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This book is one of the first to comprehensively summarise the latest thinking and research in the rapidly evolving field of quality management in intensive care. Quality indicators and outcome measures are discussed with a practical focus on patient-centred, evidence-based implementation for safer and more effective clinical practice. Chapters on topics such as teambuilding, patient satisfaction, mortality and morbidity, and electronic management systems are organised into three sections, covering quality management at the scale of the individual patient, the intensive care unit, and the national and international level. Written by a team of over forty international experts in the specialty, with editors who have been heavily involved for many years with the European Society of Intensive Care Medicine, the book reflects commonly accepted goals and guidelines for best practice, and will be valuable for practitioners worldwide. The ideal one-stop resource for intensive care physicians as well as ICU and hospital managers.
An adequate level of personal protective equipment (PPE) is necessary when treating patients with highly infectious diseases or those contaminated with hazardous substances.
Following National Institute for Health Research’s Research Centre (London, United Kingdom) approval, the authors of this study conducted a survey of specialist registrars’ knowledge of the respiratory and skin protection requirements needed during a resuscitation scenario with Advanced Life Support. Participant responses were compared to UK national recommendations and to a previous survey in 2009.
A total of 98 specialist registrars (in Anesthesiology, n=51; in Emergency Medicine (EM), n=21; and in Intensive Care Medicine (ICM) n=26) completed hand-delivered surveys. The best knowledge of PPE requirements (76%) was found for severe acute respiratory syndrome (SARS), with less knowledge about PPE requirements for anthrax, plague, Ebola virus disease (EVD), and smallpox (60%). The results show limited knowledge of PPE requirements (20%-30%) for various chemical warfare agents. Personal protective equipment knowledge regarding treatment of sarin-contaminated casualties was over-rated by 80%, and for patients with EVD, it was over-rated by up to 67% of participants.
The results of the tested cohort indicate that current knowledge regarding PPE for chemical warfare agents remains very limited.
SchumacherJ, BondAR, WoodhamV, BuckinghamA, GarnhamF, BrinkerA. Survey of UK Health Care First Responders’ Knowledge of Personal Protective Equipment Requirements. Prehosp Disaster Med. 2015;30(3):15
In this chapter we summarize integrated investigations carried out at the Randa rock-slope instability in Matter Valley, Switzerland, between 2000 and 2010. We present a 3D geometric and structural model of the current instability, which consists of 5–6 million m3 of crystalline rock. We also document the complex kinematic behavior and discuss the driving factors for observed slope movements. We show that both the May 1991 failure and the current instability are bounded laterally by the same large-scale fault, and at the base by a planar or stepped rupture surface daylighting at the contact with the Randa orthogneiss. The spatial distribution of current displacements indicates toppling in the upper section of the instability between 2200 and 2400 m asl and sliding in the lower area between 1900 and 2200 m asl. Continuous displacement time series from the surface and deep boreholes show increasing deformation rates when ground surface temperatures decrease in fall and a decrease after snowmelt in spring as the rock warms. We have not detected displacement signatures related to heavy rainstorms or snowmelt. Mapping of the locations of springs and recordings of borehole pore water pressure demonstrate locally perched groundwater in open fractures, and a low regional groundwater table located at or below the basal rupture surface. Numerical modeling results support the hypothesis that thermo-mechanical coupled deformation resulting from annual temperature changes and critically stressed fractures in a complex topography is the primary mechanism driving deep-seated displacements at Randa.
Solar energy is abundant and offers significant potential for near-term (2020) and long-term (2050) climate change mitigation. There are a wide variety of solar technologies of varying maturities that can, in most regions of the world, contribute to a suite of energy services. Even though solar energy generation still only represents a small fraction of total energy consumption, markets for solar technologies are growing rapidly. Much of the desirability of solar technology is its inherently smaller environmental burden and the opportunity it offers for positive social impacts. The cost of solar technologies has been reduced significantly over the past 30 years and technical advances and supportive public policies continue to offer the potential for additional cost reductions. Potential deployment scenarios range widely—from a marginal role of direct solar energy in 2050 to one of the major sources of energy supply. The actual deployment achieved will depend on the degree of continued innovation, cost reductions and supportive public policies.
Solar energy is the most abundant of all energy resources. Indeed, the rate at which solar energy is intercepted by the Earth is about 10,000 times greater than the rate at which humankind consumes energy. Although not all countries are equally endowed with solar energy, a significant contribution to the energy mix from direct solar energy is possible for almost every country. Currently, there is no evidence indicating a substantial impact of climate change on regional solar resources.