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Terms modified by Minimise Selected AbstractsVENOUS NEEDLE DISLODGEMENT: HOW TO MINIMISE THE RISKSJOURNAL OF RENAL CARE, Issue 4 2008Jean-Pierre Van Waeleghem SUMMARY Although haemodialysis (HD) has become a routine treatment, adverse side effects, and occasionally life threatening clinical complications, still happen. Venous needle dislodgment (VND) is one of the most serious accidents that can occur during HD. If the blood pump is not stopped, either by activation of the protective system of the dialysis machine or manually, the patient can bleed to death within minutes. Fatal and near-fatal blood loss due to VND have been described in the literature (ECRI 1998; Sandroni 2005; Mactier & Worth 2007), but published reports represent only the tip of the ice berg, as such incidents are normally handled at a local or national level. The European Dialysis and Transplant Nurses Association/European Renal Care Association (EDTNA/ERCA) has produced 12 practice recommendations to help reduce the risk of VND and detect blood leakage as early as possible. A poster summarising these recommendations has been created (Van Waeleghem et al. 2008). [source] Application of High Current and Current Zero Simulations of High-Voltage Circuit BreakersCONTRIBUTIONS TO PLASMA PHYSICS, Issue 10 2006C. M. Franck Abstract This paper reports on the use of computational fluid dynamic (CFD) simulations to predict the interruption behaviour of high-voltage circuit breakers (HV-CB) using the self-blast principle. Two different levels of accuracy of the arc model are proven to be sufficiently accurate for simulating the high-current phase and the period around current zero (CZ). For the high-current phase, a simplified equivalent model of the arc is implemented to predict the pressure build-up, and even more important to accurately trace the hot gas from the arcing zone into the exhausts and the heating volume. A detailed analysis of the gas mixing in the heating volume for different arcing times and current amplitudes showed the optimum geometrical design of the heating volume. For the CZ phase, a more detailed arc model is needed including the effects of ohmic heating, radiative energy transfer, and turbulent cooling fully resolved in space and time. The validation with experiments was done and shows good agreement which justifies the use of the implemented model. With it, scaling laws varying only one parameter at a time (pressure and applied current slope) were derived and confirm previously found empirical laws. This is of particular interest, as it is very difficult to derive such scaling laws from experiments where the scatter is always very large and where it is impossible to vary only one parameter at a time. The influence of the most important geometrical parameters of the nozzle on the interruption performance is shown. In addition to previous experimental indications of this, the simulation reveals that turbulent cooling on the arc edge is the main reason for the difference in interruption performance. Moreover, the exact spatio-temporal build-up of arc resistance and with it the detailed understanding of the arc interruption process is possible and shown here for the first time. These simulations enable us to predict HV-CB performance and to minimise the number of development tests and are routinely used in new development projects. (© 2006 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim) [source] Cell distribution of stress fibres in response to the geometry of the adhesive environmentCYTOSKELETON, Issue 6 2006Manuel Théry Abstract Cells display a large variety of shapes when plated in classical culture conditions despite their belonging to a common cell type. These shapes are transitory, since cells permanently disassemble and reassemble their cytoskeleton while moving. Adhesive micropatterns are commonly used to confine cell shape within a given geometry. In addition the micropattern can be designed so as to impose cells to spread upon adhesive and nonadhesive areas. Modulation of the pattern geometry allows the analysis of the mechanisms governing the determination of cell shape in response to external adhesive conditions. In this study, we show that the acquisition of cell shape follows two stages where initially the cell forms contact with the micropattern. Here, the most distal contacts made by the cell with the micropattern define the apices of the cell shape. Then secondly, the cell borders that link two apices move so as to minimise the distance between the two apices. In these cell borders, the absence of an underlying adhesive substrate is overcome by stress fibres forming between the apices, which in turn are marked by an accumulation of focal adhesions. By inhibiting myosin function, cell borders on nonadhesive zones become more concave, suggesting that the stress fibres work against the membrane tension in the cell border. Moreover, this suggested that traction forces are unevenly distributed in stationary, nonmigrating, cells. By comparing the stress fibres in cells with one, two, or three nonadherent cell borders it was reasoned that stress fibre strength is inversely proportional to number. We conclude that cells of a given area can generate the same total sum of tractional forces but that these tractional forces are differently spaced depending on the spatial distribution of its adherence contacts. Cell Motil. Cytoskeleton 2006. © 2006 Wiley-Liss, Inc. [source] The rise of methamphetamine in Southeast and East AsiaDRUG AND ALCOHOL REVIEW, Issue 3 2008REBECCA McKETIN Abstract Introduction and Aims. Southeast and East Asia has become a global hub for methamphetamine production and trafficking over the past decade. This paper describes the rise of methamphetamine supply and to what extent use of the drug is occurring in the region. Method and Design. The current review uses data collected through the Drug Abuse Information Network for Asia and the Pacific (DAINAP) and other available sources to analyse retrospectively methamphetamine trends within Southeast and East Asia. Results. Southeast and East Asia has experienced a methamphetamine epidemic in the past decade which began around 1997 and peaked in 2000,2001. While the situation has since stabilised in many countries, methamphetamine