HEMS inter-facility transfer: a case-mix analysis.

Helicopter emergency medical services (HEMS) are popular rescue systems despite inconsistent evidence in the scientific literature to support their use for primary interventions, as well as for inter-facility transfer (IFT). There is little research about IFT by HEMS, hence questions remain about the appropriateness of this method of transport. The aim of this study was to describe a case-mix of operational and medical characteristics for IFT activity of a sole HEMS base, and identify indicators of over-triage. This is a retrospective study on HEMS IFT over 36 months, from January 1st 2013 to December 31st 2015. Medical and operational data from the database of the Emergency Department of Lausanne University Hospital, which provides the emergency physicians for this helicopter base, were reviewed. It included distance and time of flight transport, type of care during flight, and estimated distance of transport if conducted by ground. There were 2194 HEMS missions including 979 IFT (44.6%). Most transfers involved adults (> 17 years old; 799 patients, 81.6%). Forty patients (4.1%) were classified as having benefitted from resuscitation or life-saving measures performed in flight, 615 (62.8%) from emergency treatment and 324 (33.1%) from simple clinical examination. The median distance by air between hospitals was 35.4 km. The estimated median distance by road was 47.7 km. The median duration time from origin to destination by air was 12 min. This case-mix of IFTs by HEMS presents a high severity. There are many signs in favour of over-triage. We propose indicators to help choosing whether HEMS is the most appropriate mean of transport to perform the transfer regarding patient condition, geography, and medical competences available aboard ground ambulances; this may reduce over-triage

One Health epidemic preparedness: Biosafety quality improvement training in Nigeria

Background and Aim: One of the key components of the O ne Health approach to epidemic preparedness is raising awareness and increasing the knowledge of emerging infectious diseases, prevention, and risk reduction. However, related research can involve significant risks to biosafety and biosecurity. For this purpose, we organized a multidisciplinary biosafety hands-on workshop to inform and increase the knowledge of infectious diseases and risk mitigation. This study aimed to describe the process and outcome of a hands-on biosafety training program using a One Health a pproach across a multidisciplinary and multi-specialty group in Nigeria. Materials and Methods: A face-to-face hands-on training for 48 participants was organized by the West African Center for Emerging Infectious Diseases (WAC-EID) at the Jos University Teaching Hospital, serving as a lead institution for the Nigeria project site. Topics covered included (1) an overview of the WAC-EID research; (2) overview of infection prevention and control; (3) safety in animal handling and restraint, sample collection, and processing; (4) safety in field studies including rodent, bird and bat handling; (5) safety practices in the collection of mosquito and other arthropod vectors; (6) personal protective equipment training (disinfection, donning and doffing); and (7) safety in sample collection, labeling, and transportation. The program was executed using a mixed method of slide presentations, practical hands-on sessions, and video demonstrations. Pre- and post-course evaluation assessments and evaluation measures were used to assess training. Results: A total of 48 trainees participated in this training, with 12 (25%), 16 (33.3%), 14 (29.2%), 6 (12.5%) categorized as ornithology, entomology, mammalogy, and clinical interest groups, respectively. The pass rate for the pre-test was 29.4%, while for the post-test, it was 57.1%, or a 28% improvement. 88.6% of the trainees rated the training as relevant to them. Conclusion: Didactic and hands-on biosafety training is relevant in this era of zoonotic epidemics and pandemic preparedness. During this training program, there was a clear demonstration of knowledge transfer that can change the current practices of participants and improve the safety of infectious diseases research

Intensidades da poda seca e do desbaste de cacho na composição da uva Cabernet Sauvignon.

A pesquisa foi realizada durante quatro anos, num vinhedo de Cabernet Sauvignon (Vitis vinifera L.), em Bento Gonçalves-RS. O objetivo foi determinar o efeito das intensidades da poda seca e do desbaste de cacho em variáveis relacionadas aos componentes de produção da videira e à composição do mosto de uva. Os tratamentos consistiram em dois níveis de poda seca - curta e longa - e quatro de desbaste de cacho (%) - 0; 25; 50 e 75 -; com cinco repetições. O delineamento experimental foi o em blocos casualizados, com os tratamentos em parcelas subdivididas. Os resultados mostram que a poda seca e o desbaste de cacho tiveram efeito altamente significativo na produtividade do vinhedo que, na média dos quatro anos, variou de 10.971 kg/ha ? poda curta, 75% de desbaste ? a 32.819 kg/ha ? poda longa, 0% de desbaste. Houve, também, efeito significativo na produtividade por gema, peso de ramos podados por gema e por hectare, área foliar/peso fresco do fruto e produtividade/peso de ramos podados. Entretanto, o efeito nas variáveis relacionadas a açúcar e acidez do mosto da uva foi pouco expressivo. O componente 1 da análise de componentes principais discriminou o tratamento poda curta a 75% de desbaste de cacho dos tratamentos poda longa-0% de desbaste e poda longa-25% de desbaste

