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Ambulance drivers often travel under stressful conditions at high speed while using vehicles with poor high-speed maneuverability. The occupant safety of ambulance vehicles has not yet been addressed by the automotive safety paradigm; particularly for the rear patient compartment. This study had two objectives: (1) to assess by survey the French Emergency Medical Services (EMS) to determine the layout of the vehicle most often used and the EMS personnel's behavior during transport; and (2) to conduct a crash test to analyze the injuries which may affect EMS personnel and patients in the rear patient compartment.
Firstly, a survey was distributed to the 50 largest metropolitan French EMS programs. Secondly, a crash test was performed with a Mobile Intensive Care Unit (MICU) in conditions closest to reality.
Forty-nine of the 50 biggest metropolitan French EMS programs responded to the survey. This represents 108 French MICUs. During the last three years, 12 of 49 EMS programs (24%) identified at least one accident with an MICU, and six of these 12 (50%) suffered at least one death in those accidents. A crash test using a typical French EMS MICU showed that after impact of a collision, the ambulance was moved more than five meters with major consequences for all passengers. A study-approved human cadaver placed in the position of a potential patient was partially thrown from the stretcher with a head impact. The accelerometric reaction of the anthropomorphic manikin head was measured at 48G.
The crash test demonstrated a lack of safety for EMS personnel and patients in the rear compartment. It would be preferable if each piece of medical equipment were provided with a quick release system resistant to three-dimensional 10G forces. The kinetic changes undergone by the “patient” substitute on the stretcher would probably have an effect of causing injury pathology. This study highlights the need for more research and development in this area.
FournierM, ChenaitiaH, MassonC, MicheletP, BehrM, AuffrayJP. Crew and Patient Safety in Ambulances: Results of a Personnel Survey and Experimental Side Impact Crash Test. Prehosp Disaster Med. 2013;28(4):1-6.
Catherine Esnouf, Institut National de la Recherche Agronomique (INRA), Paris,Marie Russel, Institut National de la Recherche Agronomique (INRA), Paris,Nicolas Bricas, Centre de Co-opération Internationale en Recherche Agronomique pour le Développement (CIRAD), Paris
This chapter focuses on food systems using an innovative dual approach. First of all, by considering them in interaction with energy and chemical systems within ecosystems, it poses the question of resource allocation (land and biomass). Second, a socioeconomic approach then highlights the diversity of these food systems. Different types of systems co-exist and reflect different ways of producing, processing, distributing and consuming food products. The ‘global’ food system is a constantly changing combination of these different types of systems, all of which influence each other.
Thanks to this dual approach to food systems, new research questions have emerged. New analytical frameworks would enable a clearer understanding of the interconnections between food systems within ecosystems, on the one hand, and their diversity and constant recombination on the other.
Referring to the pioneering work of Malassis (1996), Rastoin et al. (2010) defined a food system (FS) as
an interdependent network of stakeholders (companies, financial institutions, public and private organisations) localised in a given geographical area (region, state, multinational region), participating directly or indirectly in the creation of a flow of goods and services geared towards satisfying the food needs of one or more groups of consumers, both locally and outside the area considered.
The United States Army is concerned that its installations face multiple resource issues, including water security. Critical water issues include supply, cost, and quality. Strategies are needed to mitigate any adverse affects. To develop these strategies, information was gathered from national watershed screenings and regional water budgets, including supply and demand data from regions containing Army installations. The information was then used to develop installation water-demand projections that look beyond the boundaries of an installation and out 30 years into the future to identify the potential for water scarcity. Fort Bragg, North Carolina, and Fort Bliss, Texas–New Mexico, were used as specific examples to illustrate the critical role that water plays in the future of Army installations. Fort Bragg is not likely to have water availability issues out to 2030, because it will be accessing municipal water supplies. Fort Bliss will likely face water availability issues because the aquifer from which it draws its potable water is being used by more and more other parties.
The strength of the association between intensive care unit (ICU)-acquired nosocomial infections (NIs) and mortality might differ according to the methodological approach taken.
TO assess the association between ICU-acquired NIs and mortality using the concept of population-attributable fraction (PAF) for patient deaths caused by ICU-acquired NIs in a large cohort of critically ill patients.
