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Within out-of-hospital emergencies, Primary Health Care (PHC) pediatricians will likely be the first to provide health care at the scene of a life-threatening emergency (LTE) in children. Pediatricians should be trained to initially intervene, safely and effectively the LTEs, including the activation of Emergency Medical Systems (EMS), an adequate stabilization of patients and transport to the hospital.
The aims of this study are to know the training received for out-of-hospital LTEs by PHC pediatricians of the Principality of Asturias (Spain) and the perception they have about their own theoretical knowledge and practical skills in a series of emergency procedures used in LTEs; also, to analyze the differences according to the geographical context of their work.
This was a cross-sectional, descriptive, and observational study of a sample of 27 PHC pediatricians from PHC Service of Asturias, Spain, from among the total of 88 pediatricians who make up the staff of pediatricians, conducted from April through May 2019. The survey was designed ad hoc using the Curriculum in Primary Care Pediatrics (CPCP) proposed by the European Confederation of Primary Care Pediatricians (ECPCP; Europe), which indicates the theoretical and practical procedures that must be acquired by the PHC pediatricians. It is composed of 30 procedures or techniques employed in LTEs using a 11-point Likert scale rating to detect their self-perception about theoretical knowledge and practical skills from zero (“Minimum”) to 10 (“Maximum”).
There are significant differences in the mean of theoretical knowledge and practical skills in many procedures or techniques studied, depending on the different areas of work.
Asturian pediatricians are generally well-prepared to solve LTEs with a few exceptions. The degree of self-perception and acquisition of general theoretical knowledge and general practical skills in LTEs is heterogeneous, with differences according to the scope of work.
The Richter Scale measures the magnitude of the seismic activity for an earthquake; however, it does not quantify the humanitarian need at the point of impact. This poses a challenge for humanitarian stakeholders in decision and policy making, especially in risk reduction, response, recovery, and reconstruction. The new disaster metrics tool titled “The YEW Disaster Severity Index” (DSI) was developed and presented at the 2017 World Congress of Disaster and Emergency Medicine, May 2017, Toronto, Canada. It uses a median score of three for vulnerability and exposure indicators, a median score percentage of 100%, and medium YEW DSI scoring of four to five as baseline, indicating the ability to cope within local capacity. Therefore, scoring more than baseline coping capacity indicates that external assistance is needed. This special real-time report was presented at the 2nd National Pre-Hospital Care Conference and Championship, October 2018, Malaysia.
The aim of this analysis is to present the real-time humanitarian impact and response to the 2018 earthquake and tsunami at Donggala and Palu, Sulawesi in Indonesia using the new disaster metrics YEW DSI. Based on the earthquake (measuring 7.7 on the Richter Scale) and tsunami at Donggala, the humanitarian impact calculated on September 29, 2018 scored 7.4 High in the YEW DSI with 11 of the total 17 indicators scoring more than the baseline coping capacity. The same YEW DSI score of 7.4 was scored on the earthquake and tsunami at Palu, with 13 of the total 17 indicators scoring more than baseline ability to cope within local capacity. Impact analysis reports were sent to relevant authorities on September 30, 2018.
Discussion & Conclusion:
A State of Emergency was declared for a national response, which indicated an inability to cope within the local capacity, shown by the YEW DSI. The strong correlation between the earthquake magnitude, intensities, and the humanitarian impact at Donggala and Palu reported could be added into the science of knowledge in prehospital care and disaster medicine research and practice. As a conclusion, the real-time disaster response was found to be almost an exact fit with the YEW DSI indicators, demonstrating the inability to cope within the local capacity.
The objective of this meta-analysis study was to develop and validate equations estimated from in situ and in vitro methods to predict in vivo ruminal digestibility of organic matter (OM) of beef cattle diets. The database was composed of individual data of 23 diets from six experiments. Information collected from these studies was: in vivo digestibility and degradation parameters of OM calculated from in situ and in vitro incubations. The values of estimated times for the in situ and in vitro incubations to access in vivo digestibility of OM, and differences between degradation at 24, 48 and 72 h (in situ and in vitro) and in vivo digestibility were analysed in a model that included the fixed effects of forage neutral detergent fibre level. Thereafter, a multiple stepwise regression was carried out using OM digestibility as a dependent variable and degradation parameters (A = water-soluble fraction; B = potentially degradable water-insoluble fraction; and kd = degradation rate of fraction B) as independent variables. Equation validation was performed using data from a seventh experiment that have the same methods than previous studies. Stepwise regression results showed that the kd contributed significantly in most of the algorithms derived to predict in vivo digestibility. Validation analysis showed that equations developed from both in vitro and in situ incubations accurately estimated the in vivo digestibility of OM (P > 0.05). Our results suggest that equations developed to estimate OM digestibility showed both precision and accuracy; however, in situ method presented better results than in vitro.
