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High Likelihood (high + likelihood)
Selected AbstractsPerformance of Greater Sage-Grouse Models for Conservation Assessment in the Interior Columbia Basin, U.S.A.CONSERVATION BIOLOGY, Issue 5 2002Michael J. Wisdom Consequently, we evaluated the performance of two models designed to assess landscape conditions for Greater Sage-Grouse across 13.6 million ha of sagebrush steppe in the interior Columbia Basin and adjacent portions of the Great Basin of the western United States (referred to as the basin). The first model, the environmental index model, predicted conditions at the scale of the subwatershed (mean size of approximately 7800 ha) based on inputs of habitat density, habitat quality, and effects of human disturbance. Predictions ranged on a continuous scale from 0 for lowest environmental index to 2 for optimal environmental index. The second model, the population outcome model, predicted the composite, range-wide conditions for sage grouse based on the contribution of environmental index values from all subwatersheds and measures of range extent and connectivity. Population outcomes were expressed as five classes (A through E) that represented a gradient from continuous, well-distributed populations (outcome A) to sparse, highly isolated populations with a high likelihood of extirpation (outcome E). To evaluate performance, we predicted environmental index values and population outcome classes in areas currently occupied by sage grouse versus areas where extirpation has occurred. Our a priori expectations were that models should predict substantially worse environmental conditions ( lower environmental index) and a substantially higher probability of extirpation ( lower population outcome class) in extirpated areas. Results for both models met these expectations. For example, a population outcome of class E was predicted for extirpated areas, as opposed to class C for occupied areas. These results suggest that our models provided reliable landscape predictions for the conditions tested. This finding is important for conservation planning in the basin, where the models were used to evaluate management of federal lands for sage grouse. Resumen: Modelos válidos de hábitat y de poblaciones del urogallo (Centrocercus urophasianus) son una necesidad crítica para su manejo debido a la creciente preocupación por la viabilidad de la población. Por lo tanto, evaluamos el funcionamiento de dos modelos diseñados para evaluar las condiciones del paisaje para el urogallo en 13.6 millones de ha de la estepa de artemisa en la Cuenca Columbia Interior y las porciones adyacentes de la Gran Cuenca de los Estados Unidos occidentales (referidos como cuenca). El primer modelo (modelo de índice ambiental) predijo condiciones a escala de la subcuenca (tamaño promedio , 7800 ha) basado en información de la densidad del hábitat, calidad del hábitat y efectos de la perturbación humana. Las predicciones variaron en una escala continua a partir de 0 (el índice ambiental más bajo) a 2 (índice ambiental óptimo). El segundo modelo (modelo del resultado de la población) predijo las condiciones compuestas, de amplio rango, para el urogallo con base en la contribución de los valores de índice ambiental de todas las subcuencas y las medidas de extensión y de conectividad de la pradera. Los resultados de la población fueron expresados en cinco clases (A - E) que representan un gradiente de poblaciones continuas, bien-distribuidas (resultado A) a poblaciones escasas, altamente aisladas con una alta probabilidad de extirpación (resultado E). Para evaluar el funcionamiento, predijimos valores de índice ambiental y resultados de la población en las áreas actualmente ocupadas por urogallos versus áreas donde ha ocurrido la extirpación. Nuestras expectativas a priori eran que los modelos deben predecir condiciones ambientales substancialmente peores (índice ambiental más bajo) y una probabilidad de extirpación sustancialmente mayor (menor resultado de la población) en áreas extirpadas. Los resultados para ambos modelos cumplieron estas expectativas. Por ejemplo, se predijo un resultado de la población de la clase E para áreas extirpadas, en comparación con la clase C para áreas ocupadas. Estos resultados sugieren que nuestros modelos proporcionaron predicciones de paisaje confiables para las condiciones probadas. Este hallazgo es importante para planeación de la conservación de la cuenca, donde los modelos fueron utilizados para evaluar el manejo de terrenos federales para urogallos. [source] Patterns of co-morbidity between alcohol use and other substance use in the Australian populationDRUG AND ALCOHOL REVIEW, Issue 1 2003Dr. LOUISA DEGENHARDT Abstract The present study describes patterns of co-morbidity between alcohol use and other substance use problems in the Australian population using