Improving the nautical access to Zeebrugge harbor: a multidisciplinary study

A multidisciplinary study was set up to tackle the nautical problems faced by Zeebrugge Harbor by the Maritime Access Division of the Flemish Community. The problem is twofold: strong cross-currents at the harbor mouth hinder the entrance of the ships around high water, and the occurrence of thick muddy layers hinders the navigation in the harbor and causes very high dredging costs. The article focuses on the global project set up, and explains more in detail the numerical and physical modeling research

Reconstruction microchirurgicale et prise en charge globale des patients porteurs de cancer ORL : l’importance d’une approche qualité et d’un circuit protocolisé [Microsurgical reconstruction and full management of patients with head and neck cancer: Importance of a quality approach and a circuit protocolisation]

Main of study: Management and surgical reconstruction of head and neck cancers remain a challenge. From the first consultation to surgery and radiotherapy, it is necessary to save time to ensure optimum treatment and better survival rates. Objectif: To establish a kind of quality approach to the management of patients with head and neck cancers. 54 patients who had microsurgical reconstruction after head and neck cancer were included in this study between 1997 and 2006. Results : Multiple data were considered: body mass index (BMI), ASA stage, age, existence of a pre-or postoperative radiotherapy, the surgeon's experience and the number of veins drainage. The success rate is superior when more than one draining vein is sutured to the flap for patients with a BMI > 20. Radiotherapy does not seem to affect the survival of the flap. Conclusion: According to current literature, the survival rate of these patients is better when the overall time care is less than 100 days. That period is possible with a perfect organization of the medical and paramedical team. Therefore, we propose to include these patients in a circuit protocolisation care, which saves time, to better inform patients and improve survival rates. Buts: la prise en charge et la reconstruction chirurgicale des cancers ORL restent un challenge. De la première consultation à la chirurgie et la radiothérapie, il est nécessaire de gagner du temps afin d’assurer une traitement optimum et un meilleur taux de survie. Objectif : établir une sorte d’approche qualité de la prise en charge des patients porteurs de cancers ORL. 54 patients qui ont bénéficié d’une reconstruction microchirurgicale suite à un cancer ORL ont été inclus dans cette étude entre 1997 et 2006. Résultats : plusieurs données ont été étudiées : l’index de masse corporelle (IMC), le stade ASA, l’âge, l’existence d’une radiothérapie pré ou post opératoire, l’expérience du chirurgien ainsi que le nombre de veines de drainage. Le taux de succès se révèle supérieur lorsque plus d’une veine de drainage est suturée au lambeau, pour des patients ayant un IMC > 20. La radiothérapie ne semble pas avoir de répercussion sur la survie du lambeau. Conclusion : conformément à la littérature actuelle, le taux de survie de ces patients est meilleur lorsque le temps global de prise en charge est inférieur à 100 jours. Ce délai court n’est possible qu’avec une parfaite organisation de l’équipe médicale et paramédicale. De ce fait, nous proposons d’inclure ces patients dans un circuit de prise en charge protocolisé, ce qui permet de gagner du temps, de mieux informer le patient et d’améliorer le taux de survie

Streptozotocin, Type I Diabetes Severity and Bone

As many as 50% of adults with type I (T1) diabetes exhibit bone loss and are at increased risk for fractures. Therapeutic development to prevent bone loss and/or restore lost bone in T1 diabetic patients requires knowledge of the molecular mechanisms accounting for the bone pathology. Because cell culture models alone cannot fully address the systemic/metabolic complexity of T1 diabetes, animal models are critical. A variety of models exist including spontaneous and pharmacologically induced T1 diabetic rodents. In this paper, we discuss the streptozotocin (STZ)-induced T1 diabetic mouse model and examine dose-dependent effects on disease severity and bone. Five daily injections of either 40 or 60 mg/kg STZ induce bone pathologies similar to spontaneously diabetic mouse and rat models and to human T1 diabetic bone pathology. Specifically, bone volume, mineral apposition rate, and osteocalcin serum and tibia messenger RNA levels are decreased. In contrast, bone marrow adiposity and aP2 expression are increased with either dose. However, high-dose STZ caused a more rapid elevation of blood glucose levels and a greater magnitude of change in body mass, fat pad mass, and bone gene expression (osteocalcin, aP2). An increase in cathepsin K and in the ratio of RANKL/OPG was noted in high-dose STZ mice, suggesting the possibility that severe diabetes could increase osteoclast activity, something not seen with lower doses. This may contribute to some of the disparity between existing studies regarding the role of osteoclasts in diabetic bone pathology. Examination of kidney and liver toxicity indicate that the high STZ dose causes some liver inflammation. In summary, the multiple low-dose STZ mouse model exhibits a similar bone phenotype to spontaneous models, has low toxicity, and serves as a useful tool for examining mechanisms of T1 diabetic bone loss

Factors influencing the implementation of advanced midwife practitioners in healthcare settings: a qualitative study

Objective: To explore factors influencing the implementation of advanced midwife practitioner roles. Design: Semi-structured individual face-to-face and focus group interviews were conducted. Data analysis was performed using the Framework Method. Setting and participants: A purposive sample (n = 32) included chief nursing officers, middle managers, head midwives/nurses, primary care team leaders, midwives with and without advanced midwife practitioner roles, heads of midwifery educations, and obstetricians. Findings: Budgetary constraints on a governmental and healthcare organizational level were mentioned as main barriers for role implementation. The current fee-for-service financing model of healthcare professionals was also seen as an impediment. Obstetricians considered the implementation of advanced midwife practitioner roles as a possible financial and professional threat. Documenting the added value of advanced midwife practitioner roles was regarded a prerequisite for gaining support to implement such roles. Healthcare managers' and midwives' attitudes towards these roles were considered essential. Participants warned against automatically transferring the concept of advanced practice nursing to midwifery. Although participants seldom discussed population healthcare needs as a driver for implementation, healthcare organizations' heightened focus on quality improvement and client safety was seen as an opportunity for implementation. University hospitals were perceived as pioneers regarding advanced midwife practitioner roles. Key conclusions and implications for practice: Multiple factors influencing role implementation on a governmental, healthcare organizational, and workforce level illustrate the complexity of the implementation process, and highlight the need for a well-thought-out implementation plan involving all relevant stakeholders. Pilot projects for the implementation of advanced midwife practitioners in university hospitals might be useful