The rocky shores of the north-east Atlantic have been long studied. Our focus is from Gibraltar to Norway plus the Azores and Iceland. Phylogeographic processes shape biogeographic patterns of biodiversity. Long-term and broadscale studies have shown the responses of biota to past climate fluctuations and more recent anthropogenic climate change. Inter- and intra-specific species interactions along sharp local environmental gradients shape distributions and community structure and hence ecosystem functioning. Shifts in domination by fucoids in shelter to barnacles/mussels in exposure are mediated by grazing by patellid limpets. Further south fucoids become increasingly rare, with species disappearing or restricted to estuarine refuges, caused by greater desiccation and grazing pressure. Mesoscale processes influence bottom-up nutrient forcing and larval supply, hence affecting species abundance and distribution, and can be proximate factors setting range edges (e.g., the English Channel, the Iberian Peninsula). Impacts of invasive non-native species are reviewed. Knowledge gaps such as the work on rockpools and host–parasite dynamics are also outlined.
Within out-of-hospital emergencies, primary health care (PHC) nurses must face life-threatening emergencies (LTEs), which are defined as “a situation associated with an imminent life risk that entails the start-up of resources and special means to resolve the situation.”
The objectives of this study were to know the training received for out-of-hospital LTEs by PHC nurses of Asturias, Spain and the perception they have about their theoretical knowledge and practical skills in a series of emergency procedures or techniques used in LTE emergencies; as well as to analyze the differences according to the geographical area of their work.
Cross-sectional, descriptive, and observational study was conducted in 2018 of a sample of PHC service nurses of Asturias, Spain.
A total of 236 nurses from PHC service centers of Asturias, Spain, from among the total of 730 nurses who make up the staff of nurses of the PHC service of Asturias, between April and May 2018, were surveyed. The survey was designed ad hoc using the Doctrinal Body of Emergency Nursing (DBEN) proposed by the Spanish Society of Emergency Medicine (SEMES; Madrid, Spain), which indicates the theoretical and practical procedures that must be acquired by the PHC nurses. It is composed of 37 procedures or techniques employed in LTEs using an 11-point Likert scale rating to detect their self-perception about theoretical knowledge and practical skills from zero (“Minimum”) to ten (“Maximum”).
There were significant differences in the mean of theoretical knowledge and practical skills in many procedures or techniques studied, depending on the different areas of work.
All PHC nurses must be perfectly trained to provide initial quality assistance to the LTE, with both theoretical and practical knowledge of the different techniques, so that it can continue to be attended by the corresponding Emergency Service.
OBJECTIVES/SPECIFIC AIMS: Oncostreams represent a novel growth pattern of GBM. In this study we uncovered the cellular and molecular mechanism that regulates the oncostreams function in GBM growth and invasion. METHODS/STUDY POPULATION: We studied oncostreams organization and function using genetically engineered mouse gliomas models (GEMM), mouse primary patient derived GBM model and human glioma biopsies. We evaluated the molecular landscape of oncostreams by laser capture microdissection (LCM) followed by RNA-Sequencing and bioinformatics analysis. RESULTS/ANTICIPATED RESULTS: Oncostreams are multicellular structures of 10-20 cells wide and 2-400 μm long. They are distributed throughout the tumors in mouse and human GBM. Oncostreams are heterogeneous structures positive for GFAP, Nestin, Olig2 and Iba1 cells and negative for Neurofilament. Using GEMM we found a negative correlation between oncostream density and animal survival. Moreover, examination of patient’s glioma biopsies evidenced that oncostreams are present in high grade but no in low grade gliomas. This suggests that oncostreams may play a role in tumor malignancy. Our data also indicated that oncostreams aid local invasion of normal brain. Transcriptome analysis of oncostreams revealed 43 differentially expressed (DE) genes. Functional enrichment analysis of DE genes showed that “collagen catabolic processes”, “positive regulation of cell migration”, and “extracellular matrix organization” were the most over-represented GO biological process. Network analysis indicated that Col1a1, ACTA2, MMP9 and MMP10 are primary target genes. These genes were also overexpressed in more malignant tumors (WT-IDH) compared to the less malignant (IDH1- R132H) tumors. Confocal time lapse imagining of 3D tumor slices demonstrated that oncostreams display a collective motion pattern within gliomas that has not been seen before. DISCUSSION/SIGNIFICANCE OF IMPACT: In summary, oncostreams are anatomically and molecularly distinctive, regulate glioma growth and invasion, display collective motion and are regulated by the extracellular matrix. We propose oncostreams as novel pathological markers valuable for diagnosis, prognosis and designing therapeutics for GBM patients.
