145 research outputs found
A Wholistic, Environmental Approach to Washington’s Repair Methodology of its State-road Culverts
A Wholistic, Environmental Approach to Washington’s Repair Methodology of its State-road Culverts
Not all suffering is pain: sources of patients' suffering in the emergency department call for improvements in communication from practitioners
Background
Provision of prompt, effective analgesia is rightly considered as a standard of care in the emergency department (ED). However, much suffering is not ‘painful’ and may be under-recognised. We sought to describe the burden of suffering in the ED and explore how this may be best addressed from a patient centred perspective.
Methods
In a prospective cohort study, we included undifferentiated patients presenting to the ED. We undertook two face to face questionnaires with the first immediately following triage. We asked patients: (a) if they were ‘suffering’; (b) how they were suffering; and (c) what they hoped would be done to ease this. Prior to leaving the ED, we asked patients what had been done to ease their suffering. Data were analysed thematically.
Results
Of 125 patients included, 77 (61.6%) reported suffering on direct questioning and 92 (73.6%) listed at least one way in which they were suffering. 90 (72.0%) patients had a pain score >0/10 but only 37 (29.6%) reported that pain was causing suffering. Patients reported suffering from both physical symptoms (especially pain, nausea, vomiting and dizziness) and emotional distress (notably anxiety). Treatment (to ease physical and emotional symptoms), information (particularly diagnosis, reassurance and explanation), care (notably friendly staff) and closure (being seen, resolving the problem and going home) were the key themes identified as important for relief of suffering.
Conclusions
In seeking to ease suffering in the ED, clinicians must focus not only on providing analgesia but on treating Emotional distress, Physical symptoms, providing Information, Care and Closure (EPICC)
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Novel Emergency Medicine Curriculum Utilizing Self-Directed Learning and the Flipped Classroom Method: Neurologic Emergencies Small Group Module
Relationship Between Sulcal Characteristics and Brain Aging
This study aimed to determine whether sulcal morphology differs between middle age (MA) and older healthy individuals. Furthermore, we sought to determine whether age-related differences in sulcal characteristics were more strongly associated with differences in local or global cortical volumes. Participants (age 44-50, N = 403; age 64-70, N = 390) from the Personality and Total Health Through Life (PATH) study were included. Sulci were 17.3% wider, on average, in old age (OA) compared to MA participants, with the largest difference in the left superior frontal sulcus. Differences in sulcal width were generally higher in males than females. Differences in the width of the superior frontal and central sulci were significantly associated with differences in the volume of adjacent local gyri, while age-related differences in the width of lateral and superior temporal sulci were associated with differences in whole brain cortical volume. These findings suggest that sulcal characteristics provide unique information about changes in local and global brain structure in aging.The study was supported by National Health and Medical
Research Council (NHMRC) of Australia Grant No. 973302,
1002160 and 1063907. NC was funded by ARC Fellowship No.
