2,044 research outputs found

    Characterization of the complications associated with plasma exchange for thrombotic thrombocytopaenic purpura and related thrombotic microangiopathic anaemias: a single institution experience.

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    Plasma exchange (PEX) is a life-saving therapeutic procedure in patients with thrombotic thrombocytopaenic purpura (TTP) and other thrombotic microangiopathic anaemias (TMAs). However, it may be associated with significant complications, exacerbating the morbidity and mortality in this patient group

    Evaluation of Coventry & Warwickshire Substance Misuse Initiative Employment Support Project

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    The Employment Support Project in Warwickshire is built on a partnership between Warwickshire Probation Service (Lead Agency), South Warwickshire Combined Care NHS Trust, Orbit Housing Association and Jephson Homes Housing Association. These key agencies aim to integrate approaches to tackling drug misuse. This is particularly appropriate in Warwickshire where drug misuse constitutes a significant, yet still manageable, problem. The following report highlights the main achievements of this unique Employment Support Project (ESP) which is designed to encourage, support and guide drug-misusers into relevant employment, training and/or personal development opportunities. It also provides an overview of success measures, added-value and sustainability issues directly linked to the immediate and future work of the projec

    An adapted triage tool (ETAT) at Red Cross War Memorial Children’s Hospital Medical Emergency Unit, Cape Town: An evaluation

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    Objective. To evaluate the efficacy of an adapted Emergency Triage Assessment and Treatment (ETAT) tool at a children’s hospital. Design. A two-armed descriptive study. Setting. Red Cross War Memorial Children’s Hospital, Cape Town, South Africa. Methods. Triage data on 1 309 children from October 2007 and July 2009 were analysed. The number of children in each triage category (red (emergency), orange (urgent or priority) and green (non-urgent)) and their disposal were evaluated. Results. 1. The October 2007 series: 902 children aged 5 days - 15 years were evaluated. Their median age was 20 (interquartile range (IQR) 7 - 50) months, and 58.8% (n=530) were triaged green, 37.5% (n=338) orange and 3.8% (n=34) red. Over 90% of children in the green category were discharged (478/530), while 32.5% of children triaged orange (110/338) and 52.9% of children triaged red (18/34) were admitted. There was a significant increase in admission rate for each triage colour change from green through orange to red after adjustment for age category (risk ratio (RR) 2.6; 95% confidence interval (CI) 2.2 - 3.1). 2. The July 2009 cohort: 407 children with a median age of 22 months (IQR 7 - 53 months) were enrolled. Twelve children (2.9%) were triaged red, 187 (45.9%) orange and 208 (51.1%) green. A quarter (101/407) of the children triaged were admitted: 91.7% (11/12) from the red category and 36.9% (69/187) from the orange category were admitted, while 89.9% of children in the green category (187/208) were discharged. After adjusting for age category, admissions increased by more than 300% for every change in triage acuity (RR 3.2; 95% CI 2.5 - 4.1). Conclusions. The adapted ETAT process may serve as a reliable triage tool for busy paediatric medical emergency units in resource-constrained countries and could be evaluated further in community emergency settings

    An adapted triage tool (ETAT) at Red Cross War Memorial Children’s Hospital Medical Emergency Unit, Cape Town: An evaluation

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    Objective. To evaluate the efficacy of an adapted Emergency Triage Assessment and Treatment (ETAT) tool at a children’s hospital. Design. A two-armed descriptive study. Setting. Red Cross War Memorial Children’s Hospital, Cape Town, South Africa. Methods. Triage data on 1 309 children from October 2007 and July 2009 were analysed. The number of children in each triage category (red (emergency), orange (urgent or priority) and green (non-urgent)) and their disposal were evaluated. Results. 1. The October 2007 series: 902 children aged 5 days - 15 years were evaluated. Their median age was 20 (interquartile range (IQR) 7 - 50) months, and 58.8% (n=530) were triaged green, 37.5% (n=338) orange and 3.8% (n=34) red. Over 90% of children in the green category were discharged (478/530), while 32.5% of children triaged orange (110/338) and 52.9% of children triaged red (18/34) were admitted. There was a significant increase in admission rate for each triage colour change from green through orange to red after adjustment for age category (risk ratio (RR) 2.6; 95% confidence interval (CI) 2.2 - 3.1). 2. The July 2009 cohort: 407 children with a median age of 22 months (IQR 7 - 53 months) were enrolled. Twelve children (2.9%) were triaged red, 187 (45.9%) orange and 208 (51.1%) green. A quarter (101/407) of the children triaged were admitted: 91.7% (11/12) from the red category and 36.9% (69/187) from the orange category were admitted, while 89.9% of children in the green category (187/208) were discharged. After adjusting for age category, admissions increased by more than 300% for every change in triage acuity (RR 3.2; 95% CI 2.5 - 4.1). Conclusions. The adapted ETAT process may serve as a reliable triage tool for busy paediatric medical emergency units in resource-constrained countries and could be evaluated further in community emergency settings

    α,ÎČ-Unsaturated acyl ammonium species as reactive intermediates in organocatalysis : an update

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    Authors acknowledge The University of St Andrews (JB) and the EaSICAT Centre for Doctoral Training (MTW) for funding.α,ÎČ-Unsaturated acyl ammonium species are versatile intermediates that have been applied in a variety of transformations including Michael additions, domino reactions and cycloadditions. Many of these transformations are promoted by chiral Lewis base catalysts, enabling the rapid generation of molecular complexity with high stereochemical control. This review highlights recent developments in the generation and application of α,ÎČ-unsaturated acyl ammonium intermediates reported since a previous review of this area in 2016. Particular emphasis will be placed on reports providing mechanistic insight into catalytic transformations and observed selectivities. A perspective on current challenges and potential future developments in the field of α,ÎČ-unsaturated acyl ammonium catalysis is also provided.Publisher PDFPeer reviewe

