SA Lenten Devotions 2018 The Beloved of God Week 7

During the seventh week, let us focus our eyes on that cross, and as we see the Beloved hanging there in our place satisfying justice, let us take comfort in knowing that in this action He makes us His beloved children, gives us a new identity, and provides us with rest. And certain of the Resurrection to come, may we go forward in confidence and trust to carry this message of “foolishness” to the world in compassion, kindness, humility, meekness, and patience, just as our Lord came to use.https://scholar.csl.edu/osp/1009/thumbnail.jp

Improving prescribing practices with rapid diagnostic tests (RDTs): synthesis of 10 studies to explore reasons for variation in malaria RDT uptake and adherence.

OBJECTIVES: The overuse of antimalarial drugs is widespread. Effective methods to improve prescribing practice remain unclear. We evaluated the impact of 10 interventions that introduced rapid diagnostic tests for malaria (mRDTs) on the use of tests and adherence to results in different contexts. DESIGN: A comparative case study approach, analysing variation in outcomes across different settings. SETTING: Studies from the ACT Consortium evaluating mRDTs with a range of supporting interventions in 6 malaria endemic countries. Providers were governmental or non-governmental healthcare workers, private retail sector workers or community volunteers. Each study arm in a distinct setting was considered a case. PARTICIPANTS: 28 cases from 10 studies were included, representing 148 461 patients seeking care for suspected malaria. INTERVENTIONS: The interventions included different mRDT training packages, supervision, supplies and community sensitisation. OUTCOME MEASURES: Analysis explored variation in: (1) uptake of mRDTs (% febrile patients tested); (2) provider adherence to positive mRDTs (% Plasmodium falciparum positive prescribed/given Artemisinin Combination Treatment); (3) provider adherence to negative mRDTs (% P. falciparum negative not prescribed/given antimalarial). RESULTS: Outcomes varied widely across cases: 12-100% mRDT uptake; 44-98% adherence to positive mRDTs; 27-100% adherence to negative mRDTs. Providers appeared more motivated to perform well when mRDTs and intervention characteristics fitted with their own priorities. Goodness of fit of mRDTs with existing consultation and diagnostic practices appeared crucial to maximising the impact of mRDTs on care, as did prior familiarity with malaria testing; adequate human resources and supplies; possible alternative treatments for mRDT-negative patients; a more directive intervention approach and local preferences for ACTs. CONCLUSIONS: Basic training and resources are essential but insufficient to maximise the potential of mRDTs in many contexts. Programme design should respond to assessments of provider priorities, expectations and capacities. As mRDTs become established, the intensity of supporting interventions required seems likely to reduce

Discordant identification of pediatric severe sepsis by research and clinical definitions in the SPROUT international point prevalence study

Introduction: Consensus criteria for pediatric severe sepsis have standardized enrollment for research studies. However, the extent to which critically ill children identified by consensus criteria reflect physician diagnosis of severe sepsis, which underlies external validity for pediatric sepsis research, is not known. We sought to determine the agreement between physician diagnosis and consensus criteria to identify pediatric patients with severe sepsis across a network of international pediatric intensive care units (PICUs). Methods: We conducted a point prevalence study involving 128 PICUs in 26 countries across 6 continents. Over the course of 5 study days, 6925 PICU patients <18 years of age were screened, and 706 with severe sepsis defined either by physician diagnosis or on the basis of 2005 International Pediatric Sepsis Consensus Conference consensus criteria were enrolled. The primary endpoint was agreement of pediatric severe sepsis between physician diagnosis and consensus criteria as measured using Cohen's ?. Secondary endpoints included characteristics and clinical outcomes for patients identified using physician diagnosis versus consensus criteria. Results: Of the 706 patients, 301 (42.6 %) met both definitions. The inter-rater agreement (? ± SE) between physician diagnosis and consensus criteria was 0.57 ± 0.02. Of the 438 patients with a physician's diagnosis of severe sepsis, only 69 % (301 of 438) would have been eligible to participate in a clinical trial of pediatric severe sepsis that enrolled patients based on consensus criteria. Patients with physician-diagnosed severe sepsis who did not meet consensus criteria were younger and had lower severity of illness and lower PICU mortality than those meeting consensus criteria or both definitions. After controlling for age, severity of illness, number of comorbid conditions, and treatment in developed versus resource-limited regions, patients identified with severe sepsis by physician diagnosis alone or by consensus criteria alone did not have PICU mortality significantly different from that of patients identified by both physician diagnosis and consensus criteria. Conclusions: Physician diagnosis of pediatric severe sepsis achieved only moderate agreement with consensus criteria, with physicians diagnosing severe sepsis more broadly. Consequently, the results of a research study based on consensus criteria may have limited generalizability to nearly one-third of PICU patients diagnosed with severe sepsis

