Emergency department triage scales and their components : a systematic review of the scientific evidence

Emergency department (ED) triage is used to identify patients' level of urgency and treat them based on their triage level. The global advancement of triage scales in the past two decades has generated considerable research on the validity and reliability of these scales. This systematic review aims to investigate the scientific evidence for published ED triage scales. The following questions are addressed: 1. Does assessment of individual vital signs or chief complaints affect mortality during the hospital stay or within 30 days after arrival at the ED? 2. What is the level of agreement between clinicians' triage decisions compared to each other or to a gold standard for each scale (reliability)? 3. How valid is each triage scale in predicting hospitalization and hospital mortality? A systematic search of the international literature published from 1966 through March 31, 2009 explored the British Nursing Index, Business Source Premier, CINAHL, Cochrane Library, EMBASE, and PubMed. Inclusion was limited to controlled studies of adult patients (≥15 years) visiting EDs for somatic reasons. Outcome variables were death in ED or hospital and need for hospitalization (validity). Methodological quality and clinical relevance of each study were rated as high, medium, or low. The results from the studies that met the inclusion criteria and quality standards were synthesized applying the internationally developed GRADE system. Each conclusion was then assessed as having strong, moderately strong, limited, or insufficient scientific evidence. If studies were not available, this was also noted. We found ED triage scales to be supported, at best, by limited and often insufficient evidence. The ability of the individual vital signs included in the different scales to predict outcome is seldom, if at all, studied in the ED setting. The scientific evidence to assess interrater agreement (reliability) was limited for one triage scale and insufficient or lacking for all other scales. Two of the scales yielded limited scientific evidence, and one scale yielded insufficient evidence, on which to assess the risk of early death or hospitalization in patients assigned to the two lowest triage levels on a 5-level scale (validity).

The Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders: recruitment, assessment instruments, methods for the development of multicenter collaborative studies and preliminary results

OBJETIVO: Descrever o recrutamento de pacientes, instrumentos de avaliação, métodos para o desenvolvimento de estudos colaborativos multicêntricos e os resultados preliminares do Consórcio Brasileiro de Pesquisa em Transtornos do Espectro Obsessivo-Compulsivo, que inclui sete centros universitários. MÉTODO: Este estudo transversal incluiu entrevistas semi-estruturadas (dados sociodemográficos, histórico médico e psiquiátrico, curso da doença e diagnósticos psiquiátricos comórbidos) e instrumentos que avaliam os sintomas do transtorno obsessivo-compulsivo (Escala para Sintomas Obsessivo-Compulsivos de Yale-Brown e Escala Dimensional para Sintomas Obsessivo-Compulsivos de Yale-Brown), sintomas depressivos (Inventário de Depressão de Beck), sintomas ansiosos (Inventário de Ansiedade de Beck), fenômenos sensoriais (Escala de Fenômenos Sensoriais da Universidade de São Paulo), juízo crítico (Escala de Avaliação de Crenças de Brown), tiques (Escala de Gravidade Global de Tiques de Yale) e qualidade de vida (questionário genérico de avaliação de qualidade de vida, Medical Outcome Quality of Life Scale Short-form-36 e Escala de Avaliação Social). O treinamento dos avaliadores consistiu em assistir cinco entrevistas filmadas e entrevistar cinco pacientes junto com um pesquisador mais experiente, antes de entrevistar pacientes sozinhos. A confiabilidade entre todos os líderes de grupo para os instrumentos mais importantes (Structured Clinical Interview for DSM-IV, Dimensional Yale-Brown Obsessive-Compulsive Scale, Universidade de São Paulo Sensory Phenomena Scale ) foi medida após seis entrevistas completas. RESULTADOS: A confiabilidade entre avaliadores foi de 96%. Até março de 2008, 630 pacientes com transtorno obsessivo-compulsivo tinham sido sistematicamente avaliados. A média de idade (±SE) foi de 34,7 (±0,51), 56,3% eram do sexo feminino e 84,6% caucasianos. Os sintomas obsessivo-compulsivos mais prevalentes foram os de simetria e os de contaminação. As comorbidades psiquiátricas mais comuns foram depressão maior, ansiedade generalizada e transtorno de ansiedade social. O transtorno de controle de impulsos mais comum foi escoriação neurótica. CONCLUSÃO: Este consórcio de pesquisa, pioneiro no Brasil, permitiu delinear o perfil sociodemográfico, clínico e terapêutico do paciente com transtorno obsessivo-compulsivo em uma grande amostra clínica de pacientes. O Consórcio Brasileiro de Pesquisa em Transtornos do Espectro Obsessivo-Compulsivo estabeleceu uma importante rede de colaboração de investigação clínica padronizada sobre o transtorno obsessivo-compulsivo e pode abrir o caminho para projetos semelhantes destinados a integrar outros grupos de pesquisa no Brasil e em todo o mundo.

