Structured training in intraosseous infusion to improve potentially life saving skills in pediatric emergencies - Results of an open prospective national quality development project over 3 years

BACKGROUND: Children in emergencies need peripheral intravenous (IV) access in order to receive drugs or fluids. The success of IV access is associated with the age of patients and fails in up to 50% of children younger than 6 years. In such situations, it is essential that physicians and paramedics have a tool and easily learnable skills with a high chance of success. According to international guidelines intraosseous (IO) access would be the next step after failed IV access. Our hypothesis was that the success rate in IO puncturing can be improved by standardizing the training; so we developed an IO workshop. METHODS: Twenty-eight hospitals and ambulance services participated in an evaluation process over 3 years. IO workshops and the distribution of standardized IO sets were coordinated by the study group of the University Hospital of Berne. Any attempted or successful IO punctures were evaluated with a standardized interview. RESULTS: We investigated 35 applications in 30 patients (a total of 49 punctures) between November 2001 and December 2004. IO puncture was not successful in 5 patients. The success rate depended neither on the occupation nor the experience of users. Attendance at a standardized IO workshop increased the overall success rate from 77% to 100%, which was statistically not significant (P = 0.074). CONCLUSIONS: Standardized training in IO puncturing seems to improve success more than previous experience and occupation of providers. However, we could not show a significant increase in success rate after this training. Larger supranational studies are needed to show a significant impact of teaching on rarely used emergency skills.

Asynchronous ECG time sampling: Saving bits with Golomb-Rice encoding

We present a technique for online compression of ECG signals using the Golomb-Rice encoding algorithm. This is facilitated by a novel time encoding asynchronous analog-to-digital converter targeted for low-power, implantable, long-term bio-medical sensing applications. In contrast to capturing the actual signal (voltage) values the asynchronous time encoder captures and encodes the time information at which predefined changes occur in the signal thereby minimizing the sensor's energy use and the number of bits we store to represent the information by not capturing unnecessary samples. The time encoder transforms the ECG signal data to pure time information that has a geometric distribution such that the Golomb-Rice encoding algorithm can be used to further compress the data. An overall online compression rate of about 6 times is achievable without the usual computations associated with most compression methods.

Towards End-User Driven Power Saving Control in Android devices

Abstract. During the last decade mobile communications increasingly became part of people's daily routine. Such usage raises new challenges regarding devices' battery lifetime management when using most popular wireless access technologies, such as IEEE 802.11. This paper investigates the energy/delay trade-off of using an end-user driven power saving approach, when compared with the standard IEEE 802.11 power saving algorithms. The assessment was conducted in a real testbed using an Android mobile phone and high-precision energy measurement hardware. The results show clear energy benefits of employing user-driven power saving techniques, when compared with other standard approaches.

Saving the Australian War Effort in 1916? The Significance and Impact of Global Climatic Conditions and Pests on William Morris Hughes’ Negotiations with the British Government

Taking up the thesis of Dipesh Chakrabarty (2009) that human history (including cultural history) on the one hand and natural history on the other must be brought into conversation more than has been done so in the past, this presentation will focus more closely on the significance and the impact of global climatic conditions and pests on the negotiations that Australian Prime Minister William Morris Hughes carried on with the British government between March and November 1916. Whereas Australia had been able to sell most of its produce in 1914 and 1915 the situation looked more serious in 1916, not least due to the growing shortage in shipping. It was therefore imperative for the Australian government to find a way to solve this problem, not least because it wanted to keep up its own war effort at the pace it had been going so far. In this context intentions to make or press ahead with a contribution to a war perceived to be more total those of the past interacted with natural phenomena such as the declining harvest in many parts of the world in 1916 as a consequence of climatic conditions as well as pests in many parts of the world.

Saving soils at degradation frontlines: Sustainable land management in drylands

Healthy soils are fundamental to life. They grow the food we eat and the wood we use for shelter and fuel, purify the water we drink, and hold fast to the roots of the natural world we cherish. They are the ground beneath our feet and beneath our homes. But they are under threat, especially from human overuse and climate change. Nowhere is this more evident than in dryland areas, where soil degradation – or desertification – wears away at this essential resource, sometimes with sudden rapidity when a tipping point is crossed. Though it is a challenge, preserving and restoring healthy soils in drylands is possible, and it concerns all of us. Sustainable land management points the way.