trafficking and use are still increasing in parts of the Mekong region and there is evidence of large-scale manufacture in Cambodia, Indonesia, Malaysia and the Philippines. Methamphetamine is typically smoked or ingested, but injection of the drug is apparent. Conclusion. While the peak of the methamphetamine epidemic has passed in parts of Southeast and East Asia, attention is needed to minimise the potential consequences of spreading methamphetamine production, trafficking and use in the Mekong region and in the peninsular and archipelago of Southeast Asia. [source] SOME THOUGHTS ON ECONOMICS AND REGULATIONECONOMIC PAPERS: A JOURNAL OF APPLIED ECONOMICS AND POLICY, Issue 1 2004Graeme Samuel The author discusses the role of the ACCC in promoting competition policy in Australia. The ACCC's regulatory activities in focusing on of those industries where competition is limited are examined. It is argued that the focus here is two fold: to create conditions for fair competition in industries that rely on the services of facilities with natural monopoly characteristics and the administration of price caps to minimise the impact of monopoly power. [source] Oral sodium clodronate induced osteonecrosis of the jaw in a patient with myelomaEUROPEAN JOURNAL OF HAEMATOLOGY, Issue 1 2007Amir H Montazeri Abstract Bisphosphonate therapy has been shown to significantly reduce the incidence of skeletal complications in patients with myeloma. Several recent reports have described osteonecrosis of the jaw (ONJ) associated with bisphosphonates. These reports mainly demonstrate an association between ONJ and potent i.v. bisphosphonates. We report a case of ONJ in a patient with myeloma, who had only been treated with oral sodium clodronate. While the degree of risk for osteonecrosis in patients taking oral bisphosphonates, such as clodronate, remains uncertain it would be prudent to consider carefully the indications for the use of these agents to minimise the risk of ONJ. [source] Mobilisation of tumour cells along with CD34+ cells to peripheral blood in multiple myelomaEUROPEAN JOURNAL OF HAEMATOLOGY, Issue 5-6 2001Lene Meldgaard Knudsen Abstract:Background: Cells belonging to the malignant clone are found in the peripheral blood in myeloma patients. In order to minimise the content of tumour cells in the stem cell product it is crucial to perform stem cell harvest at a time when tumour cells in the peripheral blood are at a minimum. Objective: The aim of the study was to compare the mobilisation kinetics of normal CD34+ cells and myeloma plasma cells during mobilisation with either G-CSF alone or high-dose cyclophosphamide (HDCy) plus G-CSF. Design and methods: Morning blood samples were drawn each day during mobilisation from start of G-CSF or HDCy and to the end of leukapheresis, and were analysed by flow cytometry for content of CD34+ cells and myeloma plasma cells (CD38+ + CD45,). Tumour cells were also estimated by a patient-specific real-time polymerase chain reaction (PCR) method based on the 5, nuclease TaqMan technology. Results: Flow cytometry data from 16 patients showed concomitant mobilisation of CD34+ cells and myeloma plasma cells. Seven patients were mobilised twice; first with G-CSF alone and then with HDCy plus G-CSF. There was no difference between the two mobilisation regimens regarding tumour cell mobilisation kinetics. Real-time PCR was performed in one patient and confirmed the mobilisation of tumour cells at the time when CD34+ blood cells were at a maximum. Conclusions: Tumour cells are mobilised to the peripheral blood at the same time as CD34+ cells in multiple myeloma patients after priming with both G-CSF alone and HDCy in combination with G-CSF. [source] Sampling and analytical plus subsampling variance components for five soil indicators observed at regional scaleEUROPEAN JOURNAL OF SOIL SCIENCE, Issue 5 2009B. G. Rawlins Summary When comparing soil baseline measurements with resampled values there are four main sources of error. These are: i) location (errors in relocating the sample site), ii) sampling errors (representing the site with a sample of material) iii) subsampling error (selecting material for analysis) and iv) analytical error (error in laboratory measurements). In general we cannot separate the subsampling and analytical sources of error (since we always analyse a different subsample of a specimen), so in this paper we combine these two sources into subsampling plus analytical error. More information is required on the relative magnitudes of location and sampling errors for the design of effective resampling strategies to monitor changes in soil indicators. Recently completed soil surveys of the UK with widely differing soils included a duplicate site and subsampling protocol to quantify ii), and the sum of iii) and iv) above. Sampling variances are estimated from measurements on duplicate samples , two samples collected on a support of side length 20 m separated by a short distance (21 m). Analytical and subsampling variances are estimated from analyses of two subsamples from each duplicate site. After accounting for variation caused by region, parent material class and land use, we undertook a nested analysis of data from 196 duplicate sites across three regions to estimate the relative magnitude of medium-scale (between sites), sampling and subsampling plus analytical variance components, for five topsoil indicators: total metal concentrations of copper (Cu), nickel (Ni) and zinc (Zn), soil pH and soil organic carbon (SOC) content. The variance components for each indicator diminish by about an order of magnitude from medium-scale, to sampling, to analytical plus subsampling. Each of the three fixed effects (parent material, land use and region) were statistically significant for each of the five indicators. The most effective way to minimise the overall uncertainty of our observations at sample sites is to reduce the sampling variance. [source] Corporate Social Responsibility European StyleEUROPEAN LAW JOURNAL, Issue 2 2008Olivier De Schutter This article explains how, while CSR may have been initially an idea about the scope of the responsibility of companies towards their environment, it has now become a process in which the representatives of the business community have come to occupy the main role, and