article by review of the published literature from the perspective of determinants of health (such as genetics/biology, behavior, environment, and socioeconomics), population-based disease prevalence differences, existing national and international health policies and regulations, as well as inter-regional shifts in population demographics and health outcomes. This paper highlights some of the emerging threats and risks to public health, identifies gaps in existing frameworks to manage health issues associated with migration, and suggests changes in approach to population mobility, globalization, and public health. The proposed integrated approach includes a broad spectrum of stakeholders ranging from individual health-care providers to policy makers and international organizations that are primarily involved in global health management, or are influenced

  15. The impact of evidence-based sepsis guidelines on emergency department clinical practice: a pre-post medical record audit.

    Science.gov (United States)

    Romero, Bernadine; Fry, Margaret; Roche, Michael

    2017-11-01

    To explore the number of patients presenting with sepsis before and after guideline implementation; the impact of sepsis guidelines on triage assessment, emergency department management and time to antibiotics. Sepsis remains one of the leading causes of mortality and morbidity within hospitals. Globally, strategies have been implemented to reduce morbidity and mortality rates, which rely on the early recognition and management of sepsis. To improve patient outcomes, the New South Wales government in Australia introduced sepsis guidelines into emergency departments. However, the impact of the guidelines on clinical practice remains unclear. A 12-month pre-post retrospective randomised medical record audit of adult patients with a sepsis diagnosis. Data were extracted from the emergency department database and paper medical record. Data included patient demographic (age, gender), clinical information (time of arrival, triage code, seen by time, disposition, time to antibiotic, pathology, time to intravenous fluids) and patient assessment data (heart rate, respiratory rate, blood pressure, temperature, oxygen saturations, medication). This study demonstrated a statistically significant 230-minute reduction in time to antibiotics post implementation of the guidelines. The post group (n = 165) received more urgent triage categories (n = 81; 49·1%), a 758-minute reduction in mean time to second litre of intravenous fluids and an improvement in collection of lactate (n = 112, 67·9%), also statistically significant. The findings highlight the impact the guidelines can have on clinician decision-making and behaviour that support best practice and positive patient outcomes. The sepsis guidelines improved the early assessment, recognition and management of patients presenting with sepsis in one tertiary referral emergency department. The use of evidenced-based guidelines can impact clinical decision-making and behaviour, resulting in the translation and support of

  16. Towards evidence based emergency medicine: Best BETs from the Manchester Royal Infirmary. BET 3: Toe fractures in adults.

    Science.gov (United States)

    Paradise, David

    2012-11-01

    A short cut review was carried out to establish whether intervention and follow up of patients with toe phalanx fractures is better than no treatment at reducing time to return to normal activity and need for surgical intervention. 40 papers were found using the reported searches, of which 1 presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of this best paper is tabulated. It is concluded that there is no evidence to determine whether intervention of any type improves outcome in toe phalanx fractures.

  17. Is restlessness best understood as a process? Reflecting on four boys’ restlessness during music therapy in kindergarten

    Science.gov (United States)

    Helle-Valle, Anna; Binder, Per-Einar; Anderssen, Norman; Stige, Brynjulf

    2017-01-01

    ABSTRACT ADHD can be considered an internationally recognized framework for understanding children’s restlessness. In this context, children’s restlessness is understood as a symptom of neurodevelopmental disorder. However, there are other possible understandings of children’s restlessness. In this article, we explore four boys’ collaborative and creative process as it is described and understood by three adults. The process is framed by a community music therapy project in a Norwegian kindergarten, and we describe four interrelated phases of this process: Exploring musical vitality and cooperation, Consolidating positions, Performing together, and Discovering ripple effects. We discuss these results in relation to seven qualities central to a community music therapy approach: participation, resource orientation, ecology, performance, activism, reflexivity and ethics. We argue that in contrast to a diagnostic approach that entails a focus on individual problems, a community music therapy approach can shed light on adult and systemic contributions to children’s restlessness. PMID:28532331

  18. A Risk Metric Assessment of Scenario-Based Market Risk Measures for Volatility and Risk Estimation: Evidence from Emerging Markets

    Directory of Open Access Journals (Sweden)

    Sitima Innocent

    2015-03-01

    Full Text Available The study evaluated the sensitivity of the Value- at- Risk (VaR and Expected Shortfalls (ES with respect to portfolio allocation in emerging markets with an index portfolio of a developed market. This study utilised different models for VaR and ES techniques using various scenario-based models such as Covariance Methods, Historical Simulation and the GARCH (1, 1 for the predictive ability of these models in both relatively stable market conditions and extreme market conditions. The results showed that Expected Shortfall has less risk tolerance than VaR based on the same scenario-based market risk measures

  19. Analysing the long-run relationship among oil market, nuclear energy consumption, and economic growth: An evidence from emerging economies

    International Nuclear Information System (INIS)

    Naser, Hanan

    2015-01-01

    The primary objectives of this paper is to scrutinize the long-run relationship and the causal linkage between oil consumption, nuclear energy consumption, oil prices and economic growth. For this purpose, Johansen cointegration technique is applied using time series data for four emerging economies: Russia, China, South Korea and India, over the period from 1965 to 2010. Johansen cointegration results indicate that there is a long-run relationship between the proposed variables in each country. Exclusion tests show that both energy sources enter the cointegration space significantly (except for Russia), which suggests that energy has a long-run impact on economic growth. Results of the causal linkage between the variables point that energy consumption (i.e., oil or nuclear) has either a predictive power for economic growth, or a feedback impact between with real Gross Domestic Product (GDP) growth in all countries. Hence, energy conservation policies might harmful negative consequences on the growth of economic for this group of countries. - Highlights: • There is a long-run relationship among oil market, nuclear energy consumption, and economic growth. • Countries are energy dependent in stimulating economic growth. • There is feedback impact between oil consumption and economic growth in three out of four countries. • An increase in oil prices has drawbacks on emerging economies growth

  20. Evidence of children's vulnerability to radiation in the context of radiological/nuclear events and considerations for emergency response.

    Science.gov (United States)

    Lane, Rachel; Reinhardt, Pascale; Thompson, Patsy

    2010-11-01

    International organisations, such as International Atomic Energy Agency, United Nations Scientific Committee on the Effects of Atomic Radiation and World Health Organisation, together with committees of experts such as Biological Effects of Ionising Radiation and Committee on Medical Aspects of Radiation in the Environment, have assessed the effects of radiation on large exposed populations (Chernobyl accident, and Hiroshima/Nagasaki atomic bombings) and on nuclear energy workers and people living near nuclear facilities. Childhood and in utero exposure to moderate and high levels of ionizing radiation, such as those experienced during the atomic bombings of Japan, or from radiotherapy, is an established cause of leukaemia and solid cancer. There is no evidence of increase in solid cancers (excluding thyroid cancer) or leukaemia in the children from Chernobyl, and no evident link between worker's exposure to radiation and leukaemia in their offspring or with the presence of leukaemia clusters around nuclear power plants. It has also not been possible to demonstrate the evidence of radiation hereditary effects in human populations. In accordance with international guidance, Canadian Nuclear Safety Commission recommends optimisation of protection strategies to reduce doses to children. The development of credible radiological/nuclear event scenarios would assist in identifying probable sources of radioactivity and pathways of exposure for children. Such scenarios should then be used to identify protection strategies appropriate for children.

  1. Evidence of children's vulnerability to radiation in the context of radiological/nuclear events and considerations for emergency response

    International Nuclear Information System (INIS)

    Lane, R.; Reinhardt, P.; Thompson, P.

    2010-01-01

    International organisations, such as International Atomic Energy Agency, United Nations Scientific Committee on the Effects of Atomic Radiation and World Health Organisation, together with committees of experts such as Biological Effects of Ionising Radiation and Committee on Medical Aspects of Radiation in the Environment, have assessed the effects of radiation on large exposed populations (Chernobyl accident, and Hiroshima/Nagasaki atomic bombings) and on nuclear energy workers and people living near nuclear facilities. Childhood and in utero exposure to moderate and high levels of ionizing radiation, such as those experienced during the atomic bombings of Japan, or from radiotherapy, is an established cause of leukaemia and solid cancer. There is no evidence of increase in solid cancers (excluding thyroid cancer) or leukaemia in the children from Chernobyl, and no evident link between worker's exposure to radiation and leukaemia in their offspring or with the presence of leukaemia clusters around nuclear power plants. It has also not been possible to demonstrate the evidence of radiation hereditary effects in human populations. In accordance with international guidance, Canadian Nuclear Safety Commission recommends optimisation of protection strategies to reduce doses to children. The development of credible radiological/nuclear event scenarios would assist in identifying probable sources of radioactivity and pathways of exposure for children. Such scenarios should then be used to identify protection strategies appropriate for children. (authors)

  2. Towards evidence-based emergency medicine: best BETs from the Manchester Royal Infirmary. BET 4: Hydrotherapy following rotator cuff repair.

    Science.gov (United States)

    Hay, Laura; Wylie, Katherine

    2011-07-01

    A short cut review was carried out to establish whether hydrotherapy is beneficial in rehabilitation after rotator cuff repair. 27 papers were found using the reported searches, of which one presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of that best paper are tabulated. It is concluded that while there may be some short term benefit to passive range of movement, further research is needed.

  3. Testing the emergence of New Caledonia: fig wasp mutualism as a case study and a review of evidence.

    Science.gov (United States)

    Cruaud, Astrid; Jabbour-Zahab, Roula; Genson, Gwenaëlle; Ungricht, Stefan; Rasplus, Jean-Yves

    2012-01-01

    While geologists suggest that New Caledonian main island (Grande Terre) was submerged until ca 37 Ma, biologists are struck by the presence of supposedly Gondwanan groups on the island. Among these groups are the Oreosycea fig trees (Ficus, Moraceae) and their Dolichoris pollinators (Hymenoptera, Agaonidae). These partners are distributed in the Paleotropics and Australasia, suggesting that their presence on New Caledonia could result from Gondwanan vicariance. To test this hypothesis, we obtained mitochondrial and nuclear markers (5.3 kb) from 28 species of Dolichoris, used all available sequences for Oreosycea, and conducted phylogenetic and dating analyses with several calibration strategies. All our analyses ruled out a vicariance scenario suggesting instead that New Caledonian colonization by Dolichoris and Oreosycea involved dispersal across islands from Sundaland ca 45.9-32.0 Ma. Our results show that successful long-distance dispersal of obligate mutualists may happen further suggesting that presence of intimate mutualisms on isolated islands should not be used as a priori evidence for vicariance. Comparing our results to a review of all the published age estimates for New Caledonian plant and animal taxa, we showed that support for a vicariant origin of the island biota is still lacking. Finally, as demonstrating a causal relationship between geology and biology requires independent evidence, we argue that a priori assumptions about vicariance or dispersal should not be used to constrain chronograms. This circular reasoning could lead to under or overestimation of age estimates.

  4. Testing the emergence of New Caledonia: fig wasp mutualism as a case study and a review of evidence.

    Directory of Open Access Journals (Sweden)

    Astrid Cruaud

    Full Text Available While geologists suggest that New Caledonian main island (Grande Terre was submerged until ca 37 Ma, biologists are struck by the presence of supposedly Gondwanan groups on the island. Among these groups are the Oreosycea fig trees (Ficus, Moraceae and their Dolichoris pollinators (Hymenoptera, Agaonidae. These partners are distributed in the Paleotropics and Australasia, suggesting that their presence on New Caledonia could result from Gondwanan vicariance. To test this hypothesis, we obtained mitochondrial and nuclear markers (5.3 kb from 28 species of Dolichoris, used all available sequences for Oreosycea, and conducted phylogenetic and dating analyses with several calibration strategies. All our analyses ruled out a vicariance scenario suggesting instead that New Caledonian colonization by Dolichoris and Oreosycea involved dispersal across islands from Sundaland ca 45.9-32.0 Ma. Our results show that successful long-distance dispersal of obligate mutualists may happen further suggesting that presence of intimate mutualisms on isolated islands should not be used as a priori evidence for vicariance. Comparing our results to a review of all the published age estimates for New Caledonian plant and animal taxa, we showed that support for a vicariant origin of the island biota is still lacking. Finally, as demonstrating a causal relationship between geology and biology requires independent evidence, we argue that a priori assumptions about vicariance or dispersal should not be used to constrain chronograms. This circular reasoning could lead to under or overestimation of age estimates.

  5. Neotropics provide insights into the emergence of New World monkeys: New dental evidence from the late Oligocene of Peruvian Amazonia.

    Science.gov (United States)

    Marivaux, Laurent; Adnet, Sylvain; Altamirano-Sierra, Ali J; Boivin, Myriam; Pujos, François; Ramdarshan, Anusha; Salas-Gismondi, Rodolfo; Tejada-Lara, Julia V; Antoine, Pierre-Olivier

    2016-08-01

    Recent field efforts in Peruvian Amazonia (Contamana area, Loreto Department) have resulted in the discovery of a late Oligocene (ca. 26.5 Ma; Chambira Formation) fossil primate-bearing locality (CTA-61). In this paper, we analyze the primate material consisting of two isolated upper molars, the peculiar morphology of which allows us to describe a new medium-sized platyrrhine monkey: Canaanimico amazonensis gen. et sp. nov. In addition to the recent discovery of Perupithecus ucayaliensis, a primitive anthropoid taxon of African affinities from the alleged latest Eocene Santa Rosa locality (Peruvian Amazonia), the discovery of Canaanimico adds to the evidence that primates were well-established in the Amazonian Basin during the Paleogene. Our phylogenetic results based on dental evidence show that none of the early Miocene Patagonian taxa (Homunculus, Carlocebus, Soriacebus, Mazzonicebus, Dolichocebus, Tremacebus, and Chilecebus), the late Oligocene Bolivian Branisella, or the Peruvian Canaanimico, is nested within a crown platyrrhine clade. All these early taxa are closely related and considered here as stem Platyrrhini. Canaanimico is nested within the Patagonian Soriacebinae, and closely related to Soriacebus, thereby extending back the soriacebine lineage to 26.5 Ma. Given the limited dental evidence, it is difficult to assess if Canaanimico was engaged in a form of pitheciine-like seed predation as is observed in Soriacebus and Mazzonicebus, but dental microwear patterns recorded on one upper molar indicate that Canaanimico was possibly a fruit and hard-object eater. If Panamacebus, a recently discovered stem cebine from the early Miocene of Panama, indicates that the crown platyrrhine radiation was already well underway by the earliest Miocene, Canaanimico indicates in turn that the "homunculid" radiation (as a part of the stem radiation) was well underway by the late Oligocene. These new data suggest that the stem radiation likely occurred in the Neotropics

  6. Secondary Buruli ulcer skin lesions emerging several months after completion of chemotherapy: paradoxical reaction or evidence for immune protection?

    Directory of Open Access Journals (Sweden)

    Marie-Thérèse Ruf

    2011-08-01

    Full Text Available BACKGROUND: The neglected tropical disease Buruli ulcer (BU caused by Mycobacterium ulcerans is an infection of the subcutaneous tissue leading to chronic ulcerative skin lesions. Histopathological features are progressive tissue necrosis, extracellular clusters of acid fast bacilli (AFB and poor inflammatory responses at the site of infection. After the recommended eight weeks standard treatment with rifampicin and streptomycin, a reversal of the local immunosuppression caused by the macrolide toxin mycolactone of M. ulcerans is observed. METHODOLOGY/PRINCIPAL FINDINGS: We have conducted a detailed histopathological and immunohistochemical analysis of tissue specimens from two patients developing multiple new skin lesions 12 to 409 days after completion of antibiotic treatment. Lesions exhibited characteristic histopathological hallmarks of Buruli ulcer and AFB with degenerated appearance were found in several of them. However, other than in active disease, lesions contained massive leukocyte infiltrates including large B-cell clusters, as typically found in cured lesions. CONCLUSION/SIGNIFICANCE: Our histopathological findings demonstrate that the skin lesions emerging several months after completion of antibiotic treatment were associated with M. ulcerans infection. During antibiotic therapy of Buruli ulcer development of new skin lesions may be caused by immune response-mediated paradoxical reactions. These seem to be triggered by mycobacterial antigens and immunostimulators released from clinically unrecognized bacterial foci. However, in particular the lesions that appeared more than one year after completion of antibiotic treatment may have been associated with new infection foci resolved by immune responses primed by the successful treatment of the initial lesion.

  7. Gradual reforms and the emergence of energy market in China. Evidence from tests for convergence of energy prices

    International Nuclear Information System (INIS)

    Ma, Hengyun; Oxley, Les; Gibson, John

    2009-01-01

    This study investigates the emergence of energy markets by testing for convergence of energy prices with a new dataset on energy spot prices in 35 major cities in China. Both descriptive statistics and unit root are employed to test the convergence of energy prices for each of four fuel price series. The whole study period is divided into two sub-periods in order to reconcile the gradual energy reforms. The results show the steady improvement in energy market performance in China, especially during the second sub-period, which suggests that the market appears to be playing an increasing role in determining energy prices. While panel unit root tests show energy markets are integrated in China as a whole, city-by-city univariate unit root tests suggest that there are still many regional energy markets, probably because energy reserves (especially coal) vary widely across regions. Since China's energy economy is gradually moving towards market-oriented mechanisms, the existing literature may become obsolete soon. (author)

  8. Entrepreneurial University Perspective: Tracking Labor Force Capacity to Support Industrialization Processes in the Emerging Markets, Evidence from Kazakhstan Data

    Directory of Open Access Journals (Sweden)

    Dilara Orynbassarova

    2017-01-01

    Full Text Available Industrialisation is considered as main engine of growth in economic development of the most emerging markets. This is especially true for Central Asian transitional countries as Kazakhstan, which obtained independence from the Soviet Union in 1991. For enhancing country’s competitiveness potential, Kazakhstan National Program for 2010-2014 aimed to accelerate industrial-innovative development of the country. While many papers published about the importance of industrialization activities in Kazakhstan, few have focused on examining the current capacity of labor market to meet the industry demand. Main aim of this paper was to investigate if current manpower is adequate to maintain the planned rate of growth in the country. Higher level of economic production led to higher demand of engineering labor force. High demand with low frequency supply created an imbalance in the labor market that resulted what we see as shortage of technically skilled labor. Low frequency of supply is influenced by such factors as high engineers’ outflow rate, low students enrolment and graduation rates, and lack of practical skills of the graduates hired.

  9. "Contagion" between the emerging and developed capital markets: empirical evidence and reflections on the international portfolio diversification

    Directory of Open Access Journals (Sweden)

    Wagner Moura Lamounier

    2008-10-01

    Full Text Available In this research, we analyzed the short and long term interdependence and relationship between the stock indices of the major emerging capital markets and the major developed markets for the period 1995-2005. The aim was to verify the existence and the dynamics of the “contagion” between the markets, or if the occurrence of crises and changes in the behavior of a market would have impacts on the behavior of the others. In the development of the work, we applied the methodology of the Vector Error Correction Model (VEC. We found the presence of cointegrating relationships between the markets analyzed, but was able to see that, despite being cointegrated markets, investors could benefit from international diversification of portfolios. That’s because the speed of adjustment of the long-term ratio of cointegration between the markets was low for the period analyzed. Accordingly, investors would have the opportunity to reduce risk by diversifying their portfolios.

  10. Interpreting the evidence: competing paradigms and the emergence of lesbian and gay suicide as a "social fact".

    Science.gov (United States)

    Erwin, K

    1993-01-01

    Almost two decades after the American Psychiatric Association acknowledged that homosexuality should no longer be considered a pathological condition, studies continue to show significantly higher rates of suicide, depression, substance abuse, and other indicators of psychological distress among lesbians and gay men than among heterosexuals in the United States. If homosexuality is not, in fact, pathological, then what accounts for such self-destructive behavior? This article examines contending causal theories of homosexual suicide and psychological distress ranging from religious and medical-psychiatric theories that problematize individual behavior to societal explanations that locate the cause in social intolerance and internalized oppression. Illuminating the origins of myths that persist today, it demonstrates how historical, social, and political forces have been instrumental in shaping the scientific and medical response to gay and lesbian psychological distress. Emphasis is on the need to question the "objective validity" of scientific theories in order to develop more effective responses to gay and lesbian mental health problems. Finally, this article considers alternative views of sexuality that are emerging from such sources as feminists and gay Native Americans, and proposes new directions for mental health research that encompass issues of diversity within the gay and lesbian population.

  11. Reducing rural maternal mortality and the equity gap in northern Nigeria: the public health evidence for the Community Communication Emergency Referral strategy.

    Science.gov (United States)

    Aradeon, Susan B; Doctor, Henry V

    2016-01-01

    The Sustainable Development Goal (SDG) maternal mortality target risks being underachieved like its Millennium Development Goal (MDG) predecessor. The MDG skilled birth attendant (SBA) strategy proved inadequate to end preventable maternal deaths for the millions of rural women living in resource-constrained settings. This equity gap has been successfully addressed by integrating a community-based emergency obstetric care strategy into the intrapartum care SBA delivery strategy in a large scale, northern Nigerian health systems strengthening project. The Community Communication Emergency Referral (CCER) strategy catalyzes community capacity for timely evacuations to emergency obstetric care facilities instead of promoting SBA deliveries in environments where SBA availability and accessibility will remain inadequate for the near and medium term. Community Communication is an innovative, efficient, equitable, and culturally appropriate community mobilization approach that empowers low- and nonliterate community members to become the communicators. For the CCER strategy, this community mobilization approach was used to establish and maintain emergency maternal care support structures. Public health evidence demonstrates the success of integrating the CCER strategy into the SBA strategy and the practicability of this combined strategy at scale. In intervention sites, the maternal mortality ratio reduced by 16.8% from extremely high levels within 4 years. Significantly, the CCER strategy contributed to saving one-third of the lives saved in the project sites, thereby maximizing the effectiveness of the SBAs and upgraded emergency obstetric care facilities. Pre- and postimplementation Knowledge, Attitude, and Practice Survey results and qualitative assessments support the CCER theory of change. This theory of change rests on a set of implementation steps that rely on three innovative components: Community Communication, Rapid Imitation Practice, and CCER support

  12. Damaging Effects of Bisphenol A on the Kidney and the Protection by Melatonin: Emerging Evidences from In Vivo and In Vitro Studies

    Directory of Open Access Journals (Sweden)

    Anongporn Kobroob

    2018-01-01

    Full Text Available This study investigates the effects of bisphenol A (BPA contamination on the kidney and the possible protection by melatonin in experimental rats and isolated mitochondrial models. Rats exposed to BPA (50, 100, and 150 mg/kg, i.p. for 5 weeks demonstrated renal damages as evident by increased serum urea and creatinine and decreased creatinine clearance, together with the presence of proteinuria and glomerular injuries in a dose-dependent manner. These changes were associated with increased lipid peroxidation and decreased antioxidant glutathione and superoxide dismutase. Mitochondrial dysfunction was also evident as indicated by increased reactive oxygen species production, decreased membrane potential change, and mitochondrial swelling. Coadministration of melatonin resulted in the reversal of all the changes caused by BPA. Studies using isolated mitochondria showed that BPA incubation produced dose-dependent impairment in mitochondrial function. Preincubation with melatonin was able to sustain mitochondrial function and architecture and decreases oxidative stress upon exposure to BPA. The findings indicated that BPA is capable of acting directly on the kidney mitochondria, causing mitochondrial oxidative stress, dysfunction, and subsequently, leading to whole organ damage. Emerging evidence further suggests the protective benefits of melatonin against BPA nephrotoxicity, which may be mediated, in part, by its ability to diminish oxidative stress and maintain redox equilibrium within the mitochondria.

  13. Emergence of mammalian species-infectious and -pathogenic avian influenza H6N5 virus with no evidence of adaptation.

    Science.gov (United States)

    Nam, Jeong-Hyun; Kim, Eun-Ha; Song, Daesub; Choi, Young Ki; Kim, Jeong-Ki; Poo, Haryoung

    2011-12-01

    The migratory waterfowl of the world are considered to be the natural reservoir of influenza A viruses. Of the 16 hemagglutinin subtypes of avian influenza viruses, the H6 subtype is commonly perpetuated in its natural hosts and is of concern due to its potential to be a precursor of highly pathogenic influenza viruses by reassortment. During routine influenza surveillance, we isolated an unconventional H6N5 subtype of avian influenza virus. Experimental infection of mice revealed that this isolate replicated efficiently in the lungs, subsequently spread systemically, and caused lethality. The isolate also productively infected ferrets, with direct evidence of contact transmission, but no disease or transmission was seen in pigs. Although the isolate possessed the conserved receptor-binding site sequences of avian influenza viruses, it exhibited relatively low replication efficiencies in ducks and chickens. Our genetic and molecular analyses of the isolate revealed that its PB1 sequence showed the highest evolutionary relationship to those of highly pathogenic H5N1 avian influenza viruses and that its PA protein had an isoleucine residue at position 97 (a representative virulence marker). Further studies will be required to examine why our isolate has the virologic characteristics of mammalian influenza viruses but the archetypal receptor binding profiles of avian influenza viruses, as well as to determine whether its potential virulence markers (PB1 analogous to those of H5N1 viruses or isoleucine residue at position 97 within PA) could render it highly pathogenic in mice.

  14. New evidence for endemic circulation of Ross River virus in the Pacific Islands and the potential for emergence.

    Science.gov (United States)

    Lau, Colleen; Aubry, Maite; Musso, Didier; Teissier, Anita; Paulous, Sylvie; Desprès, Philippe; de-Lamballerie, Xavier; Pastorino, Boris; Cao-Lormeau, Van-Mai; Weinstein, Philip

    2017-04-01

    An epidemic of Ross River virus (RRV) occurred in the South Pacific in 1979-1980, but RRV has not been thought to occur endemically outside Australia and Papua New Guinea. A seroprevalence study was conducted to determine whether RRV has circulated in American Samoa since 1980. RRV ELISA IgG was performed on 200 serum samples collected in American Samoa in 2010; seroneutralization tests were performed on 60 representative samples. Of 196 available ELISA IgG results, 145 (74%, 95% confidence interval 67-80%) were seropositive. Of the 60 samples subjected to seroneutralization testing, none of the 15 ELISA IgG-negative and 16 of the 45 ELISA IgG-positive samples neutralized RRV. ELISA IgG seroprevalence was higher in persons born before/during the 1979-1980 RRV outbreak (78.3%), but was also high (63.0%) in people born after the outbreak who had lived their entire lives in American Samoa. This study provides serological evidence that RRV circulation is likely to have occurred in American Samoa after 1980. Considering there are no marsupials in American Samoa, this finding implies that other species are capable of acting as reservoir hosts and indicates the potential for RRV to circulate in a much wider area than those currently recognized. Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.

  15. Evidence of genetic drift and reassortment in infectious bursal disease virus and emergence of outbreaks in poultry farms in India.

    Science.gov (United States)

    Patel, Amrutlal K; Pandey, Vinod C; Pal, Joy K

    2016-06-01

    Recurrent outbreaks of infectious bursal disease (IBD) have become a burning problem to the poultry industry worldwide. Here, we performed genetic analysis of IBD virus (IBDV) field isolates from recent outbreaks in various poultry farms in India. The sequence analysis of IBDV VP2 hypervariable region revealed amino acid pattern similar to that of very virulent (222A, 242I, 253Q, 256I, 272I, 279D, 284A, 294I, 299S and 330S) and intermediate plus virulent (222A, 242I, 253Q, 256I, 272T, 279N, 284A, 294I, 299S and 330S) type whereas analysis of VP1 revealed presence of sequence similar to that of very virulent (61I, 145T) and unique (61I, 141I, 143D, 145S) type in field isolates. Among the eight field isolates, two isolates contained very virulent type VP2 and unique type VP1, three contained intermediate plus virulent type VP2 and unique type VP1 whereas five contained both VP2 and VP1 of very virulent type. The phylogenetic analysis based on VP2 nucleotide sequence showed clustering of all eight isolates close to known very virulent strains whereas based on VP1, five isolates formed unique cluster and three isolates were placed close to very virulent strains. The isolates forming unique VP1 cluster showed highest similarity with classical virulent IBDVs suggesting their possible evolution from segment B of non-very virulent IBDVs. Interestingly, these five isolates were responsible for outbreaks in four different farms located at three different geographic locations in India. These observations indicates genetic reassortment between segment A and segment B from co-infecting IBDV strains leading to emergence of very virulent strains and their widespread prevalence in Indian poultry farms. The presence of 272I and 279D in VP2 protein of five field isolates may explain possible cause of Gumboro intermediate plus vaccine failure in prevention of the outbreaks. However, mortality caused by other three strains which are antigenically similar to VP1 of intermediate plus

  16. Prenatal factors contribute to the emergence of kwashiorkor or marasmus in severe undernutrition: evidence for the predictive adaptation model.

    Directory of Open Access Journals (Sweden)

    Terrence E Forrester

    Full Text Available Severe acute malnutrition in childhood manifests as oedematous (kwashiorkor, marasmic kwashiorkor and non-oedematous (marasmus syndromes with very different prognoses. Kwashiorkor differs from marasmus in the patterns of protein, amino acid and lipid metabolism when patients are acutely ill as well as after rehabilitation to ideal weight for height. Metabolic patterns among marasmic patients define them as metabolically thrifty, while kwashiorkor patients function as metabolically profligate. Such differences might underlie syndromic presentation and prognosis. However, no fundamental explanation exists for these differences in metabolism, nor clinical pictures, given similar exposures to undernutrition. We hypothesized that different developmental trajectories underlie these clinical-metabolic phenotypes: if so this would be strong evidence in support of predictive adaptation model of developmental plasticity.We reviewed the records of all children admitted with severe acute malnutrition to the Tropical Metabolism Research Unit Ward of the University Hospital of the West Indies, Kingston, Jamaica during 1962-1992. We used Wellcome criteria to establish the diagnoses of kwashiorkor (n = 391, marasmus (n = 383, and marasmic-kwashiorkor (n = 375. We recorded participants' birth weights, as determined from maternal recall at the time of admission. Those who developed kwashiorkor had 333 g (95% confidence interval 217 to 449, p<0.001 higher mean birthweight than those who developed marasmus.These data are consistent with a model suggesting that plastic mechanisms operative in utero induce potential marasmics to develop with a metabolic physiology more able to adapt to postnatal undernutrition than those of higher birthweight. Given the different mortality risks of these different syndromes, this observation is supportive of the predictive adaptive response hypothesis and is the first empirical demonstration of the advantageous effects of such a

  17. Ethnographic Evidence of an Emerging Transnational Arts Practice?: Perspectives on U.K. and Mexican Participatory Artists' Processes for Catalysing Change, and Facilitating Health and Flourishing.

    Science.gov (United States)

    Raw, Anni

    2014-03-01

    This article reports new ethnographic research exploring community-based, participatory arts practice in Northern England and Mexico City. Noting the value of an ethnographic approach, the study investigated whether commonalities discovered in practitioners' approaches are significant enough to constitute a generalisable participatory arts methodology, transcending significant contextual differences, and recognisable across national boundaries. Shared characteristics emerged in practitioners' modes of engagement with groups, and strategies for catalysing change; clear convergences from which a core methodology in community-based participatory arts for change is distilled. It suggests the opening of liminal spaces in which participants can reflect, rehearsing fresh ways of engaging in transformative dialogues in relation to the world in which they live. This article presents the study findings as a grounded characterisation of 'participatory arts practice': a complex but potentially powerful mechanism, in use within numerous community health projects, and evident in diverse settings, despite little or no exchange of ideas between practitioners.

  18. Preliminary Evidence for the Emergence of a Health Care Online Community of Practice: Using a Netnographic Framework for Twitter Hashtag Analytics.

    Science.gov (United States)

    Roland, Damian; Spurr, Jesse; Cabrera, Daniel

    2017-07-14

    Online communities of practice (oCoPs) may emerge from interactions on social media. These communities offer an open digital space and flat role hierarchy for information sharing and provide a strong group identity, rapid flow of information, content curation, and knowledge translation. To date, there is only a small body of evidence in medicine or health care to verify the existence of an oCoP. We aimed to examine the emergence of an oCoP through the study of social media interactions of the free open access medical education (FOAM) movement. We examined social media activity in Twitter by analyzing the network centrality metrics of tweets with the #FOAMed hashtag and compared them with previously validated criteria of a community of practice (CoP). The centrality analytics of the FOAM community showed concordance with aspects of a general CoP (in terms of community, domain, and practice), as well as some specific traits of a health care community, including social control, common purpose, flat hierarchy, and network-based and concrete achievement. This study demonstrated preliminary evidence of an oCoP focused on education and based on social media interactions. Further examination of the topology of the network is needed to definitely prove the existence of an oCoP. Given that these communities result in significant knowledge translation and practice change, further research in this area appears warranted. ©Damian Roland, Jesse Spurr, Daniel Cabrera. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 14.07.2017.

  19. The impact of emerging safety and effectiveness evidence on the use of physician-administered drugs: the case of bevacizumab for breast cancer.

    Science.gov (United States)

    Conti, Rena M; Dusetzina, Stacie B; Herbert, Ann C; Berndt, Ernst R; Huskamp, Haiden A; Keating, Nancy L

    2013-07-01

    Spending on physician-administered drugs is high and uses not approved by the US Food and Drug Administration (FDA) are frequent. Although these drugs may be targets of future policy efforts to rationalize use, little is known regarding how physicians respond to emerging safety and effectiveness evidence. We analyzed changes in bevacizumab (Avastin) use for breast cancer in response to its market launch (February 2008), 2 FDA meetings reviewing data suggesting that its risks exceed its benefits (July 2010 and June 2011), and the FDA's withdrawal of approval (November 2011). Data from a population-based audit of oncologists' prescribing (IntrinsiQ Intellidose) were used to measure the monthly number of breast cancer patients treated with bevacizumab (January 2008-April 2012). The number of bevacizumab patients following each regulatory action was estimated using negative binomial regression, compared with patients before the first FDA meeting, adjusting for cancer stage, treatment line, patient age, and outpatient office affiliation. Bevacizumab use for breast cancer increased significantly after FDA approval. After all regulatory actions, there was a 65% decline (95% CI, 64%-65%) in use compared with the period before the first meeting. The largest decline was in the 6-month period after the first meeting (37%; 95% CI, 28%-47%). The rate of decline did not differ by patient or cancer characteristics and differed minimally by office affiliation. Bevacizumab use for breast cancer declined dramatically after FDA meetings and regulatory actions, a period without changes in guideline recommendations or insurance coverage. Physicians seem to be responsive to emerging evidence concerning physician-administered drug safety and effectiveness.

  20. Applying Multi-Criteria Decision Analysis (MCDA) Simple Scoring as an Evidence-based HTA Methodology for Evaluating Off-Patent Pharmaceuticals (OPPs) in Emerging Markets.

    Science.gov (United States)

    Brixner, Diana; Maniadakis, Nikos; Kaló, Zoltán; Hu, Shanlian; Shen, Jie; Wijaya, Kalman

    2017-09-01

    Off-patent pharmaceuticals (OPPs) represent more than 60% of the pharmaceutical market in many emerging countries, where they are frequently evaluated primarily on cost rather than with health technology assessment. OPPs are assumed to be identical to the originators. Branded and unbranded generic versions can, however, vary from the originator in active pharmaceutical ingredients, dosage, consistency formulation, excipients, manufacturing processes, and distribution, for example. These variables can alter the efficacy and safety of the product, negatively impacting both the anticipated cost savings and the population's health. In addition, many health care systems lack the resources or expertise to evaluate such products, and current assessment methods can be complex and difficult to adapt to a health system's needs. Multicriteria decision analysis (MCDA) simple scoring is an evidence-based health technology assessment methodology for evaluating OPPs, especially in emerging countries in which resources are limited but decision makers still must balance affordability with factors such as drug safety, level interchangeability, manufacturing site and active pharmaceutical ingredient quality, supply track record, and real-life outcomes. MCDA simple scoring can be applied to pharmaceutical pricing, reimbursement, formulary listing, and drug procurement. In November 2015, a workshop was held at the International Society for Pharmacoeconomics and Outcomes Research Annual Meeting in Milan to refine and prioritize criteria that can be used in MCDA simple scoring for OPPs, resulting in an example MCDA process and 22 prioritized criteria that health care systems in emerging countries can easily adapt to their own decision-making processes. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  1. Evidence of reassortment of pandemic H1N1 influenza virus in swine in Argentina: are we facing the expansion of potential epicenters of influenza emergence?

    Science.gov (United States)

    Pereda, Ariel; Rimondi, Agustina; Cappuccio, Javier; Sanguinetti, Ramon; Angel, Matthew; Ye, Jianqiang; Sutton, Troy; Dibárbora, Marina; Olivera, Valeria; Craig, Maria I.; Quiroga, Maria; Machuca, Mariana; Ferrero, Andrea; Perfumo, Carlos; Perez, Daniel R.