data from the 1997 National Survey of Mental Health and Well-Being. Multiple regression analyses examined whether the observed associations between alcohol and other drug use disorders were explained by other variables, including demographic characteristics and neuroticism. We also assessed whether the presence of co-morbid substance use disorders affected treatment seeking for a mental health problem. Alcohol use was related strongly to the use of other substances. Those who did not report alcohol use within the past 12 months were less likely to report using tobacco, cannabis, sedatives, stimulants or opiates. Higher rates again were observed among those with alcohol use disorders: half (51%) of those who were alcohol-dependent were regular tobacco smokers, one-third had used cannabis (32%); 15% reported other drug use; 15% met criteria for a cannabis use disorder and 7% met criteria for another drug use disorder. These associations were not accounted for by the demographic and other variables considered here. Co-morbid substance use disorders (sedatives, stimulants or opioids) predicted a high likelihood of seeking treatment for a mental health problem among alcohol-dependent people. [source] Probabilistic risk assessment of reproductive effects of polychlorinated biphenyls on bottlenose dolphins (Tursiops truncatus) from the Southeast United States coastENVIRONMENTAL TOXICOLOGY & CHEMISTRY, Issue 12 2002Lori H. Schwacke Abstract High levels of polychlorinated biphenyls (PCBs) have been reported in the tissues of some species of marine mammals. The high concentrations are of concern because a growing body of experimental evidence links PCBs to deleterious effects on reproduction, endocrine homeostasis, and immune system function. Much of the recent research has focused on determining the exposure of marine mammal populations to PCBs, but very little effort has been devoted to the actual risk assessments that are needed to determine the expected impacts of the documented exposures. We describe a novel risk assessment approach that integrates measured tissue concentrations of PCBs with a surrogate dose-response relationship and leads to predictions of health risks for marine mammals as well as to the uncertainties associated with these predictions. Specifically, we use PCB tissue residue data from three populations of bottlenose dolphins (Tursiops truncatus), study the feasibility of published dose-response data from a surrogate species, and combine this information to estimate the risk of detrimental reproductive effects in female dolphins. Our risk analyses for dolphin populations near Beaufort (NC, USA), Sarasota (FL, USA), and Matagorda Bay (TX, USA) indicate a high likelihood that reproductive success, primarily in primiparous females, is being severely impaired by chronic exposure to PCBs. Excess risk of reproductive failure, measured in terms of stillbirth or neonatal mortality, for primiparous females was estimated as 60% (Beaufort), 79% (Sarasota), and 78% (Matagorda Bay). Females of higher parity, which have previously off-loaded a majority of their PCB burden, exhibit a much lower risk. [source] Arthroscopic reattachment of osteochondritis dissecans lesions using resorbable polydioxanone pinsEQUINE VETERINARY JOURNAL, Issue 5 2004A. J. NIXON Summary Reasons for performing study: Debridement of osteochondritis dissecans (OCD) cartilage lesions results in fibrocartilage and imperfect hyaline repair tissue, and forms a permanent irregularity to the subchondral bone plate. Objective: To evaluate the clinical, radiographic and outcome effects of OCD cartilage flap reattachment for select lesions as an alternative to OCD debridement. Hypothesis: Separated cartilage flaps resulting from OCD lesions may be re-incorporated into the hyaline cartilage surface by reattachment rather than debridement and removal. Methods: Resorbable polydioxanone pins were used to reattach OCD flap lesions in 16 joints of 12 horses. Criteria for attachment, rather than removal, included an unmineralised cartilage flap on preoperative radiographs and a relatively smooth surface with some residual perimeter attachment at surgery. Results: There were 12 subjects, 6 males and 6 females, 7 Thoroughbred or Standardbred weanlings, 3 Warmbloods, 1 Arabian and 1 Quarter Horse, mean age at surgery 6.8 months. All horses had effusion of the affected femoropatellar joint (n = 9), tarsocrural joint (n = 1) or fetlock (n = 2). Radiographic lesions varied in length between 1.8,6.3 cm; reattachment was used in 16 of 18 affected joints and the OCD cartilage was not satisfactory for salvage in 2 stifles. Number of pins required was 2,10. One horse was subjected to euthanasia due to a tendon laceration 8 weeks after surgery; of the remaining 11 horses, mean duration of follow-up was 3.9 years (range 4 months-8 years). Nine of these were sound