Double origin of hydrothermal convective flux variations in the Fossa of Vulcano (Italy)

International audienceSoil-temperature measurements can provide information on the distribution of degassing fissures, their relationship to the internal structure of the volcano, and the temporal evolution of the system. At Vulcano Island (Italy), heat flux from a <3 km-deep magma body drives a hydrothermal system which extends across the main Fossa crater. This heat flux is also associated with variable magmatic gas flow. A high-density map of soil-temperatures was made in 1996 at a constant depth of 30 cm on the central and southern inner flanks of the Fossa crater. These measurements extended over an area covering about 0.04 km2, across which the heat flux is predominantly associated with a shallow boiling aquifer. The map shows that hot zones relate to structures of higher permeability, mainly associated with a fissure system dating from the last eruptive cycle (1888–1890). From 1996 to January 2005, we studied the evolution of the heat flux for the high temperature part of the map, both by repeating our measurements as part of 14 visits, during which temperatures were measured at a constant depth, and using data from permanent stations which allowed soil-temperatures to be continuously measured for selected vertical profiles. These data allowed us to calculate the heat flux, and its variation, with good precision for values lower than about 100 W m−2, which is generally the case in the study area. Above 100 W m−2, although the heat flux value is underestimated, its variations are recorded with an error less than 10%. During the period 1996–2004, two increases in the thermal flux were recorded. The first one was related to the seismic crisis of November 1998 which opened existing or new fissures. The second, in November 2004, was probably due to magma migration, and was associated with minor seismic activity

Improving prescribing practices with rapid diagnostic tests (RDTs): synthesis of 10 studies to explore reasons for variation in malaria RDT uptake and adherence.

ObjectivesThe overuse of antimalarial drugs is widespread. Effective methods to improve prescribing practice remain unclear. We evaluated the impact of 10 interventions that introduced rapid diagnostic tests for malaria (mRDTs) on the use of tests and adherence to results in different contexts.DesignA comparative case study approach, analysing variation in outcomes across different settings.SettingStudies from the ACT Consortium evaluating mRDTs with a range of supporting interventions in 6 malaria endemic countries. Providers were governmental or non-governmental healthcare workers, private retail sector workers or community volunteers. Each study arm in a distinct setting was considered a case.Participants28 cases from 10 studies were included, representing 148 461 patients seeking care for suspected malaria.InterventionsThe interventions included different mRDT training packages, supervision, supplies and community sensitisation.Outcome measuresAnalysis explored variation in: (1) uptake of mRDTs (% febrile patients tested); (2) provider adherence to positive mRDTs (% Plasmodium falciparum positive prescribed/given Artemisinin Combination Treatment); (3) provider adherence to negative mRDTs (% P. falciparum negative not prescribed/given antimalarial).ResultsOutcomes varied widely across cases: 12-100% mRDT uptake; 44-98% adherence to positive mRDTs; 27-100% adherence to negative mRDTs. Providers appeared more motivated to perform well when mRDTs and intervention characteristics fitted with their own priorities. Goodness of fit of mRDTs with existing consultation and diagnostic practices appeared crucial to maximising the impact of mRDTs on care, as did prior familiarity with malaria testing; adequate human resources and supplies; possible alternative treatments for mRDT-negative patients; a more directive intervention approach and local preferences for ACTs.ConclusionsBasic training and resources are essential but insufficient to maximise the potential of mRDTs in many contexts. Programme design should respond to assessments of provider priorities, expectations and capacities. As mRDTs become established, the intensity of supporting interventions required seems likely to reduce

