Intraosseous vascular access in critically ill adults-a review of the literature

Aim & objectives. This literature review aim is to present a detailed investigation critiquing contemporary practices of intraosseous vascular access in adult patients. Specific objectives identified led to the exploration of clinical contexts, IO device/s and anatomical sites; education and training requirements; implications and recommendations for emergency healthcare practice and any requirements for further research. Background. The intraosseous route is an established method of obtaining vascular access in children in acute and emergency situations and is now increasingly being used in adults as an alternative to intravenous access, yet a paucity of evidence exists regarding its use, effectiveness and implementation. Search strategies. An exploratory literature review was undertaken in acknowledgement of the broad and complex nature of the project aim. Five electronic search engines were examined iteratively from June 2013 to February 2014. The search terms were ‘intraosseous’ AND ‘adult’ which were purposely limited due to the exploratory nature of the review. Studies that met the inclusion criteria of primary research articles with adult focus, paediatric lead research were excluded. Primary research international also included. Secondary research, reviews, case reports, editorials and opinion papers were excluded. Conclusion. Intraosseous vascular access is considered an alternative vascular access route although debate considering the preferred anatomical site is ongoing. Documented practices are only established in pre-hospital and specialist Emergency Department settings, however variety exists in policy and actual practice. Achieving insertion competence is relatively uncomplicated following minimal preparation although ongoing skill maintenance is less clear. Intraosseous vascular access is associated with minimal complications although pain is a significant issue for the conscious patient especially during fluid administration. Relevance to clinical practice. The intraosseous route is clearly a valuable alternative to problematic intravascular access. However further research, including cost effectiveness reviews, is required to gain clarity of whole acute care approaches

Technology Adoption and Growth

Technology change is modeled as the result of decisions of individuals and groups of individuals to adopt more advanced technologies. The structure is calibrated to the U.S. and postwar Japan growth experiences. Using this calibrated structure we explore how large the disparity in the effective tax rates on the returns to adopting technologies must be to account for the huge observed disparity in per capita income across countries. We find that this disparity is not implausibly large.

A unified theory of the evolution of international income levels

This essay develops a theory of the evolution of international income levels. In particular, it augments the Hansen-Prescott theory of economic development with the Parente-Prescott theory of relative efficiencies and shows that the unified theory accounts for the evolution of international income levels over the last millennium. The essence of this unified theory is that a country starts to experience sustained increases in its living standard when production efficiency reaches a critical point. Countries reach this critical level of efficiency at different dates not because they have access to different stocks of knowledge, but rather because they differ in the amount of society-imposed constraints on the technology choices of their citizenry.Income

Monopoly rights: a barrier to riches

Our thesis is that poor countries are poor because they employee arrangements for which the equilibrium outcomes are characterized by inferior technologies being used, and being used inefficiently. In this paper, we analyze the consequences of one such arrangement. In each industry, the arrangement enables a coalition of factor suppliers to be the monopoly seller of its input services to all firms using a particular production process. We find that the inefficiencies associated with this monopoly arrangement can be large. Whereas other studies have found that inefficiencies induced by monopoly are at most a few percent of output, we find that eliminating this monopoly arrangement could well increase output by roughly a factor of 3 without any increase in inputs.Wealth

EFFECTS OF FOOTWEAR ON SAGITTAL PLANE KINEMATICS AND CENTRE OF PRESSURE EXCURSION DURING THE BARBELL BACK SQUAT

Footwear has been proposed to alter squat performance whereby flat soles may reduce footfloor proprioception and raised heels may decrease joint range of motion. This study aimed to investigate the effects of footwear on centre of pressure excursion (CPE) and sagittal plane kinematics during the back squat. Seven males performed squats during five different footwear conditions (barefoot, weightlifting shoe, running shoe, minimal shoe, flat-soled shoe) while sagittal plane kinematics and CPE were recorded. Results showed no significant difference in CPE between any footwear conditions. Peak knee flexion was significantly greater for running shoes and weightlifting shoes compared to barefoot. Peak shank angle was significantly greater when wearing weightlifting shoes compared to minimal footwear. This suggests footwear which increases heel height may increase peak joint angles to allow for a deeper squat

Results and evaluation of the piloted European simulation based learning educator preparation project.

Paper presented at symposium: To develop and pilot a European simulation based learning educator preparation programme. A collaborative project (NESTLED) supported by the EU Lifelong Learning Programme

The costs and benefits of bank supervisory disclosure

Bank examinations, like the recent "stress test," yield information of interest to the market. Releasing those results may increase transparency. For routine annual bank exams, however, doing so could impede a supervisor's ability to collect information.Financial markets ; Banks and banking

Student nurses' experience of simulation in preparation for practice

At the University of Huddersfield the acquisition of skills and underpinning knowledge through simulation has been firmly embedded into the pre-registration nursing curriculum. This workshop will provide a summary of a pilot project on student evaluation, and the outcomes from a phenomenological study involving final year nursing students’ experiences of simulation throughout the curriculum. Simulation took several differing approaches in order to maximize learning opportunities and provide innovative assessment strategie