A European survey on current practices in epilepsy monitoring units and implications for patients' safety.

OBJECTIVE: This study aimed to survey current practices in European epilepsy monitoring units (EMUs) with emphasis on safety issues. METHODS: A 37-item questionnaire investigating characteristics and organization of EMUs, including measures for prevention and management of seizure-related serious adverse events (SAEs), was distributed to all identified European EMUs plus one located in Israel (N=150). RESULTS: Forty-eight (32%) EMUs, located in 18 countries, completed the questionnaire. Epilepsy monitoring unit beds are 1-2 in 43%, 3-4 in 34%, and 5-6 in 19% of EMUs; staff physicians are 1-2 in 32%, 3-4 in 34%, and 5-6 in 19% of EMUs. Personnel operating in EMUs include epileptologists (in 69% of EMUs), clinical neurophysiologists trained in epilepsy (in 46% of EMUs), child neurologists (in 35% of EMUs), neurology and clinical neurophysiology residents (in 46% and in 8% of EMUs, respectively), and neurologists not trained in epilepsy (in 27% of EMUs). In 20% of EMUs, patients' observation is only intermittent or during the daytime and primarily carried out by neurophysiology technicians and/or nurses (in 71% of EMUs) or by patients' relatives (in 40% of EMUs). Automatic detection systems for seizures are used in 15%, for body movements in 8%, for oxygen desaturation in 33%, and for ECG abnormalities in 17% of EMUs. Protocols for management of acute seizures are lacking in 27%, of status epilepticus in 21%, and of postictal psychoses in 87% of EMUs. Injury prevention consists of bed protections in 96% of EMUs, whereas antisuffocation pillows are employed in 21%, and environmental protections in monitoring rooms and in bathrooms are implemented in 38% and in 25% of EMUs, respectively. The most common SAEs were status epilepticus reported by 79%, injuries by 73%, and postictal psychoses by 67% of EMUs. CONCLUSIONS: All EMUs have faced different types of SAEs. Wide variation in practice patterns and lack of protocols and of precautions to ensure patients' safety might promote the occurrence and severity of SAEs. Our findings highlight the need for standardized and shared protocols for an effective and safe management of patients in EMUs.

Ethnic sensitive substance abuse work : services for non-Finnish speaking clients in substance abuse treatment units in Finland today

The purpose of this study was to examine the current situation in substance abuse treatment units in Finland in taking non-Finnish speaking clients into consideration. The initiative for this research came from the Development of Alcohol and Drugs Intervention group at Stakes (National Research and Development Centre for Welfare and Health). Their aim was to gather information about the functioning and relevance of the quality assessment forms based on the quality recommendations for substance abuse work, filled in by substance abuse treatment units. The ethnic issue was chosen as the main approach in the study. The aim of this research was to answer the following questions: what is the readiness and competence in substance abuse treatment units in Finland to receive and encounter non-Finnish speaking clients, how is the quality of these services assessed and/or developed in the units, and what has been the role and functioning of the quality recommendations and quality assessment forms in working with non-Finnish speaking clients. The research methods used in the study were both quantitative and qualitative. The information concerning language services provided in the units was gathered from the quality assessment forms and basic information forms found in the database maintained by Stakes. The total amount of units found in the database was 267. In addition to that, semi-structured theme-interviews were carried out in four substance abuse treatment units in order to get a more deep understanding of how the services function in practice. The few number of non-Finnish speaking clients in the units may explain to a certain degree the results of the research. The results however showed that there is still space for improving the services. In the light of quality recommendations, the degree of language options provided in substance abuse treatment units in Finland today is low. Also the quantity of interpreter services provided in the units is scarce. There could also be unified guidelines specially tailored for substance abuse treatment units on how to work with ethnic minorities, as the knowledge is currently adopted from several different instances. The quality recommendations as well as quality assessment forms were valued and applied in the units appropriately and were also perceived to have an effect on the functioning, and quality, in the units.

An Analysis of Eye Scanpath Entropy in a Progressively Forming Virtual Environment

