A method for reconstructing dimensions of subspaces for weakly coupled dynamical systems is offered. The tool is able to extrapolate the subspace dimensions from the zero coupling limit, where the ...division of dimensions as per the algorithm is exact. Implementation of the proposed technique to multivariate data demonstrates its effectiveness in disentangling subspace dimensionalities also in the case of emergent synchronized motions, for both numerical and experimental systems.
The Hospital Experience Reporting System was a pilot study initiated at Robert Packer Hospital in 1980 and continued for 22 months to examine abnormal or unusual failures of medical devices and to ...evaluate an inhospital reporting system. Hospital employees were encouraged to report device failures or problems, and the hospital purchasing department pursued recompensation or replacement from the manufacturer. Device deficiencies were found to be fairly common, but until HERS was implemented, only a negligible number were reported to either the hospital or to the U.S. Pharmacopoeial Convention. Cost savings brought about by this voluntary, inhospital reporting system were substantial. The study established that such a system results in safer device use.
Marine industries face a number of risks that necessitate careful analysis prior to making decisions on the siting of operations and facilities. An important emerging regulatory framework on ...environmental sustainability for business operations is the International Finance Corporation’s Performance Standard 6 (IFC PS6). Within PS6, identification of biodiversity significance is articulated through the concept of “Critical Habitat”, a definition developed by the IFC and detailed through criteria aligned with those that support internationally accepted biodiversity designations. No publicly available tools have been developed in either the marine or terrestrial realm to assess the likelihood of sites or operations being located within PS6-defined Critical Habitat. This paper presents a starting point towards filling this gap in the form of a preliminary global map that classifies more than 13 million km2 of marine and coastal areas of importance for biodiversity (protected areas, Key Biodiversity Areas KBA, sea turtle nesting sites, cold- and warm-water corals, seamounts, seagrass beds, mangroves, saltmarshes, hydrothermal vents and cold seeps) based on their overlap with Critical Habitat criteria, as defined by IFC. In total, 5798×103km2 (1.6%) of the analysis area (global ocean plus coastal land strip) were classed as Likely Critical Habitat, and 7526×103km2 (2.1%) as Potential Critical Habitat; the remainder (96.3%) were Unclassified. The latter was primarily due to the paucity of biodiversity data in marine areas beyond national jurisdiction and/or in deep waters, and the comparatively fewer protected areas and KBAs in these regions. Globally, protected areas constituted 65.9% of the combined Likely and Potential Critical Habitat extent, and KBAs 29.3%, not accounting for the overlap between these two features. Relative Critical Habitat extent in Exclusive Economic Zones varied dramatically between countries. This work is likely to be of particular use for industries operating in the marine and coastal realms as an early screening aid prior to in situ Critical Habitat assessment; to financial institutions making investment decisions; and to those wishing to implement good practice policies relevant to biodiversity management. Supplementary material (available online) includes other global datasets considered, documentation and justification of biodiversity feature classification, detail of IFC PS6 criteria/scenarios, and coverage calculations.
Display omitted
•A global map identifying potential and likely Critical Habitat, marine and coastal.•Critical Habitat as per ‘International Finance Corporation Performance Standard 6’.•Eleven biodiversity features: protected areas, seagrass beds, corals, seeps, etc.•The ocean was 1.6% ‘Likely Critical Habitat’, and 2.1% ‘Potential Critical Habitat’.•The map can be used as an early screening aid by industries.
Abstract
Background
Exposure to marketing for foods high in sugar, salt, and fat is considered a key risk factor for childhood obesity. To support efforts to limit such marketing, the World Health ...Organization Regional Office for Europe has developed a nutrient profile model (WHO NPM), published as second edition in March 2023. The German government plans to use this model in new food marketing legislation, but it has not yet been tested in Germany.
Methods
We applied the WHO NPM to a random sample of 660 food and beverage products across 22 product categories on the German market from Open Food Facts, a product database. We calculated the share of products permitted for marketing to children under current market conditions and for hypothetical reformulation scenarios. We assessed practical challenges in applying the WHO NPM and the effects of model adaptations.
