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Anxiety is a common problem in patients scheduled for a procedure, and their level of anxiety increases as the procedure date approaches; pre-procedural anxiety is observed in hepatocellular carcinoma (HCC) patients scheduled for liver ablation treatment. There is currently a lack of standardized education provided to patients about liver ablation treatment, which may contribute to patients' anxiety. To test the effectiveness of a pre-procedural video educational tool to reduce patient anxiety and increase knowledge in HCC patients in an interventional radiology clinic setting. This was a quasi-experimental, single-arm study, with a pre-test/post-test. Participant recruitment was based on a convenience sample. Inclusion criteria included: patients ages 18 and older; have biopsy-proven HCC or have a liver mass suspicious for HCC based on LI-RADS criteria imaging; no prior liver ablation treatment within three months of study onset. Participants watched a 7:04 minutes video and completed a 40-item State-Trait Anxiety Inventory and 10-item Knowledge Questionnaire before and after the video intervention to assess changes in anxiety and knowledge. Demographic variables evaluated included age, gender, education, and primary language. There were 16 participants who met inclusion criteria. The state anxiety scores were significantly lower after the intervention (Md = 33.50, n = 16) compared to before (Md = 47.50, n = 16), z = −2.67, p =.009, with a medium effect size, r = 0.47. The trait anxiety scores did not show sufficient evidence for a difference after the intervention (Md = 40.00, n = 16) compared to before (Md = 39.50, n = 16), z = 0.71, p =.50, with a small effect size, r = 0.13. The knowledge scores were significantly higher after the intervention (Md = 9.00, n = 16) compared to before (Md = 2.00, n = 16), z = −3.53, p =.0005, with a large effect size, r = 0.62. A nonparametric bootstrap and nonparametric permutation test also showed evidence for a difference in mean between the distributions of the state anxiety and knowledge pre- and post-intervention scores. The results of this study showed evidence for the effectiveness of video education in decreasing anxiety and increasing knowledge in HCC patients. A standardized pre-procedural video educational tool can be a useful practice across all interventional radiology departments as it is associated with improved quality of care and positive health outcomes. • Surgical procedures can cause anxiety in cancer patients. • Preprocedural video education in liver cancer patients decreases anxiety. • Early video education increases patient knowledge. [ABSTRACT FROM AUTHOR]

In the Emergency Department (ED), ultrasound-guided nerve blocks (UGNBs) have become a cornerstone of multimodal pain regimens. We investigated current national practices of UGNBs across academic medical center EDs, and how these trends have changed over time. We conducted a cross-sectional electronic survey of academic EDs with ultrasound fellowships across the United States. Twenty-item questionnaires exploring UGNB practice patterns, training, and complications were distributed between November 2021–June 2022. Data was manually curated, and descriptive statistics were performed. The survey results were then compared to results from Amini et al. 2016 UGNB survey to identify trends. The response rate was 80.5% (87 of 108 programs). One hundred percent of responding programs perform UGNB at their institutions, with 29% (95% confidence interval (CI), 20%–39%) performing at least 5 blocks monthly. Forearm UGNB are most commonly performed (96% of programs (95% CI, 93%–100%)). Pain control for fractures is the most common indication (84%; 95% CI, 76%–91%). Eighty-five percent (95% CI, 77%–92%) of programs report at least 80% of UGNB performed are effective. Eighty-five percent (95% CI, 66%–85%) of programs have had no reported complications from UGNB performed by emergency providers at their institution. The remaining 15% (95% CI, 8%–23%) report an average of 1 complication annually. All programs participating in our study report performing UGNB in their ED, which is a 16% increase over the last 5 years. UGNB's are currently performed safely and effectively in the ED, however practice improvements can still be made. Creating multi-disciplinary committees at local and national levels can standardize guidelines and practice policies to optimize patient safety and outcomes. [ABSTRACT FROM AUTHOR]

Although the risk of postoperative venous thromboembolism (VTE) in patients who undergo surgery for degenerative spinal disease has received attention, patients experiencing prolonged pain and disability while awaiting or considering surgery have not received adequate attention regarding the risk of VTE. To investigate the epidemiology of preoperative VTE in patients undergoing surgery for degenerative spinal disease. Retrospective cohort study using a nationwide database. Patients who underwent surgery for degenerative spinal disease. Preoperative occurrence of VTE. Data from 2014 to 2018 were obtained from the Korean National Health Insurance claims database. The occurrence of preoperative VTE within a 1-year period divided into 12 time intervals of 30 days each was investigated. The patients were categorized into two groups based on the presence of preoperative VTE. Multivariable logistic regression analysis was conducted to identify the factors associated with preoperative VTE. To validate the relationship between degenerative spinal disease and preoperative VTE, the diagnostic trends of preoperative VTE were analyzed in accordance with the identified risk factors. The overall incidence of preoperative VTE was 50 per 10,000 individuals. Multivariable analysis revealed that VTE occurred more frequently in older patients with specific medical comorbidities, particularly in those with a lumbar spinal lesion accompanied by arthritis of the hip, knee, or shoulder. We also found that the incidence rates of preoperative VTE, as well as the gradient of their increase, began to rise approximately 2 to 3 months prior to the index surgery, peaking just before the index surgery. This diagnostic trend was consistently observed in all patients irrespective of the presence of other risk factors. The incidence of preoperative VTE in patients with degenerative spinal disease exhibited a sharp increase immediately before surgery, with similar rates to those of postoperative VTE. Clinicians managing patients with degenerative spinal disease should be vigilant for preoperative as well as postoperative VTE. [ABSTRACT FROM AUTHOR]

Lumbar puncture is a common procedure performed by emergency physicians and trainees. The optimal patient positioning for lumbar puncture procedures has not been studied adequately. We performed a prospective randomized study in an urban, level I academic trauma center. Patients of all ages were included. Patients were randomized to either lateral decubitus or upright positioning. Patient demographic characteristics, level of physician training and experience, number of needle insertions and redirections, need for repositioning, alternative operator use, and laboratory results of the cerebrospinal fluid were recorded. We compared the success rate of each position as our primary outcome measure. We also evaluated number of needle insertions and re-directions and success rates based on experience and patient age. A total of 116 patients were enrolled, with 55 patients assigned to lateral decubitus and 61 to upright position for initial lumbar puncture attempt. Spinal fluid was obtained successfully in 47 of the lateral decubitus group (85.5%; 95% CI 73.8–92.4%) vs. 49 (80.3%; 95% CI 68.7–88.4%) in the upright assignment group. Comparable results were also obtained for first-pass success, number of failures, and number of bloody taps. Postgraduate year 2 residents or those with 31–50 previous lumbar punctures had the highest success rates at 94.3% (95% CI 81.2–98.4%) and 90.3% (95% CI 75.1–96.7%), respectively. Lateral decubitus and upright positioning for emergency lumbar puncture yielded equal success rates in emergency physicians and trainees. [ABSTRACT FROM AUTHOR]

Objective: Describe the implementation of a preoperative telemedicine program at a Northern California hospital-based center for abortion procedures requiring cervical preparation.Study Design: We implemented a pilot program using telemedicine for preoperative visits for patients needing cervical preparation prior to an abortion procedure from 12 to 18 weeks. We required ultrasonography for gestational age documentation in addition to placental localization in patients with a prior cesarean delivery. We prescribed misoprostol for cervical preparation for patients undergoing the telemedicine preoperative visit; in-person preoperative visits typically involve placement of osmotic dilators. Secondarily, we surveyed patients who had telemedicine and in-person preoperative visits to compare their preoperative experiences.Results: Implementation required 8 months of multidisciplinary meetings. From March 2018 through March 2019, we received 200 abortion referrals at 12 to 18 weeks gestation. Of these 200 patients, 119 did not meet telemedicine eligibility criteria, most commonly due to inability to obtain required ultrasonography (n = 89 [75%]). Of the remaining 81 patients, 43 scheduled telemedicine visits of which 41 initiated and 38 (88%) completed the visits. Twenty-one (55%) telemedicine encounters had no or minor technical difficulties. Thirty-one of 34 (91%) telemedicine and 91 of 108 (84%) in-person visit patients expressed high satisfaction with their preoperative appointment (p = 0.4); none reported dissatisfaction. Patients chose the telemedicine visit primarily for convenience and transportation concerns.Conclusion: A multidisciplinary team is essential for the successful implementation of a preoperative telemedicine program for procedural abortion care. Patients reported high satisfaction and reduced logistical burdens with the telemedicine option.Implications: Telemedicine preoperative visits for abortion procedures at 12 to 18 weeks gestation may improve access to abortion care, reduce patient burdens, and provide an alternative encounter option which may improve the patient experience. [ABSTRACT FROM AUTHOR]