    2011-01-01

    Please cite this paper as: Pereda et al. (2011) Evidence of reassortment of pandemic H1N1 influenza virus in swine in Argentina: are we facing the expansion of potential epicenters of influenza emergence? Influenza and Other Respiratory Viruses 5(6), 409–412. In this report, we describe the occurrence of two novel swine influenza viruses (SIVs) in pigs in Argentina. These viruses are the result of two independent reassortment events between the H1N1 pandemic influenza virus (H1N1pdm) and human‐like SIVs, showing the constant evolution of influenza viruses at the human–swine interface and the potential health risk of H1N1pdm as it appears to be maintained in the swine population. It must be noted that because of the lack of information regarding the circulation of SIVs in South America, we cannot discard the possibility that ancestors of the H1N1pdm or other SIVs have been present in this part of the world. More importantly, these findings suggest an ever‐expanding geographic range of potential epicenters of influenza emergence with public health risks. PMID:21668680

  2. Surgeon-level reporting presented by funnel plot is understood by doctors but inaccurately interpreted by members of the public.

    Science.gov (United States)

    Bhalla, Ashish; Mehrotra, Prerna; Amawi, Falah; Lund, Jonathan N

    2015-01-01

    Risk-adjusted outcome data for general surgeons practicing in the United Kingdom were published for the first time in 2013 with the aim of increasing transparency, improving standards, and providing the public with information to aid decision making. Most specialties used funnel plots to present their data. We assess the ability of members of the public (MoP), medical students, nonsurgical doctors (NSD), and surgeons to understand risk-adjusted surgical outcome data. A fictitious outcome dataset was created and presented in the form of a funnel plot to 10 participants from each of the aforementioned group. Standard explanatory text was provided. Each participant was given 5 minutes to review the funnel plot and complete a questionnaire. For each question, there was only 1 correct answer. Completion rate was 100% (n = 40). No difference existed between NSD and surgeons. A significant difference for identification of the "worst performing surgeon" was noted between surgeons and MoP (p funnel plot significantly "more difficult" to interpret than surgeons did (p < 0.01) and NSD (p < 0.01). MoP found these data significantly more "difficult to understand" and were less likely to both spot "outliers" and use this data to inform decisions than doctors. Surgeons should be aware that outcome data may require an alternative method of presentation to be understood by MoP. Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  3. Improving access to emergency contraception pills through strengthening service delivery and demand generation: a systematic review of current evidence in low and middle-income countries.

    Directory of Open Access Journals (Sweden)

    Angela Dawson

    Full Text Available Emergency contraception pills (ECP are among the 13 essential commodities in the framework for action established by the UN Commission on Life-Saving Commodities for Women and Children. Despite having been on the market for nearly 20 years, a number of barriers still limit women's access to ECP in low- and middle-income countries (LMIC including limited consumer knowledge and poor availability. This paper reports the results of a review to synthesise the current evidence on service delivery strategies to improve access to ECP.A narrative synthesis methodology was used to examine peer reviewed research literature (2003 to 2013 from diverse methodological traditions to provide critical insights into strategies to improve access from a service delivery perspective. The studies were appraised using established scoring systems and the findings of included papers thematically analysed and patterns mapped across all findings using concept mapping.Ten papers were included in the review. Despite limited research of adequate quality, promising strategies to improve access were identified including: advance provision of ECP; task shifting and sharing; intersectoral collaboration for sexual assault; m-health for information provision; and scale up through national family planning programs.There are a number of gaps in the research concerning service delivery and ECP in LMIC. These include a lack of knowledge concerning private/commercial sector contributions to improving access, the needs of vulnerable groups of women, approaches to enhancing intersectoral collaboration, evidence for social marketing models and investment cases for ECP.

  4. New and Emerging Evidence on the Use of Second-Generation Direct Acting Antivirals for the Treatment of Hepatitis C Virus in Renal Impairment.

    Science.gov (United States)

    Sorbera, Maria A; Friedman, Michelle L; Cope, Rebecca

    2017-06-01

    Due to the intimate relationship between liver and kidney disease in hepatitis C virus (HCV) infection, treatment options for HCV-positive patients at any stage of chronic kidney disease (CKD) are essential. The availability of second-generation, direct-acting antiviral (DAA) combinations has allowed for the advent of interferon-sparing treatment regimens with shorter durations and minimal side effects. While many of the second-generation DAAs are principally metabolized by the hepatic system, dosing in severe renal impairment (creatinine clearance [CrCl] <30 mL/min) or dialysis has remained questionable due to limited experience. New evidence regarding the use of these agents in renal impairment continues to become available, as real-world experience with these treatment regimens is reported. Simeprevir, ledipasvir, paritaprevir, ombitasvir, dasabuvir, and daclatasvir have data to suggest safety in end-stage renal disease. While safety and efficacy with sofosbuvir remains uncertain, data are now available to support utilizing a dose adjustment when glomerular filtration rates are <30 mL/min. Upcoming regimens grazoprevir/elbasvir and daclatasvir/asunaprevir/beclavubir may provide further options for patients with advanced kidney disease, and ongoing studies will continue to provide guidance for this unique patient population. This article will review the currently available literature, including the newest emerging evidence, on the use of second-generation DAAs in CKD stages 3 to 5 and dialysis.

  5. Improving access to emergency contraception pills through strengthening service delivery and demand generation: a systematic review of current evidence in low and middle-income countries.

    Science.gov (United States)

    Dawson, Angela; Tran, Nguyen-Toan; Westley, Elizabeth; Mangiaterra, Viviana; Festin, Mario

    2014-01-01

    Emergency contraception pills (ECP) are among the 13 essential commodities in the framework for action established by the UN Commission on Life-Saving Commodities for Women and Children. Despite having been on the market for nearly 20 years, a number of barriers still limit women's access to ECP in low- and middle-income countries (LMIC) including limited consumer knowledge and poor availability. This paper reports the results of a review to synthesise the current evidence on service delivery strategies to improve access to ECP. A narrative synthesis methodology was used to examine peer reviewed research literature (2003 to 2013) from diverse methodological traditions to provide critical insights into strategies to improve access from a service delivery perspective. The studies were appraised using established scoring systems and the findings of included papers thematically analysed and patterns mapped across all findings using concept mapping. Ten papers were included in the review. Despite limited research of adequate quality, promising strategies to improve access were identified including: advance provision of ECP; task shifting and sharing; intersectoral collaboration for sexual assault; m-health for information provision; and scale up through national family planning programs. There are a number of gaps in the research concerning service delivery and ECP in LMIC. These include a lack of knowledge concerning private/commercial sector contributions to improving access, the needs of vulnerable groups of women, approaches to enhancing intersectoral collaboration, evidence for social marketing models and investment cases for ECP.

  6. Conflict Prevalence in Primary School and How It Is Understood to Affect Teaching and Learning in Ghana

    Directory of Open Access Journals (Sweden)

    Nana Afia Amponsaa Opoku-Asare

    2015-07-01

    Full Text Available Verbal and non-verbal interactions that occur daily between teachers and headteachers, teachers and pupils, and among pupils can generate conflict that may adversely affect teaching, learning, and schooling effectiveness. Little attention is, however, paid to the quality of relationships that exists between teachers and pupils, among teachers, among pupils, between teachers and their school heads, and between schools and their local communities. This study sought to investigate conflict prevalence in Ghana’s primary schools, and how relationship conflict is understood to affect teaching and learning at the level of headteachers as administrators, teachers as classroom managers, and pupils as learners, and direct beneficiaries of primary education. Using data gathered via interview, questionnaire administration, and observation in 30 public primary schools in 10 circuits of one district of Ashanti Region, the findings revealed a high prevalence of fighting, heckling, bullying, and other forms of relationship conflict among pupils; strained teacher–pupil relations due to insolence, indiscipline, and use of offensive language; and teacher–parent arguments and quarrels due to harsh punishment and verbal assault of pupils. Teacher–pupil conflicts may extend to teachers excluding the affected pupils from teaching and learning activities, denying them the rights to ask and answer questions, and have their class exercises marked, leading to lowered pupil self-esteem, reduced concentration during lessons, and passive involvement in learning activities, which could result in truancy and school dropout. Strengthening guidance mechanisms and encouraging peer mediation could significantly curb conflict in school environments and thereby raise educational standards in the district.

  7. Effectiveness of Implementing Evidence-based Interventions to Reduce C-spine Image Ordering in the Emergency Department: A Systematic Review.

    Science.gov (United States)

    Desai, Shashwat; Liu, Chaocheng; Kirkland, Scott W; Krebs, Lynette D; Keto-Lambert, Diana; Rowe, Brian H

    2017-12-19

    Appropriate use of imaging for adult patients with cervical spine (C-spine) injuries in the emergency department (ED) is a longstanding issue. Guidance for C-spine ordering exists; however, the effectiveness of the decision support implementation in the ED is not well studied. This systematic review examines the implementation and effectiveness of evidence-based interventions aimed at reducing C-spine imaging in adults presenting to the ED with neck trauma. Six electronic databases and the gray literature were searched. Comparative intervention studies were eligible for inclusion. Two independent reviewers screened for study eligibility, study quality, and extracted data. The change in imaging was reported using individual odds ratios (ORs) with 95% confidence intervals (CIs) using random effects. A total of 990 unique citations were screened for relevance of which six before-after studies and one randomized controlled trial were included. None of the studies were assessed as high quality. Interventions consisted primarily of locally developed guidelines or established clinical decision rules such as the NEXUS or the Canadian C-spine rule. Overall, implementation of interventions aimed at reducing C-spine image ordering resulted in a statistically significant reduction in imaging (OR = 0.69, 95% CI = 0.51-0.93); however, heterogeneity was high (I 2  = 82%). Subgroup analysis revealed no differences between studies that specified enrolling alert and stable patients compared to unspecified trauma (p = 0.81) or between studies employing multifaceted versus nonmultifaceted interventions (p = 0.66). While studies generally provided details on implementation strategies (e.g., teaching sessions, pocket cards, posters, computerized decision support) the effectiveness of these implementation strategies were frequently not reported. There is moderate evidence regarding the effectiveness of interventions to reduce C-spine image ordering in adult patients seen in the

  8. GLP-2: A POORLY UNDERSTOOD MEDIATOR ENROLLED IN VARIOUS BARIATRIC/METABOLIC SURGERY-RELATED PATHOPHYSIOLOGIC MECHANISMS

    Science.gov (United States)

    CAZZO, Everton; GESTIC, Martinho Antonio; UTRINI, Murillo Pimentel; CHAIM, Felipe David Mendonça; GELONEZE, Bruno; PAREJA, José Carlos; CHAIM, Elinton Adami; MAGRO, Daniéla Oliveira

    2016-01-01

    ABSTRACT Introduction: Glucagon-like peptide-2 (GLP-2) is a gastrointestinal hormone whose effects are predominantly trophic on the intestinal mucosa. Aim: Critically evaluate the current literature on the influence of bariatric/metabolic surgery on the levels of GLP-2 and its potential clinical implications. Method s: Narrative review through online research on the databases Medline and Lilacs. There were six prospective human studies, two cross-sectional human studies, and three experimental animal studies selected. Results: There is evidence demonstrating significant increase in the levels of GLP-2 following gastric bypass, Scopinaro operation, and sleeve gastrectomy. There are no differences between gastric bypass and sleeve gastrectomy in regards to the increase in the GLP-2 levels. There is no correlation between the postoperative levels of GLP-2 and the occurrence of adequate or insufficient postoperative weight loss. Conclusion: GLP-2 plays significant roles on the regulation of nutrient absorption, permeability of gut mucosa, control of bone resorption, and regulation of satiety. The overall impact of these effects potentially exerts a significant adaptive or compensatory effect within the context of varied bariatric surgical techniques. PMID:28076485

  9. Video game addiction in emerging adulthood: Cross-sectional evidence of pathology in video game addicts as compared to matched healthy controls.

    Science.gov (United States)

    Stockdale, Laura; Coyne, Sarah M

    2018-01-01

    The Internet Gaming Disorder Scale (IGDS) is a widely used measure of video game addiction, a pathology affecting a small percentage of all people who play video games. Emerging adult males are significantly more likely to be video game addicts. Few researchers have examined how people who qualify as video game addicts based on the IGDS compared to matched controls based on age, gender, race, and marital status. The current study compared IGDS video game addicts to matched non-addicts in terms of their mental, physical, social-emotional health using self-report, survey methods. Addicts had poorer mental health and cognitive functioning including poorer impulse control and ADHD symptoms compared to controls. Additionally, addicts displayed increased emotional difficulties including increased depression and anxiety, felt more socially isolated, and were more likely to display internet pornography pathological use symptoms. Female video game addicts were at unique risk for negative outcomes. The sample for this study was undergraduate college students and self-report measures were used. Participants who met the IGDS criteria for video game addiction displayed poorer emotional, physical, mental, and social health, adding to the growing evidence that video game addictions are a valid phenomenon. Copyright © 2017 Elsevier B.V. All rights reserved.

  10. GLP-2: A POORLY UNDERSTOOD MEDIATOR ENROLLED IN VARIOUS BARIATRIC/METABOLIC SURGERY-RELATED PATHOPHYSIOLOGIC MECHANISMS.

    Science.gov (United States)

    Cazzo, Everton; Gestic, Martinho Antonio; Utrini, Murillo Pimentel; Chaim, Felipe David Mendonça; Geloneze, Bruno; Pareja, José Carlos; Chaim, Elinton Adami; Magro, Daniéla Oliveira

    2016-01-01

    Glucagon-like peptide-2 (GLP-2) is a gastrointestinal hormone whose effects are predominantly trophic on the intestinal mucosa. Critically evaluate the current literature on the influence of bariatric/metabolic surgery on the levels of GLP-2 and its potential clinical implications. s: Narrative review through online research on the databases Medline and Lilacs. There were six prospective human studies, two cross-sectional human studies, and three experimental animal studies selected. There is evidence demonstrating significant increase in the levels of GLP-2 following gastric bypass, Scopinaro operation, and sleeve gastrectomy. There are no differences between gastric bypass and sleeve gastrectomy in regards to the increase in the GLP-2 levels. There is no correlation between the postoperative levels of GLP-2 and the occurrence of adequate or insufficient postoperative weight loss. GLP-2 plays significant roles on the regulation of nutrient absorption, permeability of gut mucosa, control of bone resorption, and regulation of satiety. The overall impact of these effects potentially exerts a significant adaptive or compensatory effect within the context of varied bariatric surgical techniques. O peptídeo semelhante ao glucagon-2 (GLP-2) é hormônio gastrointestinal com efeitos predominantemente tróficos sobre a mucosa intestinal. Avaliar criticamente a literatura atual a respeito da cirurgia bariátrica/metabólica sobre os níveis de GLP-2 e suas potenciais implicações clínicas. Revisão narrativa realizada através de pesquisa on-line nas bases de dados Medline e LILACS. Foram selecionados seis estudos prospectivos em humanos, dois transversais em humanos e três experimentais em animais. Existem evidências demonstrando aumento significativo nos níveis de GLP-2 após o bypass gástrico, a operação de Scopinaro e a gastrectomia vertical. Não foram observadas diferenças entre o bypass gástrico e a gastrectomia vertical em relação ao aumento do GLP-2

  11. Posttraumatic stress disorder and anesthesia emergence.

    Science.gov (United States)

    Lovestrand, Donnamarie; Phipps, Steven; Lovestrand, Steven

    2013-06-01

    Emergence agitation or delirium is a known phenomenon in the postanesthesia period. The underlying cause is not definitively understood. In a U.S. Army hospital's postanesthesia care unit, combat-related posttraumatic stress disorder (PTSD) can complicate interventions. Scant evidence-based research exists on the issue. By presenting case studies of 2 patients who underwent different surgical procedures, the authors argue that traditional modalities to reorient and calm patients experiencing emergence agitation who have PTSD are not shown to be effective. The first procedure demonstrates outcomes in a situation handled through traditional interventions. The second procedure demonstrates outcomes after incorporation of evidence-driven interventions. The authors conclude that best practice includes a proper identification of patients at risk of emergence agitation, a minimally stimulating environment, intraoperative sympatholytic therapy, and patient and staff education. Although the case studies presented support these principles, research is needed to provide stronger evidence. Military medical and research personnel can take the lead on this issue and be a source for improved outcomes and high-quality patient care.

  12. Estratégia em negócios internacionais: evidência em uma trading company que atua entre economias emergentes International business strategy: evidence from a trading company that operates in emerging economies

    Directory of Open Access Journals (Sweden)

    Karim Marini Thomé

    2013-04-01

    economias emergentes foi identificado como a capacidade da firma em gerenciar as interfaces entre os recursos e capacidades da firma, as demandas de competitividade industrial e as condições e transições institucionais. Esta capacidade possibilitou à firma estudada se sobressair à dificuldade e a explorar oportunidades de negócios em diferentes partes do globo.This case study revisits the questions raised by Peng (2004; 2003 with respect to what drives firm strategy and the determinants of success or failure in international business. Specifically, the study investigates what drives the strategy of a trading company and determines its success in international business. The theoretical framework focuses on trading companies and the triangular relationships between these companies, their clients and their suppliers and on three approaches or bases of strategy in international business, those of industrial competitiveness, firm resources and capabilities, and institutional contexts and transitions. The study, descriptive and qualitative in nature, collected data by means of in-depth interviews, document analysis and non-participant observation during the period from July, 2010 to January, 2011. The firm selected for study is a trading company conducting a large percentage of its total transactions between emerging economies. Results demonstrate that there is no single driver of this trading company strategy. Rather, there was evidence of the use of a variety of strategies, driven at times by the demands of industrial competitiveness, at times by firm resources and capabilities, and at times by institutional conditions. Each driver corresponded to a specific moment in the trajectory of the trading company studied. In addition, there was no evidence neither of a linear chronological order for these drivers, nor of driver obsolescence. On the contrary, the evidence of the study suggests that drivers are cumulative and cyclical, requiring review and even re-thinking when

  13. Home is to be understood

    DEFF Research Database (Denmark)

    Buhl, Mie; Werner Hansen, Siv

    2018-01-01

    situation in Denmark is, as in many other countries at the moment, complex. On the one hand laws and regulations are concurrently tightened concerning residency permits, boarder control, and possession of belongings. On the other hand a nationwide humanitarian (non-political) network of citizens who have...... engages with the current societal issue of migration by instigating a co-creation experiment, which aims to convert the museum’s vision (defined by values such as ‘community’, ‘participation’, ‘responsibility’ and ‘change’) into practice. In particular, we address how the museum creates a space...... and visual ethnography (Pink, 2013; Rose, 2012) from the process of initiating and planning of the project and including visual material from the launch of the exhibition. References: Bishop, C. (2006). The Social turn: Collaboration and Its Discontents, Artforum http...

  14. How flares can be understood

    International Nuclear Information System (INIS)

    Severny, A.B.

    1977-01-01

    Specific features of the flare phenomenon which are important for understanding of flares are the following: (1) Fine structure of visible emission of flares, especially at the very beginning and in the pre-flare active region. This structure can be seen also in later stages of development as bright points, some of which exist from the flare beginning (Babin's observations at Crimea, 1972-1976). (2) Turbulent motion with velocities up to 250-300 km s -1 as can be estimated from broadening of emission lines. (3) Predominantly red asymmetry of emission lines in the explosive phase and during further development of flares. (4) 'Supersonic' velocities and supergravitational accelerations of separate moving masses of the flare plasma. (5) The appearance of flares in areas with high grad H, exceeding 0.1 G km -1 which is equivalent to regions of electric currents > approximately 10 11 A. (6) Strong variations of net magnetic flux through the active region, as it follows from Meudon, Crimean, and Sacramento Peak (Rust's) observations. (Auth.)

  15. Can delusions be understood linguistically?

    Science.gov (United States)

    Hinzen, Wolfram; Rosselló, Joana; McKenna, Peter

    2016-01-01

    ABSTRACT Delusions are widely believed to reflect disturbed cognitive function, but the nature of this remains elusive. The “un-Cartesian” cognitive-linguistic hypothesis maintains (a) that there is no thought separate from language, that is, there is no distinct mental space removed from language where “thinking” takes place; and (b) that a somewhat broadened concept of grammar is responsible for bestowing meaning on propositions, and this among other things gives them their quality of being true or false. It is argued that a loss of propositional meaning explains why delusions are false, impossible and sometimes fantastic. A closely related abnormality, failure of linguistic embedding, can additionally account for why delusions are held with fixed conviction and are not adequately justified by the patient. The un-Cartesian linguistic approach to delusions has points of contact with Frith’s theory that inability to form meta-representations underlies a range of schizophrenic symptoms. It may also be relevant to the nature of the “second factor” in monothematic delusions in neurological disease. Finally, it can inform the current debate about whether or not delusions really are beliefs. PMID:27322493

  16. We Have Not Understood Descartes.

    Science.gov (United States)

    Vallias, Andras

    1996-01-01

    Describes a personal involvement with digital media and the origins of the conception of the "diagrammatic" poem. Reflects on what is considered to be a poem in tune with today's computerized society. (PA)

  17. Characteristics of evidence-based medicine training in Royal College of Physicians and Surgeons of Canada emergency medicine residencies - a national survey of program directors.

    Science.gov (United States)

    Bednarczyk, Joseph; Pauls, Merril; Fridfinnson, Jason; Weldon, Erin

    2014-03-21

    Recent surveys suggest few emergency medicine (EM) training programs have formal evidence-based medicine (EBM) or journal club curricula. Our primary objective was to describe the methods of EBM training in Royal College of Physicians and Surgeons of Canada (RCPSC) EM residencies. Secondary objectives were to explore attitudes regarding current educational practices including e-learning, investigate barriers to journal club and EBM education, and assess the desire for national collaboration. A 16-question survey containing binary, open-ended, and 5-pt Likert scale questions was distributed to the 14 RCPSC-EM program directors. Proportions of respondents (%), median, and IQR are reported. The response rate was 93% (13/14). Most programs (85%) had established EBM curricula. Curricula content was delivered most frequently via journal club, with 62% of programs having 10 or more sessions annually. Less than half of journal clubs (46%) were led consistently by EBM experts. Four programs did not use a critical appraisal tool in their sessions (31%). Additional teaching formats included didactic and small group sessions, self-directed e-learning, EBM workshops, and library tutorials. 54% of programs operated educational websites with EBM resources. Program directors attributed highest importance to two core goals in EBM training curricula: critical appraisal of medical literature, and application of literature to patient care (85% rating 5 - "most importance", respectively). Podcasts, blogs, and online journal clubs were valued for EBM teaching roles including creating exposure to literature (4, IQR 1.5) and linking literature to clinical practice experience (4, IQR 1.5) (1-no merit, 5-strong merit). Five of thirteen respondents rated lack of expert leadership and trained faculty educators as potential limitations to EBM education. The majority of respondents supported the creation of a national unified EBM educational resource (4, IQR 1) (1-no support, 5- strongly

  18. Emergency surgery

    DEFF Research Database (Denmark)

    Stoneham, M; Murray, D; Foss, N

    2014-01-01

    undertaken on elderly patients with limited physiological reserve. National audits have reported variations in care quality, data that are increasingly being used to drive quality improvement through professional guidance. Given that the number of elderly patients presenting for emergency surgery is likely...... to rise as the population ages, this review summarises the evidence on which such guidance is based, and provides information about how anaesthetists might participate in audit and research aimed at improving local and national outcomes for these most vulnerable of patients....

  19. Coupling between stress coping style and time of emergence from spawning nests in salmonid fishes: Evidence from selected rainbow trout strains (Oncorhynchus mykiss)

    DEFF Research Database (Denmark)

    Andersson, Madelene Åberg; Khan, Uniza Wahid; Øverli, Øyvind

    2013-01-01

    /shyness, dominance, and metabolic rate; resembling those of proactive and reactive stress coping styles. In farmed fish populations, however the relation between emergence and stress coping styles seems to be absent, an effect which has been related to lack of selection pressure during emergence. In the present....... For this task LR and HR larvae were hatched in mixed batches, and thirty individuals from the earliest and latest 25% of emerging larvae were randomly collected. Thereafter, a line specific genetic marker was used to distinguish the proportion of LR and HR occurring in early and late fractions. The result...

  20. Eye Emergencies

    Science.gov (United States)

    ... The Marfan Foundation Marfan & Related Disorders What is Marfan Syndrome? What are Related Disorders? What are the Signs? ... Emergencies Eye Emergencies Lung Emergencies Surgeries Eye Emergencies Marfan syndrome significantly increases your risk of retinal detachment, a ...

  1. Physician follow-up and long-term use of evidence-based medication for patients with hypertension who were discharged from an emergency department: a prospective cohort study.

    Science.gov (United States)

    Atzema, Clare L; Yu, Bing; Schull, Michael J; Jackevicius, Cynthia A; Ivers, Noah M; Lee, Douglas S; Rochon, Paula; Austin, Peter C

    2018-04-03

    More than 25% of the population has hypertension. The number of patients seeking care for hypertension in emergency departments has increased by more than 60% in the last decade, with less than 10% of these patients subsequently admitted to hospital. Managing physicians recommend early follow-up to patients who are discharged from the emergency department, but there is a paucity of literature assessing the impact or timing of follow-up on patient outcomes. Using a population-based cohort design, we included patients more than 65 years of age who were discharged from an Ontario emergency department with a primary diagnosis of hypertension between 2007 and 2014. We identified 2 cohorts: an incident cohort, and a cohort in which patients were on no more than 1 class of evidence-based antihypertensive medication at the time of presentation. Using logistic regression, we assessed the association of early follow-up care (within 7 d) and basic care (8-30 d), compared with no care within 30 days, on patient use of a new evidence-based antihypertensive medication 1 year later. Our study included 2088 patients with a new diagnosis of hypertension (the first cohort), and 6420 patients in the second cohort. Of patients with new diagnoses, 48.2% and 30.2% obtained early and basic follow-up care, respectively, compared with 50.0% and 30.9% of patients in the second cohort. Compared with patients without follow-up care within 30 days, the adjusted odds of filling an evidence-based antihypertensive medication prescription 1 year later in the incident group were 2.36 (95% confidence interval [CI] 1.86-2.99) for those who received early care, and 2.00 (95% CI 1.55-2.58) for those who received basic care. The adjusted odds in the second cohort were 2.12 (95% CI 1.84-2.43) and 1.96 (95% CI 1.69-2.27), respectively. Early follow-up care after leaving an emergency department with a diagnosis of hypertension was associated with improved long-term use of evidence-based antihypertensive

  2. Male emergence schedule and dispersal behaviour are modified by mate availability in heterogeneous landscapes: evidence from the orange-tip butterfly

    Directory of Open Access Journals (Sweden)

    W James Davies

    2015-01-01

    Full Text Available Protandry (prior emergence of males in insect populations is usually considered to be the result of natural selection acting directly on eclosion timing. When females are monandrous (mate once, males in high density populations benefit from early emergence in the intense scramble competition for mates. In low density populations, however, scramble competition is reduced or absent, and theoretical models predict that protandry will be less favoured. This raises the question of how males behave in heterogeneous landscapes characterized by high density core populations in a low density continuum. We hypothesized that disadvantaged late emerging males in a core population would disperse to the continuum to find mates. We tested this idea using the protandrous, monandrous, pierid butterfly Anthocharis cardamines (the orange-tip in a core population in Cheshire, northwest England. Over a six-year period, predicted male fitness (the number of matings a male can expect during his residence time, determined by the daily ratio of virgin females to competing males consistently declined to <1 in late season. This decline affected a large proportion (∼44% of males in the population and was strongly associated with decreased male recapture-rates, which we attribute to dispersal to the surrounding continuum. In contrast, reanalysis of mark-release-recapture data from an isolated population in Durham, northeast England, showed that in the absence of a continuum very few males (∼3% emerged when fitness declined to <1 in late season. Hence the existence of a low density continuum may lead to the evolution of plastic dispersal behaviour in high density core populations, maintaining late emerging males which would otherwise be eliminated by selection. This has important theoretical consequences, since a truncated male emergence curve is a key prediction in game theoretic models of emergence timing which has so far received limited support. Our results have

  3. An Evidence-Based Alcohol Screening, Brief Intervention and Referral to Treatment (SBIRT) Curriculum for Emergency Department (ED) Providers Improves Skills and Utilization

    Science.gov (United States)

    Substance Abuse, 2007

    2007-01-01

    Objective: Emergency Departments (EDs) offer an opportunity to improve the care of patients with at-risk and dependent drinking by teaching staff to screen, perform brief intervention and refer to treatment (SBIRT). We describe here the implementation at 14 Academic EDs of a structured SBIRT curriculum to determine if this learning experience…

  4. On the night shift: advanced nurse practice in emergency medicine.

    Science.gov (United States)

    Jenkins, Jennifer

    2016-05-01

    Advanced nurse practitioners in the author's emergency department (ED) work autonomously and as part of a team to assess, diagnose and treat patients with unexplained and undiagnosed illnesses and injuries over a 24-hour cycle of care. The complexity of the role in EDs is often not fully understood, and expectations can vary between trusts and between different clinical areas within trusts. This article describes one night shift in the author's ED to explain the complexity of advanced nurse practitioners' roles in this environment. The article focuses on autonomous decision-making skills and the use of advanced clinical skills in the context of evidence-based practice.

  5. Appraising the influence of pro-environmental self-identity on sustainable consumption buying and curtailment in emerging markets: evidence from China and Poland

    OpenAIRE

    Dermody, Janine; Koenig-Lewis, Nicole; Zhao, Anita Lifen; Hanmer-Lloyd, Stuart

    2017-01-01

    Understanding sustainable consumption buying and curtailment behavior in emerging markets is limited, yet this knowledge is vital to the future of these economies. The newer conceptualization of pro-environmental self-identity (PESI), as environmentally-friendly dynamic-self, can significantly inform comprehension of these behaviors, and strengthen them. Utilizing intra-personal influences and situational cueing, this paper appraises the influence of PESI on the sustainable buying and curtail...

  6. Emergency contraception

    Science.gov (United States)

    ... the uterus CHOICES FOR EMERGENCY CONTRACEPTION Two emergency contraceptive pills may be bought without a prescription. Plan ... to provide ongoing birth control. MORE ABOUT EMERGENCY CONTRACEPTIVE PILLS Women of any age can buy Plan ...

  7. Lung Emergencies

    Science.gov (United States)

    ... The Marfan Foundation Marfan & Related Disorders What is Marfan Syndrome? What are Related Disorders? What are the Signs? ... Emergencies Lung Emergencies Surgeries Lung Emergencies People with Marfan syndrome can be at increased risk of sudden lung ...

  8. Sex-Specific Associations in Nutrition and Activity-Related Risk Factors for Chronic Disease: Australian Evidence from Childhood to Emerging Adulthood

    Directory of Open Access Journals (Sweden)

    Erin Hoare

    2018-01-01

    Full Text Available Global assessments of burden of disease suggests there are sex differences in risk factors for chronic disease, including overweight/obesity, dietary patterns and habitual physical activity. Given that prevention efforts aim to target such factors to reduce disease risk, the age at which sex differences may occur is of particular interest. Early life to young adulthood is the optimal time for intervention, with lifestyle habits typically forming during this period. This study aimed to identify the sex differences in risk factors for chronic disease during childhood (5–9 years, adolescence (10–17 years and emerging adulthood (18–25 years in a large population-representative Australian sample. Among children in this study (n = 739, no sex-related differences were observed. Among adolescents (n = 1304, females were more likely than males to meet daily fruit and vegetable recommendations (12.9% vs. 7.5%; OR = 1.84, 95% CI = 1.16, 2.93, p < 0.05. Among emerging adults (n = 909, females were less likely to be overweight/obese (30.1% vs. 39.8%; OR = 0.65, 95% CI = 0.44, 0.95, p < 0.05 and more likely to meet physical activity recommendations (52.1% vs. 42.3%; OR = 1.44, 95% CI = 1.01, 2.06, p < 0.05. These findings suggest that sex differences for risk factors of chronic disease occur during adolescence and emerging adulthood, although the differences are not consistent across age periods. From adolescence onwards, it appears that females exhibit lower risk factors than males and a life span approach to risk factor monitoring is warranted.

  9. Factors Associated with the Emergence of Highly Pathogenic Avian Influenza A (H5N1) Poultry Outbreaks in China: Evidence from an Epidemiological Investigation in Ningxia, 2012.

    Science.gov (United States)

    Liu, H; Zhou, X; Zhao, Y; Zheng, D; Wang, J; Wang, X; Castellan, D; Huang, B; Wang, Z; Soares Magalhães, R J

    2017-06-01

    In April 2012, highly pathogenic avian influenza virus of the H5N1 subtype (HPAIV H5N1) emerged in poultry layers in Ningxia. A retrospective case-control study was conducted to identify possible risk factors associated with the emergence of H5N1 infection and describe and quantify the spatial variation in H5N1 infection. A multivariable logistic regression model was used to identify risk factors significantly associated with the presence of infection; residual spatial variation in H5N1 risk unaccounted by the factors included in the multivariable model was investigated using a semivariogram. Our results indicate that HPAIV H5N1-infected farms were three times more likely to improperly dispose farm waste [adjusted OR = 0.37; 95% CI: 0.12-0.82] and five times more likely to have had visitors in their farm within the past month [adjusted OR = 5.47; 95% CI: 1.97-15.64] compared to H5N1-non-infected farms. The variables included in the final multivariable model accounted only 20% for the spatial clustering of H5N1 infection. The average size of a H5N1 cluster was 660 m. Bio-exclusion practices should be strengthened on poultry farms to prevent further emergence of H5N1 infection. For future poultry depopulation, operations should consider H5N1 disease clusters to be as large as 700 m. © 2015 Blackwell Verlag GmbH.

  10. Emergence in Dynamical Systems

    Directory of Open Access Journals (Sweden)

    John Collier

    2013-12-01

    Full Text Available Emergence is a term used in many contexts in current science; it has become fashionable. It has a traditional usage in philosophy that started in 1875 and was expanded by J. S. Mill (earlier, under a different term and C. D. Broad. It is this form of emergence that I am concerned with here. I distinguish it from uses like ‘computational emergence,’ which can be reduced to combinations of program steps, or its application to merely surprising new features that appear in complex combinations of parts. I will be concerned specifically with ontological emergence that has the logical properties required by Mill and Broad (though there might be some quibbling about the details of their views. I restrict myself to dynamical systems that are embodied in processes. Everything that we can interact with through sensation or action is either dynamical or can be understood in dynamical terms, so this covers all comprehensible forms of emergence in the strong (nonreducible sense I use. I will give general dynamical conditions that underlie the logical conditions traditionally assigned to emergence in nature.The advantage of this is that, though we cannot test logical conditions directly, we can test dynamical conditions. This gives us an empirical and realistic form of emergence, contrary those who say it is a matter of perspective.

  11. Historicism and Industry Emergence

    DEFF Research Database (Denmark)

    Kirsch, David; Moeen, Mahka; Wadhwani, Dan

    2014-01-01

    Management and organization scholars have increasingly turned to historical sources to examine the emergence and evolution of industries over time. This scholarship has typically used historical evidence as observations for testing theoretically relevant processes of industry emergence....... In this chapter, an alternative approach is explored that focuses on reconstructing causes and processes that time and theory have erased. The emergence of three industries—plant biotechnology, savings banking, and the automobile—shows how time, along with prevailing functional models of industry evolution, leads...... excluded phenomena and explanations, reconstructing uncertainty and alternative paths of industry emergence, and studying the processes of information elision and exclusion in the formation of industry knowledge....

  12. An evidence based alcohol screening, brief intervention and referral to treatment (SBIRT) curriculum for emergency department (ED) providers improves skills and utilization.

    Science.gov (United States)

    Bernstein, Edward; Bernstein, Judith; Feldman, James; Fernandez, William; Hagan, Melissa; Mitchell, Patricia; Safi, Clara; Woolard, Robert; Mello, Mike; Baird, Janette; Lee, Christina; Bazargan-Hejazi, Shahrzad; Broderick, Kerry; Laperrier, Kathryn A; Kellermann, Arthur; Wald, Marlena M; Taylor, Robert E; Walton, Kim; Grant-Ervin, Michelle; Rollinson, Denise; Edwards, David; Chan, Theodore; Davis, Dan; Buchanan Marshall, Jean; Aseltine, Robert; James, Amy; Schilling, Elizabeth; Abu-Hasaballah, Khamis; Baumann, Brigitte M; Boudreaux, Edwin D; Maio, Ronald F; Cunningham, Rebecca M; Murrell, Teresa; Doezema, David; Anglin, Deirdre; Eliassen, Adriana; Martin, Marcus; Pines, Jesse; Buchanan, Leslie; Turner, James; D'Onofrio, Gail; Degutis, Linda C; Owens, Patricia

    2007-01-01

    Emergency Departments (EDs) offer an opportunity to improve the care of patients with at-risk and dependent drinking by teaching staff to screen, perform brief intervention and refer to treatment (SBIRT). We describe here the implementation at 14 Academic EDs of a structured SBIRT curriculum to determine if this learning experience improves provider beliefs and practices. ED faculty, residents, nurses, physician extenders, social workers, and Emergency Medical Technicians (EMTs) were surveyed prior to participating in either a two hour interactive workshops with case simulations, or a web-based program (www.ed.bmc.org/sbirt). A pre-post repeated measures design assessed changes in provider beliefs and practices at three and 12 months post-exposure. Among 402 ED providers, 74% reported SBIRT skills all improved significantly over baseline. Gains decreased somewhat at 12 months, but remained above baseline. Length of time in practice was positively associated with SBIRT utilization, controlling for gender, race and type of profession. Persistent barriers included time limitations and lack of referral resources. ED providers respond favorably to SBIRT. Changes in utilization were substantial at three months post-exposure to a standardized curriculum, but less apparent after 12 months. Booster sessions, trained assistants and infrastructure supports may be needed to sustain changes over the longer term.

