Severity assessment tools in ICU patients with 2009 influenza A (H1N1) pneumonia.

The aim of this study was to determine if severity assessment tools (general severity of illness and community-acquired pneumonia specific scores) can be used to guide decisions for patients admitted to the intensive care unit (ICU) due to pandemic influenza A pneumonia. A prospective, observational, multicentre study included 265 patients with a mean age of 42 (±16.1) years and an ICU mortality of 31.7%. On admission to the ICU, the mean pneumonia severity index (PSI) score was 103.2 ± 43.2 points, the CURB-65 score was 1.7 ± 1.1 points and the PIRO-CAP score was 3.2 ± 1.5 points. None of the scores had a good predictive ability: area under the ROC for PSI, 0.72 (95% CI, 0.65-0.78); CURB-65, 0.67 (95% CI, 0.59-0.74); and PIRO-CAP, 0.64 (95% CI, 0.56-0.71). The PSI score (OR, 1.022 (1.009-1.034), p 0.001) was independently associated with ICU mortality; however, none of the three scores, when used at ICU admission, were able to reliably detect a low-risk group of patients. Low risk for mortality was identified in 27.5% of patients using PIRO-CAP, but above 40% when using PSI (I-III) or CURB65 (<2). Observed mortality was 13.7%, 13.5% and 19.4%, respectively. Pneumonia-specific scores undervalued severity and should not be used as instruments to guide decisions in the ICU.

Use of quality assessment tools in systematic reviews was varied and inconsistent

OBJECTIVES To assess the use of quality assessment tools among a cross-section of systematic reviews (SRs) and to further evaluate whether quality was used as a parameter in the decision to include primary studies within subsequent meta-analysis. STUDY DESIGN AND SETTING We searched PubMed for SRs (interventional, observational, and diagnostic) published in Core Clinical Journals between January 1 and March 31, 2014. RESULTS Three hundred nine SRs were identified. Quality assessment was undertaken in 222 (71.8%) with isolated use of the Cochrane risk of bias tool (26.1%, n = 58) and the Newcastle-Ottawa Scale (15.3%, n = 34) most common. A threshold level of primary study quality for subsequent meta-analysis was used in 12.9% (40 of 309) of reviews. Overall, fifty-four combinations of quality assessment tools were identified with a similar preponderance of tools used among observational and interventional reviews. Multiple tools were used in 11.7% (n = 36) of SRs overall. CONCLUSION We found that quality assessment tools were used in a majority of SRs; however, a threshold level of quality for meta-analysis was stipulated in just 12.9% (n = 40). This cross-sectional analysis provides further evidence of the need for more active or intuitive editorial processes to enhance the reporting of SRs.

Environmental assessment of low speed policies for motor vehicle mobility in city centres

streets in local residential areas in large cities, real traffic tests for pollutant emissions and fuel consumption have been carried out in Madrid city centre. Emission concentration and car activity were simultaneously measured by a Portable Emissions Measurement System. Real life tests carried out at different times and on different days were performed with a turbo-diesel engine light vehicle equipped with an oxidizer catalyst and using different driving styles with a previously trained driver. The results show that by reducing the speed limit from 50 km h-1 to 30 km h-1, using a normal driving style, the time taken for a given trip does not increase, but fuel consumption and NOx, CO and PM emissions are clearly reduced. Therefore, the main conclusion of this work is that reducing the speed limit in some narrow streets in residential and commercial areas or in a city not only increases pedestrian safety, but also contributes to reducing the environmental impact of motor vehicles and reducing fuel consumption. In addition, there is also a reduction in the greenhouse gas emissions resulting from the combustion of the fuel.

Oil and Gas Environmental Documentation Guidance Based on Existing Environmental Assessment Documentation

The hard push for domestic oil and gas production suggests a developing divergence from environmentally sound practices. As states feel the pressure to match energy growth to national need, adequate consideration for the surrounding environment should continue to be a high priority. Through an analyses of twelve environmental assessment documents, recommendations for an oil and gas specific environmental assessment documentation guidance has been created. Guidance recommendations for the affected environment, mitigation options, alternatives, public comment process and the overall approach to an environmental assessment document is outlined within this capstone.

Herbert Hoover national historic site, interpretive prospectus (1971) B1; Natural resources management plan (1980) B2; Cultural resources management plan (1981) B3; Annual statement for interpretation and visitor services B4; Snowmobile use, environmental assessment (EA) : environmental impact statement.

Mode of access: Internet.

Pipe Spring National Monument (N.M.), interim interpretive plan, second draft (1977) B1; Master plan (1978) B2; Development concept plan, environmental assessment (EA) B3; Statement for management (1981) B4; Record of decision, draft development concept plan and Finding of no significant impact (FONSI) (1982) : environmental impact statement.

Mode of access: Internet.

Malin-Warner 230 kV transmission line construction (OR,CA), environmental assessment (EA), Finding of no significant impact (FONSI).

Mode of access: Internet.

BMB Enterprises Inc. right-of-way request for a hydroelectric generating facility, Deep Creek Mountains, environmental assessment (EA).

Mode of access: Internet.

Black Mountain public land disposal, supplement to Engen Mountain Development Corporation proposed winter sports area environmental assessment (EA), draft planning amendment environmental assessment (EA).

Mode of access: Internet.

Areawide environmental assessment on the development of a NEPA compliance strategy for new source coal mining activity in the western Kentucky coal field /

Mode of access: Internet.

Proposed 1986 amendments to the California Desert Conservation Area plan : environmental assessment /

"BLM CA TE 87 001 1792."

Environmental assessment of subsurface disposal of municipal wastewater treatment sludge : interim report ; prepared by Ronald Lofy.

"A current report on solid waste management"--Cover.

Environmental assessment of the exemption of motor gasoline from the mandatory allocation and price regulations.

Issued May 1978.

Guidelines for assessing the environmental impact of public mass transportation projects. Notebook 5: environmental assessment reference book. Final report.

Transportation Department, Office of Environment and Safety, Washington, D.C.

Women's Rights National Historical Park : draft general management plan/environmental assessment /

"June 1985"--Cover.