Thousands of orthopedic surgeons in the United State face medical malpractice claims annually; however, little is known regarding the common causes for litigation against shoulder surgeons. In addition, the current analysis does not take into consideration how surgical frequency affects the litigation likelihood. The purpose of our investigation was to identify the most common causes of litigation against shoulder surgeons in the United States adjusting for surgical frequency. The VerdictSearch database was used using the search terms "medical malpractice," "shoulder," and "NOT cancer." Results were queried, and all studies pertaining to orthopedic shoulder surgery included. Data gathered included cause of lawsuit, indemnity paid, type of surgery performed, results of the cases, verdict or settlement, and, if applicable, technical error. A query of a multisurgeon institutional database was conducted to determine how frequently surgeries were performed. Then the frequency of litigation was adjusted by the procedure frequency to determine which surgery has the greatest likelihood to be litigated relative to rotator cuff surgery. Forty-five cases were included in our study. After adjusting for the procedure frequency, the most likely procedure to be litigated, relative to rotator cuff repair, was manipulation under anesthesia (MUA), 251 times more likely to be litigated, and washout/lavage procedures, 17 times more likely to be litigated. Injection and total shoulder arthroplasty were 23 and 14 times less likely to be litigated relative to rotator cuff repair, respectively. In addition, the average age of the patients was 47 years, and 53% of the cases involved a male plaintiff. The most commonly litigated procedures were rotator cuff repair (42%), MUA (13%), and humeral open reduction and internal fixation (9%). The most commonly cited symptoms for litigation against shoulder surgeons were pain (60%) and loss of range of motion (40%). Of the 45 cases, 44% ended in physician loss, with the average indemnity paid via verdict being $1,118,714 vs. $416,875 for settlement. This study identifies that MUA and lavage/washout procedures are much more likely to be litigated relative to rotator cuff repair. Rotator cuff repair is actually one of the least likely procedures to be litigated. Furthermore, settlement may represent a method of decreasing the indemnity paid for malpractice cases for which surgeons are implicated. [ABSTRACT FROM AUTHOR]

The first scheduled surgical or diagnostic procedure of the day sets the tone for the entire daily operating room (OR) schedule. Delayed first procedures of the day result in subsequent delays, affecting productivity, staffing, and most importantly, patient care. Factors that impact the start of the first scheduled case, include late patient arrival, lack of staffing, and incomplete pertinent laboratory results. Subsequently, this may lead to cancelations and will directly affect the patient's satisfaction with the process. Cases running in procedural rooms past their scheduled end times result in extra pay for staff, while canceled cases lead to lost revenue; these expenses are consequences of inefficiency. It is hard to determine the financial ramifications of late starts to an organization because overhead facility costs and staff salaries are multifactorial and specific to the setting. This quality improvement (QI) project evaluated the effectiveness of a change in shift start time for nurses as a solution to improving on-time starts by measuring first case on-time starts and the patient and radiology team satisfaction scores. • We proposed that a quality improvement (QI) project focusing on the change in shift start time for nurses as a solution to improving on-time starts and surgical patient satisfaction in an interventional radiology setting. • By changing the shift times of the nurses, the on-time starts for procedures within the department increased by 55.1%. • An increase in patient satisfaction scores regarding wait time and experience with the staff was noted to increase exponentially pre and post project implementation. [ABSTRACT FROM AUTHOR]

Urban forest governance comprises the formal and informal rules, institutions, and processes that influence collective decision-making in urban forest management. As such, it shapes key processes and outcomes that are implicated in urban environmental justice, including whose priorities and values are reflected in urban forest management and how and where urban trees are distributed. However, despite its central role in determining urban forest processes and outcomes, equity within urban forest governance remains obscure. To address this, we conducted a literature review to identify how equitable urban forest governance is conceptualized and evaluated in the literature, and what gaps in knowledge remain. Our review found that while distributional justice was the prevalent framing in the literature, recommendations for collaborative governance approaches reflect a shift towards procedural and recognitional justice. Most studies, however, used a top-down approach to evaluate policy outcomes and few incorporated community experiences or involvement within governance processes, leaving the roles and experiences of community actors underexplored. Our findings suggest that the existing literature has thus far failed to explicitly interrogate procedural and recognitional justice within urban forest governance. This highlights a critical need to more clearly incorporate procedural and recognitional justice themes and approaches into future urban forest governance theory, research, and practice. Based on our review, we offer a guiding analytical framework that identifies key considerations for equitable urban forest governance. • Distributional justice was the most common way authors framed their work. • The most common methods were spatial analysis and/or interviews with leading actors. • Collaborative governance reflects a shift toward procedural and recognitional justice. • Future studies should apply community-centered procedural/recognitional approaches. • Our review informs an analytical framework for equitable urban forest governance. [ABSTRACT FROM AUTHOR]

Sustained mechanical and environmental loadings on offshore structures result in creep phenomena. Creep and relaxation significantly affects the development of strains and stresses, thus they influence the durability of structures. Creep originates from the behaviour of the phases within the cement matrix. Seawater modifies the phases composition of cement matrix because of the variety of ions and their possible interactions with cement hydration products. This, in turn, affects the mechanical behaviour of structures, including creep. For durability and safety purposes, the design of offshore structures should consider the possible coupling between cement hydration, seawater exposure, and creep. Therefore, there was a need to develop a new protocol to evaluate the behaviour and durability of marine structures. As part of this new protocol, a new rig has been developed to evaluate the creep of cement-based materials immersed in seawater. The obtained results show that the short-term creep of structures in seawater is faster than in tap water. In the long term, even though multiple phases are microscopically formed due to seawater attack, the positive and negative effects of these phases formation and dissolution lead to almost similar creep development in seawater. This protocol can be used to assess the chemo-mechanical durability of multiple structural materials in order to develop low carbon materials. Additionally, it could improve the design of offshores structures by estimating the maximum permissible load based on the rigidity of structures and their chemical degradation level. • New test rig designed for combining creep and seawater exposure of structural materials. • Recomposed seawater contained all the ions present in natural seawater. • Microstructural characterization allowed identifying damaged and formed phases in cement-based materials. • Experimental results show coupled effects of cement hydration, chemical attack, and mechanical loading. • Hydration-seawater coupling had more influence on creep for short-term mechanical loading. [ABSTRACT FROM AUTHOR]