Collectives of humans-with-media in mathematics education: Notebooks, blackboards, calculators, computers and ... notebooks throughout 100 years of ICMI

The main aim of this study was to present evidence of the ways in which different media have conditioned and dramatically reorganized education, in general, and mathematics education, in particular. After an introduction of the theme, we discuss the epistemological perspective that provides the foundation for our analysis: the notion of humans-with-media. Then, we briefly illustrate how the medium is related to the scientific production of mathematical knowledge. We take a detour into the world of art to examine how devices and instruments have historically been associated with the production of mathematical knowledge. Then, we review studies on the history of education to show how traditional media were introduced into schools and have influenced education. In particular, we examine how devices such as blackboards and notebooks, which were novelties a 100 years ago, came to be accepted in schools and the mathematical activities that were promoted with their use. Finally, we discuss how information technology has changed education and how the Internet may have an impact on mathematics education comparable to that of the notebook over a century ago. © FIZ Karlsruhe 2009.

Directorio de organismos nacionales a cargo de las políticas y programas para las mujeres de América Latina y el Caribe = Directory of national organizations dealing with programmes and policies on women in Latin America and the Caribbean

Publicación bilingüe

Relationship Between Jaw Apparatus, Feeding Habit, and Food Source in Oriental Woodpeckers

Associations among feeding habit, beak type, and food source in birds have been widely studied and are well known to exist. The relationship between feeding habit and jaw apparatus in birds has not attracted attention from ornithologists, perhaps because of the complexity of the skeletal morphology of the feeding system of birds. The goal of this study was to compare the jaw apparatus and foraging strategies of various Oriental species of the Picidae (Meiglyptini and Picini tribes) using a morphofunctional analysis of the skeletal structure of the jaw apparatus. This study showed that there are at least three types of jaw apparatus in these woodpeckers, as follows: 1) robust, developed, and complex; 2) complexity and development intermediate, as observed in Meiglyptes tristis and Dinopium spp., whose main foraging method involves gleaning, probing, and tapping; and 3) poorly developed, as observed in Picus miniaceus and Hemicircus concretus. The success of woodpeckers as a natural group is due not only to their feeding diversity, but also their ability to explore a wide range of different resources, as appropriate to their jaw apparatus.

O setor sucroalcooleiro no Pontal do Paranapanema: uma análise a partir do licenciamento ambiental

The development of the sugar and alcohol sector and its sugar cane cultivation has been given in an accelerated way in Pontal do Paranapanema, mainly from the last decade, and with this has taken quick changes in the dynamic socio-economic and environmental of the region, further accentuating some conflicts and dilemmas social and environmental legacy. This work was done in order that these issues are further explored, that of moving towards a greater theoretical-scientific maturity, and even has a better apparatus to support measures (corrective or preventive) that show required anti such conflicts. For this purpose, we used the environmental licensing as a means of doing this analysis, since it is one of the main instruments of control/ regulation of the State against the development of activities of the sugar and alcohol sector. We also used a little of the vast potential of information that is contained in the environmental agencies. In this case, we used six Environmental Impact Study / Environmental Impact Report (EIS /EIR), six Preliminary Environmental Reports(PER), five Characterization of Enterprise Memorials (CEM), among other documents /studies present there. Some of the information, organized and made available in this work, has even greater potential to be exploited. It was also made an essential literature survey and of the laws related to licensing and alcohol and sugar sector

Ecosystem approach and the Fuzzy logic: a dialectical proposal for information on Environmental Health

The ever-growing production and the problematization of Environmental Health have shown the need to apprehend complex realities and deal with uncertainties from the most diversified instruments which may even incorporate local aspects and subjectivities by means of qualitative realities, while broadening the capacity of the information system. This paper presents a view on the reflection upon some challenges and possible convergences between the ecosystemic approach and the Fuzzy logic in the process of dealing with scientific information and decision-making in Environmental Health.

