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Full Capacity (full + capacity)
Selected AbstractsCharacteristics of Medical Surge Capacity Demand for Sudden-impact DisastersACADEMIC EMERGENCY MEDICINE, Issue 11 2006Samuel J. Stratton MD Objectives To describe the characteristics of the demand for medical care during sudden-impact disasters, focusing on local U.S. communities and the initial phases of sudden-impact disasters. Methods Established databases and published reports were used as data sources. Data were obtained to describe the baseline capacity of the U.S. medical system. Information for the initial phases of a sudden-impact disaster was sought to allow for characterization of the length of time before a U.S. community can expect arrival of outside assistance, the expected types of medical surge demands, the expected time for the peak in medical-care demand, and the expected health system access points. Results The earliest that outside assistance arrived for a community subject to a sudden-impact disaster was 24 hours, with a range from 24 to 96 hours. After sudden-impact disasters, 84% to 90% of health care demand was for conditions that were managed on an ambulatory basis. Emergency departments (EDs) were the access point for care, with peak demand time occurring within 24 hours. The U.S. emergency care system was functioning at relatively full capacity on the basis of data collected for the study that showed that annually, 90% of EDs were boarding admitted inpatients, and 75% were diverting ambulances. Conclusions As part of planning for sudden-impact disasters, communities should be expected to sustain medical services for 24 hours, and up to 96, before arrival of external resources. For effective medical surge-capacity response during sudden-impact disasters, there should be a priority for emergency medical care with a focus on ambulatory injuries and illnesses. [source] New prospects for immunotherapy at diagnosis of type 1 diabetesDIABETES/METABOLISM: RESEARCH AND REVIEWS, Issue 4 2009Paolo Pozzilli Immune intervention at diagnosis of type 1 diabetes (T1D) aims to prevent or reverse the disease by blocking autoimmunity, thereby preserving/restoring ,-cell mass and function. Recent clinical trials of non-specific and of antigen-specific immune therapies have demonstrated the feasibility of modulation of islet-specific autoimmunity in patients with partial prevention of loss of insulin secretion. In a series of review articles published in this issue of the journal, some of the most promising approaches of immune intervention in T1D are presented. Here we outline the rationale of such interventions and future prospects in this area. Copyright © 2009 John Wiley & Sons, Ltd. Insulin therapy in type 1 diabetes (T1D) rescues the patient from a certain death but not cure the disease. The goal of any therapeutic intervention in T1D is the preservation of insulin-secreting cells; this is achieved by the abrogation of pathogenic reactivity to beta cell autoantigens while preserving full capacity to generate a normal immune response against foreign antigens. Although several therapeutic candidates have been investigated in experimental models of T1D many of which showed promising results, a successful extrapolation of these findings to human T1D has proved to be difficult. In part, this failure results from the considerable disease heterogeneity associated with diverse genetic and non-genetic disease determinants and the spectrum of clinical phenotype at diagnosis. Thus, a younger age at onset is associated with stronger genetic susceptibility, more intense immune response to ,-cell antigens, shorter duration of symptoms, more severe metabolic derangement at diagnosis and a more rapid rate of ,-cell-destruction 1,3. Therefore, designing therapies that would be effective in all clinical settings is definitely challenging. In this issue five different approaches are discussed ranging from antigen-specific therapies [DiaPep277 and glutamic acid decarboxylase(GAD)], to non-antigen-specific immunoregulation (anti-CD3) and to anti-inflammatory (anti-IL1 receptor antagonist). These approaches are currently being tested in large international multicenter trials, and all of them use very similar outcome in terms of a beneficial effect (C-peptide secretion as evidence of a therapeutic effect on restoration of ,-cell function). The authors have been asked to follow a similar format in presenting their approaches so that the reader can easily compare them in terms of rationale and therapeutic goals. [source] Adolescent Foley Catheter Technique for Visualizing Hymenal Injuries in Adolescent Sexual AssaultACADEMIC EMERGENCY MEDICINE, Issue 9 2003Jeffrey S. Jones MD Abstract Objectives: To determine the usefulness of the Foley catheter balloon technique for visualizing injuries of the estrogenized hymen in adolescent sexual assault victims compared with supine labial traction. Methods: A prospective clinical trial of 20 adolescent (age 13,16 years old) victims of sexual assault evaluated at a free-standing Nurse Examiner Clinic was conducted over a four-month study period. The clinic, affiliated with an emergency medicine residency program, is staffed by registered nurses who have been specially trained to perform medicolegal examinations using colposcopy with digital imaging. The Foley catheter technique uses an inflated balloon in the distal vaginal vault to expand the estrogenized hymen to its full capacity so that the edge may be readily visualized for signs of trauma. The Foley technique was compared with gross inspection, using supine labial traction, to photodocument hymenal abnormalities. Photographs of the hymen were obtained using the labial traction technique and then with the Foley technique. Three emergency physicians independently examined each pair of photographs with high interrater agreement for the presence of injury (,= 0.88). Results: Twenty adolescent sexual assault victims volunteered for the study; mean age was 14.8 years. Gross inspection of the hymen using supine labial traction identified hymenal injuries in three patients (15%). Use of the Foley catheter balloon technique allowed identification of hymenal abnormalities in nine additional cases (60%). The common injuries to the hymen included lacerations (30%), followed by ecchymosis and abrasions. One patient (5%) voiced discomfort (mild pressure sensation) during inflation of the balloon. Conclusions: The Foley catheter balloon technique is a simple method allowing improved photodocumentation of hymenal trauma in adolescent sexual assault victims compared with supine labial traction. [source] Regulation of axonal growth and guidance by the neurotrophin family of neurotrophic factorsCLINICAL AND EXPERIMENTAL PHARMACOLOGY AND PHYSIOLOGY, Issue 10 2003Lisa N Gillespie Summary 1.,The neurotrophins play an important role during development to stimulate and guide axonal growth for the establishment of a correctly wired and functional neural system. Neurotrophins can also regulate adult nervous system plasticity by promoting neuronal survival and stimulating nerve regrowth following injury. 2.,Therefore, the potential exists for these neurotrophic factors to be used as therapeutic agents for the treatment of neurodegenerative disorders. However, in order to realize the full capacity of neurotrophic factors as therapeutic agents, it is important to understand the mechanisms by which they elicit their survival and regenerative effects. 3.,The present paper reviews some of the ways in which neurotrophins regulate axonal growth and guidance. [source] | ||||||||||