and had entered work, while 2 were sound but remained unbroken 4 and 6 months post operatively, respectively. Radiographic resolution of the OCD lesion occurred in 14 of 16 pinned joints in the 9 horses with long-term follow-up. The 2 remaining joints had a 3 and a 5 mm mineralised flap in the original defect sites. Conclusions: This study indicated cartilage flap reattachment was an alternative to removal in selected OCD lesions. Potential relevance: Relatively smooth OCD cartilage flaps may be salvaged by reattachment and can result in normal radiographic subchondral contour and a high likelihood of athletic performance. Further case numbers are required to determine which lesions are too irregular or contain too much mineral for effective incorporation after reattachment. [source] Developing an approach to defining the potential distributions of invasive plant species: a case study of Hakea species in South AfricaGLOBAL ECOLOGY, Issue 5 2008David C. Le Maitre ABSTRACT Aim, Models of the potential distributions of invading species have to deal with a number of issues. The key one is the high likelihood that the absence of an invading species in an area is a false absence because it may not have invaded that area yet, or that it may not have been detected. This paper develops an approach for screening pseudo-absences in a way that is logical and defensible. Innovation, The step-wise approach involves: (1) screening environmental variables to identify those most likely to indicate conditions where the species cannot invade; (2) identifying and selecting the most likely limiting variables; (3) using these to define the limits of its invasion potential; and (4) selecting points outside these limits as true absence records for input into species distribution models. This approach was adopted and used for the study of three prominent Hakea species in South Africa. Models with and without the false absence records were compared. Two rainfall variables and the mean minimum temperature of the coldest month were the strongest predictors of potential distributions. Models which excluded false absences predicted that more of the potential distribution would have a high invasion potential than those which included them. Main conclusions, The approach of applying a priori knowledge can be useful in refining the potential distribution of a species by excluding pseudo-absence records which are likely to be due to the species not having invaded an area yet or being undetected. The differences between the potential distributions predicted by the different models convey more information than making a single prediction, albeit a consensus model. The robustness of this approach depends strongly on an adequate knowledge of the ecology, invasion history and current distribution of that species. [source] Thoracic duct cyst: Sclerotherapy as alternative for surgical treatmentHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 3 2007Johannes J. Dool MD Abstract Background. Thoracic duct cysts of the cervical portion are rare benign lesions for which surgery is the treatment of choice. Methods. We present 2 cases of a thoracic duct cyst of the cervical portion. One patient was treated by surgery and the other patient by ethanol sclerotherapy. Results. After establishing diagnosis by radiologic assessment and chemical and cytological fine-needle aspirate of the cystic masses, both patients were treated successfully. Conclusion. Ethanol sclerotherapy provides an alternative therapy for thoracic duct cyst when evaluation establishes a high likelihood of clinical diagnosis. © 2006 Wiley Periodicals, Inc. Head Neck, 2007 [source] Predicting Hospital Admission and Returns to the Emergency Department for Elderly PatientsACADEMIC EMERGENCY MEDICINE, Issue 3 2010Michael A. LaMantia MD Abstract Objectives:, Methods to accurately identify elderly patients with a high likelihood of hospital admission or subsequent return to the emergency department (ED) might facilitate the development of interventions to expedite the admission process, improve patient care, and reduce overcrowding. This study sought to identify variables found among elderly ED patients that could predict either hospital admission or return to the ED. Methods:, All visits by patients 75 years of age or older during 2007 at an academic ED serving a large community of elderly were reviewed. Clinical and demographic data were used to construct regression models to predict admission or ED return. These models were then validated in a second group of patients 75 and older who presented during two 1-month periods in 2008. Results:, Of 4,873 visits, 3,188 resulted in admission (65.4%). Regression modeling identified five variables statistically related to the probability of admission: age, triage score, heart rate, diastolic blood pressure, and chief complaint. Upon validation, the