whose purpose is to promote learning among business organisations, rather than to identify the components of a regulatory framework for CSR. The central question now, therefore, is whether the so-called ,business case' for CSR is strong enough, so that we may hope that the forces of market will suffice to encourage companies to behave responsibly, over and above their obligation to comply with their legal obligations. The article shows, however, that this case rests on certain presuppositions about markets and the business environment, which cannot be simply assumed, but should be affirmatively created by a regulatory framework for CSR. Following the introduction, it proceeds in four stages. First, it examines the development of CSR in the EU. Second, it offers a critical examination of the so-called ,business case' for CSR, taking into account the growing diversity within the enlarged EU. It then discusses, as an alternative, what a regulatory framework for CSR could resemble, highlighting a number of initiatives which have been taken in this regard by the EU. The article finally concludes that, since the failure of the European Multi-Stakeholder Forum on CSR in 2004, the debate has made a turn in the wrong direction, both because of the mistaken view that the establishment of a regulatory framework for CSR would threaten the competitiveness of European companies, and because of the naive (and contradictory) view that reliance on market mechanisms will suffice to ensure that corporations will seek to minimise the negative social and environmental impacts of their activities, even in circumstances where they are not legally obliged to do so. [source] Near real-time spatial management based on habitat predictions for a longline bycatch speciesFISHERIES MANAGEMENT & ECOLOGY, Issue 6 2006A. J. HOBDAY Abstract, Southern bluefin tuna (SBT), Thunnus maccoyii (Castelnau), is a quota-managed species that makes annual winter migrations to the Tasman Sea off south-eastern Australia. During this period it interacts with a year-round tropical tuna longline fishery (Eastern Tuna and Billfish Fishery, ETBF). ETBF managers seek to minimise the bycatch of SBT by commercial ETBF longline fishers with limited or no SBT quota through spatial restrictions. Access to areas where SBT are believed to be present is restricted to fishers holding SBT quota. A temperature-based SBT habitat model was developed to provide managers with an estimate of tuna distribution upon which to base their decisions about placement of management boundaries. Adult SBT temperature preferences were determined using pop-up satellite archival tags. The near real-time predicted location of SBT was determined by matching temperature preferences to satellite sea surface temperature data and vertical temperature data from an oceanographic model. Regular reports detailing the location of temperature-based SBT habitat were produced during the period of the ETBF fishing season when interactions with SBT occur. The SBT habitat model included: (i) predictions based on the current vertical structure of the ocean; (ii) seasonally adjusted temperature preference data for the 60 calendar days centred on the prediction date; and (iii) development of a temperature-based SBT habitat climatology that allowed visualisation of the expected change in the distribution of the SBT habitat zones throughout the season. At the conclusion of the fishing season an automated method for placing management boundaries was compared with the subjective approach used by managers. Applying this automated procedure to the habitat predictions enabled an investigation of the effects of setting management boundaries using old data and updating management boundaries infrequently. Direct comparison with the management boundaries allowed an evaluation of the efficiency and biases produced by this aspect of the fishery management process. Near real-time fishery management continues to be a realistic prospect that new scientific approaches using novel tools can support and advance. [source] Optimising codend configuration in a multispecies demersal trawl fisheryFISHERIES MANAGEMENT & ECOLOGY, Issue 2 2006M. K. BROADHURST Abstract, The relative efficiencies and selectivities of conventional and modified codends were examined in a demersal trawl fishery targeting several species, including eastern king prawns, Penaeus plebejus (Hess), whiting, Sillago spp. and cephalopods. The modifications to codends included: (i) reducing the circumference; (ii) increasing the mesh size in conventional diamond-mesh designs; and (iii) orientating meshes on the bar so that they were square shaped. The codends were tested against a fine-meshed control in paired comparisons onboard three commercial trawlers. The conventional codend comprised 41-mm diamond-shaped mesh attached to an anterior extension section at a ratio of 150 to 100 meshes and was demonstrated to be non-selective for the targeted species. Reducing codend circumference to 100 meshes and increasing the size of mesh to 45 mm both improved selection for eastern king prawns, but the lateral mesh openings were estimated to be insufficient to allow juveniles of the other key species to escape. By contrast, codends made from 35- and 41-mm mesh hung on the bar improved the size selection for eastern king prawns and selected stout whiting, Sillago robusta (Stead) (the smallest commercial-sized fish) across narrow selection ranges and at 50% sizes of retention (L50s) that were closely correlated to the transverse morphology of fish and the maximum mesh opening. With the exception of a reduction in catches of octopus, Octopus spp., by the 41-square codend, there were no other impacts on commercial catches by the square-mesh designs. It was concluded that diamond-mesh codends are inappropriate for use throughout this multispecies fishery and that a modified design comprising at least 35-mm mesh hung on the bar is required to minimise the fishing mortality of unwanted sizes of the key target species. The results are discussed in terms of the utility of these types of modifications for closely regulating selection in penaeid-shrimp trawls. [source] Reduction of a native fish fauna by alien species: an example from Brazilian freshwater tropical lakesFISHERIES MANAGEMENT & ECOLOGY, Issue 2 