IEEE 802.15.4: a Federating Communication Protocol for Time-Sensitive Wireless Sensor Networks

Wireless Sensor Networks (WSNs) have been attracting increasing interests for developing a new generation of embedded systems with great potential for many applications such as surveillance, environment monitoring, emergency medical response and home automation. However, the communication paradigms in WSNs differ from the ones attributed to traditional wireless networks, triggering the need for new communication protocols. In this context, the recently standardised IEEE 802.15.4 protocol presents some potentially interesting features for deployment in wireless sensor network applications, such as power-efficiency, timeliness guarantees and scalability. Nevertheless, when addressing WSN applications with (soft/hard) timing requirements some inherent paradoxes emerge, such as power-efficiency versus timeliness, triggering the need of engineering solutions for an efficient deployment of IEEE 802.15.4 in WSNs. In this technical report, we will explore the most relevant characteristics of the IEEE 802.15.4 protocol for wireless sensor networks and present the most important challenges regarding time-sensitive WSN applications. We also provide some timing performance and analysis of the IEEE 802.15.4 that unveil some directions for resolving the previously mentioned paradoxes.

Impact of long-stay beds on the performance of a tertiary hospital in emergencies

ABSTRACT OBJECTIVE To assess the impact of implementing long-stay beds for patients of low complexity and high dependency in small hospitals on the performance of an emergency referral tertiary hospital. METHODS For this longitudinal study, we identified hospitals in three municipalities of a regional department of health covered by tertiary care that supplied 10 long-stay beds each. Patients were transferred to hospitals in those municipalities based on a specific protocol. The outcome of transferred patients was obtained by daily monitoring. Confounding factors were adjusted by Cox logistic and semiparametric regression. RESULTS Between September 1, 2013 and September 30, 2014, 97 patients were transferred, 72.1% male, with a mean age of 60.5 years (SD = 1.9), for which 108 transfers were performed. Of these patients, 41.7% died, 33.3% were discharged, 15.7% returned to tertiary care, and only 9.3% tertiary remained hospitalized until the end of the analysis period. We estimated the Charlson comorbidity index – 0 (n = 28 [25.9%]), 1 (n = 31 [56.5%]) and ≥ 2 (n = 19 [17.5%]) – the only variable that increased the chance of death or return to the tertiary hospital (Odds Ratio = 2.4; 95%CI 1.3;4.4). The length of stay in long-stay beds was 4,253 patient days, which would represent 607 patients at the tertiary hospital, considering the average hospital stay of seven days. The tertiary hospital increased the number of patients treated in 50.0% for Intensive Care, 66.0% for Neurology and 9.3% in total. Patients stayed in long-stay beds mainly in the first 30 (50.0%) and 60 (75.0%) days. CONCLUSIONS Implementing long-stay beds increased the number of patients treated in tertiary care, both in general and in system bottleneck areas such as Neurology and Intensive Care. The Charlson index of comorbidity is associated with the chance of patient death or return to tertiary care, even when adjusted for possible confounding factors.

Indicadores de qualidade na emerg��ncia m��dica pr��-hospitalar : painel operacional para o INEM, I.P.

RESUMO - A Emerg��ncia M��dica Pr��-Hospitalar �� uma parte importante na cadeia de cuidados de sa��de, quer pela gravidade das situa����es a que atende, quer por funcionar como gatekeeper. O estudo �� dedicado a instrumentos de medi����o e em simult��neo a medi����es de qualidade como processo de melhoria cont��nua da qualidade na EMPH. Existem projetos a n��vel internacional para implementa����o de pain��is de indicadores, alguns atribuem significativa relev��ncia aos processos assistenciais. O European Emergency Data Project (EDD) foi selecionado para servir como painel de indicadores a explorar neste trabalho. Porque a n��vel cient��fico est�� bem desenhado, as defini����es e vari��veis est��o bem explicitadas e interessa ao INEM, I.P. utilizar um painel que lhe permita um benchmarking. Criou-se um dashboard para os indicadores selecionados e com ele analisaram-se os dados para aferir a qualidade do SEM. N��o foi poss��vel, pela sua inexist��ncia, coletar dados para dois dos indicadores propostos. Foram apresentadas propostas de melhoria no sistema de capta����o de dados do INEM, I.P. para que a institui����o possa monitorizar periodicamente os indicadores selecionados. A exist��ncia de dados e a sua fiabilidade para utilizar na medi����o por indicadores �� algo que se explorou neste trabalho de campo, e as fraquezas encontradas foram mat��ria para oportunidades, recomenda����es, e caminho para discuss��o e o fortalecimento da institui����o.

