Delivering Healthcare to the Armed Forces (PDF 88 KB)

A Protocol for Ensuring Equitable Access to Health and Social Care Services

Forces de Casimir i les seves aplicacions

Report for the scientific sojourn carried out at the Darmouth College, from august 2007 until february 2008. It has been very successful, from different viewpoints: scientific, philosophical, human. We have definitely advanced, during the past six months, towards the comprehension of the behaviour of the fluctuations of the quantum vacuum in the presence of boundaries, moving and non-moving, and also in situations where the topology of space-time changes: the dynamical Casimir effect, regularization problems, particle creation statistics, according to different BC, etc. We have solved some longstanding problems and got in this subject quite remarkable results (as we will explain in more detail below). We also pursued a general approach towards a viable modified f(R) gravity in both the Jordan and the Einstein frames (which are known to be mathematically equivalent, but physically not so). A class of exponential, realistic modified gravities has been introduced by us and investigated with care. Special focus was made on step-class models, most promising from the phenomenological viewpoint and which provide a natural way to classify all viable modified gravities. One- and two-steps models were considered, but the analysis is extensible to N-step models. Both inflation in the early universe and the onset of recent accelerated expansion arise in these models in a natural, unified way, what makes them very promising. Moreover, it is monstrated in our work that models in this category easily pass all local tests, including stability of spherical body solution, non-violation of Newton's law, and generation of a very heavy positive mass for the additional scalar degree of freedom.

Metastatic spinal cord compression: Full Guideline

Metastatic spinal cord compression: Diagnosis and management of patients at risk of or with metastatic spinal cord compressionThis Guideline is published in recognition that patients with metastatic spinal cord compression (MSCC) sometimes suffer delays and avoidable disability. It considers the available evidence and makes recommendations (to ensure that facilities are available and treatment is co-ordinated) to promote best practice and whenever possible to prevent paralysis from adversely affecting the quality of life for people with metastatic cancer.

Metastatic spinal cord compression: Implementing NICE guidance

Metastatic spinal cord compression: Implementing NICE guidanceThis presentation has been written to help you raise awareness of the NICE clinical guideline on Metastatic spinal cord compression: Diagnosis & management of adults at risk of and with MSCC. This guideline has been written for healthcare professionals and other staff who care for people with metastatic spinal cord compression..

Local and regional drugs task forces: handbook.

This handbook has been developed within the context of the institutional structures recommended under the National Drugs Strategy 2009-2016 and within the overall framework of the National Social Inclusion Plan 2007-2016. It sets out the role of the Drugs Task Forces within the national and local framework required to address the existing and emerging problems associated with drug use for individuals, families and communities in the context of the long term development of the work of the Drugs Task Forces.This resource was contributed by The National Documentation Centre on Drug Use.

A survey on the enlistment of pharmacists in a hospital battalion of the Swiss Armed Forces

Background: Pharmacists, mainly militiamen, are incorporated in the Swiss Armed Forces, for instance in hospital battalions to supply drugs and medical devices, as well as to coordinate hygiene service. Presently, their duties are only very globally defined. Aims: The objective of this survey was to investigate the tasks that were actually assumed by the military pharmacy of the 2nd Hospital Battalion. Methods: Two types of commitments, offering military and civilian interest's convergence, were considered between 2005 and 2011: (1) army camps for the disabled and (2) operations and supports provided to two nursing homes. While relieving the civil caregiver usually involved with disabled or elderly people, such missions offer indeed the possibility to the army medical service to train its care and logistical processes with real patients, even in the absence of any sanitary crisis or war in the country. Results: Two basis activities have been assumed: (1) centralized supply of drugs and medical devices and (2) coordination of hygiene monitoring and disinfection operations. New tasks were also performed: (3) support to the management of ward-based pharmacies, (4) pillboxes preparation, (5) medication review and (6) selective participation in clinical rounds. The last two were integrated in an interdisciplinary education process. Conclusions: Results shows that, apart from traditional duties, new clinical-oriented activities have been evenly developed and assumed by militia pharmacists. They call thus for a possible renewed definition of the tasks of military hospital pharmacists and of their related military education. A wider study in all hospital battalions is yet mandatory.

Compression-based Image Registration

Image registration is an important component of image analysis used to align two or more images. In this paper, we present a new framework for image registration based on compression. The basic idea underlying our approach is the conjecture that two images are correctly registered when we can maximally compress one image given the information in the other. The contribution of this paper is twofold. First, we show that the image registration process can be dealt with from the perspective of a compression problem. Second, we demonstrate that the similarity metric, introduced by Li et al., performs well in image registration. Two different versions of the similarity metric have been used: the Kolmogorov version, computed using standard real-world compressors, and the Shannon version, calculated from an estimation of the entropy rate of the images

Simulated joint and muscle forces in reversed and anatomic shoulder prostheses.

Reversed shoulder prostheses are increasingly being used for the treatment of glenohumeral arthropathy associated with a deficient rotator cuff. These non-anatomical implants attempt to balance the joint forces by means of a semi-constrained articular surface and a medialised centre of rotation. A finite element model was used to compare a reversed prosthesis with an anatomical implant. Active abduction was simulated from 0 degrees to 150 degrees of elevation. With the anatomical prosthesis, the joint force almost reached the equivalence of body weight. The joint force was half this for the reversed prosthesis. The direction of force was much more vertically aligned for the reverse prosthesis, in the first 90 degrees of abduction. With the reversed prosthesis, abduction was possible without rotator cuff muscles and required 20% less deltoid force to achieve it. This force analysis confirms the potential mechanical advantage of reversed prostheses when rotator cuff muscles are deficient.

