Technical Feasibility and Application of Mechanical Thrombectomy with the Solitaire FR Revascularization Device in Acute Basilar Artery Occlusion

Acute BAO is a devastating neurological condition associated with a poor clinical outcome and a high mortality rate. Recanalization has been identified as a major prognostic factor for good outcome in BAO. Mechanical thrombectomy using retrievable stents is an emerging treatment option for acute stroke. First clinical trials using stent retrievers have shown promising high recanalization rates. However, these studies mainly included large artery occlusions in the anterior circulation with only a few or single cases of BAO. Therefore, the purpose of this study was to evaluate technical feasibility, safety, and efficacy of mechanical thrombectomy using retrievable stent in the treatment of acute BAO.

Diseño arquitectónico y protección en caso de incendio: desarrollo normativo español en materia de evacuación en los siglos XIX y XX

Esta es la búsqueda de respuestas a esa duda constante: De dónde venimos y que hemos ido dejando por el camino. ¿Está todo claro en este recorrido o hemos actuado por acumulación de errores heredados de procesos anteriores? Es la investigación a través del descubrimiento de nuestro pasado, de nuestros orígenes en materia de seguridad de protección contra incendios, y sobre todo de ejecución de una arquitectura pensada para ser recorrida con mayor seguridad y ser evacuada en un tiempo razonable. El trabajo investiga, a nivel nacional, la evolución de la sociedad y sus efectos sobre la manera de interpretar el problema de la seguridad contra incendios en los edificios. El interés fundamentalmente es poner en claro todos aquellos aspectos que afectan a la evacuación de las personas. Para ello se han estudiado los principales hitos de actuación, las preocupaciones principales surgidas en cada momento y las soluciones adoptadas. Se ha comprobado su aplicación o su demora hasta que se ha producido el siguiente gran suceso que ha motivado una nueva revisión de los procedimientos de diseño y control. En primer lugar, tratando de relacionar los incendios fundamentales que han influido en nuestra forma de abordar el problema en distintos momentos de la historia de España. En segundo lugar, haciendo un recorrido sobre la figura del arquitecto y su participación en los medios de control y legislación sobre la manera de intervenir en el servicio de incendios o de resolver los edificios en materia de protección contra incendios o evacuación de sus ocupantes. En definitiva, descubriendo los escritos de algunos especialistas, fundamentales para entender nuestra manera de abordar el problema de la protección en los edificios, a lo largo de la historia. Se ha revisado como se han producido los siniestros más importantes en teatros y otros locales públicos .Analizando la forma en que los arquitectos implicados han tratado de resolver las posibles deficiencias ante el riesgo. Se trata de la tipología edificatoria donde, por primera vez, surge la preocupación por adoptar medidas y procedimientos de seguridad en caso de incendio. Resultan locales con una importante siniestralidad, donde se desarrolla la principal actividad lúdica del momento, y que por el importante número de personas que albergan, son fuente de preocupación entre el público y las autoridades. Otras cuestiones en un tema tan amplio, que quedan simplemente esbozadas en este trabajo de investigación, son los procedimientos de los sistemas de extinción, la estructura organizativa de la ciudad, las primeras sociedades de seguros de incendios, la aparición de patentes a partir del desarrollo industrial del siglo XIX. Todo ello, con el hilo conductor de la reglamentación que se ha ido elaborando al respecto. Al principio, sobre espectáculos públicos, acotando el punto de partida en la materia de nuestra reglamentación. Anticipando sistemas constructivos y datos dimensionales de la evacuación. Llegados a mediados del siglo XX, abordando otros usos. Haciendo seguimiento de la modernización de los procesos edificatorios y la reglamentación sectorial. Recabando información de las organizaciones profesionales que comienzan a reclamar una coordinación nacional de los sistemas preventivos y que desemboca en el Proyecto de Reglamento de prevención contra el fuego que nunca será publicado. Toda esta etapa, plagada de documentos de carácter voluntario u obligatorio, local y nacional, van definiendo los criterios dimensionales con los que debe resolverse los elementos arquitectónicos susceptibles de servir para la evacuación. Se trata de una etapa intensa en documentación, cambiante, sujeta a los criterios que establecen los países del entorno más avanzados en la materia. Las dos últimas décadas del siglo, acotadas por la transición política y varios siniestros de graves consecuencias, definen el proceso normativo que culmina con el código técnico de la edificación que hoy conocemos. Es un periodo de aprendizaje y asimilación del capítulo de la seguridad, donde los métodos son variados. Donde la intencionalidad última es trasladar un sistema prescriptivo a un modelo prestacional propio de la madurez en el análisis del tema y en las corrientes de los países del entorno. ABSTRACT This is the search for answers to that constant question: Where do we come from and what have left along the way? Has everything been clear on this journey, or have we acted as a result of a collection of errors learned from prior processes? This has been research through exploration of our past, of our origins regarding fire protection safety, and, above all, of the endeavour to utilize architecture aimed at offering the highest level of safety and evacuation in a reasonable time. This project has researched society’s change nationwide and its effects on how to interpret the difficulty of fire protection safety in buildings. Its focus has fundamentally been to clarify those aspects that affect the evacuation of people. To this end, the main milestones of action, the principal concerns that have arisen at each step, and the solutions taken have all been studied. A check was performed on their application; or their delay until a significant event occurred that prompted a new revision of design and control procedures. Firstly, this was done by attempting to connect the main fires that have influenced how we handle the problem at different times in Spain’s history. Secondly, an examination was done on the figure of the architect and his participation in the means of control and legislation on how to intercede in fire services, or how the architect finds solutions for buildings in terms of fire protection, or the evacuation of their occupants. In short, the written works of certain specialists, who are essential to our understanding of how to deal with the problem of protection in buildings, were explored throughout history. A study was done on the most significant disasters in theatres and other public establishments. This was done by analysing the way the architects involved have aimed to solve possible points liable to risk. It is a classification of building where, for the first time, the concern arose to adopt safety measures and procedures in the event of fires. Public establishments with considerable accident rates emerged. Here the main entertainment activities of the time took place. These spaces were a source of worry among the public and authorities due to the high number of persons they accommodated. Other issues in such an extensive subject, which are only outlined in this research study, are procedures in extinguishing systems, the organizational structure of cities, the first fire insurance companies, and the appearance of patents after the industrial development of the 19th century. All of these aspects are joined by the common thread of regulations that have been created in this matter. At the beginning, these regulations were for public shows, thus defining the starting point for our regulations. This was done in anticipation of structural systems and size data of evacuations. With the arrival of the mid-20th century, different uses were addressed. A modernization of construction processes and the industry regulations were tracked. Information was gathered from professional organizations that began to demand a national coordination of prevention systems which led to the Regulation Project on fire prevention which will never be published. Throughout this stage, replete with voluntary and compulsory documents, both on the local and national level, the dimensional criteria to be used in the resolution of architectural elements open to use in evacuation were defined. This was a period that was filled with documentation, change, and subject to the criteria that the most advanced countries in the field established in this regard. The final two decades of the century, marked by political transition and several accidents with grave consequences, defined the regulation process that culminated with the building technical code known today. This was a period of learning and understanding in the chapter of safety, where the methods are varied. In this chapter, the ultimate goal is to insert a prescriptive-based standard into a performance-based code suitable for cultivated experience in analysis of the subject and the tendencies in countries dealing with this field.