Eleven ICUs of a French university hospital.
We analyzed surveillance data on ICU-acquired NIs collected prospectively during the period from 1995 through 2003. The primary outcome was mortality from ICU-acquired NI stratified by site of infection. A matched-pair, case-control study was performed. Each patient who died before ICU discharge was defined as a case patient, and each patient who survived to ICU discharge was denned as a control patient. The PAF was calculated after adjustment for confounders by use of conditional logistic regression analysis.
Among 8,068 ICU patients, a total of 1,725 deceased patients were successfully matched with 1,725 control Patients. The adjusted PAF due to ICU-acquired NI for patients who died before ICU discharge was 14.6% (95% confidence interval [CI], 14.4%—14.8%). Stratified by the type of infection, the PAF was 6.1% (95% CI, 5.7%–6.5%) for pulmonary infection, 3.2% (95% CI, 2.8%–3.5%) for central venous catheter infection, 1.7% (95% CI, 0.9%–2.5%) for bloodstream infection, and 0.0% (95% CI, –0.4% to 0.4%) for urinary tract infection.
ICU-acquired NI had an important effect on mortality. However, the statistical association between ICU-acquired NI and mortality tended to be less pronounced in findings based on the PAF than in study findings based on estimates of relative risk. Therefore, the choice of methods does matter when the burden of NI needs to be assessed.
The response of Arctic ice masses to climate change is studied using ice cores containing information on past climatic and environmental features. Interpretation of this information requires accurate chronological data. Absolute dating of ice cores from sub-polar Arctic glaciers is possible using well-known radioactive layers deposited by atmospheric nuclear tests (maximum fallout in 1963) and the Chernobyl accident (1986). Analysis of several isotopes (3H, 137Cs) shows that 3H provides the most accurate dating of the 1963 maximum, as indicated also in comparison with results from total-beta measurements (90Sr and 137Cs). Mean annual net mass balances are derived from the dated ice cores from 1963 up to the date of the drillings. The 137Cs and 3H deposited by nuclear tests, after decay correction, are used to define a melt index for all 13 ice cores studied. The relative strength of melting and percolation post-depositional processes is studied on the basis of these 137Cs and 3H deposits.
The cabbage seedpod weevil, Ceutorhynchus obstrictus (Marsham) [= C. assimilis (Paykull)] (Colonnelli 1993), is a univoltine species native to Europe that feeds on canola and other oilseed cruciferous plants. The adult overwinters in debris and soil outside fields and colonizes canola at the blooming stage (Dosdall et al. 2001). Eggs are laid singly into the immature pods and each larva consumes five to seven seeds before cutting a hole in the pod to wriggle out and pupate in the soil (Dmoch 1965). Yield losses are difficult to assess because the plant compensates for bud and pod injuries caused by insects or pathogens (Lamb 1989). Nevertheless, pod feeding by larvae causes much damage, as canola yields can be reduced from 15 to 35% (Homan and McCaffrey 1993). Feeding by adults can also be significant, as it can reduce oil content, seed weight, and seed germination (Buntin et al. 1995).
Stratigraphic analyses of outcrops, shorelines, and diatoms from the southern Bolivian Altiplano (Uyuni-Coipasa basin) reveal two major lacustrine phases during the late-glacial period and the early Holocene, based on a chronology established by radiocarbon and U/Th control. A comparison of14C and230Th/234U ages shows that during times of high lake level, radiocarbon ages are valid. However, during low-water periods,14C ages must be corrected for a reservoir effect. The lacustrine Tauca phase started a little before 16,00014C yr B.P., and the lake level reached its maximum between 13,000 and 12,00014C yr B.P. A dry event (Ticaña) occurred after ca. 12,000 and before 950014C yr B.P. A moderate lacustrine oscillation (Coipasa event) occurred between ca. 9500 and 850014C yr B.P., using a reservoir-corrected conventional14C chronology. Comparisons between the lake-level chronology in the Uyuni-Coipasa basin and data from other southern tropical areas of South America suggest that the lacustrine evolution may reflect large-scale climatic changes.
