52 research outputs found
Cyclic oversupply of residential development-instant fragmentation of traditional mono-centric city
This study examines the residential expansion of Tartu urban region in Estonia. This paper assesses the evolution of planning practices to get a comprehensive understanding of the driving forces behind the dynamics of residential development in the conditions of suburbanisation at the emerging market. The study focuses explicitly on speed and scope of planning cycles by matching the operational scale of physical planning with master plans, parcels as survey elements and real estate transactions. The results show that housing bubble for residential markets, following recession in the 2000s and recovery in 2010s, their manifestation in the local planning practices and housing development scene call for a more strategic thinking of how we understand and evaluate spatial changes. A profit-driven supply-side entrepreneurial intervention to planning during the growth years put too much emphasis on delivery of quantity, namely land supply, rather than the benefits of quality, allocation choices and social dimension, often overriding regulative frameworks. Discretional ad hoc solutions and fragmented site-by-site development have been the main approaches in issuing land use change with little implication of housing demand. Extensive master planning for residential development has resulted in massive ‘overbooking’ of urban land parcels as only quarter of planned urban core and half of the planned periurban development has been carried out.Eje 2: Forma y estructura urbana, organización del territorio, orientación del crecimiento.Facultad de Arquitectura y Urbanism
Cyclic oversupply of residential development-instant fragmentation of traditional mono-centric city
This study examines the residential expansion of Tartu urban region in Estonia. This paper assesses the evolution of planning practices to get a comprehensive understanding of the driving forces behind the dynamics of residential development in the conditions of suburbanisation at the emerging market. The study focuses explicitly on speed and scope of planning cycles by matching the operational scale of physical planning with master plans, parcels as survey elements and real estate transactions. The results show that housing bubble for residential markets, following recession in the 2000s and recovery in 2010s, their manifestation in the local planning practices and housing development scene call for a more strategic thinking of how we understand and evaluate spatial changes. A profit-driven supply-side entrepreneurial intervention to planning during the growth years put too much emphasis on delivery of quantity, namely land supply, rather than the benefits of quality, allocation choices and social dimension, often overriding regulative frameworks. Discretional ad hoc solutions and fragmented site-by-site development have been the main approaches in issuing land use change with little implication of housing demand. Extensive master planning for residential development has resulted in massive ‘overbooking’ of urban land parcels as only quarter of planned urban core and half of the planned periurban development has been carried out.Eje 2: Forma y estructura urbana, organización del territorio, orientación del crecimiento.Facultad de Arquitectura y Urbanism
Cyclic oversupply of residential development-instant fragmentation of traditional mono-centric city
This study examines the residential expansion of Tartu urban region in Estonia. This paper assesses the evolution of planning practices to get a comprehensive understanding of the driving forces behind the dynamics of residential development in the conditions of suburbanisation at the emerging market. The study focuses explicitly on speed and scope of planning cycles by matching the operational scale of physical planning with master plans, parcels as survey elements and real estate transactions. The results show that housing bubble for residential markets, following recession in the 2000s and recovery in 2010s, their manifestation in the local planning practices and housing development scene call for a more strategic thinking of how we understand and evaluate spatial changes. A profit-driven supply-side entrepreneurial intervention to planning during the growth years put too much emphasis on delivery of quantity, namely land supply, rather than the benefits of quality, allocation choices and social dimension, often overriding regulative frameworks. Discretional ad hoc solutions and fragmented site-by-site development have been the main approaches in issuing land use change with little implication of housing demand. Extensive master planning for residential development has resulted in massive ‘overbooking’ of urban land parcels as only quarter of planned urban core and half of the planned periurban development has been carried out.Eje 2: Forma y estructura urbana, organización del territorio, orientación del crecimiento.Facultad de Arquitectura y Urbanism
Density Functional Theory of Bosons in a Trap
A time-dependent Kohn-Sham (KS) like theory is presented for N bosons in thre
e and lower-dimensional traps. We derive coupled equations, which allow one to
calculate the energies of elementary excitations. A rigorous proof is given to
show that the KS like equation correctly describes properties of the
one-dimensional condensate of impenetrable bosons in a general time-dependent
harmonic trap in the larg N limit.Comment: 10 page
A review of hyperfibrinolysis in cats and dogs
The fibrinolytic system is activated concurrently with coagulation; it regulates haemostasis and prevents thrombosis by restricting clot formation to the area of vascular injury and dismantling the clot as healing occurs. Dysregulation of the fibrinolytic system, which results in hyperfibrinolysis, may manifest as clinically important haemorrhage. Hyperfibrinolysis occurs in cats and dogs secondary to a variety of congenital and acquired disorders. Acquired disorders associated with hyperfibrinolysis, such as trauma, cavitary effusions, liver disease and Angiostrongylus vasorum infection, are commonly encountered in primary care practice. In addition, delayed haemorrhage reported in greyhounds following trauma and routine surgical procedures has been attributed to a hyperfibrinolytic disorder, although this has yet to be characterised. The diagnosis of hyperfibrinolysis is challenging and, until recently, has relied on techniques that are not readily available outside referral hospitals. With the recent development of point‐of‐care viscoelastic techniques, assessment of fibrinolysis is now possible in referral practice. This will provide the opportunity to target haemorrhage due to hyperfibrinolysis with antifibrinolytic drugs and thereby reduce associated morbidity and mortality. The fibrinolytic system and the conditions associated with increased fibrinolytic activity in cats and dogs are the focus of this review article. In addition, laboratory and point‐of‐care techniques for assessing hyperfibrinolysis and antifibrinolytic treatment for patients with haemorrhage are reviewed
A descriptive analysis of the Canadian prehospital and transport transfusion (CAN-PATT) network
Objective
Out-of-hospital blood transfusion (OHBT) is becoming increasingly common across the prehospital environment, yet there is significant variability in OHBT practices. The Canadian Prehospital and Transport Transfusion (CAN-PATT) network was established to collaborate, standardize, and evaluate the effectiveness of out-of-hospital blood transfusion (OHBT) across Canada. The objectives of this study are to describe the setting and organizational characteristics of CAN-PATT member organizations and to provide a cross-sectional examination of the current OHBT practices of CAN-PATT organizations.