Silicone adhesive multilayer foam dressings as adjuvant prophylactic therapy to prevent hospital-acquired pressure ulcers : a pragmatic noncommercial multicentre randomized open-label parallel-group medical device trial

Background: Silicone adhesive multilayer foam dressings are used as adjuvant therapy to prevent hospital‐acquired pressure ulcers (PUs). Objectives: Determine if silicone foam dressings in addition to standard prevention reduce PU incidence category 2 or worse compared to standard prevention alone. Methods: Multicentre, randomised controlled, medical device trial conducted in eight Belgian hospitals. At risk adult patients were centrally randomised (n=1633) to study groups based on a 1:1:1 allocation: experimental group 1 (n=542) and 2 (n=545) ‐ pooled as the treatment group ‐ and the control group (n=546). Experimental groups received PU prevention according to hospital protocol, and a silicone foam dressing on these body sites. The control group received standard of care. The primary endpoint was the incidence of a new PU category 2 or worse at these body sites. Results: In the intention‐to‐treat population (n=1605); 4.0% of patients developed PUs category 2 or worse in the treatment group and 6.3% in the control group (RR=0.64, 95% CI 0.41 to 0.99, P=0.04). Sacral PUs were observed in 2.8% and 4.8% of the patients in the treatment group and the control group, respectively (RR=0.59, 95% CI 0.35 to 0.98, P=0.04). Heel PUs occurred in 1.4% and 1.9% of patients in the treatment and control group respectively (RR=0.76, 95% CI 0.34 to 1.68, P=0.49). Conclusions: Silicone foam dressings reduce the incidence of PUs category 2 or worse in hospitalised at‐risk patients when used in addition to standard of care. Results show a decrease for sacrum, but no statistical difference for heel/trochanter areas

Stress in nurses : stress-related affect and its determinants examined over the nursing day

Peer reviewedPostprin

Calibration of overtopping roughness factors for concrete armor units in non-breaking conditions using the CLASH database

The roughness factor (γf) is a parameter used in overtopping estimators to account for the effects of armor unit geometry, the number of layers in the armor and other structural characteristics. Different values of γf for the same armors are given in the literature; however, in this study, the value of γf was calibrated for each overtopping estimator using the best available overtopping data. A methodology based on a bootstrapping technique is proposed to statistically characterize the roughness factors which best fit each formula. For each selected armor unit and overtopping formula, three percentiles (10%, 50% and 90%) of γf are given. Five sets of γf are given for five different overtopping estimators, calibrated using overtopping data from the CLASH database and additional tests with Cubipod armors in non-breaking conditions. The results indicate differences up to 20% in the optimum values of γf compared to those given in the literature. Optimum roughness factors are provided for the CLASH neural network (CLNN); the CLNN was found to be a better overtopping estimator than the other four overtopping formulas compared in this study. The γf is dependent on both the overtopping estimator and the dataset used. Armor porosity affects not only armor roughness and overtopping but also armor hydraulic stability; thus, recommended packing densities must be followed to avoid changes in porosity during lifetime. The sensitivity of the overtopping prediction to the roughness factor depends on the relative crest freeboard (Rc/Hm0); the greater the Rc/Hm0, the higher the sensitivity.The authors are grateful for financial support from Spanish Ministerio de Economia y Competitividad (Grant BIA2012-33967). The first author was funded through the FPU program (Formacion del Profesorado Universitario, Grant AP2010-4366) by the Spanish Ministerio de Educacion, Cultura y Deporte. The authors also thank Debra Westall for revising the manuscript.Molines, J.; Medina Folgado, JR. (2015). Calibration of overtopping roughness factors for concrete armor units in non-breaking conditions using the CLASH database. Coastal Engineering. 96:62-70. https://doi.org/10.1016/j.coastaleng.2014.11.008S62709

Risk assessment practice within primary mental health care: A logics perspective

From the 1980s onwards, discourses of risk have continued to grow, almost in ubiquity. Ideas and practices of risk and risk aversion have extended to UK mental health care where services are expected to assess and manage risks, and high-quality clinical assessment has been revised to incorporate risk assessment. This article problematises practices of risk assessment in mental health provision, focussing on the base-rate problem. It presents an analysis of audio recordings of risk assessments completed within a primary care mental health service. The analysis is informed by a critical logics approach which, using ideas from discourse theory as well as Lacanian psychoanalysis, involves developing a set of logics to describe, analyse and explain social phenomena. We characterise the assessments as functioning according to social logics of well-oiled administration and preservation, whereby bureaucratic processes are prioritised, contingency ironed out or ignored, and a need to manage potential risks to the service are the dominant operational frames. These logics are considered in terms of their beatific and horrific fantasmatic dimensions, whereby risk assessment is enacted as infallible (beatific) until clients become threats (horrific), creating a range of potential false negatives, false positives and so forth. These processes function to obscure or background problems with risk assessment, by generating practices that favour and offer protection to assessors, at the expense of those being assessed, thus presenting a challenge to the stated aim of risk assessment practice