Proletær kultur i Norge i 1930-åra

Proletær kultur i Norge i 1930-år

The Study Protocol for the LINC (LUCAS in Cardiac Arrest) Study: a study comparing conventional adult out-of-hospital cardiopulmonary resuscitation with a concept with mechanical chest compressions and simultaneous defibrillation

BACKGROUND: The LUCAS™ device delivers mechanical chest compressions that have been shown in experimental studies to improve perfusion pressures to the brain and heart as well as augmenting cerebral blood flow and end tidal CO(2,) compared with results from standard manual cardiopulmonary resuscitation (CPR). Two randomised pilot studies in out-of-hospital cardiac arrest patients have not shown improved outcome when compared with manual CPR. There remains evidence from small case series that the device can be potentially beneficial compared with manual chest compressions in specific situations. This multicentre study is designed to evaluate the efficacy and safety of mechanical chest compressions with the LUCAS™ device whilst allowing defibrillation during on-going CPR, and comparing the results with those of conventional resuscitation. METHODS/DESIGN: This article describes the design and protocol of the LINC-study which is a randomised controlled multicentre study of 2500 out-of-hospital cardiac arrest patients. The study has been registered at ClinicalTrials.gov (http://clinicaltrials.gov/ct2/show/NCT00609778?term=LINC&rank=1). RESULTS: Primary endpoint is four-hour survival after successful restoration of spontaneous circulation. The safety aspect is being evaluated by post mortem examinations in 300 patients that may reflect injuries from CPR. CONCLUSION: This large multicentre study will contribute to the evaluation of mechanical chest compression in CPR and specifically to the efficacy and safety of the LUCAS™ device when used in association with defibrillation during on-going CPR

Fracture fixation in the operative management of hip fractures (FAITH): an international, multicentre, randomised controlled trial

© 2017 Elsevier Ltd Background Reoperation rates are high after surgery for hip fractures. We investigated the effect of a sliding hip screw versus cancellous screws on the risk of reoperation and other key outcomes. Methods For this international, multicentre, allocation concealed randomised controlled trial, we enrolled patients aged 50 years or older with a low-energy hip fracture requiring fracture fixation from 81 clinical centres in eight countries. Patients were assigned by minimisation with a centralised computer system to receive a single large-diameter screw with a side-plate (sliding hip screw) or the present standard of care, multiple small-diameter cancellous screws. Surgeons and patients were not blinded but the data analyst, while doing the analyses, remained blinded to treatment groups. The primary outcome was hip reoperation within 24 months after initial surgery to promote fracture healing, relieve pain, treat infection, or improve function. Analyses followed the intention-to-treat principle. This study was registered with ClinicalTrials.gov, number NCT00761813. Findings Between March 3, 2008, and March 31, 2014, we randomly assigned 1108 patients to receive a sliding hip screw (n=557) or cancellous screws (n=551). Reoperations within 24 months did not differ by type of surgical fixation in those included in the primary analysis: 107 (20%) of 542 patients in the sliding hip screw group versus 117 (22%) of 537 patients in the cancellous screws group (hazard ratio [HR] 0·83, 95% CI 0·63–1·09; p=0·18). Avascular necrosis was more common in the sliding hip screw group than in the cancellous screws group (50 patients [9%] vs 28 patients [5%]; HR 1·91, 1·06–3·44; p=0·0319). However, no significant difference was found between the number of medically related adverse events between groups (p=0·82; appendix); these events included pulmonary embolism (two patients [\u3c1%] vs four [1%] patients; p=0·41) and sepsis (seven [1%] vs six [1%]; p=0·79). Interpretation In terms of reoperation rates the sliding hip screw shows no advantage, but some groups of patients (smokers and those with displaced or base of neck fractures) might do better with a sliding hip screw than with cancellous screws. Funding National Institutes of Health, Canadian Institutes of Health Research, Stichting NutsOhra, Netherlands Organisation for Health Research and Development, Physicians\u27 Services Incorporated

Cancellations of (helicopter-transported) mobile medical team dispatches in the Netherlands