Cria����o de um sistema de apoio para o suporte avan��ado de vida

Disserta����o de mestrado integrado em Engenharia Biom��dica (��rea de especializa����o em Eletr��nica M��dica)

Atua����o dos enfermeiros na emerg��ncia pr��-hospitalar em situa����es de paragem c��rdio-respirat��ria

Disserta����o de mestrado em Enfermagem da Pessoa em Situa����o Cr��tica

Cardiopulmonary resuscitation: update, controversies and new advances

Cardiopulmonary arrest is a medical emergency in which the lapse of time between event onset and the initiation of measures of basic and advanced support, as well as the correct care based on specific protocols for each clinical situation, constitute decisive factors for a successful therapy. Cardiopulmonary arrest care cannot be restricted to the hospital setting because of its fulminant nature. This necessitates the creation of new concepts, strategies and structures, such as the concept of life chain, cardio-pulmonary resuscitation courses for professionals who work in emergency medical services, the automated external defibrillator, the implantable cardioverter-defibrillator, and mobile intensive care units, among others. New concepts, strategies and structures motivated by new advances have also modified the treatment and improved the results of cardiopulmonary resuscitation in the hospital setting. Among them, we can cite the concept of cerebral resuscitation, the application of the life chain, the creation of the universal life support algorithm, the adjustment of drug doses, new techniques - measure of the end-tidal carbon dioxide levels and of the coronary perfusion pressure - and new drugs under research.

Research activities at european level performed at the Institute for P��blic Safety of Catalonia

To start off, this document describes the Catalan model for emergencies response and its reference frame in terms of geography, location population���In addition, describes the main actors involved in emergencies response such as: police, the Fire and Rescue Emergency Service, the Emergency Medical System, Civil Protection, Reception and Management of Emergency Calls, Rural Agents, ADF���s and UME. Civil Protection, Firefighters and Police are includes in the training model developed by the Institute for Public Safety of Catalonia which at the same time does research in both security and safety matters. Research activities are performed by the Area for Research, Knowledge and International Cooperation at the ISPC and an example of these activities are European Research Projects such as COIM-Best (Coordination Improvement by Best Practices) and BESECU (cross-cultural differences of human behaviour in fire disasters and other crisis situations) among others.

Activit�� des services d'urgence dans le canton de Vaud: analyse r��trospective 2000-2010

[TABLE DES MATIERES] 1 R��sum�� des travaux effectues ( M��thode. - R��sultats. - Conclusion). - 2 Introduction. - 3 But et objectifs. - 4 Contexte. - 5 M��thode (Type d'��tude. - Bases de donn��es consult��es. - Base des missions engag��es par la Centrale 144 Vaud (r��f��renc��e sous �� base 144 ��). - Base des missions ambulanci��res effectu��es sur territoire vaudois (r��f��renc��e sous �� base AMB ��). - Base des missions SMUR effectu��es par les SMUR du Canton de Vaud (r��f��renc��e sous �� base SMUR ��). - D��finitions et descriptions des variables. - Analyses statistiques). - 6 R��sultats (Pr��ambule - difficult��s rencontr��es. - Evaluation du processus d'enregistrement. - Couverture d'enregistrement des missions. - Evaluation de la qualit�� du remplissage des fiches de missions. - Indicateurs de l'activit�� des services d'urgence pr�� hospitali��re terrestres - ��volution sur la p��riode 2000-2010. - APPELS AU 144. - Volume d'activit�� des ambulances et des SMUR. - D��mographie de la population prise en charge par les ambulances et par les SMUR. - Types de missions ambulances et SMUR. - Chronologie des missions ambulances et SMUR. - Lieux de prise en charge et orientation des missions ambulances et SMUR. - Devenir imm��diat des patients pris en charge par le SMUR. - Devenir a 48h des patients pris en charge par les SMUR). - 7 Suite des analyses (Etude de l'ad��quation de l'utilisation des services d'urgence pr�� hospitali��re. - Etude de l'ad��quation des soins prodigu��s sur le lieu de la mission. - Etude de l'ad��quation de la dur��e des interventions pour les prises en charges de maladies cardio-vasculaires et c��r��bro-vasculaires). - 8 Discussion. - conclusions. - propositions . - 9 R��f��rences