Results
The median share of products permitted for marketing to children across the 22 categories was 20% (interquartile range (IQR) 3-59%) and increased to 38% (IQR 11-73%) with model adaptations proposed by the German government. With targeted reformulation (i.e. a 30% reduction in fat, sugar, sodium, and/or energy) the share increased substantially (defined as a relative increase by at least 50%) in several product categories (including bread, processed meat, yogurt, convenience foods, and savoury plant-based foods), but changed less in others. Practical challenges included the ascertainment of the trans-fatty acid content of products, among others.
Conclusions
The application of the WHO NPM in Germany was found to be feasible. Its use in the proposed legislation on food marketing in Germany seems likely to serve its intended public health objective of limiting marketing in a targeted manner specifically for less healthy products. It seems plausible that it may incentivise reformulation in some product categories. Practical challenges could be addressed with adaptations and procedural provisions.
Key messages
• The practical application of the WHO Europe Nutrient Profile Model 2023 edition to a random sample of food and beverage products on the German market was found to be feasible.
• With targeted reformulation, the share of products permitted for marketing to children under the WHO Europe Nutrient Profile Model increases substantially.
To develop evidence-based clinical practice guidelines for interventional techniques in the diagnosis and treatment of chronic spinal pain.
Systematic assessment of the literature.
I. Lumbar Spine • ...The evidence for accuracy of diagnostic selective nerve root blocks is limited; whereas for lumbar provocation discography, it is fair. • The evidence for diagnostic lumbar facet joint nerve blocks and diagnostic sacroiliac intraarticular injections is good with 75% to 100% pain relief as criterion standard with controlled local anesthetic or placebo blocks. • The evidence is good in managing disc herniation or radiculitis for caudal, interlaminar, and transforaminal epidural injections; fair for axial or discogenic pain without disc herniation, radiculitis or facet joint pain with caudal, and interlaminar epidural injections, and limited for transforaminal epidural injections; fair for spinal stenosis with caudal, interlaminar, and transforaminal epidural injections; and fair for post surgery syndrome with caudal epidural injections and limited with transforaminal epidural injections. • The evidence for therapeutic facet joint interventions is good for conventional radiofrequency, limited for pulsed radiofrequency, fair to good for lumbar facet joint nerve blocks, and limited for intraarticular injections. • For sacroiliac joint interventions, the evidence for cooled radiofrequency neurotomy is fair; limited for intraarticular injections and periarticular injections; and limited for both pulsed radiofrequency and conventional radiofrequency neurotomy. • For lumbar percutaneous adhesiolysis, the evidence is fair in managing chronic low back and lower extremity pain secondary to post surgery syndrome and spinal stenosis. • For intradiscal procedures, the evidence for intradiscal electrothermal therapy (IDET) and biaculoplasty is limited to fair and is limited for discTRODE. • For percutaneous disc decompression, the evidence is limited for automated percutaneous lumbar discectomy (APLD), percutaneous lumbar laser disc decompression, and Dekompressor; and limited to fair for nucleoplasty for which the Centers for Medicare and Medicaid Services (CMS) has issued a noncoverage decision. II. Cervical Spine • The evidence for cervical provocation discography is limited; whereas the evidence for diagnostic cervical facet joint nerve blocks is good with a criterion standard of 75% or greater relief with controlled diagnostic blocks. • The evidence is good for cervical interlaminar epidural injections for cervical disc herniation or radiculitis; fair for axial or discogenic pain, spinal stenosis, and post cervical surgery syndrome. • The evidence for therapeutic cervical facet joint interventions is fair for conventional cervical radiofrequency neurotomy and cervical medial branch blocks, and limited for cervical intraarticular injections. III. Thoracic Spine • The evidence is limited for thoracic provocation discography and is good for diagnostic accuracy of thoracic facet joint nerve blocks with a