c-statistic of the receiver operating characteristic (ROC) curve was 0.73, moderately predictive of admission. We were unable to produce models that predicted ED return for these elderly patients. Conclusions:, A derived and validated triage-based model is presented that provides a moderately accurate probability of hospital admission of elderly patients. If validated experimentally, this model might expedite the admission process for elderly ED patients. Our models failed, as have others, to accurately predict ED return among elderly patients, underscoring the challenge of identifying those individuals at risk for early ED returns. ACADEMIC EMERGENCY MEDICINE 2010; 17:252,259 © 2010 by the Society for Academic Emergency Medicine [source] Surgical outcomes of partial nephrectomy for renal cell carcinoma: A joint study by the Japanese Society of Renal CancerINTERNATIONAL JOURNAL OF UROLOGY, Issue 4 2007Yutaka Senga Objective: A joint study was undertaken by the Japanese Society of Renal Cancer to investigate the present status of partial nephrectomy in Japan and to speculate about what may be the indications for partial nephrectomy in patients with renal cell carcinoma. Methods: Data were tabulated for 469 patients from participating medical institutions and various clinical factors were investigated with regard to disease progression (local recurrence and distant metastasis). Results: Disease progression was observed in 21 patients (4.5%). No significant relation to disease progression was observed for sex, laterality, tumor histology, grade and tumor size. Although patients with solitary tumors displayed excellent prognosis irrespective of tumor diameter, patients with multiple tumors displayed a high likelihood of disease progression. Patients older than 77 years old and patients with imperative indication were found to have a poorer prognosis. Conclusion: In patients with solitary tumors, partial nephrectomy can be actively performed, even if the patient displays elective indications and the tumor is >4 cm in diameter. In patients displaying multiple tumors with imperative indications, the decision whether to perform partial nephrectomy should be made by the patients and their physicians after considering the impact on curability and the quality of life. [source] Using habitat distribution models to evaluate large-scale landscape priorities for spatially dynamic speciesJOURNAL OF APPLIED ECOLOGY, Issue 1 2008Regan Early Summary 1Large-scale conservation planning requires the identification of priority areas in which species have a high likelihood of long-term persistence. This typically requires high spatial resolution data on species and their habitat. Such data are rarely available at a large geographical scale, so distribution modelling is often required to identify the locations of priority areas. However, distribution modelling may be difficult when a species is either not recorded, or not present, at many of the locations that are actually suitable for it. This is an inherent problem for species that exhibit metapopulation dynamics. 2Rather than basing species distribution models on species locations, we investigated the consequences of predicting the distribution of suitable habitat, and thus inferring species presence/absence. We used habitat surveys to define a vegetation category which is suitable for a threatened species that has spatially dynamic populations (the butterfly Euphydryas aurinia), and used this as the response variable in distribution models. Thus, we developed a practical strategy to obtain high resolution (1 ha) large scale conservation solutions for E. aurinia in Wales, UK. 3Habitat-based distribution models had high discriminatory power. They could generalize over a large spatial extent and on average predicted 86% of the current distribution of E. aurinia in Wales. Models based on species locations had lower discriminatory power and were poorer at generalizing throughout Wales. 4Surfaces depicting the connectivity of each grid cell were calculated for the predicted distribution of E. aurinia habitat. Connectivity surfaces provided a distance-weighted measure of the concentration of habitat in the surrounding landscape, and helped identify areas where the persistence of E. aurinia populations is expected to be highest. These identified successfully known areas of high conservation priority for E. aurinia. These connectivity surfaces allow conservation planning to take into account long-term spatial population dynamics, which would be impossible without being able to predict the species' distribution over a large spatial extent. 