Female asylum seekers with musculoskeletal pain: the importance of diagnosis and treatment of hypovitaminosis D.

BACKGROUND: Hypovitaminosis D is well known in different populations, but may be under diagnosed in certain populations. We aim to determine the first diagnosis considered, the duration and resolution of symptoms, and the predictors of response to treatment in female asylum seekers suffering from hypovitaminosis D. METHODS: Design: A pre- and post-intervention observational study. Setting: A network comprising an academic primary care centre and nurse practitioners. Participants: Consecutive records of 33 female asylum seekers with complaints compatible with osteomalacia and with hypovitaminosis D (serum 25-(OH) vitamin D < 21 nmol/l). Treatment intervention: The patients received either two doses of 300,000 IU intramuscular cholecalciferol as well as 800 IU of cholecalciferol with 1000 mg of calcium orally, or the oral treatment only. Main outcome measures: We recorded the first diagnosis made by the physicians before the correct diagnosis of hypovitaminosis D, the duration of symptoms before diagnosis, the responders and non-responders to treatment, the duration of symptoms after treatment, and the number of medical visits and analgesic drugs prescribed 6 months before and 6 months after diagnosis. Tests: Two-sample t-tests, chi-squared tests, and logistic regression analyses were performed. Analyses were performed using SPSS 10.0. RESULTS: Prior to the discovery of hypovitaminosis D, diagnoses related to somatisation were evoked in 30 patients (90.9%). The mean duration of symptoms before diagnosis was 2.53 years (SD 3.20). Twenty-two patients (66.7%) responded completely to treatment; the remaining patients were considered to be non-responders. After treatment was initiated, the responders' symptoms disappeared completely after 2.84 months. The mean number of emergency medical visits fell from 0.88 (SD 1.08) six months before diagnosis to 0.39 (SD 0.83) after (P = 0.027). The mean number of analgesic drugs that were prescribed also decreased from 1.67 (SD 1.5) to 0.85 (SD 1) (P = 0.001). CONCLUSION: Hypovitaminosis D in female asylum seekers may remain undiagnosed, with a prolonged duration of chronic symptoms. The potential pitfall is a diagnosis of somatisation. Treatment leads to a rapid resolution of symptoms, a reduction in the use of medical services, and the prescription of analgesic drugs in this vulnerable population.

Incidenceof out-of-hospital adult nontraumatic cardiac arrest presenting as a convulsion

Introduction: The majority of convulsions are due to an epileptic seizure or a convulsive syncope. The incidence of out-of-hospital cardiac arrest (OH-CA) presenting as a convulsion is unknown. Objective: This study aimed to measure the incidence of adult nontraumatic OH-CA presenting as a convulsion, a rate that has not been published so far, to the best of our knowledge. Methods: We prospectively collected all incoming calls with an out-of-hospital nontraumatic seizure as the chief complaint in patients >18 years old during a 24-month period. Among these calls, we collected cases identified as OH-CA by paramedics. Results: During the 24-month period, the emergency medical services (EMS) dispatch center received 561 calls for an out-of-hospital nontraumatic convulsion in an adult. Twelve cases were ultimately classified as CA. In this group, one bystander spontaneously reported that the patient was known for epilepsy. The incidence of OH-CA presenting as convulsions was therefore 2.1% of all calls for convulsion. Over the same period, the EMS dispatch center received 1,035 calls related to an adult nontraumatic OH-CA. Therefore, the rate of OH-CA presenting as a convulsion represented 1.2% of all adult nontraumatic OH-CA. Conclusion:L Only 12 cases out of the 531 calls for nontraumatic adult convulsions were confirmed OHCA (2.1%). Nevertheless, this unusual presentation of OH-CA must be recognized by dispatchers, even when a patient is reported by bystander as a known epileptic. Dispatchers should keep bystanders on the line or call them back before paramedics' arrival, and have them confirm the progressive return of a normal pat- tern of breathing and state of consciousness; if not, they should encourage the bystander to initiate CPR when necessary. An intervention should be implemented to improve the detection by dispatchers of OH-CA presenting as convulsion by the development of a specific interview and directed observation. For dispatchers, a past medical history of epilepsy should not be regarded as sufficient information to rule out OH-CA. It is mandatory that known epileptic patients should be monitored in the same way as nonepileptic patients.