Resuscitated sudden cardiac death caused by left main coronary artery compression by an aneurysm of the sinus of Valsalva.

A 49-year-old woman, without known cardiovascular risk factors. Hoarseness of voice caused by a paralysis of left vocal cord. She was admitted to hospital because of acute coronary syndrome, associated to resuscitated cardiac arrest (asystolia documented) without later neurology sequels. Physical examination was anodyne. Echocardiographic study demonstrated a compatible image with a large left sinus of Valsalva aneurysm (SVA) (Panel A) and mild aortic regurgitation. Cardiac catheterization confirmed the presence of left SVA (Panel B) that produced extrinsic compression of the left main coronary artery (Panels C and D). Repair surgery was made by means of closing the aneurysmal orifice with a patch of dacron. Intra-operatory echocardiographic control study found severe aortic regurgitation, so valvular replacement with 19 mm mechanical prosthesis and extension of the valve annulus with patch of dacron was performed, associated with bypass with safena vein graft to left coronary artery. SVA is a very infrequent cardiac anomaly, generally with silent clinical course until it ruptures. Myocardial ischaemia caused by coronary artery compression is unusual. We described the case of a patient diagnosed of left SVA, whose initial clinical manifestation was the appearance of resuscitated sudden cardiac death in the context of an acute coronary syndrome.

Statistical similarity between the compression of a porous material and earthquakes

It has been long stated that there are profound analogies between fracture experiments and earthquakes; however, few works attempt a complete characterization of the parallelisms between these so separate phenomena. We study the Acoustic Emission events produced during the compression of Vycor (SiO&sub&2&/sub&). The Gutenberg-Richter law, the modified Omori's law, and the law of aftershock productivity hold for a minimum of 5 decades, are independent of the compression rate, and keep stationary for all the duration of the experiments. The waiting-time distribution fulfills a unified scaling law with a power-law exponent close to 2.45 for long times, which is explained in terms of the temporal variations of the activity rate.

The cervico-thoracic outlet compression syndrome. Analysis of surgical treatment.

Surgical treatment of the thoracic outlet compression syndrome is being presently reconsidered. Until these last few years, there was the choice between two interventions only: scalenotomy, a simple operation entailing no complication, but with a 60% recurrence rate--or the resection of the first rib through an axillary approach, an efficacious intervention which caused, however, serious nervous complications in 14% of treated cases. The follow-up of 75 cases operated for a TOCS reveals to the authors that--all techniques taken into account--results are unsatisfactory in 33% of cases. These failures are due either to technical deficiencies, or to a complication arising in the course of the operation, or to an erroneous diagnosis. The authors resort to surgery only to treat serious vascular syndromes (absolute indication) or invalidating neurological compression syndromes, after failure of physical therapy (relative indication). They propose a cervical approach--the only one enabling a safe dissection of the brachial plexus--a partial scalenectomy, resection of all fibrous bands pressing on nervous trunks, or the resection of a cervical rib. Should the costo-clavicular space appear anatomically too narrow, the first rib, already partially freed by the cervical approach, will be resected through the axillary route.

Safety and efficacy in gamma knife radiosurgery for trigeminal neuralgia due to megadolichbasilar artery compression: a prospective series of 29 consecutive patients

Purpose: To analyse prospectively the long-term results of Gamma Knife surgery (GKS) in patients with trigeminal neuralgia secondary to megadolichobasilar artery (MBA). Methods: Between December 1992 and November 2010, 33 consecutive patients presenting with ITN secondary to MBA were operated by GKS and followed prospectively in Timone University Hospital. The follow up is at least of 1 year in 29 patients. The median age was 74.90 years (range 51 to 90). The GKS typically was performed using MR and CT imaging guidance and a single 4 mm isocenter. The median of the prescription dose (at the 100%) was 90 Gy (range 80 to 90). The target was placed on the cisternal portion of the Vth nerve. Clinical and dosimetric parameters were analyzed. GKS was the first surgical procedure in 23 patients (79.31%). Results: The median follow- up period was 46.12 months (range 12.95 to 157.93). All the 29 patients (100%) were initially pain free in a median time of 13.5 days (range 0 to 240). The probability of remaining pain free at 0.5, 1, 2 years was 93.1%, 79.3% and 75.7% respectively, reaching at this time the flat part of the curve. Seven patients (24.13%) experienced a recurrence with a median delay of 10.75 months (range 3.77 to 12.62). The actuarial rate of recurrence was not higher than in our population with essential TN although atypical pain was associated with a much higher risk of recurrence (HR= 6.92, p= 0.0117). The hypoesthesia actuarial rates at 0.5 years was 4.3% and at 1 year reach 13% and remains stable till 12 years with a median delay of onset of 7 (5, 12) months. Female patients had a statistically much lower probability of developing a facial numbness (p of 0.03). No patient reported a bothersome hypoesthesia. Conclusion: Retrogaserian, high dose GKS, turned out to be very safe with only 13.04% hypoesthesia, which was never disabling (0%), while achieving high quality pain control. The majority of the patients demonstrated a prolonged effect of radiosurgery in absence of any trigeminal nerve disturbance.

Forces

Aquest treball descriu una unitat didàctica de Física per estudiants de 4rt d’ESO. Els següents conceptes son introduïts i practicats durant un total de nou sessions: massa i pes, diferents tipus de forces, representació vectorial de forces, i dinàmica. A més dels exercicis de classe estàndard, els alumnes són exposats a dos laboratoris virtuals diferents que els ajuden a visualitzar i explorar els conceptes esmentats. Els estudiants més motivats poden escollir fer exercicis addicionals d’una llista d’activitats lliures. La unitat inclou una descripció completa de totes les activitats proposades.