• During the COVID-19 pandemic the activity of the law enforcement never stopped. • Adjustments to the existing CSI SOP are crucial for safeguarding forensic technicians. • Main measures to make the operations possible during the pandemic are provided. The Coronavirus disease 2019 (COVID-19) is spreading around the world, representing a global pandemic. In this context, governments from around the world suspended almost all education, industry and business activities, alongside restricting the movement of people. Nevertheless, during this period, the activity of the law enforcement and forensic investigators never stopped. At present, guidelines regarding forensic autopsies of SARS-CoV-2 virus-positive cases and the handling of potentially infected biological samples are available in literature. However, less attention has been given to the development of specific adjustments to the existing crime scene investigation protocols and procedures for this exceptional time. This manuscript aims to share the methods and strategies adopted for the investigation of high priority criminal cases during the pandemic. Furthermore, other pandemic-related processes are critically explored, in order to propose adjustments for any forensic services to be prepared to face similar challenges in the future. The overall goal of this manuscript is to provide a summary of the main measures and the procedures developed to make the operations possible, while safeguarding the technicians in the field and the activity in the forensic laboratory. In order to minimize the risk of infection for personnel, adjustments to the standard practice have been proposed for each of the different phases of crime scene management, i.e. CSI call policy, equipment preparation, working groups, procedure at the scene, chain of custody and analyses of the evidence at the forensic lab. As this is a current study, based on limited cases and limited sources in the literature, changes and updates to the indications provided in this paper may be needed in the near future, according to new virological data epidemiological trends. [ABSTRACT FROM AUTHOR]

The objective of this review was to collate, summarise and report evidence on the use of VR as an interventional tool for pain and anxiety management during ED procedures. Guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) we searched Medline, Embase, CINAHL, Scopus and PsychInfo databases, grey literature and reference lists of included studies. From 162 articles, 4 fulfilled the selection criteria and demonstrated VR was effective as an intervention for management of pain and anxiety during ED procedures. The level of evidence was variable: 2 randomised controlled trials (RCT); a descriptive study; and a commentary on a literature review. Participants were aged 4–17 years and the sample sizes were small (n = 20, 59, 64). One RCT compared efficacy of VR to 2 other standard of care (SOC) distractors while the other RCT assessed for VR efficacy and safety. All four articles cited benefits of VR distraction as a procedural intervention in ED. A small number of studies involving children undergoing needle insertion in ED found VR to be a safe and effective means of managing procedural anxiety, providing a more effective strategy than standard care. Studies with larger samples, involving different procedures and across age groups are required. [ABSTRACT FROM AUTHOR]

Background: This study sought to assess target lesion failure (TLF) and clinically driven target lesion revascularization (CD-TLR) through 1 year following second-generation drug-eluting magnesium scaffold (Magmaris) implantation using a dedicated technique (so-called "4 P's" strategy).Methods and Results: The 4 P's strategy stands for: correct patient selection, proper scaffold sizing, pre-dilatation (<20% residual stenosis), post-dilatation. All the patient and lesion characteristics, preparation, and sizing of the device were compared in patients with TLF and CD-TLR through 1-year follow-up. We analyzed 315 patients for this study. At 1 year, there were 14 TLFs and 10 CD-TLRs. The TLF rates were 7.7%, 4.9%, and 4.1%; while the CD-TLR rates were 7.7%, 2.5%, and 3.2% in the undersized, properly sized, and oversized vessel groups, correspondingly. Diameter stenosis (DS) after pre-dilatation in patients with TLF and CD-TLR was significantly greater than in those without TLF and CD-TLR. In patients with a properly sized scaffold, DS after pre-dilatation was similar in patients with and without TLF and CD-TLR. However, in patients with non-properly sized scaffolds, greater post-balloon DS was observed in patients with TLF and CD-TLR.Conclusions: Improper sizing and poor lesion preparation before Magmaris implantation appear to be related to TLF during 1-year follow-up. [ABSTRACT FROM AUTHOR]

Background: Lateral canthotomy is a vision-saving procedure. However, the low incidence of orbital compartment syndrome and the expense of simulators to practice this procedure can lead to low confidence and delays in the performance of the procedure by emergency physicians.Discussion: We used a simple, inexpensive, easily assembled eye model for lateral canthotomy education at a residency program and a national conference obtaining feedback from simulation participants. Residents rated procedure laboratories that included the lateral canthotomy model as 4.9 to 5 (on a 5-point Likert scale, with 5 being the best score). National conference participants rated the model a 9 as a useful training model for practitioners on a 10-point Likert scale.Conclusion: This simple task trainer is practical, inexpensive, quickly assembled, and useful as a tool for practicing emergency medicine providers. [ABSTRACT FROM AUTHOR]

Patient satisfaction, Procedure, Pediatric emergency department, Pain. [Extracted from the article]

• Hand hygiene compliance varied based on different criteria and moments. • Duration and hand drying method of hand hygiene should be strengthened. • Area and motivation are observed factors influencing hand hygiene. • Sufficient human resources, supervision and education are important to improve hand hygiene. Higher requirement is put forward in the measurement of hand hygiene (HH) during a pandemic. This study aimed to describe HH compliance measurement and explore observed influencing factors with respect to coronavirus disease 2019 (COVID-19) guidelines in China. Compliance was measured as the percentage of compliant opportunities based on criteria for 17 moments. The criteria for compliance included HH behavior, procedure, duration, hand drying method, and the overall that counts them all. The observed influencing factors included different departments and areas and protection motivation. Descriptive analysis and logistic regression were performed. The compliance of overall criteria, HH behavior, procedure, duration, and hand drying method were 79.44%, 96.71%, 95.74%, 88.93%, and 88.42%, respectively, which were significantly different from each other (P <.001). Meanwhile, the overall and hand drying method compliance in semi-contaminated areas (odds ratio [OR] = 1.829, P <.001; OR = 2.149, P =.001) and hygienic areas (OR = 1.689, P =.004; OR = 1.959, P =.015) were significantly higher than those in contaminated area. The compliance with HH behavior for the motivation of patient-protection (OR = 0.362, P <.001) was lower than that for the motivation of self-protection. HH compliance was firstly measured using different criteria for 17 moments according to COVID-19 guidelines in China. The measurement of HH compliance needs clearer definition and comprehensive practice. Contaminated areas and motivation of patient-protection contribute to lower compliance, which may be addressed by allocating more human resources and increasing supervision and education. [ABSTRACT FROM AUTHOR]

L'IRM est parfois indispensable pour la planification de radiothérapie. Or un nombre croissant de patients est porteur d'un dispositif cardiaque implantable (pacemaker ou défibrillateur). La contre-indication historique à une IRM peut constituer une perte de chance pour certains patients. Cette revue de la littérature fait le point sur la prescription d'une IRM et la procédure à suivre en fonction des différents types de dispositif cardiaque implantable. Plusieurs études rétrospectives et deux larges études prospectives récentes ont montré que le port d'un dispositif cardiaque implantable n'est pas une contre-indication absolue sous réserve de précautions protocolaires d'usage reposant sur une concertation tri-disciplinaire entre oncologue, radiologue et cardiologue avec une programmation et une surveillance cardiologiques du dispositif cardiaque implantable pour des IRM ≤ 1,5 T. Le taux de complications majeures est inférieur à 5 % dans toutes les études hormis lorsqu'un remplacement de sonde est réalisé. Lorsque cela est anticipable, il est préférable d'implanter un dispositif cardiaque implantable IRM-compatible qu'un dispositif cardiaque implantable classique mais un remplacement n'est actuellement pas préconisé. Les données sont insuffisantes au-delà de 1,5 T et en cas de répétabilité des IRM dans le cadre de traitements par IRM-Linac. La réalisation d'une IRM en situation de dispositif cardiaque implantable n'est pas une contre-indication absolue et constitue un risque faible de morbidité ; elle repose sur une évaluation tri-disciplinaire. MRI is sometimes critical to optimal radiotherapy planning but may be contraindicated in increasing numbers of patients who carry an implantable cardiac device (ICD, pacemaker or defibrillator). This literature search reviews studies of MRI in DCI patients, morbidity and procedures for the different types of ICD. Several retrospective studies and two recent large prospective studies have shown that the use of an ICD is not an absolute contraindication to MRI, given that specific DCI monitoring is performed under the tridisciplinary supervision of the oncologist, radiologist and cardiologist for MRI ≤ 1.5 T. The rate of major complications is less than 5% unless probe replacement is performed. When it can be anticipated, new MRI-compatible ICD can be implanted rather than conventional ICD, but probe replacement is not currently recommended. Data for MRI beyond 1.5 T and in case of MRI repeatability in the context of MRI-Linac treatments are lacking. MRI may be performed in ICD patients, as the risk of morbidity is very low; provided that tridisciplinary evaluation is performed. [ABSTRACT FROM AUTHOR]