Party drug use in techno nights: a field survey among French-speaking Swiss attendees.

This study was designed to investigate the lifestyle and substance use habits of dance music event attendees together with their attitudes toward prevention of substance misuse, harm reduction measures and health-care resources. A total of 302 attendees aged 16-46 years (mean=22.70, S.D.=4.65) were randomly recruited as they entered dance music events. Rates for lifetime and current use (last 30 days) were particularly high for alcohol (95.3% and 86.6%, respectively), cannabis (68.8% and 53.8%, respectively), ecstasy (40.4% and 22.7%, respectively) and cocaine (35.9% and 20.7%, respectively). Several patterns of substance use could be identified: 52% were alcohol and/or cannabis only users, 42% were occasional poly-drug users and 6% were daily poly-drug users. No significant difference was observed between substance use patterns according to gender. Pure techno and open-air events attracted heavier drug users. Psychological problems (such as depressed mood, sleeping problems and anxiety attacks), social problems, dental disorders, accidents and emergency treatment episodes were strongly related to party drug use. Party drug users appeared to be particularly receptive to harm reduction measures, such as on-site emergency staff, pill testing and the availability of cool water, and to prevention of drug use provided via counseling. The greater the involvement in party drug use, the greater the need for prevention personnel to be available for counseling. General practitioners appeared to be key professionals for accessing health-care resources.

HELPER. Aplicaci��n de gesti��n de flota

Helper proporciona la gesti�� de la flota del sistema d'emerg��ncies de Catalunya que utilitza un model sanitari centralitzat pel que fa a la recepci�� de les trucades ia la log��stica per�� amb bases sanit��ries distribu��des per tot el territori catal��.

Conjunto m��nimo b��sico de datos al alta hospitalaria [Recurso electr��nico] : grupos relacionados por el diagn��stico (GRDs) : hospitales concertados 2010

En la port.: Direcci��n General de Planificaci��n e Innovaci��n Sanitaria, Servicio de Conciertos Sanitarios

Recepci��n, clasi���caci��n seg��n escala Manchester y atenci��n sanitaria inicial al paciente que acude a un Dispositivo de Cuidados Cr��ticos y Urgencias (DCCU) con motivo de consulta ���Diabetes���: Posibilidad de intervenci��n ���nalista de la enfermera en la consulta de triage (Triage Avanzado) ante la hipoglucemia. Colaboraci��n multidisciplinar y criterios de derivaci��n

The Andalusian Public Health System (SSPA) is considering the last time an attempt urgent process management through triage consultation, both hospital and primary care environment and tables situations in which the nurse responsible for these consultations can carry out a ���nal statement of which only she is directly responsible through their independent intervention and referral (Triage Advanced). Pose, at once and consistently to the idea of teamwork, where they can be the limits to that intervention ���nalist and the circuits to follow. This paper proposes a de���nition line of one of those situations through triage concepts universally tested, and takes full advantage of advanced practice pro���le offered by nurses Device Critical Care (DCCU) of the SSPA and any the emerging legal and regulatory framework in terms of standardized collaborative prescription, us know legitimate receivers. This work stems from the vision of professionals and our contribution to that line of institutional work that must be consensus.