Methods
This was a cross-sectional examination of all six critical care transport organizations that are involved in CAN-PATT network. Surveys were sent to identified leads from each organization. The survey focused on three main areas of interest: 1) critical care transport organizational service and coverage, 2) provider, and crew configurations, and 3) OHBT transfusion practices.
Results
All six surveys were completed and returned. There are a total of 30 critical care transport bases (19 rotor-wing, 20 fixed-wing and 6 land) across Canada and 11 bases have a blood-on-board program. Crew configurations very between organizations as either dual paramedic or paramedic/nurse teams. Median transport times range from 30 to 46 minutes for rotor-wing assets and 64 to 90 minutes for fixed-wing assets. Half of the CAN-PATT organizations started their out-of-hospital blood transfusion programs within the last three years. Most organizations carry at least two units of O-negative, K-negative red blood cells and some organizations also carry group A thawed plasma, fibrinogen concentrate and/or prothrombin complex concentrate. All organizations advocate for early administration of tranexamic acid for injured patients suspected of bleeding. All organizations return un-transfused blood components to their local transfusion medicine laboratory within a predefined timeframe to reduce wastage.
Conclusions
Variations in OHBT practices were identified and we have suggested considerations for standardization of transfusion practices and patient care as it relates to OHBT. This standardization will also enable a robust means of data collection to study and optimize outcomes of patients receiving OHBT. A fulsome description of the participating organizations within CAN-PATT should enhance interpretation of future OHBT studies that will be conducted by this network
Development of a national out-of-hospital transfusion protocol: a modified RAND Delphi study
Background: Early resuscitation with blood components or products is emerging as best practice in selected patients with trauma and medical patients; as a result, out-of-hospital transfusion (OHT) programs are being developed based on limited and often conflicting evidence. This study aimed to provide guidance to Canadian critical care transport organizations on the development of OHT protocols.
Methods: The study period was July 2021 to June 2022. We used a modified RAND Delphi process to achieve consensus on statements created by the study team guiding various aspects of OHT in the context of critical care transport. Purposive sampling ensured representative distribution of participants in regard to geography and relevant clinical specialties. We conducted 2 written survey Delphi rounds, followed by a virtual panel discussion (round 3). Consensus was defined as a median score of at least 6 on a Likert scale ranging from 1 (“Definitely should not include”) to 7 (“Definitely should include”). Statements that did not achieve consensus in the first 2 rounds were discussed and voted on during the panel discussion.
Results: Seventeen subject experts participated in the study, all of whom completed the 3 Delphi rounds. After the study process was completed, a total of 39 statements were agreed on, covering the following domains: general oversight and clinical governance, storage and transport of blood components and products, initiation of OHT, types of blood components and products, delivery and monitoring of OHT, indications for and use of hemostatic adjuncts, and resuscitation targets of OHT.
Interpretation: This expert consensus document provides guidance on OHT best practices. The consensus statements should support efficient and safe OHT in national and international critical care transport programs.
The transfusion of blood components such as red blood cells (RBCs) and plasma is increasingly common in prehospital and transport medicine.1–3 In addition, the potential benefits of out-of-hospital administration of whole blood or blood products such as fibrinogen and prothrombin complex concentrate in selected patients are being investigated. In this report, we use the umbrella term “out-of-hospital transfusion” (OHT) to refer to the transfusion of whole blood, blood components such as RBCs and plasma, or blood products such as fibrinogen and prothrombin complex concentrate. Although the increasing practice of OHT suggests general consensus on a likely clinical benefit, evidence regarding the effect of OHT on morbidity and mortality is limited and conflicting.2,4–6 The generalizability of the limited evidence is further complicated in that the feasibility and potential benefit of OHT are dependent on multiple regional factors such as geography, patient factors and health care configuration. For example, 2 secondary analyses of the data sets from the Prehospital Air Medical Plasma (PAMPer) and the Control of Major Bleeding After Trauma (COMBAT) clinical trials suggested that OHT was beneficial if transport times were greater than 20 minutes and that a benefit present in blunt trauma does not translate to a benefit in penetrating trauma.7,8 In addition, out-of-hospital management of acute hemorrhage extends beyond OHT and includes factors such as administration of tranexamic acid, avoidance of hypothermia and physical means of hemorrhage control where possible.9,10 Efficient and effective implementation of OHT requires a combination of medical and logistic considerations that span multiple specialties. This is particularly relevant in countries like Canada, with long transport times to tertiary care centres, and remote communities that have limited or no access to physicians or blood components and products at their local health care facilities.11
We invited an expert panel to provide expert opinions on out-of-hospital hemorrhage management and, in particular, OHT to develop national consensus recommendations to guide OHT practice and to begin to optimize the effectiveness and safety of OHT
Self-incrimination and silence Position of the defendant in England, the United States and Canada
SIGLEAvailable from British Library Document Supply Centre- DSC:D60589 / BLDSC - British Library Document Supply CentreGBUnited Kingdo
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