The Richter Scale measures the magnitude of a seismic occurrence, but it does not feasibly quantify the magnitude of the “disaster” at the point of impact in real humanitarian needs, based on United Nations International Strategy for Disaster Reduction (UNISDR; Geneva, Switzerland) 2009 Disaster Terminology. A Disaster Severity Index (DSI) similar to the Richter Scale and the Mercalli Scale has been formulated; this will quantify needs, holistically and objectively, in the hands of any stakeholders and even across timelines.
An agreed terminology in quantifying “disaster” matters; inconsistency in measuring it by stakeholders posed a challenge globally in formulating legislation and policies responding to it.
A quantitative, mathematical calculation which uses the median score percentage of 100% as a baseline, indicating the ability to cope within the local capacity, was used. Seventeen indicators were selected based on the UNISDR 2009 disaster definition of vulnerability and exposure and holistic approach as a pre-condition. The severity of the disaster is defined as the level of unmet needs. Thirty natural disasters were tested, retrospectively, and non-parametric tests were used to test the correlation of the DSI score against the indicators.
The findings showed that 20 out of 30 natural disasters tested fulfilled the inability to cope, within local capacity in disaster terminology. Non-parametric tests showed that there was a correlation between the 30 DSI scored and the indicators.
By computing a median fit percentage score of 100% as the ability to cope, and the correlation of the 17 indicators, in this DSI Scale, 20 natural disasters fitted into the disaster definition. This DSI will enable humanitarian stakeholders to measure and compare the severity of the disaster objectively, as well as enable future response to be based on needs.
YewYY, Castro DelgadoR, HeslopDJ, Arcos GonzálezP. The Yew Disaster Severity Index: A New Tool in Disaster Metrics. Prehosp Disaster Med. 2019;34(1):8–19.
Conclusions and recommendations of health technology assessment (HTA) reports have an impact on all relevant actors involved in the health system (health authorities, administrators, health professionals, patients, citizens and industry). The involvement of all those relevant stakeholders in the HTA process facilitates making valid and informed decisions and an efficient allocation of resources. Improving communication, participation and transparency among all agents will lead to more efficient evaluation and decision-making processes.
To review key aspects of the relations between HTA agencies and health industries, two process were carried out: a narrative review of literature searched in Medline, PubMed, Embase, CINAHL and WOS (2007-2017) and a review of websites of international HTA agencies. References and webs with information on the framework, objectives, methodologies, impact or results of the relationships were included.
A total of 1961 references were located and forty-five were selected. From the synthesis of the selected references the following key aspects of the relationships between HTA and industry were identified: (i) the importance of early dialogues with industry to align HTA objectives with the generation of evidence; (ii) challenges of the bias in the evidence produced by industry; (iii) difficulties in industry engagement in HTA processes; and (iv) industry interest in HTA. The review of six agency websites provided information on industry involvement in strategic activities, early dialogues, provision of documentation, management of industry clarifications, review of the report/allegations and other forms of relationship.
Both the review of the literature and the contents of the web pages of international agencies with experience in relations with industry show that the interest is in the creation of collaborative frameworks between regulatory authorities that decide on authorization and price and reimbursement and HTA agencies, while both try to maintain an early, transparent and systematic interaction with the healthcare industry.
The goal of this study was to find out the training received in Urgent and Emergency Medicine (UEM) by the Primary Health Care (PHC) physicians of Asturias (Spain), as well as their perception of their own theoretical knowledge and practical skills in a series of procedures employed in life-threatening emergencies (LTEs), and also to analyze the differences according to the geographical area of their work.
This was a cross-sectional survey of PHC physicians using an ad hoc survey of a sample of 213 physicians in Asturias regarding their self-perception of theoretical knowledge and practical skills in techniques used in LTEs by areas of work (rural, suburban, and urban). The interview was conducted by mail from April through May 2017. The data processing has used absolute and relative frequencies, as well as central tendency parameters and dispersion parameters. The estimates for the entire population have been made using confidence intervals for the mean of 95%. In the comparison of parameters, the differences between parameters with a probability of error less than five percent (P<.05) have been considered significant. For the comparison of means between the different techniques in the different areas of work, ANOVA was used.