Paperikoneen online-pölymittauksen tuotekehitys

Tämän opinnäytetyön on teettänyt ACA Systems Oy. Työn kokeellinen osuus suoritet-tiin Stora Enso Oyj:n Varkauden tehtaalla, jossa mittauksia ja prosessin seurantaa toteu-tettiin kuukauden ajan. Työn tavoitteena oli tutkia ACA Systemsin kehittämän paperi-koneen online-pölymittauslaitteen DPA:n mittauskorrelaatiota todelliseen pölytasoon, reagointia erilaisiin prosessimuuttujiin ja tuotekehitysmahdollisuuksia. Tähän työkaluina käytettiin R.A. Emerson & Companyn mustakangasmenetelmää, paperikoneen pro-sessien mittausdataa, visuaalista seurantaa ja kokemusperäistä tietoa. Työn teoriaosiossa käsitellään päällystämättömän hienopaperin pölyävyyteen vaikuttavia tekijöitä Varkau-den paperiprosessin näkökulmasta. Paperikoneelle soveltuvasta online-pölymittauslaitteesta ei ole vielä DPA:n kaltaista kaupallista sovellusta. Paperin pölyävyys on hankala suure mitata, mutta koska pöly aiheuttaa paljon ongelmia ja lisäkustannuksia painokoneilla, niin kysyntää toimivalle sovellukselle, ja tarve tuotekehitykselle on olemassa. Seurannan aikana DPA reagoi selvästi teoriassakin pölytasoa nostaviin prosessimuutok-siin. DPA- ja Emerson-pölymittausmenetelmien välillä havaittiin selkeä tilastollinen korrelaatio. Pienillä ja kohtuullisilla pölytasoilla DPA:n ja Emersonin väliset mittausar-vojen erot olivat pieniä ja niiden kasvu oli lineaarista. Suureen pölymäärään DPA reagoi voimakkaasti, ja sen antama pölyarvo nousi moninkertaisesti Emersonin asteikkoon verrattuna. Tämä johtunee siitä, että kun DPA:n suodattimeen kertyy suuremmilla pöly-tasoilla tietty pölymäärä, niin se tukkii toimielimen suodattimen aiheuttaen nopeasti kasvavan voimakkaan paine-eron, joka on puolestaan verrannollinen DPA:n antamaan pölyarvoon. Kehittämällä DPA:n mittausaluetta ja toimintavarmuutta, siitä on mahdollista saada hyvä apuväline paperikoneen pölytason seurantaan. Laitetta voitaisiin hyödyntää erityi-sesti koeajoissa, jolloin päästäisiin kiinni prosessimuuttujien aiheuttamiin pölytasojen muutoksiin. Paperilaji- ja päiväkohtaisesta pölytason seurannasta on apua paperin pö-lyämättömyyden laadunhallinnassa. Myös reklamaatioiden todellisuutta liiallisesta pö-lyävyydestä voidaan arvioida tallennetun mittaustiedon perusteella. Työn kokeellisia tuloksia ja havaintoja tullaan hyödyntämään laitteen tuotekehityksessä. Työ sisältää luottamuksellista tausta-aineistoa.Al This final thesis has been commissioned by ACA Systems Oy. The experimental part was carried out at Stora Enso Oyj`s mill where the measurements and process monitor-ing were performed during one month. The aim was to inspected measurement correla-tion between a paper dust measuring device DPA developed by ACA Systems and actual dust levels. Other objectives were to find out how the device responds to process variables and what are the product development opportunities. In the investigation R. A. Emerson & Company`s black cloth method, processes measurement data of the paper machine, visual observation and empirical data were used. The theoretical section deals with causes of dusting in uncoated fine paper from the perspective of Varkaus mill. AS yet, here are no online measuring devices like DPA for paper machines. Dusting is a difficult quantity to measure and it caused a lot of problems and additional costs by printing machines. So there is need for a functioning application and product develop-ment. DPA reacts clearly to the same process changes that rise dust level even in theory during follow-up. A clear statistical correlation between DPA and Emerson dust measurement methods was found. The differences between DPA and Emerson were small at low and moderate levels of dust and their growth was linear. DPA reacted strongly to large amounts of dust and the dust value rose manifold compared with the scale of Emerson. This is probably due to the fact that DPA`s filter clogged up with dust at certain amount of dust. This caused a strong pressure difference, which is proportional to the DPA`s value of the dust. With the development of DPA`s measurement range and reliability it is possible to ob-tain a good tool for paper dust level monitoring. The device could be used specifically by test runs to got hands on the process variables what caused dust level changes. Paper Type and daily dust level monitoring will help by the quality control of dusting. Also the reality of excessive dusting reclamations can be estimated whit the help of basis measurement data. The experimental results and findings will be used in the device product development. This final thesis contains some confidential information