Management of bleeding following major trauma: a European guideline

INTRODUCTION Evidence-based recommendations can be made with respect to many aspects of the acute management of the bleeding trauma patient, which when implemented may lead to improved patient outcomes. METHODS The multidisciplinary Task Force for Advanced Bleeding Care in Trauma was formed in 2005 with the aim of developing guidelines for the management of bleeding following severe injury. Recommendations were formulated using a nominal group process and the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) hierarchy of evidence and were based on a systematic review of published literature. RESULTS Key recommendations include the following: The time elapsed between injury and operation should be minimised for patients in need of urgent surgical bleeding control, and patients presenting with haemorrhagic shock and an identified source of bleeding should undergo immediate surgical bleeding control unless initial resuscitation measures are successful. A damage control surgical approach is essential in the severely injured patient. Pelvic ring disruptions should be closed and stabilised, followed by appropriate angiographic embolisation or surgical bleeding control, including packing. Patients presenting with haemorrhagic shock and an unidentified source of bleeding should undergo immediate further assessment as appropriate using focused sonography, computed tomography, serum lactate, and/or base deficit measurements. This guideline also reviews appropriate physiological targets and suggested use and dosing of blood products, pharmacological agents, and coagulation factor replacement in the bleeding trauma patient. CONCLUSION A multidisciplinary approach to the management of the bleeding trauma patient will help create circumstances in which optimal care can be provided. By their very nature, these guidelines reflect the current state-of-the-art and will need to be updated and revised as important new evidence becomes available.

Adaptaciones de puestos de trabajo de centros de salud en trabajadores especialmente sensibles a riesgos laborales

An overview was conducted of work-person adjustments engaged in workers classified as especially sensitive for certain occupational risks in health sector. The purpose of this research was to provide workplace accommodations featuring because of some disability or health limitation associated with impairments from the tasks performance. During 2012 in the community health centers of a primary care district, 46 workers were catalogued especially sensitive that received an average of 3,2 adjustment measure in workplace. The findings showed a wide variety of accommodations including modifications in working arrangement, in the way to performance of the tasks, and in a lesser extent, changes in near environmental factors to the workplace and/or workstation. All prevention efforts were setting on provide to maintain continuity of working life inside compatible-limits with health and safety of workers. Our results offer a first approach to the knowledge of health limitations management that hamper responsiveness to demand of tasks.

La réhabilitation psychosociale a l'aube du XXIème siècle. I: Principes, population cible et pathologie en cause

The relatively recent development of the psychosocial rehabilitation has its origins mainly in the progress of modern psychopharmacology, the assertion of the rights of the patients and the result of the studies showing that the evolution of persons suffering from severe and persistent mental illnesses can prove to be positive in many cases. In spite of the heterogeneity of the experiences and of the theoretical references, the core principles of the psychosocial rehabilitation imposed themselves. These principles can be classified according to three levels, that of relational ethics, that of the method of intervention and that of the institutional device. A recent study showed that 2.4@1000 of the general adult population of the Canton of Vaud live in sociotherapeutic and rehabilitation accommodations. In this sample, there is a important percentage of relatively young persons (55.3% are under 40). In institutional accommodation there is a majority of patients suffering from major personality disorders and addiction (40.6%), followed by psychotic disorders (37.2%), persistent mood disorders (12.3%), neurotic disorders (6.6%) and psycho-organic disorders (3.3%). In home based rehabilitation, the ratio of patients with psychotic disorders is more important (53.1%). This difference would indicate that people with schizophrenia would have a better social outcome than personality disorders with addiction

Policy Addressing Civil Rights/Discrimination Complaints, January 3, 2011

The Iowa Governor’s Office of Drug Control Policy (ODCP) shall comply with all applicable federal and state laws prohibiting discrimination, as well as the State of Iowa’s Equal Opportunity, Affirmative Action and Anti-Discrimination Policy for Executive Branch Employees (Section 2.40 of Iowa Department of Administrative Services Managers and Supervisors Manual). Federal law prohibits discrimination against individuals or groups, either in employment or in the delivery of services or benefits, on the basis of age, race, color, national origin, religion, sex, or disability. State law prohibits discrimination in the areas of employment, housing, credit, public accommodations and education. Under the Iowa Civil Rights Act of 1965, discrimination, or different treatment, is illegal if based on race, color, creed, national origin, religion, sex, sexual orientation, gender identity, pregnancy, physical disability, mental disability, retaliation (because of filing a previous discrimination complaint, participating in an investigation of a discrimination complaint, or having opposed discriminatory conduct), age (in employment and credit), familial status (in housing and credit) or marital status (in credit). State policy requires all employees and applicants for employment in the executive branch be afforded equal access. The intent of this policy is to ensure that employment opportunities, within the executive branch of state government, are accessible to all persons, and that executive branch agencies do not discriminate against any person because of race, creed, color, religion, sex, national origin, age, or physical or mental disability.