With respect to the training of physicians, in general, for managing emergencies, both at the regional level and by areas of work (rural, suburban, and urban), none of the sets analyzed attained five points. By areas of work, it was the suburban region where there was a greater average general level of knowledge. There were significant differences in the average theoretical knowledge and the average practical skills in the procedures studied according to the different areas of work. The greater number of significant differences was between the urban and suburban regions and within the urban area.
It’s necessary to ensure an adequate homogeneity of the levels of theoretical knowledge and practical skills of PHC physicians in order to guarantee the equity of provision of health care in emergencies in different geographical areas.
Cernuda MartínezJA, Castro DelgadoR, Ferrero FernándezE, Arcos GonzálezP. Self-Perception of Theoretical Knowledge and Practical Skills by Primary Health Care Physicians in Life-Threatening Emergencies. Prehosp Disaster Med. 2018;33(5):508–518.
A study was conducted over eight consecutive days in February 2010 in which daily variations in the vertical distributions of heterotrophic bacteria, mesozooplankton and ichthyoplankton at 1–1200 m in the South-western Atlantic Ocean were investigated. Diurnal and nocturnal samples were collected at an oceanographic station at four regional depths: Tropical Water (TW) (1 m), South Atlantic Central Water (SACW) (250 m), Antarctic Intermediate Water (AAIW) (800 m) and Upper Circumpolar Deep Water (UCDW) (1200 m). Bacterial, mesozooplankton and larval fish densities significantly differed between sample depths but not between sampling tow times. In total, 154 zooplankton species and 18 larval fish species were identified. The highest number of taxa was obtained from the night-time TW trawls. This depth zone had the highest densities of mesozooplankton, larval fish and bacterioplankton (auto and heterotrophic), associated with the highest temperature and salinity and the lowest inorganic nutrient concentrations. Two sample groups were identified based on their mesozooplankton and larval fish compositions: night-time TW and other water masses (daytime TW, SACW, AAIW and UCDW). Thirty-two indicator species were detected in night-time TW. The copepod Nullosetigera impar was, to the best of our knowledge, identified for the first time on the Brazilian coast. Our results showed significant variability in the abundance and vertical distribution of mesozooplankton, bacterioplankton and larval fish along the water column in an oceanic area. We have provided new data and insights on the composition and vertical distribution of mesozooplankton, larval fish and bacterioplankton in deep waters in the South-western Atlantic Ocean.
The synthesis of Y2Ti2O7-Al2O3 compositional (multiphase) ceramics from powder mixtures Al2O3-Y2O3-TiO2 was carried out in two stages: 1) under the traditional sintering and then 2) in regime of directed laser heating. It was established that the sintering of mixtures with different content of components and the ratio of TiO2/Y2O3 = 2.34 in ceramic specimens the main phases are Y2Ti2O7 and α-Al2O3. The content of the main phases in ceramic materials also depends upon the oxide content in the initial mixtures. In ceramics the Y3Al5O12 is formed only at sufficiently high content of titanium and yttrium oxides in initial mixtures. In laser remelting, the phase composition is substantially different from that obtained at the traditional sintering, and depends on the mode of laser heating: irradiation power and the moving speed of the laser beam (i.e., heating temperature). Under certain conditions of laser remelting can be obtained superficial ceramic layer with crystallographic directional crystallization of Y2Ti2O7 and Al2O3 crystallites. The size of crystallites and the coefficient texturing also depend on the mode of laser treatment.
The Spanish National Network (REDETS) is a group of eight agencies, units and services, depending on National and Regional Governments that coordinate their work within a common methodological framework, guided by the principles of mutual recognition and cooperation. The necessity of considering a Quality Management System has been detected and, consequently, a common tool for all the members needs to be developed. We describe in this study the process to achieve that goal.
Based on both a review of previous literature and the proposal for a self-evaluating tool, a group of experts from each agency through consensus have developed a tool for self-evaluation in Health Technology Assessment (HTA) agencies. Through the structure described in the handbook of the Andalusian Agency for Healthcare Quality (ACSA), each standard should have a statement or proposal that needs to also include evidence or good practices, and the corresponding evaluation questions. In separate workgroups, the definition of these proposals, evidence and evaluation questions were developed. One face-to-face meeting and two meetings via teleconference were necessary to achieve a final document with all the quality standards.
From a proposed structure of sixty-six standards, the titles, definitions, statements and evidence as well as good practices and evaluation questions were established in workgroups with consensus among all of the members (1 - 3). The final version of the self-assessment tool was composed of sixty-eight standards, grouped in twelve quality criteria structured in four dimensions: I Responsibility, II Clients and Stakeholders, III Production Process, and IV Resources.
