Controlled donation after circulatory death (DCD) donors make an important contribution to organ transplantation but there is considerable scope for further increasing the conversion of potential to ...actual DCD organ donors. The period between withdrawal of life-supporting treatment and death (the withdrawal period) is a major determinant of whether organ donation proceeds and it is therefore timely to review recent relevant studies in this area.
The duration and haemodynamic nature of the withdrawal period is extremely variable, and clinical guidelines for management of the potential donor during this period differ widely. Recent evidence suggests that kidneys from DCD donors with a prolonged withdrawal period can be used to increase the number of transplants performed and provide satisfactory graft function, suggesting that it is not the duration but the haemodynamic profile of the donor during this phase that are important. This suggestion questions the relevance of clinical indices predicting death within 1 h of treatment withdrawal.
Future studies should aim to define clinical and physiological variables during the withdrawal period that can be used to maximize well tolerated use of organs from potential DCD donors; these thresholds are likely to differ according to organ type.
Antimicrobial stewardship (AMS) programmes optimize antimicrobial use and address antimicrobial resistance. Pharmacists are often key agents of these programmes. The effectiveness of hospital-based ...AMS interventions when they are led by pharmacists, however, has not previously been reported.
To evaluate the effectiveness of pharmacist-led AMS interventions in improving antimicrobial use for hospital inpatients.
Standard systematic review methods were used. The search strategies and databases used in a previous Cochrane review were applied. Studies that reported pharmacist-led AMS interventions were included. Narrative synthesis was used to report the findings. PRISMA guidelines were followed.
From 6971 records retrieved and screened, 52 full-text articles were included. Most studies were undertaken in teaching hospitals (N = 45) and many were conducted in North America (N = 27). Most interventions targeted junior or ward physicians and lasted between one and six months. All studies evaluated educational interventions often in combination with other interventions and reported improvements ‘in compliance with target AMS practice’. Greater compliance was achieved with multiple interventions. Pharmacist-led interventions reduced the duration of antimicrobial therapy without increasing mortality. No consistency of evidence was achieved in relation to interventions and reduced duration of hospital stay, nor infections due to antimicrobial resistance or occurrence of Clostridium difficile.
This is the first systematic review to evaluate the effectiveness of pharmacist-led AMS interventions in hospital inpatients. Education-based interventions were effective in increasing guideline compliance and reducing duration of antimicrobial therapy. Future hospital-based AMS programmes should consider the involvement of pharmacists to deliver and promote AMS interventions and programmes.
The past two decades have contributed a large body of preclinical work that has assisted in our understanding of the underlying pathophysiological mechanisms that cause chronic pain. In this context, ...it has been recognized that effective treatment of pain is a priority and that treatment often involves the use of one or a combination of agents with analgesic action. The current review presents an evidence-based approach to the pharmacotherapy of chronic pain. Medline searches were done for all agents used as conventional treatment in chronic pain. Published papers up to June 2005 were included. The search strategy included randomized, controlled trials, and where available, systematic reviews and meta-analyses. Further references were found in reference sections of papers located using the above search strategy. Agents for which there were no controlled trials supporting efficacy in treatment of chronic pain were not included in the present review, except in cases where preclinical science was compelling, or where initial human work has been positive and where it was thought the reader would be interested in the scientific evidence to date.
Membranes provide a unique opportunity for heavy industry decarbonization and a real solution requires optimal system design. We use a superstructure process model to minimize capital and operational ...expenses for post-combustion carbon capture systems. We consider membranes having CO2 permeances between 100 and 5000 GPU and selectivities for CO2 over N2 ranging from 10 to 300. For the four heavy industry-representative cases studied, we find membranes with selectivities approximately above 30 have essentially the same economics. When the permeance of CO2 is above 1000 GPU, and the selectivity is between 20 and 30, we find that membrane systems can achieve low capture costs ($20 to $55 per ton) and high energy efficiencies (150 to 500 kWh per ton). A quantitative relationship between membrane properties and optimized process economics enables effective product development for commercial applications.
Renewing Europe's Housing Turkington, Richard; Watson, Christopher
Renewing Europe's Housing,
11/2014, Letnik:
50702
eBook, Book
Odprti dostop
Many European cities have a shortage of good quality, affordable housing, but this problem has become less prominent in policy than it should be. This timely book aims to redress that balance. After ...an introductory chapter, expert contributors provide contemporary comparative accounts of housing renewal policy and practice in nine European countries in its physical, economic, social, community and cultural aspects. Shared concerns over energy conservation, social protection and inclusion, and the roles and responsibilities of the public and private sectors form the basis of a proposed policy agenda for housing renewal across Europe. The concluding chapters draw conclusions from a pan-European perspective and consider the future prospects for renewing older housing.
Academics, practitioners, policy-makers and students of housing, urban studies, planning, regeneration, environmental health and sustainability will all want to read this book.
Soil organic carbon (C) plays a critical role in supporting the productive capacity of soils and their ability to provide a wide range of ecologically important functions including the storage of ...atmospherically derived carbon dioxide (CO2). The present paper collates available information on Scottish soil C stocks and C losses and reviews the potential pressures on terrestrial C, which may threaten future C stocks. Past, present and possible future land use, land management practices and land use changes (LUCs) including forestry, agriculture, nitrogen (N) additions, elevated CO2 and climate change for Scotland are discussed and evaluated in relation to the anthropogenic pressures on soil C. The review deduces that current available data show little suggestion of significant changes in C stocks of Scottish soils, although this may be due to a lack of long-term trend data. However, it can be concluded that there are many pressures, such as climate change, intensity of land use practices, scale of LUC, soil erosion and pollution, which may pose significant threats to the future of Scottish soil C if these factors are not taken into consideration in future land management decisions. In particular, this is due to the land area covered by vulnerable peats and highly organic soils in Scotland compared with other areas in the UK. It is therefore imperative that soil C stocks for different land use, management practices and LUCs are monitored in more detail to provide further insight into the potential changes in sequestered C and subsequent greenhouse gas emissions, as advised by the United Nations Framework Convention on Climate Change (UNFCCC).