The Challenge of Housing for Ex-Offenders, Data Download, Iowa Department of Corrections, September 2010

On October 5, 2010 there were 25,829 probationers and parolees (including special sentence) under community-based corrections field supervision statewide. As shown in the pie charts below, LSI-R offender assessments show that a sizeable percent of offenders are dissatisfied with their living accommodations – particularly for higher risk offenders.

LSI-R Scores: Change Matters - Part III, Data Download, Iowa Department of Corrections, June 2009

In this issue, we take a closer look at the individual risk factors measured by the LSI-R. There are several risk factors that the LSI-R assessment tool measures: Criminal History; Education/Employment; Financial; Family/Marital; Accommodations (Living Situation); Leisure/Recreation; Companions; Alcohol/Drug Problem; Emotional/Personal; and Attitudes/Orientation.

Công bằng Nha cửa và Bạn,

(In Vietnamese)Familial status, or presence of children in the home, protects families with children under 18 years of age. Also protected are families seeking custody of a child or expecting the birth of a child. There is only a narrow exception to this part of the law: units designated as “housing for older persons.” Property owners are required by the law to allow reasonable modifications to a property (at the tenant’s expense) and to make reasonable accommodations in policies in order to accommodate the needs of persons with disabilities.

Fair Housing and You

Familial status, or presence of children in the home, protects families with children under 18 years of age. Also protected are families seeking custody of a child or expecting the birth of a child. There is only a narrow exception to this part of the law: units designated as “housing for older persons.” Property owners are required by the law to allow reasonable modifications to a property (at the tenant’s expense) and to make reasonable accommodations in policies in order to accommodate the needs of persons with disabilities.

Harassment in Education: It's Against the Law, 2011

Harassment is illegal in all areas protected by Iowa Code Chapter 216. This includes education, employment, public accommodations, credit and housing. Acts of harassment take place every day in schools across the country. Frequently these acts, even if reported to administration, are dismissed as harmless, as "kids will be kids," or as "no big deal." Many people do not realize that harassment that interferes with a person's educational progress is illegal, just as it is illegal in the workplace.

El Acoso en la Educación: Es Contra la Ley, 2011

Harassment is illegal in all areas protected by Iowa Code Chapter 216. This includes education, employment, public accommodations, credit and housing. Acts of harassment take place every day in schools across the country. Frequently these acts, even if reported to administration, are dismissed as harmless, as "kids will be kids," or as "no big deal." Many people do not realize that harassment that interferes with a person's educational progress is illegal, just as it is illegal in the workplace.

Brain Injury Quick Guide: Information and Resources for Teachers and School Staff, July 2013

The Brain Injury Quick Guide was developed as a resource tool for educators and school staff. Functional challenges (including social, physical, communication, and cognitive) are common following brain injury. This booklet serves as a resource outlining common challenges students may face in the classroom as well as strategies for addressing these challenges. Case studies outlining common challenges with possible strategies are provided with suggestions for IEP/504 plan accommodations. Basic brain anatomy and brain injury statistics are also reviewed.

Mississippi Drive (Iowa 92) from Main Street to the Norbert F. Beckey Bridge in Muscatine, Iowa, STP-U-5330(614)—27-70, Muscatine County, 2015

The proposed action consists of upgrading Mississippi Drive (Iowa Highway 92) through downtown Muscatine, Iowa. The Mississippi Drive Corridor Project begins south of the Main Street/Grandview Avenue intersection, continuing to the East 2nd Street/Norbert F. Beckey Bridge intersection, which marks the end of the project. It passes through a mix of commercial, residential, Central Business District and industrial land uses. The total length of the project is approximately 1.6 miles, including 19 intersections (6 with traffic signals). Refer to the vicinity map on Figure 1. The current roadway is a 3- to 4-lane, urban facility with both divided and undivided medians. The roadway, ranging from 40 to 64 feet wide, is considered difficult to cross for pedestrians, especially for small children or elderly. The width of this roadway is being considered to be narrowed to improve the accessibility to the downtown from the Mississippi River riverfront area by pedestrians. This project also includes accommodations for bicycles and pedestrians and measures to reduce flooding on the roadway.