2004A. O. Latini Abstract The consequences of introducing Cichla cf. monoculus Spix & Agassiz, Astronotus ocellatus (Agassiz) and Pygocentrus nattereri Kner into lakes in the River Doce basin, Brazil, on richness, diversity and efficiency of aquatic macrophytes as natural refugia to native fishes was investigated. Samples were taken from lakes with and without alien fishes in areas with and without aquatic macrophytes. The presence of alien fishes reduced richness and diversity of the native fish community. The refugia function, which could be attributed to the clustering of aquatic macrophytes, does not exist in these lakes probably because the alien fishes exploit such habitats for reproduction. Since introductions threaten the native fish diversity of the region, studies on regional dispersion and factors that minimise the spread of alien fishes are needed. [source] The effects of low summer flow on wild salmon (Salmo salar), trout (Salmo trutta) and grayling (Thymallus thymallus) in a small streamFRESHWATER BIOLOGY, Issue 12 2009W. D. RILEY Summary 1.,The effects of an experimentally imposed low summer flow on habitat use, displacement and survival of wild populations of juvenile salmon (Salmo salar), trout (Salmo trutta) and grayling (Thymallus thymallus) were investigated in a chalk stream. The habitat use and mobility of the fish in response to reduced flow was determined using passive integrated transponder-tag detector systems. 2.,Habitat use was compared to that available under different flow regimes. These consisted of an initial control phase of normal summer flow, an abrupt step change to 21 days of low flow, followed by a second control phase when normal summer flow was reinstated. First year (0+) salmon showed little change in their preferred substratum during low flow, whilst 1+ salmon increased their use of gravel and reduced that of mud during the day. Both 0+ and 1+ salmon were found in relatively deep water by day under low flow, whilst 1+ salmon preferred relatively shallow water at night. First year trout increased their use of gravel and reduced their use of mud and submerged tree roots under low flow, using relatively deep and fast flowing water by day. Older trout increased their use of gravel and occupied relatively deep, slow flowing water by day and relatively fast and shallow water at night. Grayling showed little change in their preferred substratum, but occupied relatively shallow water following the introduction of low flow. 3.,The range of movement of juvenile salmon increased at night under low flow, and was greater by day under normal flow. There was also an initial increase in the range of movement of 0+ trout following the introduction of low flow. Older trout initially moved less under low flow. With reduced flow, the range of movement by grayling increased significantly during the day. 4.,There was no net downstream displacement of any species with reduced flow, but the mortality rate in 0+ salmon, trout and grayling increased. This may be related to their small size and increased vulnerability to predation under low flow, and due to the reduction in depth and loss of the stream margins that are normally the preferred habitat of 0+ trout and grayling. 5.,The findings of this field study have implications for the management of braided, and highly regulated, chalk stream systems. In particular, they underline the importance of the stream margins as juvenile salmonid habitat, and suggest that a flow management strategy is required to mitigate for drought conditions. Such a strategy might include pre-emptive controls on abstraction and the maintenance of river flow via a prioritised route, predetermined using fish or habitat surveys, to minimise the effects of drought conditions on the more vulnerable or valued fish groups. [source] Bernard Soulier syndrome in pregnancy: a systematic reviewHAEMOPHILIA, Issue 4 2010P. PEITSIDIS Summary., Bernard Soulier syndrome (BSS) is a rare disorder of platelets, inherited mainly as an autosomal recessive trait. It is characterised by qualitative and quantitative defects of the platelet membrane glycoprotein (GP) Ib-IX-V complex. The main clinical characteristics are thrombocytopenia, prolonged bleeding time and the presence of giant platelets. Data on the clinical course and outcome of pregnancy in women with Bernard Soulier syndrome is scattered in individual case reports. In this paper, we performed a systematic review of literature and identified 16 relevant articles; all case reports that included 30 pregnancies among 18 women. Primary postpartum haemorrhage was reported in 10 (33%) and secondary in 12 (40%) of pregnancies, requiring blood transfusion in 15 pregnancies. Two women had an emergency obstetric hysterectomy. Alloimmune thrombocytopenia was reported in 6 neonates, with one intrauterine death and one neonatal death. Bernard Soulier syndrome in pregnancy is associated with a high risk of serious bleeding for the mother and the neonate. A multidisciplinary team approach and individualised management plan for such women are required to minimise these risks. An international registry is recommended to obtain further knowledge in managing women with this rare disorder. [source] Pregnancy and rare bleeding disordersHAEMOPHILIA, Issue 5 2009R. KADIR Summary., Rare bleeding disorders include deficiency of fibrinogen, prothrombin, factor V, factor VII, factor X, factor XI and factor XIII together with combined deficiency disorders, factor V+VIII deficiency, and deficiency of the vitamin K-dependent factors (factor II, VII, IX and X). They account for 3,5% of all inherited coagulation disorders. Due to their rarity, information about pregnancy complications and management is limited and mostly derived from case reports. Deficiency of fibrinogen and FXIII are both found to be strongly associated with increased risk of recurrent miscarriage and placental abruption. Factor replacement is used to reduce these risks. However, the risk of miscarriage and ante-partum complications is less clear in women with other bleeding disorders. Haemostatic abnormalities in women with rare bleeding disorders seem to persist throughout pregnancy especially if the defect is severe. Therefore women affected with these disorders are at risk of post-partum haemorrhage. The fetus can also be