A Comparison of Risk Evaluation in Emergency Medical Services Helicopter Operation Regulations

This study represents a comparison of Helicopter Emergency Medical Services (HEMS) operations, between US Federal Aviation Regulations (FARs), and European Joint Aviation Regulations Operations Specifications. Presently, US regulations allow HEMS operators to conduct work under FAR Part 135, Commercial Aviation Operations, or under FAR Part 91, General Aviation Operations. This allows HEMS operators to accept a greater level of risk by substituting lower minimum procedural standards under FAR Part 91 than under FAR Part 135, and may be partly culpable for a higher rate of fatal crashes in HEMS operations conducted under FAR Part 91. In stark contrast, explicit criteria and minimum operating considerations are stated in the European regulations. The Federal Aviation Administration (FAA) has been slow to take a similar clear and firm regulatory stance as that of its European counterpart regarding the human factors involved in the risk assessment of HEMS operations. Providing clearly defined steps to analyze and mitigate unnecessary threats, developing optimum performance guidelines, as well as minimum acceptable operational standards would benefit not only the US HEMS industry but also the patients and public it serves by reducing exposure to preventable dangers

A randomized, placebo-controlled trial of prednisone in early Henoch Schönlein Purpura [ISRCTN85109383]

BACKGROUND: Henoch Schönlein Purpura (HSP) is the most common systemic vasculitis of childhood. There is considerable controversy over whether children with HSP should be treated with corticosteroids. The goal of this study was to investigate whether early corticosteroid administration could reduce the rate of renal or gastrointestinal complications in children with HSP. METHODS: Forty children with HSP, seen in the emergency room of a tertiary-care, paediatric centre, entered a randomized, double-blind, placebo controlled study. The treatment group (n = 21) received oral prednisone, 2 mg/kg/day for one week, with weaning over a second week, while the placebo group (n = 19) received an identical appearing placebo. Co-primary outcomes were the rate of renal involvement at one year and the rate of acute gastrointestinal complications. Co-primary outcomes were analysed using Fisher's Exact test. RESULTS: At one year, there was no difference in the rate of renal involvement (3/21 prednisone group vs. 2/19 placebo group, P = 1.0). There was also no statistically significant difference in the rate of acute gastrointestinal complications (2/21 prednisone group vs. 3/19 placebo group, P = 0.7). Two children in the placebo group did experience intussusceptions compared with none in the prednisone group (P = 0.2). CONCLUSIONS: Early prednisone therapy in HSP does not appear to reduce the risk of renal involvement at one year, or the risk of acute gastrointestinal complications. There may be a reduced risk of intussusception. The routine, early use of prednisone in uncomplicated HSP cannot be recommended at this time

Childhood lead exposure in France: benefit estimation and partial cost-benefit analysis of lead hazard control

<p>Abstract</p> <p>Background</p> <p>Lead exposure remains a public health concern due to its serious adverse effects, such as cognitive and behavioral impairment: children younger than six years of age being the most vulnerable population. In Europe, the lead-related economic impacts have not been examined in detail. We estimate the annual costs in France due to childhood exposure and, through a cost benefit analysis (CBA), aim to assess the expected social and economic benefits of exposure abatement.</p> <p>Methods</p> <p>Monetary benefits were assessed in terms of avoided national costs. We used results from a 2008 survey on blood-lead (B-Pb) concentrations in French children aged one to six years old. Given the absence of a threshold concentration being established, we performed a sensitivity analysis assuming different hypothetical threshold values for toxicity above 15 μg/L, 24 μg/L and 100 μg/L. Adverse health outcomes of lead exposure were translated into social burden and economic costs based on literature data from literature. Direct health benefits, social benefits and intangible avoided costs were included. Costs of pollutant exposure control were partially estimated in regard to homes lead-based paint decontamination, investments aiming at reducing industrial lead emissions and removal of all lead drinking water pipes.</p> <p>Results</p> <p>The following overall annual benefits for the three hypothetical thresholds values in 2008 are: €22.72 billion, €10.72 billion and €0.44 billion, respectively. Costs from abatement ranged from €0.9 billion to 2.95 billion/year. Finally, from a partial CBA of lead control in soils and dust the estimates of total net benefits were € 3.78 billion, € 1.88 billion and €0.25 billion respectively for the three hypothesized B-Pb effect values.</p> <p>Conclusions</p> <p>Prevention of childhood lead exposure has a high social benefit, due to reduction of B-Pb concentrations to levels below 15 μg/L or 24 μg/L, respectively. Reducing only exposures above 100 μg/L B-Pb has little economic impact due to the small number of children who now exhibit such high exposure levels. Prudent public policies would help avoiding future medical interventions, limit the need for special education and increase future productivity, and hence lifetime income for children exposed to lead.</p

The return of the 'Conchie': newspaper representations of conscientious objectors and pacifists in World War II

This chapter will consider the ways in which British regional and national newspapers represented conscientious objectors in the early stages of World War 11

Albumin Excretion as a Measure of Glomerular Dysfunction in Children

The urine albumin/creatinine concentration ratio (U(A)/U(C)) and the albumin excretion rate per unit weight (U(A)V/Wt) have been compared with the theoretically ideal parameter for measuring glomerular damage, clearance of albumin/clearance of creatinine (C(A)/C(C)), using a simple sensitive immunochemical technique for albumin. It is shown that U(A)/U(C) on random urine specimens can be as satisfactorily used to predict C(A)/C(C) as U(A)V/Wt. Normal data over a wide range of body size of this simple parameter are presented; higher values in the newborn reflect increased permeability of the neonatal glomerulus