A sign of presence in virtual environments is that people respond to situations and events as if they were real, where response may be considered at many different levels, ranging from unconscious physiological responses through to overt behavior,emotions, and thoughts. In this paper we consider two responses that gave different indications of the onset of presence in a gradually forming environment. Two aspects of the response of people to an immersive virtual environment were recorded: their eye scanpath, and their skin conductance response (SCR). The scenario was formed over a period of 2 min, by introducing an increasing number of its polygons in random order in a head-tracked head-mounted display. For one group of experimental participants (n 8) the environment formed into one in which they found themselves standing on top of a 3 m high column. For a second group of participants (n 6) the environment was otherwise the same except that the column was only 1 cm high, so that they would be standing at normal ground level. For a third group of participants (n 14) the polygons never formed into a meaningful environment. The participants who stood on top of the tall column exhibited a significant decrease in entropy of the eye scanpath and an increase in the number of SCR by 99 s into the scenario, at a time when only 65% of the polygons had been displayed. The ground level participants exhibited a similar decrease in scanpath entropy, but not the increase in SCR. The random scenario grouping did not exhibit this decrease in eye scanpath entropy. A drop in scanpath entropy indicates that the environment had cohered into a meaningful perception. An increase in the rate of SCR indicates the perception of an aversive stimulus. These results suggest that on these two dimensions (scanpath entropy and rate of SCR) participants were responding realistically to the scenario shown in the virtual environment. In addition, the response occurred well before the entire scenario had been displayed, suggesting that once a set of minimal cues exists within a scenario,it is enough to form a meaningful perception. Moreover, at the level of the sympathetic nervous system, the participants who were standing on top of the column exhibited arousal as if their experience might be real. This is an important practical aspect of the concept of presence.

The star forming region Monoceros R2 as a gamma-ray source

After the release of the gamma-ray source catalog produced by the Fermi satellite during its first two years of operation, a significant fraction of sources still remain unassociated at lower energies. In addition to well-known high-energy emitters (pulsars, blazars, supernova remnants, etc.), theoretical expectations predict new classes of gamma-ray sources. In particular, gamma-ray emission could be associated with some of the early phases of stellar evolution, but this interesting possibility is still poorly understood. Aims: The aim of this paper is to assess the possibility of the Fermi gamma-ray source 2FGL J0607.5-0618c being associated with the massive star forming region Monoceros R2. Methods: A multi-wavelength analysis of the Monoceros R2 region is carried out using archival data at radio, infrared, X-ray, and gamma-ray wavelengths. The resulting observational properties are used to estimate the physical parameters needed to test the different physical scenarios. Results: We confirm the 2FGL J0607.5-0618c detection with improved confidence over the Fermi two-year catalog. We find that a combined effect of the multiple young stellar objects in Monoceros R2 is a viable picture for the nature of the source.

Fluoriditasetarkastelu ja päästöjen hallinta ferrokromi- ja terästeollisuudessa

Työn alkuosassa kartoitettiin AvestaPolarit –yhtiöiden Tornion tehtaiden keskeiset fluoridilähteet kuten fluspaatti, valukuonat, valupulverit ja fluorivetyhappo. Valupulverien ja kuonien haihtumis- ja liukoisuuskäyttäytymistä valaistiin kotimaisten ja kansainvälisten tutkimusten avulla. Tutkimustuloksia sovellettiin pääpiirteittäin Tornion tehtaiden tilanteeseen ottamalla huomioon tekijät, jotka saattoivat lieventää tai vahvistaa fluoridien vaikutusta ympäristöön. Yleisesti fluoridien ympäristö- ja terveysvaikutukset arvioitiin vähäisiksi. Työn kokeellisessa osassa määritettiin Tornion tehtaiden ferrokromitehtaan, terässulaton, kuumavalssaamon ja kylmävalssaamon fluoriditaseet. Jokaisen osastojen syötteiden fluoridipitoisuudet selvitettiin tuottajien ilmoittamien tuotekoostumuksien, spesifikaatioiden ja fluoridianalyysien perusteella. Fluoridien kokonaismäärät laskettiin jokaiselle syötteelle ja ne suhteutettiin kunkin osaston vuoden 2001 tuotantotasoon. Tasetarkastelussa suurimpina fluoridisyötteinä nousivat odotetusti esiin terässulaton käyttämä kuonanmuodostaja-aine fluspaatti (CaF2) ja kylmävalssaamon peittaushappo, 70 prosenttinen fluorivetyhappo (HF). Lisäksi muita merkittäviä syötteitä olivat kylmävalssaamon käyttämä kalkkipitoinen sekakuona ja ferrokromitehtaan sulatuskoksi. Tuotoksien eli päästöjen fluoridipitoisuudet saatiin selville päästömittauksin. Jätevesistä otettiin pääosin viikoittaisia kokoomanäytteitä, jotka analysoitiin tehtaan laboratoriossa. Kaasumaiset tuotokset oli määritetty kertamittauksien perusteella. Kiinteiden tuotoksien eli sakkojen ja kuonien fluoridimittaukset suoritettiin 3 sulatuksen kuonanäytteistä ja sakan vuosinäytteestä. Tuotoksista suurimmat ominaispäästökertoimet olivat juuri terässulaton AOD-konvertterin ja senkkauunin kuonilla ja kylmävalssaamon neutraloidulla regenerointisakalla ja neutralointisakoilla. Näistä ei aiheutunut varsinaista päästöä lähiympäristöön, koska sakat ja kuonat loppusijoitetaan tehtaan kaatopaikalle tai niitä käytetään liukenemattomassa muodossa. Tornion tehtaiden fluoridisyötteiden ja -tuotoksien mittausepätarkkuudet vaikuttivat fluoriditaseeseen. Ferrokromitehtaan fluoridisyötteet olivat kokonaismäärältään selvästi suurempia kuin tuotokset. Terässulaton fluoriditaseen tuotokset olivat suurempia kuin syötteet ja kylmävalssaamon syötteet sekä tuotokset olivat karkeasti arvioiden samaa suuruusluokkaa. Kuumavalssaamon fluoridisyötteet ja -tuotokset olivat mitättömiä. Fluoriditaseen epävarmuustekijöitä voidaan vähentää suorittamalla esimerkiksi useita fluoridimittauksia kaasumaisista päästöistä.