criterion standard of at least 75% pain relief with controlled diagnostic blocks. • The evidence is fair for thoracic epidural injections in managing thoracic pain. • The evidence for therapeutic thoracic facet joint nerve blocks is fair, limited for radiofrequency neurotomy, and not available for thoracic intraarticular injections. IV. Implantables • The evidence is fair for spinal cord stimulation (SCS) in managing patients with failed back surgery syndrome (FBSS) and limited for implantable intrathecal drug administration systems. V. ANTICOAGULATION • There is good evidence for risk of thromboembolic phenomenon in patients with antithrombotic therapy if discontinued, spontaneous epidural hematomas with or without traumatic injury in patients with or without anticoagulant therapy to discontinue or normalize INR with warfarin therapy, and the lack of necessity of discontinuation of nonsteroidal anti-inflammatory drugs (NSAIDs), including low dose aspirin prior to performing interventional techniques. • There is fair evidence with excessive bleeding, including epidural hematoma formation with interventional techniques when antithrombotic therapy is continued, the risk of higher thromboembolic phenomenon than epidural hematomas with discontinuation of antiplatelet therapy prior to interventional techniques and to continue phosphodiesterase inhibitors (dipyridamole, cilostazol, and Aggrenox). • There is limited evidence to discontinue antiplatelet therapy with platelet aggregation inhibitors to avoid bleeding and epidural hematomas and/or to continue antiplatelet therapy (clopidogrel, ticlopidine, prasugrel) during interventional techniques to avoid cerebrovascular and cardiovascular thromboembolic fatalities. • There is limited evidence in reference to newer antithrombotic agents dabigatran (Pradaxa) and rivaroxan (Xarelto) to discontinue to avoid bleeding and epidural hematomas and are continued during interventional techniques to avoid cerebrovascular and cardiovascular thromboembolic events.
Evidence is fair to good for 62% of diagnostic and 52% of therapeutic interventions assessed.
The authors are solely responsible for the content of this article. No statement on this article should be construed as an official position of ASIPP. The guidelines do not represent "standard of care."
Therapeutic lumbar facet joint interventions are implemented to provide long-term pain relief after the facet joint has been identified as the basis for low back pain. The therapeutic lumbar facet ...joint interventions generally used for the treatment of low back pain of facet joint origin are intraarticular facet joint injections, lumbar facet joint nerve blocks, and radiofrequency neurotomy.
To evaluate and update the effect of therapeutic lumbar facet joint interventions in managing chronic low back pain.
A systematic review of therapeutic lumbar facet joint interventions for the treatment of chronic low back pain.
The available literature on lumbar facet joint interventions in managing chronic low back pain was reviewed. The quality assessment and clinical relevance criteria utilized were the Cochrane Musculoskeletal Review Group criteria as utilized for interventional techniques for randomized trials and the criteria developed by the Newcastle-Ottawa Scale criteria for observational studies. The level of evidence was classified as good, fair, and limited or poor based on the quality of evidence developed by the U.S. Preventative Services Task Force. Data sources included relevant literature identified through searches of PubMed and EMBASE from 1966 through June 2012, and manual searches of the bibliographies of known primary and review articles.
The primary outcome measure was pain relief with short-term relief defined as up to 6 months and long-term relief as 12 months. Secondary outcome measures were improvement in functional status, psychological status, return to work, and reduction in opioid intake.
For this systematic review, 122 studies were identified. Of these, 11 randomized trials and 14 observational studies met inclusion criteria for methodological quality assessment. The evidence for radiofrequency neurotomy is good and fair to good for lumbar facet joint nerve blocks for short- and long-term improvement; whereas the evidence for intraarticular injections and pulsed radiofrequency neurotomy is limited.
The limitations of this systematic review include the continued paucity of evidence, specifically for intraarticular injection therapy.
