International Scope of Emergency Ultrasound: Barriers in Applying Ultrasound to Guide Central Line Placement by Providers in Nairobi, Kenya

Background While ultrasound (US) use for internal jugular central venous catheter (CVC) placement is standard of care in North America, most developing countries have not adopted this practice. Previous surveys of North American physicians have identified lack of training and equipment availability as the most important barriers to the use of US. Go to: Objective We sought to identify perceived barriers to the use of US to guide CVC insertion in a resource-constrained environment. Go to: Methods Prior to an US-guided CVC placement training course conducted at the Aga Khan University Hospital in Nairobi, Kenya, physicians were asked to complete a survey to determine previous experience and perceived barriers. Survey responses were analyzed using summary statistics and the Rank-Sum test based on different specialty, gender, and previous US experience. Go to: Results There were 23 physicians who completed the course and the survey. 52% (95% CI: 0.30–0.73) had put in \u3e20 CVCs. 21.7% (95% CI: 0.08–0.44) of participants had previous US training, but none in the use of US for CVC insertion. The respondents expressed agreement with statements describing the ease of the use and improved success rate with US guidance. There was less agreement to statements describing the relative convenience and cost effectiveness of US CVC placement compared to the landmark technique. The main perceived barriers to utilization of US guidance included lack of training and limited availability of US equipment and sterile sheaths. Go to: Conclusion Perceived barriers to US-guided CVC placement in our population closely mirrored those found among North American physicians, including lack of training and limited availability of US machines and equipment. These barriers have the potential to be addressed by targeted educational and administrative interventions

Is Hong Kong Democratizing

We argue that the transition to Chinese authority has not undermined democratic governance in Hong Kong and that voice and accountability have improved since the handover. We seek to explain this surprising result and conclude with a discussion of the implications of our findings for China, Taiwan, and cross-strait relations

Accessing Patient Records in Virtual Healthcare Organisations

The ARTEMIS project is developing a semantic web service based P2P interoperability infrastructure for healthcare information systems that will allow healthcare providers to securely share patient records within virtual healthcare organisations. Authorisation decisions to access patient records across organisation boundaries can be very dynamic and must occur within a strict legislative framework. In ARTEMIS we are developing a dynamic authorisation mechanism called PBAC that provides a means of contextual and process oriented access control to enforce healthcare business processes. PBAC demonstrates how healthcare providers can dynamically share patient records for care pathways across organisation boundaries

Effects of Thickening Time on the Application of Cement Slurry for High Pressure /High Temperature Drilling.

High pressure/High temperature operations remain a high challenge for the industry as deeper reservoir operations are pursued around the globe. In addition to deeper depths, an increasing number of wells are still being drilled and completed in much more hostile down-hole environments. Though high pressure/high temperature wells have always presented drilling challenges, their operations continued to remain very high as the vast reserves of hydrocarbon promised to bridge the gap between demand and supply for energy. The world’s energy demand is rising and favorable economics have allowed oil companies to continue to prospect and drill in these more challenging areas that are actually prone to high pressures / high temperatures than ever before. This paper addresses some of the challenges relative to cement slurry designs that requires careful engineering practices and needs proper cementing operations and optimization. It presents a simulation study using retarder sensitivity to select thickening time, optimize cement properties and also predict the subsequent HPHT sensitivity on cement slurries. The results showed that the modified Magnesium Oxide(mixture of water-glass and magnesium oxide) was best for slurry design for high pressure/high temperature which gave tighter matrix of cement paste. The application of retarder reduced the thickening time but the Water-Glass Solution improved the Magnesium Oxide cement thickening time, indicating that thickening time was dependent on time of exposure and on temperature. The rheological properties of the slurry showed that at HPHT, there were decreases in plastic viscosity, gel strength and the yield point. The study therefore determined one of the best cement slurry design practices for different down-hole applications in HPHT wells. KEY WORDS : Cement slurry, Thickening Time, Modified magnium Oxide,High temperature/High Pressure

Developing a questionnaire to assess community severance, walkability, and wellbeing: results from the Street Mobility Project in London

This working paper describes the development of the survey questionnaire component of the toolkit designed to measure community severance, and assess its potential associations with transport and health. We discuss the cognitive testing and piloting of the questionnaire in two contrasting case study areas in inner London, and present results from the survey data

Initiating dialogue between stakeholders and establishing a common language for community severance through cross disciplinary workshops

The concept of community severance has slowly been making its way into concrete transport plans and policies but it still lacks a consensual definition. This is because the issue has been approached by researchers from a range of disciplines, which have specific and diverse ways of constructing scientific knowledge. The objective of this paper, the first in a series of working papers to be generated by the Street Mobility and Network Accessibility research project is to build bridges between these different approaches and provide a base for the integration of community severance into public policy. The paper is the outcome of a series of workshops attended by a cross-disciplinary team of researchers and stakeholders, including policy-makers and local practitioners. On the basis of these discussions, a framework for cross-disciplinary research on community severance is developed, taking into consideration the chain of direct and indirect effects of transport infrastructure and motorised traffic and the range and complexity in the methodologies used for analysing and formulating solutions to the problem. In a second stage, we examine the consistency between this framework and the opinions and experiences of stakeholders