Paperikoneen viira- ja puristinosan mitoituslaskennan ohjeistaminen

Työssä laadittiin viira- ja puristinosan rungoston mitoituslaskentaa varten ohjeet FE-analysointiin. Työ suoritettiin keräämällä aluksi eri yksiköissä Valmetilla käytössä olevat mitoituslaskentaohjeet, aihetta käsittelevät muistiot ja diplomityöt sekä sekä keskustelemalla muiden viira- ja puristinosastolla laskentaa suorittavien suunnittelijoiden kanssa. Tämän jälkeen ohjeista koottiin ja täydennettiin yksi yhteinen ohjeisto, joka on jatkossa kaikkien laskijoiden käytössä. Valmiit ohjeet koottiin Valmetin Rautpohjan osastoiden yhteiseen Notes- järjestelmään. Ohjekannasta tehtiin sellainen, että siihen on helppo myöhemmin lisätä muiden rakenneryhmien ohjeita. Ohjeet jaettiin viiteen ryhmään ohjeiden lukemisen ja päivityksen helpottamiseksi. Mitoituslaskentaohjeiden käyttöä testattiin laskemalla yhden todellisen projektin puristinosan runkolaskelmat ohjeiden avulla. Yhteisen ohjeistuksen avulla yhtenäistettiin mallinnus- ja laskentatapoja niin Valmetin sisällä kuin mitoituslaskentaa tekevien alihankkijoiden keskuudessa.

Improved predictive mapping of indoor radon concentrations using ensemble regression trees based on automatic clustering of geological units.

PURPOSE: According to estimations around 230 people die as a result of radon exposure in Switzerland. This public health concern makes reliable indoor radon prediction and mapping methods necessary in order to improve risk communication to the public. The aim of this study was to develop an automated method to classify lithological units according to their radon characteristics and to develop mapping and predictive tools in order to improve local radon prediction. METHOD: About 240 000 indoor radon concentration (IRC) measurements in about 150 000 buildings were available for our analysis. The automated classification of lithological units was based on k-medoids clustering via pair-wise Kolmogorov distances between IRC distributions of lithological units. For IRC mapping and prediction we used random forests and Bayesian additive regression trees (BART). RESULTS: The automated classification groups lithological units well in terms of their IRC characteristics. Especially the IRC differences in metamorphic rocks like gneiss are well revealed by this method. The maps produced by random forests soundly represent the regional difference of IRCs in Switzerland and improve the spatial detail compared to existing approaches. We could explain 33% of the variations in IRC data with random forests. Additionally, the influence of a variable evaluated by random forests shows that building characteristics are less important predictors for IRCs than spatial/geological influences. BART could explain 29% of IRC variability and produced maps that indicate the prediction uncertainty. CONCLUSION: Ensemble regression trees are a powerful tool to model and understand the multidimensional influences on IRCs. Automatic clustering of lithological units complements this method by facilitating the interpretation of radon properties of rock types. This study provides an important element for radon risk communication. Future approaches should consider taking into account further variables like soil gas radon measurements as well as more detailed geological information.

Dépistage du risque d'allergie et prévention en maternité : enquête des pratiques AllerNaiss [Screening for the risk of allergy and prevention in French maternity units: A survey].