  13. Time to Amyloid Positivity and Preclinical Changes in Brain Metabolism, Atrophy, and Cognition: Evidence for Emerging Amyloid Pathology in Alzheimer's Disease

    Directory of Open Access Journals (Sweden)

    Philip S. Insel

    2017-05-01

    Full Text Available Background: Aβ pathology is associated with longitudinal changes of brain metabolism, atrophy, and cognition, in cognitively healthy elders. However, Aβ information is usually measured cross-sectionally and dichotomized to classify subjects as Aβ-positive or Aβ-negative, making it difficult to evaluate when brain and cognitive changes occur with respect to emerging Aβ pathology. In this study, we use longitudinal Aβ information to combine the level and rate of change of Aβ to estimate the time to Aβ-positivity for each subject and test this temporal proximity to significant Aβ pathology for associations with brain structure, metabolism, and cognition.Methods: In 89 cognitively healthy elders with up to 10 years of follow-up, we estimated the points at which rates of fluorodeoxyglucose (FDG PET, MRI, and cognitive and functional decline begin to accelerate with respect to the time to Aβ-positivity. Points of initial acceleration in rates of decline were estimated using mixed-effects models with penalized regression splines.Results: Acceleration of rates of FDG PET were observed to occur 20+ years before the conventional threshold for Aβ-positivity. Subtle signs of cognitive dysfunction were observed 10+ years before Aβ-positivity.Conclusions: Aβ may have subtle associations with other hallmarks of Alzheimer's disease before Aβ biomarkers reach conventional thresholds for Aβ-positivity. Therefore, we propose that emerging Aβ pathology occurs many years before cognitively healthy elders reach the current threshold for Aβ positivity (preclinical AD. To allow prevention in the earliest disease stages, AD clinical trials may be designed to also include subjects with Aβ biomarkers in the sub-threshold range.

  14. Childhood Emergencies

    Science.gov (United States)

    ... I Waiting So Long? Admission to the Hospital Heroes on Medicine's Front Line Observation Emergency Care Fact Sheet Health & Safety Tips Campaigns SUBSCRIBE Emergency 101 Share this! Home » Emergency 101 Childhood Emergencies Keeping children healthy and safe is every parent’s No. 1 ...

  15. A systematic review of management strategies for children's mental health care in the emergency department: update on evidence and recommendations for clinical practice and research.

    Science.gov (United States)

    Newton, Amanda S; Hartling, Lisa; Soleimani, Amir; Kirkland, Scott; Dyson, Michele P; Cappelli, Mario

    2017-06-01

    Children with mental health crises require access to specialised resources and services which are not yet standard in general and paediatric EDs. In 2010, we published a systematic review that provided some evidence to support the use of specialised care models to reduce hospitalisation, return ED visits and length of ED stay. We perform a systematic review to update the evidence base and inform current policy statements. Twelve databases and the grey literature were searched up to January 2015. Seven studies were included in the review (four newly identified studies). These studies compared ED-based strategies designed to assess, treat and/or therapeutically support or manage a mental health presentation. The methodological quality of six studies was assessed using the Cochrane Effective Practice and Organization of Care Risk of Bias tool (one interrupted time series study) and a modified Newcastle-Ottawa Scale (three retrospective cohort and two before-after studies). The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was applied to rate overall evidence quality (high, moderate, low or very low) for individual outcomes from these six studies. An additional study evaluated the psychometric properties of a clinical instrument and was assessed using criteria developed by the Society of Pediatric Psychology Assessment Task Force (well-established, approaching well-established or promising assessment). There is low to very low overall evidence quality that: (1) use of screening laboratory tests to medically clear mental health patients increases length of ED stay and costs, but does not increase the risk of clinical management or disposition change if not conducted; and (2) specialised models of ED care reduce lengths of ED stay, security man-hours and restraint orders. One mental health assessment tool of promising quality, the home, education, activities and peers, drugs and alcohol, suicidality, emotions and behaviour, discharge

  16. Towards evidence based emergency medicine: Best BETs from the Manchester Royal Infirmary. BET 2: Core stability versus conventional exercise for treating non-specific low back pain.

    Science.gov (United States)

    Davin, John; Callaghan, Michael

    2016-02-01

    A short cut review was carried out to establish whether core stability exercises are better than conventional exercise for treating non-specific low back pain. 6 papers were found of which 4 presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these best papers are tabulated. The clinical bottom line is the perception that a core stability rehabilitation programme will improve low back pain has not been proven. 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/

  17. Emerging Evidence for the Importance of Dietary Protein Source on Glucoregulatory Markers and Type 2 Diabetes: Different Effects of Dairy, Meat, Fish, Egg, and Plant Protein Foods

    Directory of Open Access Journals (Sweden)

    Kevin B. Comerford

    2016-07-01

    Full Text Available Observational studies provide evidence that a higher intake of protein from plant-based foods and certain animal-based foods is associated with a lower risk for type 2 diabetes. However, there are few distinguishable differences between the glucoregulatory qualities of the proteins in plant-based foods, and it is likely their numerous non-protein components (e.g., fibers and phytochemicals that drive the relationship with type 2 diabetes risk reduction. Conversely, the glucoregulatory qualities of the proteins in animal-based foods are extremely divergent, with a higher intake of certain animal-based protein foods showing negative effects, and others showing neutral or positive effects on type 2 diabetes risk. Among the various types of animal-based protein foods, a higher intake of dairy products (such as milk, yogurt, cheese and whey protein consistently shows a beneficial relationship with glucose regulation and/or type 2 diabetes risk reduction. Intervention studies provide evidence that dairy proteins have more potent effects on insulin and incretin secretion compared to other commonly consumed animal proteins. In addition to their protein components, such as insulinogenic amino acids and bioactive peptides, dairy products also contain a food matrix rich in calcium, magnesium, potassium, trans-palmitoleic fatty acids, and low-glycemic index sugars—all of which have been shown to have beneficial effects on aspects of glucose control, insulin secretion, insulin sensitivity and/or type 2 diabetes risk. Furthermore, fermentation and fortification of dairy products with probiotics and vitamin D may improve a dairy product’s glucoregulatory effects.

  18. Emerging Evidence for the Importance of Dietary Protein Source on Glucoregulatory Markers and Type 2 Diabetes: Different Effects of Dairy, Meat, Fish, Egg, and Plant Protein Foods

    Science.gov (United States)

    Comerford, Kevin B.; Pasin, Gonca

    2016-01-01

    Observational studies provide evidence that a higher intake of protein from plant-based foods and certain animal-based foods is associated with a lower risk for type 2 diabetes (T2DM). However, there are few distinguishable differences between the glucoregulatory qualities of the proteins in plant-based foods, and it is likely their numerous non-protein components (e.g., fibers and phytochemicals) that drive the relationship with T2DM risk reduction. Conversely, the glucoregulatory qualities of the proteins in animal-based foods are extremely divergent, with a higher intake of certain animal-based protein foods showing negative effects, and others showing neutral or positive effects on T2DM risk. Among the various types of animal-based protein foods, a higher intake of dairy products (such as milk, yogurt, cheese and whey protein) consistently shows a beneficial relationship with glucose regulation and/or T2DM risk reduction. Intervention studies provide evidence that dairy proteins have more potent effects on insulin and incretin secretion compared to other commonly consumed animal proteins. In addition to their protein components, such as insulinogenic amino acids and bioactive peptides, dairy products also contain a food matrix rich in calcium, magnesium, potassium, trans-palmitoleic fatty acids, and low-glycemic index sugars—all of which have been shown to have beneficial effects on aspects of glucose control, insulin secretion, insulin sensitivity and/or T2DM risk. Furthermore, fermentation and fortification of dairy products with probiotics and vitamin D may improve a dairy product’s glucoregulatory effects. PMID:27455320

  19. DOES BEVERAGE TYPE AND DRINKING CONTEXT MATTER IN AN ALCOHOL-RELATED INJURY? EVIDENCE FROM EMERGENCY DEPARTMENT PATIENTS IN LATIN AMERICA

    Science.gov (United States)

    Andreuccetti, Gabriel; Carvalho, Heraclito B.; Ye, Yu; Bond, Jason; Monteiro, Maristela; Borges, Guilherme; Cherpitel, Cheryl J.

    2014-01-01

    Background Previous studies have already substantiated alcohol’s causal role in injuries. Yet the role that alcoholic beverage preferences and the drinking context play in the risk for injury is still under-investigated. In this study a cross-national comparison of the association between alcohol and injury focusing on beverage type preference and the drinking context is reported. Methods Emergency department injured patients were interviewed in eight countries from the Latin American and Caribbean (LAC) region. Data on the type of alcoholic beverage, total alcohol volume, and the place where the injury occurred were obtained from patients who reported any alcohol consumption within 6 hours prior to being injured. Patients who did not drink prior to injury were also asked about their typical drinking pattern and the injury place. Differences within- and between-groups were evaluated regarding patients’ typical drinking and drinking before injury. Results Beer was the most prevalent beverage type usually consumed among injured patients across countries, however, patients who drank before injury had a higher typical consumption of spirits than those not drinking prior to injury. The total alcohol volume typically consumed and drinking in public settings were also found to be positively associated with alcohol-related injury. Conclusions A similar beverage-specific association with alcohol-related injury was found across LAC countries, mainly attributed to beer consumption, and spirits drinkers seem to have a greater chance of becoming involved in injury events. Future prevention strategies should inform the public about harms from drinking associated with the context in which drinking takes place. PMID:24556276

  20. Genome-Wide Analysis Provides Evidence on the Genetic Relatedness of the Emergent Xylella fastidiosa Genotype in Italy to Isolates from Central America.

    Science.gov (United States)

    Giampetruzzi, Annalisa; Saponari, Maria; Loconsole, Giuliana; Boscia, Donato; Savino, Vito Nicola; Almeida, Rodrigo P P; Zicca, Stefania; Landa, Blanca B; Chacón-Diaz, Carlos; Saldarelli, Pasquale

    2017-07-01

    Xylella fastidiosa is a plant-pathogenic bacterium recently introduced in Europe that is causing decline in olive trees in the South of Italy. Genetic studies have consistently shown that the bacterial genotype recovered from infected olive trees belongs to the sequence type ST53 within subspecies pauca. This genotype, ST53, has also been reported to occur in Costa Rica. The ancestry of ST53 was recently clarified, showing it contains alleles that are monophyletic with those of subsp. pauca in South America. To more robustly determine the phylogenetic placement of ST53 within X. fastidiosa, we performed a comparative analysis based on single nucleotide polymorphisms (SNPs) and the study of the pan-genome of the 27 currently public available whole genome sequences of X. fastidiosa. The resulting maximum-parsimony and maximum likelihood trees constructed using the SNPs and the pan-genome analysis are consistent with previously described X. fastidiosa taxonomy, distinguishing the subsp. fastidiosa, multiplex, pauca, sandyi, and morus. Within the subsp. pauca, the Italian and three Costa Rican isolates, all belonging to ST53, formed a compact phylotype in a clade divergent from the South American pauca isolates, also distinct from the recently described coffee isolate CFBP8072 imported into Europe from Ecuador. These findings were also supported by the gene characterization of a conjugative plasmid shared by all the four ST53 isolates. Furthermore, isolates of the ST53 clade possess an exclusive locus encoding a putative ATP-binding protein belonging to the family of histidine kinase-like ATPase gene, which is not present in isolates from the subspecies multiplex, sandyi, and pauca, but was detected in ST21 isolates of the subspecies fastidiosa from Costa Rica. The clustering and distinctiveness of the ST53 isolates supports the hypothesis of their common origin, and the limited genetic diversity among these isolates suggests this is an emerging clade within subsp

  1. British Muslims and the UK government's 'war on terror' within: evidence of a clash of civilizations or emergent de-civilizing processes?

    Science.gov (United States)

    Vertigans, Stephen

    2010-03-01

    In the immediate aftermath of the September 2001 attacks on America, defending civilization was quickly established at the core of the 'war on terror'. Unintentionally or otherwise this incorporation of civilization connected with Samuel Huntington's 'Clash of Civilizations' thesis. Within the 'war on terror' the dark side of counterterrorism has become apparent through international practices like extrajudicial killing, extraordinary rendition and torture. The impact of Western governments' policies upon their indigenous Muslim populations has also been problematic but social and political analysis has been relatively limited. This paper seeks to help address the scarcity of sociological contributions. Hidden costs of the UK government's attempts to utilize violence and enhance social constraints within the nation-state are identified. It is argued that although counterterrorism strategies are contributing to a self-fulfilling spiral of hatred that could be considered evidence in support of the 'Clash of Civilizations', the thesis is unhelpful when trying to grasp the underlying processes. Instead the paper draws upon Norbert Elias's application of the concepts of 'civilizing' and 'de-civilizing' to help improve levels of understanding about the processes and consequences of particular Muslim communities being targeted by security forces. The paper concludes with an exploration of the majority of the population's acquiescence and willingness to accept restraints upon Muslims in order to safeguard their own security.

  2. Emergency Contraception

    Science.gov (United States)

    ... to a doctor to have an IUD inserted. Emergency contraceptive pills can be very effective if they are ... use. Some women feel nauseous after they take emergency contraceptive pills. This feeling should go away in about ...

  3. Emergency Checklist

    Science.gov (United States)

    ... Week National Prescription Drug Take-Back Day Emergency Checklist If someone may have been poisoned, call the ... visit to the emergency room. Below is a checklist to help you in the event of a ...

  4. Importance of Internet surveillance in public health emergency control and prevention: evidence from a digital epidemiologic study during avian influenza A H7N9 outbreaks.

    Science.gov (United States)

    Gu, Hua; Chen, Bin; Zhu, Honghong; Jiang, Tao; Wang, Xinyi; Chen, Lei; Jiang, Zhenggang; Zheng, Dawei; Jiang, Jianmin

    2014-01-17

    ; collection of public opinion and reaction; and clarification, prevention, and control of rumors. Internet surveillance can be used as an efficient and economical tool to prevent and control public health emergencies, such as H7N9 outbreaks.

  5. Synaptic clustering within dendrites: an emerging theory of memory formation.

    Science.gov (United States)

    Kastellakis, George; Cai, Denise J; Mednick, Sara C; Silva, Alcino J; Poirazi, Panayiota

    2015-03-01

    It is generally accepted that complex memories are stored in distributed representations throughout the brain, however the mechanisms underlying these representations are not understood. Here, we review recent findings regarding the subcellular mechanisms implicated in memory formation, which provide evidence for a dendrite-centered theory of memory. Plasticity-related phenomena which affect synaptic properties, such as synaptic tagging and capture, synaptic clustering, branch strength potentiation and spinogenesis provide the foundation for a model of memory storage that relies heavily on processes operating at the dendrite level. The emerging picture suggests that clusters of functionally related synapses may serve as key computational and memory storage units in the brain. We discuss both experimental evidence and theoretical models that support this hypothesis and explore its advantages for neuronal function. Copyright © 2015 Elsevier Ltd. All rights reserved.

  6. Emergent Expertise?

    Science.gov (United States)

    McGivern, Patrick

    2014-01-01

    The concept of emergence appears in various places within the literature on expertise and expert practice. Here, I examine some of these applications of emergence in the light of two prominent accounts of emergence from the philosophy of science and philosophy of mind. I evaluate these accounts with respect to several specific contexts in which…

  7. An Inverse Problem Study: Credit Risk Ratings as a Determinant of Corporate Governance and Capital Structure in Emerging Markets: Evidence from Chinese Listed Companies

    Directory of Open Access Journals (Sweden)

    ManYing Kang

    2017-11-01

    Full Text Available Credit risk rating is shown to be a relevant determinant in order to estimate good corporate governance and to self-optimize capital structure. The conclusion is argued from a study on a selected (and justified sample of (182 companies listed on the Shanghai Stock Exchange (SHSE and the Shenzhen Stock Exchange (SZSE and which use the same Shanghai Brilliance Credit Rating & Investors Service Company (SBCR assessment criteria, for their credit ratings, from 2010 to 2015. Practically, 3 debt ratios are examined in terms of 11 characteristic variables. Moreover, any relationship between credit rating and corporate governance can be thought to be an interesting finding. The relationship we find between credit rating and leverage is not as evident as that found by other researchers for different countries; it is significantly positively related to the outside director, firm size, tangible assets and firm age, and CEO and chairman office plurality. However, leverage is found to be negatively correlated with board size, profitability, growth opportunity, and non-debt tax shield. Credit rating is positively associated with leverage, but in a less significant way. CEO-Board chairship duality is insignificantly related to leverage. The non-debt tax shield is significantly correlated with leverage. The correlation coefficient between CEO duality and auditor is positive but weakly significant, but seems not consistent with expectations. Finally, profitability cause could be regarded as an interesting finding. Indeed, there is an inverse correlation between profitability and total debt (Notice that the result supports the pecking order theory. In conclusion, it appears that credit rating has less effect on the so listed large Chinese companies than in other countries. Nevertheless, the perspective of assessing credit risk rating by relevant agencies is indubitably a recommended time dependent leverage determinant.

  8. When the rule becomes the exception. no evidence of gene flow between two Zerynthia cryptic butterflies suggests the emergence of a new model group.

    Science.gov (United States)

    Zinetti, Francesca; Dapporto, Leonardo; Vovlas, Alessio; Chelazzi, Guido; Bonelli, Simona; Balletto, Emilio; Ciofi, Claudio

    2013-01-01

    There is increasing evidence that most parapatric cryptic/sister taxa are reproductively compatible across their areas of contact. Consequently, the biological species concept, which assumes absence of interbreeding, is becoming a not so effective criterion in evolutionary ecology. Nevertheless, the few parapatric sister taxa showing complete reproductive barriers represent interesting models to study speciation processes and the evolution of reproductive isolation. In this study, we examined contact populations in northwestern Italy of two butterfly species, Zerynthia polyxena and Z. cassandra, characterized by different genitalic morphotypes. We studied levels of divergence among 21 populations distributed from Sicily to France using three genetic markers (the mitochondrial COI and ND1 genes and the nuclear wingless gene) and genitalic geometric morphometrics. Moreover, we performed species distribution modelling to estimate different climatic requirements of Z. polyxena and Z. cassandra. We projected climatic data into glacial maximum scenarios in order to verify if and to which extent glacial cycles could have contributed to speciation processes. Genetic and morphometric analyses identified two main groups. All specimens showed a concordant pattern of diversification, including those individuals sampled in the contact area. Haplotype distribution and climatic models showed that during glacial maxima both species experienced a strong range contraction and presumably remained separated into different microrefugia in southern France, in the Italian Peninsula and on the islands of Elba and Sicily. Long term separation was probably favoured by reduced dispersal ability and high phylopatry, while genitalic diversification probably favoured interbreeding avoidance. Conversely, the aposematic wing pattern remained almost identical. We compared our results with those obtained in other species and concluded that Z. polyxena and Z. cassandra represent a valuable model in

  9. Emerging infectious disease or evidence of endemicity? A multi-season study of beak and feather disease virus in wild red-crowned parakeets (Cyanoramphus novaezelandiae).

    Science.gov (United States)

    Jackson, Bethany; Varsani, Arvind; Holyoake, Carly; Jakob-Hoff, Richard; Robertson, Ian; McInnes, Kate; Empson, Raewyn; Gray, Richard; Nakagawa, Kahori; Warren, Kristin

    2015-09-01

    Beak and feather disease virus (BFDV) is a single-stranded DNA virus that is the etiological agent of beak and feather disease in both wild and captive parrots. Given that BFDV is globally recognized as a conservation threat for wild parrots, between 2011-2013, red-crowned parakeets (Cyanoramphus novaezelandiae, n = 229), which are endemic to New Zealand, were captured in mist nets on Tiritiri Matangi Island and Hauturu-o-Toi/Little Barrier Island (LBI), New Zealand, for disease surveillance. Blood and feathers from all birds were tested by PCR for BFDV, and full genomes were recovered and sequenced. A subset of blood samples (n = 96) were tested for antibodies to BFDV by the haemagglutination inhibition (HI) test. A further 238 feather samples were obtained from red-crowned parakeets from three sites in the Wellington region of the North Island, and these were screened for BFDV. The DNA-based prevalence of BFDV infection determined on Tiritiri Matangi Island was 1.09% (CI 95 %, 0.1-3.9%); on Hauturu-o-Toi/LBI, 4.4% (95% CI, 0.5%-15.1%); on Kapiti Island, 3.4% (CI 95%, 1.1-7.8%); at the ZEALANDIA-Karori sanctuary, 1.6% (95% CI, 0-8.4%); and on Matiu-Somes Island, 0% (CI 95%, 0-12.3%). Seroprevalence for BFDV, indicating prior or current exposure, in the Tiritiri Matangi Island population, it was 2% (CI 95%, 0-10.1%), and in the Hauturu-o-Toi/LBI population was 14% (CI 95%, 5.3-27.9%). BFDV-positive birds showed no signs of clinical disease, with the exception of an individual bird obtained opportunistically from Shakespear Regional Park during the study period, which had classical signs of feather loss. Phylogenetic analysis of the 11 full genome sequences recovered from BFDV-positive red-crowned parakeets revealed evidence of ongoing viral flow between red-crowned parakeets and eastern rosellas (Platycercus eximius) in the Hauraki Gulf/Auckland region, with separate but closely related strains from the Wellington region of the North Island. This is the first study

  10. Emergent Gravity and the Dark Universe

    Directory of Open Access Journals (Sweden)

    Erik P. Verlinde

    2017-05-01

    Full Text Available Recent theoretical progress indicates that spacetime and gravity emerge together from the entanglement structure of an underlying microscopic theory. These ideas are best understood in Anti-de Sitter space, where they rely on the area law for entanglement entropy. The extension to de Sitter space requires taking into account the entropy and temperature associated with the cosmological horizon. Using insights from string theory, black hole physics and quantum information theory we argue that the positive dark energy leads to a thermal volume law contribution to the entropy that overtakes the area law precisely at the cosmological horizon. Due to the competition between area and volume law entanglement the microscopic de Sitter states do not thermalise at sub-Hubble scales: they exhibit memory effects in the form of an entropy displacement caused by matter. The emergent laws of gravity contain an additional 'dark' gravitational force describing the 'elastic' response due to the entropy displacement. We derive an estimate of the strength of this extra force in terms of the baryonic mass, Newton's constant and the Hubble acceleration scale a_0 =cH_0, and provide evidence for the fact that this additional `dark gravity~force' explains the observed phenomena in galaxies and clusters currently attributed to dark matter.

  11. Dental Emergencies

    OpenAIRE

    Pedersen, Marke

    1982-01-01

    Emergency dental problems can result from trauma, dental pathology, or from dental treatment itself. While the physician can treat many instances of dental trauma, the patient should see a dentist as soon as possible so that teeth can be saved. Emergency treatment of dental pathology usually involves relief of pain and/or swelling. Bleeding is the most frequent post-treatment emergency. The physician should be able to make the patient comfortable until definitive dental treatment can be avail...

  12. Reproductive emergencies.

    Science.gov (United States)

    Jutkowitz, L Ari

    2005-03-01

    The emergency clinician is frequently called on to manage problems relating to the female reproductive tract. Because owners sel-dom have the medical knowledge needed to differentiate normal from abnormal reproductive behaviors, they frequently look to the emergency veterinarian for guidance and information during and after parturition. For this reason, it is essential that the veterinarian have a good understanding of the normal reproductive cycle as well as the common emergencies that may occur. This article reviews the events surrounding normal parturition in the dog and cat and the reproductive emergencies seen most commonly in practice.

  13. Priorities for emergency department syncope research

    NARCIS (Netherlands)

    Sun, Benjamin C.; Costantino, Giorgio; Barbic, Franca; Bossi, Ilaria; Casazza, Giovanni; Dipaola, Franca; McDermott, Daniel; Quinn, James; Reed, Matthew; Sheldon, Robert S.; Solbiati, Monica; Thiruganasambandamoorthy, Venkatesh; Krahn, Andrew D.; Beach, Daniel; Bodemer, Nicolai; Brignole, Michele; Casagranda, Ivo; Duca, Piergiorgio; Falavigna, Greta; Ippoliti, Roberto; Montano, Nicola; Olshansky, Brian; Raj, Satish R.; Ruwald, Martin H.; Shen, Win-Kuang; Stiell, Ian; Ungar, Andrea; van Dijk, J. Gert; van Dijk, Nynke; Wieling, Wouter; Furlan, Raffaello

    2014-01-01

    There is limited evidence to guide the emergency department (ED) evaluation and management of syncope. The First International Workshop on Syncope Risk Stratification in the Emergency Department identified key research questions and methodological standards essential to advancing the science of

  14. Disentangling the Emerging Evidence around Atypical Fractures

    DEFF Research Database (Denmark)

    Abrahamsen, Bo; Clark, Emma M

    2012-01-01

    to radiology reports. The interests of the patients are probably best served by reserving long-term bisphosphonate treatment for patients who are at the highest risk of osteoporotic fractures and considering drug holidays after 5 years in patients at low risk. Recent studies have further strengthened the case...

  15. Nutraceuticals as natural healers: Emerging evidences

    African Journals Online (AJOL)

    STORAGESEVER

    2009-03-20

    Mar 20, 2009 ... chemopreventive benefits of dietary fibers against colon cancer. Nutritional Labeling and Education Act (NLEA) in. 1990 has triggered the productivity of processed and semiprocessed nutraceutical foods. ... functional properties as the emulsifying, foaming, gelling and water absorption, are competent ...

  16. Dollarization in emerging markets: evidence from Georgia

    Czech Academy of Sciences Publication Activity Database

    Loiseau-Aslanidi, Olga

    2012-01-01

    Roč. 48, č. 3 (2012), s. 70-84 ISSN 1540-496X Grant - others:UK(CZ) GAUK 259027 Institutional support: PRVOUK-P23 Keywords : dollarization * Georgia * money-in-utility function Subject RIV: AH - Economics Impact factor: 1.190, year: 2012

  17. Studying Emerge

    DEFF Research Database (Denmark)

    Davies, Sarah Rachael; Selin, Cynthia; Rodegher, Sandra

    2015-01-01

    The Emerge event, held in Tempe, AZ in March 2012, brought together a range of scientists, artists, futurists, engineers and students in order to experiment with innovative methods for thinking about the future. These methodological techniques were tested through nine workshops, each of which made...... use of a different format; Emerge as a whole, then, offered an opportunity to study a diverse set of future-oriented engagement practices. We conducted an event ethnography, in which a team of 11 researchers collaboratively developed accounts of the practices at play within Emerge and its workshops...

  18. Pressure-induced emergence of unusually high-frequency transverse excitations in a liquid alkali metal: Evidence of two types of collective excitations contributing to the transverse dynamics at high pressures

    Energy Technology Data Exchange (ETDEWEB)

    Bryk, Taras [Institute for Condensed Matter Physics of the National Academy of Sciences of Ukraine, 1 Svientsitskii Street, UA-79011 Lviv (Ukraine); Lviv Polytechnic National University, 12 S. Bandera Street, UA-79013 Lviv (Ukraine); Ruocco, G. [Dipartimento di Fisica, Universita di Roma La Sapienza, 5 Piazzale Aldo Moro, I-00185 Roma (Italy); Center for Life Nano Science @Sapienza, Istituto Italiano di Tecnologia, 295 Viale Regina Elena, I-00161 Roma (Italy); Scopigno, T. [Dipartimento di Fisica, Universita di Roma La Sapienza, 5 Piazzale Aldo Moro, I-00185 Roma (Italy); IPCF-CNR, c/o Universita di Roma La Sapienza, 5 Piazzale Aldo Moro, I-00185 Roma (Italy); Seitsonen, Ari P. [Département de Chimie, Université de Zurich, Winterthurerstrasse 190, CH-8057 Zürich (Switzerland); Département de Chimie, École Normale Supérieure, 24 rue Lhomond, F-75005 Paris (France)

    2015-09-14

    Unlike phonons in crystals, the collective excitations in liquids cannot be treated as propagation of harmonic displacements of atoms around stable local energy minima. The viscoelasticity of liquids, reflected in transition from the adiabatic to elastic high-frequency speed of sound and in absence of the long-wavelength transverse excitations, results in dispersions of longitudinal (L) and transverse (T) collective excitations essentially different from the typical phonon ones. Practically, nothing is known about the effect of high pressure on the dispersion of collective excitations in liquids, which causes strong changes in liquid structure. Here dispersions of L and T collective excitations in liquid Li in the range of pressures up to 186 GPa were studied by ab initio simulations. Two methodologies for dispersion calculations were used: direct estimation from the peak positions of the L/T current spectral functions and simulation-based calculations of wavenumber-dependent collective eigenmodes. It is found that at ambient pressure, the longitudinal and transverse dynamics are well separated, while at high pressures, the transverse current spectral functions, density of vibrational states, and dispersions of collective excitations yield evidence of two types of propagating modes that contribute strongly to transverse dynamics. Emergence of the unusually high-frequency transverse modes gives evidence of the breakdown of a regular viscoelastic theory of transverse dynamics, which is based on coupling of a single transverse propagating mode with shear relaxation. The explanation of the observed high-frequency shift above the viscoelastic value is given by the presence of another branch of collective excitations. With the pressure increasing, coupling between the two types of collective excitations is rationalized within a proposed extended viscoelastic model of transverse dynamics.

  19. Heat emergencies

    Science.gov (United States)

    ... directly) to the person's skin and use a fan to lower body temperature. Place cold compresses on ... RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice . 9th ed. Philadelphia, PA: Elsevier; ...

  20. Ear emergencies

    Science.gov (United States)

    ... from an explosion, blow to the head, flying, scuba diving, falling while water skiing, or being slapped on ... Byyny RL, Shockley LW. Scuba diving and dysbarism. In: Marx JA, ... Rosen's Emergency Medicine: Concepts and Clinical Practice . 8th ...

  1. EMERGENCY TRIAGE

    OpenAIRE

    Renata Rajapakse

    2015-01-01

    This paper describes emergency triage. It presents the reasons for implementation of triage and its benefits. Focuses on the Manchester triage system, which is formally validated triage model in Slovenia.

  2. Emergent emotion

    OpenAIRE

    O'Connell, Elaine Finbarr

    2016-01-01

    I argue that emotion is an ontologically emergent and sui generis. I argue that emotion meets both of two individually necessary and jointly sufficient conditions for ontological emergence. These are, (i) that emotion necessarily has constituent parts to which it cannot be reduced, and (ii) that emotion has a causal effect on its constituent parts (i.e. emotion demonstrates downward causation).\\ud \\ud I argue that emotion is partly cognitive, partly constituted by feelings and partly perceptu...

  3. 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.

  4. Emerging images

    KAUST Repository

    Mitra, Niloy J.

    2009-01-01

    Emergence refers to the unique human ability to aggregate information from seemingly meaningless pieces, and to perceive a whole that is meaningful. This special skill of humans can constitute an effective scheme to tell humans and machines apart. This paper presents a synthesis technique to generate images of 3D objects that are detectable by humans, but difficult for an automatic algorithm to recognize. The technique allows generating an infinite number of images with emerging figures. Our algorithm is designed so that locally the synthesized images divulge little useful information or cues to assist any segmentation or recognition procedure. Therefore, as we demonstrate, computer vision algorithms are incapable of effectively processing such images. However, when a human observer is presented with an emergence image, synthesized using an object she is familiar with, the figure emerges when observed as a whole. We can control the difficulty level of perceiving the emergence effect through a limited set of parameters. A procedure that synthesizes emergence images can be an effective tool for exploring and understanding the factors affecting computer vision techniques. © 2009 ACM.

  5. EMERGENCY CALLS

    CERN Multimedia

    2001-01-01

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

  6. Anorectal emergencies

    Science.gov (United States)

    Lohsiriwat, Varut

    2016-01-01

    Anorectal emergencies refer to anorectal disorders presenting with some alarming symptoms such as acute anal pain and bleeding which might require an immediate management. This article deals with the diagnosis and management of common anorectal emergencies such as acutely thrombosed external hemorrhoid, thrombosed or strangulated internal hemorrhoid, bleeding hemorrhoid, bleeding anorectal varices, anal fissure, irreducible or strangulated rectal prolapse, anorectal abscess, perineal necrotizing fasciitis (Fournier gangrene), retained anorectal foreign bodies and obstructing rectal cancer. Sexually transmitted diseases as anorectal non-surgical emergencies and some anorectal emergencies in neonates are also discussed. The last part of this review dedicates to the management of early complications following common anorectal procedures that may present as an emergency including acute urinary retention, bleeding, fecal impaction and anorectal sepsis. Although many of anorectal disorders presenting in an emergency setting are not life-threatening and may be successfully treated in an outpatient clinic, an accurate diagnosis and proper management remains a challenging problem for clinicians. A detailed history taking and a careful physical examination, including digital rectal examination and anoscopy, is essential for correct diagnosis and plan of treatment. In some cases, some imaging examinations, such as endoanal ultrasonography and computerized tomography scan of whole abdomen, are required. If in doubt, the attending physicians should not hesitate to consult an expert e.g., colorectal surgeon about the diagnosis, proper management and appropriate follow-up. PMID:27468181

  7. Dental Emergencies: Management Strategies That Improve Outcomes [Digest].

    Science.gov (United States)

    Pedigo, Ryan Anthony; Zaurova, Milana

    2017-06-22

    Points & Pearls is a digest of Emergency Medicine Practice . Acute dental emergencies are a common chief complaint presenting to emergency departments, and they are increasing substantially in frequency. The diagnosis and management of dental emergencies is a core competency of the emergency clinician, and proper therapeutic strategies can significantly improve cosmetic and functional outcomes for patients. This issue provides a systematic review of the literature on common acute traumatic and atraumatic dental emergencies with a focus on the historical and physical examination findings that must be understood to identify life-threatening infections, relieve pain, salvage natural teeth, and communicate with specialists in the further management of patients after emergency treatment.

  8. Emerging Options for Emergency Contraception

    OpenAIRE

    Atsuko Koyama; Laura Hagopian; Judith Linden

    2013-01-01

    Emergency post-coital contraception (EC) is an effective method of preventing pregnancy when used appropriately. EC has been available since the 1970s, and its availability and use have become widespread. Options for EC are broad and include the copper intrauterine device (IUD) and emergency contraceptive pills such as levonorgestrel, ulipristal acetate, combined oral contraceptive pills (Yuzpe method), and less commonly, mifepristone. Some options are available over-the-counter, while others...

  9. Hematologic emergencies

    Directory of Open Access Journals (Sweden)

    Daniele Vallisa

    2012-01-01

    Full Text Available In recent years, the surprising progress made in other areas of hematology (advances in the understanding of leukemogenesis, improved transplant techniques has been conspicuously absent in the management of hematologic emergencies. And yet, every step toward greater knowledge, every new treatment option will be of little value unless we are able to manage the acute complications of hematologic diseases. These complications are better defined as hematologic emergencies, and they are characterized by a high rate of mortality. This review is based on a search of the literature that was initially confined to articles published in the journal Hematology from 2000 to 2009. The search was then extended to the Cochrane Library and to Pub Med in February 2010 with the following Keywords emergencies; urgencies; hematology. The same key words were employed in a search of the archives of Blood and the New England Journal of Medicine from 2000 to 2010. The results confirm that hematologic emergencies can be caused by hematologic malignancies as well as by non-neoplastic hematologic diseases. Within the former category; this review examines the causes; manifestations; treatment and prevention of disseminated intravascular coagulation; superior vena caval syndrome; spinal cord compression; tumor lysis syndrome; hyperleukocytosis; and hypercalcemia. We also review emergency situations associated with non-neoplatic haematological diseases; such as thrombotic thrombocytopenic purpura; drug-induced hemolytic anemia; and acute sickle-cell crisis.

  10. Emergency neuroradiology

    International Nuclear Information System (INIS)

    Scarabino, T.; Hospital of Andria; Salvolini, U.; Jinkins, J.R.

    2006-01-01

    The book is directed at emergency radiologists and neuroradiologists. It aims at providing exhaustive information that will help the reader understand the clinical problems in the full range of neurological emergencies and to select the methodological and technical options that will ensure prompt and effective response and correct interpretation of the clinical findings. The various chapters address the most common neuroradiological emergencies, summarize their fundamental physiopathological features, describe the main semiological and differential diagnostic features, and provide operative suggestions for the selection of the appropriate techniques to be applied in a sequential order. The book addresses the application of state-of-the-art techniques and their implications for clinical practice (particularly the contributions of standard and functional MRI and of spiral and multislice CT). The illustrations provide not only training but also reference material for routine clinical work. (orig.)

