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Management of the airway is an important and challenging aspect of many clinicians' work and is a source of complications and litigation. The new edition of this popular book remains a clear, practical and highly-illustrated guide to all necessary aspects of airway management. The book has been updated throughout, to cover all changes to best practice and clinical management and provides extensive coverage of the key skills and knowledge required to manage airways in a wide variety of patients and clinical settings. The best of the previous editions has been preserved, whilst new chapters on videolaryngoscopy, awake tracheal intubation, lung separation, airway ultrasonography, airway management in an epidemic and many more have been added. This is an essential text for anyone who manages the airway including trainees and specialists in anaesthesia, emergency medicine, intensive care medicine, prehospital medicine as well as nurses and other healthcare professionals.
New radiocarbon (14C) dates suggest a simultaneous appearance of two technologically and geographically distinct axe production practices in Neolithic Britain; igneous open-air quarries in Great Langdale, Cumbria, and from flint mines in southern England at ~4000–3700 cal BC. In light of the recent evidence that farming was introduced at this time by large-scale immigration from northwest Europe, and that expansion within Britain was extremely rapid, we argue that this synchronicity supports this speed of colonization and reflects a knowledge of complex extraction processes and associated exchange networks already possessed by the immigrant groups; long-range connections developed as colonization rapidly expanded. Although we can model the start of these new extraction activities, it remains difficult to estimate how long significant production activity lasted at these key sites given the nature of the record from which samples could be obtained.
Palliative care for nursing home residents with advanced dementia is often sub-optimal due to poor communication and limited care planning. In a cluster randomized controlled trial, registered nurses (RNs) from 10 nursing homes were trained and funded to work as Palliative Care Planning Coordinators (PCPCs) to organize family case conferences and mentor staff. This qualitative sub-study aimed to explore PCPC and health professional perceptions of the benefits of facilitated case conferencing and identify factors influencing implementation.
Semi-structured interviews were conducted with the RNs in the PCPC role, other members of nursing home staff, and physicians who participated in case conferences. Analysis was conducted by two researchers using a thematic framework approach.
Interviews were conducted with 11 PCPCs, 18 other nurses, eight allied health workers, and three physicians. Perceived benefits of facilitated case conferencing included better communication between staff and families, greater multi-disciplinary involvement in case conferences and care planning, and improved staff attitudes and capabilities for dementia palliative care. Key factors influencing implementation included: staffing levels and time; support from management, staff and physicians; and positive family feedback.
The facilitated approach explored in this study addressed known barriers to case conferencing. However, current business models in the sector make it difficult for case conferencing to receive the required levels of nursing qualification, training, and time. A collaborative nursing home culture and ongoing relationships with health professionals are also prerequisites for success. Further studies should document resident and family perceptions to harness consumer advocacy.
The present study aimed to identify themes emerging from an inclusive therapeutic recreational camp experience for children with disabilities who attended a 10-day summer camp. Concept mapping was used to analyse the experience of 42 participants. Results emerged with seven themes: Personal Growth; Nurturing Relationships; Non-judgmental Environment and Attitude; Traditional/Classic Camp Fun; Beneficial and Unique Opportunities; Learning/Thinking with Structures and Rules; and Independence and Recognition. Results suggested that children with disabilities experienced positive personal growth and learned new skills from an integrated, therapeutic camp. These children benefited from the social and psychological aspects of the camp experience, as well as the learned skillset and behaviours. Clinical implications and future research directions are also discussed.
Hypoxaemic hypoxia (airway obstruction) is more damaging to cells than anaemic or stagnant hypoxia. In order to fully understand the classification of hypoxia, it is useful to consider the example of carbon monoxide poisoning. It is known that hypoxaemic hypoxia is of particular importance in the development of cellular hypoxia and it goes without saying that, in the context of the difficult airway, the principal cause of hypoxaemia is airway obstruction. It is important to understand the mechanisms by which hypoxaemia develops, and the factors which determine the rate of this process. Causes of hypoxaemia occurring during anaesthesia can be divided into the following three categories: problems with O2 supply, problems with O2 delivery from lips to lung, and problems with O2 transfer from lung to blood. Pre-oxygenation aims to increase body O2 stores to their maximum, so that periods of apnoea are tolerated for longer before critical desaturation occurs.