Flooding can often occur in many places due to the increasing trend of rainfall events (climate change), the urbanization process of a catchment area, or by an undersized urban channel. Reservoirs are used for limiting flooding since they can store an enough water volume. This research presents a practical procedure for sizing off-line reservoirs with an application in urban channels for places with space limitations. A complete formulation is presented, which can be easily used for designers and engineers for computing dimensions of off-line reservoirs. The formulation is applied to a case study located at the Cartagena de Indias, Colombia. [ABSTRACT FROM AUTHOR]

Les soins psychiatriques nécessitent parfois l'application d'une mesure de protection à l'égard d'un patient. Une procédure d'urgence peut être activée par le Procureur du Roi qui peut décider d'hospitaliser sous contrainte, sur base de l'avis écrit d'un médecin, la personne dans un service psychiatrique. La présente étude comporte donc plusieurs objectifs : (1) une investigation des profils des patients concernés, (2) les applications pratiques de ce type de mesure et (2) l'évaluation des critères liés à la prise de décision d'une hospitalisation contrainte. Cette étude a été réalisée dans un service hospitalier d'Urgences Médico-Psycho-Sociales en Belgique, via une analyse de dossiers sur une année. Les données fournissent des informations descriptives détaillées des patients concernés (n = 238, âge moyen de 39,99 ans, 59,66 % d'hommes) par la procédure d'urgence et ses applications pratiques, ainsi que la mise en évidence de facteurs liés à la prise de décision d'une hospitalisation contrainte. Cet état des lieux concernant la procédure urgente (évaluation et hospitalisation) est suivi d'une réflexion relative aux procédures et pratiques psychiatriques dans ce contexte de contrainte. Psychiatric cares sometimes lead to coercive measures for the patient. Emergency procedures are initiated by the competent Public Prosecutor who can decide to hospitalize patient under constraint on the basis of a medical certificate. This procedure raises questions at different levels. The present study included several objectives: (1) investigation of the profile of the patients; (2) practical application of this type of procedure; (3) evaluation of the criteria related to the decision-making process leading to forced hospitalization. This study was conducted in a Medical-Psycho-Social emergency unit in Belgium. This is a retrospective search, conducted on the basis of file analyses. Were included all patients who experienced emergency psychiatric assessment at the request of the magistrate. The following information were collected: date and time of admission, date of birth, sex, sector, diagnosis, use of therapeutic isolation, outcome of the evaluation, type of support, and the sex of the evaluators. These data were analyzed through descriptive and inferential statistical analyses. Two hundreds and thirty-eight 238 persons were admitted in the emergency unit at the request of a magistrate. The average age is 39.99 years (59.66% men) and 62.18% of patients are registered in their hospital sector, while 34.87% of admissions are made outside the sector. Psychiatric night care is activated in 34.03% of cases, while 28.15% of psychiatric assessment requests arrive in the morning and 37.39% in the afternoon. The service receives between 4 and 5 requests from the magistrate per week. While 15.96% of them are referred on weekends, 84.04% are sent to the service on weekdays. Regarding the main diagnosis, 42.43% show a psychotic disorder, 13.44% a (hypo) manic episode, 10.50% an abuse of substance, 9.66% of behavioral disorders, 7.56% a personality disorder, 5.88% an adjustment disorder, 5.05% a depressive disorder and 3.36% a mental retardation. Therapeutic isolation is used in 34.87% of situations. In 55.04% of the cases, the procedure was stopped, while 43.69% lead to hospitalization under constraint. If the procedure is stopped, another follow-up is proposed: 22.38% of in-house ambulatory follow-up, 16.41% of outpatient follow-up, 14.17% with a mobile unit, 9.70% of in-house hospitalization, 9.70% of judicial follow-up, 8.95% of care by a medical service, 5.22% of network referral, and 2.23% of social follow-up. Patients whose assessment leads to hospitalization under constraint are significantly older than those whose procedure is stopped. The sex of the patient does not influence the outcome of the assessment. The decision to hospitalize under constraint is not influenced by the time of admission or the sex of the evaluator. However, the results demonstrate a significant link between therapeutic isolation and the decision to hospitalize under constraint. Patients spending the night in the emergency room are more often hospitalized under constraint. In addition, the main diagnosis posed is significantly related to the outcome of the psychiatric evaluation. The majority of people diagnosed with psychotic disorders and (hypo) manic episodes are hospitalized under constraint, while people met for substance abuse, behavioral disorders and adjustment disorders are not. A very small proportion of patients with personality disorder, depressive disorder or mental retardation are forced into hospital. This study provides detailed descriptions of the patients involved in the emergency procedure and its practical application, as well as the identification of factors related to forced hospitalization. This work allows an inventory of the urgent procedure (psychiatric assessment and forced hospitalization) and improves the understanding of psychiatric procedures and practices. [ABSTRACT FROM AUTHOR]

Research has shown that do not resuscitate (DNR) and do not intubate (DNI) orders may be construed by physicians to be more restrictive than intended by patients. Previous studies of physicians found that DNR/DNI orders are associated with being less willing to provide invasive care. The purpose of this study was to assess the influence of code status on emergency residents' decision-making regarding offering invasive procedures for those patients with DNR/DNI compared with their full code counterparts. We conducted a nationwide survey of emergency medicine residents using an instrument of 4 clinical vignettes involving patients with serious illnesses. Two versions of the survey, survey A and survey B, alternated the DNR/DNI and full code status for the vignettes. Residency leaders were contacted in August 2018 to distribute the survey to their residents. Three hundred and three residents responded from across the country. The code status was strongly associated with decisions to intubate or perform CPR and influenced the willingness to offer other invasive procedures. DNR/DNI status was associated with less frequent willingness to place central venous catheters (88.2% for DNR/DNI vs. 97.2% for full code, p < 0.001), admit patients to the intensive care unit (89.9% vs. 99.0%, p < 0.001), offer dialysis (79.3% vs. 98.0%, p < 0.001), and surgical consultation (78.7% vs. 94.2%, p < 0.001). In a nationwide survey, emergency medicine residents were less willing to provide invasive procedures for patients with DNR/DNI status, including the placement of central venous catheters, admission to the intensive care unit, and consultation for dialysis and surgery. [ABSTRACT FROM AUTHOR]

Background: Health technology assessment (HTA) plays an important role in reimbursement decision-making in many countries, but recommendations vary widely throughout jurisdictions, even for the same drug. This variation may be due to differences in the weighing of evidence or differences in the processes or procedures, which are known as HTA practices.Objective: To provide insight into the effects of differences in practices on interpretation of intercountry differences in HTA recommendations for conditionally approved drugs.Methods: HTA recommendations for conditionally approved drugs (N = 27) up until June 2017 from England/Wales, France, Germany, the Netherlands, and Scotland were included. Recommendations and practice characteristics were extracted from these five jurisdictions and this data was validated. The effect of nonsubmissions, resubmissions, and reassessments; cost-effectiveness assessments; and price negotiations on changes in the percentage of negative recommendations and the interpretation of intercountry differences in HTA outcomes were analyzed using Fisher exact tests.Results: The inclusion of cost-effectiveness assessments led to significant increases in the proportion of negative recommendations in England/Wales (from 4% to 50%, P<.01) and Scotland (from 21% to 71%, P<.01). The subsequent inclusion of price negotiations led to significant reductions in the proportion of negative recommendations in England/Wales (from 50% to 14%, P<.01), France (from 31% to 3%, P=.012), and Germany (from 34% to 0%, P<.01). Results indicated that the inclusion of nonsubmissions and resubmissions might affect Scottish negative HTA recommendations (from 7% to 21%), but this effect was not significant. No significant effects were observed in the Netherlands, possibly owing to sample size.Conclusion: Variations in HTA practices between international jurisdictions can have a substantial and significant impact on conclusions about recommendations by HTA bodies, as exemplified in this cohort of conditionally approved products. Studies comparing international HTA recommendations should carefully consider possible practice variations between jurisdictions. [ABSTRACT FROM AUTHOR]