Leading Safety Indicators: Proactively Monitoring Safety Performance

Traditional measures or indicators of workplace safety performance reflect unrecognized hazards, unsafe conditions, reckless behavior, and other safety program shortcomings only after a worker is injured or falls ill. In contrast to traditional or lagging indicators, leading indicators can predict poor safety performance to ensure that safety program failings are addressed before an occupational injury or illness actually occurs. This Capstone Project identified a variety of proactive safety management practices, policies, and activities shown to have a positive impact on workplace safety as leading safety indicators. The end result is a comprehensive framework of leading safety indicators that employers can use to proactively gauge safety program performance and address unrecognized hazards, unsafe conditions, reckless behavior, and other safety program deficiencies.

Acidentes com perfurocortantes em profissionais da assistência do SAMU, Maceió

Introdução – Os acidentes de trabalho envolvendo material biológico entre profissionais de saúde são frequentes e constituem um problema de saúde pública, pois representam uma preocupação constante das instituições e dos profissionais de saúde. Os profissionais do pré hospitalar tornam-se mais expostos pela tensão emocional vivida, pela natureza e circunstâncias do seu exercício profissional. Objetivos – Identificar a ocorrência de acidentes ocupacionais com materiais perfurocortantes nos profissionais de saúde do SAMU Maceió; identificar os acidentes mais frequentes, os períodos em que ocorrem e avaliar as condutas tomadas após o acidente. Métodos – Estudo descritivo com orientação analítico-descritiva desenvolvido numa amostra de 40 profissionais de saúde, Enfermeiro socorrista, Técnico Enfermagem e Médicos Socorristas. A recolha de informação foi suportada num questionário elaborado para o efeito. Resultados – A nossa amostra apresentou uma média de idades de 39,2 anos, o sexo feminino foi maioritário com 70,0% e 50,0% trabalha entre 6 a 10 anos na unidade. A maioria dos acidentes perfuro cortantes foram provocados por agulhas (75,0%) e dos quais não resultou incapacidade em 75%. A maioria dos acidentes ocorreram no verão e no turno da noite. Grande número de profissionais (70%) não cumpriu com as normas de procedimentos após o acidente e 80,0% dos profissionais não realizaram a quimioprofilaxia, não cumprindo com o protocolo do Ministérios da Saúde do Brasil. O paciente-fonte foi identificado em 87,5% dos casos mas verificamos uma subnotificação dos acidentes pois 45,0% dos profissionais não o fizeram. Nenhum profissional frequentou formação específica sobre acidentes de trabalho Conclusões – Verificamos uma alta incidência de acidentes perfurocortantes entre os profisionais do SAMU. Existe uma subnotificação do acidente e um déficite nas condutas apropriadas após o acidente. A população estudada necessita de uma maior sensibilização/formação quanto às medidas preventivas de segurança no ambiente de trabalho e motivação para o controle e prevenção dos acidentes ocupacionais no exercício de sua profissão. Palavras-chave: Acidente de trabalho. Materiais biológicos. Materiais perfurocortantes.

Symposium on traffic safety effectiveness (impact) evaluation projects. Final report.

National Highway Traffic Safety Administration, Office of Program and Demonstration Evaluation, Washington, D.C.

An investigation of used car safety: final report. Volume I-summary and program plan.

Mode of access: Internet.

An investigation of used car safety: final report. Volume II-Qualitative evaluation.

Mode of access: Internet.

An investigation of used car safety: final report. Volume IV. Quantitative evaluation, part 2: economic considerations.

Mode of access: Internet.

Regional safety program management seminars. Volume I of II. Final report.

National Highway Safety Bureau, Washington, D.C.

Multiple component patient safety intervention in English hospitals:controlled evaluation of second phase