Hypoplastic left heart syndrome is a rare but serious form of congenital cardiac disease, characterized by underdevelopment of the components of the left heart, rendering the left ventricle non-functional. Its aetiology is largely unknown, but there is certainly a genetic component. Prenatal diagnosis nowadays uncovers about half of cases. Postnatal options for treatment include comfort care, 3-stage palliative surgery, or cardiac transplantation. In this review, we discuss the morphology, possible pathogenetic mechanisms, clinical management, and perspectives of prenatal intervention based on work in animal models.
Probabilistic risk analysis aims to quantify the risk caused by high technology installations. Increasingly, such analyses are being applied to a wider class of systems in which problems such as lack of data, complexity of the systems, uncertainty about consequences, make a classical statistical analysis difficult or impossible. The authors discuss the fundamental notion of uncertainty, its relationship with probability, and the limits to the quantification of uncertainty. Drawing on extensive experience in the theory and applications of risk analysis, the authors focus on the conceptual and mathematical foundations underlying the quantification, interpretation and management of risk. They cover standard topics as well as important new subjects such as the use of expert judgement and uncertainty propagation. The relationship of risk analysis with decision making is highlighted in chapters on influence diagrams and decision theory. Finally, the difficulties of choosing metrics to quantify risk, and current regulatory frameworks are discussed.
The Weibull distribution finds wide application in reliability theory, and is useful in analyzing failure and maintenance data. Its popularity arises from the fact that it offers flexibility in modeling failure rates, is easy to calculate, and most importantly, adequately describes many physical life processes. Examples include electronic components, ball bearings, semi-conductors, motors, various biological organisms, fatigued materials, corrosion and leakage of batteries. Classical and Bayesian techniques of Weibull estimation are described in [Abernathy et al., 1983] and [Kapur and Lamberson, 1977].
Components with constant failure rates (i.e. exponential life distributions) need not be maintained, only inspected. If they are found unfailed on inspection, they are ‘as good as new’. Components with increasing failure rates usually require preventive maintenance. Life data on such components is often heavily censored, as components are removed from service for many reasons other than failure. Weibull methods are therefore discussed in relation to censoring. In this chapter we assume that the censoring process is independent or random; that is, the censoring process is independent of the failure process. This may arise, for example, when components undergo planned revision, or are failed by overload caused by some upstream failures. In other cases a service sojourn may terminate for a reason which is not itself a failure, but is related to failure. When components are removed during preventive maintenance to repair degraded performance, we certainly may not assume that the censoring is independent.
Project risk management is a rapidly growing area with applications in all engineering areas. We shall particularly concentrate on applications within the construction industry, but the techniques discussed are more widely applicable. Construction risks have been the subject of study for many years. In particular, [Thompson and Perry, 1992] gives a good overall guide to the subject with a large number of references. Several different models and examples of risk analyses for large projects are given in [Cooper and Chapman, 1987]. A description of many projects (in particular high-technology projects) from the twentieth century, the problems encountered during management, and the generic lessons learnt are given in [Morris, 1994].
Large scale infrastructure projects typically have long lead times, suffer from high political and financial uncertainties, and the use of innovative but uncertain technologies. Because of the high risks and costs involved it has become common to apply risk management techniques with the aim of gaining insight into the principal sources of uncertainty in costs and/or time.
A project risk analysis performed by a candidate contractor before it bids for work is valuable because it can give the management quantitative insight into the sources of uncertainty in a project. This gives management a guide to the risks that need to be dealt with in the contract, or in financing arrangements.
The general problem of statistical inference is one in which, given observations of some random phenomenon, we try to make an inference about the probability distribution describing it. Much of statistics is devoted to the problem of inference. Usually we will suppose that the distribution is one of a family of distributions f(t|θ) parameterized by θ, and we try to make an assessment of the likely values taken by θ. An example is the exponential distribution f(t|λ) = λ exp(−λt), but also the joint distribution of n independent samples from the same exponential, f(t1, …, tn|λ) = λn exp(−λ(t1 + … + tn)), falls into the same category and is relevant when making inference on the basis of n independent samples.
Unfortunately, statisticians are not in agreement about the ways in which statistical inference should be carried out. There is a plethora of estimation methods which give rise to different estimates. Statisticians are not even in agreement about the principles that should be used to judge the quality of estimation techniques. The various creeds of statistician, of which the most important categories are Bayesian and frequentist, differ largely in the choice of principles to which they subscribe. (An entertaining guide to the differences is given in the paper of Bradley Efron ‘Why isn't everyone a Bayesian?’ and the heated discussion that follows, [Efron, 1986].) To some extent the question is whether one thinks that statistical inference should be inductive or deductive.