affected and potentially at risk of bleeding complications. Specialised multidisciplinary management is essential to minimise the potential maternal and neonatal complications and ensure an optimal outcome. This paper presents literature review for pregnancy complications in each of the rare bleeding disorders. In addition general principles for management of pregnancy, labour and delivery are discussed. [source] Near Field Emission SEMIMAGING & MICROSCOPY (ELECTRONIC), Issue 1 2009Localised Electron Excitation Imaging via SPM Recent developments in electron optics enable "extreme" high-resolution Scanning Electron Microscopes (SEM)s to attain subnanometer resolution using landing energies as low as 200 eV, which is essential to prevent damaging of the investigated object and minimise the interaction volume. We have also implemented low beam energies in a simplified SEM where the electron source, remote in standard SEMs, is brought within tens of nanometers to the object. This microscope, which we call the "near field emission scanning electron microscope" (NFESEM), is capable of imaging conducting surfaces with nanometer resolution using beam energies less than 60eV. [source] An audit of intra-oral digital radiographs for endodonticsINTERNATIONAL ENDODONTIC JOURNAL, Issue 4 2010R. Austin Aim, The aim of this study was to improve the quality of digital radiographs taken during endodontic treatment at King's College Hospital Dental Institute, UK. There were three phases. The first phase compared the Schick CDR system with Digora Optime. The second and third phases involved ways of improving the quality of the digital radiographs produced by the Schick CDR system. Methodology, The Faculty of General Dental Practitioners Royal College of Surgeons of England (FGDP) guidelines on Selection Criteria for Dental Radiography and Guidance Notes for Dental Practitioners on the Safe Use of X-Ray Equipment-National Radiological Protection Board enabled the use of a three point quality scale (one excellent, two diagnostically acceptable, three unacceptable), which took into consideration sensor angulation, positioning, contrast and focusing. The recommended FGDP guidelines are not less than 70% images scoring excellent. For the first phase 50 exposures recorded with the Schick CDR system were compared with 50 recorded using Digora Optime. For the second and third phases 50 radiographs for each phase were evaluated with images generated by the Schick system with training provided between the phases. Results, Images produced by the Schick system showed an inferior quality compared with the images generated by the Digora method. Both systems failed to reach the desired quality FGDP standard of 70% excellent (Schick 55% Digora 69%). Comparison of the results in the second and third phases showed that training the operator improved the quality but recommended the purchase of a size 1 or 0 Schick sensors to improve positioning errors. Conclusions, This study was carried out in order to minimise the ionising radiation dose to patients and to maximise the clinical and administrative benefits of using a digital system. It demonstrated an improvement in the quality of radiographs across all criteria measured up to and beyond the desired standard, from 55% of radiographs scoring excellent in the first phase to 80% in the third phase. As a result of the study it was decided to install the Schick CDR system because of the speed it produced images even though the first phase of this study demonstrated inferior image quality. The audit had clear, measurable standards with explicit targets. The audits have been through the entire audit cycle, data collection, change and a further data collection to provide evidence of the benefit of the change. A third data collection, demonstrated an ongoing commitment to quality. [source] Electrophysiologic characteristics and radiofrequency ablation of focal atrial tachycardia arising from para-Hisian regionINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 3 2007Y. Zhou Summary This study describes the electrophysiologic characteristics and radiofrequency ablation of focal atrial tachycardia (AT) arising from para-Hisian region in 14 (6.0%) patients of a consecutive series of 224 patients patients. Inverted or biphasic P wave in V1 and uncharacteristic P wave in inferior leads were observed during tachycardia, suggesting that there isn't a characteristic P-wave morphology for para-Hisian AT. During electrophysiological study, tachycardia could be induced with programmed atrial extrastimuli in 11 patients while a spontaneous onset and offset with ,warm-up and cool-down' phenomenon were seen in other three patients. Moreover, the tachycardias were sensitive to intravenous administration of adenosine triphosphate in all patients. On the basis of these findings, the mechanism is suggestive of triggered activity or micro-reentry, but automaticity cannot be conclusively excluded. Radiofrequency energy was delivered to the earliest site of atrial activation during AT. Ablating energy was carefully titrated, starting at 5 W and increasing gradually upto a maximum of 40 W, to achieve the ceasing of tachycardia. The long-term outcome was a 100% success rate in these 14 patients and there were no irreversible complications associated with ablation. Thus, the mapping and ablation of focal AT arising from para-Hisian region is safe and effective, delivery of radiofrequency energy in a titrated manner and continuous monitoring of atrioventricular (AV) conduction advocated to minimise the risk of damage to the anterograde AV conduction. [source] Low-molecular-weight heparin as bridging therapy during interruption of oral anticoagulation in patients undergoing colonoscopy or gastroscopyINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 2 2007M. Constans Summary Nowadays, most patients under oral anticoagulant therapy (OAT) require invasive procedures such as colonoscopy (CC) or gastroscopy (GC). The goals of the management of OAT are to minimise the risk of thromboembolism and bleeding. We have performed the first prospective, observational study to evaluate these parameters using fixed-dose high-risk thromboprophylactic therapy with sodic bemiparin (Hibor®) as bridging therapy. From January 2004 to January 2005, patients under OAT were