The dopamine D3 receptor gene (DRD3) is a meaningful candidate gene because it unifies the dopamine and the limbic hypotheses for schizophrenia. We tested for an allelic association between schizophrenia and the DRD3 Mscl alleles, hypothesising heterogeneity between childhood/early adolescence-onset schizophrenia (CO-SZ) and adult-onset schizophrenia (A-SZ).
The frequencies of the DRD3 alleles were compared between 70 DSM-III-R schizophrenics (35 CO-SZ and 35 A-SZ) and 79 controls.
Compared with the controls, the subsample of A-SZ, but not CO-SZ, showed an over-proportion (P = 0.025) of allele 1. The association was not found in the total sample, combining the two subsamples.
Consistently with former studies, our data suggest an aetiological heterogeneity between CO-SZ and A-SZ and a possible specificity of the excess of allele 1 to the familial form of schizophrenia and to schizophrenia with a better outcome.
Little is known about the long-term outcome of schizophrenia that has its onset during childhood and early adolescence (early-onset schizophrenia, or EO-SZ). Whether or not EO-SZ is an aetiologically separate form of schizophrenia (SZ) is unresolved.
The study was a 14.8-year follow-up, using methods such as systematic sampling, evaluation of possible non-respondent bias, consensus best-estimate diagnoses (DSM–III–R) made independently in childhood and adulthood, measures of positive and negative dimensions, of non-psychotic behaviour disturbances (NPBD) and of developmental problems before the appearance of SZ.
There was high stability of EO-SZ (n=40) diagnoses (mean onset at 14.0 years) until adulthood (mean age at follow-up 28.8 years) but a lower stability of positive and negative schizophrenic dimensions. There was a poor outcome of EO-SZ, a strong over-representation of males but few gender differences, and no effect of age of onset on clinical features and outcome.
EO-SZ taken as a whole shows no qualitative differences to adult-onset SZ. However, a distinction through the onset of preschizophrenic developmental problems or NPBD might be a way to investigate heterogeneity within EO-SZ.
The aim of this study was to verify the presence and stability across life of the positive/negative distinction in early-onset schizophrenia (EO-SZ) through a longitudinal factor analysis of the schizophrenic dimensions, and to identify the factors predicting several indices of long-term outcome for EO-SZ.
Forty children consecutively referred for DSM–III–R schizophrenia (SZ) in a specific catchment area comprised the sample.
Across a 14.8-year follow-up, longitudinal factor analysis identified two separate factors corresponding to the positive and negative symptom dimensions. We also observed that: the GAS rated over the last three years of adult illness and the severity of negative symptoms during the stabilised interepisode intervals in adulthood were the indices of adult outcome that were most easily predicted; and the best childhood predictors of adult outcome were premorbid functioning and severity of positive and negative symptoms during acute episodes.
The presence of premorbid non-psychotic behaviour disturbances (NPBD) and premorbid developmental problems was not related to severity of outcome, in contrast to the former variables.
During strong El Niño events, rainfall anomalies and changes in wind patterns are observed in different regions of South America. Along the central Brazilian coast, during the 1983 El Niño year, the frontal systems were blocked to the south, provoking a reversal of the longshore sand transport. Long-duration reversals of longshore transport were also recorded in Holocene beach-ridge terraces from the Rio Doce coastal plain. This led to the formulation of a model relating these reversals of longshore transport to El Niño-like conditions. El Niño-like conditions are past average climate situations that generate the same perturbations as the strong El Niño events observed during the last decade. They are likely to correspond to the long-duration low phase of the Southern Oscillation. To confirm this hypothesis we compared the Holocene beach-ridge record with other palaeoenvironmental records from regions where strong El Niño events would have a substancial signal as well: (1) water-level fluctuations of Lake Titicaca, (2) a pollen and sediment record in an eastern Amazonian lake, (3) changes of the Rio Xingu discharge in eastern Amazonia, and (4) variations of sand supply at the Rio Piura and Rio Chira outlets in the Sechura Desert. The occurrences of El Niño-like conditions were numerous before 3900-3600 yr B.P., absent between 39003600 and 2800-2500 yr B.P., and infrequent after 2800-2500 yr B.P.
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