Allergy has been on the rise for half a century and concerns nearly 30% of children; it has now become a real public health problem. The guidelines on prevention of allergy set up by the French Society of Paediatrics (SFP) and the European Society of Paediatric Allergology and Clinical Immunology (ESPACI) are based on screening children at risk through a systematic search of the family history and recommend, for children at risk, exclusive breastfeeding whenever possible or otherwise utilization of hypoallergenic infant formula, which has demonstrated efficacy. The AllerNaiss practice survey assessed the modes of screening and prevention of allergy in French maternity units in 2012. The SFP guidelines are known by 82% of the maternity units that took part in the survey, and the ESPACI guidelines by 55% of them. A screening strategy is in place in 59% of the participating maternity wards, based on local consensus for 36% of them, 13% of the units having a written screening procedure. Screening is based on the search for a history of allergy in first-degree relatives (99%) during pregnancy (51%), in the delivery room (50%), and after delivery (89%). A mode of prevention of the risk of allergy exists in 62% of the maternity units, most often in writing (49%). A hypoallergenic infant formula is prescribed for non-breastfed children in 90% of the units. The survey shows that there is a real need for formalization of allergy risk screening and prevention of allergy in newborns in French maternity units.

A reappraisal of 'International Stratigraphic Lexicon' and the need for the creation named units critical catalogues

Analysis of stratigraphic terminology and classification, shows that time-related stratigraphic units, which by definition have a global extent, are the concern of international cornrnissions and committees of the intemational Union of Geological Sciences (IUGS) . In contrast, lithostratigraphic, and other closely related units, are regional in extent and are catalogued in the International Stratigraphic Lexicon (ISL), the last volume of which, was published in 1987. Tlie intemational Commission on Stratigraphy (ICS) is currently attempting to revitalize the publication of ISL, given that the information contained in published volumes has never been updated, and that there has been a significant increase in stratigraphic research in recent decades. The proliferation of named units in the South Pyrenean and Ebro Basin Paleogene is evaluated to illustrate the extent of the problem. Moreover, new approaches to stratigraphic analysis have led to the naming of genetic units according to similar guidelines followed in the naming of descnptive or lithostratigraphic units. This has led to considerable confusion. The proposal to revitalize the ISL is accepted as part of the solution, that should also include the publication of critica1 catalogues, and the creation of norms for genetic unit terminology.

Aerosol therapy in intensive and intermediate care units: prospective observation of 2808 critically ill patients.

PURPOSE: Unlike in the outpatient setting, delivery of aerosols to critically ill patients may be considered complex, particularly in ventilated patients, and benefits remain to be proven. Many factors influence aerosol delivery and recommendations exist, but little is known about knowledge translation into clinical practice. METHODS: Two-week cross-sectional study to assess the prevalence of aerosol therapy in 81 intensive and intermediate care units in 22 countries. All aerosols delivered to patients breathing spontaneously, ventilated invasively or noninvasively (NIV) were recorded, and drugs, devices, ventilator settings, circuit set-up, humidification and side effects were noted. RESULTS: A total of 9714 aerosols were administered to 678 of the 2808 admitted patients (24 %, CI95 22-26 %), whereas only 271 patients (10 %) were taking inhaled medication before admission. There were large variations among centers, from 0 to 57 %. Among intubated patients 22 % (n = 262) received aerosols, and 50 % (n = 149) of patients undergoing NIV, predominantly (75 %) inbetween NIV sessions. Bronchodilators (n = 7960) and corticosteroids (n = 1233) were the most frequently delivered drugs (88 % overall), predominantly but not exclusively (49 %) administered to patients with chronic airway disease. An anti-infectious drug was aerosolized 509 times (5 % of all aerosols) for nosocomial infections. Jet-nebulizers were the most frequently used device (56 %), followed by metered dose inhalers (23 %). Only 106 (<1 %) mild side effects were observed, despite frequent suboptimal set-ups such as an external gas supply of jet nebulizers for intubated patients. CONCLUSIONS: Aerosol therapy concerns every fourth critically ill patient and one-fifth of ventilated patients.

Colony-colony interactions between highly invasive ants

Among invasive species, ants are a particularly prominent group with enormous impacts on native biodiversity and ecosystem functioning. Globalization and on-going climate change are likely to increase the rate of ant invasions in the future, leading to simultaneous introductions of several highly invasive species within the same area, Here, we investigate pairwise interactions among four highly invasive species, Linepithema humile,Lashis neglectus, Pheidole megacephala and Wasmannia auropunctata, at the whole colony level, using a laboratory set-up. :Each colony consisted of 300 workers and one queen. The number of surviving workers in the competing colonies was recorded daily over 7 weeks. We modelled the survival of each colony during pairwise colony interactions, using a nonlinear model characterizing the survival dynamics of each colony individually. The least dominant species was P. megacephala, which always went extinct. Interactions among the three other species showed more complex dynamics, rendering the outcome of the interactions less predictable. Overall, W auropunctata and L neglectus were the most dominant species. This study shows the importance of scaling up to the colony level in order to gain realism in predicting the outcome of multiple invasions.