Healthcare systems can potentially improve their safety, quality of service, and performance efficiency with a cost reduction, through the introduction and implementation of healthcare information management systems. This study aims to examine the frequency of miscoding errors in principal and secondary diagnoses, exploring demographic and coder-related factors contributing to these errors through the use of the QuadraMed system. The study also investigates the association of coding errors with patient safety and service quality to estimate the potential financial implications resulting from these inaccuracies in the healthcare system. This analytical cross-sectional retrospective study was conducted at a local hospital in Najran, Saudi Arabia, from July 2021 to February 2022 using the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification (ICD-10-AM) coding system. The costing and financial data were collected from the reimbursement department for eligible 750 patient cases in terms of payment mode, services availed, and length of stay. The financial claims were evaluated to estimate the impact on the quality of service and patient safety. The reimbursement amount was calculated based on codes. The data were analyzed using SPSS and the odds ratio was calculated to estimate the risk of major coding errors in different departments. Primary codes 240 (32%) and 40 (5.3) secondary codes were reviewed and percentages and inaccuracies were calculated after recording. The percentage of inaccurate medical codes in principal diagnosis was 57(26.8%) and the percentage of inaccurate medical codes in secondary diagnosis was 21 (9.9%). The primary diagnostic codes have more coding errors with a total number of 240 (32%) coding errors with a moderate level of agreement between the original coder and independent coder with a kappa value of 0.462. The identified recording was done by the independent coder, and the secondary diagnostic code showed 40 (5.3%) cases, with a poor kappa value of 0.128. The results showed the highest number of primary diagnostic codes was among surgery clinics 79 (63.2%). The highest number of secondary diagnostic codes were reported among consultant clinics 12 (9.6%) The study concludes that the identification of miscoding in the healthy population has a financial impact on the healthcare organization's infrastructure. [ABSTRACT FROM AUTHOR]

Cognitive development is often thought to depend on qualitative changes in problem-solving strategies, with early developing algorithmic procedures (e.g., counting when adding numbers) considered being replaced by retrieval of associations (e.g., between operands and answers of addition problems) in adults. However, algorithmic procedures might also become automatized with practice. In a large cross-sectional fMRI study from age 8 to adulthood (n = 128), we evaluate this hypothesis by measuring neural changes associated with age-related reductions in a behavioral hallmark of mental addition, the problem-size effect (an increase in solving time as problem sum increases). We found that age-related decreases in problem-size effect were paralleled by age-related increases of activity in a region of the intraparietal sulcus that already supported the problem-size effect in 8- to 9-year-olds, at an age the effect is at least partly due to explicit counting. This developmental effect, which was also observed in the basal ganglia and prefrontal cortex, was restricted to problems with operands ≤ 4. These findings are consistent with a model positing that very-small arithmetic problems–and not larger problems–might rely on an automatization of counting procedures rather than a shift towards retrieval, and suggest a neural automatization of procedural knowledge during cognitive development. • Does cognitive development involve procedural automatization? • We tracked correlates of the arithmetic problem-size effect from age 8 to adulthood. • Young children showed intraparietal activity partly associated with counting. • We found age-related increases of activity in that region as performance improved. • This effect was specific to very-small problems, supporting procedural automatization. [ABSTRACT FROM AUTHOR]

The decision to make a referral for a primary physician is influenced by several factors such as the need for specialist consultation and requesting support for diagnosis or disease management using advanced equipment. Unfortunately, primary care physicians are faced with a number of hospitals that have different resources. This study aims to improve the quality of referral services by facilitating primary care physicians in determining the right referral hospital or specialty care. Prototyping method was used to extend rule-reasoning decision support in an electronic referral system where hospital coordinates and real-time availability of bed exist. The research was conducted in DI Yogyakarta province, Indonesia. Appropriate referral hospital was inferred based on the presence of differential diagnosis and or required procedure. The history of medical diagnosis and procedures from hospital claim data was used as knowledge-based that connect hospital master data. IF... AND (OR)... THEN rule-reasoning was used to recommend referral hospitals based on a differential diagnosis and or required medical procedure determined by a primary care physician in the electronic referral system. To narrow down the referral hospitals, the Google Maps API was used to estimate the distance from primary health facilities to several available hospital options. Information on the availability of beds was also visualized for preference in determining the choice of a referral hospital. A decision support system can help primary care physicians to find the right referral hospital or specialty care for a desired patient before making a referral to a higher level of health facility. [ABSTRACT FROM AUTHOR]

• Students understand implicit and explicit processes and constraints in the classroom. • Exploring how students create "loopholes" in assignments helps teachers see how they influence their students. • Certain aspects of digital composing interfaces influence the ways in which students respond to assignment prompts. • In general, students use loopholes by invoking the ethos of the professor or by first summarizing in class activities. In this study, we examine how students' use of "loopholes," in a weekly reflective writing assignment illustrates some strategies students use when navigating, and more specifically pushing back against, both implicit and explicit assignment expectations. In addition, this study expresses the import of opening the "blackbox," or implicit expectations/procedures, of both the classroom and the instructor by comparing student resistance to how users modify and change existing systems, programs, or interfaces. Situated within current conversations concerned with how digital composition redefines literacy, such a comparison allows for us to examine the ways in which students assess the often implicit procedures and constraints we, as teachers, may unwittingly reinforce, as well as allows for an examination of how students exercise their own writing skills in response to written assignment prompts for low-stakes writing in new digital interfaces. By analyzing instances of resistance in their reflections, this study illustrates how students attempt to circumvent assignment criteria for their own purposes, especially in the case of personal and low-stakes writing, as well as how digital interfaces in particular allow for students to push against the boundaries of certain written assignments in unique ways. [ABSTRACT FROM AUTHOR]

Background Deterioration of the distal radioulnar joint (DRUJ) in rheumatoid arthritis (RA) manifests as pain, weakness, and reduced range of motion. The Darrach and Sauvé-Kapandji (S-K) procedures are used when medical management fails to control these symptoms. However, there is a paucity of literature comparing the outcomes of these procedures. The purpose of this study is to compare the clinical and radiographic outcomes of the Darrach and S-K procedures in RA patients. Materials and Methods This is a retrospective, single institution cohort study of RA patients who underwent the Darrach or S-K procedure between 2008 and 2016. Ulnar translation, range of motion, and functional improvement were compared. Results Nine patients (13 wrists) underwent the Darrach procedure, and nine patients (11 wrists) underwent the S-K procedure. The average length of follow-up was 1.3 years. Pain, function, and range of motion improved in both groups. The degree of ulnar translation did not significantly change after either procedure. Conclusion Given their similar outcomes, we found no evidence that the S-K procedure is superior to the Darrach procedure or vice versa. However, when surgery is indicated for younger RA patients with DRUJ disease and ulnar translation, the S-K may be better suited to prevent radiocarpal joint dislocation. [ABSTRACT FROM AUTHOR]