included. Periprocedure prophylaxis consisted of: Acenocumarol patients: Day ,3: withdrawal acenocumarol. Days ,2,,1,0: Hibor ®3500 UI/d sc and days +1,+2,+3: Hibor® 3500 U/I + acenocumarol. And day +5: acenocumarol only. Warfarin patients: Days ,5,,4: withdrawal warfarin, ,3,,2,,1, 0; Hibor® 3500 UI/day sc, days +1,+2,+3,+4: Hibor® 3500 UI/day sc and warfarin and day +5; warfarin only. Thromboembolic complications and bleeding were recorded in a 3 month follow-up. We included 100 consecutive patients in the intention-to-treat group. The remaining 98 patients were 50 women and 48 men. Mean age of women was 71.1 (range: 46,87) years and 70.7 (range: 39,86) years in men. Eighty-three took acenocumarol, and 15 warfarin. Thirty-two gastroscopies and 61 colonoscopies were performed and in five patients both were performed. No thromboembolic and bleeding complications related to bemiparin were observed in the 103 endoscopies. Two patients developed pruritus at the punction site. Fixed-dose high-risk thromboprophilactic therapy with bemiparin (Hibor®) is safe and effective as a bridging therapy in patients under OAT who require GC or CC. [source] Interventions to reduce the incidence of falls in older adult patients in acute-care hospitals: a systematic reviewINTERNATIONAL JOURNAL OF EVIDENCE BASED HEALTHCARE, Issue 4 2009Cindy Stern BHS(Hons) Abstract Aim, Falls can cause serious physical and emotional injuries to patients leading to poor quality of life and increased length of hospital stay. The aim of this study was to present the best available evidence regarding the effectiveness of risk assessment or other interventions that aimed to minimise the number of falls. Methods, A systematic review of randomised controlled trials was undertaken to determine the effectiveness of interventions that were designed to reduce the incidence of falls in older acute-care patients. Only trials published between 1998 and 2008 were considered. Results, Only seven studies were included in the review, indicating the evidence on this topic is sparse. There is some evidence to suggest that implementing the following interventions in acute hospitals may be effective in reducing the amount of falls of older adult inpatients: ,,A multidisciplinary multifactorial intervention program consisting of falls risk alert card, an exercise program, an education program and the use of hip protectors after approximately 45 days ,,A one-on-one patient education package entailing information on risk factors and preventative strategies for falls as well as goal setting ,,A targeted fall risk factor reduction intervention that includes a fall risk factor screen, recommended interventions encompassing local advice and a summary of the evidence There is also some evidence to suggest that implementing a multidisciplinary multifactorial intervention that consists of systematic assessment and treatment of fall risk factors, as well as active management of postoperative complications, can reduce the amount of falls in patients following surgery for femoral neck fracture. Conclusion, There is some evidence to suggest that certain multifactorial interventions are more effective than others and that increasing patient education or targeting fall risk factors may be of benefit. Further high-quality research is needed in order to ascertain effective fall-prevention strategies in acute-care facilities. [source] Fat, wheat bran and salt effects on cooking properties of meat patties studied by response surface methodologyINTERNATIONAL JOURNAL OF FOOD SCIENCE & TECHNOLOGY, Issue 10 2010Hasibe Tekin Summary Response surface methodology was used to investigate the main effects and interactions of composition (processing) variables such as fat (10,30%), wheat bran (5,15%) and NaCl (0,2%) on cooking properties of beef patties. In addition, the ridge analysis was conducted to find the values of processing variables that maximise and minimise the cooking parameters (moisture retention, fat retention, reduction in thickness, reduction in diameter, cooking yield, shrinkage and water-holding capacity). It was found that the moisture and fat retention, reduction in thickness and cooking yield values decreased; however, reduction in diameter and shrinkage values increased, respectively, as the amount of fat increased. However, wheat bran addition increased fat retention, moisture retention, cooking yield and water-holding capacity values of the patties. Increasing NaCl levels decreased water-holding capacity value by its quadratic effect and moisture and fat retention value by its interaction effect with wheat bran. [source] Pictures and silences: memories of sexual abuse of disabled peopleINTERNATIONAL JOURNAL OF SOCIAL WELFARE, Issue 4 2002Darja Zavir The article de,individualises the debate about sexual abuse of disabled people, especially women, by showing that both the sexual and asexual identity of impaired persons are invariably fashioned within the institutional arrangement of domination and subjugation. It shows that if disabled persons are seen as asexual or if they are sexualised, they cannot escape sexual violence, which is not an aberration, but is intrinsic to the social construction of disability. The article includes personal testimonies of women with different disabilities from Slovenia, who were abused either at home or in public care and shows some responses of the professionals and caregivers who minimise the importance of abuse. It claims that ignoring the memories of sexual abuse is part of a subtle and unintentional discrimination, which reflects a continuity of prejudices and hatred toward disabled children and adults in the private realm as well as in public care. People from ethnic minorities, such as Roma, are still today more often diagnosed as mentally disabled, which shows that the disability diagnosis has to be seen as part of cultural responses towards an economically and socially marginalised group. The author uses different perspectives: historical, social work theories, cultural studies and feminist analysis. [source] Direct shipping logistic planning for a hub-and-spoke network with given discrete intershipment timesINTERNATIONAL TRANSACTIONS IN OPERATIONAL RESEARCH, Issue 1 2006Libby Chong Abstract This paper proposes a heuristic procedure to solve the problem of scheduling