Assessing the effectiveness of the Ramsar Convention in preserving wintering waterbirds in the Mediterranean

lthough biological conservation is based on international agreements, its effectiveness depends on how countries implement such recommendations as effective conservation tools. The Ramsar Convention is the oldest international treaty for wetland and waterbird conservation, establishing the world's largest network of protected areas. However, since it does not constitute any binding measure, its effectiveness in protecting wintering waterbird populations at an international scale has been questioned. Here, we use long-term (1991–2012) count data to assess the effectiveness of the Ramsar Convention in the Mediterranean Basin. We compared abundance and temporal trends of 114 waterbird species between 251 Ramsar wetlands and 3486 non-Ramsar wetlands. We found that the Ramsar network is critical for wintering waterbirds, concentrating nearly half of all waterbirds counted in the Mediterranean Basin in only 7% of monitored wetlands. Waterbird trends followed a northwestsoutheast gradient, with a population decrease in the East. A significant and positive Ramsar effect on population trends was only found for the species of higher conservation concern in the Maghreb, particularly when a management plan was implemented. The Ramsar Convention was previously used on very important wetlands for waterbirds in Southern Europe, but is now an underused conservation tool. Our study suggests weaknesses in the use of Ramsar as an effective conservation tool in most of the Mediterranean Basin. However, the Ramsar Convention effectiveness to enhance waterbird populations in the Maghreb should encourage strengthening the Ramsar Convention. It should be done particularly in countries with limited environmental agreements and by systematic implementation of management plans. Conservation measures International conventions Protected areas Protection status Monitoring WetlandsacceptedVersio

Partially distributed coordination with Reo and constraint automata

Algorithms and the Foundations of Software technolog

SIMBIO-SYS : Scientific Cameras and Spectrometer for the BepiColombo Mission

The SIMBIO-SYS (Spectrometer and Imaging for MPO BepiColombo Integrated Observatory SYStem) is a complex instrument suite part of the scientific payload of the Mercury Planetary Orbiter for the BepiColombo mission, the last of the cornerstone missions of the European Space Agency (ESA) Horizon + science program. The SIMBIO-SYS instrument will provide all the science imaging capability of the BepiColombo MPO spacecraft. It consists of three channels: the STereo imaging Channel (STC), with a broad spectral band in the 400-950 nm range and medium spatial resolution (at best 58 m/px), that will provide Digital Terrain Model of the entire surface of the planet with an accuracy better than 80 m; the High Resolution Imaging Channel (HRIC), with broad spectral bands in the 400-900 nm range and high spatial resolution (at best 6 m/px), that will provide high-resolution images of about 20% of the surface, and the Visible and near-Infrared Hyperspectral Imaging channel (VIHI), with high spectral resolution (6 nm at finest) in the 400-2000 nm range and spatial resolution reaching 120 m/px, it will provide global coverage at 480 m/px with the spectral information, assuming the first orbit around Mercury with periherm at 480 km from the surface. SIMBIO-SYS will provide high-resolution images, the Digital Terrain Model of the entire surface, and the surface composition using a wide spectral range, as for instance detecting sulphides or material derived by sulphur and carbon oxidation, at resolutions and coverage higher than the MESSENGER mission with a full co-alignment of the three channels. All the data that will be acquired will allow to cover a wide range of scientific objectives, from the surface processes and cartography up to the internal structure, contributing to the libration experiment, and the surface-exosphere interaction. The global 3D and spectral mapping will allow to study the morphology and the composition of any surface feature. In this work, we describe the on-ground calibrations and the results obtained, providing an important overview of the instrument performances. The calibrations have been performed at channel and at system levels, utilizing specific setup in most of the cases realized for SIMBIO-SYS. In the case of the stereo camera (STC), it has been necessary to have a validation of the new stereo concept adopted, based on the push-frame. This work describes also the results of the Near-Earth Commissioning Phase performed few weeks after the Launch (20 October 2018). According to the calibration results and the first commissioning the three channels are working very well.Peer reviewe

Effect of surgical experience and spine subspecialty on the reliability of the {AO} Spine Upper Cervical Injury Classification System