5Synthesis and applications. Where species location data are unsuitable for building high resolution predictive habitat distribution models, habitat data of sufficient quality can be easier to collect. We show that they can perform as well as or better than species data as a response variable. When coupled with a technique to translate distribution model predictions into landscape priority (such as connectivity calculations), we believe this approach will be a powerful tool for large-scale conservation planning. [source] Clinic in the Air?JOURNAL OF TRAVEL MEDICINE, Issue 6 2008A Retrospective Study of Medical Emergency Calls From A Major International Airline Background There is a high likelihood of a medical professional being onboard the aircraft at the time of emergency. Therefore, a health-care professional should be familiar with in-flight medical events and how to deal with them. Methods I present a 12-month retrospective study of medical distress calls from a major Asian international airline for which International SOS provided in-flight telemedical assistance. All the calls from the airplane to our center were analyzed from January 1, 2006, to January 1, 2007. The number of recommended diversions, availability of a medical professional, the range of medical problems, and used medications were considered. Results Overall, there were 191 in-flight air-to-ground consultations. Twenty-three (12.04%) calls were made for pediatric problems, with the youngest patient being 9 months old. Gastrointestinal complaints and simple faints comprised 50.2% of all calls. Most of the in-flight problems were successfully treated symptomatically with the initial recommendation to lie the patient down and administer oxygen. Metoclopramide, stemetil, loperamide, and buscopan were the most often administered drugs. A doctor was onboard in 45.5% of all calls. A recommendation to divert the aircraft was made in six (3.1%) cases. Conclusions Although developments in telemedical assistance and the content of a medical kit make the management of potential in-flight medical emergency much easier, they will never turn a commercial aircraft into a flying clinic. Preflight check-in screening by airlines and encouraging future air travelers with health concerns to seek medical help before flying should be recommended. [source] Review article: the role of surgery in gastro-oesophageal reflux diseaseALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 12 2007N. VAKIL Summary Background, Rates for laparoscopic fundoplication are declining in the United States and there is no consensus on the indications for referral to surgery in gastro-oesophageal reflux disease. Aim, To highlight recent studies on the outcomes of laparoscopic fundoplication in adults that cast doubt on the traditional indications for surgery in reflux disease. Results, Patients who are well maintained on medical therapy have more to lose with surgical intervention than to gain, and should not be offered surgery. Likewise, the notion that surgery prevents oesophageal cancer is a hypothesis that is not supported by current evidence, therefore surgical intervention should not be offered to these patients. The only clear-cut candidates for surgery include: patients with anatomic abnormalities such as a large hiatus hernia, or those with persistent regurgitation that causes troublesome symptoms despite medical therapy; and carefully selected patients with extra-oesophageal disorders who have symptoms of reflux disease such as heartburn and regurgitation, an incomplete response to medical therapy and persistent plus demonstrable reflux on pH or impedance testing that is associated with their symptoms. Patients should be aware of the high likelihood of needing continued acid inhibitory therapy following surgery and the possibility of side-effects. Conclusion, Only a few carefully selected patients should undergo fundoplication for reflux disease. [source] Review article: drug-induced microscopic colitis , proposal for a scoring system and review of the literatureALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 4 2005L. BEAUGERIE Summary The pathophysiology of microscopic colitis is unknown, although it is thought to be because of an abnormal immune reaction to luminal antigens in predisposed hosts. Specific antigens have not been proved, although various infectious triggers and drugs have been proposed. The responsibility of several drugs has been questioned, some with strong clinical and/or histological evidence suggesting causality. The issue of drug-induced microscopic colitis is important because of the burden of this disease. Thus, any case that can be cured by withdrawal of a drug must be identified. In this report, we propose a scoring system for drug-induced microscopic colitis, adapting existing criteria of drug causality, and review the literature using this framework. Based on this review, several drugs are identified with intermediate or high likelihood of inducing microscopic colitis. Finally, we suggest how to treat individual patients suspected of having drug-induced colitis according to