and routing shipments in a hybrid hub-and-spoke network, when a given set of feasible discrete intershipment times is given. The heuristic procedure may be used to assist in the cooperative operational planning of a physical goods network between shippers and logistics service provider, or to assist shippers in making logistics outsourcing decisions. The objective is to minimise the transportation and inventory holding costs. It is shown through a set of problem instances that this heuristic procedure provides better solutions than existing economic order quantity-based approaches. Computational results are presented and discussed. [source] Air temperature effect on spray evaporation in sprinkler irrigation,IRRIGATION AND DRAINAGE, Issue 4 2002Dr Giulio Lorenzini évaporation aérienne; irrigation par arroseur; équipement expérimental Abstract The temperature effect of the surrounding environment on mean steady aerial water evaporation in sprinkler irrigation is investigated. An experimental set-up was designed and built to work at opportune operating conditions holding all the other variables constant to minimise the experimental error. One hundred and thirty-seven tests were performed for this work, of which 81 were considered valid for a statistical analysis of the data measured. Evaporation ranged from 4.15 to 7.73% as the air temperature varied from 21.0 to 27.0° C. Results show a clear dependence of sprinkler water evaporation on air temperature with a logarithmic relation. Further investigations will examine broader temperature intervals to improve the assessment and will consider the effects due to other parameters affecting the phenomenon. Copyright © 2002 John Wiley & Sons, Ltd. Résumé Les effets de la température de l'environnement sur l'irrigation par arroseur ont été examinés. Un eq,uipement expérimental a été conçu et créé pour fonctionner dans des conditions d'emploi propices, et on a travaillé aussi pour tenir les autres variables le plus possible constantes pour minimiser l'erreur expérimentale. On a réalisé 137 tests et seulement 81 ont été considérés bons pour l'analyse statistique. On a vu que l'évaporation change de 4.15 à 7.73 pour cent avec le changement de température de 21.0 à 27.0° C. Les résultats montrent une claire dépendance logarithmique de l'évaporation avec la température de l'air. On propose dans le futur d'étendre l'intervalle des températures pour confirmer les résultats déjà vus et aussi de tester les influences d'autres variables d'intérêt pour ce phénomène. Copyright © 2002 John Wiley & Sons, Ltd. [source] Conceptualising spirituality and religion for healthcareJOURNAL OF CLINICAL NURSING, Issue 21 2008Barbara Pesut Aims., To discuss some of the challenges of conceptualising spirituality and religion for healthcare practice. Background., With the growing interest in spirituality in healthcare, has come the inevitable task of trying to conceptualise spirituality, a daunting task given the amorphous nature of spirituality, the changing understandings of spirituality among individuals and the diverse globalised society within which this task is taking place. Spirituality's relationship to religion is a particularly challenging point of debate. Design., Critical review. Conclusions., Three social and historical conditions , located in the context of Western thought , have contributed to current conceptualisations of spirituality and religion: the diminishment of the social authority of religion as a result of the Enlightenment focus on reason, the rise of a postmodern spirituality emphasising spiritual experience and current tensions over the ideological and political roles of religion in society. The trend to minimise the social influence of religion is a particular Western bias that seems to ignore the global megatrend of the resurgence of religion. Current conceptualisations are critiqued on the following grounds: that they tend to be ungrounded from a rich history of theological and philosophical thought, that a particular form of elitist spirituality is emerging and that the individualistic emphasis in recent conceptualisations of spirituality diminishes the potential for societal critique and transformation while opening the door for economic and political self interest. Relevance to clinical practice., Constructing adequate conceptualisations of spirituality and religion for clinical practice entails grounding them in the wealth of centuries of philosophical and theological thinking, ensuring that they represent the diverse society that nursing serves and anchoring them within a moral view of practice. [source] An Exploratory Model for Evaluating Crisis Events and Managers' Concerns in Non-Profit OrganisationsJOURNAL OF CONTINGENCIES AND CRISIS MANAGEMENT, Issue 4 2003John E. Spillan Few organisations avoid the experience of crisis management. Some time during their life they are confronted with some type of crisis that may strain their resources and distract them from their central mission of serving its clients. Crisis management seeks to minimise the impact of these events. Although the crisis management literature is plentiful regarding larger organisations, little has been written on this subject as it relates to non-profit organisations. This study examines the perceptions and experiences of crisis events among non-profit organisation managers located in the north-eastern part of the U.S. The results reveal that only a little more than a quarter of the respondents indicated that a formal crisis management team or any plans to implement it were operating in their non-profit organisation. [source] Equal effects of gelatin and hydroxyethyl starch (6% HES 130/0.42) on modified thrombelastography in childrenACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 3 2009W. A. OSTHAUS Background: Artificial colloids are frequently used to prevent or treat circulatory failure due to hypovolaemia. Whereas gelatin has been shown not to affect coagulation besides its haemodilutional effect, hydroxyethyl starches (HES) have additional negative effects on haemostasis. The third-generation HES solutions have been developed to minimise these effects. We therefore conducted a prospective, randomised study, to verify the hypothesis that a 6% HES 130/0.42/6 : 1 and a 4% gelatin infusion influences modified