Background: Surgical cricothyrotomy is a rare procedure but it must be mastered by any physician who is involved in advanced airway management. Lack of experience and practice, the high-stress nature of a "can't intubate, can't oxygenate" emergency, and the unavailability of realistic simulators all contribute to physician hesitance and inaptitude while employing cricothyrotomy during difficult and failed airways. The REAL CRIC Trainer was created to alleviate some of the barriers surrounding a surgical airway. It is designed to provide the user an affordable, easy to replicate, reusable, and extremely realistic experience in cricothyrotomy to prepare for this rare event.Discussion: The REAL CRIC Trainer uses a 3-dimensional printed tracheal model that is covered with pork belly skin, replicating human neck tissue. Red dyed normal saline is connected to the pork belly using intravenous tubing to simulate bleeding as an incision is made into the porcine skin. A bag-valve-mask connected to an endotracheal tube and to the trachea model will simulate breathing and replicate the puff of air experienced as the cricothyroid membrane is pierced with a scalpel. This simulator is cost effective and easy to replicate. Detailed step-by-step instructions are provided so that physicians working in any specialty involved in advanced airway management can easily recreate this trainer.Conclusions: This simulator makes it practical for physicians in a variety of clinical settings to incorporate its use into regular practice sessions, thereby assuring that physicians are ready to perform an emergent cricothyrotomy if necessary. [ABSTRACT FROM AUTHOR]

Abstract This paper presents an environmental flow methodology that was developed to accommodate shallow, highly dynamic micro-tidal estuaries found along the wave-dominated coast of South Arica. This method differs to most other approaches that primarily focus on larger permanently open systems having unrestricted inlets. Following an adaptive, design science research approach, the 7-step method adopted both ecohydrological and ecosystem-based concepts, encapsulating key hydrologicalhydrodynamic-biogeochemical processes, as well as biotic responses. The procedure also addresses a key challenge often encountered in applying these approaches to complex estuarine systems - the mismatch of temporal and spatial scales between abiotic processes and biotic responses. The method simplifies and aggregates abiotic processes to appropriate scales suitable for analysis of biotic responses, by introducing concepts such zoning and major physical states that characterize an estuary. The method's flexibility in data requirements lends itself to applications in countries where data is limited or where differences exist in data quality between systems. Essential in any environmental flow determination process, however, is long-term monitoring to incrementally improve confidence of the input data, but also to evaluate whether allocated flows achieve desired objectives set. Future challenges include refining the method to accommodate flow changes within much shorter timeframes and in conjunction with escalating global change pressures amongst other; pollution, living resource exploitation and physical destruction of habitat. Graphical abstract Unlabelled Image Highlights • An environmental flows method for highly dynamic micro-tidal estuaries. • A 7-step method encompassing ecohydrological and ecosystem-based concepts. • Abiotic processes were aggregated into physical states and zones to predict biotic responses. • The method is flexible to a range of statistical and modelling techniques and lends itself to application in data-poor countries. [ABSTRACT FROM AUTHOR]

Highlights • This is a validation of procedures for obtaining all-night fMRI data in sleeping subjects without sleep deprivation. • Subjects slept in the scanner on two consecutive nights, allowing the first night to serve as an adaptation night. • Performing all-night fMRI sleep studies is feasible. • Because the two nights of the study were performed consecutively, some sleep deprivation from Night 1 may have occurred. • It is envisioned that other laboratories can adopt the core features of this protocol to obtain similar results. Abstract Background Previous functional magnetic resonance imaging (fMRI) sleep studies have been hampered by the difficulty of obtaining extended amounts of sleep in the sleep-adverse environment of the scanner and often have resorted to manipulations such as sleep depriving subjects before scanning. These manipulations limit the generalizability of the results. New method The current study is a methodological validation of procedures aimed at obtaining all-night fMRI data in sleeping subjects with minimal exposure to experimentally induced sleep deprivation. Specifically, subjects slept in the scanner on two consecutive nights, allowing the first night to serve as an adaptation night. Results/comparison with existing method(s) Sleep scoring results from simultaneously acquired electroencephalography data on Night 2 indicate that subjects (n = 12) reached the full spectrum of sleep stages including slow-wave (M = 52.1 min, SD = 26.5 min) and rapid eye movement (REM, M = 45.2 min, SD = 27.9 min) sleep and exhibited a mean of 2.1 (SD = 1.1) nonREM-REM sleep cycles. Conclusions It was found that by diligently applying fundamental principles and methodologies of sleep and neuroimaging science, performing all-night fMRI sleep studies is feasible. However, because the two nights of the study were performed consecutively, some sleep deprivation from Night 1 as a cause of the Night 2 results is likely, so consideration should be given to replicating the current study with a washout period. It is envisioned that other laboratories can adopt the core features of this protocol to obtain similar results. [ABSTRACT FROM AUTHOR]

The change of the dominant design in the automotive industry from internal combustion engines to alternative power trains requires an adaptation of the product portfolio and a transformation of the production system. In the transition phase, an increased changeability is needed. This paper proposes a procedure for managing this transition, based on an integrated assessment of product, production planning and already existing production facilities. A modular product kit reduces the impact of change. An agile production planning process for the upcoming investments allows implementing a suitable degree of changeability without a loss of competitiveness, regarding risk and profitability under uncertainty. [ABSTRACT FROM AUTHOR]

Background: During the past 17 years of conflict the deployed US military health care system has found new and innovative ways to reduce combat mortality down to the lowest case fatality rate in US history. There is currently a data dearth of emergency department (ED) care delivered in this setting. We seek to describe ED interventions in this setting.Methods: We used a series of ED procedure codes to identify subjects within the Department of Defense Trauma Registry from January 2007 to August 2016.Results: During this time, 28,222 met inclusion criteria. The median age of causalities in this dataset was 25 years and most (96.9%) were male, US military (41.3%), and part of Operation Enduring Freedom (66.9%). The majority survived to hospital discharge (95.5%). Most subjects sustained injuries by explosives (55.3%) and gunshot wound (GSW). The majority of subjects had an injury severity score that was considered minor (74.1%), while the preponderance of critically injured casualties sustained injuries by explosive (0.7%). Based on AIS, the most frequently seriously injured body region was the extremities (23.9%). The bulk of administered blood products were packed red blood cells (PRBC, 26.4%). Endotracheal intubation was the most commonly performed critical procedure (11.9%). X-ray (79.9%) was the most frequently performed imaging study.Conclusions: US military personnel comprised the largest proportion of combat casualties and most were injured by explosive. Within this dataset, ED providers most frequently performed endotracheal intubation, administered blood products, and obtained diagnostic imaging studies. [ABSTRACT FROM AUTHOR]

Graphical abstract Highlights • A dosimetry procedure for 177Lu-DOTATATE is proposed. • 177Lu-DOTATATE dosimetry is feasible in clinical routine and repeatable. • Standard dosimetry will lead to personalized therapy and improved outcome. Abstract Purpose Peptide receptor radionuclide therapy with 177Lu-DOTATATE has become a standard treatment modality in neuroendocrine tumours (NETs). No consensus has yet been reached however regarding the absorbed dose threshold for lesion response, the absorbed dose limit to organs-at-risk, and the optimal fractionation and activity to be administered. This is partly due to a lack of uniform and comparable dosimetry protocols. The present article details the development of an organ-at-risk dosimetry procedure, which could be implemented and used routinely in a clinical context. Methods Forty-seven patients with NETs underwent 177Lu-DOTATATE therapy. Three SPECT/CT images were acquired at 4, 24 and 144–192 h post-injection. Three blood samples were obtained together with the SPECT/CT acquisitions and 2 additional samples were obtained around 30 min and 1 h post-injection. A bi-exponential fit was used to compute the source organ time-integrated activity coefficients. Coefficients were introduced into OLINDA/EXM software to compute organ-at-risk absorbed doses. Median values for all patients were computed for absorbed dose coefficient D / A 0 and for late effective half-life T 1 / 2 e f f for kidneys, spleen and red marrow. Results Dosimetry resulted in a median[interquartile range] of 0.78[0.35], 1.07[0.58] and 0.028[0.010] Gy/GBq for D / A 0 and of 55[9], 71[9] and 52[18] h for T 1 / 2 e f f for kidneys, spleen and red marrow respectively. Conclusions A dosimetry procedure for organs-at-risk in 177Lu-DOTATATE therapy based on serial SPECT/CT images and blood samples can be implemented routinely in a clinical context with limited patient burden. The results obtained were in accordance with those of other centres. [ABSTRACT FROM AUTHOR]