the level of evidence for that particular drug. [source] Human Rights and Unfair Dismissal: Private Acts in Public SpacesTHE MODERN LAW REVIEW, Issue 6 2008Article first published online: 24 OCT 200, Virginia Mantouvalou This article addresses the termination of employment because of the conduct of the employee in her leisure time, in the light of the right to private life. It explores the impact on the retention of employment of activities taking place outside the workplace and outside working hours, and argues that the approach of UK courts and tribunals, which is based on a primarily spatial conceptualisation of privacy, is flawed. A fresh approach to privacy, resting on the idea of domination, is proposed, which is sensitive to the particularities of the employment relationship. Considering the fairness enquiry in dismissal, it argues that off-duty conduct may lead to lawful termination of employment only if there is a clear and present impact or a high likelihood of such impact on business interests; a speculative and marginal danger does not suffice. It further proposes that a particularly meticulous test is appropriate when certain suspect categories, such as the employees' sexual preferences, are at stake. [source] The Importance of Emergency Medicine in Organ Donation: Successful Donation Is More Likely When Potential Donors Are Referred From the Emergency DepartmentACADEMIC EMERGENCY MEDICINE, Issue 9 2009Glen E. Michael MD Abstract Objectives:, This study sought to identify factors that are associated with successful organ retrieval among patients referred to organ procurement services for potential organ donation. Particular attention was paid to the frequency, patient characteristics, and outcomes of patients referred for donation from the emergency department (ED). Methods:, For this retrospective cohort study, data were collected on all solid-organ donor referrals made to a single organ procurement organization serving 78 hospitals over a 45-month period. Data retrieved included patient age, sex, race, referral site (ED vs. inpatient), and mechanism of injury. Outcome of referral (organs retrieved or not) was the primary outcome variable. Pearson chi-square and Student's t-tests were used for bivariate statistical analysis. Multiple logistic regression analysis was used to determine which variables remained associated with organ retrieval after controlling for potential confounders. Results:, A total of 6,886 donor referrals were made in the study population. Of these, 155 were excluded due to incomplete data, leaving 6,731 subjects for analysis. Using bivariate statistical analysis, we found that successful organ retrieval was associated with younger age (donor mean age 40.8 years, 95% confidence interval [CI] = 39.1 to 42.5 vs. nondonor mean age 59.4, 95% CI = 58.9 to 59.9), mechanism of injury (p < 0.001), and referral from the ED (ED 15.5% retrieved, inpatient 5.9%, odds ratio [OR] = 2.92, 95% CI = 2.32 to 3.67). After controlling for potential confounders with multiple logistic regression, referral from the ED remained significantly associated with successful organ retrieval (OR = 1.52, 95% CI = 1.18 to 1.97), as did age (OR = 0.96, 95% CI = 0.96 to 0.97) and mechanism of injury (p < 0.001). On regression analysis, race emerged as a significant predictor of organ retrieval (p < 0.001). Medically suitable patients referred from the ED were significantly more likely on bivariate analysis to have consent for donation granted compared to patients referred from inpatient settings (OR = 1.48, 95% CI = 1.03 to 2.12), but this association was not found to be significant on regression analysis (OR = 1.37, 95% CI = 0.93 to 2.02). Conclusions:, Referral of potential organ donors from the ED is associated with an increased likelihood of successful organ retrieval. The authors conclude that further attention and resources should be directed toward the role of emergency medicine (EM) in the organ procurement process, owing to the relatively high likelihood of successful organ retrieval among patients referred from the ED. [source] The evolution of social inbreeding mating systems in spiders: limited male mating dispersal and lack of pre-copulatory inbreeding avoidance in a subsocial predecessorBIOLOGICAL JOURNAL OF THE LINNEAN SOCIETY, Issue 4 2009JASMIN RUCH Cooperation and group living are extremely rare in spiders and only few species are known to be permanently social. Inbreeding is a key characteristic of social spiders, resulting in high degrees of within-colony relatedness that may foster kin-selected benefits of cooperation. Accordingly, philopatry and regular inbreeding are suggested to play a major role in the repeated independent origins of sociality in spiders. We conducted field observations and laboratory experiments to investigate the mating system of the subsocial spider Stegodyphus