The development and deployment of FOTOS: a fast observation of trace organics system

Flüchtige organische Bestandteile (engl.: VOC) sind in der Atmosphäre in Spuren vorhanden, spielen aber trotzdem eine wichtige Rolle in der Luftchemie: sie beeinflussen das Ozon der Troposphäre, städtischen Smog, Oxidationskapazität und haben direkte und indirekte Auswirkungen auf die globale Klimaveränderung. Eine wichtige Klasse der VOC sind die Nicht-Methan-Kohlenwasserstoffe (engl.: NMHC), die überwiegend von anthropogenen Quellen kommen. Aus diesem Grund ist für Luftchemiker ein Messinstrument nötig, das die VOC, die NMHC eingeschlossen, mit einer höheren Zeitauflösung misst, besonders für Echtzeitmessungen an Bord eines Forschungsflugzeuges. Dafür wurde das System zur schnellen Beobachtung von organischen Spuren (engl.: FOTOS) entworfen, gebaut für den Einsatz in einem neuen Wissenschaftlichen Flugzeug, das in großen Höhen und über weite Strecken fliegt, genannt HALO. In der Folge wurde FOTOS in zwei Messkampagnen am Boden getestet. FOTOS wurde entworfen und gebaut mit einem speziell angefertigten, automatisierten, kryogenen Probensystem mit drei Fallen und einem angepassten, erworbenen schnellen GC-MS. Ziel dieses Aufbaus war es, die Vielseitigkeit zu vergrößern und das Störungspotential zu verringern, deshalb wurden keine chemischen Trocknungsmittel oder adsorbierenden Stoffe verwendet. FOTOS erreichte eine Probenfrequenz von 5.5 Minuten, während es mindestens 13 verschiedene C2- bis C5-NMHC maß. Die Drei-Sigma-Detektionsgrenze für n- und iso-Pentan wurde als 2.6 und 2.0 pptv ermittelt, in dieser Reihenfolge. Labortests bestätigten, dass FOTOS ein vielseitiges, robustes, hochautomatisiertes, präzises, genaues, empfindliches Instrument ist, geeignet für Echtzeitmessungen von VOC in Probenfrequenzen, die angemessen sind für ein Forschungsflugzeug wie HALO. Um die Leistung von FOTOS zu bestätigen, wurde vom 26. Januar bis 4. Februar 2010 ein Zwischenvergleich gemacht mit dem GC-FID-System am Meteorologischen Observatorium Hohenpeißenberg, einer WMO-GAW-globalen Station. Dreizehn verschiedene NMHC wurden innerhalb des Rahmens der GWA Data Quality Objectives (DQO) analysiert und verglichen. Mehr als 80% der Messungen von sechs C3- bis C5-NMHC erfüllten diese DQO. Diese erste Messkampagne im Feld hob die Robustheit und Messgenauigkeit von FOTOS hervor, zusätzlich zu dem Vorteil der höheren Probenfrequenz, sogar in einer Messung am Boden. Um die Möglichkeiten dieses Instrumentes im Feld zu zeigen, maß FOTOS ausgewählte leichte NMHC während einer Messkampagne im Borealen Waldgebiet, HUMPPA-COPEC 2010. Vom 12. Juli bis zum 12. August 2010 beteiligte sich eine internationale Gruppe von Instituten und Instrumenten an Messungen physikalischer und chemischer Größen der Gas- und Partikelphasen der Luft über dem Borealen Wald an der SMEAR II-Station nahe Hyyttiälä, Finnland. Es wurden mehrere Hauptpunkte von Interesse im Mischungsverhältnis der Alkane und im Isomerenverhätnis von Pentan identifiziert, insbesondere sehr unterschiedliche Perioden niedriger und hoher Variabilität, drei Rauchschwaden von Biomassen-Verbrennung von russischen Waldbränden und zwei Tage mit extrem sauberer Luft aus der Polarregion. Vergleiche der NMHC mit anderen anthropogenen Indikatoren zeigten mehrere Quellen anthropogener Einflüsse am Ort auf und erlaubten eine Unterscheidung zwischen lokalen und weiter entfernten Quellen. Auf einen minimalen natürlichen Beitrag zum 24h-Kreislauf von NOx wurde geschlussfolgert aus der Korrelation von NOx mit Alkanen. Altersschätzungen der Luftmassen durch das Isomerenverhältnis von Pentan wurden erschwert durch sich verändernde Verhältnisse der Quellen und durch Besonderheiten der Photochemie während des Sommers im hohen Norden. Diese Messungen zeigten den Wert des Messens leichter NMHC, selbst in abgelegenen Regionen, als einen zusätzlichen spezifischen Marker von anthropogenem Einfluss.