  11. Emergency situations

    International Nuclear Information System (INIS)

    2007-01-01

    The nuclear activities are exercised so as to prevent the accidents. They are subjected to a rule whom application is controlled by the Asn. The risk of grave accident is so limited to a very low level of probability. He cannot be however completely pushed aside. The expression ' radiological emergency situation ' indicates a situation which ensues from an incident or of an accident risking to lead to an emission of radioactive materials or a level of radioactivity susceptible to strike a blow at the public health. The term ' nuclear crisis ' is used for the events which can lead to a radiological emergency situation on a nuclear basic installation or during a transport of radioactive materials. The preparation and the management of emergency situations, that they are of natural, accidental or terrorist origin, became a major concern of our society. We propose you of to know more about it in this file. (N.C.)

  12. Emergency neuroradiology

    Energy Technology Data Exchange (ETDEWEB)

    Scarabino, T. [Scientific Inst. ' Casa Sollievo della Sofferenza' , San Giovanni Rotondo (Italy). Dept. of Neuroradiology]|[Hospital of Andria (Italy). Dept. of Radiology, ASL BA/1; Salvolini, U. [Ancona Univ. (Italy). Neuroradiology and Dept. of Radiology; Jinkins, J.R. (eds.) [New York State Univ., Brooklyn, NY (United States). Dept. of Radiology, Downstate Medical Center

    2006-07-01

    The book is directed at emergency radiologists and neuroradiologists. It aims at providing exhaustive information that will help the reader understand the clinical problems in the full range of neurological emergencies and to select the methodological and technical options that will ensure prompt and effective response and correct interpretation of the clinical findings. The various chapters address the most common neuroradiological emergencies, summarize their fundamental physiopathological features, describe the main semiological and differential diagnostic features, and provide operative suggestions for the selection of the appropriate techniques to be applied in a sequential order. The book addresses the application of state-of-the-art techniques and their implications for clinical practice (particularly the contributions of standard and functional MRI and of spiral and multislice CT). The illustrations provide not only training but also reference material for routine clinical work. (orig.)

  13. [Medical emergency teams

    DEFF Research Database (Denmark)

    Bunkenborg, G.; Lund, C.; Petersen, John Asger

    2008-01-01

    The aim of medical emergency teams (MET) is to identify and treat deteriorating patients on general wards, and to avoid cardiac arrest, unplanned intensive care unit admission and death. The effectiveness of METs has yet to be proven, as the only two randomised, controlled trials on the subject...... show conflicting results. Despite the lack of evidence, METs are gaining popularity and are being implemented in Danish hospitals as part of Operation Life Udgivelsesdato: 2008/8/25...

  14. EMERGENCY CONTRACEPTION

    Directory of Open Access Journals (Sweden)

    Dragana Pantić

    2007-10-01

    Full Text Available Emergency contraception refers to any device or drug that is used as an emergency procedure to prevent pregnancy after unprotected sexual intercourse.The first method of emergency contraception was high dose of estrogen. Concern about side effects led to subsequent development of the so-called Yuzpe regimen which combined ethinil estradiol with levonorgestrel and levonorgestrel alone. Less convenient to use is the copper intauterine contraceptive device.It is known that in some women sexual steroids may inhibit or delay ovulation and may interfere with ovum and sperm transport and implantation. Copper intrauterine device causes a foreign-body effect on the endometrium and a direct toxic effect to sperm and blastocyst.The Yuzpe regimen reduces the risk of pregnancy after a single act of sexual intercourse by about 75% and the levonorgestrel alone by about 85%. The copper intrauterine device is an extremely effective method for selected patients.Nausea and vomiting are common among women using the Yuzpe regimen and considerably less common among women using levonorgestrel alone regimen.Emergency contraception is relatively safe with no contraindications except pregnancy. It is ineffective if a woman is pregnant. There is no need for a medical hystory or a phisical examination before providing emergency contraceptive pills. They are taken long before organogenesis starts, so they should not have a teratogenic effect.Counseling should include information about correct use of the method, possible side effects and her preferences for regular contraception.Unintended pregnancy is a great problem. Several safe, effective and inexpensive methods of emergency contraception are available including Yuzpe regimen, levonorges-trel-only regimen and copper intrauterine device.

  15. EMERGING MARKETS

    Directory of Open Access Journals (Sweden)

    GHEORGHE CARALICEA-MĂRCULESCU

    2012-03-01

    Full Text Available The emerging markets are winning the currency war, because at this very moment its the battle of global financial institutions , as to who is more vulnerable and more exposed to the debt crisis and have their hands in more risky assets. US and Euro with their intertwining the financial stuff of the nation, the banks and the corporations are in a deep mess. One goes down, takes the other ones too. Right now , they all are struggling and getting beaten up , while the emerging markets are quiet and not really expressing their stands on the current situation except are reacting by all only putting their own houses in order.

  16. Nuclear emergencies

    International Nuclear Information System (INIS)

    1991-01-01

    This leaflet, which is in the form of a fold-up chart, has panels of text which summarize the emergencies that could arise and the countermeasures and emergency plans that have been prepared should nuclear accident occur or affect the United Kingdom. The levels of radiation doses at which various measures would be introduced are outlined. The detection and monitoring programmes that would operate is illustrated. The role of NRPB and the responsible government departments are set out together with an explanation of how the National Arrangements for Incidents involving Radioactivity would be coordinated. (UK)

  17. The Emergence of City Logistics

    DEFF Research Database (Denmark)

    Gammelgaard, Britta; Aastrup, Jesper

    2014-01-01

    . The study aims at understanding the social processes towards reduced congestion and greenhouse gas emissions from goods transport in inner cities. Originality/value: By better understanding the organization processes leading to implementation of city logistics, other projects in other cities may learn from......Purpose: Many city logistics projects in Europe have failed. The purpose of this article is to increase understanding of how city logistics emerge. A better understanding of the complex organizational processes with many actors and stakeholders in city logistics projects may prevent further...... failures. Design/methodology/approach: Theory on organizational change is applied to capture the processes leading to emergence of city logistics. The methodology is process analysis on a single longitudinal case. Findings: The emergence of the Copenhagen city logistics project can be understood...

  18. The Emergence of City Logistics

    DEFF Research Database (Denmark)

    Gammelgaard, Britta; Aastrup, Jesper

    2014-01-01

    Purpose: Many city logistics projects in Europe have failed. The purpose of this article is to increase understanding of how city logistics emerge. A better understanding of the complex organizational processes with many actors and stakeholders in city logistics projects may prevent further...... failures. Design/methodology/approach: Theory on organizational change is applied to capture the processes leading to emergence of city logistics. The methodology is process analysis on a single longitudinal case. Findings: The emergence of the Copenhagen city logistics project can be understood....... The study aims at understanding the social processes towards reduced congestion and greenhouse gas emissions from goods transport in inner cities. Originality/value: By better understanding the organization processes leading to implementation of city logistics, other projects in other cities may learn from...

  19. Professional Emergence on Transnational Issues

    DEFF Research Database (Denmark)

    Seabrooke, Leonard; Tsingou, Eleni

    2015-01-01

    Addressing complex transnational problems requires coordination from different professionals. The emergence of new actors and issues has been addressed by those interested in studies of organizations through concepts and methods that highlight the importance of communities, fields, and networks....... These approaches are important in identifying the sources of what becomes established, but less geared to identifying interactions that are emergent. This article extends a linked ecologies approach to emergence, arguing that interaction on transnational issues should first be understood by how...... they are conceptually linked by actors and organizations. A linked ecologies approach asks us to displace locating known actors within structures and instead pays attention to professional interactions on how ‘issue distinctions’ are made, the relationship between issue distinctions and professional tasks, and who...

  20. Emergency Preparedness

    CERN Document Server

    2001-01-01

    The trends of RPC work in the area of preparedness for nuclear and radiological accidents are listed. RPC in cooperation with Swedish Government developed the project on preparation for iodine prophylaxis in case of accident at Ignalina NPP and arranged seminar on emergency preparedness issues in 2001.

  1. Emerging Materiality

    DEFF Research Database (Denmark)

    Bertelsen, Olav Wedege; Breinbjerg, Morten; Pold, Søren

    2009-01-01

    The authors examine how materiality emerges from complex chains of mediation in creative software use. The primarily theoretical argument is inspired and illustrated by interviews with two composers of electronic music. The authors argue that computer mediated activity should not primarily...

  2. Emergent Behaviour

    NARCIS (Netherlands)

    Blom, H.A.P.; Everdij, M.H.C.; Bouarfa, S.; Cook, A; Rivas, D

    2016-01-01

    In complexity science a property or behaviour of a system is called emergent if it is not a property or behaviour of the constituting elements of the system, though results from the interactions between its constituting elements. In the socio-technical air transportation system these interactions

  3. 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...

  4. Emerging Options for Emergency Contraception

    Science.gov (United States)

    Koyama, Atsuko; Hagopian, Laura; Linden, Judith

    2013-01-01

    Emergency post-coital contraception (EC) is an effective method of preventing pregnancy when used appropriately. EC has been available since the 1970s, and its availability and use have become widespread. Options for EC are broad and include the copper intrauterine device (IUD) and emergency contraceptive pills such as levonorgestrel, ulipristal acetate, combined oral contraceptive pills (Yuzpe method), and less commonly, mifepristone. Some options are available over-the-counter, while others require provider prescription or placement. There are no absolute contraindications to the use of emergency contraceptive pills, with the exception of ulipristal acetate and mifepristone. This article reviews the mechanisms of action, efficacy, safety, side effects, clinical considerations, and patient preferences with respect to EC usage. The decision of which regimen to use is influenced by local availability, cost, and patient preference. PMID:24453516

  5. Emerging Options for Emergency Contraception

    Directory of Open Access Journals (Sweden)

    Atsuko Koyama

    2013-01-01

    Full Text Available Emergency post-coital contraception (EC is an effective method of preventing pregnancy when used appropriately. EC has been available since the 1970s, and its availability and use have become widespread. Options for EC are broad and include the copper intrauterine device (IUD and emergency contraceptive pills such as levonorgestrel, ulipristal acetate, combined oral contraceptive pills (Yuzpe method, and less commonly, mifepristone. Some options are available over-the-counter, while others require provider prescription or placement. There are no absolute contraindications to the use of emergency contraceptive pills, with the exception of ulipristal acetate and mifepristone. This article reviews the mechanisms of action, efficacy, safety, side effects, clinical considerations, and patient preferences with respect to EC usage. The decision of which regimen to use is influenced by local availability, cost, and patient preference.

  6. 44 CFR 68.9 - Admissible evidence.

    Science.gov (United States)

    2010-10-01

    ... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Admissible evidence. 68.9 Section 68.9 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF... admissible. (b) Documentary and oral evidence shall be admissible. (c) Admissibility of non-expert testimony...

  7. Yes Virginia, quantum mechanics can be understood

    CERN Document Server

    Wallace, John P

    2017-01-01

    Virginia, B. W. Wooster, and Jeeves take up physics with the hope of understanding quantum mechanics. In the process they take a rather grand tour on an old sailing ship and aid a sow in distress. On their journey they discover that physics is not as difficult a subject as they imagined. When they dismantled physics and reassembled it in a form where gravity, strong, electromagnetic and the weak forces all stem from understanding the gaming strategy known as the fair-game. That great cultural divide first expounded by the novelist C.P.Snow was found to be a mere ditch that can be stepped over. The sins of the past were violations of energy conservation and strange notions about what mass actually represents. Now mass is defined without the assistance of the Standard Model. Things will not be the same. Singularities have been banished. The electron now has a scale and is no longer captive in a point. The gluon is no longer essential along with the single virtual photon.

  8. The Center of Gravity, Systemically Understood

    Science.gov (United States)

    2013-05-23

    Swain and Larry G. Heysteck (Riyadh, Saudi Arabia: CMH , Desert Storm Interviews, 1991), 33. 91Purvis, et al., 17. 40...Sullivan. "Interview: Centcom Planning Cell." In Unedited Transcript, edited by Richard Swain and Larry G. Heysteck. Riyadh, Saudi Arabia: CMH

  9. Evil Understood as the Absence of Freedom

    DEFF Research Database (Denmark)

    Rabjerg, Bjørn

    2017-01-01

    Self-development is closely related to the idea of formation (or what is referred to as Bildung in German). But when speaking of formation, we have to address the question, ‘what are we formed by?’ Is the human being formed by him- or herself, or by resources originating from outside the self? Fr...

  10. Emerging Multinationals

    DEFF Research Database (Denmark)

    Gammeltoft, Peter

    ) and books (e.g. Goldstein 2007; Benito and Narula 2007). This paper takes stock of the mounting trend of outward FDI from emerging economies, with special focus on a group of five countries, which are becoming increasingly economically and politically influential, viz. the ‘BRICS' countries. An ‘S......' is appended here to the conventional acronym of ‘BRIC' (Brazil, Russia, India, China) to include the largest economy on the African continent, South Africa. The five BRICS countries produced some USD25 billion of outward FDI flows in 2004, corresponding to some 3 percent of world FDI flows and well over half...... (61 percent) of total developing country outflows. OFDI from the BRICS countries has grown rapidly over the last few years, while still remaining modest compared to many developed countries. Following a brief discussion of FDI and emerging economies in general the article proceeds to hypothesise...

  11. Emerging Jets

    CERN Document Server

    Schwaller, Pedro; Weiler, Andreas

    2015-01-01

    In this work, we propose a novel search strategy for new physics at the LHC that utilizes calorimeter jets that (i) are composed dominantly of displaced tracks and (ii) have many different vertices within the jet cone. Such emerging jet signatures are smoking guns for models with a composite dark sector where a parton shower in the dark sector is followed by displaced decays of dark pions back to SM jets. No current LHC searches are sensitive to this type of phenomenology. We perform a detailed simulation for a benchmark signal with two regular and two emerging jets, and present and implement strategies to suppress QCD backgrounds by up to six orders of magnitude. At the 14 TeV LHC, this signature can be probed with mediator masses as large as 1.5 TeV for a range of dark pion lifetimes, and the reach is increased further at the high-luminosity LHC. The emerging jet search is also sensitive to a broad class of long-lived phenomena, and we show this for a supersymmetric model with R-parity violation. Possibilit...

  12. Natural Fabrications Science, Emergence and Consciousness

    CERN Document Server

    Seager, William

    2012-01-01

    The spectacular success of the scientific enterprise over the last four hundred years has led to the promise of an all encompassing vision of the natural world. In this elegant picture, everything we observe is based upon just a few fundamental processes and entities. The almost infinite variety and complexity of the world is thus the product of emergence. But the concept of emergence is fraught with controversy and confusion. This book ponders the question of how emergence should be understood within the scientific picture, and whether a complete vision of the world can be attained that includes consciousness.

  13. Haemorrhagia post partum; an implementation study on the evidence-based guideline of the Dutch Society of Obstetrics and Gynaecology (NVOG) and the MOET (Managing Obstetric Emergencies and Trauma-course) instructions; the Fluxim study

    Science.gov (United States)

    2010-01-01

    Background One of the most important causes of maternal mortality and severe morbidity worldwide is post partum haemorrhage (PPH). Factors as substandard care are frequently reported in the international literature and there are similar reports in the Netherlands. The incidence of PPH in the Dutch population is 5% containing 10.000 women a year. The introduction of an evidence-based guideline on PPH by the Dutch society of Obstetrics and Gynaecology (NVOG) and the initiation of the MOET course (Managing Obstetrics Emergencies and Trauma) did not lead to a reduction of PPH. This implies the possibility of an incomplete implementation of both the NVOG guideline and MOET-instructions. Therefore, the aim of this study is to develop and test a tailored strategy to implement both the NVOG guideline and MOET-instructions Methods/Design One step in the development procedure is to evaluate the implementation of the guideline and MOET-instructions in the current care. Therefore measurement of the actual care will be performed in a representative sample of 20 hospitals. This will be done by prospective observation of the third stage of labour of 320 women with a high risk of PPH using quality indicators extracted from the NVOG guideline and MOET instructions. In the next step barriers and facilitators for guideline adherence will be analyzed by performance of semi structured interviews with 30 professionals and 10 patients, followed by a questionnaire study among all Dutch gynaecologists and midwives to quantify the barriers mentioned. Based on the outcomes, a tailored strategy to implement the NVOG guideline and MOET-instructions will be developed and tested in a feasibility study in 4 hospitals, including effect-, process- and cost evaluation. Discussion This study will provide insight into current Dutch practice, in particular to what extent the PPH guidelines of the NVOG and the MOET-instructions have been implemented in the actual care, and into the barriers and

  14. Haemorrhagia post partum; an implementation study on the evidence-based guideline of the Dutch Society of Obstetrics and Gynaecology (NVOG and the MOET (Managing Obstetric Emergencies and Trauma-course instructions; the Fluxim study

    Directory of Open Access Journals (Sweden)

    Grol Richard P

    2010-01-01

    Full Text Available Abstract Background One of the most important causes of maternal mortality and severe morbidity worldwide is post partum haemorrhage (PPH. Factors as substandard care are frequently reported in the international literature and there are similar reports in the Netherlands. The incidence of PPH in the Dutch population is 5% containing 10.000 women a year. The introduction of an evidence-based guideline on PPH by the Dutch society of Obstetrics and Gynaecology (NVOG and the initiation of the MOET course (Managing Obstetrics Emergencies and Trauma did not lead to a reduction of PPH. This implies the possibility of an incomplete implementation of both the NVOG guideline and MOET-instructions. Therefore, the aim of this study is to develop and test a tailored strategy to implement both the NVOG guideline and MOET-instructions Methods/Design One step in the development procedure is to evaluate the implementation of the guideline and MOET-instructions in the current care. Therefore measurement of the actual care will be performed in a representative sample of 20 hospitals. This will be done by prospective observation of the third stage of labour of 320 women with a high risk of PPH using quality indicators extracted from the NVOG guideline and MOET instructions. In the next step barriers and facilitators for guideline adherence will be analyzed by performance of semi structured interviews with 30 professionals and 10 patients, followed by a questionnaire study among all Dutch gynaecologists and midwives to quantify the barriers mentioned. Based on the outcomes, a tailored strategy to implement the NVOG guideline and MOET-instructions will be developed and tested in a feasibility study in 4 hospitals, including effect-, process- and cost evaluation. Discussion This study will provide insight into current Dutch practice, in particular to what extent the PPH guidelines of the NVOG and the MOET-instructions have been implemented in the actual care, and into

  15. Evidence-Based Development

    DEFF Research Database (Denmark)

    Hertzum, Morten; Simonsen, Jesper

    2004-01-01

    Systems development is replete with projects that represent substantial resource investments but result in systems that fail to meet users’ needs. Evidence-based development is an emerging idea intended to provide means for managing customer-vendor relationships and working systematically toward...... and electronic patient records for diabetes patients, this paper reports research in progress regarding the prospects and pitfalls of evidence-based development....

  16. Abdominal emergencies

    International Nuclear Information System (INIS)

    Raissaki, M.

    2012-01-01

    Full text: There are numerous conditions that affect mainly or exclusively the pediatric population. These constitute true emergencies, related to patient's health. Delay in diagnosis and treatment of abdominal non-traumatic emergencies may result in rapid deterioration, peritonitis, sepsis, even death or in severe complications with subsequent morbidity. Abdominal emergencies in children mostly present with pain, tenderness, occasionally coupled by vomiting, fever, abdominal distension, and failure to pass meconium or stools. Diarrhea, blood per rectum, abnormal laboratory tests and lethargy may also be manifestations of acute abdominal conditions. Abdominal emergencies have a different aetiology, depending on age and whether the pain is acute or chronic. Symptoms have to be matched with age and gender. Newborns up to 1 months of age may have congenital diseases: atresia, low obstruction including Hirschsprung's disease, meconium ileus. Meconium plug is one of the commonest cause of low obstruction in newborns that may also develop necrotizing enterocolitis, incarcerated inguinal hernia and mid-gut volvulus. Past the immediate postnatal period, any duodenal obstruction should be considered midgut volvulus until proven otherwise and patients should undergo ultrasonography and/or properly performed upper GI contrast study that records the exact position of the deduno-jejunal junction. Infants 6 months-2 years carry the risk of intussusception, mid-gut volvulus, perforation, acute pyelonephritis. Preschool and school-aged children 2-12 years carry the risk of appendicitis, genito-urinary abnormalities including torsion, urachal abnormalities, haemolytic uremic syndrome and Henoch-Schonlein purpura. Children above 12 years suffer from the same conditions as in adults. Most conditions may affect any age despite age predilection. Abdominal solid organ ultrasonography (US) coupled with gastrointestinal ultrasonography is the principle imaging modality in radiosensitive

  17. Emerging Therapies.

    Science.gov (United States)

    Guerra, Amaliris; Musallam, Khaled M; Taher, Ali T; Rivella, Stefano

    2018-04-01

    At present, the only definitive cure for β-thalassemia is a bone marrow transplant (BMT); however, HLA-blood-matched donors are scarcely available. Current therapies undergoing clinical investigation with most potential for therapeutic benefit are the β-globin gene transfer of patient-specific hematopoietic stem cells followed by autologous BMT. Other emerging therapies deliver exogenous regulators of several key modulators of erythropoiesis or iron homeostasis. This review focuses on current approaches for the treatment of hemoglobinopathies caused by disruptions of β-globin. Copyright © 2017 Elsevier Inc. All rights reserved.

  18. Brain and language: evidence for neural multifunctionality.

    Science.gov (United States)

    Cahana-Amitay, Dalia; Albert, Martin L

    2014-01-01

    This review paper presents converging evidence from studies of brain damage and longitudinal studies of language in aging which supports the following thesis: the neural basis of language can best be understood by the concept of neural multifunctionality. In this paper the term "neural multifunctionality" refers to incorporation of nonlinguistic functions into language models of the intact brain, reflecting a multifunctional perspective whereby a constant and dynamic interaction exists among neural networks subserving cognitive, affective, and praxic functions with neural networks specialized for lexical retrieval, sentence comprehension, and discourse processing, giving rise to language as we know it. By way of example, we consider effects of executive system functions on aspects of semantic processing among persons with and without aphasia, as well as the interaction of executive and language functions among older adults. We conclude by indicating how this multifunctional view of brain-language relations extends to the realm of language recovery from aphasia, where evidence of the influence of nonlinguistic factors on the reshaping of neural circuitry for aphasia rehabilitation is clearly emerging.

  19. Earthquakes and emergence

    Science.gov (United States)

    Earthquakes and emerging infections may not have a direct cause and effect relationship like tax evasion and jail, but new evidence suggests that there may be a link between the two human health hazards. Various media accounts have cited a massive 1993 earthquake in Maharashtra as a potential catalyst of the recent outbreak of plague in India that has claimed more than 50 lives and alarmed the world. The hypothesis is that the earthquake may have uprooted underground rat populations that carry the fleas infected with the bacterium that causes bubonic plague and can lead to the pneumonic form of the disease that is spread through the air.

  20. Emergent complex neural dynamics

    Science.gov (United States)

    Chialvo, Dante R.

    2010-10-01

    A large repertoire of spatiotemporal activity patterns in the brain is the basis for adaptive behaviour. Understanding the mechanism by which the brain's hundred billion neurons and hundred trillion synapses manage to produce such a range of cortical configurations in a flexible manner remains a fundamental problem in neuroscience. One plausible solution is the involvement of universal mechanisms of emergent complex phenomena evident in dynamical systems poised near a critical point of a second-order phase transition. We review recent theoretical and empirical results supporting the notion that the brain is naturally poised near criticality, as well as its implications for better understanding of the brain.

  1. [The evaluation of academic emergency department design].

    Science.gov (United States)

    Deniz, Turgut; Aydinuraz, Kuzey; Oktay, Cem; Saygun, Meral; Ağalar, Fatih

    2007-01-01

    In our study which was based upon a questionnaire, the inner and outer architectural designs of emergency services of Emergency Medicine Departments were investigated. In this descriptive study, a standard questionnaire was sent to 26 Emergency Medicine Departments which were operating at that time. In the questionnaire, the internal, external architectural and functional features were questioned. Answers of 22 Emergency Medicine Departments were analysed. Two Emergency Medicine Departments that were not operating at that time were not included in the study. The analysis of the replies revealed that only 59% (n=13) of the Emergency Medicine Departments were designed as an emergency service prior to the construction. The ambulance parking areas were not suitable in 77% of the emergency units while only 54.5% (n=12) had protection against adverse weather conditions. In only 59% (n=13) of the emergency units, a triage unit was present and in only one of the in only one (4.5%), a decontamination room was available. It was understood that only 32% (n=8) of the emergency units were appropriate in enlarging their capacity taking the local risk factors into consideration. There was a toilette for disabled patients in only 18% (n=4) of the units as well. Considering a 12-year of history of the Emergency Medicine in Turkey, the presence of a lecture room is still 68% (n=15) in emergency departments which reflects that academic efforts in this field is emerging in challenging physical conditions. The results of our study revealed that emergency service architecture was neglected in Turkey and medical care given was precluded by the insufficient architecture. The design of emergency services has to be accomplished under guidance of scientific data and rules taking advices of architects who have knowledge and experience on this field.

  2. Visions of technology: : Big data lessons understood by EU policy makers in their review of the legal frameworks on intellectual property rights, access to and re-use of PSI and the protection of personal data

    NARCIS (Netherlands)

    Lammerant, Hans; de Hert, Paul; Gutwirth, Serge; Leenes, Ronald; De Hert, Paul

    2016-01-01

    This article’s focus is on how the advent of big data technology and practices has been understood and addressed by policy makers in the EU. We start with a reflection on of how big data affects business processes and how it con- tributes to the creation of a data economy. Then we look at EU policy

  3. Emerging technologies

    Energy Technology Data Exchange (ETDEWEB)

    Lu, Shin-yee

    1993-03-01

    The mission of the Emerging Technologies thrust area at Lawrence Livermore National Laboratory is to help individuals establish technology areas that have national and commercial impact, and are outside the scope of the existing thrust areas. We continue to encourage innovative ideas that bring quality results to existing programs. We also take as our mission the encouragement of investment in new technology areas that are important to the economic competitiveness of this nation. In fiscal year 1992, we have focused on nine projects, summarized in this report: (1) Tire, Accident, Handling, and Roadway Safety; (2) EXTRANSYT: An Expert System for Advanced Traffic Management; (3) Odin: A High-Power, Underwater, Acoustic Transmitter for Surveillance Applications; (4) Passive Seismic Reservoir Monitoring: Signal Processing Innovations; (5) Paste Extrudable Explosive Aft Charge for Multi-Stage Munitions; (6) A Continuum Model for Reinforced Concrete at High Pressures and Strain Rates: Interim Report; (7) Benchmarking of the Criticality Evaluation Code COG; (8) Fast Algorithm for Large-Scale Consensus DNA Sequence Assembly; and (9) Using Electrical Heating to Enhance the Extraction of Volatile Organic Compounds from Soil.

  4. Emerging memories

    Science.gov (United States)

    Baldi, Livio; Bez, Roberto; Sandhu, Gurtej

    2014-12-01

    Memory is a key component of any data processing system. Following the classical Turing machine approach, memories hold both the data to be processed and the rules for processing them. In the history of microelectronics, the distinction has been rather between working memory, which is exemplified by DRAM, and storage memory, exemplified by NAND. These two types of memory devices now represent 90% of all memory market and 25% of the total semiconductor market, and have been the technology drivers in the last decades. Even if radically different in characteristics, they are however based on the same storage mechanism: charge storage, and this mechanism seems to be near to reaching its physical limits. The search for new alternative memory approaches, based on more scalable mechanisms, has therefore gained new momentum. The status of incumbent memory technologies and their scaling limitations will be discussed. Emerging memory technologies will be analyzed, starting from the ones that are already present for niche applications, and which are getting new attention, thanks to recent technology breakthroughs. Maturity level, physical limitations and potential for scaling will be compared to existing memories. At the end the possible future composition of memory systems will be discussed.

  5. Complex systems dynamics in aging: new evidence, continuing questions.

    Science.gov (United States)

    Cohen, Alan A

    2016-02-01

    There have long been suggestions that aging is tightly linked to the complex dynamics of the physiological systems that maintain homeostasis, and in particular to dysregulation of regulatory networks of molecules. This review synthesizes recent work that is starting to provide evidence for the importance of such complex systems dynamics in aging. There is now clear evidence that physiological dysregulation--the gradual breakdown in the capacity of complex regulatory networks to maintain homeostasis--is an emergent property of these regulatory networks, and that it plays an important role in aging. It can be measured simply using small numbers of biomarkers. Additionally, there are indications of the importance during aging of emergent physiological processes, functional processes that cannot be easily understood through clear metabolic pathways, but can nonetheless be precisely quantified and studied. The overall role of such complex systems dynamics in aging remains an important open question, and to understand it future studies will need to distinguish and integrate related aspects of aging research, including multi-factorial theories of aging, systems biology, bioinformatics, network approaches, robustness, and loss of complexity.

  6. Contraceptive availability during an emergency response in the United States.

    Science.gov (United States)

    Ellington, Sascha R; Kourtis, Athena P; Curtis, Kathryn M; Tepper, Naomi; Gorman, Susan; Jamieson, Denise J; Zotti, Marianne; Barfield, Wanda

    2013-03-01

    This article provides the evidence for contraceptive need to prevent unintended pregnancy during an emergency response, discusses the most appropriate types of contraceptives for disaster situations, and details the current provisions in place to provide contraceptives during an emergency response.

  7. Responsibility modelling for civil emergency planning

    OpenAIRE

    Sommerville, Ian; Storer, Timothy; Lock, Russell

    2009-01-01

    This paper presents a new approach to analysing and understanding civil emergency planning based on the notion of responsibility modelling combined with HAZOPS-style analysis of information requirements. Our goal is to represent complex contingency plans so that they can be more readily understood, so that inconsistencies can be highlighted and vulnerabilities discovered. In this paper, we outline the framework for contingency planning in the United Kingdom and introduce the notion of respons...

  8. Chronic disruptive pain in emerging adults with and without chronic health conditions and the moderating role of psychiatric disorders: Evidence from a population-based cross-sectional survey in Canada.

    Science.gov (United States)

    Qadeer, Rana A; Shanahan, Lilly; Ferro, Mark A

    2017-10-01

    There has been a growth in the proportion of emerging adults vulnerable to pain-related sequelae of chronic health conditions (CHCs). Given the paucity of research during this important developmental period, this study investigated the association between CHCs and chronic disruptive pain among emerging adults and the extent to which psychiatric disorders moderate this association. Data come from the 2012 Canadian Community Health Survey - Mental Health (CCHS-MH). This cross-sectional survey included 5987 participants that were 15-30 years of age and self-reported their CHCs (n=2460, 41%) and the extent to which pain impacted daily functioning using items from the Health Utilities Index Mark 3 (HUI 3). Group comparisons between respondents with CHCs and healthy controls were made using chi-square tests. Odds ratios (OR) and 95% confidence intervals (CI) were computed from ordinal logistic regression models adjusting for sociodemographic covariates. Product-term interactions between CHCs and psychiatric disorders were included in the models to explore moderating effects. All analyses were weighted to maintain representativeness of the study sample to the Canadian population. The mean age of participants was 23.5 (SE 0.1) years and 48% were female. Compared to healthy controls, a greater proportion of participants with CHCs reported having chronic pain (20.3% vs. 4.5%, p<0.001). Among those with chronic pain, respondents with CHCs reported a greater number of activities prevented because of chronic disruptive pain (χ 2 =222.28, p<0.001). Similarly, in logistic regression models, participants with CHCs had greater odds of reporting chronic disruptive pain (OR=4.94, 95% CI=4.08-5.99). Alcohol (β=-0.66; p=0.025) and drug abuse/dependence disorders (β=-1.24; p=0.012) were found to moderate the association between CHCs and chronic disruptive pain. Specifically, the probability of chronic disruptive pain was higher for emerging adults without CHCs and with alcohol or

  9. Emergency laparoscopy--current best practice.

    Science.gov (United States)

    Warren, Oliver; Kinross, James; Paraskeva, Paraskevas; Darzi, Ara

    2006-08-31

    Emergency laparoscopic surgery allows both the evaluation of acute abdominal pain and the treatment of many common acute abdominal disorders. This review critically evaluates the current evidence base for the use of laparoscopy, both diagnostic and interventional, in the emergency abdomen, and provides guidance for surgeons as to current best practise. Laparoscopic surgery is firmly established as the best intervention in acute appendicitis, acute cholecystitis and most gynaecological emergencies but requires further randomised controlled trials to definitively establish its role in other conditions.

  10. Special Globelics session proposal on: Lessons learned for priority setting and indicators relevant to the impact of research programmes in Europe and Emerging Economies. An evidence-based debate between the research and the policy-shaping community

    Energy Technology Data Exchange (ETDEWEB)

    Caloghirou, Y.; Vonortas, N.

    2016-07-01

    The purpose of this session is to present a coherent set of papers offering useful insights on research priority setting processes/activities and indicators used to measure the impact of research and technology development programmes in Europe and Emerging Economies (Brazil, Chile, Peru and Russia). In particular, the first paper focuses on the research collaborative networks funded by the European Union during the past three decades and offers a comprehensive picture of science-industry collaboration in Europe by using network indicators and providing data on the characteristics and the innovative performance of young firms participating in these networks. The second paper presents three cases of non-traditional indicators for R&D funding agencies from emerging economies and aims at contributing to the discussions on the importance of employing suitable indicators that can complement classic STI indicators. The third paper seeks to provide a critical overview of the recent exercise in the evaluation of public research institutions in Russia. The session (180 min) aims at bringing together researchers from both developed and emerging countries as well as policy makers and will be divided into two parts . The first part will be devoted in papers’ presentation and the second one in papers’ discussion by invited policy experts and officials. (Author)

  11. Successes and Challenges of Emerging Economy Multinationals

    DEFF Research Database (Denmark)

    Successes and Challenges of Emerging Economy Multinationals investigates a broad variety of cases presenting clear evidence of fast successful internationalization of emerging economy multinationals originating not only from big economic players such as China, India and Russia but also from other...

  12. Emergency teams in Danish emergency departments

    DEFF Research Database (Denmark)

    Lafrenz, Thomas; Lindberg, Søren Østergaard; La Cour, Jeppe Lerche

    2012-01-01

    The use of designated emergency teams for cardiac arrest and trauma patients is widely implemented. However, the use of designated teams in Danish emergency departments (EDs) has not been investigated. Our aim was to investigate the use and staffing of emergency teams in Danish EDs.......The use of designated emergency teams for cardiac arrest and trauma patients is widely implemented. However, the use of designated teams in Danish emergency departments (EDs) has not been investigated. Our aim was to investigate the use and staffing of emergency teams in Danish EDs....

  13. A workshop report on HIV mHealth synergy and strategy meeting to review emerging evidence-based mHealth interventions and develop a framework for scale-up of these interventions

    Directory of Open Access Journals (Sweden)

    Sarah Karanja

    2011-11-01

    Full Text Available g up evidence based mHealth interventions. The participants acknowledged the importance of the meeting in setting the pace for strengthening and coordinating mHealth initiatives and unanimously agreed to hold a follow up meeting after three months.

  14. Evidence-Based Development

    DEFF Research Database (Denmark)

    Hertzum, Morten; Simonsen, Jesper

    2004-01-01

    Systems development is replete with projects that represent substantial resource investments but result in systems that fail to meet users’ needs. Evidence-based development is an emerging idea intended to provide means for managing customer-vendor relationships and working systematically toward...... meeting customer needs. We are suggesting that the effects of the use of a system should play a prominent role in the contractual definition of IT projects and that contract fulfilment should be determined on the basis of evidence of these effects. Based on two ongoing studies of home-care management...

  15. Agricultural intensification, priming for persistence and the emergence of Nipah virus: a lethal bat-borne zoonosis.

    Science.gov (United States)

    Pulliam, Juliet R C; Epstein, Jonathan H; Dushoff, Jonathan; Rahman, Sohayati A; Bunning, Michel; Jamaluddin, Aziz A; Hyatt, Alex D; Field, Hume E; Dobson, Andrew P; Daszak, Peter

    2012-01-07

    Emerging zoonoses threaten global health, yet the processes by which they emerge are complex and poorly understood. Nipah virus (NiV) is an important threat owing to its broad host and geographical range, high case fatality, potential for human-to-human transmission and lack of effective prevention or therapies. Here, we investigate the origin of the first identified outbreak of NiV encephalitis in Malaysia and Singapore. We analyse data on livestock production from the index site (a commercial pig farm in Malaysia) prior to and during the outbreak, on Malaysian agricultural production, and from surveys of NiV's wildlife reservoir (flying foxes). Our analyses suggest that repeated introduction of NiV from wildlife changed infection dynamics in pigs. Initial viral introduction produced an explosive epizootic that drove itself to extinction but primed the population for enzootic persistence upon reintroduction of the virus. The resultant within-farm persistence permitted regional spread and increased the number of human infections. This study refutes an earlier hypothesis that anomalous El Niño Southern Oscillation-related climatic conditions drove emergence and suggests that priming for persistence drove the emergence of a novel zoonotic pathogen. Thus, we provide empirical evidence for a causative mechanism previously proposed as a precursor to widespread infection with H5N1 avian influenza and other emerging pathogens.