In summary, there is good evidence for the use of conventional radiofrequency neurotomy, and fair to good evidence for lumbar facet joint nerve blocks for the treatment of chronic lumbar facet joint pain resulting in short-term and long-term pain relief and functional improvement. There is limited evidence for intraarticular facet joint injections and pulsed radiofrequency thermoneurolysis.
In 2008, a group of conservation scientists compiled a list of 100 priority questions for the conservation of the world's biodiversity. However, now almost a decade later, no one has yet published a ...study gauging how much progress has been made in addressing these 100 high-priority questions in the peer-reviewed literature. We took a first step toward reexamining the 100 questions to identify key knowledge gaps that remain. Through a combination of a questionnaire and a literature review, we evaluated each question on the basis of 2 criteria: relevance and effort. We defined highly relevant questions as those that - if answered - would have the greatest impact on global biodiversity conservation and quantified effort based on the number of review publications addressing a particular question, which we used as a proxy for research effort. Using this approach, we identified a set of questions that, despite being perceived as highly relevant, have been the focus of relatively few review publications over the past 10 years. These questions covered a broad range of topics but predominantly tackled 3 major themes: conservation and management of freshwater ecosystems, role of societal structures in shaping interactions between people and the environment, and impacts of conservation interventions. We believe these questions represent important knowledge gaps that have received insufficient attention and may need to be prioritized in future research. En 2008 un grupo de científicos de la conservación recopilaron una lista de 100 preguntas prioritarias para la conservación mundial de la biodiversidad (Sutherland et al. 2009). Sin embargo, ahora casi una década después, nadie ha publicado en la literatura revisada por pares un estudio que estime cuánto progreso se ha logrado en el tratado de estas 100 preguntas de alta prioridad. Realizamos un primer paso hacia la reexaminación de las 100 preguntas para identificar los vacíos importantes de conocimiento que todavía permanecen. Por medio de una combinación de un cuestionario y una revisión de la literatura, evaluamos cada pregunta con base en dos criterios: relevancia y esfuerzo. Definimos a las preguntas de alta relevancia como aquellas que - de ser respondidas - tendrían el mayor impacto sobre la conservación mundial de la biodiversidad y cuantificamos el esfuerzo con base en el número de publicaciones revisadas que trataban sobre alguna pregunta en particular, lo cual usamos como un sustituto para el esfuerzo de investigación. Con este método identificamos un conjunto de preguntas que, a pesar de ser percibidas como muy relevantes, han sido el foco de relativamente pocas publicaciones en los últimos diez años. Estas preguntas cubrieron una amplia gama de temas pero abordaban principalmente tres grandes temas: conservación y manejo de los ecosistemas de agua dulce, el papel de las estructuras de la sociedad en la formación de las interacciones entre las personas y el ambiente, y los impactos de las intervenciones de conservación. Creemos que estas preguntas representan vacíos importantes de conocimiento que han recibido poca atención y probablemente tendrán que volverse una prioridad en investigaciones futuras. 2008年, 保护学家为全球生物多祥性保护列出了 100 个优先问题 (Sutherland etal. 2009) o 然而，近十 年后的今天, 还没有ー篇同行评议的文章统计过我们在解决这100 个优先问题上取得的进展。我们初步地重新 检验了这 100 个问題，以确定目前存在的关键知识空缺。通过问卷调査和文献综述,我们用相关性和努力程度 这两个标准对每个问题都进行了评估。我们将“高度相关的问题”定义为，如果得到回答，将对全球生物多祥1É 保护产生重要影响的问題; 努力程度则是用针对该问题的综述文章的数量作为研究投入的指标来进行量化。我 们用这种方法确定了一系列在过去十年中被认为与全球生物多祥性保护高度相关，但却较少受到综述文章关注 的问题。这些问题覆盖面广，但主要涉及三大类主題: 淡水生态系统的保护和管理、社会结构对构建人与自然相 互作用的影响，以及保护干预措施的效果。我们认为这些问题代表了那些没有得到足够关注的知识空缺，可能需 要在未来的研究中优先考虑。
PDF