Quality management requires an evaluation tool and this version, based on a systematic review and consensus, is a useful and practical instrument for developing a handbook by each member of REDETS. An online version of the tool is in process of development.
The work described in this paper is part of the development of a framework to support the joint execution of cooperative missions by a group of vehicles, in a simulated, augmented, or real environment. Such a framework brings forward the need for formal languages in which to specify the vehicles that compose a team, the scenario in which they will operate, and the mission to be performed. This paper introduces the Scenario Description Language (SDL) and the Team Description Language (TDL), two Extensible Markup Language based dialects that compose the static components necessary for representing scenario and mission knowledge. SDL provides a specification of physical scenario and global operational constraints, while TDL defines the team of vehicles, as well as team-specific operational restrictions. The dialects were defined using Extensible Markup Language schemas, with all required information being integrated in the definitions. An interface was developed and incorporated into the framework, allowing for the creation and edition of SDL and TDL files. Once the information is specified, it can be used in the framework, thus facilitating environment and team specification and deployment. A survey answered by practitioners and researchers shows that the satisfaction with SDL+TDL is elevated (the overall evaluation of SDL+TDL achieved a score of 4 out of 5, with 81%/78.6% of the answers ≥4); in addition, the usability of the interface was evaluated, achieving a score of 86.7 in the System Usability Scale survey. These results imply that SDL+TDL is flexible enough to represent scenarios and teams, through a user-friendly interface.
The surrounding area of the St. Peter and St. Paul Archipelago (SPSPA) (0°55′10″N 29°20′33″W) was investigated in order to verify the physical and chemical influences in species composition and abundance, and the patterns of distribution of phytoplankton in the water column, especially in the thermocline depths. The expedition was held on board the Cruzeiro do Sul Hydro-oceanographic ship, from 21 to 23 July 2010 in two perpendicular and opposite transects. A cylinder-conical net and Niskin bottles were used. Two water masses were identified (Tropical Water and South Atlantic Central Water), and the thermocline depths varied from 40 to 110 m. A total of 128 species of phytoplanktonic organisms were identified, belonging to four phyla. The most conspicuous species was the cyanobacteria Trichodesmium thiebautii; nevertheless, 22 species were considered new registers for the region. The total phytoplanktonic density (1 × 103 to 183 × 103 cells l−1) was low and typical of oligotrophic regions, decreasing slightly with depth. Among the 35 species identified in the vertical distribution, 22 were present in the thermocline depth. The total density of Trichodesmium thiebautii, Oxytoxum longiceps and Protoperidinium minimum had significant correlations with the physical and chemical parameters. These data indicate that SPSPA can be associated to an island mass effect in the local oceanic circulation that mainly affects the physical and chemical characteristics of the surrounding waters. Consequently, these interactions influence the phytoplanktonic community, mainly those located at the end of the photic zone and those that are under the influence of thermocline oscillation.
It was established that at selective laser sintering of Al2O3 - Al compacted mixtures oxidation of the Al particles took place due to diffusion of oxygen into the volume of the workpieces. Depending on the content of aluminum, composite ceramics of various types were formed.
Low maternal vitamin D levels have been associated with adverse pregnancy outcome. A recent study has suggested that low maternal vitamin D levels at the time of delivery are also associated with an almost fourfold increase in caesarean section risk. The aim of the present study was to investigate whether there is a difference in maternal serum 25-hydroxyvitamin D (25(OH)D) levels at 11–13 weeks' gestation according to the mode of delivery. Maternal serum 25(OH)D levels were measured at 11–13 weeks' gestation in 995 singleton pregnancies resulting in the birth of phenotypically normal neonates at term. The measured 25(OH)D levels were adjusted for maternal age, BMI, racial origin, smoking, method of conception and season of blood testing, and the adjusted levels (multiple of the median; MoM) were compared between those who subsequently delivered vaginally and those that delivered by caesarean section. Delivery was vaginal in 79·6 % of cases, by emergency caesarean section in 11·6 % and by elective caesarean section in 8·8 %. The median 25(OH)D level in our population was 46·82 (interquartile range (IQR) 27·75–70·13) nmol/l. The adjusted maternal median 25(OH)D levels in the emergency and elective caesarean section groups (0·99, IQR 0·71–1·46 MoM and 0·96, IQR 0·73–1·27 MoM, respectively) were not significantly different from the vaginal delivery group (0·99, IQR 0·71–1·33 MoM; P = 0·53 and P = 0·81, respectively). First-trimester maternal serum 25(OH)D levels are similar between women who subsequently have a vaginal delivery and those who deliver by elective or emergency caesarean section.