  16. Emergency teams in Danish emergency departments

    DEFF Research Database (Denmark)

    Lafrenz, Thomas; Lindberg, Søren Østergaard; La Cour, Jeppe Lerche

    2012-01-01

    The use of designated emergency teams for cardiac arrest and trauma patients is widely implemented. However, the use of designated teams in Danish emergency departments (EDs) has not been investigated. Our aim was to investigate the use and staffing of emergency teams in Danish EDs....

  17. On Evidence and Argument in Phenomenological Research | Walsh ...

    African Journals Online (AJOL)

    Set against a background of calls for evidence-based practice, this paper explores the role of evidence and argument in phenomenological research. Drawing on Smith's (1998) analysis of original argument, the author considers how evidence can be discerned, understood, and communicated, and the resulting kinds and ...

  18. Emergency Contraception Website

    Science.gov (United States)

    Text Only Full media Version Get Emergency Contraception NOW INFO about Emergency Contraception Q&A about Emergency Contraception Español | Arabic Find a Morning After Pill Provider Near You This website is ...

  19. Emergency Medical Services

    Science.gov (United States)

    ... need help right away, you should use emergency medical services. These services use specially trained people and ... emergencies, you need help where you are. Emergency medical technicians, or EMTs, do specific rescue jobs. They ...

  20. The Emerging Physics of Consciousness

    CERN Document Server

    Tuszynski, Jack A

    2006-01-01

    Consciousness remains one of the major unsolved problems in science. How do the feelings and sensations making up conscious experience arise from the concerted actions of nerve cells and their associated synaptic and molecular processes? Can such feelings be explained by modern science, or is there an entirely different kind of explanation needed? And how can this seemingly intractable problem be approached experimentally? How do the operations of the conscious mind emerge out of the specific interactions involving billions of neurons? This book seeks answers to these questions on the underlying assumption that consciousness can be understood using the intellectual potential of modern physics and other sciences. There are a number of theories of consciousness, some based on classical physics while others require the use of quantum concepts. The latter ones have drawn criticism from the parts of the scientific establishment while simultaneously claiming that classical approaches are doomed to failure. The cont...

  1. Emerging issues in complementary feeding

    DEFF Research Database (Denmark)

    Michaelsen, Kim F.; Grummer-Strawn, Laurence; Bégin, France

    2017-01-01

    addressed these issues. There are several emerging research areas that are likely to provide a better understanding of how complementary feeding influences growth, development, and health. These include the effect of the young child's diet on body composition, gastrointestinal microbiota, and environmental......The complementary feeding period (6-24 months) is a window of opportunity for preventing stunting, wasting, overweight, and obesity and for improving long-term development and health. Because WHO published its guiding principles for complementary feeding in 2003, new knowledge and evidence have...... been generated in the area of child feeding. The aim of this paper is to highlight some of the emerging issues in complementary feeding and potential implications on the guidelines revision. Evidence on the effect of the quality and quantity of protein and fat intake on child growth during...

  2. Emerging Pathogens Initiative (EPI)

    Data.gov (United States)

    Department of Veterans Affairs — The Emerging Pathogens Initiative (EPI) database contains emerging pathogens information from the local Veterans Affairs Medical Centers (VAMCs). The EPI software...

  3. How Lafd Cert May Be Understood as a Smart Practice: How it is Pioneering a Transition to Whole Community Cert and How it Can Serve as the Template for Cert Programs Nationally

    Science.gov (United States)

    2017-01-10

    Instructors to Build a More Robust Training Cadre with a Broader Skill Set .........................................................69 LIST OF...emergency management: mitigation, preparedness, response, and recovery.16 Lichterman describes the components of CERT training as examples of soft ...protection skills . The lessons learned in Mexico City strongly indicated a need for a plan to train volunteers to help themselves and others as part

  4. Psoriasis: classical and emerging comorbidities*

    Science.gov (United States)

    de Oliveira, Maria de Fátima Santos Paim; Rocha, Bruno de Oliveira; Duarte, Gleison Vieira

    2015-01-01

    Psoriasis is a chronic inflammatory systemic disease. Evidence shows an association of psoriasis with arthritis, depression, inflammatory bowel disease and cardiovascular diseases. Recently, several other comorbid conditions have been proposed as related to the chronic inflammatory status of psoriasis. The understanding of these conditions and their treatments will certainly lead to better management of the disease. The present article aims to synthesize the knowledge in the literature about the classical and emerging comorbidities related to psoriasis. PMID:25672294

  5. Development of an amygdalocentric neurocircuitry-reactive aggression theoretical model of emergence delirium in posttraumatic stress disorder: an integrative literature review.

    Science.gov (United States)

    McLott, Jason; Jurecic, Jerry; Hemphill, Luke; Dunn, Karen S

    2013-10-01

    The purposes of this integrative literature review were to (1) present a synopsis of current literature describing posttraumatic stress disorder (PTSD), the amygdalocentric neurocircuitry, emergence delirium, reactive aggression, and the interaction of general anesthetics and the amygdalocentric neurocircuitry; (2) synthesize this evidence; and (3) develop a new theoretical model that can be tested in future research studies. Over the past decade, a dramatic rise in PTSD among veterans has been reported because of recent combat deployments. Modern anesthetics alter the function of the amygdalocentric neurocircuitry to produce amnesia and sedation. The etiology of emergence delirium is poorly understood, and the condition is uncommon outside the pediatric population. Emergence delirium among patients with PTSD, however, has been reported by military nurse anesthetists. To date, there have been no scientific studies conducted to identify the cause of emergence delirium in combat veterans with PTSD. This new theoretical model may explain why noxious stimuli at the time of emergence may stimulate the thalamus, leading to activation of an uninhibited amygdalocentric neurocircuitry. Because of the loss of top-down inhibition, the hyperactive amygdala then stimulates the hypothalamus, which is responsible for creating an increase in excitatory activity in the unconscious patient, resulting in emergence delirium.

  6. Ulipristal acetate in emergency contraception.

    Science.gov (United States)

    Goldstajn, Marina Sprem; Baldani, Dinka Pavicić; Skrgatić, Lana; Radaković, Branko; Vrbić, Hrvoje; Canić, Tomislav

    2014-03-01

    Despite the widespread availability of highly effective methods of contraception, unintended pregnancy is common. Unplanned pregnancies have been linked to a range of health, social and economic consequences. Emergency contraception reduces risk of pregnancy after unprotected intercourse, and represents an opportunity to decrease number of unplanned pregnancies and abortions. Emergency contraception pills (ECP) prevent pregnancy by delaying or inhibiting ovulation, without interfering with post fertilization events. If pregnancy has already occurred, ECPs will not be effective, therefore ECPs are not abortificants. Ulipristal acetate (17alpha-acetoxy-11beta-(4N-N,N-dymethilaminophenyl)-19-norpregna--4,9-diene-3,20-dione) is the first drug that was specifically developed and licensed for use as an emergency contraceptive. It is an orally active, synthetic, selective progesterone modulator that acts by binding with high affinity to the human progesterone receptor where it has both antagonist and partial agonist effects. It is a new molecular entity and the first compound in a new pharmacological class defined by the pristal stem. Up on the superior clinical efficacy evidence, UPA has been quickly recognized as the most effective emergency contraceptive pill, and recently recommended as the first prescription choice for all women regardless of the age and timing after intercourse. This article provides literature review of UPA and its role in emergency contraception.

  7. Risk perception, experience, and objective risk: a cross-national study with European emergency survivors.

    Science.gov (United States)

    Knuth, Daniela; Kehl, Doris; Hulse, Lynn; Schmidt, Silke

    2014-07-01

    Understanding public risk perceptions and their underlying processes is important in order to learn more about the way people interpret and respond to hazardous emergency events. Direct experience with an involuntary hazard has been found to heighten the perceived risk of experiencing the same hazard and its consequences in the future, but it remains unclear if cross-over effects are possible (i.e., experience with one hazard influencing perceived risk for other hazards also). Furthermore, the impact of objective risk and country of residence on perceived risk is not well understood. As part of the BeSeCu (Behavior, Security, and Culture) Project, a sample of 1,045 survivors of emergencies from seven European countries (i.e., Germany, the Czech Republic, Poland, Sweden, Spain, Turkey, and Italy) was drawn. Results revealed heightened perceived risk for emergency events (i.e., domestic and public fires, earthquakes, floods, and terrorist attacks) when the event had been experienced previously plus some evidence of cross-over effects, although these effects were not so strong. The largest country differences in perceived risk were observed for earthquakes, but this effect was significantly reduced by taking into account the objective earthquake risk. For fires, floods, terrorist attacks, and traffic accidents, only small country differences in perceived risk were found. Further studies including a larger number of countries are welcomed. © 2013 Society for Risk Analysis.

  8. Tularemia in Germany—A Re-emerging Zoonosis

    Directory of Open Access Journals (Sweden)

    Mirko Faber

    2018-02-01

    Full Text Available Tularemia, also known as “rabbit fever,” is a zoonosis caused by the facultative intracellular, gram-negative bacterium Francisella tularensis. Infection occurs through contact with infected animals (often hares, arthropod vectors (such as ticks or deer flies, inhalation of contaminated dust or through contaminated food and water. In this review, we would like to provide an overview of the current epidemiological situation in Germany using published studies and case reports, an analysis of recent surveillance data and our own experience from the laboratory diagnostics, and investigation of cases. While in Germany tularemia is a rarely reported disease, there is evidence of recent re-emergence. We also describe some peculiarities that were observed in Germany, such as a broad genetic diversity, and a recently discovered new genus of Francisella and protracted or severe clinical courses of infections with the subspecies holarctica. Because tularemia is a zoonosis, we also touch upon the situation in the animal reservoir and one-health aspects of this disease. Apparently, many pieces of the puzzle need to be found and put into place before the complex interaction between wildlife, the environment and humans are fully understood. Funding for investigations into rare diseases is scarce. Therefore, combining efforts in several countries in the framework of international projects may be necessary to advance further our understanding of this serious but also scientifically interesting disease.

  9. Global climate change and implications for disease emergence.

    Science.gov (United States)

    Slenning, B D

    2010-01-01

    The early consequences of global climate change (GCC) are well documented. However, future impacts on ecosystem health, and on the health of humans, domestic animals, and wildlife, are much less well understood. Evidence of increasing frequency of extreme weather events (the 2003 trans-European heat wave, extended droughts in Australia and South America), of geographic changes in vector-borne disease (bluetongue and hanta viruses emerging in northern Europe, dengue virus expanding in central and northern America), and of altered animal behavioral responses (changes in bird migration patterns and fishery numbers) warrants action. To make valid choices, however, practitioners and decision makers must understand what is known about GCC and what is only theory. There will be a multitude of microbial, vector, and host responses to climate change, for example, and not all organisms will respond similarly or across equal time scales. Unfortunately, for many organisms and ecosystems the scientific community has a relatively poor understanding of current effectors and balances, making it problematic to describe the current situation, let alone to validate future predictions. The need for enhanced basic research and systematic surveillance programs is obvious, but putting such programs into place is daunting. However, the threats are real and fast approaching. What is done in the next few years may be decisive, whether for the good or the ill of all.

  10. Immaterial Evidence

    Directory of Open Access Journals (Sweden)

    Ivanov N. A.

    2012-11-01

    Full Text Available It is substantiated in the article that some of the objects which either could serve as instruments of a crime for criminal actions, or they were obtained through the commission of a crime, are immaterial objects, and they may be conditionally designated as evidence. The author relates to immaterial evidence physical fields, radiation, undocumented information, computer programs, property rights, intangible benefits, heat and electric power, and information processes.

  11. Digital evidence

    Directory of Open Access Journals (Sweden)

    Lukić Tatjana

    2012-01-01

    Full Text Available Although computer makes human activities faster and easier, innovating and creating new forms of work and other kinds of activities, it also influenced the criminal activity. The development of information technology directly affects the development of computer forensics without which, it can not even imagine the discovering and proving the computer offences and apprehending the perpetrator. Information technology and computer forensic allows us to detect and prove the crimes committed by computer and capture the perpetrators. Computer forensics is a type of forensics which can be defined as a process of collecting, preserving, analyzing and presenting digital evidence in court proceedings. Bearing in mind, that combat against crime, in which computers appear as an asset or object of the offense, requires knowledge of digital evidence as well as specific rules and procedures, the author in this article specifically addresses the issues of digital evidence, forensic (computer investigation, specific rules and procedures for detecting, fixing and collecting digital evidence and use of this type of evidence in criminal proceedings. The author also delas with international standards regarding digital evidence and cyber-space investigation.

  12. Association between Air Pollution and Emergency Room Visits for Atrial Fibrillation.

    Science.gov (United States)

    Solimini, Angelo G; Renzi, Matteo

    2017-06-20

    Despite the large prevalence in the population, possible factors responsible for the induction of atrial fibrillation (AF) events in susceptible individuals remain incompletely understood. We investigated the association between air pollution levels and emergency department admissions for AF in Rome. We conducted a 14 years' time-series study to evaluate the association between the daily levels of air pollution (particulate matter, PM 10 and PM 2.5 , and nitrogen dioxide, NO₂) and the daily count of emergency accesses for AF (ICD-9 code: 427.31). We applied an over-dispersed conditional Poisson model to analyze the associations at different lags after controlling for time, influenza epidemics, holiday periods, temperature, and relative humidity. Additionally, we evaluated bi-pollutant models by including the other pollutant and the influence of several effect modifiers such as personal characteristics and pre-existing medical conditions. In the period of study, 79,892 individuals were admitted to the emergency departments of Rome hospitals because of AF (on average, 15.6 patients per day: min = 1, max = 36). Air pollution levels were associated with increased AF emergency visits within 24 h of exposure. Effect estimates ranged between 1.4% (0.7-2.3) for a 10 µg/m³ increase of PM 10 to 3% (1.4-4.7) for a 10 µg/m³ increase of PM 2.5 at lag 0-1 day. Those effects were higher in patients ≥75 years for all pollutants, male patients for PM 10 , and female patients for NO₂. The presence of previous cardiovascular conditions, but not other effect modifiers, increase the pollution effects by 5-8% depending on the lag. This study found evidence that air pollution is associated with AF emergency visits in the short term.

  13. Early evidence of the ballgame in Oaxaca, Mexico.

    Science.gov (United States)

    Blomster, Jeffrey P

    2012-05-22

    As a defining characteristic of Mesoamerican civilization, the ballgame has a long and poorly understood history. Because the ballgame is associated with the rise of complex societies, understanding its origins also illuminates the evolution of socio-politically complex societies. Although initial evidence, in the form of ceramic figurines, dates to 1700 BCE, and the oldest known ballcourt dates to 1600 BCE, the ritual paraphernalia and ideology associated with the game appear around 1400 BCE, the start of the so-called Early Horizon, defined by the spread of Olmec-style symbols across Mesoamerica. Early Horizon evidence of ballgame paraphernalia both identical to and different from that of the Gulf Coast Olmec can be seen on figurines from coastal Chiapas and the central highlands of Mexico, respectively. The Mexican state of Oaxaca, however, has yielded little data on early involvement in the ballgame. The discovery of a ballplayer figurine in the Mixteca Alta region of Oaxaca demonstrates the early participation of this region in the iconography and ideology of the ballgame. In lieu of an actual ballcourt, the focus may have been on the symbolic component of ballplayers and their association with supernatural forces, as part of emerging leaders' legitimization strategies.

  14. 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.

  15. OEM Emergency Preparedness Information

    Data.gov (United States)

    U.S. Environmental Protection Agency — The Office of Emergency Management compiles a wide variety of information in support of Emergency Preparedness, including certain elements of the System for Risk...

  16. Searle on Emergence

    Czech Academy of Sciences Publication Activity Database

    Havlík, Vladimír

    2012-01-01

    Roč. 19, Supp.2 (2012), s. 40-48 ISSN 1335-0668 Institutional support: RVO:67985955 Keywords : emergence * mind * consciousness * emergent property * system property Subject RIV: AA - Philosophy ; Religion

  17. Emerging noninfectious diseases

    Directory of Open Access Journals (Sweden)

    Ezequiel Consiglio

    Full Text Available In recent years, emerging diseases were defined as being infectious, acquiring high incidence, often suddenly, or being a threat or an unexpected phenomenon. This study discusses the hallmarks of emerging diseases, describing the existence of noninfectious emerging diseases, and elaborating on the advantages of defining noninfectious diseases as emerging ones. From the discussion of various mental health disorders, nutritional deficiencies, external injuries and violence outcomes, work injuries and occupational health, and diseases due to environmental factors, the conclusion is drawn that a wide variety of noninfectious diseases can be defined as emergent. Noninfectious emerging diseases need to be identified in order to improve their control and management. A new definition of "emergent disease" is proposed, one that emphasizes the pathways of emergence and conceptual traits, rather than descriptive features.

  18. Dog Bite Emergencies

    Science.gov (United States)

    ... Emergency Care Animal Welfare Veterinary Careers Public Health Dog Bite Emergencies What do I do if I’ ... vaccination records. What do I do if my dog bites someone? Dog bites are scary for everyone ...

  19. Is it an Emergency?

    Science.gov (United States)

    ... I Waiting So Long? Admission to the Hospital Heroes on Medicine's Front Line Observation Emergency Care Fact ... The dispatcher may need more information. Teach your children how to place an emergency call, in case ...

  20. Nuclear emergency preparedness: national organisation

    International Nuclear Information System (INIS)

    El Messaoudi, M.; Essadki, H.; Lferde, M.; Moutia, Z.

    2006-01-01

    As in all other industries, the nuclear facilities can be the object of accidents whose consequences go beyond the limits of their site and consequently radioactive releases would be issued in the environment justifying the protection measures of population. Even if all the precautions were taken during the stages from the design to the operation, to reduce the risk of accident in nuclear installations, this risk can not be completely suppressed. For the radiological risk, as for the other major risks, the protection of the public always was taken in consideration by public power. The nuclear emergency plan gives the opportunity to have a quick appropriate reaction to a sudden event, which has (or might have) direct consequences for the population. The Moroccan public authorities had proceeded to reinforce at the national level, the control of nuclear safety and protection against radiation by the set up of a new nuclear safety authority. Evidently, the organization and the management of a nuclear and/or radiological emergency were at centre of this reform. Taking into account the subjective risk of radiological terrorism, the authorities should reinforce measurements guaranteeing radiological safety and security, and elaborate the appropriate emergency plans. The aim of this paper is to give a progress report on nuclear emergency plan aspects and to present a corresponding organization which could be applied by national authority. (authors)

  1. Harwell emergency handbook

    International Nuclear Information System (INIS)

    1986-12-01

    The Harwell Laboratory Emergency Handbook 1987 contains emergency procedures to deal with any incident which might occur at AERE Harwell involving radioactive or toxic material releases. The Handbook gives details of the duties of members of the Site Emergency Organization and other key members of staff, the methods by which incidents are controlled, the communication links and liaison arrangements with other organizations and the possible consequences and actions that may be needed following an emergency. (UK)

  2. Derivatives in emerging markets

    OpenAIRE

    Dubravko Mihaljek; Frank Packer

    2010-01-01

    Turnover of derivatives has grown more rapidly in emerging markets than in developed countries. Foreign exchange derivatives are the most commonly traded of all risk categories, with increasingly frequent turnover in emerging market currencies and a growing share of cross-border transactions. As the global reach of the financial centres in emerging Asia has expanded, the offshore trading of many emerging market currency derivatives has risen as well. Growth in derivatives turnover is positive...

  3. Surgical emergencies in oncology

    NARCIS (Netherlands)

    Bosscher, M. R. F.; van Leeuwen, Barbara; Hoekstra, Harald

    An oncologic emergency is defined as an acute, potentially life threatening condition in a cancer patient that has developed as a result of the malignant disease or its treatment. Many oncologic emergencies are signs of advanced, end-stage malignant disease. Oncologic emergencies can be divided into

  4. Emerging technology and ethics

    CERN Document Server

    Wakunuma, Kutoma

    2011-01-01

    This e-book on Emerging Technologies and Ethics includes a collection of essays which explore the future and ethics of emerging information and communication technologies. Articles in the collection include an overview of the legal implications which may be relevant to the ethical aspects of emerging technologies and also ethical issues arising from the mass-take up of mobile technologies.

  5. Characterization of radiological emergencies

    International Nuclear Information System (INIS)

    Chester, C.V.

    1986-01-01

    This paper identifies conditions that should be considered by the designers of mobile teleoperator equipment intended for service in radiological emergencies. We include a definition of radiological emergency and a taxonomy of emergencies. We will indicate the range of operating conditions that an equipment designer should consider and the type of operations that his machine might be expected to perform. 2 refs., 1 tab

  6. Neurologic emergencies in sports.

    Science.gov (United States)

    Williams, Vernon B

    2014-12-01

    Sports neurology is an emerging area of subspecialty. Neurologists and non-neurologists evaluating and managing individuals participating in sports will encounter emergencies that directly or indirectly involve the nervous system. Since the primary specialty of sports medicine physicians and other practitioners involved in the delivery of medical care to athletes in emergency situations varies significantly, experience in recognition and management of neurologic emergencies in sports will vary as well. This article provides a review of information and elements essential to neurologic emergencies in sports for the practicing neurologist, although content may be of benefit to readers of varying background and expertise. Both common neurologic emergencies and less common but noteworthy neurologic emergencies are reviewed in this article. Issues that are fairly unique to sports participation are highlighted in this review. General concepts and principles related to treatment of neurologic emergencies that are often encountered unrelated to sports (eg, recognition and treatment of status epilepticus, increased intracranial pressure) are discussed but are not the focus of this article. Neurologic emergencies can involve any region of the nervous system (eg, brain, spine/spinal cord, peripheral nerves, muscles). In addition to neurologic emergencies that represent direct sports-related neurologic complications, indirect (systemic and generalized) sports-related emergencies with significant neurologic consequences can occur and are also discussed in this article. Neurologists and others involved in the care of athletes should consider neurologic emergencies in sports when planning and providing medical care.

  7. [Emergent viral infections

    NARCIS (Netherlands)

    Galama, J.M.D.

    2001-01-01

    The emergence and re-emergence of viral infections is an ongoing process. Large-scale vaccination programmes led to the eradication or control of some viral infections in the last century, but new viruses are always emerging. Increased travel is leading to a rise in the importation of exotic

  8. Emergency laparoscopy – current best practice

    Directory of Open Access Journals (Sweden)

    Paraskeva Paraskevas

    2006-08-01

    Full Text Available Abstract Emergency laparoscopic surgery allows both the evaluation of acute abdominal pain and the treatment of many common acute abdominal disorders. This review critically evaluates the current evidence base for the use of laparoscopy, both diagnostic and interventional, in the emergency abdomen, and provides guidance for surgeons as to current best practise. Laparoscopic surgery is firmly established as the best intervention in acute appendicitis, acute cholecystitis and most gynaecological emergencies but requires further randomised controlled trials to definitively establish its role in other conditions.

  9. Advertising Emergency Department Wait Times

    Science.gov (United States)

    Weiner, Scott G.

    2013-01-01

    Advertising emergency department (ED) wait times has become a common practice in the United States. Proponents of this practice state that it is a powerful marketing strategy that can help steer patients to the ED. Opponents worry about the risk to the public health that arises from a patient with an emergent condition self-triaging to a further hospital, problems with inaccuracy and lack of standard definition of the reported time, and directing lower acuity patients to the higher cost ED setting instead to primary care. Three sample cases demonstrating the pitfalls of advertising ED wait times are discussed. Given the lack of rigorous evidence supporting the practice and potential adverse effects to the public health, caution about its use is advised. PMID:23599836

  10. Emergent universe with wormholes in massive gravity

    Science.gov (United States)

    Paul, B. C.; Majumdar, A. S.

    2018-03-01

    An emergent universe (EU) scenario is proposed to obtain a universe free from big-bang singularity. In this framework the present universe emerged from a static Einstein universe phase in the infinite past. A flat EU scenario is found to exist in Einstein’s gravity with a non-linear equation of state (EoS). It has been shown subsequently that a physically realistic EU model can be obtained considering cosmic fluid composed of interacting fluids with a non-linear equation of state. It results a viable cosmological model accommodating both early inflation and present accelerating phases. In the present paper, the origin of an initial static Einstein universe needed in the EU model is explored in a massive gravity theory which subsequently emerged to be a dynamically evolving universe. A new gravitational instanton solution in a flat universe is obtained in the massive gravity theory which is a dynamical wormhole that might play an important role in realizing the origin of the initial state of the emergent universe. The emergence of a Lorentzian universe from a Euclidean gravity is understood by a Wick rotation τ = i t . A universe with radiation at the beginning finally transits into the present observed universe with a non-linear EoS as the interactions among the fluids set in. Thus a viable flat EU scenario where the universe stretches back into time infinitely, with no big bang is permitted in a massive gravity.

  11. India emerging: New financial architecture

    Directory of Open Access Journals (Sweden)

    Sankarshan Basu

    2016-09-01

    Full Text Available The global financial crisis of 2007–2008 highlighted the need to re-evaluate several well established tenets in the world of finance. Questions have been raised the world over about the existing paradigm, leading to an acceptance that new financial architecture needed to be evolved and that new models need to emerge, keeping in mind the multiplicity of socio-economic realities that exist round the globe. In this context, the imperative for a new financial architecture in India is quite evident, and the ensuing panel discussion throws up some India-specific issues that need to be explored by the various stakeholders involved in this attempt.

  12. Color on emergency mapping

    Science.gov (United States)

    Jiang, Lili; Qi, Qingwen; Zhang, An

    2007-06-01

    There are so many emergency issues in our daily life. Such as typhoons, tsunamis, earthquake, fires, floods, epidemics, etc. These emergencies made people lose their lives and their belongings. Every day, every hour, even every minute people probably face the emergency, so how to handle it and how to decrease its hurt are the matters people care most. If we can map it exactly before or after the emergencies; it will be helpful to the emergency researchers and people who live in the emergency place. So , through the emergency map, before emergency is occurring we can predict the situation, such as when and where the emergency will be happen; where people can refuge, etc. After disaster, we can also easily assess the lost, discuss the cause and make the lost less. The primary effect of mapping is offering information to the people who care about the emergency and the researcher who want to study it. Mapping allows the viewers to get a spatial sense of hazard. It can also provide the clues to study the relationship of the phenomenon in emergency. Color, as the basic element of the map, it can simplify and clarify the phenomenon. Color can also affects the general perceptibility of the map, and elicits subjective reactions to the map. It is to say, structure, readability, and the reader's psychological reactions can be affected by the use of color.

  13. Update on emergency contraception.

    Science.gov (United States)

    Fok, Wing Kay; Blumenthal, Paul D

    2016-12-01

    Emergency contraception provides a critical and time-sensitive opportunity for women to prevent undesired pregnancy after intercourse. Both access and available options for emergency contraception have changed over the last several years. Emergency contraceptive pills can be less effective in obese women. The maximum achieved serum concentration of levonorgestrel (LNG) is lower in obese women than women of normal BMI, and doubling the dose of LNG (3 mg) increases its concentration maximum, approximating the level in normal BMI women receiving one dose of LNG. Repeated use of both LNG and ulipristal acetate (UPA) is well tolerated. Hormonal contraception can be immediately started following LNG use, but should be delayed for 5 days after UPA use to avoid dampening the efficacy of UPA. The copper intrauterine device (IUD) is the only IUD approved for emergency contraception (and the most effective method of emergency contraception), but use of LNG IUD as emergency contraception is currently being investigated. Accurate knowledge about emergency contraception remains low both for patients and healthcare providers. Emergency contraception is an important yet underutilized tool available to women to prevent pregnancy. Current options including copper IUD and emergency contraceptive pills are safe and well tolerated. Significant gaps in knowledge of emergency contraception on both the provider and user level exist, as do barriers to expedient access of emergency contraception.

  14. Train operation in emergencies

    CERN Document Server

    Jia, Limin; Qin, Yong

    2017-01-01

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

  15. Defining an emerging disease.

    Science.gov (United States)

    Moutou, F; Pastoret, P-P

    2015-04-01

    Defining an emerging disease is not straightforward, as there are several different types of disease emergence. For example, there can be a 'real' emergence of a brand new disease, such as the emergence of bovine spongiform encephalopathy in the 1980s, or a geographic emergence in an area not previously affected, such as the emergence of bluetongue in northern Europe in 2006. In addition, disease can emerge in species formerly not considered affected, e.g. the emergence of bovine tuberculosis in wildlife species since 2000 in France. There can also be an unexpected increase of disease incidence in a known area and a known species, or there may simply be an increase in our knowledge or awareness of a particular disease. What all these emerging diseases have in common is that human activity frequently has a role to play in their emergence. For example, bovine spongiform encephalopathy very probably emerged as a result of changes in the manufacturing of meat-and-bone meal, bluetongue was able to spread to cooler climes as a result of uncontrolled trade in animals, and a relaxation of screening and surveillance for bovine tuberculosis enabled the disease to re-emerge in areas that had been able to drastically reduce the number of cases. Globalisation and population growth will continue to affect the epidemiology of diseases in years to come and ecosystems will continue to evolve. Furthermore, new technologies such as metagenomics and high-throughput sequencing are identifying new microorganisms all the time. Change is the one constant, and diseases will continue to emerge, and we must consider the causes and different types of emergence as we deal with these diseases in the future.

  16. Nível do câmbio e crescimento econômico: teorias e evidências para países em desenvolvimento e emergentes Exchange rate levels and economic growth: theoretical analysis and empirical evidence for developing and emerging countries

    Directory of Open Access Journals (Sweden)

    Eliane Cristina de Araújo

    2010-12-01

    Full Text Available O artigo analisa, teórica e empiricamente, a relação entre nível da taxa de câmbio e crescimento econômico nos países em desenvolvimento. Inicialmente, os objetivos da política cambial são discutidos, enfatizando sua importância como instrumento gerador de crescimento econômico. Dando continuidade, alguns canais de influência do nível da taxa de câmbio sobre o crescimento econômico são apontados: (i os canais do investimento; (ii da exportação dos bens não tradicionais; (iii do desempenho do setor de bens comercializáveis; (iv da compensação às falhas de mercado e falhas contratuais; e (v de estímulo às elasticidades-renda das exportações. Na parte empírica, uma medida de subvalorização cambial é construí-da para 82 países em desenvolvimento entre 1980 e 2007. Essa medida é empregada para captar a relação entre taxa de câmbio desvalorizada e crescimento econômico. Os resultados indicam uma correlação positiva e significante entre a medida de subvalorização cambial construída e o crescimento econômico nos países que fazem parte da amostra.The article analyses, theoretically and empirically, the relationship between exchange rate level and economic growth in emerging and developing countries. Firstly, the exchange rate policy objectives are discussed, emphasizing the importance of this policy to generate economic growth. Continuing, the article explores the channels through which exchange rates can affect economic growth, highlighting its stimulus to investment, export of non-traditional goods, productivity as well as its compensation to market failures and its stimulus to export income-elasticity. In the empirical part, a measure of exchange rate undervaluation based on Rodrik (2007 is built for 82 emerging and developing countries, between 1980 and 2007. This measure is used to investigate the relationship between devalued exchange rate and economic growth, by econometric techniques for panel data

  17. Emergency teams in Danish emergency departments.

    Science.gov (United States)

    Lafrenz, Thomas; Lindberg, Søren Østergaard; La Cour, Jeppe Lerche; Folkestad, Lars; Hallas, Peter; Brabrand, Mikkel

    2012-06-01

    The use of designated emergency teams for cardiac arrest and trauma patients is widely implemented. However, the use of designated teams in Danish emergency departments (EDs) has not been investigated. Our aim was to investigate the use and staffing of emergency teams in Danish EDs. A cross-sectional questionnaire study was sent to all 20 Danish EDs designated for emergency care. The response rate was 95% (n = 19). Three EDs were excluded due to incomplete data. All EDs (n = 16) received critically ill patients, cardiac arrests and trauma patients. In all EDs, a designated team responded to cardiac arrest (CAT) and trauma patients (TT). Only 31% of EDs had access to a designated medical emergency team (MET). CAT consisted of a median of six (range 5-10) different personnel groups. Of these, three (1-6) were physicians and only one (0-2) was a senior physician. TTs consisted of a median of nine (7-11) different personnel groups. Of these, four (2-6) were physicians, and three (2-4) were senior physicians. In 25% of the EDs, there was no access to a MET. In 31% of the EDs, an ad hoc-team was created. In 14%, a team was created by the attending emergency physician. The staffing of ad hoc-teams relied on diagnosis, symptoms and triage scores. Designated teams for patients in cardiac arrest and trauma patients are available in all Danish EDs. More senior staff form part of trauma teams than cardiac arrest teams. There is limited access to designated teams caring for critically ill medical patients in Danish EDs.

  18. KAERI Radiological Emergency Plan

    Energy Technology Data Exchange (ETDEWEB)

    Oui, Khang Byung; Lee, Goan Yup; Lee, Jong Tai

    2004-06-15

    The Radiological Emergency Plan of KAERI is to draw up based on the Civil Defence Law, the Disaster and Safety Management Law, the Act of Physical Protection and Emergency Preparedness in Nuclear Facilities, the National Radiological Emergency Plan, and made reference to the DOE order and IAEA TECDOC etc. This plan describes the preventive measures, emergency response, re-entry and restoration to ensure adequate response capabilities to the nuclear accidents which would cause a significant risk to the KAERI staffs and the public near to the site. And the Operation of Radiological Emergency Management System is included in this plan to test the effectiveness of this plan and to improve the response capabilities of the emergency staffs against nuclear accidents.

  19. Linking Emerging Infectious Diseases Research and Policy ...

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

    In China and Southeast Asia, the lack of policy or regulation enforcements means that the use of antibiotics is not well-controlled. This research will provide evidence and guidance to develop country-specific and regional strategies to improve the responsible use of antibiotics and to reduce the emergence of resistant ...

  20. Emergency pediatric radiology

    Energy Technology Data Exchange (ETDEWEB)

    Carty, H. [ed.

    1999-11-01

    This unique book covers the main clinical presentations of children to an emergency room and considers in detail the radiological investigation of such emergencies. Numerous high-quality illustrations of the radiological manifestations of acutely presenting illness in children ensure that the volume will serve as a rapid reference source for both pediatricians and radiologists. All of the authors are specialist pediatric radiologists who provide emergency radiological services on a daily basis, and the text reflects this level of expertise. (orig.)

  1. Theoretical magnetic flux emergence

    OpenAIRE

    MacTaggart, David

    2011-01-01

    Magnetic flux emergence is the subject of how magnetic fields from the solar interior can rise and expand into the atmosphere to produce active regions. It is the link that joins dynamics in the convection zone with dynamics in the atmosphere. In this thesis, we study many aspects of magnetic flux emergence through mathematical modelling and computer simulations. Our primary aim is to understand the key physical processes that lie behind emergence. The first chapter intro...

  2. Flux Emergence (Theory)

    Science.gov (United States)

    Cheung, Mark C. M.; Isobe, Hiroaki

    2014-07-01

    Magnetic flux emergence from the solar convection zone into the overlying atmosphere is the driver of a diverse range of phenomena associated with solar activity. In this article, we introduce theoretical concepts central to the study of flux emergence and discuss how the inclusion of different physical effects (e.g., magnetic buoyancy, magnetoconvection, reconnection, magnetic twist, interaction with ambient field) in models impact the evolution of the emerging field and plasma.

  3. Energy emergency handbook

    Energy Technology Data Exchange (ETDEWEB)

    1979-01-01

    This Handbook identifies selected state and federal measures available to mitigate the impact of an energy emergency, and provides a comprehensive energy emergency communications directory. In the case of state remedial actions, particular emphasis has been placed on typical implementation procedures and likely impacts. The discussions of federal actions focus on initation and implementation procedures. The directory is designed to facilitate communications of all types (telephone, Telex, TWX, or facsimile) among key energy emergency officials in the federal and state governments.

  4. Emergency department management of priapism [digest].

    Science.gov (United States)

    Podolej, Gregory S; Babcock, Christine; Kim, Jeremy

    2017-01-22

    Priapism is a genitourinary emergency that demands a thorough, time-sensitive evaluation. There are 3 types of priapism: ischemic, nonischemic, and recurrent ischemic priapism; ischemic priapism accounts for 95% of cases. Ischemic priapism must be treated within 4 to 6 hours to minimize morbidity, including impotence. The diagnosis of ischemic priapism relies heavily on the history and physical examination and may be facilitated by penile blood gas analysis and penile ultrasound. This issue reviews current evidence regarding emergency department treatment of ischemic priapism using a stepwise approach that begins with aspiration of cavernosal blood, cold saline irrigation, and penile injection with sympathomimetic agents. Evidence-based management and appropriate urologic follow-up of nonischemic and recurrent ischemic priapism maximizes patient outcomes and resource utilization. [Points & Pearls is a digest of Emergency Medicine Practice].

