New insights into the natural history of thrombo-embolic disease provided by imaging and disease quantification

Venous thromboembolism (VTE) is a common disease with a myriad of presentation. It is often difficult to diagnosis with symptoms which are shared with many other disorders. Because of the overlap in symptomatology with other pathologies it is both commonly overlooked when present and commonly considered when absent. The threshold for investigating suspected VTE has dropped over time, in part due to a greater awareness of the disease among clinicians, but also because of the greater availability of diagnostic tests which are both accurate at positively diagnosing VTE and are patient friendly. This has resulted in a mushrooming of the number of diagnostic tests being performed for suspected VTE in radiology departments. As such radiology provides a window into the disease in a way that no other speciality can. All branches of medicine having their share of VTE patients but radiology provides a unique opportunity to study VTE patients as, no matter from which speciality they arise when the disease is suspected, they will almost inevitably end up undergoing a definitive radiological test. There is much still to learn about VTE however developments in modern imaging and computerised databases have advanced our understanding of this common disease. The window that radiology provides into VTE has contributed towards those advances

Otimização da produção em máquina multiprodutos na indústria de papel: um estudo utilizando o método AHP – analytic hierarchy process / Production optimization in a multi-product machine in the paper industry: a study using the AHP – analytic hierarchy process method

Este artigo apresenta um framework para sequenciamento ideal de produção a partir do uso da análise hierárquica de processo – ahp, para uma máquina produtora de bobinas de papel, que processa sete diferentes produtos. Foi desenvolvida a análise de critérios como: produtividade, setup, demanda, lote mínimo e prazo de entrega, de maneira a fornecer informações consistentes que visam otimizar a utilização da máquina em questão. Observou-se que o método ahp é uma ferramenta de auxílio no processo decisório, pois contempla tanto os aspectos técnicos, como converte aspectos subjetivos em dados matematicamente confiáveis, além de sua grande flexibilidade para incorporar novas variáveis de análise

Infrared quasi-fixed solutions in the NMSSM

The considerable part of the parameter space in the MSSM corresponding to the infrared quasi fixed point scenario is almost excluded by LEP II bounds on the lightest Higgs boson mass. In the NMSSM the mass of the lightest Higgs boson reaches its maximum value in the strong Yukawa coupling limit when Yukawa couplings are essentially larger than gauge ones at the Grand Unification scale. In this limit the solutions of the renormalisation group equations are attracted to the infrared and Hill type effective fixed lines or surfaces in the Yukawa coupling parameter space. They are concentrated in the vicinity of quasi fixed points for $Y_i(0)\to\infty$. However the solutions are attracted to such points rather weakly. For this reason when all $Y_i(0)\sim 1$ the solutions of the renormalisation group equations are gathered near a line in the Hill type effective surface. In the paper the approximate solutions for the NMSSM Yukawa couplings are given. The possibility of $b$--quark and $\tau$--lepton Yukawa coupling unification at the scale $M_{X}$ is also discussed.Comment: 32 pages, 8 figures included, LaTeX 2

Paediatric major incident simulation and the number of discharges achieved using a major incident rapid discharge protocol in a major trauma centre: a retrospective study

Objectives Hospitals have the responsibility of creating, testing and maintaining major incident (MI) plans. Plans emphasise readiness for acceptance of casualties, though often they neglect discharge planning and care for existing inpatients to make room for the sudden influx.After collaboration and design of a discharge policy for a paediatric MI, we aimed to establish the number of beds made available (primary outcome) to assess potential surge and patient flow. We hypothesised that prompt patient discharge would improve overall departmental flow. Flow is vital for sick patients awaiting admission, for those requiring theatre and also to keep the emergency department clear for ongoing admissions.Method and setting A simulated MI was declared at a London major trauma centre. Five paediatric priority 1 and 15 priority 2 and priority 3 patients were admitted. Using live bed boards, staff initiated discharge plans, and audits were conducted based on hospital bed occupancy and discharge capacity. The patients identified as dischargable were identified and folllowed up for 7 days.Results Twenty-nine ward beds were created (42% of the total capacity). Handwritten summaries just took 13.3% of the time that electronic summaries took for the same patients by the same doctor. In-hospital transfers allowed five critically injured children into paediatric intensive care unit (PICU), and creation of a satellite PICU allowed for an additional six more if needed.Conclusion We increased level 3 capacity threefold and created 40% extra capacity for ward patients. A formalised plan helped with speed and efficiency of safe discharge during an MI. Carbon copy handwritten discharge letters allowed tracking and saved time. Robust follow-up procedures must be in place for any patients discharged

Learning from terrorist mass casualty incidents: a global survey

Background: Reports published directly after terrorist mass casualty incidents frequently fail to capture difficulties that may have been encountered. An anonymised consensus-based platform may enable discussion and collaboration on the challenges faced. Our aim was to identify where to focus improvement for future responses. Methods: We conducted a mixed methods study by email of clinicians\u27 experiences of leading during terrorist mass casualty incidents. An initial survey identified features that worked well, or failed to, during terrorist mass casualty incidents plus ongoing challenges and changes that were implemented as a result. A follow-up, quantitative survey measured agreement between responses within each of the themes using a Likert scale. Results: Thirty-three participants responded from 22 hospitals that had received casualties from a terrorist incident, representing 17 cities in low-middle, middle and high income countries. The first survey identified themes of sufficient (sometimes abundant) human resource, although coordination of staff was a challenge. Difficulties highlighted were communication, security, and management of blast injuries. The most frequently implemented changes were education on specific injuries, revising future plans and preparatory exercises. Persisting challenges were lack of time allocated to training and psychological well-being. The follow-up survey recorded highest agreement amongst correspondents on the need for re-triage at hospital (90% agreement), coordination roles (85% agreement), flexibility (100% agreement), and large-scale exercises (95% agreement). Conclusion: This survey collates international experience gained from clinicians managing terrorist mass casualty incidents. The organisation of human response, rather than consumption of physical supplies, emerged as the main finding