Objective: To independently evaluate the impact of the second phase of the Health Foundation's Safer Patients Initiative (SPI2) on a range of patient safety measures. Design: A controlled before and after design. Five substudies: survey of staff attitudes; review of case notes from high risk (respiratory) patients in medical wards; review of case notes from surgical patients; indirect evaluation of hand hygiene by measuring hospital use of handwashing materials; measurement of outcomes (adverse events, mortality among high risk patients admitted to medical wards, patients' satisfaction, mortality in intensive care, rates of hospital acquired infection). Setting: NHS hospitals in England. Participants: Nine hospitals participating in SPI2 and nine matched control hospitals. Intervention The SPI2 intervention was similar to the SPI1, with somewhat modified goals, a slightly longer intervention period, and a smaller budget per hospital. Results: One of the scores (organisational climate) showed a significant (P=0.009) difference in rate of change over time, which favoured the control hospitals, though the difference was only 0.07 points on a five point scale. Results of the explicit case note reviews of high risk medical patients showed that certain practices improved over time in both control and SPI2 hospitals (and none deteriorated), but there were no significant differences between control and SPI2 hospitals. Monitoring of vital signs improved across control and SPI2 sites. This temporal effect was significant for monitoring the respiratory rate at both the six hour (adjusted odds ratio 2.1, 99% confidence interval 1.0 to 4.3; P=0.010) and 12 hour (2.4, 1.1 to 5.0; P=0.002) periods after admission. There was no significant effect of SPI for any of the measures of vital signs. Use of a recommended system for scoring the severity of pneumonia improved from 1.9% (1/52) to 21.4% (12/56) of control and from 2.0% (1/50) to 41.7% (25/60) of SPI2 patients. This temporal change was significant (7.3, 1.4 to 37.7; P=0.002), but the difference in difference was not significant (2.1, 0.4 to 11.1; P=0.236). There were no notable or significant changes in the pattern of prescribing errors, either over time or between control and SPI2 hospitals. Two items of medical history taking (exercise tolerance and occupation) showed significant improvement over time, across both control and SPI2 hospitals, but no additional SPI2 effect. The holistic review showed no significant changes in error rates either over time or between control and SPI2 hospitals. The explicit case note review of perioperative care showed that adherence rates for two of the four perioperative standards targeted by SPI2 were already good at baseline, exceeding 94% for antibiotic prophylaxis and 98% for deep vein thrombosis prophylaxis. Intraoperative monitoring of temperature improved over time in both groups, but this was not significant (1.8, 0.4 to 7.6; P=0.279), and there were no additional effects of SPI2. A dramatic rise in consumption of soap and alcohol hand rub was similar in control and SPI2 hospitals (P=0.760 and P=0.889, respectively), as was the corresponding decrease in rates of Clostridium difficile and meticillin resistant Staphylococcus aureus infection (P=0.652 and P=0.693, respectively). Mortality rates of medical patients included in the case note reviews in control hospitals increased from 17.3% (42/243) to 21.4% (24/112), while in SPI2 hospitals they fell from 10.3% (24/233) to 6.1% (7/114) (P=0.043). Fewer than 8% of deaths were classed as avoidable; changes in proportions could not explain the divergence of overall death rates between control and SPI2 hospitals. There was no significant difference in the rate of change in mortality in intensive care. Patients' satisfaction improved in both control and SPI2 hospitals on all dimensions, but again there were no significant changes between the two groups of hospitals. Conclusions: Many aspects of care are already good or improving across the NHS in England, suggesting considerable improvements in quality across the board. These improvements are probably due to contemporaneous policy activities relating to patient safety, including those with features similar to the SPI, and the emergence of professional consensus on some clinical processes. This phenomenon might have attenuated the incremental effect of the SPI, making it difficult to detect. Alternatively, the full impact of the SPI might be observable only in the longer term. The conclusion of this study could have been different if concurrent controls had not been used.