12010227
A national audit of the management pathways for new HIV diagnoses
The British HIV Association recommends that new diagnoses be reviewed by an HIV specialist within two weeks. NHS England outcome measures include the proportion of new diagnoses commencing antiretroviral therapy (ART) within 91 days. We aimed to review the extent to which these recommendations were followed, to explore the topics discussed with new diagnoses, and to identify reasons behind delayed ART initiation. UK specialist HIV services were invited to retrospectively review the notes of their last 40 new diagnoses over a 15-month period. One-hundred and thirty-two services provided data for 2281 eligible individuals. Most new diagnoses were reviewed by a specialist within two weeks (67.7%) and were commenced on ART within 91 days (83%), however, there were some concerning delays in those tested at home and in general practice. Partner notification and treatment benefits were discussed with most individuals, unlike the availability of community support and U = U (“undetectable equals untransmittable”). Lengthy delays in ART initiation were mostly due to individuals initially declining ART or missing appointments. Our findings suggest a need for more streamlined pathways into HIV care, review of new diagnoses who have not commenced ART within 8 weeks, and protocol development to ensure discussion of relevant topics
Gas gangrene and osteomyelitis of the foot in a diabetic patient treated with tea tree oil
Diabetic foot wounds represent a class of chronic non-healing wounds that can lead to the development of soft tissue infections and osteomyelitis. We reviewed the case of a 44-year-old female with a diabetic foot wound who developed gas gangrene while treating her wound with tea tree oil, a naturally derived antibiotic agent. This case report includes images that represent clinical examination and x-ray findings of a patient who required broad-spectrum antibiotics and emergent surgical consultation. Emergency Department (ED) detection of these complications may prevent loss of life or limb in these patients
Prognostic factors and monomicrobial necrotizing fasciitis: gram-positive versus gram-negative pathogens
<p>Abstract</p> <p>Background</p> <p>Monomicrobial necrotizing fasciitis is rapidly progressive and life-threatening. This study was undertaken to ascertain whether the clinical presentation and outcome for patients with this disease differ for those infected with a gram-positive as compared to gram-negative pathogen.</p> <p>Methods</p> <p>Forty-six patients with monomicrobial necrotizing fasciitis were examined retrospectively from November 2002 to January 2008. All patients received adequate broad-spectrum antibiotic therapy, aggressive resuscitation, prompt radical debridement and adjuvant hyperbaric oxygen therapy. Eleven patients were infected with a gram-positive pathogen (Group 1) and 35 patients with a gram-negative pathogen (Group 2).</p> <p>Results</p> <p>Group 2 was characterized by a higher incidence of hemorrhagic bullae and septic shock, higher APACHE II scores at 24 h post-admission, a higher rate of thrombocytopenia, and a higher prevalence of chronic liver dysfunction. Gouty arthritis was more prevalent in Group 1. For non-survivors, the incidences of chronic liver dysfunction, chronic renal failure and thrombocytopenia were higher in comparison with those for survivors. Lower level of serum albumin was also demonstrated in the non-survivors as compared to those in survivors.</p> <p>Conclusions</p> <p>Pre-existing chronic liver dysfunction, chronic renal failure, thrombocytopenia and hypoalbuminemia, and post-operative dependence on mechanical ventilation represent poor prognostic factors in monomicrobial necrotizing fasciitis. Patients with gram-negative monobacterial necrotizing fasciitis present with more fulminant sepsis.</p
Potential utility of hyperbaric oxygen therapy and propolis in enhancing the leishmanicidal activity of glucantime
Un entorno didáctico para el desarrollo de proyectos de compilación basado en "bytecode"
[ES] En este trabajo se describe el diseño y la implementación de un nuevo entorno de
desarrollo basado en código intermedio bytecode para proyectos de construcción de compiladores
de la asignatura de Lenguajes de Programación y Procesadores de Lenguajes,
algunos aspectos del trabajo son como la definición de un lenguaje fuente, elaboración de
herramientas para generación de fichero classfile, etc. Los objetivos principales del nuevo
entorno son fomentar el uso de herramientas más comunes de la industria de lenguajes
de programación por la parte del alumno y reducir el esfuerzo de mantenimiento de
los materiales docentes por la parte del profesor tales como mantenimiento de las herramientas
propias de la asignatura.[EN] This project describes the design and implementation of a development environment
based on bytecode for compiler construction projects. Some of the topics include formal
definition of a source programming language, development of a classfile generator, etc.
With this new development environment, we aim to promote the usage of tools commonly
used in the programming language industry, but not in Programing Languages
And Compilers course taught at Escuela Técnica Superior de Ingeniería Informática. Another
goal of this project is minimize course material’s maintenance work done by teaching
staff.Mu, K. (2018). Un entorno didáctico para el desarrollo de proyectos de compilación basado en "bytecode". http://hdl.handle.net/10251/107536TFG
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