Summary Vocal attack time (VAT) is the time lag between the growth of sound pressure (SP) and electroglottographic (EGG) signals at vocal initiation. The characteristics of voice initiation are ...associated with issues of vocal hygiene, efficiency, and quality. Vocal onsets have commonly been qualitatively characterized into three types: hard, simultaneous, and breathy. This study examines the effect of voice onset type on VAT values in normal speakers. SP and EGG recordings were obtained for 55 female and 57 male subjects while producing multiple tokens of three tasks (sustained /ɑ/ and “always” as unaspirated onsets, and “hallways” as an aspirated onset). Results revealed a significant effect of onset type on VAT, with the mean VAT for the “hallways” (aspirated) task greater than the mean VAT for the sustained /ɑ/ and “always” (unaspirated) tasks. There was no significant VAT difference between the sustained /ɑ/ and “always” tasks. Findings confirm the sensitivity of the VAT measure to vocal onset type and suggest its potential application as an objective and quantitative clinical measure of the type of vocal onset.
HURRICANE LOSS ESTIMATION MODELS Watson, Charles C.; Johnson, Mark E.
Bulletin of the American Meteorological Society,
11/2004, Letnik:
85, Številka:
11
Journal Article
Recenzirano
Odprti dostop
The results of hurricane loss models are used regularly for multibillion dollar decisions in the insurance and financial services industries. These models are proprietary, and this “black box” nature ...hinders analysis. The proprietary models produce a wide range of results, often producing loss costs that differ by a ratio of three to one or more. In a study for the state of North Carolina, 324 combinations of loss models were analyzed, based on a combination of nine wind models, four surface friction models, and nine damage models drawn from the published literature in insurance, engineering, and meteorology. These combinations were tested against reported losses from Hurricanes Hugo and Andrew as reported by a major insurance company, as well as storm total losses for additional storms. Annual loss costs were then computed using these 324 combinations of models for both North Carolina and Florida, and compared with publicly available proprietary model results in Florida. The wide range of resulting loss costs for open, scientifically defensible models that perform well against observed losses mirrors the wide range of loss costs computed by the proprietary models currently in use. This outcome may be discouraging for governmental and corporate decision makers relying on this data for policy and investment guidance (due to the high variability across model results), but it also provides guidance for the efforts of future investigations to improve loss models. Although hurricane loss models are true multidisciplinary efforts, involving meteorology, engineering, statistics, and actuarial sciences, the field of meteorology offers the most promising opportunities for improvement of the state of the art.
Systemic amyloidosis is a disease that often involves multiple organ systems, including the peripheral nervous system. Patients may present with severe, refractory neuropathic pain; however, the ...optimal treatment approach for pain for these patients remains unclear.
A man with severe, refractory neuropathic pain in his bilateral upper and lower extremities and the trunk secondary to amyloid neuropathy is presented. Multiple medication trials, including neuropathic and opioid agents, produced considerable adverse effects and minimal relief. Scrambler therapy, a novel electrical stimulation modality, was used and was associated with substantial short-term but nonsustained benefit. Spinal cord stimulation was considered, but given his diffuse symptoms, it was deemed a less-than-optimal approach. Ultimately, an intrathecal drug delivery system was placed with infusion of hydromorphone, resulting in substantial pain reduction in all involved areas and with an improved adverse effect profile. This intervention resulted in immense improvement in the patient's quality of life, despite progression of his systemic amyloidosis.
Severe pain in the setting of amyloid neuropathy is often difficult to treat. To our knowledge, this represents the first report of Scrambler therapy or an implanted intrathecal drug delivery system used for a patient with refractory amyloidosis-related neuropathic pain, resulting in substantial analgesic benefit and improved quality of life.
Iq'mik, a form of smokeless tobacco (ST), is traditionally used by Cup'ik and Yup'ik Eskimo people of western Alaska. Iq'mik is sometimes incorrectly considered to be a healthier alternative to ...smoking because its ingredients are perceived as "natural." Our chemical characterization of iq'mik shows that iq'mik is not a safe alternative to smoking or other ST use.
We measured nicotine and pH levels of tobacco and ash used to prepare iq'mik. We also characterized levels of toxins which are known to be present in ST including tobacco-specific nitrosamines (TSNAs) and polycyclic aromatic hydrocarbons (PAHs) using chromatographic separations coupled with isotope dilution mass spectrometry.
Nicotine content in the iq'mik tobacco was very high, ranging from 35 to 43 mg/g, with a mean of 39 mg/g. The pH of the iq'mik tobacco-ash mixture was 11, an extremely high level compared with most ST products. High levels of PAHs were seen in the fire-cured tobacco samples with a benzoapyrene level of 87 ng/g. Average TSNA levels in the tobacco were 34, 2,700, and 340 ng/g for 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL), N'-nitrosonornicotine (NNN), and 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK), respectively.
Iq'mik contains high levels of the more easily absorbed unionized nicotine as well as known carcinogenic TSNAs and PAHs. The perception that iq'mik is less hazardous than other tobacco products due to the use of "natural" ingredients is not warranted. This chemical characterization of iq'mik gives a better understanding of the risk of possible adverse health effects of its use.
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