The trauma centre of the Trauma Center Region North-West Netherlands (TRNWN) has consensus criteria for Mobile Medical Team (MMT) scene dispatch. The MMT can be dispatched by the EMS-dispatch centre or by the on-scene ambulance crew and is transported by helicopter or ground transport. Although much attention has been paid to improve the dispatch criteria, the MMT is often cancelled after being dispatched. The aim of this study was to assess the cancellation rate and the noncompliant dispatches of our MMT and to identify factors associated with this form of primary overtriage. By retrospective analysis of all MMT dispatches in the period from 1 July 2006 till 31 December 2006 using chart review, we conducted a consecutive case review of 605 dispatches. Four hundred and sixty seven of these were included for our study, collecting data related to prehospital triage, patient's condition on-scene and hospital course. Average age was 35.9 years; the majority of the patients were male (65.3%). Four hundred and thirty patients were victims of trauma, sustaining injuries in most cases from blunt trauma (89.3%). After being dispatched, the MMT was cancelled 203 times (43.5%). Statistically significant differences between assists and cancellations were found for overall mortality, mean RTS, GCS and ISS, mean hospitalization, length and amount of ICU admissions (p < 0.001). All dispatches were evaluated by using the MMT-dispatch criteria and mission appropriateness criteria. Almost 26% of all dispatches were neither appropriate, nor met the dispatch criteria. Fourteen missions were appropriate, but did not meet the dispatch criteria. The remaining 318 dispatches had met the dispatch criteria, of which 135 (30.3%) were also appropriate. The calculated additional costs of the cancelled dispatches summed up to a total of a,not sign 34,448, amounting to 2.2% of the total MMT costs during the study period. In our trauma system, the MMT dispatches are involved with high rates of overtriage. After being dispatched, the MMT is cancelled in almost 50% of all cases. We found an undertriage rate of 4%, which we think is acceptable. All cancellations were justified. The additional costs of the cancelled missions were within an acceptable range. According to this study, it seems to be possible to reduce the overtriage rate of the MMT dispatches, without increasing the undertriage rate to non-acceptable level

Current Developments in Intraspinal Agents for Cancer and Noncancer Pain

Since the late 1980s, intrathecal (IT) analgesic therapy has improved, and implantable IT drug delivery devices have become increasingly sophisticated. Physicians and patients now have myriad more options for agents and their combination, as well as for refining their delivery. As recently as 2007, The Polyanalgesic Consensus Conference of expert panelists updated its algorithm for drug selection in IT polyanalgesia. We review this algorithm and the emerging therapy included. This article provides an update on newly approved as well as emerging IT agents and the advances in technology for their delivery

Factors Associated with Revision Surgery after Internal Fixation of Hip Fractures

Background: Femoral neck fractures are associated with high rates of revision surgery after management with internal fixation. Using data from the Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) trial evaluating methods of internal fixation in patients with femoral neck fractures, we investigated associations between baseline and surgical factors and the need for revision surgery to promote healing, relieve pain, treat infection or improve function over 24 months postsurgery. Additionally, we investigated factors associated with (1) hardware removal and (2) implant exchange from cancellous screws (CS) or sliding hip screw (SHS) to total hip arthroplasty, hemiarthroplasty, or another internal fixation device. Methods: We identified 15 potential factors a priori that may be associated with revision surgery, 7 with hardware removal, and 14 with implant exchange. We used multivariable Cox proportional hazards analyses in our investigation. Results: Factors associated with increased risk of revision surgery included: female sex, [hazard ratio (HR) 1.79, 95% confidence interval (CI) 1.25-2.50; P = 0.001], higher body mass index (fo

Quantifying the physical effects of stream restoration: With unmanned aerial vehicles and geographic information systems