tentoriicola. The species is suggested to resemble the ,missing link' in the transition from subsociality to permanent sociality in Stegodyphus spiders because its social period is prolonged in comparison to other subsocial species. Individuals in our two study populations were spatially clustered around maternal nests, indicating that clusters consist of family groups as found in the subsocial congener Stegodyphus lineatus. Male mating dispersal was limited and we found no obvious pre-copulatory inbreeding avoidance, suggesting a high likelihood of mating with close kin. Rates of polygamy were low, a pattern ensuring high relatedness within broods. In combination with ecological constraints, such as high costs of dispersal, our findings are consistent with the hypothesis that the extended social period in S. tentoriicola is accompanied with adaptations that facilitate the transition towards permanent sociality. © 2009 The Linnean Society of London, Biological Journal of the Linnean Society, 2009, 98, 851,859. [source] Defining Team Performance for Simulation-based Training: Methodology, Metrics, and Opportunities for Emergency MedicineACADEMIC EMERGENCY MEDICINE, Issue 11 2008Marc J. Shapiro MD Abstract Across health care, teamwork is a critical element for effective patient care. Yet, numerous well-intentioned training programs may fail to achieve the desired outcomes in team performance. Hope for the improvement of teamwork in health care is provided by the success of the aviation and military communities in utilizing simulation-based training (SBT) for training and evaluating teams. This consensus paper 1) proposes a scientifically based methodology for SBT design and evaluation, 2) reviews existing team performance metrics in health care along with recommendations, and 3) focuses on leadership as a target for SBT because it has a high likelihood to improve many team processes and ultimately performance. It is hoped that this discussion will assist those in emergency medicine (EM) and the larger health care field in the design and delivery of SBT for training and evaluating teamwork. [source] Early prediction of aphasia outcome in left basal ganglia hemorrhageACTA NEUROLOGICA SCANDINAVICA, Issue 3 2001C.-L. Liang Objectives , The independent predictors of aphasia outcome for patients with left basal ganglia hemorrhage were evaluated. Patients and methods, We included 140 patients of 1036 patients with spontaneous intracerebral hemorrhage admitted to our hospital from January 1993 through December 1997. Aphasia was assessed using the aphasia scale of the Scandinavian stroke scale. Univariate and step-wise logistic regression analyses were performed to assess the relationships between the initial aphasia score, age, gender, blood volume, locations of hematoma and aphasia outcome. Results, Step-wise logistic regression analysis revealed that the following two factors were independently associated with the final aphasia outcome: initial aphasia score (P<0.0001) and location of hematoma involving the posterior limb of the internal capsule (P=0.004). Conclusions, A particularly high likelihood of poor aphasia outcomes of patients with left basal ganglia hemorrhage are predicted in those who have poor initial aphasia score and whose brain computed tomography shows the hematoma involves the posterior limb of the internal capsule. [source] The role of procalcitonin as a predictor of nosocomial sepsis in preterm infantsACTA PAEDIATRICA, Issue 12 2006DAN TURNER Abstract Aim: To assess the role of procalcitonin in detecting nosocomial sepsis in preterm infants, after the onset of clinical symptoms. Subjects: 100 preterm infants, 24,36 wk of gestation, were followed from the age of 3 d until discharge. Procalcitonin and C-reactive protein (CRP) levels were measured within 3 d of sepsis workup events. Results: 141 blood samples were drawn from 36 infants during 85 episodes of sepsis workup performed between 4 and 66 d of life. Of these episodes, 51 (60%) were not a result of documented sepsis and thereby served as the negative comparison group. Median procalcitonin levels were higher in the septic group compared with the non-septic group at the time of the sepsis workup (2.7 vs 0.5 ng/ml, p=0.003), at 1,24 h after the sepsis workup (4.6 vs 0.6 ng/ml, p=0.003), and at 25,48 h (6.9 vs 2.0 ng/ml, p=0.016). Using high cutoff levels, both procalcitonin (2.3 ng/ml) and CRP (30 mg/l) had high specificity and positive predictive value (97%, 91% and 96%, 87%, respectively) but low sensitivity (48% and 41%, respectively) to detect sepsis. Areas under the ROC curve for procalcitonin and CRP were 0.74 and 0.73, respectively. Conclusion: Procalcitonin >2.3 ng/ml or CRP >30 ,g/l indicates a high likelihood for neonatal sepsis, and antibiotic therapy should be continued even in the presence of sterile cultures. [source] | |||||||||||||