    The set-shifting profiles of anorexia nervosa and autism spectrum disorder using the Wisconsin Card Sorting Test: a systematic review and meta-analysis

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    Difficulties in set-shifting are commonly reported in both autism spectrum disorder (ASD) and anorexia nervosa (AN) populations. Despite this, it is not known whether this cognitive profile persists across different ages, or whether the profiles seen in ASD and AN are comparable. This systematic review and meta-analyses aimed to compare the set-shifting profiles, as measured by the Wisconsin Card Sorting Test (WCST) in adults and younger people with either ASD or AN, relative to healthy controls (HCs) and to statistically compare performance on the WCST between ASD and AN. In all, 24 studies on ASD and 22 studies on AN were identified. In ASD, there were significant differences between the clinical group and HCs, with the ASD group making significantly more perseverative errors, indicating greater difficulty in set-shifting [pooled effect size of d = 0.67, 95% confidence interval (CI) 0.53-0.81, p ⩜ 0.001]. This effect was consistent across the age span. For AN studies, there was a significant difference between adults with AN and HCs (d = 0.52, 95% CI 0.36-0.68, p ⩜ 0.001) but a non-significant effect in child studies (d = 0.25, 95% CI -0.05 to 0.55, z = 1.66, p = 0.096). Meta-regression indicated no effect of diagnosis (AN or ASD) on performance in adult studies but there was a non-significant trend (p = 0.053) towards children with ASD performing worse than children with AN. While difficulties with set-shifting appear to be stable in ASD, there may be differences between children and adults with AN, which warrant further investigation

    In Nightingale's footsteps: A qualitative analysis of the impact of leadership development within the clinical learning environment

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    Aim To identify and describe the impact areas of a newly developed leadership development programme focussed on positioning leaders to improve the student experience of the clinical learning environment. Background There is a need to consider extending traditional ways of developing leaders within the clinical learning in order to accommodate an increased number of students and ensure their learning experience is fulfilling and developmental. The Florence Nightingale Foundation implemented a bespoke leadership development programme within the clinical learning environment. Identifying the areas of impact will help to inform organisational decision making regarding the benefits of encouraging and supporting emerging leaders to undertake this type of programme. Method For this qualitative descriptive study, eight health care professionals who took part in a bespoke leadership development programme were interviewed individually and then collectively. The Florence Nightingale Foundation fellowship/scholarship programme is examined to determine impact. Results Two key themes were described in relation to impact of the programme. These were ‘Personal Development’ and ‘Professional Impact’. The two key themes comprised several subthemes. The notion of time and space to think was subsumed within each theme. Conclusion Data highlights that the Florence Nightingale Foundation programme had a distinct impact on participants by transforming thinking and increasing self-confidence to enable changes to make improvements both within their organisations and at national level. Implications for Nursing Management Health care managers must continue to invest in building leadership capacity and capability through programmes that can help position individuals to realize their potential to positively influence health outcomes and wider society

    Influence of mismatch on the defects in relaxed epitaxial InGaAs/GaAs(100) films grown by molecular beam epitaxy

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    Thick (∌3 ÎŒm) films of InxGa1−xAs grown on GaAs(100) substrates, across the whole composition range, have been examined by transmission electron microscopy and double‐crystal x‐ray diffraction. The results were compared with the observed growth mode of the material determined by in situ reflection high‐energy electron diffraction in the molecular beam epitaxy growth system. The quality of the material degraded noticeably for compositions up to x∌0.5 associated with an increased density of dislocations and stacking faults. In contrast, improvements in quality as x approached 1.0 were correlated with the introduction of an increasingly more regular array of edge dislocations

    \u3ci\u3eMedicine Meets Virtual Reality 14\u3c/i\u3e

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    Chapter, Real-Time Augmented Feedback Benefits Robotic Laparoscopic Training, co-authored by Nicholas Steriou, UNO faculty member. Machine intelligence will eclipse human intelligence within the next few decades - extrapolating from Moore’s Law - and our world will enjoy limitless computational power and ubiquitous data networks. Today’s iPod¼ devices portend an era when biology and information technology will fuse to create a human experience radically different from our own. Already, our healthcare system now appears on the verge of crisis; accelerating change is part of the problem. Each technological upgrade demands an investment of education and money, and a costly infrastructure more quickly becomes obsolete. Practitioners can be overloaded with complexity: therapeutic options, outcomes data, procedural coding, drug names etc. Furthermore, an aging global population with a growing sense of entitlement demands that each medical breakthrough be immediately available for its benefit: what appears in the morning paper is expected simultaneously in the doctor’s office. Meanwhile, a third-party payer system generates conflicting priorities for patient care and stockholder returns. The result is a healthcare system stressed by scientific promise, public expectation, economic and regulatory constraints and human limitations. Change is also proving beneficial, of course. Practitioners are empowered by better imaging methods, more precise robotic tools, greater realism in training simulators, and more powerful intelligence networks. The remarkable accomplishments of the IT industry and the Internet are trickling steadily into healthcare. The Medicine Meets Virtual Reality series can readily see the progress of the past fourteen years: more effective healthcare at a lower overall cost, driven by cheaper and better computers.https://digitalcommons.unomaha.edu/facultybooks/1236/thumbnail.jp
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