  5. Chemical Emergencies Overview

    Science.gov (United States)

    ... Fact Sheet: Hazardous Substances Emergency Events Surveillance System Hazardous Substances in the Environment Medical Management Guidelines for Acute Chemical Exposures ToxFAQs American Association ...

  6. Radiological Emergency Response Data

    Data.gov (United States)

    U.S. Environmental Protection Agency — Quality Data Asset includes all current and historical emergency radiological response event and incident of national significance data and surveillance, monitoring,...

  7. Inspection of Emergency Arrangements

    International Nuclear Information System (INIS)

    2013-01-01

    The Working Group on Inspection Practices (WGIP) was tasked by the NEA CNRA to examine and evaluate the extent to which emergency arrangements are inspected and to identify areas of importance for the development of good inspection practices. WGIP members shared their approaches to the inspection of emergency arrangements by the use of questionnaires, which were developed from the requirements set out in IAEA Safety Standards. Detailed responses to the questionnaires from WGIP member countries have been compiled and are presented in the appendix to this report. The following commendable practices have been drawn from the completed questionnaires and views provided by WGIP members: - RBs and their Inspectors have sufficient knowledge and information regarding operator's arrangements for the preparedness and response to nuclear emergencies, to enable authoritative advice to be given to the national coordinating authority, where necessary. - Inspectors check that the operator's response to a nuclear emergency is adequately integrated with relevant response organisations. - Inspectors pay attention to consider the integration of the operator's response to safety and security threats. - The efficiency of international relations is checked in depth during some exercises (e.g. early warning, assistance and technical information), especially for near-border facilities that could lead to an emergency response abroad. - RB inspection programmes consider the adequacy of arrangements for emergency preparedness and response to multi-unit accidents. - RBs assess the adequacy of arrangements to respond to accidents in other countries. - The RB's role is adequately documented and communicated to all agencies taking part in the response to a nuclear or radiological emergency. - Inspectors check that threat assessments for NPPs have been undertaken in accordance with national requirements and that up-to-date assessments have been used as the basis for developing emergency plans for

  8. Evidence of multifractality from emerging European stock markets.

    Science.gov (United States)

    Caraiani, Petre

    2012-01-01

    We test for the presence of multifractality in the daily returns of the three most important stock market indices from Central and Eastern Europe, Czech PX, Hungarian BUX and Polish WIG using the Empirical Mode Decomposition based Multifractal Detrended Fluctuation Analysis. We found that the global Hurst coefficient varies with the q coefficient and that there is multifractality evidenced through the multifractal spectrum. The exercise is replicated for the sample around the high volatility period corresponding to the last global financial crisis. Although no direct link has been found between the crisis and the multifractal spectrum, the crisis was found to influence the overall shape as quantified through the norm of the multifractal spectrum.

  9. Nutraceuticals as natural healers: Emerging evidences | Ali | African ...

    African Journals Online (AJOL)

    The protective effects of tocotrienols in flax seed oil, the curcuminoids in turmeric, carotenoids in carrots, flavonoids in fruits/vegetables, omega-3 fatty acids in sea foods, allyl-sulfides in garlic and -glucans in mush-rooms/cereals are few common examples to be cited here. Excess saturated fat is attributed to pose adverse ...

  10. Household Expenditures on Private Tutoring: Emerging Evidence from Malaysia

    Science.gov (United States)

    Kenayathulla, Husaina Banu

    2013-01-01

    Private tutoring has been a burgeoning phenomenon in Malaysia for decades. This study examines the determinants of private tutoring expenditures in Malaysia using the 2004/2005 Household Expenditures Survey and applies hurdle regression models to the data. The results indicate that total household expenditures, household head's level of education,…

  11. Brain-kidney cross-talk: Definition and emerging evidence.

    Science.gov (United States)

    Afsar, Baris; Sag, Alan A; Yalcin, Can Ege; Kaya, Eren; Siriopol, Dimitrie; Goldsmith, David; Covic, Adrian; Kanbay, Mehmet

    2016-12-01

    Cross-talk is broadly defined as endogenous homeostatic signaling between vital organs such as the heart, kidneys and brain. Kidney-brain cross-talk remains an area with excitingly few publications despite its purported clinical relevance in the management of currently undertreated conditions such as resistant hypertension. Therefore, this review aims to establish an organ-specific definition for kidney-brain cross-talk and review the available and forthcoming literature on this topic. Copyright © 2016 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

  12. Food product design: emerging evidence for food policy.

    Science.gov (United States)

    Al-Hamdani, Mohammed; Smith, Steven

    2017-03-01

    The research on the impact of specific brand elements such as food descriptors and package colors is underexplored. We tested whether a "light" color and a "low-calorie" descriptor on food packages gain favorable consumer perception ratings as compared with regular packages. Our online experiment recruited 406 adults in a 3 (product type: Chips versus Juice versus Yoghurt) × 2 (descriptor type: regular versus low-calorie) × 2 (color type: regular versus light) mixed design. Dependent variables were sensory (evaluations of the product's nutritional value and quality), product-based (evaluations of the product's physical appeal), and consumer-based (evaluations of the potential consumers of the product) scales. "Low-calorie" descriptors were found to increase sensory ratings as compared with regular descriptors and light-colored packages received higher product-based ratings as compared with their regular-colored counterparts. Food package color and descriptors present a promising venue for understanding preventative measures against obesity.[Formula: see text].

  13. Traumatic hand injuries: the emergency clinician's evidence-based approach.

    Science.gov (United States)

    Andrade, Aaron; Hern, H Gene

    2011-06-01

    At the start of your Saturday afternoon shift, you are not surprised to see that several patients are waiting to be seen for physical injuries. The first patient is a 34-year-old woman who sustained injury to her hand while skiing, 2 hours prior to her arrival. She reports falling with her hand still tethered to the pole's grip, landing on her outstretched right hand. She felt a painful snap in her right thumb, which still hurts, but otherwise she did not sustain any other trauma. Her only complaint currently is pain at the base of the right thumb. The patient is otherwise completely healthy, has no past medical or surgical history, and takes no medications. Upon examination, the affected hand appears to be surprisingly normal except for mild tenderness and swelling over the ulnar aspect of her first metacarpophalangeal joint and mildly decreased strength in her pincher grasp. X-ray reveals no fracture. You wonder if there is additional testing that should be done to evaluate this injury. You move on to a second patient, a 24-year-old man who cut his ring finger knuckle when he punched a wall 2 days ago. Physical examination reveals a small puncture wound over the IV metacarpophalangeal joint with mild swelling, erythema, warmth, and decreased range of motion secondary to pain. X-ray reveals no fracture, but there's something suspicious about this case. A third patient is a 37-year-old industrial worker whose finger contacted the stream of a high-powered grease injector. Physical examination reveals a small puncture wound over the volar proximal interphalangeal joint of his left long finger, mild tenderness to palpation over the area, and slight decreased range of motion secondary to pain. You wonder if the injury is as benign as it looks.

  14. Emergence of a bacterial clone with enhanced virulence by acquisition of a phage encoding a secreted phospholipase A2.

    Science.gov (United States)

    Sitkiewicz, Izabela; Nagiec, Michal J; Sumby, Paul; Butler, Stephanie D; Cywes-Bentley, Colette; Musser, James M

    2006-10-24

    The molecular basis of pathogen clone emergence is relatively poorly understood. Acquisition of a bacteriophage encoding a previously unknown secreted phospholipase A(2) (designated SlaA) has been implicated in the rapid emergence in the mid-1980s of a new hypervirulent clone of serotype M3 group A Streptococcus. Although several lines of circumstantial evidence suggest that SlaA is a virulence factor, this issue has not been addressed experimentally. We found that an isogenic DeltaslaA mutant strain was significantly impaired in ability to adhere to and kill human epithelial cells compared with the wild-type parental strain. The mutant strain was less virulent for mice than the wild-type strain, and immunization with purified SlaA significantly protected mice from invasive disease. Importantly, the mutant strain was significantly attenuated for colonization in a monkey model of pharyngitis. We conclude that transductional acquisition of the ability of a GAS strain to produce SlaA enhanced the spread and virulence of the serotype M3 precursor strain. Hence, these studies identified a crucial molecular event underlying the evolution, rapid emergence, and widespread dissemination of unusually severe human infections caused by a distinct bacterial clone.

  15. Radiation monitoring strategy in nuclear or radiological emergencies

    International Nuclear Information System (INIS)

    Lahtinen, J.

    2003-01-01

    Full text: Radiation measurements provide indispensable data needed for the management of a nuclear or radiological emergency. There must exist pre-prepared emergency monitoring strategies, with accompanying procedures and methods, that help the authorities to perform measurements efficiently and, consequently, to evaluate the radiological situation correctly and to carry out proper countermeasures on time. However, defining a realistic yet comprehensive radiation monitoring strategy for emergencies is far from being an easy task. The very concept of 'emergency monitoring strategy' should be understood in a broad sense. In an ideal case, a strategy has interfaces with all related emergency and information exchange arrangements and agreements both at the national and international level. It covers all activities from the recognition of a potential hazard situation to environmental sampling performed during the late phases of an accident. It integrates routine-monitoring practices with the special requirements set by emergency monitoring and the use of fixed monitoring stations with that of mobile measurement teams. It includes elements for gathering, analyzing, transmitting and presenting data, as well as for combining them with different kinds of forecasts. It also takes into account the various intrinsic characteristics of possible threat scenarios and contains options for adapting measuring activities according to prevailing environmental conditions. Furthermore, a strategy must have relevant links to the social and economical realities and to the primary interests of different stakeholders. In order to assist individual countries in establishing national strategies, international organisations (IAEA, OECD/NEA, EU) have published basic guidelines for emergency response and radiation measurements. Nuclear accidents, especially the Chernobyl case with its large-scale environmental consequences, and other kinds of shocking events (like the one on September 11, 2001

  16. The relationship between emergence from spawning gravel and growth in farmed rainbow trout Oncorhynchus mykiss

    DEFF Research Database (Denmark)

    Åberg Andersson, Madelene; Laursen, Danielle Caroline; SILVA, P.I.M.

    2013-01-01

    The relationship between the timing of emergence from spawning gravel and growth after emergence was investigated in farmed Oncorhynchus mykiss. A relationship between the time of emergence and growth became evident after 6 months of rearing, where individuals with an intermediate emergence time...

  17. Emergências hipertensivas Hypertensive emergencies

    Directory of Open Access Journals (Sweden)

    Gilson Soares Feitosa-Filho

    2008-09-01

    Full Text Available As urgências e as emergências hipertensivas são ocorrências clínicas que podem representar mais de 25% dos atendimentos a urgências médicas. O médico deverá estar habilitado a diferenciá-las, pois o prognóstico e o tratamento são distintos. Estima-se que 3% de todas as visitas às salas de emergência decorrem de elevações significativas da pressão arterial. Nos quadros relacionados a estes atendimentos, a emergência hipertensiva é a entidade clínica mais grave que merece cuidados intensivos. É caracterizada por pressão arterial marcadamente elevada e sinais de lesões de órgãos-alvo (encefalopatia, infarto agudo do miocárdio, angina instável, edema agudo de pulmão, eclâmpsia, acidente vascular encefálico. O objetivo deste estudo foi apresentar os principais pontos sobre o seu apropriado diagnóstico e tratamento. Foi realizada busca por artigos originais com os unitermos "crise hipertensiva" e "emergência hipertensiva" nas bases de dados Pubmed e MedLine nos últimos dez anos. As referências disponíveis destes artigos foram verificadas. Os artigos foram identificados e revisados e o presente estudo condensa os principais resultados descritos. Para esta revisão foram considerados ensaios clínicos em língua inglesa, estudos retrospectivos e artigos de revisão. A crise hipertensiva é a entidade clínica com aumento súbito da PA (> 180 x 120 mmHg, acompanhada por sintomas, que podem ser leves (cefaléia, tontura, zumbido ou graves (dispnéia, dor precordial, coma e até morte, com ou sem lesão aguda de órgãos-alvo. Se os sintomas forem leves e sem lesão aguda de órgãos alvos, define-se a urgência hipertensiva. Se o quadro clínico apresentar risco de vida e refletir lesão aguda de órgãos-alvo têm-se, então, a emergência hipertensiva. Muitos pacientes também apresentam uma PA elevada demais, por não usarem suas medicações, tratando-se apenas de hipertensão arterial sistêmica crônica n

  18. Complement inhibition by Sarcoptes scabiei protects Streptococcus pyogenes - An in vitro study to unravel the molecular mechanisms behind the poorly understood predilection of S. pyogenes to infect mite-induced skin lesions.

    Science.gov (United States)

    Swe, Pearl M; Christian, Lindsay D; Lu, Hieng C; Sriprakash, Kadaba S; Fischer, Katja

    2017-03-01

    On a global scale scabies is one of the most common dermatological conditions, imposing a considerable economic burden on individuals, communities and health systems. There is substantial epidemiological evidence that in tropical regions scabies is often causing pyoderma and subsequently serious illness due to invasion by opportunistic bacteria. The health burden due to complicated scabies causing cellulitis, bacteraemia and sepsis, heart and kidney diseases in resource-poor communities is extreme. Co-infections of group A streptococcus (GAS) and scabies mites is a common phenomenon in the tropics. Both pathogens produce multiple complement inhibitors to overcome the host innate defence. We investigated the relative role of classical (CP), lectin (LP) and alternative pathways (AP) towards a pyodermic GAS isolate 88/30 in the presence of a scabies mite complement inhibitor, SMSB4. Opsonophagocytosis assays in fresh blood showed baseline immunity towards GAS. The role of innate immunity was investigated by deposition of the first complement components of each pathway, specifically C1q, FB and MBL from normal human serum on GAS. C1q deposition was the highest followed by FB deposition while MBL deposition was undetectable, suggesting that CP and AP may be mainly activated by GAS. We confirmed this result using sera depleted of either C1q or FB, and serum deficient in MBL. Recombinant SMSB4 was produced and purified from Pichia pastoris. SMSB4 reduced the baseline immunity against GAS by decreasing the formation of CP- and AP-C3 convertases, subsequently affecting opsonisation and the release of anaphylatoxin. Our results indicate that the complement-inhibitory function of SMSB4 promotes the survival of GAS in vitro and inferably in the microenvironment of the mite-infested skin. Understanding the tripartite interactions between host, parasite and microbial pathogens at a molecular level may serve as a basis to develop improved intervention strategies targeting scabies

  19. Critical differences between elective and emergency surgery: identifying domains for quality improvement in emergency general surgery.

    Science.gov (United States)

    Columbus, Alexandra B; Morris, Megan A; Lilley, Elizabeth J; Harlow, Alyssa F; Haider, Adil H; Salim, Ali; Havens, Joaquim M

    2018-04-01

    The objective of our study was to characterize providers' impressions of factors contributing to disproportionate rates of morbidity and mortality in emergency general surgery to identify targets for care quality improvement. Emergency general surgery is characterized by a high-cost burden and disproportionate morbidity and mortality. Factors contributing to these observed disparities are not comprehensively understood and targets for quality improvement have not been formally developed. Using a grounded theory approach, emergency general surgery providers were recruited through purposive-criterion-based sampling to participate in semi-structured interviews and focus groups. Participants were asked to identify contributors to emergency general surgery outcomes, to define effective care for EGS patients, and to describe operating room team structure. Interviews were performed to thematic saturation. Transcripts were iteratively coded and analyzed within and across cases to identify emergent themes. Member checking was performed to establish credibility of the findings. A total of 40 participants from 5 academic hospitals participated in either individual interviews (n = 25 [9 anesthesia, 12 surgery, 4 nursing]) or focus groups (n = 2 [15 nursing]). Emergency general surgery was characterized by an exceptionally high level of variability, which can be subcategorized as patient-variability (acute physiology and comorbidities) and system-variability (operating room resources and workforce). Multidisciplinary communication is identified as a modifier to variability in emergency general surgery; however, nursing is often left out of early communication exchanges. Critical variability in emergency general surgery may impact outcomes. Patient-variability and system-variability, with focus on multidisciplinary communication, represent potential domains for quality improvement in this field. Copyright © 2017 Elsevier Inc. All rights reserved.

  20. Emergency exercise scenario tools

    International Nuclear Information System (INIS)

    Sjoeblom, K.

    1998-03-01

    Nuclear power plant emergency exercises require a realistically presented accident situation which includes various aspects: plant process, radioactivity, radiation, weather and people. Experiences from nuclear power plant emergency exercises show that preparing accident scenarios even for relatively short exercises is tedious. In the future modern computer technology and past experience could be used for making exercise planning more effective. (au)

  1. [Emergency departments and psychiatry].

    Science.gov (United States)

    Cambon, Amandine; Very, Étienne; Schmitt, Laurent

    2014-12-01

    Psychiatric care is becoming an increasingly important part of general emergency departments. Historically incorporated into the psychiatric hospital, emergency mental health care has since been moved to the general hospital. This move was intended to boost the accessibility and deinstitutionalisation of psychiatry. The end of the "asylum" opened up new dialogue with the somatic care network.

  2. More about ... Emergency medicine

    African Journals Online (AJOL)

    11. More about ... Emergency medicine. Poisonous plants. Andreas Engelbrecht, MB ChB,. FCEM, MMed (Fam Med), Dip PEC,. DA, DTM&H. Adjunct Professor and Head, Division of. Emergency Medicine, Department of Family. Medicine, University of Pretoria and Steve Biko. Academic Hospital. A M Cilliers, MB ChB, DOH.

  3. Emergency presurgical visit

    Directory of Open Access Journals (Sweden)

    Alfredo Castro Díaz

    2009-07-01

    Full Text Available The objective has been to create a Protocol of Structured Presurgical Visit applicable to the patients who are undergoing an emergency surgery, to provide the user and his family all the necessary cares on the basis of those nursing diagnosis that prevail in all the cases of surgical emergency interventions. The used method has been an analysis of the emergency surgical interventions more prevalent from February 2007 until October 2008 in our area (a regional hospital, and statistic of those nursing diagnosis that more frequently appeared in these interventions, the previous moment to the intervention and in addition common to all of them. The results were the following ones: the more frequent emergency operations were: Caesarean, ginecological curettage, laparotomy, help in risk childbirth, orthopaedic surgery and appendectomy. The more frequent nursing diagnosis in all the emergency operations at the previous moment of the intervention were: risk of falls, pain, anxiety, deficit of knowledge, risk of infection, movement stress syndrome, risk of hemorrhage, cutaneous integrity deterioration. The conclusion is that users present at the previous moment to an emergency operation several problems, which force to the emergency surgical ward nurse to the introduction of the nursing methodology, in order to identify the problems, to mark results and to indicate the interventions to achieve those results, besides in a humanitarian way and with quality. This can be obtained by performing a Structured Emergency Presurgical Visit.

  4. Emergent Collaboration on Twitter

    DEFF Research Database (Denmark)

    Lundgaard, Daniel; Razmerita, Liana; Tan, Chee-Wee

    2018-01-01

    This paper explores the organizing elements that foster emergent collaboration within large-scale communities on online social platforms like Twitter. This study is based on a case study of the #BlackLivesMatter social movement and draws on organizing dynamics and online social network literature...... foster emergent collaboration in social movements using Twitter....

  5. Emerging wind energy technologies

    DEFF Research Database (Denmark)

    Rasmussen, Flemming; Grivel, Jean-Claude; Faber, Michael Havbro

    2014-01-01

    This chapter will discuss emerging technologies that are expected to continue the development of the wind sector to embrace new markets and to become even more competitive.......This chapter will discuss emerging technologies that are expected to continue the development of the wind sector to embrace new markets and to become even more competitive....

  6. Football emergency medicine

    African Journals Online (AJOL)

    With the planning and preparation for effective and efficient medical service provision during the 2010 FIFA World Cup South Africa, the collaboration between the disciplines of sports and emergency medicine has resulted in the dawning of the subspecialty of football emergency medicine. Sports physicians and related ...

  7. Management of Radiological emergencies

    International Nuclear Information System (INIS)

    Lentijo, J. C.; Gil, E.; San Nicolas, J.; Lazuen, J. A.

    2004-01-01

    Spain has a system of planning and response to emergency situations that is structured and coordinated by the General Directorship of civil Defense of the Ministry of the Interior and in which all levels of the Public Administration. state, autonomous and municipal-and owners of potentially hazardous activities participate. Activities involving a nuclear or radiological risk have specific emergency plans whose general principles are based on the general emergency system and whose technical bases are consistent with international practices and recommendations. The Consejo de Seguridad Nuclear actively participates in the design, implementation and activation of these plans, and for this purpose has an organization superimposed on its ordinary working organization that is activated in the event of an accident, as well as an Emergency Room specifically designed to deal with nuclear and radiological emergencies. (Author)

  8. Electric power emergency handbook

    Energy Technology Data Exchange (ETDEWEB)

    Labadie, J.R.

    1980-09-01

    The Emergency Electric Power Administration's Emergency Operations Handbook is designed to provide guidance to the EEPA organization. It defines responsibilities and describes actions performed by the government and electric utilities in planning for, and in operations during, national emergencies. The EEPA Handbook is reissued periodically to describe organizational changes, to assign new duties and responsibilities, and to clarify the responsibilities of the government to direct and coordinate the operations of the electric utility industry under emergencies declared by the President. This Handbook is consistent with the assumptions, policies, and procedures contained in the National Plan for Emergency Preparedness. Claimancy and restoration, communications and warning, and effects of nuclear weapons are subjects covered in the appendices.

  9. Educational program emergency planning.

    Science.gov (United States)

    Curtis, Tammy

    2009-01-01

    Tragic university shootings have prompted administrators of higher education institutions to re-evaluate their emergency preparedness plans and take appropriate measures for preventing and responding to emergencies. To review the literature and identify key components needed to prevent shootings at higher education institutions in the United States, and in particular, institutions housing radiologic science programs. Twenty-eight emergency preparedness plans were retrieved electronically and reviewed from a convenience sample of accredited radiologic science programs provided by the Joint Review Committee on Education in Radiologic Technology Web site. The review of the 28 emergency preparedness plans confirmed that most colleges are prepared for basic emergencies, but lack the key components needed to successfully address mass-casualty events. Only 5 (18%) of the 28 institutions addressed policies concerning school shootings.

  10. Chapter 10. Emergency preparedness

    International Nuclear Information System (INIS)

    2001-01-01

    Emergency preparedness is a set of measures the aim of which is to mitigate possible impacts of incident radiation accidents at nuclear installations and their consequences to the environment. Emergency Response Centre of Nuclear Regulatory Authority of the Slovak Republic (UJD) was established as a technical support tool of UJD to evaluate the technical conditions of nuclear installations and also for assessment of radiation situation in case of accident and for prognosis of development of possible accident and evolution of its impact on the population and the environment. At the same time it serves as an advisory body for the national Emergency Commission for the Radiation Accidents for planning of optimal protective measures focusing on minimising the impact on population and the vicinity of NPP. Besides of completion of emergency procedures related to NPPs Bohunice also the first part of procedures for NPP Mochovce and procedures using a new EU code system RODOS. In 2000 UJD focused activities in emergency preparedness area on inspections, approval of on-site emergency plans of nuclear installations, review of emergency transport orders and of-site emergency plans. In accordance with an UJD inspection plan the inspectors of UJD carried out several inspections in area of emergency preparedness at all NPPs. The inspections were focused on checking the emergency exercises, review of preparedness of NPP staff in the area of emergency planning and review of documentation. There were no important insufficiencies revealed during the inspections. During the year 2000 the exercises were performed at all nuclear installations and the emergency transport orders were exercised as well. Testing of communication, preparedness of individual members of emergency headquarters, co-operation, operability of emergency centres and exchange of information were the main tasks of these exercises. In March the emergency exercise at the National Radioactive waste Repository on Mochovce

  11. Is selection relevant in the evolutionary emergence of drug resistance?

    OpenAIRE

    Day, Troy; Huijben, Silvie; Read, Andrew F.

    2015-01-01

    The emergence of drug resistant pathogens is often considered a canonical case of evolution by ‘natural’ selection. Here we argue that the strength of selection can be a poor predictor of the rate of resistance emergence. It is possible for a resistant strain to be under negative selection and still emerge in an infection or spread in a population. Measuring the right parameters is a necessary first step towards the development of evidence-based resistance management strategies. We argue that...

  12. Contraceptive Availability During an Emergency Response in the United States

    Science.gov (United States)

    Ellington, Sascha R; Kourtis, Athena P; Curtis, Kathryn M; Tepper, Naomi; Gorman, Susan; Jamieson, Denise J; Zotti, Marianne; Barfield, Wanda

    2015-01-01

    This article provides the evidence for contraceptive need to prevent unintended pregnancy during an emergency response, discusses the most appropriate types of contraceptives for disaster situations, and details the current provisions in place to provide contraceptives during an emergency response. PMID:23421580

  13. New Zealand Emergency Medicine Network: a collaboration for acute care research in New Zealand.

    Science.gov (United States)

    2015-04-01

    The specialty of emergency medicine in Australasia is coming of age. As part of this maturation there is a need for high-quality evidence to inform practice. This article describes the development of the New Zealand Emergency Medicine Network, a collaboration of committed emergency care researchers who share the vision that New Zealand/Aotearoa will have a world-leading, patient-centred emergency care research network, which will improve emergency care for all, so that people coming to any ED in the country will have access to the same world-class emergency care. © 2015 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  14. An Overview of Evidence-Based Program Registers (EBPRs) for Behavioral Health

    Science.gov (United States)

    Burkhardt, Jason T.; Schröter, Daniela C.; Magura, Stephen; Means, Stephanie N.; Coryn, Chris L.S.

    2015-01-01

    Evaluations of behavioral health interventions have identified many that are potentially effective. However, clinicians and other decision makers typically lack the time and ability to effectively search and synthesize the relevant research literature. In response to this opportunity, and to increasing policy and funding pressures for the use of evidence-based practices, a number of “what works” websites have emerged to assist decision makers in selecting interventions with the highest probability of benefit. However, these registers as a whole are not well understood. This article, which represents phase one of a concurrent mixed methods study, presents a review of the scopes, structures, dissemination strategies, uses, and challenges faced by evidence-based registers in the behavioral health disciplines. The major findings of this study show that in general, registers of evidence-based practices are able, to a degree, to identify the most effective practices and meet the needs of decision makers. However, much needs to be done to improve the ability of the registers to fully realize their purpose. PMID:25450777

  15. Blog and Podcast Watch: Orthopedic Emergencies.

    Science.gov (United States)

    Grock, Andrew; Rezaie, Salim; Swaminathan, Anand; Min, Alice; Shah, Kaushal H; Lin, Michelle

    2017-04-01

    The WestJEM Blog and Podcast Watch presents high quality open-access educational blogs and podcasts in emergency medicine (EM) based on the ongoing ALiEM Approved Instructional Resources (AIR) and AIR-Professional series. Both series critically appraise resources using an objective scoring rubric. This installment of the Blog and Podcast Watch highlights the topic of orthopedic emergencies from the AIR series. The AIR series is a continuously building curriculum that follows the Council of Emergency Medicine Residency Directors (CORD) annual testing schedule. For each module, relevant content is collected from the top 50 Social Media Index sites published within the previous 12 months, and scored by eight AIR board members using five equally weighted measurement outcomes: Best Evidence in Emergency Medicine (BEEM) score, accuracy, educational utility, evidence based, and references. Resources scoring ≥30 out of 35 available points receive an AIR label. Resources scoring 27-29 receive an honorable mention label, if the executive board agrees that the post is accurate and educationally valuable. A total of 87 blog posts and podcasts were evaluated. Key educational pearls from the three AIR posts and the 14 honorable mentions are summarized. The WestJEM Blog and Podcast Watch series is based on the AIR and AIR-Pro series, which attempts to identify high quality educational content on open-access blogs and podcasts. This series provides an expert-based, post-publication curation of educational social media content for EM clinicians with this installment focusing on orthopedic emergencies.

  16. Acute oncological emergencies.

    LENUS (Irish Health Repository)

    Gabriel, J

    2012-01-01

    The number of people receiving systemic anti-cancer treatment and presenting at emergency departments with treatment-related problems is rising. Nurses will be the first point of contact for most patients and need to be able to recognise oncological emergencies to initiate urgent assessment of patients and referral to the acute oncology team so that the most appropriate care can be delivered promptly. This article discusses the role of acute oncology services, and provides an overview of the most common acute oncological emergencies.

  17. [Improving emergency department organisation].

    Science.gov (United States)

    Yordanov, Youri; Beltramini, Alexandra; Debuc, Erwan; Pateron, Dominique

    2015-01-01

    Emergency departments use has been constantly increasing over the world. Overcrowding is defined as a situation which compromises patient safety because of delayed cares. This situation is often reached. Emergency departments have to continuously improve their organization to be able to ensure the same quality of care to a higher number of patients. Thus a good organization is essential: it doesn't always avoid overcrowding. The rest of the hospital has to be involved in this process to ensure efficiency. We examine the various interventions and procedures that can be found in medical literature for improving patients flow and management in emergency departments.

  18. Leader emergence through interpersonal neural synchronization.

    Science.gov (United States)

    Jiang, Jing; Chen, Chuansheng; Dai, Bohan; Shi, Guang; Ding, Guosheng; Liu, Li; Lu, Chunming

    2015-04-07

    The neural mechanism of leader emergence is not well understood. This study investigated (i) whether interpersonal neural synchronization (INS) plays an important role in leader emergence, and (ii) whether INS and leader emergence are associated with the frequency or the quality of communications. Eleven three-member groups were asked to perform a leaderless group discussion (LGD) task, and their brain activities were recorded via functional near infrared spectroscopy (fNIRS)-based hyperscanning. Video recordings of the discussions were coded for leadership and communication. Results showed that the INS for the leader-follower (LF) pairs was higher than that for the follower-follower (FF) pairs in the left temporo-parietal junction (TPJ), an area important for social mentalizing. Although communication frequency was higher for the LF pairs than for the FF pairs, the frequency of leader-initiated and follower-initiated communication did not differ significantly. Moreover, INS for the LF pairs was significantly higher during leader-initiated communication than during follower-initiated communications. In addition, INS for the LF pairs during leader-initiated communication was significantly correlated with the leaders' communication skills and competence, but not their communication frequency. Finally, leadership could be successfully predicted based on INS as well as communication frequency early during the LGD (before half a minute into the task). In sum, this study found that leader emergence was characterized by high-level neural synchronization between the leader and followers and that the quality, rather than the frequency, of communications was associated with synchronization. These results suggest that leaders emerge because they are able to say the right things at the right time.

  19. Symmetry and emergence

    Science.gov (United States)

    Witten, Edward

    2018-02-01

    In a modern understanding of particle physics, global symmetries are approximate and gauge symmetries may be emergent. This view, which has echoes in condensed-matter physics, is supported by a variety of arguments from experiment and theory.

  20. Clustering of Emerging Flux

    Science.gov (United States)

    Ruzmaikin, A.

    1997-01-01

    Observations show that newly emerging flux tends to appear on the Solar surface at sites where there is flux already. This results in clustering of solar activity. Standard dynamo theories do not predict this effect.

  1. Winter Weather Emergencies

    Science.gov (United States)

    Severe winter weather can lead to health and safety challenges. You may have to cope with Cold related health ... Although there are no guarantees of safety during winter weather emergencies, you can take actions to protect ...

  2. Emergency medicine in space.

    Science.gov (United States)

    Stewart, Lowan H; Trunkey, Donald; Rebagliati, G Steve

    2007-01-01

    Recent events, including the development of space tourism and commercial spaceflight, have increased the need for specialists in space medicine. With increased duration of missions and distance from Earth, medical and surgical events will become inevitable. Ground-based medical support will no longer be adequate when return to Earth is not an option. Pending the inclusion of sub-specialists, clinical skills and medical expertise will be required that go beyond those of current physician-astronauts, yet are well within the scope of Emergency Medicine. Emergency physicians have the necessary broad knowledge base as well as proficiency in basic surgical skills and management of the critically ill and injured. Space medicine shares many attributes with extreme conditions and environments that many emergency physicians already specialize in. This article is an introduction to space medicine, and a review of current issues in the emergent management of medical and surgical disease during spaceflight.

  3. Radiation Emergencies - Multiple Languages

    Science.gov (United States)

    ... 简体中文) Expand Section Decontamination - 简体中文 (Chinese, Simplified (Mandarin dialect)) Bilingual PDF Health Information Translations Nuclear or Radiation Emergencies - 简体中文 (Chinese, Simplified (Mandarin ...

  4. Chemical Emergencies - Multiple Languages

    Science.gov (United States)

    ... Expand Section Chemical Emergencies - 简体中文 (Chinese, Simplified (Mandarin dialect)) Bilingual PDF Health Information Translations Decontamination - 简体中文 (Chinese, Simplified (Mandarin dialect)) Bilingual PDF ...

  5. Emerging Targets in Photopharmacology

    NARCIS (Netherlands)

    Lerch, Michael M.; Hansen, Mickel J.; van Dam, Gooitzen M.; Szymanski, Wiktor; Feringa, Ben L.

    2016-01-01

    The field of photopharmacology uses molecular photoswitches to establish control over the action of bioactive molecules. It aims to reduce systemic drug toxicity and the emergence of resistance, while achieving unprecedented precision in treatment. By using small molecules, photopharmacology

  6. Hypoglycemia in Emergency Department

    Directory of Open Access Journals (Sweden)

    Yu-Jang Su

    2015-03-01

    Conclusions: When hypoglycemic patients present in the emergency department, physicians should pay attention to the presence of infection, malignancy, liver diseases (liver cirrhosis and biliary tract infection, and acute renal failure.

  7. Emergency Notification System

    Data.gov (United States)

    US Agency for International Development — The USAID ENS provides quick and effective notification messages during any emergency affecting the Ronald Reagan Building, SA-44, Potomac Yards and USAID Washington...

  8. Emergency Nurses Association

    Science.gov (United States)

    ... Infectious Diseases Opioid Crisis Behavioral Health Infection Control Human Trafficking Membership Join Renew Membership Options Member Benefits Get ... to Train Emergency Nurses to Help Victims of Human Trafficking! MISSION ZERO Act for ZERO Preventable Deaths Support ...

  9. OEM Emergency Response Information

    Data.gov (United States)

    U.S. Environmental Protection Agency — The Office of Emergency Management retains records of all incident responses in which it participates. This data asset includes three major sources of information:...

  10. Blog and Podcast Watch: Cutaneous Emergencies

    Directory of Open Access Journals (Sweden)

    Andrew Grock

    2017-02-01

    Full Text Available The WestJEM Blog and Podcast Watch presents high quality open-access educational blogs and podcasts in emergency medicine (EM based on the ongoing Academic Life in Emergency Medicine (ALiEM Approved Instructional Resources (AIR and AIR-Professional series. Both series critically appraise resources using an objective scoring rubric. This installment of the Blog and Podcast Watch highlights the topic of cutaneous emergencies from the AIR series.    The AIR series is a continuously building curriculum that follows the Council of Emergency Medicine Residency Directors (CORD annual testing schedule. For each module, relevant content is collected from the top 50 most accessed sites per the Social Media Index published within the previous 12 months and scored by eight board members using five equally weighted measurement outcomes: Best Evidence in Emergency Medicine (BEEM score, accuracy, educational utility, evidence based, and references. Resources scoring ≥30 out of 35 available points receive an AIR label. Resources scoring 27-29 receive an “honorable mention” label, if the editorial board agrees that the post is accurate and educationally valuable. A total of 35 blog posts and podcasts were evaluated. None scored ≥30 points necessary for the AIR label, although four honorable mention posts were identified. Key educational pearls from these honorable mention posts are summarized. This Blog and Podcast Watch series is based on the AIR and AIR-Pro series, which attempts to identify high quality educational content on open-access blogs and podcasts. This series provides an expertbased, post-publication curation of educational social media content for EM clinicians with this installment focusing on cutaneous emergencies. [West J Emerg Med. 2017;18(2288-292.

  11. Emergency nurses' knowledge and self-rated practice skills when caring for older patients in the Emergency Department.

    Science.gov (United States)

    Rawson, Helen; Bennett, Paul N; Ockerby, Cherene; Hutchinson, Alison M; Considine, Julie

    2017-11-01

    Older adults are high users of emergency department services and their care requirements can present challenges for emergency nurses. Although clinical outcomes for older patients improve when they are cared for by nurses with specialist training, emergency nurses' knowledge and self-assessment of care for older patients is poorly understood. To assess emergency nurses' knowledge and self-rating of practice when caring for older patients. A cross-sectional self-report survey of emergency nurses (n=101) in Melbourne, Australia. Mean scores were 12.7 (SD 2.66) for the 25-item knowledge of older persons questionnaire, and 9.04 (SD 1.80) for the 15-item gerontic health related questions. Scores were unaffected by years of experience as a registered nurse or emergency nurse. More than 80% of nurses rated themselves as 'very good' or 'good' in assessing pain (94.9%), identifying delirium (87.8%), and identifying dementia (82.8%). Areas with a 'poor' ratings were identifying depression (46.5%), assessing polypharmacy (46.5%) and assessing nutrition (37.8%). There was variation in knowledge and self-rating of practice related to care of older patients. The relationship between knowledge and self-ratings of practice in relation to actual emergency nursing care of older people and patient outcomes warrants further exploration. Copyright © 2017 College of Emergency Nursing Australasia. Published by Elsevier Ltd. All rights reserved.