Electron paramagnetic resonance (EPR) spectral components of spin-labeled lipids in saturated phospholipid bilayers: effect of cholesterol

Electron paramagnetic resonance (EPR) spectroscopy was used to study the main structural accommodations of spin labels in bilayers of saturated phosphatidylcholines with acyl chain lengths ranging from 16 to 22 carbon atoms. EPR spectra allowed the identification of two distinct spectral components in thermodynamic equilibrium at temperatures below and above the main phase transition. An accurate analysis of EPR spectra, using two fitting programs, enabled determination of the thermodynamic profile for these major probe accommodations. Focusing the analysis on two-component EPR spectra of a spin-labeled lipid, the influence of 40 mol % cholesterol in DPPC was studied.

In search of information systems value : a case study of the EHR benefits realisation efforts of three Swedish hospitals.

The Swedish public health care organisation could very well be undergoing its most significant change since its specialisation during the late 19th and early 20th century. At the heart of this change is a move from using manual patient journals to electronic health records (EHR). EHR are complex integrated organisational wide information systems (IS) that promise great benefits and value as well as presenting great challenges to the organisation. The Swedish public health care is not the first organisation to implement integrated IS, and by no means alone in their quest for realising the potential benefits and value that it has to offer. As organisations invest in IS they embark on a journey of value-creation and capture. A journey where a costbased approach towards their IS-investments is replaced with a value-centric focus, and where the main challenges lie in the practical day-to-day task of finding ways to intertwine technology, people and business processes. This has however proven to be a problematic task. The problematic situation arises from a shift of perspective regarding how to manage IS in order to gain value. This is a shift from technology delivery to benefits delivery; from an ISimplementation plan to a change management plan. The shift gives rise to challenges related to the inability of IS and the elusiveness of value. As a response to these challenges the field of IS-benefits management has emerged offering a framework and a process in order to better understand and formalise benefits realisation activities. In this thesis the benefits realisation efforts of three Swedish hospitals within the same county council are studied. The thesis focuses on the participants of benefits analysis projects; their perceptions, judgments, negotiations and descriptions of potential benefits. The purpose is to address the process where organisations seek to identify which potential IS-benefits to pursue and realise, this in order to better understand what affects the process, so that realisation actions of potential IS-benefits could be supported. A qualitative case study research design is adopted and provides a framework for sample selection, data collection, and data analysis. It also provides a framework for discussions of validity, reliability and generalizability. Findings displayed a benefits fluctuation, which showed that participants’ perception of what constituted potential benefits and value changed throughout the formal benefits management process. Issues like structure, knowledge, expectation and experience affected perception differently, and this in the end changed the amount and composition of potential benefits and value. Five dimensions of benefits judgment were identified and used by participants when finding accommodations of potential benefits and value to pursue. Identified dimensions affected participants’ perceptions, which in turn affected the amount and composition of potential benefits. During the formal benefits management process participants shifted between judgment dimensions. These movements emerged through debates and interactions between participants. Judgments based on what was perceived as expected due to one’s role and perceived best for the organisation as a whole were the two dominant benefits judgment dimensions. A benefits negotiation was identified. Negotiations were divided into two main categories, rational and irrational, depending on participants’ drive when initiating and participating in negotiations. In each category three different types of negotiations were identified having different characteristics and generating different outcomes. There was also a benefits negotiation process identified that displayed management challenges corresponding to its five phases. A discrepancy was also found between how IS-benefits are spoken of and how actions of IS benefits realisation are understood. This was a discrepancy between an evaluation and a realisation focus towards IS value creation. An evaluation focus described IS-benefits as well-defined and measurable effects and a realisation focus spoke of establishing and managing an on-going place of value creation. The notion of valuescape was introduced in order to describe and support the understanding of IS value creation. Valuescape corresponded to a realisation focus and outlined a value configuration consisting of activities, logic, structure, drivers and role of IS.

Bridging the gap between post-secondary students with disabilities and faculty members with their perceptions of access and accommodation

The purpose of this study was to identify factors related to successful university course completion for students with disAbilities including the knowledge that faculty members and students with disAbilities have about accommodation issues; the accommodations that students with disAbilities and faculty use and find effective in the university setting; faculty members' perceptions of and attitudes toward students with disAbilities; and the attitudes that students with disAbilities have toward faculty. Fiftyseven participants were involved in the research, eight students with disabilities and forty-nine faculty members. The main objective of the research was to describe how the skills, knowledge, and attitudes of students and faculty members, and organizational supports interact to support students' academic success. The utilization and effectiveness of accommodations to overcome barriers associated with disAbility in a post-secondary setting are described in relation to students' and faculty members' perceptions of academic success.