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This article discusses the evaluation of the management of the Laponia World Heritage site (Laponia WHS) in northern Sweden. After inscription on the World Heritage list in 1996, difficulties emerged in establishing a common understanding about the involvement of various stakeholders into the site’s management model, the key point of contention being the influence of the representatives from indigenous Sami people and how that should be organised. In 2011, the management organisation led by Laponiatjuottjudus (the Sami name for the Laponia WHS management organisation) was established and implemented. This organisation gave Sami representatives a majority in the Laponia steering board and the position as chairperson in the board. This marked a remarkable shift in the Swedish national management system of land in not only handing over a state decision-making power to the local level but also to representatives of the indigenous population. The evaluation of the management model presented by Laponiatjuottjudus resulted in a number of responses from several stakeholders participating in a consultation process. These responses, from stakeholders with conflicting positions in relation to the issue described above, are the subject of this study. The analysis of these data collected reveals the existence of four major approaches or narratives to the Laponia WHS, with narratives connected to nature, the indigenous population and local governance, the economic effects of the existing system, and lastly the local community narrative. The study concludes that present management of Laponia WHS, the Laponiatjuottjudus, is a unique attempt to widen the management and planning process that partly interferes with the existing national planning model. At the same time, the analysis reveals that the Sami demands for influence over land management in the north still faces major challenges connected to its colonial legacy.
Background: Emergency department (ED) overcrowding is associated with a broad spectrum of poor medical outcomes, including medical errors, mortality, higher rates of leaving without being seen, and reduced patient and physician satisfaction. The largest contributor to overcrowding is access block – the inability of admitted patients to access in-patient beds from the ED. One component to addressing access block involves streamlining the decision process to rapidly determine which hospital service will admit the patient. Aim Statement: As of Sep 2011, admission algorithms at our institution were supported and formalised. The pancreatitis algorithm clarified whether general surgery or internal medicine would admit ED patients with pancreatitis. We hypothesize that this prior uncertainty delayed the admission decision and prolonged ED length of stay (LOS) for patients with pancreatitis. Our project evaluates whether implementing a pancreatitis admission algorithm at our institution reduced ED time to disposition (TTD) and LOS. Measures & Design: A retrospective review was conducted in a tertiary care academic hospital in Montreal for all adult ED patients diagnosed with pancreatitis from Apr 2010 to Mar 2014. The data was used to plot separate run charts for ED TTD and LOS. Serial measurements of each outcome were used to monitor change and evaluate for special cause variation. The mean ED LOS and TTD before and after algorithm implementation were also compared using the Student's t test. Evaluation/Results: Over four years, a total of 365 ED patients were diagnosed with pancreatitis and 287 (79%) were admitted. The mean ED LOS for patients with pancreatitis decreased following the implementation of an admission algorithm (1616 vs. 1418 mins, p = 0.05). The mean ED TTD was also reduced (1171 vs. 899 mins, p = 0.0006). A non-random signal of change was suggested by a shift above the median prior to algorithm implementation and one below the median following. Discussion/Impact: This project demonstrates that in a busy tertiary care academic hospital, an admission algorithm helped reduce ED TTD and LOS for patients with pancreatitis. This proves especially valuable when considering the potential applicability of such algorithms to other disease processes, such as gastrointestinal bleeding and congestive heart failure, among others. Future studies demonstrating this external applicability, and the impact of such decision algorithms on physician decision fatigue and within non-academic institutions, proves warranted.
The World Health Organization’s (WHO; Geneva, Switzerland) Emergency Medical Team (EMT) Initiative created guidelines which define the basic procedures to be followed by personnel and teams, as well as the critical points to discuss before deploying a field hospital. However, to date, there is no formal standardized training program established for EMTs before deployment. Recognizing that the World Association of Disaster and Emergency Medicine (WADEM; Madison, Wisconsin USA) Congress brings together a diverse group of key stakeholders, a pre-Congress workshop was organized to seek out collective expertise and to identify key EMT training competencies for the future development of training programs and protocols. The future of EMT training should include standardization of curriculum and the recognition or accreditation of selected training programs. The outputs of this pre-WADEM Congress workshop provide an initial contribution to the EMT Training Working Group, as this group works on mapping training, competencies, and curriculum. Common EMT training themes that were identified as fundamental during the pre-Congress workshop include: the ability to adapt one’s professional skills to low-resource settings; context-specific training, including the ability to serve the needs of the affected population in natural disasters; training together as a multi-disciplinary EMT prior to deployment; and the value of simulation in training.
AlbinaA, ArcherL, BoivinM, CranmerH, JohnsonK, KrishnarajG, ManeshiA, OddyL, Redwood-CampbellL, RussellR. International Emergency Medical Teams Training Workshop Special Report. Prehosp Disaster Med. 2018;33(3):335–338.
New developments in manufacturing and automation, from three-dimensional printing to the “Internet of things,” signify dramatic changes in our society. The push toward quantum materials is driving device fabrication toward atomic precision. Recent results suggest that scanning transmission electron microscopy (STEM) with sub-angstrom scale beams could offer a solution. However, a detailed theoretical understanding of the interaction of the electron beam with solids is needed to form a basis for new technology. This article summarizes the existing literature on electron-beam interactions with solids with a focus on irreversible transformation. We further suggest that the theoretical framework of a two-temperature model developed for fast ion damage in solids could be applicable to predicting the effects of fast electrons. Recent results from STEM-directed epitaxial growth on crystalline–amorphous interfaces are discussed in detail. Finally, perspectives on the development of this field in the near future are offered.
Literature about fish kidney peroxisomes is scarce. To tackle this caveat, a stereological approach on renal peroxisome morphological parameters was performed for the first time in a fish, establishing correlations with maturation stages as it was previously done in brown trout liver. Three-year-old brown trout males and females were collected at the major seasons of their reproductive cycle. Trunk kidney was fixed and processed for catalase cytochemistry. Classical stereological methods were applied to electromicrographs to quantitate morphological parameters. Different seasonal variation patterns were observed between genders, and between renal proximal tubule segments I and II. In males, peroxisomes from proximal tubule segment II had a relatively higher volume and number in May, being individually bigger in February. Females presented similar trends, though with less marked variations. Overall, males and females did not show exactly the same seasonal patterns for most peroxisomal parameters, and no correlations were found between the latter and the gonado-somatic index (GSI). Hence, and despite the variations, the morphology of renal peroxisomes is not strictly correlated with gonad maturation kinetics, therefore suggesting that kidney peroxisome morphology is not seasonally modulated by sex steroids, like estradiol, as it seems to happen in liver peroxisomes.