  12. Transfusion Related Emergencies

    OpenAIRE

    Osborn, Megan Boysen; Tran, Min-Ha

    2016-01-01

    Audience: This exercise is appropriate for all emergency medicine learners (residents and medical students) and learners from other specialties (internal medicine, family medicine, anesthesia). Introduction: About 85 million red blood cell units are transfused worldwide each year. Transfusion reactions can complicate up to 8% of blood transfusions and can range from benign to life threatening. An emergency physician must be able to discuss the risks and benefits of blood transfusion...

  13. Emerging topics in FXTAS

    DEFF Research Database (Denmark)

    Hall, Deborah A; Birch, Rachael C; Anheim, Mathieu

    2014-01-01

    This paper summarizes key emerging issues in fragile X-associated tremor/ataxia syndrome (FXTAS) as presented at the First International Conference on the FMR1 Premutation: Basic Mechanisms & Clinical Involvement in 2013.......This paper summarizes key emerging issues in fragile X-associated tremor/ataxia syndrome (FXTAS) as presented at the First International Conference on the FMR1 Premutation: Basic Mechanisms & Clinical Involvement in 2013....

  14. Emergency Communications Console

    Science.gov (United States)

    1978-01-01

    NASA has applied its communications equipment expertise to development of a communications console that provides, in a compact package only slightly larger than an electric typewriter, all the emergency medical services communications functions needed for a regional hospital. A prototype unit, built by Johnson Space Center, has been installed in the Odessa (Texas) Medical Center Hospital. The hospital is the medical control center for the 17-county Permian Basin Emergency Medical System in west Texas. The console project originated in response to a request to NASA from the Texas governor's office, which sought a better way of providing emergency medical care in rural areas. Because ambulance travel time is frequently long in remote areas of west Texas, it is important that treatment begin at the scene of the emergency rather than at the hospital emergency room. A radio and telephone system linking ambulance emergency technicians and hospital staff makes this possible. But earlier equipment was complex, requiring specialized operators. A highly reliable system was needed to minimize breakdowns and provide controls of utmost simplicity, so that the system could be operated by physicians and nurses rather than by communications specialists. The resulting console has both radio and telephone sections. With the radio equipment, hospital personnel can communicate with ambulance drivers and paramedics, receive incoming electrocardiagrams, consult with other hospitals, page hospital staff and set up a radio-to-telephone "patch." The telephone portion of the system includes a hotline from the Permian Basin Emergency Medical Service's resource control center, an automatic dialer for contacting special care facilities in the Permian Basin network, a hospital intercom terminal and a means of relaying cardioscope displays and other data between hospitals. The integrated system also provides links with local disaster and civil defense organizations and with emergency "Dial 911

  15. Design of emergency shield

    International Nuclear Information System (INIS)

    Soliman, S.E.

    1993-01-01

    Manufacturing of an emergency movable shield in the hot laboratories center is urgently needed for the safety of personnel in case of accidents or spilling of radioactive materials. In this report, a full design for an emergency shield is presented and the corresponding dose rates behind the shield for different activities (from 1 mCi to 5 Ci) was calculated by using micro shield computer code. 4 figs., 1 tab

  16. Emerging contaminants in groundwater

    OpenAIRE

    Stuart, M.E.; Manamsa, K.; Talbot, J.C.; Crane, E.J.

    2011-01-01

    The term ‘emerging contaminants’ is generally used to refer to compounds previously not considered or known to be significant to groundwater (in terms of distribution and/or concentration) which are now being more widely detected. As analytical techniques improve, previously undetected organic micropollutants are being observed in the aqueous environment. Many emerging contaminants remain unregulated, but the number of regulated contaminants will continue to grow slowly over th...

  17. Planning for nuclear emergencies

    International Nuclear Information System (INIS)

    Lakey, J.R.A.

    1989-01-01

    This paper aims to stimulate discussions between nuclear engineers and the radiological protection professions in order to facilitate planning for nuclear emergencies. A brief review is given of the response to nuclear accidents. Studying accidents can lead to prevention, but some effort must be put into emergency response. Such issues as decontamination and decommissioning, socio-economic consequences, education and training for nuclear personnel and exercises and drills, are raised. (UK)

  18. Accident and emergency management

    International Nuclear Information System (INIS)

    Andersen, V.; Moellenbach, K.; Heinonen, R.; Jakobsson, S.; Kukko, T.; Berg, Oe.; Larsen, J.S.; Westgaard, T.; Magnusson, B.; Andersson, H.; Holmstroem, C.; Brehmer, B.; Allard, R.

    1988-06-01

    There is an increasing potential for severe accidents as the industrial development tends towards large, centralised production units. In several industries this has led to the formation of large organisations which are prepared for accidents fighting and for emergency management. The functioning of these organisations critically depends upon efficient decision making and exchange of information. This project is aimed at securing and possibly improving the functionality and efficiency of the accident and emergency management by verifying, demonstrating, and validating the possible use of advanced information technology in the organisations mentioned above. With the nuclear industry in focus the project consists of five main activities: 1) The study and detailed analysis of accident and emergency scenarios based on records from incidents and rills in nuclear installations. 2) Development of a conceptual understanding of accident and emergency management with emphasis on distributed decision making, information flow, and control structure sthat are involved. 3) Development of a general experimental methodology for evaluating the effects of different kinds of decision aids and forms of organisation for emergency management systems with distributed decision making. 4) Development and test of a prototype system for a limited part of an accident and emergency organisation to demonstrate the potential use of computer and communication systems, data-base and knowledge base technology, and applications of expert systems and methods used in artificial intelligence. 5) Production of guidelines for the introduction of advanced information technology in the organisations based on evaluation and validation of the prototype system. (author)

  19. Industrial emerging chemicals in the environment

    Directory of Open Access Journals (Sweden)

    Vojinović-Miloradov Mirjana B.

    2014-01-01

    Full Text Available In the recent time, considerable interest has grown concerning the presence of the emerging industrial chemicals, EmIC. They are contaminants that have possible pathway to enter to the environment and they are dominantly released by industrial and anthropogenic activities. EmIC are applied in different fields using as industrial chemicals (new and recently recognized, global organic contaminants (flame retardant chemicals, pharmaceuticals (for both human and animal uses, endocrine-modulating compounds, biological metabolites, personal care products, household chemicals, nanomaterial (energy storage products, lubricants, anticorrosive and agriculture chemicals and others that are applied to a wide variety of everyday items such as clothing, upholstery, electronics and automobile interiors. NORMAN (Network of reference laboratories for monitoring of emerging environmental pollutants has established an open, dynamic, list of emerging substances and pollutants. EmIC have been recently detected in the environment due to their long-term presence, pseudo-persistence and increased use. Improvements in sophisticated analytical methods and time integrative passive sampling have enabled the identification and quantification of EmIC, in very low concentrations (ppb, ppt and lower, which likely have been present in all environmental mediums for decades. Passive technology is an innovative technique for the time-integrated measurement of emerging contaminants in water, sediment, soil and air. Passive samplers are simple handling cost-effective tool that could be used in environmental monitoring programmes. These devices are now being considered as a part of an emerging strategy for monitoring a range of emerging industrial chemicals and priority pollutants in the aquatic environment. EmIC are substances that are not included in the routine monitoring programmes and whose fate, behaviour and (ecotoxicological effects are still not well understood. Emerging

  20. Studying the emerging nuclear suppliers

    International Nuclear Information System (INIS)

    Rydell, R.F.

    1990-01-01

    None of these events---nor any of the many others that are cited in the case studies of this book---can be singled out as heralding a revolutionary transformation of the global nuclear marketplace. The cumulative effect of such developments, however, may well be the emergence of a market in the year 2000 that is far less concentrated than today's market for nuclear reactors and fuel cycle technology. If this gradual structural transformation is accompanied by the entry into the market of new buyers and sellers that do not accept the Nuclear Non-Proliferation Treaty (NPT), safeguards administered by the IAEA, or other international norms directed at preventing the spread of nuclear weapon capabilities, the result may indeed have revolutionary dimensions for the business, diplomacy, and research of nuclear energy. A similar outcome could arise even f these norms are widely accepted but are not matched by an increase in the resources available to national governments and key international agencies that implement these norms. This paper identifies some of the pitfalls that researchers often encounter in researching the emerging suppliers and will outline some basic ground rules to guide the collection and interpretation of empirical evidence on supplier behavior

  1. Evidence for the relationship between diet and cancer.

    Science.gov (United States)

    Ross, S A

    2010-09-01

    The relationship between diet and cancer has advanced in recent years, but much remains to be understood with respect to diet and dietary components in cancer risk and prevention. Evidence from clinical trial outcomes, epidemiological observations, preclinical models and cell culture systems have all provided clues about the biology of cancer prevention. Sequencing of the human genome has opened the door to an exciting new phase for nutritional science. There are also many advances in our understanding of the control of gene expression in eukaryotic cells that might impact cancer development, including mechanisms regulating chromatin structure and dynamics, epigenetic processes (DNA methylation, histone posttranslational modification), transcription factors, and noncoding RNA and evidence suggests that environmental factors such as diet influence these processes. Unraveling the effects of bioactive food components on genes and their encoded proteins as well as identifying genetic influences on dietary factors is essential for identifying those who will and will not benefit from intervention strategies for cancer prevention. Additional research needs concerning diet and cancer prevention include: identification and validation of cancer biomarkers and markers of dietary exposure; investigation of the exposure/temporal relationship between food component intakes and cancer prevention; examination of possible tissue specificity in response to dietary factors; and examination of interactions among bioactive food components as determinants of response. Other emerging areas that require greater attention include understanding the link between obesity, diet and cancer, the interaction between diet and the microbiome, as well as how bioactive food components modulate inflammatory processes. Importantly, for the future of nutrigenomics, the "omics" (e.g., genomics, epigenomics, transcriptomics, proteomics, metabolomics) approach may provide useful biomarkers of cancer

  2. Child Abuse: The Value of Systematic Screening at Emergency Rooms

    NARCIS (Netherlands)

    Sittig, J.S.

    2015-01-01

    There is no conclusive evidence that diagnostic tools detect physical child abuse among children coming to emergency rooms (ERs), but his evidence is urgently needed because both false-positive and false-negative diagnoses have serious adverse effects. This thesis describes several aspects of the

  3. Evidence, hierarchies, and typologies: horses for courses.

    Science.gov (United States)

    Petticrew, M; Roberts, H

    2003-07-01

    Debate is ongoing about the nature and use of evidence in public health decision making, and there seems to be an emerging consensus that the "hierarchy of evidence" may be difficult to apply in other settings. It may be unhelpful however to simply abandon the hierarchy without having a framework or guide to replace it. One such framework is discussed. This is based around a matrix, and emphasises the need to match research questions to specific types of research. This emphasis on methodological appropriateness, and on typologies rather than hierarchies of evidence may be helpful in organising and appraising public health evidence.

  4. Emergency Management of Myasthenia Gravis

    Science.gov (United States)

    ... to weakened throat muscles and accumulated secretions. EMERGENCY MANAGEMENT OF MG The MGFA mission is to facilitate ... fax mgfa@myasthenia.org • www.myasthenia.org EMERGENCY MANAGEMENT OF MG Emergency Management Important information for the ...

  5. Lung tissue mechanics as an emergent phenomenon.

    Science.gov (United States)

    Suki, Béla; Bates, Jason H T

    2011-04-01

    The mechanical properties of lung parenchymal tissue are both elastic and dissipative, as well as being highly nonlinear. These properties cannot be fully understood, however, in terms of the individual constituents of the tissue. Rather, the mechanical behavior of lung tissue emerges as a macroscopic phenomenon from the interactions of its microscopic components in a way that is neither intuitive nor easily understood. In this review, we first consider the quasi-static mechanical behavior of lung tissue and discuss computational models that show how smooth nonlinear stress-strain behavior can arise through a percolation-like process in which the sequential recruitment of collagen fibers with increasing strain causes them to progressively take over the load-bearing role from elastin. We also show how the concept of percolation can be used to link the pathologic progression of parenchymal disease at the micro scale to physiological symptoms at the macro scale. We then examine the dynamic mechanical behavior of lung tissue, which invokes the notion of tissue resistance. Although usually modeled phenomenologically in terms of collections of springs and dashpots, lung tissue viscoelasticity again can be seen to reflect various types of complex dynamic interactions at the molecular level. Finally, we discuss the inevitability of why lung tissue mechanics need to be complex.

  6. Streptococcus zooepidemicus: an emerging canine pathogen.

    Science.gov (United States)

    Priestnall, Simon; Erles, Kerstin

    2011-05-01

    Streptococcus equi subsp. zooepidemicus (S. zooepidemicus) has caused several outbreaks of haemorrhagic pneumonia in dogs in recent years. This highly contagious and often fatal disease is characterised by sudden onset of clinical signs including pyrexia, dyspnoea and haemorrhagic nasal discharge. Post mortem examination typically reveals pulmonary haemorrhage and pleural effusion. Histopathology demonstrates fibrino-suppurative, necrotising and haemorrhagic pneumonia in most cases. The pathogenesis of S. zooepidemicus infection in dogs is incompletely understood. Bacterial virulence factors as well as host factors may contribute to the severe outcome. S. zooepidemicus occasionally causes zoonotic infections with potentially serious consequences. Canine vaccines for S. zooepidemicus are currently not available and prevention of the disease therefore relies on limiting bacterial spread by implementing stringent control measures in kennels. Further research, particularly sequence analysis of canine strains, is required to gain insights into epidemiology and pathogenesis of this emerging disease. Copyright © 2010 Elsevier Ltd. All rights reserved.

  7. Information Systems Coordinate Emergency Management

    Science.gov (United States)

    2012-01-01

    -changing planet. This information can be captured, analyzed, and visualized by geographic information systems (GIS) to produce maps, charts, and other tools that can reveal information essential to a wide variety of applications including emergency management. Knowing precise, real-time information about the size, location, environmental conditions, and resulting damage of an event like a flood or wildfire as well as the location and numbers of emergency responders and other resources contributes directly to the effectiveness of disaster mitigation. The need for such information is also evident when responding to homeland security threats, such as a terrorist attack. Recognizing the value of its geospatial information resources for this and other purposes, in 1998 Stennis and the state of Mississippi partnered to form what became the Enterprise for Innovative Geospatial Solutions (EIGS) industry cluster, supporting the growth of remote sensing and GIS-based research and business. As part of EIGS, several companies partnered with NASA through dual use and Small Business Innovation Research (SBIR) contracts. Among those was NVision.

  8. Systems With Emergent Dynamics

    Science.gov (United States)

    Stewart, Ian

    2002-09-01

    Evolutionary biologists often reject deterministic models of evolutionary processes because they equate `deterministic' with `goal-seeking', and have learned the hard way not to trust goal-seeking explanations of evolutionary adaptations. On the other hand, the general theory of dynamical systems potentially has much to offer for evolutionary biology— for example, as a resolution of the conflict between gradualism and punctuated equilibrium. The concept of a system with emergent dynamics retains the deterministic nature of dynamical systems, while eliminating any goal-seeking interpretation. Define an emergent property of a complex system to be a property whose computation from the entity-level rules of the system is intractable (in some reasonable sense). Say that a dynamical system has emergent dynamics if the computation of trajectories is intractable. Then systems with emergent dynamics are deterministic but not goal-seeking. As such, they offer a sensible way to use dynamical systems as models for evolutionary processes in biology, and in other areas. We discuss these issues and examine a few simple aspects of emergence in dynamical systems.

  9. Abdominal emergencies during pregnancy.

    Science.gov (United States)

    Bouyou, J; Gaujoux, S; Marcellin, L; Leconte, M; Goffinet, F; Chapron, C; Dousset, B

    2015-12-01

    Abdominal emergencies during pregnancy (excluding obstetrical emergencies) occur in one out of 500-700 pregnancies and may involve gastrointestinal, gynecologic, urologic, vascular and traumatic etiologies; surgery is necessary in 0.2-2% of cases. Since these emergencies are relatively rare, patients should be referred to specialized centers where surgical, obstetrical and neonatal cares are available, particularly because surgical intervention increases the risk of premature labor. Clinical presentations may be atypical and misleading because of pregnancy-associated anatomical and physiologic alterations, which often result in diagnostic uncertainty and therapeutic delay with increased risks of maternal and infant morbidity. The most common abdominal emergencies are acute appendicitis (best treated by laparoscopic appendectomy), acute calculous cholecystitis (best treated by laparoscopic cholecystectomy from the first trimester through the early part of the third trimester) and intestinal obstruction (where medical treatment is the first-line approach, just as in the non-pregnant patient). Acute pancreatitis is rare, usually resulting from trans-ampullary passage of gallstones; it usually resolves with medical treatment but an elevated risk of recurrent episodes justifies laparoscopic cholecystectomy in the 2nd trimester and endoscopic sphincterotomy in the 3rd trimester. The aim of the present work is to review pregnancy-induced anatomical and physiological modifications, to describe the main abdominal emergencies during pregnancy, their specific features and their diagnostic and therapeutic management. Copyright © 2015. Published by Elsevier Masson SAS.

  10. Psychiatric service users' experiences of emergency departments

    DEFF Research Database (Denmark)

    Carstensen, Kathrine; Lou, Stina; Jensen, Lotte Groth

    2017-01-01

    Background: There is increased clinical and political attention towards integrating general and psychiatric emergency departments (ED). However, research into psychiatric service users’ experiences regarding general EDs is limited. Aim: To identify and summarize current, qualitative evidence rega...... the discomfort. Overall, the results of this review speak in favour of integrated EDs where service users’ needs are more likely to be recognized and accommodated.......Background: There is increased clinical and political attention towards integrating general and psychiatric emergency departments (ED). However, research into psychiatric service users’ experiences regarding general EDs is limited. Aim: To identify and summarize current, qualitative evidence...... regarding service users’ experiences attending EDs. A secondary aim is to apply and test the newly developed CERQual approach to summarizing qualitative review findings. Methods: A systematic literature review of five databases based on PRISMA guidelines yielded 3334 unique entries. Screening by title...

  11. Mechanisms of action of hormonal emergency contraceptives.

    Science.gov (United States)

    Leung, Vivian W Y; Levine, Marc; Soon, Judith A

    2010-02-01

    Hormonal emergency contraceptives have been used to prevent unwanted pregnancy for more than 3 decades. The mechanisms of action of the regimen containing a combination of estrogen and progestin, known as the Yuzpe regimen, and those of the levonorgestrel regimen continue to be controversial, especially over the possibility that these regimens might act by interfering with implantation of the fertilized ovum. We performed a search of the PubMed (1949-July 2009) and EMBASE (1980-July 2009) databases to identify literature on the mechanisms of action of these contraceptive regimens, and data were extracted from pertinent English-language studies. We classified studies according to the approach taken by the investigators to study the actions of emergency contraceptives on pregnancy: an indirect method that uses statistical models to determine whether emergency contraceptives would be as effective as reported if they act only by disrupting ovulation; direct observation of the effects of emergency contraceptives on surrogate outcomes, including ovulation, sperm activity, hormonal levels, and endometrial receptivity to implantation; and analysis of directly observed pregnancy outcomes against statistical data. Acceptability of emergency contraceptives by women and clinicians may depend on personal opinions about when life or pregnancy begins. The evidence strongly supports disruption of ovulation as a mechanism of action. The data suggest that emergency contraceptives are unlikely to act by interfering with implantation, although the possibility has not been completely excluded. The data also suggest that emergency contraceptives are ineffective after ovulation. Women and clinicians who consider implantation or later events to be the beginning of pregnancy should be aware that emergency contraceptives are likely nonabortive by this definition of pregnancy.

  12. Well Researched, Yet Little Understood: Young Adults and Physical Activity

    Science.gov (United States)

    Cothran, Donetta; Kulinna, Pamela Hodges

    2005-01-01

    The authors present two beginning studies. One investigated the teaching-style preferences of young adults, and the other looked at physical activity trends within this age group. One key to understanding young adults and physical activity is to recognize the importance of participant cognition on physical activity patterns. From this…

  13. Emotions are understood from biological motion across remote cultures.

    Science.gov (United States)

    Parkinson, Carolyn; Walker, Trent T; Memmi, Sarah; Wheatley, Thalia

    2017-04-01

    Patterns of bodily movement can be used to signal a wide variety of information, including emotional states. Are these signals reliant on culturally learned cues or are they intelligible across individuals lacking exposure to a common culture? To find out, we traveled to a remote Kreung village in Ratanakiri, Cambodia. First, we recorded Kreung portrayals of 5 emotions through bodily movement. These videos were later shown to American participants, who matched the videos with appropriate emotional labels with above chance accuracy (Study 1). The Kreung also viewed Western point-light displays of emotions. After each display, they were asked to either freely describe what was being expressed (Study 2) or choose from 5 predetermined response options (Study 3). Across these studies, Kreung participants recognized Western point-light displays of anger, fear, happiness, sadness, and pride with above chance accuracy. Kreung raters were not above chance in deciphering an American point-light display depicting love, suggesting that recognizing love may rely, at least in part, on culturally specific cues or modalities other than bodily movement. In addition, multidimensional scaling of the patterns of nonverbal behavior associated with each emotion in each culture suggested that similar patterns of nonverbal behavior are used to convey the same emotions across cultures. The considerable cross-cultural intelligibility observed across these studies suggests that the communication of emotion through movement is largely shaped by aspects of physiology and the environment shared by all humans, irrespective of differences in cultural context. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  14. The bare parameters of Gribov's Langrangian are understood and determined

    International Nuclear Information System (INIS)

    Bishari, M.

    1977-01-01

    In the context of the ''1/N Dual Unitarization'' scheme, an explicit dynamical study of the triple bare pomeron mechanism which governs the interaction term in Gribov's Lagrangian is presented. Together with the previously established bare pomeron slope and intercept, controlling respectively, the kinetic and mass terms in Gribov's Lagrangian, this work demonstrates the viability of the ''1/N Dual Unitarization'' approach for a field theory of interaction bare pomerons. (author)

  15. Can morphogenesis be understood in terms of physical rules?

    Indian Academy of Sciences (India)

    Unknown

    In a similar way, 3D structures of bio- logical systems constructed by computer can serve as a data base which can be applied to research, education and practical purposes. 2.1 Construction of human lung airway. The lung airway is constructed within the amniotic fluid by branching of a duct. Since it does not touch other tis-.

  16. Happiness in Economics as Understood Across Ism and Religion

    Directory of Open Access Journals (Sweden)

    Abdul Ghafar Ismail

    2014-12-01

    Full Text Available The concept of happiness has been discussed long time ago by economists. Recently, it became the most related and important thing to be studied because of its impact in societies. Discussion about happiness basically interprets within two separate views. First, happiness related with economic variable, for instance, how money can create happiness. Second happiness is discussed within the context of religion. However, the discussion did not combine both contexts, economic variable and religion, to interpret happiness. Therefore, it is important to highlight the concept of happiness in a different way such as in this article. Different cultures will have their own perspective on the determination of happiness. From just “individual perspective” of happiness, they then formed an ism through involvement of a big society from the same culture. Some isms such as hedonism and materialism are synonyms in characterizing the concept of happiness in this modern world. At the same time, the isms are actually working with the economic and non-economic indicators as elements to strengthen the ism itself. On the other hand, the concept of happiness from the perspective of religion will also be a part of discussion in this article. Therefore, this article will reveal that the meaning of happiness is different in terms of religion and ism. So, to carry out both ism and religion simultaneously in shaping a more intrinsic value of happiness is not an easy task. Furthermore, religion is always associated with spiritual value that makes it hard for some people to practice religion and their isms at the same time. Thus, this article will propose that the right interpretation of isms based on their faith in religion can contribute to the concept of genuine happiness.

  17. Sharing their stories helps young people to feel more understood.

    Science.gov (United States)

    Butler, Zoe

    2017-05-10

    My passion for improving mental health services started after a young woman I knew took her own life. She was part of a theatre group I volunteered for, and the distress experienced by fellow members prompted me to take action.

  18. Default options in the ICU: widely used but insufficiently understood

    Science.gov (United States)

    Hart, Joanna; Halpern, Scott D.

    2015-01-01

    Purpose of review Default options dramatically influence the behavior of decision makers and may serve as effective decision support tools in the ICU. Their use in medicine has increased in an effort to improve efficiency, reduce errors, and harness the potential of healthcare technology. Recent findings Defaults often fall short of their predicted influence when employed in critical care settings as quality improvement interventions. Investigations reporting the use of defaults are often limited by variations in the relative effect across sites. Preimplementation experiments and long-term monitoring studies are lacking. Summary Defaults in the ICU may help or harm patients and clinical efficiency depending on their format and use. When constructing and encountering defaults, providers should be aware of their powerful and complex influences on decision making. Additional evaluations of the appropriate creation of healthcare defaults and their resulting intended and unintended consequences are needed. PMID:25203352

  19. Q Fever: An Old but Still a Poorly Understood Disease

    Directory of Open Access Journals (Sweden)

    Hamidreza Honarmand

    2012-01-01

    Full Text Available Q fever is a bacterial infection affecting mainly the lungs, liver, and heart. It is found around the world and is caused by the bacteria Coxiella burnetii. The bacteria affects sheep, goats, cattle, dogs, cats, birds, rodents, and ticks. Infected animals shed this bacteria in birth products, feces, milk, and urine. Humans usually get Q fever by breathing in contaminated droplets released by infected animals and drinking raw milk. People at highest risk for this infection are farmers, laboratory workers, sheep and dairy workers, and veterinarians. Chronic Q fever develops in people who have been infected for more than 6 months. It usually takes about 20 days after exposure to the bacteria for symptoms to occur. Most cases are mild, yet some severe cases have been reported. Symptoms of acute Q fever may include: chest pain with breathing, cough, fever, headache, jaundice, muscle pains, and shortness of breath. Symptoms of chronic Q fever may include chills, fatigue, night sweats, prolonged fever, and shortness of breath. Q fever is diagnosed with a blood antibody test. The main treatment for the disease is with antibiotics. For acute Q fever, doxycycline is recommended. For chronic Q fever, a combination of doxycycline and hydroxychloroquine is often used long term. Complications are cirrhosis, hepatitis, encephalitis, endocarditis, pericarditis, myocarditis, interstitial pulmonary fibrosis, meningitis, and pneumonia. People at risk should always: carefully dispose of animal products that may be infected, disinfect any contaminated areas, and thoroughly wash their hands. Pasteurizing milk can also help prevent Q fever.

  20. Learning Outcomes of 'Understanding Research' as understood by ...

    African Journals Online (AJOL)

    Simon Bhekumuzi

    criterion for DT use, Tapscott (1998) referred to current digital users as the Net Generation, and later Prensky. (2001) referred to them as Digital natives, implying that as they are born in the digital era, it predisposes them to learning via digital technologies. The normalisation of technology in the everyday life of learners ...

  1. How Inclusive Education Is Understood by Principals of Independent Schools

    Science.gov (United States)

    Gous, Jennifer Glenda; Eloff, Irma; Moen, Melanie Carmen

    2014-01-01

    Inclusive education has become a practice that has been adopted by many schools across the globe and most usually in first-world countries. As a whole-school system, it occurs less frequently in developing countries including South Africa which unlike many developing countries has a sound infrastructure and many excellent schools in both the state…

  2. How to Talk about Media You Haven't Understood

    OpenAIRE

    Casilli, Antonio,

    2014-01-01

    The following text, featured in the special issue of the Journal of Visual Culture (vol. 13, n. 1, April 2014) celebrating the 50th anniversary of Marshall McLuhan's 'Understanding Media: The Extensions of Man' is based on the talk given by Antonio A. Casilli at the McLuhan centenary conference 'McLuhan 100 Then Now Next' (7-11 November 2011, University of Toronto).

  3. Urine Collection in the Emergency Department: What Really Happens in There?

    Directory of Open Access Journals (Sweden)

    Harrison Alter

    2012-12-01

    Full Text Available Introduction: In women with suspected urinary tract infection (UTI, a non-contaminated voidedspecimen is considered important for valid urinalysis and culture results. We assess whethermidstream parted-labia catch (MSPC instructions were provided by nurses, understood, andperformed correctly, according to the patient.Methods: We conducted a cross-sectional survey of English- and Spanish-speaking female patientssubmitting voided urine samples for urinalysis for suspected UTI. The survey was conducted in apublic teaching hospital emergency department (ED from June to December 2010, beginning 2months after development and dissemination of a nursing MSPC instructions protocol. Researchassistants administered the survey within 2 hours of urine collection. Nurses were unaware of thestudy purpose.Results: Of 129 patients approached, 74 (57% consented and were included in the analysis.Median age was 35; 44% were Latino. Regarding instructions from nurses, patients reported thefollowing: 45 (61%; 95% CI 50-72% received any instructions; of whom 37 (82%; 95% CI 71-93%understood them completely. Sixteen (36%; 95% CI 22-51% were instructed to collect midstream;and 7 (16%; 95% CI 6-29% to part the labia. Regardless of receiving or understanding instructions,33 (45%; 95% CI 33-57% reported actually collecting midstream, and 11 (15%, 95% CI 8-25%parting the labia.Conclusion: In this ED, instructions for MSPC urine collection frequently were not given, despite anursing protocol, and patients rarely performed the essential steps. An evidence-based approachto urine testing in the ED that considers urine collection technique, is needed.

  4. Evaluating emergency risk communications: a dialogue with the experts.

    Science.gov (United States)

    Thomas, Craig W; Vanderford, Marsha L; Crouse Quinn, Sandra

    2008-10-01

    Evaluating emergency risk communications is fraught with challenges since communication can be approached from both a systemic and programmatic level. Therefore, one must consider stakeholders' perspectives, effectiveness issues, standards of evidence and utility, and channels of influence (e.g., mass media and law enforcement). Evaluation issues related to timing, evaluation questions, methods, measures, and accountability are raised in this dialogue with emergency risk communication specialists. Besides the usual evaluation competencies, evaluators in this area need to understand and work collaboratively with stakeholders and be attuned to the dynamic contextual nature of emergency risk communications. Sample resources and measures are provided here to aid in this emerging and exciting field of evaluation.

  5. Emerging Multinational Companies and Strategic Fit

    DEFF Research Database (Denmark)

    Gammeltoft, Peter; Filatotchev, Igor; Hobdari, Bersant

    2012-01-01

    There is an increasing awareness in international business that institutional factors need to be better incorporated into the understanding of international investments decisions of multinational companies. This applies equally to outward foreign direct investment by emerging economy firms...... dimensions, domestically, abroad and in the global environment. We then proceed to interpret recent evidence on ‘emerging multinationals’, including the contributions in this special issue, in the context of this framework. We conclude with proposing promising areas of future research........ The intense renewal of interest in these ‘emerging multinationals’ over the last half decade or so has stimulated an increasing volume of contributions offering alternative theoretical perspectives, macro-level surveys of aggregate trends and case studies of firms and their strategies and operations. Not much...

  6. Hanford Emergency Response Plan

    International Nuclear Information System (INIS)

    Wagoner, J.D.

    1994-04-01

    The Hanford Emergency Response Plan for the US Department of Energy (DOE), Richland Operations Office (RL), incorporates into one document an overview of the emergency management program for the Hanford Site. The program has been developed in accordance with DOE orders, and state and federal regulations to protect worker and public health and safety and the environment in the event of an emergency at or affecting the Hanford Site. This plan provides a description of how the Hanford Site will implement the provisions of DOE 5500 series and other applicable Orders in terms of overall policies and concept of operations. It should be used as the basis, along with DOE Orders, for the development of specific contractor and RL implementing procedures

  7. Fuel cells : emerging markets

    International Nuclear Information System (INIS)

    Callaghan Jerram, L.; Adamson, K.A.; Butler, J.; Huleatt-James, N.

    2009-01-01

    This presentation highlighted the findings of the 2009 review of the fuel cell industry and emerging markets as they appeared in Fuel Cell Today (FCT), a benchmark document on global fuel cell activity. Since 2008, the industry has seen a 50 per cent increase in fuel cell systems shipped, from 12,000 units to 18,000 units. Applications have increased for backup power for datacentres, telecoms and light duty vehicles. The 2009 review focused on emerging markets which include non-traditional regions that may experience considerable diffusion of fuel cells within the next 5 year forecast period. The 2009 review included an analysis on the United Arab Emirates, Mexico, Brazil and India and reviewed primary drivers, likely applications for near-term adoption, and government and private sector activity in these regions. The presentation provided a forecast of the global state of the industry in terms of shipments as well as a forecast of countries with emerging markets

  8. The emerging nuclear suppliers

    International Nuclear Information System (INIS)

    Dunn, L.A.

    1990-01-01

    Since the early 1980s, a growing amount of attention has been paid to a small group of mostly developing countries that have come to be called the emerging nuclear suppliers. Argentina and Brazil, China and South Korea, India and Pakistan, Spain and Yugoslavia have frequently been mentioned in this category. Their actual and potential nuclear export dealings and policies have been the subject of academic writings and policy papers, of scholarly symposia and exchanges at meetings of the traditional nuclear suppliers. With foundation and other support, UCLA's Center for International and Strategic Affairs has begun a major project to develop a database on the transactions, policies, and export control institutions of the emerging suppliers. This chapter provides some guidelines for policy toward the emerging nuclear suppliers

  9. Hanford Emergency Response Plan

    Energy Technology Data Exchange (ETDEWEB)

    Wagoner, J.D.

    1994-04-01

    The Hanford Emergency Response Plan for the US Department of Energy (DOE), Richland Operations Office (RL), incorporates into one document an overview of the emergency management program for the Hanford Site. The program has been developed in accordance with DOE orders, and state and federal regulations to protect worker and public health and safety and the environment in the event of an emergency at or affecting the Hanford Site. This plan provides a description of how the Hanford Site will implement the provisions of DOE 5500 series and other applicable Orders in terms of overall policies and concept of operations. It should be used as the basis, along with DOE Orders, for the development of specific contractor and RL implementing procedures.

  10. Forensic radiology: An emerging tool in identification

    OpenAIRE

    Raghav Kumar; Appaji Athota; Trisha Rastogi; Sunil Kumar Karumuri

    2015-01-01

    In any mass disaster condition, identification of the person is most important. For this purpose, the forensic investigators use different methods for identifying the dead. They consider skeletal remains of the dead as the initial step in identification. Radiographs carry great evidence to act as antemortem records and also assist in identifying the person, age, gender, race, etc. Forensic dentistry is also emerging as a new branch in forensics. So, the forensic dentist must be aware of diffe...

  11. Negative discourse and emergence of game genres

    DEFF Research Database (Denmark)

    Marchetti, Emanuela; Valente, Andrea

    2013-01-01

    In this paper the apparently meaningless concept of a 1 dimensional computer game is explored, via netnography. A small number of games was designed and implemented, in close contact with online communities of players and developers, providing evidence that 1 dimension is enough to produce...... interesting gameplay, to allow for level design and even to leave room for artistic considerations on 1D rendering. General techniques to re-design classic 2D games into 1D are also emerging from this exploration....

  12. Feedback in the Emergency Medicine Clerkship

    OpenAIRE

    Bernard, Aaron W; Kman, Nicholas E; Khandelwal, Sorabh

    2011-01-01

    Objective Feedback is a technique used in medical education to help develop and improve clinical skills. A comprehensive review article specifically intended for the emergency medicine (EM) educator is lacking, and it is the intent of this article to provide the reader with an in-depth, up-to-date, and evidence-based review of feedback in the context of the EM clerkship. Methods The review article is organized in a progressive manner, beginning with the definition of feedback, the importance ...

  13. Feedback in the Emergency Medicine Clerkships

    OpenAIRE

    Sorabh Khandelwal; Nicholas E Kman; Aaron W Bernard

    2011-01-01

    Objective: Feedback is a technique used in medical education to help develop and improve clinical skills. A comprehensive review article specifically intended for the emergency medicine (EM) educator is lacking, and it is the intent of this article to provide the reader with an in-depth, up-to-date, and evidence-based review of feedback in the context of the EM clerkship. Methods: The review article is organized in a progressive manner, beginning with the definition of feedback, the importanc...

  14. Emergent technologies: 25 years

    Science.gov (United States)

    Rising, Hawley K.