Enhancing Workers’ Well-Being. Scientific and social relevance of managing stress in the workplace

Purpose. Despite work-related stress is one of the most studied topic in organizational psychology, many aspects as for example the use of different measures (e.g. subjective and objective, qualitative and quantitative) are still under debate. According to this, in order to enhance knowledge concerning which factors and processes contribute to create healthy workplaces, this thesis is composed by four different studies aiming to understand: a) the role of relevant antecedents (e.g. leadership, job demands, work-family conflict, social support etc.) and outcomes (e.g. workplace phobia, absenteeism etc.) of work-related stress; and b) how to manage psychosocial risk factors in the workplace. The studies. The first study focused on how disagreement between supervisors and their employees on leadership style (transformational and transactional) could affect workers well-being and work team variables. The second and third study used both subjective and objective data in order to increase the quality of the reliability of the results gained. Particularly, the second study focused on job demand and its relationship with objective sickness leave. Findings showed that despite there is no direct relationship between these two variables, job demand affects work-family conflict, which in turn affect exhaustion, which leads to absenteeism. The third study analysed the role of a new concept never studied before in organizational settings (workplace phobia), as a health outcome in the JD-R model, demonstrating also its relationship with absenteeism. The last study highlighted the added value of using the mixed methods research approach in order to detect and analyse context-specific job demands which could affects workers’ health. Conclusion. The findings of this thesis answered both to open questions in the scientific literature and to the social request of managing psychosocial risk factors in the workplace in order to enhance workers well-being.

Climate Change and International Law. Exploring the Linkages Between Human Rights, Environment, Trade and Investment

Mapping the relevant principles and norms of international law, the paper discusses scientific evidence and identifies current legal foundations of climate change mitigation adaptation and communication in international environmental law, human rights protection and international trade regulation in WTO law. It briefly discusses the evolution and architecture of relevant multilateral environmental agreements, in particular the UN Framework Convention on Climate Change. It discusses the potential role of human rights in identifying pertinent goals and values of mitigation and adaptation and eventually turns to principles and rules of international trade regulation and investment protection which are likely to be of crucial importance should the advent of a new multilateral agreement fail to materialize. The economic and legal relevance of rules on tariffs, border tax adjustment and subsidies, services and intellectual property and investment law are discussed in relation to the production, supply and use of energy. Moreover, lessons from trade negotiations may be drawn for negotiations of future environmental instruments. The paper offers a survey of the main interacting areas of public international law and discusses the intricate interaction of all these components informing climate change mitigation, adaptation and communication in international law in light of an emerging doctrine of multilayered governance. It seeks to contribute to greater coherence of what today is highly fragmented and rarely discussed in an overall context. The paper argues that trade regulation will be of critical importance in assessing domestic policies and potential trade remedies offer powerful incentives for all nations alike to participate in a multilateral framework defining appropriate goals and principles.

Basic Erosive Wear Examination (BEWE): a new scoring system for scientific and clinical needs

A new scoring system, the Basic Erosive Wear Examination (BEWE), has been designed to provide a simple tool for use in general practice and to allow comparison to other more discriminative indices. The most severely affected surface in each sextant is recorded with a four level score and the cumulative score classified and matched to risk levels which guide the management of the condition. The BEWE allows re-analysis and integration of results from existing studies and, in time, should initiate a consensus within the scientific community and so avoid continued proliferation of indices. Finally, this process should lead to the development of an internationally accepted, standardised and validated index. The BEWE further aims to increase the awareness of tooth erosion amongst clinicians and general dental practitioners and to provide a guide as to its management.