Na 50 Nachlass Arthur Schopenhauer - 'Schopenhauer-Archiv', 966 - Ermunterung zur wissenschaftlichen Betätigung nach Eintritt in die Pension

u.a. Materialismus; Sozialismus; Arbeit; Jean Paul; 100. Geburtstag Schopenhauers; Schopenhauer-Denkmal; Finanzielle Unterstützung; Frankfurt am Main; Wien; Italien;

Population-level risks of physical activity: Saving bones and screening hearts

Documented risks of physical activity include reduced bone mineral density at high activity volume, and sudden cardiac death among adults and adolescents. Further illumination of these risks is needed to inform future public health guidelines. The present research seeks to 1) quantify the association between physical activity and bone mineral density (BMD) across a broad range of activity volume, 2) assess the utility of an existing pre-screening questionnaire among US adults, and 3) determine if pre-screening risk stratification by questionnaire predicts referral to physician among Texas adolescents. ^ Among 9,468 adults 20 years of age or older in the National Health and Nutrition Examination Survey (NHANES) 2007-2010, linear regression analyses revealed generally higher BMD at the lumbar spine and proximal femur with greater reported activity volume. Only lumbar BMD in women was unassociated with activity volume. Among men, BMD was similar at activity beyond four times the minimum volume recommended in the Physical Activity Guidelines. These results suggest that the range of activity reported by US adults is not associated with low BMD at either site. ^ The American Heart Association / American College of Sports Medicine Preparticipation Questionnaire (AAPQ) was applied to 6,661 adults 40 years of age or older from NHANES 2001-2004 by using NHANES responses to complete AAPQ items. Following AAPQ referral criteria, 95.5% of women and 93.5% of men would be referred to a physician before exercise initiation, suggesting little utility for the AAPQ among adults aged 40 years or older. Unnecessary referral before exercise initiation may present a barrier to exercise adoption and may strain an already stressed healthcare infrastructure. ^ Among 3181 athletes in the Texas Adolescent Athlete Heart Screening Registry, 55.2% of boys and 62.2% of girls were classified as high-risk based on questionnaire answers. Using sex-stratified contingency table analyses, risk categories were not significantly associated with referral to physician based on electrocardiogram or echocardiogram, nor were they associated with confirmed diagnoses on follow-up. Additional research is needed to identify which symptoms are most closely related to sudden cardiac death, and determine the best methods for rapid and reliable assessment. ^ In conclusion, this research suggests that the volume of activity reported by US adults is not associated with low BMD at two clinically relevant sites, casts doubts on the utility of two existing cardiac screening tools, and raises concern about barriers to activity erected through ineffective screening. These findings augment existing research in this area that may inform revisions to the Physical Activity Guidelines regarding risk mitigation.^

Saving Young Lives: Pathfinder International’s Youth-Friendly Postabortion Care Project

As many as 2.5 million adolescent women seek abortion each year, and nearly 70,000 women die from complications related to unsafe abortion, of which almost half are women under the age of 25. A further 5 million women suffer disability due to unsafe abortion yearly. In most developing countries, abortion is legally restricted or highly inaccessible, which leads young women to seek services from unskilled practitioners often leading to incomplete, septic abortions and massive bleeding, which can result in permanent injury, infertility, and death. Based on our deeply held belief that all people, including adolescents, have a right to sexual and reproductive health services and the importance of addressing adolescent needs within Postabortion Care (PAC) services, Pathfinder used private funds to initiate a Youth-Friendly Postabortion Care (YFPAC) program in eight sub-Saharan African countries. Implemented between June 2007 and May 2008, the YFPAC program offered an opportunity to apply the PAC Consortium’s Technical Guidance on Youth-Friendly PAC, generating promising approaches and lessons learned. The goal of the YFPAC initiative was to increase access to PAC services that are responsive to adolescent needs in sub-Saharan Africa. While outcomes varied according to the country, the overall outcomes included: Increased community support for services and activities that prevent unwanted pregnancy, decreased stigma around abortion, and awareness of the issue of unsafe abortion among adolescent women: 311 peer educators reached almost 17,487 youth and other community members; 171 stakeholders (e.g., religious and traditional leaders, health officials, and local government officials) were sensitized on YFPAC, resulting in a positive shift in communities’ attitudes toward youth in need of PAC services. 125 service providers were trained to deliver YFPAC services and three doctors in Ghana were provided with a technical update on YFPAC. YFPAC services are available in Angola, Ghana, Nigeria, Mozambique, Tanzania, Uganda, Ethiopia, and Kenya. Pathfinder introduced YFPAC services into 25 facilities (in 27 service delivery points), and provided more than 3,800 clients with YFPAC services throughout the eight countries. The number of adolescent PAC clients seen at the project facilities increased— 710 clients were seen in the first quarter, 1,144 were seen in the fourth. The number of adolescent PAC clients who adopt a contraceptive method to prevent future unintended pregnancies has increased. Statistics show an average postabortion contraceptive acceptance of 69%, with the highest acceptance being 83% and the lowest being 44%. Evidence-based approaches, tools, and lessons learned are being disseminated and used for scale-up or replication of YFPAC interventions.