Background The implementation of MALDI-TOF MS for microorganism identification has changed the routine of the microbiology laboratories as we knew it. Most microorganisms can now be reliably identified within minutes using this inexpensive, user-friendly methodology. However, its application in the identification of mycobacteria isolates has been hampered by the structure of their cell wall. Improvements in the sample processing method and in the available database have proved key factors for the rapid and reliable identification of non-tuberculous mycobacteria isolates using MALDI-TOF MS. Aims The main objective is to provide information about the proceedings for the identification of non-tuberculous isolates using MALDI-TOF MS and to review different sample processing methods, available databases, and the interpretation of the results. Sources Results from relevant studies on the use of the available MALDI-TOF MS instruments, the implementation of innovative sample processing methods, or the implementation of improved databases are discussed. Content Insight about the methodology required for reliable identification of non-tuberculous mycobacteria and its implementation in the microbiology laboratory routine is provided. Implications Microbiology laboratories where MALDI-TOF MS is available can benefit from its capacity to identify most clinically interesting non-tuberculous mycobacteria in a rapid, reliable, and inexpensive manner. [ABSTRACT FROM AUTHOR]

Adherence to procedures is critical to the safety and performance of maintenance tasks; however, few studies of procedure compliance among maintenance personnel have been reported. The present study evaluated a theoretical model in which management approaches to procedure compliance were linked to compliance outcomes through user perceptions of positive and negative procedure attributes. New scales were developed to assess these variables; hypotheses derived from the model were tested in survey data collected from maintainers in the mining industry (N = 176). A structural equation model showed acceptable fit statistics; findings were broadly consistent with the initial hypotheses. As predicted, positive and negative dimensions of procedure attributes and compliance/non-compliance were perceived as distinct constructs, and were implicated in different pathways of the model. Also supporting the initial hypotheses, user involvement and managers’ learning-oriented responses to non-compliance were linked to favourable compliance outcomes through perceived procedure attributes. Learning-oriented responses were also directly associated with greater compliance. In addition, and contrary to prediction, punitive management responses positively predicted compliance. As discussed in the paper, these findings contribute new insights, relevant in both research and industry contexts, to understanding procedure compliance among maintainers. [ABSTRACT FROM AUTHOR]

We investigate the semantics of the procedure concept, and of one of the main techniques introduced by E. W. Dijkstra in his article Recursive Programming to implement it, namely the “static link,” sometimes also called “access link” or “lexical link.” We show that a confusion about that technique persists, even in recent textbooks. Our analysis is meant to clarify the meaning of that technique, and of the procedure concept. Our main contribution is to propose a better characterization of the “static link.” [ABSTRACT FROM AUTHOR]

Background: Cricothyroidotomy is a lifesaving procedure required in up to 2% of emergent airways. Emergency medicine training programs frequently instruct this procedure via cadaver training, but cadaver cost and availability limit the opportunity for all trainees to perform the critical initial skin incision. Cadaver autografting is a novel way to simulate all steps of the procedure.Objective: Our aim was to determine whether the technique of autografting cadaver tissue improves the experience of cricothyroidotomy simulation education for emergency medicine trainees. The investigators hypothesized that autografted cadaver tissue would be a useful adjunct.Methods: In this prospective crossover study, volunteers were randomized to first perform cricothyroidotomy on previously incised native neck tissue or on autografted tissue, and then vice versa. The autograft consisted of cadaver iliotibial band covered with lateral thigh skin and subcutaneous tissue to simulate cricothyroid membrane and native anterior neck anatomy. Volunteer emergency medicine residents and sub-interns were included. Twenty-seven residents and nine students participated. Outcomes were evaluated via Likert scale.Results: Thirty of 36 (83%) participants agreed or strongly agreed that they preferred cadaver autografting to the previously incised native tissue. Thirty-two of 36 (89%) agreed or strongly agreed that cadaver autografting was useful vs. 23 of 36 (64%) who answered similarly regarding previously incised native tissue (p = 0.001). Twenty-six of 36 (72%) were more comfortable with cricothyroidotomy in the emergency department after using cadaver autografting vs. 19 of 36 (53%) after using the native tissue (p = 0.003).Conclusions: Autografted cadaver tissue while simulating cricothyroidotomy was perceived to be a useful adjunct by the majority of participating emergency medicine trainees. [ABSTRACT FROM AUTHOR]

Extra Corporeal Membrane Oxygenation (ECMO) has historically been reserved for refractory pulmonary and cardiac support in children and adult. Operative intervention on ECMO was traditionally contraindicated due to hemorrhagic complications exacerbated by critical illness and anticoagulation needs. With advancements in ECMO circuitry and anticoagulation strategies operative procedures during ECMO have become feasible with minimal hemorrhagic risks. Here we review anticoagulation and operative intervention considerations in the pediatric population during ECMO cannulation. Pediatric surgical interventions currently described in the literature while on ECMO support include thoracotomy/thoracoscopy, tracheostomy, laparotomy, and injury related procedures i.e. wound debridement. A patient should not be precluded from a surgical intervention while on ECMO, if the surgery is indicated. [ABSTRACT FROM AUTHOR]

Background The most common bariatric procedures, Roux-en-Y gastric bypass (RYGB), adjustable gastric banding (LAGB), and sleeve gastrectomy (SG), generally induce significant weight loss and health improvements. However, little is known about how patients decide which procedure to undergo. Objective Investigate patients’ reasons for and against undergoing RYGB, LAGB, and SG. Setting Online questionnaire. Methods Data were analyzed from 236 Australian adults with current RYGB (15.7%), LAGB (22.0%), or SG (62.3%) who completed a questionnaire including an open-ended question about why they underwent their procedure. Data were coded for content and analyzed. Results Patients most often underwent RYGB because of its evidence base and success rate and the patient’s characteristics , whereas the most common reason for SG was a medical practitioner’s recommendation, preference, or choice , followed by the patients’ evaluation of information gathered from their own research and observations of others’ success. The most common reasons for undergoing LAGB related to characteristics of the procedure , including its reversibility and a perception of LAGB as less invasive. The most common reason against undergoing both RYGB and SG was a desire to avoid postsurgical complications and risks such as leaks or malabsorption, whereas the most common reason against LAGB was information and evidence from other people’s unsuccessful experiences and failure rates. Conclusions Patients’ reasons for and against procedures differed by procedure. In addition to the surgeon’s influence, patients demonstrated clear procedure preferences based on their own research, knowledge, and experiences. Preferences should be understood to assist patients to select the most appropriate procedure for their circumstances. [ABSTRACT FROM AUTHOR]

Paints based on the pigment white lead have traditionally been used in art. Currently, however, this pigment is difficult to find, either in powder or in paint, with sufficient purity and without undesired additives. Furthermore, the traditional methods of producing it are not feasible to use in the studio or laboratory. Therefore, the present work proposes a new method of producing the pigment on a small scale, to be used in the fields of the plastic arts, in restoration of works of art, and in research. The method consists of precipitating white lead from aqueous solutions of lead nitrate and sodium carbonate. The procedure is simple, quick, and without unpleasant materials or handling, and the resulting pigment is of great purity and similar to traditional white lead. [ABSTRACT FROM AUTHOR]

Stakeholder participation is considered a key principle for sustainable development in the context of natural resource and disaster risk management. Participatory modelling (PM) is an interactive and iterative process in which stakeholder involvement is supported by modelling and communication tools. Planning and decision-making for sustainable development (SD)integrate three substantive dimensions − social, ecological and economic. The procedural dimension of SD, however, is equally important, and here we see great potential for PM. In this study, we evaluate five PM research projects against criteria for the procedural dimension of SD. This provides a basis for identifying key issues and needs for further research into PM for SD. While the cases show great potential, especially for supporting knowledge integration, learning and transparent handling of values and perspectives, they indicate a particular need to develop PM in respect of organizational integration. This issue is closely connected to the possibility of effectively implementing PM in practice. [ABSTRACT FROM AUTHOR]