OBJECTIVE The objective of this paper was to determine the interobserver reliability and intraobserver reproducibility of the AO Spine Upper Cervical Injury Classification System based on surgeon experience (< 5 years, 5–10 years, 10–20 years, and > 20 years) and surgical subspecialty (orthopedic spine surgery, neurosurgery, and "other" surgery). METHODS A total of 11,601 assessments of upper cervical spine injuries were evaluated based on the AO Spine Upper Cervical Injury Classification System. Reliability and reproducibility scores were obtained twice, with a 3-week time interval. Descriptive statistics were utilized to examine the percentage of accurately classified injuries, and Pearson’s chi-square or Fisher’s exact test was used to screen for potentially relevant differences between study participants. Kappa coefficients (κ) determined the interobserver reliability and intraobserver reproducibility. RESULTS The intraobserver reproducibility was substantial for surgeon experience level (< 5 years: 0.74 vs 5–10 years: 0.69 vs 10–20 years: 0.69 vs > 20 years: 0.70) and surgical subspecialty (orthopedic spine: 0.71 vs neurosurgery: 0.69 vs other: 0.68). Furthermore, the interobserver reliability was substantial for all surgical experience groups on assessment 1 (< 5 years: 0.67 vs 5–10 years: 0.62 vs 10–20 years: 0.61 vs > 20 years: 0.62), and only surgeons with > 20 years of experience did not have substantial reliability on assessment 2 (< 5 years: 0.62 vs 5–10 years: 0.61 vs 10–20 years: 0.61 vs > 20 years: 0.59). Orthopedic spine surgeons and neurosurgeons had substantial intraobserver reproducibility on both assessment 1 (0.64 vs 0.63) and assessment 2 (0.62 vs 0.63), while other surgeons had moderate reliability on assessment 1 (0.43) and fair reliability on assessment 2 (0.36). CONCLUSIONS The international reliability and reproducibility scores for the AO Spine Upper Cervical Injury Classification System demonstrated substantial intraobserver reproducibility and interobserver reliability regardless of surgical experience and spine subspecialty. These results support the global application of this classification system

How to improve automated external defibrillator placement for out-of-hospital cardiac arrests: A case study.

In out-of-hospital cardiac arrests (OHCAs), the use of an automatic external defibrillator (AED) by a bystander remains low, as AEDs may be misplaced with respect to the locations of OHCAs. As the distribution of historical OHCAs is potentially predictive of future OHCA locations, the purpose of this study is to assess AED positioning with regard to past locations of OHCAs, in order to improve the efficiency of public access defibrillation programs. This is a retrospective observational study from 2014 to 2018. The locations of historical OHCAs and AEDs were loaded into a geodata processing tool. Median distances between AEDs were collected, as well as the number and rates of OHCAs covered (distance of <100 meters from the nearest AED). Areas with high densities of uncovered OHCAs (hotspots) were identified in order to propose the placement of additional AEDs. Areas over-covered by AEDs (overlays) were also identified in order to propose the relocation of overlapping AEDs. There were 2,971 OHCA, 79.3% of which occurred at home, and 633 AEDs included in the study. The global coverage rate was 7.5%. OHCAs occurring at home had a coverage rate of 4.5%. Forty hotspots were identified, requiring the same number of additional AEDs. The addition of these would increase the coverage from 7.5% to 17.6%. Regarding AED overlays, 17 AEDs were found to be relocatable without reducing the AED coverage of historical OHCAs. This study confirms that geodata tools can assess AED locations and increase the efficiency of their placement. Historical hotspots and AED overlays should be considered, with the aim of efficiently relocating or adding AEDs. At-home OHCAs should become a priority target for future public access defibrillation programs as they represent the majority of OHCAs but have the lowest AED coverage rates

Underuse of Epinephrine for the Treatment of Anaphylaxis in the Prehospital Setting.

Anaphylaxis is a life-threatening reaction. Its key management is rapid diagnosis and prompt administration of intramuscular epinephrine. There are many barriers to epinephrine use. To assess the performance of dispatchers at suspecting anaphylaxis, proposing epinephrine treatment, helping find an epinephrine autoinjector (EAI) and using it. This is a retrospective study. Calls classified as "anaphylaxis" or "allergy" were included, and voice recordings were reviewed. Clinical, environmental, and operational variables were collected. Anaphylaxis was suspected if sudden dyspnoea, abdominal symptoms (vomiting, abdominal pain, or diarrhoea), dizziness, or loss of consciousness were present. The dispatch handled 120,618 dispatch calls. Dispatchers suspected 611 (0.5%) cases of allergy. Among those, 437 (72%) were deemed consistent with anaphylaxis: 65 patients received epinephrine prior to the dispatcher's advice, and dispatchers proposed the use of an EAI to 141 patients (38%). An EAI was available in 45 situations. The proposition was accepted on 18 cases and performed in 16 cases. The median time from the EAI being in hand and the injection was 50 seconds. Trained dispatchers are able to suspect anaphylaxis, decide when to treat and provide guidance on using an EAI, although their performance can be improved. There is a need for easier access to EAIs in public places