    2013-03-01

    This paper will talk about the technologies that have been emerging over the 25 years since the Human Vision and Electronic Imaging conference began that the conference has been a part of, and that have been a part of the conference, and will look at those technologies that are emerging today, such as social networks, haptic technologies, and still emerging imaging technologies, and what we might look at for the future.Twenty-five years is a long time, and it is not without difficulty that we remember what was emerging in the late 1980s. Yet to be developed: The first commercial digital still camera was not yet on the market, although there were hand held electronic cameras. Personal computers were not displaying standardized images, and image quality was not something that could be talked about in a standardized fashion, if only because image compression algorithms were not standardized yet for several years hence. Even further away were any standards for movie compression standards, there was no personal computer even on the horizon which could display them. What became an emergent technology and filled many sessions later, image comparison and search, was not possible, nor the current emerging technology of social networks- the world wide web was still several years away. Printer technology was still devising dithers and image size manipulations which would consume many years, as would scanning technology, and image quality for both was a major issue for dithers and Fourier noise.From these humble beginnings to the current moves that are changing computing and the meaning of both electronic devices and human interaction with them, we will see a course through the changing technology that holds some features constant for many years, while others come and go.

  15. Blog and Podcast Watch: Cutaneous Emergencies.

    Science.gov (United States)

    Grock, Andrew; Morley, Eric J; Roppolo, Lynn; Khadpe, Jay; Ankel, Felix; Lin, Michelle

    2017-02-01

    The WestJEM Blog and Podcast Watch presents high quality open-access educational blogs and podcasts in emergency medicine (EM) based on the ongoing Academic Life in Emergency Medicine (ALiEM) Approved Instructional Resources (AIR) and AIR-Professional series. Both series critically appraise resources using an objective scoring rubric. This installment of the Blog and Podcast Watch highlights the topic of cutaneous emergencies from the AIR series. The AIR series is a continuously building curriculum that follows the Council of Emergency Medicine Residency Directors (CORD) annual testing schedule. For each module, relevant content is collected from the top 50 most accessed sites per the Social Media Index published within the previous 12 months and scored by eight board members using five equally weighted measurement outcomes: Best Evidence in Emergency Medicine (BEEM) score, accuracy, educational utility, evidence based, and references. Resources scoring ≥30 out of 35 available points receive an AIR label. Resources scoring 27-29 receive an "honorable mention" label, if the editorial board agrees that the post is accurate and educationally valuable. A total of 35 blog posts and podcasts were evaluated. None scored ≥30 points necessary for the AIR label, although four honorable mention posts were identified. Key educational pearls from these honorable mention posts are summarized. This Blog and Podcast Watch series is based on the AIR and AIR-Pro series, which attempts to identify high quality educational content on open-access blogs and podcasts. This series provides an expert-based, post-publication curation of educational social media content for EM clinicians with this installment focusing on cutaneous emergencies.

  16. Crisis and the Emergence of Illicit Markets: A Pragmatist View on Economic Action outside the Law

    OpenAIRE

    Dewey, M.

    2014-01-01

    Although illicit exchange has also been an organized, silent, and ever-present response to harsh economic crisis, only protest and social movements have captured scholars’ attention. In order to fill this void, this paper analyzes the emergence of illegal markets under situations of social breakdown. I claim that an illicit market emerging under socio-economic crisis conditions might be understood as the result of a constant valuation process and the intervention of what Herbert Mead called “...

  17. Emergence of Qualitative Research in Colombian Psychology: A Beginning that Still Does not End

    OpenAIRE

    Jorge Larreamendy-Joerns; Juanita Henao; Alexandra Arango

    2006-01-01

    This article deals with the processes of emergence and evolution of qualitative research in psychology in Colombia. Two major arguments are advanced. First, these processes can only be fully understood in the light of the history of psychology in Colombia, and, at the same time, within the context of emergence and consolidation of the social sciences in Colombia. Second, the evolution of qualitative research in North American psychology coincides in some aspects with its corresponding path in...

  18. The Emergence of Ideas

    DEFF Research Database (Denmark)

    Halskov, Kim; Dalsgård, Peter

    2007-01-01

    The development of new ideas is an essential concern for many design projects. There are, however, few in-depth studies of how such ideas emerge within these contexts. In this article we offer an analysis of the emergence of ideas from specific sources of inspiration, as they arise through...... negotiation and transformation, and are mediated by design artefacts during an Inspiration Card Workshop, a collaborative event in which findings from domain studies are combined with technological sources of inspiration, in order to generate design concepts. We present a micro-analytic study...

  19. Ultrasonography in abdominal emergencies

    International Nuclear Information System (INIS)

    Risi, D.; Alessi, G.; Meli, C.; Marzano, M.; Fiori, E.; Caterino, S.

    1989-01-01

    From February 1986 to March 1988 113 abdominal US exams were performed in emergency situation to evaluate the accuracy of this methodology: 13 were blunt traumas, 18 post-operative complications. A real-time scanner with a linear probe of 5 MHz was employed. The results were confirmed by surgical and/or clinical and instrumental evaluation. In 81% of the examinations, ultrasonography allowed a diagnosis to be made. Gallbladder and biliary pathologies were the most common findings. The results (sensibility 96%, specificity 88%, accuracy 95%) confirm the affidability of ultrasonography in abdominal emergencies, as shown in literature

  20. Abdominal Aortic Emergencies.

    Science.gov (United States)

    Lech, Christie; Swaminathan, Anand

    2017-11-01

    This article discusses abdominal aortic emergencies. There is a common thread of risk factors and causes of these diseases, including age, male gender, hypertension, dyslipidemia, and connective tissue disorders. The most common presenting symptom of these disorders is pain, usually in the chest, flank, abdomen, or back. Computed tomography scan is the gold standard for diagnosis of pathologic conditions of the aorta in the hemodynamically stable patient. Treatment consists of a combination of blood pressure and heart rate control and, in many cases, emergent surgical intervention. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. Structural Emergency Control Paradigm

    DEFF Research Database (Denmark)

    Vu, Thanh Long; Chatzivasileiadis, Spyros; Chiang, Hsiao-Dong

    2017-01-01

    demand and hopefully stabilize the system. This traditional emergency control results in interrupted service with severe economic damage to customers. Also, such control is usually less effective due to the lack of coordination among protective devices. In this paper, we propose a novel structural......Power grids normally operate at some stable operating condition where power supply and demand are balanced. In response to emergency situations, load shedding is a prevailing approach where local protective devices are activated to cut a suitable amount of load to quickly rebalance the supply...

  2. Pathogenesis of Noroviruses, Emerging RNA Viruses

    Directory of Open Access Journals (Sweden)

    Stephanie M. Karst

    2010-03-01

    Full Text Available Human noroviruses in the family Caliciviridae are a major cause of epidemic gastroenteritis. They are responsible for at least 95% of viral outbreaks and over 50% of all outbreaks worldwide. Transmission of these highly infectious plus-stranded RNA viruses occurs primarily through contaminated food or water, but also through person-to-person contact and exposure to fomites. Norovirus infections are typically acute and self-limited. However, disease can be much more severe and prolonged in infants, elderly, and immunocompromised individuals. Norovirus outbreaks frequently occur in semi-closed communities such as nursing homes, military settings, schools, hospitals, cruise ships, and disaster relief situations. Noroviruses are classified as Category B biodefense agents because they are highly contagious, extremely stable in the environment, resistant to common disinfectants, and associated with debilitating illness. The number of reported norovirus outbreaks has risen sharply since 2002 suggesting the emergence of more infectious strains. There has also been increased recognition that noroviruses are important causes of childhood hospitalization. Moreover, noroviruses have recently been associated with multiple clinical outcomes other than gastroenteritis. It is unclear whether these new observations are due to improved norovirus diagnostics or to the emergence of more virulent norovirus strains. Regardless, it is clear that human noroviruses cause considerable morbidity worldwide, have significant economic impact, and are clinically important emerging pathogens. Despite the impact of human norovirus-induced disease and the potential for emergence of highly virulent strains, the pathogenic features of infection are not well understood due to the lack of a cell culture system and previous lack of animal models. This review summarizes the current understanding of norovirus pathogenesis from the histological to the molecular level, including

  3. Himalaya: Emergence and Evolution

    Indian Academy of Sciences (India)

    Home; Journals; Resonance – Journal of Science Education; Volume 8; Issue 6. Himalaya: Emergence and Evolution. Rasoul Sorkhabi. Book Review Volume 8 Issue 6 June 2003 pp 80-81. Fulltext. Click here to view fulltext PDF. Permanent link: http://www.ias.ac.in/article/fulltext/reso/008/06/0080-0081. Author Affiliations.

  4. Common paediatric cardiac emergencies

    African Journals Online (AJOL)

    majority of these children have tetralogy of Fallot, but other lesions such as pulmonary or tricuspid atresia can also present with spells. Proposed mechanisms include spasm of the right ventricular outflow tract, intravascular volume depletion and systemic vasodilation. A 'tet' spell constitutes an emergency, as there is a high ...

  5. Emergencies in Eritrea

    African Journals Online (AJOL)

    Methodology: The study was a cross sectional study on 137 Life Saving Skills trained health workers randomly selected out of the ... represents the first comprehensive assessment of the knowledge and skills of nurses and associate nurses in emergency ... Eritrean context by the Reproductive Health Technical. Committee ...

  6. Emerging supercomputer architectures

    Energy Technology Data Exchange (ETDEWEB)

    Messina, P.C.

    1987-01-01

    This paper will examine the current and near future trends for commercially available high-performance computers with architectures that differ from the mainstream ''supercomputer'' systems in use for the last few years. These emerging supercomputer architectures are just beginning to have an impact on the field of high performance computing. 7 refs., 1 tab.

  7. Emergency Medicine Dermatology

    Directory of Open Access Journals (Sweden)

    Shannon Toohey

    2017-04-01

    Full Text Available Audience: This modified team-based learning (mTBL exercise is appropriate for junior and senior emergency medicine learners. Introduction: Rashes and dermatologic complaints are common in the emergency department. It is essential that emergency physicians understand various types of lesions and rashes as well as be able to distinguish between benign and life-threatening dermatologic complaints. The Modified Lynch Algorithm provides a systematic approach to the diagnosis of rashes by providing a number of questions and branching points to narrow down the differential diagnosis of important and life-threatening rashes for the emergency physician.1 While there are a number of other methods to narrow down the differential diagnosis for rash, the Modified Lynch Algorithm is primarily based on the type of rash and is well suited for this exercise because it provides an excellent opportunity for learners to think about the differential diagnosis for those rashes. Objectives: By the end of this educational session, the learner will: 1 List the six primary types of rash (maculopapular, petechial/purpura, diffuse erythematous, non-erythematous, vesiculo-bullous, and pustular. 2 Be able to accurately describe various types of lesions and rashes with appropriate terminology; 3 Understand the use of the Modified Lynch Algorithm and how it can be used to narrow down the differential diagnosis in patients presenting with rash. Method: This is an mTBL session.

  8. Neonatal cardiac emergencies

    African Journals Online (AJOL)

    Neonatal cardiac emergencies. The neonatal period is one that fills many generalists with fear – this article will help to dispel these concerns. George A Comitis, MB ChB, DCH (SA), DA (SA), FCPaed (SA), Cert Cardiology (SA) Paed. Consultant, Paediatric Cardiology Service of the Western Cape, Red Cross War Memorial ...

  9. Emerging Communities of Practice

    Science.gov (United States)

    McAlister, Martha

    2016-01-01

    Communities of practice are emerging as an innovative approach to faculty development. While collaborative learning is becoming popular in the classroom, autonomy and individualism continue to dominate the culture of higher education for faculty. However, as we begin to recognize that old solutions to new problems are no longer effective, there is…

  10. Hospital emergency preparedness

    African Journals Online (AJOL)

    Tamara Shefer

    Emergency preparedness and professional competency among health care providers during hurricanes Katrina and Rita: Pilot study results. Disaster Management and. Response, 5(4), 99-110. United Nations International Strategy for Disaster Reduction (UNISDR). (2008). 2008-2009 World. Disaster Reduction Campaign.

  11. LNG - emergency control

    Energy Technology Data Exchange (ETDEWEB)

    Berardinelli, Ricardo Porto; Correa, Kleber Macedo; Moura Filho, Nelson Barboza de; Fernandez, Carlos Antonio [TRANSPETRO, Rio de Janeiro, RJ (Brazil); Matos, Jose Eduardo Nogueira de [PETROBRAS, Rio de Janeiro, RJ (Brazil)

    2009-07-01

    The operation of liquefied natural gas (LNG) is pioneering within the PETROBRAS System. PETROBRAS Transporte - TRANSPETRO is going to operate two flexible LNG terminals, located in Ceara and Rio de Janeiro. In accordance with the Corporate Health, Safety and Environmental (HSE) Directive - Training, Education and Awareness, PETROBRAS Transporte S.A. - TRANSPETRO has prepared an action plan with the objective of ensuring the operational safety of the undertaking. Among other actions a training program for the emergency control of LNG will be inserted into the timetable. The above mentioned training program was held over a period of 20 hours, and was divided between theory and practice. In the theoretical part, the characteristics of the product, the history of accidents and the emergency response procedures were covered. In the practical part, 3000 gallons of LNG were utilized where the behavior of the product could be confirmed following a confined leak, thereby verifying the efficacy of the emergency control resources. The teaching process of the course was developed in the company through the preparation of specific procedures, emergency plans and the formation of internal instructors. (author)

  12. Emerging Asian Economics.

    Science.gov (United States)

    Trezise, Philip H.

    What we can expect in the future from the miracle economies of Japan, South Korea, Taiwan, Singapore, and Hong Kong, whether they pose a threat to the older industrial states of Western Europe and North American, and whether China is to be the next emerging Asian economy are discussed. The amazing economic recovery of these East Asian countries…

  13. Fire Department Emergency Response

    Energy Technology Data Exchange (ETDEWEB)

    Blanchard, A. [Westinghouse Savannah River Company, AIKEN, SC (United States); Bell, K.; Kelly, J.; Hudson, J.

    1997-09-01

    In 1995 the SRS Fire Department published the initial Operations Basis Document (OBD). This document was one of the first of its kind in the DOE complex and was widely distributed and reviewed. This plan described a multi-mission Fire Department which provided fire, emergency medical, hazardous material spill, and technical rescue services.

  14. 7. Emergency contraception

    African Journals Online (AJOL)

    Sitwala

    Lusaka. Emergency Contraception Among Women With. Abortion At University ... education was significantly associated with the outcome of EC awareness .... increasing their length of exposure to unprotected sexual activities before marriage. Early marriages could have occurred in this study population among. Ever use of ...

  15. Emerging Art Markets

    NARCIS (Netherlands)

    Kraussl, R.G.W.; Logher, R.

    2010-01-01

    This paper analyzes the performance and risk-return characteristics of three major emerging art markets: Russia, China, and India. According to three national art market indices, built by hedonic regressions based on auction sales prices, the geometric annual returns are 10.00%, 5.70%, and 42.20%

  16. [Medical emergency teams

    DEFF Research Database (Denmark)

    Bunkenborg, G.; Lund, C.; Petersen, John Asger

    2008-01-01

    The aim of medical emergency teams (MET) is to identify and treat deteriorating patients on general wards, and to avoid cardiac arrest, unplanned intensive care unit admission and death. The effectiveness of METs has yet to be proven, as the only two randomised, controlled trials on the subject...

  17. Costs of Emergency Care

    Science.gov (United States)

    ... All RSS Feeds ACEP In the News Multimedia Image Gallery ACEP Video ACEP Radio ACEP Ads Resources Statistics & Reports Health Policy Campaigns Published Letters Journalism Awards Fact Sheets Social Media Contact Us Site Body Main Content Annals of Emergency Medicine | EMAF Website | ...

  18. Preparing for Emergency

    DEFF Research Database (Denmark)

    Melchiors, Jacob; Todsen, Tobias; Nilsson, Philip

    2015-01-01

    evidence for validity, based on successfully distinguishing the 2 groups, using an independent samples t test (P 2) = 0.78. CONCLUSION: The tool for assessing EC competence proved reliable and valid...

  19. Evidence, hierarchies, and typologies: horses for courses

    OpenAIRE

    Petticrew, M; Roberts, H

    2003-01-01

    Debate is ongoing about the nature and use of evidence in public health decision making, and there seems to be an emerging consensus that the "hierarchy of evidence" may be difficult to apply in other settings. It may be unhelpful however to simply abandon the hierarchy without having a framework or guide to replace it. One such framework is discussed. This is based around a matrix, and emphasises the need to match research questions to specific types of research. This emphasis on methodologi...

  20. Metaphor and metamorphosis : Paul Ricoeur and Gilles Deleuze on the emergence of novelty

    NARCIS (Netherlands)

    Boven, Martijn

    2016-01-01

    This dissertation develops a new reading of the works of two French philosophers, Paul Ricoeur (1913-2005) and Gilles Deleuze (1925-1995). through a focus on their understanding of the emergence of novelty. Ricoeur’s conception of novelty is understood in terms of a living metaphor. The living

  1. Disclosing doubtful indications for emergency cesarean sections in rural hospitals in Tanzania

    DEFF Research Database (Denmark)

    Maaløe, Nanna; Bygbjerg, Ib Christian; Onesmo, Rwakyendela

    2012-01-01

    To investigate in depth to what extent indications for emergency cesarean sections followed evidence-based audit criteria for realistic best practice.......To investigate in depth to what extent indications for emergency cesarean sections followed evidence-based audit criteria for realistic best practice....

  2. Emergency general surgery in the geriatric patient.

    Science.gov (United States)

    Desserud, K F; Veen, T; Søreide, K

    2016-01-01

    Emergency general surgery in the elderly is a particular challenge to the surgeon in charge of their care. The aim was to review contemporary aspects of managing elderly patients needing emergency general surgery and possible alterations to their pathways of care. This was a narrative review based on a PubMed/MEDLINE literature search up until 15 September 2015 for publications relevant to emergency general surgery in the geriatric patient. The number of patients presenting as an emergency with a general surgical condition increases with age. Up to one-quarter of all emergency admissions to hospital may be for general surgical conditions. Elderly patients are a particular challenge owing to added co-morbidity, use of drugs and risk of poor outcome. Frailty is an important potential risk factor, but difficult to monitor or manage in the emergency setting. Risk scores are not available universally. Outcomes are usually severalfold worse than after elective surgery, in terms of both higher morbidity and increased mortality. A care bundle including early diagnosis, resuscitation and organ system monitoring may benefit the elderly in particular. Communication with the patient and relatives throughout the care pathway is essential, as indications for surgery, level of care and likely outcomes may evolve. Ethical issues should also be addressed at every step on the pathway of care. Emergency general surgery in the geriatric patient needs a tailored approach to improve outcomes and avoid futile care. Although some high-quality studies exist in related fields, the overall evidence base informing perioperative acute care for the elderly remains limited. © 2015 BJS Society Ltd Published by John Wiley & Sons Ltd.

  3. Methylphenidate Actively Induces Emergence from General Anesthesia

    Science.gov (United States)

    Solt, Ken; Cotten, Joseph F.; Cimenser, Aylin; Wong, Kin F.K.; Chemali, Jessica J.; Brown, Emery N.

    2011-01-01

    Background Although accumulating evidence suggests that arousal pathways in the brain play important roles in emergence from general anesthesia, the roles of monoaminergic arousal circuits are unclear. In this study we tested the hypothesis that methylphenidate (an inhibitor of dopamine and norepinephrine transporters) induces emergence from isoflurane anesthesia. Methods Using adult rats we tested the effect of methylphenidate IV on time to emergence from isoflurane anesthesia. We then performed experiments to test separately for methylphenidate-induced changes in arousal and changes in minute ventilation. A dose-response study was performed to test for methylphenidate–induced restoration of righting during continuous isoflurane anesthesia. Surface electroencephalogram recordings were performed to observe neurophysiological changes. Plethysmography recordings and arterial blood gas analysis were performed to assess methylphenidate-induced changes in respiratory function. Droperidol IV was administered to test for inhibition of methylphenidate's actions. Results Methylphenidate decreased median time to emergence from 280 to 91 s. The median difference in time to emergence without compared to with methylphenidate was 200 [155, 331] s (median, [95% confidence interval]). During continuous inhalation of isoflurane, methylphenidate induced return of righting in a dose-dependent manner, induced a shift in electroencephalogram power from delta to theta, and induced an increase in minute ventilation. Administration of droperidol (0.5 mg/kg IV) prior to methylphenidate (5 mg/kg IV) largely inhibited methylphenidate-induced emergence behavior, electroencephalogram changes, and changes in minute ventilation. Conclusions Methylphenidate actively induces emergence from isoflurane anesthesia by increasing arousal and respiratory drive, possibly through activation of dopaminergic and adrenergic arousal circuits. Our findings suggest that methylphenidate may be clinically

  4. The difficult medical emergency call

    DEFF Research Database (Denmark)

    Møller, Thea Palsgaard; Kjærulff, Thora Majlund; Viereck, Søren

    2017-01-01

    BACKGROUND: Pre-hospital emergency care requires proper categorization of emergency calls and assessment of emergency priority levels by the medical dispatchers. We investigated predictors for emergency call categorization as "unclear problem" in contrast to "symptom-specific" categories and the ......BACKGROUND: Pre-hospital emergency care requires proper categorization of emergency calls and assessment of emergency priority levels by the medical dispatchers. We investigated predictors for emergency call categorization as "unclear problem" in contrast to "symptom-specific" categories...... and the effect of categorization on mortality. METHODS: Register-based study in a 2-year period based on emergency call data from the emergency medical dispatch center in Copenhagen combined with nationwide register data. Logistic regression analysis (N = 78,040 individuals) was used for identification...

  5. Developing utility emergency preparedness exercises

    International Nuclear Information System (INIS)

    Sjoeblom, K.

    1986-01-01

    Utility emergency preparedness exercises constitute an important link in upgrading the response to nuclear power plant emergencies. Various emergency exercises are arranged annually at the Loviisa nuclear power plant. The on-site simulator is a practical tool in developing suitable accident scenarios and demonstrating them to the site emergency players and spectators. The exercises concentrate on emergency management and radiological activities. It is important to create a high degree of motivation. (author)

  6. Emerging Directions in Emotional Episodic Memory

    Science.gov (United States)

    Dolcos, Florin; Katsumi, Yuta; Weymar, Mathias; Moore, Matthew; Tsukiura, Takashi; Dolcos, Sanda

    2017-01-01

    Building upon the existing literature on emotional memory, the present review examines emerging evidence from brain imaging investigations regarding four research directions: (1) Social Emotional Memory, (2) The Role of Emotion Regulation in the Impact of Emotion on Memory, (3) The Impact of Emotion on Associative or Relational Memory, and (4) The Role of Individual Differences in Emotional Memory. Across these four domains, available evidence demonstrates that emotion- and memory-related medial temporal lobe brain regions (amygdala and hippocampus, respectively), together with prefrontal cortical regions, play a pivotal role during both encoding and retrieval of emotional episodic memories. This evidence sheds light on the neural mechanisms of emotional memories in healthy functioning, and has important implications for understanding clinical conditions that are associated with negative affective biases in encoding and retrieving emotional memories. PMID:29255432

  7. Emerging Administrations under European Union Rules

    Directory of Open Access Journals (Sweden)

    Bogdan Berceanu

    2012-05-01

    Full Text Available The idea of emergence is generally used to indicate the appearance of patterns, structures, orproperties that cannot be adequately explained by referring only to the system’s pre-existing componentsand their interactions. The term “emergence” has an interdisciplinary approach specific to administrativesciences, too. In this article, the concept of “emergence” signifies lato sensu a kind of change and it will beused to refer to countries that have a high volatility and that are in transition and to define the changes thatsuffer the public administrations of the countries which are part of the European construction. EuropeanUnion through its policies and legislation has a great impact on economic and social conditions in MemberStates. The aim of the paper is to present a theoretical approach on the dimension of emergingadministrations understood as changes and reforms that suffer the institutions from the EU member statesunder the pressure of the European Union rules. The study is using the concept of emergence to researchand to analyze the nature of the changes in the public administration starting from the approach of thesystems theory.

  8. Epigenetic mechanisms in non-alcoholic fatty liver disease: An emerging field.

    Science.gov (United States)

    Gallego-Durán, Rocío; Romero-Gómez, Manuel

    2015-10-28

    Non-alcoholic fatty liver disease (NAFLD) is an emerging health concern in both developed and non-developed world, encompassing from simple steatosis to non-alcoholic steatohepatitis (NASH), cirrhosis and liver cancer. Incidence and prevalence of this disease are increasing due to the socioeconomic transition and change to harmful diet. Currently, gold standard method in NAFLD diagnosis is liver biopsy, despite complications and lack of accuracy due to sampling error. Further, pathogenesis of NAFLD is not fully understood, but is well-known that obesity, diabetes and metabolic derangements played a major role in disease development and progression. Besides, gut microbioma and host genetic and epigenetic background could explain considerable interindividual variability. Knowledge that epigenetics, heritable events not caused by changes in DNA sequence, contribute to development of diseases has been a revolution in the last few years. Recently, evidences are accumulating revealing the important role of epigenetics in NAFLD pathogenesis and in NASH genesis. Histone modifications, changes in DNA methylation and aberrant profiles or microRNAs could boost development of NAFLD and transition into clinical relevant status. PNPLA3 genotype GG has been associated with a more progressive disease and epigenetics could modulate this effect. The impact of epigenetic on NAFLD progression could deserve further applications on therapeutic targets together with future non-invasive methods useful for the diagnosis and staging of NAFLD.

  9. Pseudogene-Derived LncRNAs: Emerging Regulators of Gene Expression

    Directory of Open Access Journals (Sweden)

    Michael John Milligan

    2015-02-01

    Full Text Available In the more than one decade since the completion of the Human Genome Project, the prevalence of non-protein-coding functional elements in the human genome has emerged as a key revelation in post-genomic biology. Highlighted by the ENCODE and FANTOM consortia, these elements include tens of thousands of pseudogenes, as well as comparably numerous long non-coding RNA (lncRNA genes. Pseudogene transcription and function remain insufficiently understood. However, the field is of great importance for human disease due to the high sequence similarity between pseudogenes and their parental protein-coding genes, which generates the potential for sequence-specific regulation. Recent case studies have established essential and coordinated roles of both pseudogenes and lncRNAs in development and disease in metazoan systems, including functional impacts of lncRNA transcription at pseudogene loci on the regulation of the pseudogenes' parental genes. This review synthesizes the nascent evidence for regulatory modalities jointly exerted by lncRNAs and pseudogenes in human disease, and for recent evolutionary origins of these systems.

  10. Documenting the emergence of bio-ontologies: or, why researching bioinformatics requires HPSSB.

    Science.gov (United States)

    Leonelli, Sabina

    2010-01-01

    This paper reflects on the analytic challenges emerging from the study of bioinformatic tools recently created to store and disseminate biological data, such as databases, repositories, and bio-ontologies. I focus my discussion on the Gene Ontology, a term that defines three entities at once: a classification system facilitating the distribution and use of genomic data as evidence towards new insights; an expert community specialised in the curation of those data; and a scientific institution promoting the use of this tool among experimental biologists. These three dimensions of the Gene Ontology can be clearly distinguished analytically, but are tightly intertwined in practice. I suggest that this is true of all bioinformatic tools: they need to be understood simultaneously as epistemic, social, and institutional entities, since they shape the knowledge extracted from data and at the same time regulate the organisation, development, and communication of research. This viewpoint has one important implication for the methodologies used to study these tools; that is, the need to integrate historical, philosophical, and sociological approaches. I illustrate this claim through examples of misunderstandings that may result from a narrowly disciplinary study of the Gene Ontology, as I experienced them in my own research.

  11. Emerging regenerative approaches for periodontal reconstruction: a consensus report from the AAP Regeneration Workshop.

    Science.gov (United States)

    Cochran, David L; Cobb, Charles M; Bashutski, Jill D; Chun, Yong-Hee Patricia; Lin, Zhao; Mandelaris, George A; McAllister, Bradley S; Murakami, Shinya; Rios, Hector F

    2015-02-01

    of phosphate and pyrophosphate metabolism; and 4) approaches directed at harnessing current therapies used for other purposes. The results indicate that, with most emerging technologies, the specific mechanisms of action are not well understood nor are the specific target cells identified. Patient-related outcomes were typically not addressed in the literature. Numerous recommendations can be made for future research priorities for both basic science and clinical application of emerging therapies. The need to emphasize the importance of regeneration of a functional periodontal organ system was noted. The predictability and efficacy of outcomes, as well as safety concerns and the cost-to-benefit ratio were also identified as key factors for emerging technologies. A number of technologies appear viable as emerging regenerative approaches for periodontal hard and soft tissue regeneration and are expanding the potential of reconstructing the entire periodontal organ system. The cost-to-benefit ratio and safety issues are important considerations for any new emerging therapies. Clinical Recommendation: At this time, there is insufficient evidence on emerging periodontal regenerative technologies to warrant definitive clinical recommendations.

  12. Emergency plan belgian experience

    International Nuclear Information System (INIS)

    Clymans, A.

    1989-01-01

    The Chernobyl disaster prompted authorities in Belgium to carry out a comprehensive review of all emergency plans and, in particular, those designed specifically for nuclear accidents. This review was aimed at determining what type of plans existed and to what extent such plans were operational. This paper sets out to present a broad overview of different aspects of this problem: organization of public emergency plans, co-ordination of operations, merits and demerits of centralization as opposed to decentralization, planning zones, obligation to release information to the public and relations with the media, and finally the international dimension to the problem. The author expresses the hope that the latter area will inspire practical suggestions [fr

  13. Update on emergency contraception.

    Science.gov (United States)

    Murphy, Patricia Aikins

    2012-01-01

    Emergency contraception (EC) is any method used after sexual intercourse to prevent pregnancy. This article provides an overview of the history of EC methods and describes the current availability of oral and intrauterine EC. Oral forms include the Yuzpe regimen (combining ethinyl estradiol and levonorgestrel), levonorgestrel-only pills, and ulipristal acetate, which is a new emergency contraceptive drug recently approved by the US Food and Drug Administration. The copper T-380A intrauterine device can also be used for EC. Information about dosing, timing, access, and other considerations in the provision of EC is covered. Clinicians should be aware of all available options in order to counsel women in need of EC appropriately. © 2012 by the American College of Nurse-Midwives.

  14. Emerging and Disruptive Technologies.

    Science.gov (United States)

    Kricka, Larry J

    2016-08-01

    Several emerging or disruptive technologies can be identified that might, at some point in the future, displace established laboratory medicine technologies and practices. These include increased automation in the form of robots, 3-D printing, technology convergence (e.g., plug-in glucose meters for smart phones), new point-of-care technologies (e.g., contact lenses with sensors, digital and wireless enabled pregnancy tests) and testing locations (e.g., Retail Health Clinics, new at-home testing formats), new types of specimens (e.g., cell free DNA), big biology/data (e.g., million genome projects), and new regulations (e.g., for laboratory developed tests). In addition, there are many emerging technologies (e.g., planar arrays, mass spectrometry) that might find even broader application in the future and therefore also disrupt current practice. One interesting source of disruptive technology may prove to be the Qualcomm Tricorder XPrize, currently in its final stages.

  15. Hantaviruses as emergent zoonoses

    Directory of Open Access Journals (Sweden)

    LS Ullmann

    2008-01-01

    Full Text Available Hantaviruses belong to the Bunyaviridae family, which consists of vector-borne viruses. These viruses can provoke two infection types: hemorrhagic fever with renal syndrome (HFRS - which occurs in the Old World - and hantavirus cardiopulmonary syndrome (HCPS - an emergent zoonosis that can be found in many countries of the western hemisphere. Rodents are hantavirus reservoirs and each species seems to host a different virus type. Humans acquire the infection by inhaling contaminated aerosol particles eliminated by infected animals. The factors involved in the emergence of hantavirus infections in the human population include ecological modifications and changes in human activities. The most important risk factor is contact between man and rodents, as a result of agricultural, forestry or military activities. Rodent control remains the primary strategy for preventing hantavirus diseases, including via health education and hygienic habits.

  16. Blog and Podcast Watch: Neurologic Emergencies.

    Science.gov (United States)

    Grock, Andrew; Joshi, Nikita; Swaminathan, Anand; Rezaie, Salim; Gaafary, Chris; Lin, Michelle

    2016-11-01

    The WestJEM Blog and Podcast Watch presents high quality open-access educational blogs and podcasts in emergency medicine (EM) based on the ongoing ALiEM Approved Instructional Resources (AIR) and AIR-Professional series. Both series critically appraise resources using an objective scoring rubric. This installment of the Blog and Podcast Watch highlights the topic of neurologic emergencies from the AIR series. The AIR series is a continuously building curriculum that follows the Council of Emergency Medicine Residency Director's (CORD) annual testing schedule. For each module, relevant content is collected from the top 50 Social Media Index sites published within the previous 12 months, and scored by eight board members using five equally weighted measurement outcomes: Best Evidence in Emergency Medicine (BEEM) score, accuracy, educational utility, evidence based, and references. Resources scoring ≥30 out of 35 available points receive an AIR label. Resources scoring 27-29 receive an honorable mention label, if the executive board agrees that the post is accurate and educationally valuable. A total of 125 blog posts and podcasts were evaluated. Key educational pearls from the 14 AIR posts are summarized, and the 20 honorable mentions are listed. The WestJEM Blog and Podcast Watch series is based on the AIR and AIR-Pro series, which attempts to identify high quality educational content on open-access blogs and podcasts. This series provides an expert-based, post-publication curation of educational social media content for EM clinicians with this installment focusing on neurologic emergencies.

  17. Vascular emergency: neuroradiological aspects

    International Nuclear Information System (INIS)

    Nasel, C.

    2001-01-01

    Common causes to consultate a neuroradiologist in case of emergencies are trauma, brain infarction, need a rapid assessment of the potentially nonnecrotic area within the ischaemic lesion. If hemorrhage, mostly occurring in the form of subarachnoid bleeding, is suspected, the source of bleeding has to be detected. With cranial computed tomography (CT) a thorough evaluation and staging of ischaemic stroke is possible with respect to thrombolysis. To detect irreversible damage of brain tissue, a combined perfusion-diffusion MRI should be performed. (author)

  18. Guidelines for emergency laparoscopy

    Directory of Open Access Journals (Sweden)

    Sauerland Stefan

    2006-10-01

    Full Text Available Abstract Acute abdominal pain is a leading symptom in many surgical emergency patients. Laparoscopy allows for accurate diagnosis and immediate therapy of many intraabdominal pathologies. The guidelines of the EAES (European Association for Endoscopic Surgery provides scientifically founded recommendations about the role of laparoscopy in the different situations. Generally, laparoscopy is well suited for the therapy of the majority of diseases that cause acute abdominal pain.

  19. Pediatric oncologic emergencies

    International Nuclear Information System (INIS)

    Zietz, Hallie A.

    1997-01-01

    Oncologic emergencies arise in three ways: disease or therapy induced cytopenias; a space occupying lesion causing pressure on or obstruction of surrounding tissues; or leukemia or tumors creating life-threatening metabolic or hormonal problems. Knowledge of presenting signs and symptoms of these emergencies are essential in pediatric oncologic nursing. Neutropenia opens the door for all manner of infections, but the most life threatening is septicemia progressing to shock. A variety of organisms can cause septic shock in the neutropenic patient, but episodes are most often due to gram-negative organisms and the endotoxins they release. Shock, while still compensated, may present with a elevated or subnormal temperature, flushed, warm, dry skin, widening pulse pressure, tachycardia, tachypnoea and irritability, but without medical intervention will progress to hypo tension, cool, clammy extremities, decreased urinary out- put, and eventually to bradycardia and cardiogenic shock. Another emergency in the cytopenia category is bleeding as a result of thrombocytopenia. Of greatest concern is intracranial hemorrhage that may occur at platelet counts of less than 5,000/mm3. Space-occupying lesions of the chest may produce superior vena cava syndrome (SVGS), pleural and pericardial effusions, and cardiac tamponade. SVGS is most often caused by non-Hodgkin's lymphoma (NHL) and presents as cough, hoarseness, dyspnea, orthopnea and chest pain. Signs include swelling, plethora, cyanosis, edema of conjunctiva and wheezing. Pleural and pericardial effusions present with respiratory or cardiac distress as does cardiac tamponade. Abdominal emergencies arise because of inflammation, mechanical obstruction, hemorrhage (often from steroid induced ulcers), and perforation. Pain is the most common presenting symptom, although vital sign alterations, fever, blood in vomitus or stool, abdominal distension and cessation of flatus are also important components of the acute abdomen

  20. Architecture humanitarian emergencies

    DEFF Research Database (Denmark)

    Gomez-Guillamon, Maria; Eskemose Andersen, Jørgen; Contreras, Jorge Lobos

    2013-01-01

    Introduced by scientific articles conserning architecture and human rights in light of cultures, emergencies, social equality and sustainability, democracy, economy, artistic development and science into architecture. Concluding in definition of needs for new roles, processes and education of arc......, Architettura di Alghero in Italy, Architecture and Design of Kocaeli University in Turkey, University of Aguascalientes in Mexico, Architectura y Urbanismo of University of Chile and Escuela de Architectura of Universidad Austral in Chile....