Energy saving potential of semi-transparent photovoltaic elements for building integration

Within the building energy saving strategies, BIPV (building integrated photovoltaic systems) present a promising potential based on the close relationship existing between these multifunctional systems and the overall building energy balance. Building integration of STPV (semi-transparent photovoltaic) elements affects deeply the building energy demand since it influences the heating, cooling and lighting loads as well as the local electricity generation. This work analyses over different window-to-wall ratios the overall energy performance of five STPV elements, each element having a specific degree of transparency, in order to assess the energy saving potential compared to a conventional solar control glass compliant with the local technical standard. The prior optical characterization, focused to measure the spectral properties of the elements, was experimentally undertaken. The obtained data were used to perform simulations based on a reference office building using a package of specific software tools (DesignBuilder, EnergyPlus, PVsyst, and COMFEN) to take proper account of the STPV peculiarities. To evaluate the global energy performance of the STPV elements a new Energy Balance Index was formulated. The results show that for intermediate and large façade openings the energy saving potential provided by the STPV solutions ranges between 18% and 59% compared to the reference glass.

A CO2-saving-based methodology to measure the impact of the SUMP in European Cities: Application to the City of Burgos

Urban mobility in Europe is always a responsibility of the municipalities which propose measures to reduce CO2 emissions in terms of mobility aimed at reducing individual private transport (car). The European Commission's Action Plan on Urban Mobility calls for an increase in the take-up of Sustainable Urban Mobility Plans in Europe. SUMPs aim to create a sustainable urban transport system. Europe has got some long term initiatives and has been using some evaluation procedures, many of them through European projects. Nevertheless, the weak point with the SUMPs in Spain, has been the lack of concern about the evaluation and the effectiveness of the measures implemented in a SUMP. For this reason, it is difficult to know exactly whether or not the SUMPs have positively influenced in the modal split of the cities, and its contribution to reduce CO2 levels. The case of the City of Burgos is a very illustrative example as it developed a CiViTAS project during the years 2005-2009, with a total investment of 6M?. The results have been considered as ?very successful? even at European level. The modal split has changed considerably for better, The cost-effectiveness ratio of the SUMP in the city can be measured with the CO2 ton saved, specifically 36 ? per CO2 ton saved, which is fully satisfactory and in line with calculations from other European researchers. Additionally, the authors propose a single formula to measure the effectiveness of the activities developed under the umbrella of a SUMP.

Sustainability assessment of energy saving measures: A multi-criteria approach for residential buildings retrofitting—A case study of the Spanish housing stock

The building sector is well known to be one of the key energy consumers worldwide. The renovation of existing buildings provides excellent opportunities for an effective reduction of energy consumption and greenhouse gas emissions but it is essential to identify the optimal strategies. In this paper a multi-criteria methodology is proposed for the comparative analysis of retrofitting solutions. Life Cycle Assessment (LCA) and Life Cycle Cost (LCC) are combined by expressing environmental impacts in monetary values. A Pareto optimization is used to select the preferred strategies. The methodology is exemplified by a case study: the renovation of a representative housing block from the 1960s located in Madrid. Eight scenarios have been proposed, from the Business as Usual scenario (BAU), through Spanish Building Regulation requirements (for new buildings) up to the Passive House standard. Results show how current renovation strategies that are being applied in Madrid are far from being optimal solutions. The required additional investment, which is needed to obtain an overall performance improvement of the envelope compared with the common practice to date, is relatively low (8%) considering the obtained life cycle environmental and financial savings (43% and 45%, respectively).