Open Data and Earth Observations The Case of Opening Up Access to and Use of Earth Observation Data Through the Global Earth Observation System of Systems

Earth observations (EO) represent a growing and valuable resource for many scientific, research and practical applications carried out by users around the world. Access to EO data for some applications or activities, like climate change research or emergency response activities, becomes indispensable for their success. However, often EO data or products made of them are (or are claimed to be) subject to intellectual property law protection and are licensed under specific conditions regarding access and use. Restrictive conditions on data use can be prohibitive for further work with the data. Global Earth Observation System of Systems (GEOSS) is an initiative led by the Group on Earth Observations (GEO) with the aim to provide coordinated, comprehensive, and sustained EO and information for making informed decisions in various areas beneficial to societies, their functioning and development. It seeks to share data with users world-wide with the fewest possible restrictions on their use by implementing GEOSS Data Sharing Principles adopted by GEO. The Principles proclaim full and open exchange of data shared within GEOSS, while recognising relevant international instruments and national policies and legislation through which restrictions on the use of data may be imposed.The paper focuses on the issue of the legal interoperability of data that are shared with varying restrictions on use with the aim to explore the options of making data interoperable. The main question it addresses is whether the public domain or its equivalents represent the best mechanism to ensure legal interoperability of data. To this end, the paper analyses legal protection regimes and their norms applicable to EO data. Based on the findings, it highlights the existing public law statutory, regulatory, and policy approaches, as well as private law instruments, such as waivers, licenses and contracts, that may be used to place the datasets in the public domain, or otherwise make them publicly available for use and re-use without restrictions. It uses GEOSS and the particular characteristics of it as a system to identify the ways to reconcile the vast possibilities it provides through sharing of data from various sources and jurisdictions on the one hand, and the restrictions on the use of the shared resources on the other. On a more general level the paper seeks to draw attention to the obstacles and potential regulatory solutions for sharing factual or research data for the purposes that go beyond research and education.

Scientific Production on Open Access : A Worldwide Bibliometric Analysis in the Academic and Scientific Context

This research aims to diachronically analyze the worldwide scientific production on open access, in the academic and scientific context, in order to contribute to knowledge and visualization of its main actors. As a method, bibliographical, descriptive and analytical research was used, with the contribution of bibliometric studies, especially the production indicators, scientific collaboration and indicators of thematic co-occurrence. The Scopus database was used as a source to retrieve the articles on the subject, with a resulting corpus of 1179 articles. Using Bibexcel software, frequency tables were constructed for the variables, and Pajek software was used to visualize the collaboration network and VoSViewer for the construction of the keywords' network. As for the results, the most productive researchers come from countries such as the United States, Canada, France and Spain. Journals with higher impact in the academic community have disseminated the new constructed knowledge. A collaborative network with a few subnets where co-authors are from different countries has been observed. As conclusions, this study allows identifying the themes of debates that mark the development of open access at the international level, and it is possible to state that open access is one of the new emerging and frontier fields of library and information science

Scientific Production on Open Access : A Worldwide Bibliometric Analysis in the Academic and Scientific Context

This research aims to diachronically analyze the worldwide scientific production on open access, in the academic and scientific context, in order to contribute to knowledge and visualization of its main actors. As a method, bibliographical, descriptive and analytical research was used, with the contribution of bibliometric studies, especially the production indicators, scientific collaboration and indicators of thematic co-occurrence. The Scopus database was used as a source to retrieve the articles on the subject, with a resulting corpus of 1179 articles. Using Bibexcel software, frequency tables were constructed for the variables, and Pajek software was used to visualize the collaboration network and VoSViewer for the construction of the keywords' network. As for the results, the most productive researchers come from countries such as the United States, Canada, France and Spain. Journals with higher impact in the academic community have disseminated the new constructed knowledge. A collaborative network with a few subnets where co-authors are from different countries has been observed. As conclusions, this study allows identifying the themes of debates that mark the development of open access at the international level, and it is possible to state that open access is one of the new emerging and frontier fields of library and information science

Scientific Production on Open Access : A Worldwide Bibliometric Analysis in the Academic and Scientific Context

This research aims to diachronically analyze the worldwide scientific production on open access, in the academic and scientific context, in order to contribute to knowledge and visualization of its main actors. As a method, bibliographical, descriptive and analytical research was used, with the contribution of bibliometric studies, especially the production indicators, scientific collaboration and indicators of thematic co-occurrence. The Scopus database was used as a source to retrieve the articles on the subject, with a resulting corpus of 1179 articles. Using Bibexcel software, frequency tables were constructed for the variables, and Pajek software was used to visualize the collaboration network and VoSViewer for the construction of the keywords' network. As for the results, the most productive researchers come from countries such as the United States, Canada, France and Spain. Journals with higher impact in the academic community have disseminated the new constructed knowledge. A collaborative network with a few subnets where co-authors are from different countries has been observed. As conclusions, this study allows identifying the themes of debates that mark the development of open access at the international level, and it is possible to state that open access is one of the new emerging and frontier fields of library and information science