An Intelligent System for Investigations and Provision of Safety for Complex Constructions

Methodology of computer-aided investigation and provision of safety for complex constructions and a prototype of the intelligent applied system, which implements it, are considered. The methodology is determined by the model of the object under scrutiny, by the structure and functions of investigation of safety as well as by a set of research methods. The methods are based on the technologies of object-oriented databases, expert systems and on the mathematical modeling. The intelligent system’s prototype represents component software, which provides for support of decision making in the process of safety investigations and investigation of the cause of failure. Support of decision making is executed by analogy, by determined search for the precedents (cases) with respect to predicted (on the stage of design) and observed (on the stage of exploitation) parameters of the damage, destruction and malfunction of a complex hazardous construction.

Neurophysiological investigations for the diagnosis of non-epileptic attack disorder in neuropsychiatry services:from safety standards to improved effectiveness

OBJECTIVE: The discipline of clinical neuropsychiatry currently provides specialised services for a number of conditions that cross the traditional boundaries of neurology and psychiatry, including non-epileptic attack disorder. Neurophysiological investigations have an important role within neuropsychiatry services, with video-electroencephalography (EEG) telemetry being the gold standard investigation for the differential diagnosis between epileptic seizures and non-epileptic attacks. This article reviews existing evidence on best practices for neurophysiology investigations, with focus on safety measures for video-EEG telemetry. METHODS: We conducted a systematic literature review using the PubMed database in order to identify the scientific literature on the best practices when using neurophysiological investigations in patients with suspected epileptic seizures or non-epileptic attacks. RESULTS: Specific measures need to be implemented for video-EEG telemetry to be safely and effectively carried out by neuropsychiatry services. A confirmed diagnosis of non-epileptic attack disorder following video-EEG telemetry carried out within neuropsychiatry units has the inherent advantage of allowing diagnosis communication and implementation of treatment strategies in a timely fashion, potentially improving clinical outcomes and cost-effectiveness significantly. CONCLUSION: The identified recommendations set the stage for the development of standardised guidelines to enable neuropsychiatry services to implement streamlined and evidence-based care pathways.

Safety habits promoted by Hispanic parents for school-aged and adolescent children

Accidents are the leading cause of death among children. Compliance with safety measures have been shown to reduce morbidity and mortality in children. However, Hispanic parents and children have not been adequately studied in the literature in regard to trauma and safety habits utilized. In this exploratory-descriptive study, a convenience sample of 48 Hispanic parents were questioned about their child's activities. The purpose was to determine what safety equipment was used during these activities and how often they were used. Responses to an English/Spanish questionnaire were summarized by frequencies and percentages. Findings suggested that these Hispanic children were at risk for injury due to a low percentage of children wearing the necessary protective equipment. Therefore, education must stress consistent use of safety equipment if injuries are to be prevented. ^

2013-2014 annual report

Piedmont Technical College submits an annual report to the Governor and General Assembly. The report covers the mission, objectives to accomplish the mission, and performance measures that show the degree to which objectives are being met.