Aichi Target 11 (AT11), adopted by 193 Parties to the Convention on Biological Diversity (CBD) in 2010, states that protected areas (PAs) must be equitably managed by 2020. However, significant challenges remain in terms of actual implementation of equitable management in PAs. These challenges include, among others, the lack of a standardized approach to assess and monitor social equity and the difficulty of reducing social equity to a series of metrics. This perspective addresses these challenges and it proposes a minimum set of ten indicators for assessing and monitoring the three dimensions of social equity in protected areas: recognition, procedure and distribution. The indicators target information on social equity regarding cultural identity, statutory and customary rights, knowledge diversity; free, prior and informed consent mechanisms, full participation and transparency in decision-making, access to justice, accountability over decisions, distribution of conservation burdens, and sharing of conservation benefits. The proposed indicator system is a first step in advancing an approach to facilitate our understanding of how the different dimensions of social equity are denied or recognized in PAs globally. The proposed system would be used by practitioners to mainstream social equity indicators in PAs assessments at the site level and to report to the CBD on the ‘equitably managed’ element of AT11. [ABSTRACT FROM AUTHOR]

Background Consistent domestic hand hygiene can reduce diarrhea-related morbidity and mortality and the spread of other communicable diseases. However, it remains uncertain which technique of handwashing is most effective and practicable during everyday life. The goal of this study is to determine how the handwashing technique, as performed in the daily life by the participants of this case study in Harare, Zimbabwe, influences microbial handwashing effectiveness. Methods Handwashing technique of 173 primary caregivers was observed in their homes and hand rinse samples were collected before and after handwashing. Samples were analyzed for Escherichia coli and total coliform concentrations. Generalized linear models were used to predict fecal hand contamination after washing from observed handwashing technique. Results Cleaning under fingernails, scrubbing the fingertips, using soap, and drying hands through rubbing on clothes or a clean towel statistically significantly reduced E coli contamination of hands after washing. Tap use, scrubbing fingertips, and rubbing hands on clothes to dry them statistically significantly reduced total coliform contamination. Conclusions Recommendations for effective and practicable domestic handwashing in Harare, Zimbabwe, should include performing specific handscrubbing steps (ie, cleaning under the fingernails and rubbing the fingertips), and soap and tap use. This calls for further research to develop behavior change interventions that explicitly promote effective handwashing technique at critical times. [ABSTRACT FROM AUTHOR]

Abstract Duplication of the anterior skull base structures is an extremely rare malformation of failed midline blastogenesis. We present the case of a child with an obstructive oral cavity mass diagnosed on prenatal imaging. The child was successfully delivered by EXIT procedure, a tracheotomy was performed, and postnatal imaging demonstrated an array of craniofacial malformations, including complete duplication of the maxilla, pituitary glands, aqueducts of Sylvius, and basilar arteries. The child underwent excision of the duplicate maxilla, resulting in a wide cleft palate that will be repaired at a future date. [ABSTRACT FROM AUTHOR]

The resources for action idea suggests that procedures, although they appear to be constraints that control, direct and restrict actions, are in fact resources that support a wide range of actions. Whereas the notion has gained considerable traction in the academic discourse, few empirical studies investigated how procedures are used as resources or if they are the only resources deployed. This paper applies resources for action approach to describe how a cockpit manages emergencies and other non-normal situations and the role played by the Quick Reference Handbook (QRH). Data was collected through participant observation, interviews, and analysis of technical documents. The results indicate that some situations encountered by pilots are far more complicated than the procedure anticipates. In order to cope with these situations, pilots employed strategies that interleaved a range of resources, often consulting fragments of the QRH checklists rather than following them from start to finish. These findings suggest that emergency checklists should be divided into smaller units that can be followed independently, and that procedures should sometimes provide pilots with choices rather than mandatory instructions. The other resources deployed can also enhance the performance of pilots. [ABSTRACT FROM AUTHOR]

Although many prominent Relational Database Management Systems provides inbuilt security controls and mechanisms, the information resided in the data-store are at great risk. This research aims to reduce the risk of unauthorized data access by providing an extra layer of security. This research proposes a novel method for incorporating information security while designing the relational database by segregating the information on the basis of its sensitivity level and creating referential integrity constraints dynamically at run time. Different techniques to identify and quantify sensitive attributes and restructuring database architecture have been discussed for the proposed approach. The primary keys of the restructured tables and most critical information attributes were secured using Transparent Data Encryption utility provided by Oracle 11 g to prohibit illegitimate use of information. The performance of the proposed architecture was evaluated with 1,000,000 records which shows that by increasing the number of records, the response time of Select statement increased dramatically whereas it increased gradually for Insert, Update and Delete operations. [ABSTRACT FROM AUTHOR]

Machines pose various types of hazards and exposure to these hazards can result in injury or death. Risks linked to machinery can be managed by controlling hazardous energies. Safety procedures are thus used to control hazardous energies on machinery when workers perform different tasks such as maintenance, unjamming, or repair work. These procedures are part of a safety management policy for hazardous energies. The policy is described in a document referred to as the lockout program, which includes activities and work targeted by lockout, audits, hazard identification, training, communication and so on. The objective of this paper is to understand how the lockout program is actually implemented. As such, seven lockout programs from eight sawmills were analyzed. Twenty-two interviews were conducted with machine operators, maintenance workers and managers to gain a better understanding of the actual application of lockout programs, identify weak points and propose improvements. Fifty-seven lockout procedures were also observed. It was found that (i) hazard identification was incomplete, (ii) lockout program signatures and dates were missing, (iii) actual lockout practices were better than the procedures described in the programs regarding lockout hardware, rules to observe when using lockout hardware (e.g. keeping keys in one’s possession at all times) and machinery design for facilitating lockout, (iv) locks were applied to control systems during minor unjamming contrary to lockout principles, and (v) permits were issued as alternatives to lockout for troubleshooting without risk assessment. In actual fact, risk assessment is needed for both interventions requiring lockout and those without lockout. [ABSTRACT FROM AUTHOR]

It has been recently proposed that adults might solve single-digit addition and subtraction problems by rapidly moving through an ordered representation of numbers. In the present study, we tested whether these movements manifest themselves by on-line shifts of attention during arithmetic problem-solving. In two experiments, adult participants were presented with single-digit addition, subtraction and multiplication problems. Operands and operator were presented sequentially on the screen. Although both the first operand and the operator were presented at the center of the screen, the second operand was presented either to the left or to the right side of space. We found that addition problems were solved faster when the second operand appeared to the right than to the left side (Experiments 1 & 2). In contrast, subtraction problems were solved faster when the second operand appeared to the left than to the right side (Experiment 1). No operation-dependent spatial bias was observed in the same time window when the second operand was zero (Experiment 1), and no bias was observed when the operation was a multiplication (Experiment 2). Therefore, our results demonstrate that solving single-digit addition and subtraction, but not multiplication, is associated with horizontal shifts of attention. Our findings support the idea that mental movements to the left or right of a sequential representation of numbers are elicited during single-digit arithmetic. [ABSTRACT FROM AUTHOR]

The anterior sagittal trans-ano-rectal approach (ASTRA) provides excellent exposure to the urethra and vagina for partial or total urogenital sinus mobilization and subsequent reconstruction for patients with urogenital sinus anomalies. It is a frequent approach to reconstruction for children with a high confluence. However, the division of the anterior anal external sphincter and the rectal wall in the ASTRA incurs morbidity, which include fecal incontinence if one veers from the midline, and increased risk of wound infection due to fecal soilage. We demonstrate a modified technique to the ASTRA without dividing the anterior anal sphincter and rectal wall, with achievement of comparable exposure and excellent vaginal mobilization and length. [ABSTRACT FROM AUTHOR]