Stream restoration efforts often aim at restoring the physical complexity in streams, as an increased habitat heterogeneity is believed to increase biodiversity. It is important to quantify the physical complexity of streams before and after restoration, to know what actions are needed, and to monitor the results of the restoration. The use of unmanned aerial vehicles (UAVs) and geographic information systems (GIS) for data acquisition is rapidly increasing, and the use of UAVs and GIS could facilitate the monitoring process. The aim of this study was to determine how the spatial complexity in streams can be determined by using UAVs and GIS. The physical features and the spatial complexity were quantified in five reaches in the Lögde River, pre- and post-restoration, by analyzing UAV photos in a GIS program. Three of six reach descriptive metrics, and three of seven complexity metrics, were shown significantly different after restoration. To validate the GIS analyzing method, a qualitative comparison of data from the GIS analysis to field survey data was conducted. The GIS method was shown effective for distinguishing morphological features on a larger spatial scale, and to show the spatial distribution of instream features, such as wood pieces and boulders. The accuracy when digitizing the bankfull edge of the stream was low on small scales, and the method likely underestimates the number of wood pieces and boulders in the streams. Preferable camera settings and weather conditions to avoid blurry UAV photos, and thereby enhance the accuracy of the GIS analysis, are discussed

Yrkesrelaterad livskvalitet - upplevd påverkan av att hjälpa

Posttraumatiskt Stressyndrom (PTSD) är en erkänd diagnos som listades i DSM-III år 1980. Något som inte har uppmärksammats på samma sätt är de symptom som upplevs av individer som i andra hand exponeras för trauma. Exempelvis de som tar emot en primärdrabbads berättelse. För att beskriva påverkan av att ta emot en primärdrabbads berättelse har termen yrkesrelaterad livskvalitet (Professional quality of life) använts. Forskning med fokus på yrkesrelaterad livskvalitet har bedrivits inom många olika yrken. En grupp som berörts är personal som engagerar sig i våld i nära relationer men litteraturen är begränsad. I förevarande studie användes ProQOL (som består av medkänsletillfredsställelse, utbrändhetsupplevelse och sekundär traumatisering) och QPS Nordic för att undersöka den yrkesrelaterade livskvaliteten hos dem som engagerar sig som hjälpare i kvinnojourer. I studien deltog 55 kvinnor som är anställda eller frivillig/volontärarbetare på kvinnojour. Studien utreder även om tillgång till handledning, upplevt socialt stöd, antal timmar i kontakt med hjälpsökande per vecka och anställningsform påverkar den yrkesrelaterade livskvaliteten. Resultaten tyder på att det finns både negativ och positiv påverkan av ett engagemang som hjälpare. Utbrändhetsupplevelse har stark korrelation med antal timmar i kontakt med hjälpsökande samt en moderat korrelation med socialt stöd. Sekundär traumatisering har stark korrelation med antal timmar i kontakt med hjälpsökande. Resultaten visar även att socialt stöd, antal timmar i kontakt med hjälpsökande och tillgång till handledning förklarar en hög andel av variansen för sekundär traumatisering och utbrändhetsupplevelse samt att anställningsform inte tycks ha betydelse för den yrkesrelaterade livskvaliteten

Effects of triclopyr on wood ants (family Formica)

Chemical pollutants are one of the main threats against biodiversity and chemicals affecting non-target organisms are of great environmental concern. The herbicide triclopyr is commonly used to keep weeds under control and is believed to be weakly toxic to animals and only lethal in high doses. However, the knowledge of possible sub-lethal behavior effects in low doses is scarce. This study investigates whether the wood ant (family Formica) show behavioral changes when exposed to sub-lethal doses of triclopyr. The main hypotheses tested were; i) ants behaving normally show a preference for dark surfaces (i.e. scototaxis); and ii) triclopyr affect this behavior trait among ants. The hypotheses were tested by exposing ants to diets containing 1, 10 and 100 mg/L triclopyr for 24 hours (acute) and 7 days (chronic). To what extent ants preferred the white surface (proportion of frames with the ant visible), their activity (proportion of speed above 1 mm/s) their exploration (proportion area covered) and their average velocities was measured using a newly developed tracking software (ToxTrac). The results clearly show that ants have preference for dark surfaces and thus, that the first hypothesis is valid. However, the second hypothesis appear invalid as the different exposures to triclopyr did not affect the examined behaviors. Based on the results, triclopyr appear to not affect non-target organism such as ants, although possible behavioral effects in other organisms and other behavioral traits cannot be excluded.