thrombelastography (TEM) parameters in children in the same manner and to the same extent. Methods: A total of 50 paediatric patients aged 0,12 years scheduled for surgery were assigned to receive either 10 ml/kg HES 130/0.42 or gelatin. Blood gas analysis, haemodynamic parameters and TEM measurements were performed before and after colloid administration. Results: Patient characteristics, indications/surgical procedures and the main results obtained from blood gas analysis were comparable between the two groups. After administration of either gelatin or HES, all TEM parameters, except for clotting time, indicated impaired coagulation whereas the mean values of all TEM parameters remained within the normal ranges. Comparing the gelatin and HES 130/0.42/6 : 1 groups, none of the measured TEM parameters was found to show between-group differences at baseline or after colloid infusion. Conclusion: In conclusion, we could demonstrate that the investigational product, HES 130/0.42/6 : 1 solution, administered at a dosage of 10 ml/kg to children, had comparable effects on coagulation monitored with TEM as a gelatin solution. Perioperative administration of HES 130/0.42/6 : 1 does not alter coagulation to an extent above and beyond the effect of haemodilution. [source] Clinical care and technical recommendations for 90yttrium microsphere treatment of liver cancerJOURNAL OF MEDICAL IMAGING AND RADIATION ONCOLOGY, Issue 3 2010S-C Wang Summary Selective internal radiation therapy (SIRT) with 90yttrium microspheres is a relatively new clinical modality for treating non-resectable malignant liver tumours. This interventional radiology technique employs percutaneous microcatheterisation of the hepatic arterial vasculature to selectively deliver radioembolic microspheres into neoplastic tissue. SIRT results in measurable tumour responses or delayed disease progression in the majority of eligible patients with hepatocellular carcinoma or hepatic metastases arising from colorectal cancer. It has also been successfully used as palliative therapy for non-colorectal malignancies metastatic to the liver. Although most adverse events are mild and transient, SIRT also carries some risks for serious and , rarely , fatal outcomes. In particular, entry of microspheres into non-target vessels may result in radiation-induced tissue damage, such as severe gastric ulceration or radiation cholecystitis. Radiation-induced liver disease poses another significant risk. By careful case selection, considered dose calculation and meticulous angiographic technique, it is possible to minimise the incidence of such complications to less than 10% of all treatments. As the number of physicians employing SIRT expands, there is an increasing need to consolidate clinical experience and expertise to optimise patient outcomes. Authored by a panel of clinicians experienced in treating liver tumours via SIRT, this paper collates experience in vessel mapping, embolisation, dosimetry, microsphere delivery and minimisation of non-target delivery. In addition to these clinical recommendations, the authors propose institutional criteria for introducing SIRT at new centres and for incorporating the technique into multidisciplinary care plans for patients with hepatic neoplasms. [source] Blood volume is normal after pre-operative overnight fastingACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 4 2008M. JACOB Background: Pre-operative fasting is assumed to cause a deficit in intravascular blood volume (BV), as a result of ongoing urine production and insensible perspiration. Standard regimes consist of volume loading prior or simultaneous to any anaesthetic procedure to minimise the risk of hypotension. However, fluid overload in the context of major abdominal surgery has been shown to deteriorate patient outcome. Our study aimed to quantify total intravascular BV after fasting by direct measurements and to compare it with calculated normal values in comparable non-fasted patients. Methods: After 10 h of fasting, total plasma volume (PV) and red cell volume (RCV) were measured via the double-label technique (indocyanine green dilution and erythrocytes labelled with fluorescein, respectively) following induction of general anaesthesia in 53 gynaecological patients suffering from malignoma of the cervix. The corresponding normal values were calculated individually from age, body height and body weight. Results: Measured BV, RCV and PV after fasting were 4123±589, 1244±196 and 2879±496 ml, respectively. The differences to the corresponding calculated normal values were not significant (3882±366, 1474±134 and 2413±232 ml, respectively). The measured haematocrit reflected a slight anaemic state (0.35±0.03). Conclusion: Our data suggest that even after prolonged pre-operative fasting, cardio-pulmonary healthy patients remain intravascularly normovolaemic. Therefore, hypotension associated with induction of general or neuraxial anaesthesia should perhaps be treated with moderate doses of vasopressors rather than with undifferentiated volume loading. [source] Rectovaginal fistula following colectomy with an end-to-end anastomosis stapler for a colorectal adenocarcinomaJOURNAL OF SMALL ANIMAL PRACTICE, Issue 12 2006A. Klein An 11-year-old, female neutered Labrador retriever was presented with a micro-invasive differentiated papillar adenocarcinoma at the colorectal junction. A colorectal end-to-end anastomosis stapler device was used to perform resection and anastomosis using a transanal technique. A rectovaginal fistula was diagnosed two days later. An exploratory laparotomy was conducted and the fistula was identified and closed. Early dehiscence of the colon was also suspected and another colorectal anastomosis was performed using a manual technique. Comparison to a conventional manual technique of intestinal surgery showed that the use of an automatic staple device was quicker and easier. To the authors' knowledge, this is the first report of a rectovaginal fistula occurring after end-to-end anastomosis stapler colorectal resection-anastomosis in the dog. To minimise the risk of this potential complication associated with the limited surgical visibility, adequate tissue retraction and inspection of the anastomosis site are essential. [source] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||