804 resultados para basic life support (BLS)
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Lodox Statscan provides high-speed, high-quality, low radiation, full body imaging in a single scan, combined with three-dimensional reconstructive and zooming functionality. Several trauma centres have incorporated it into their advanced trauma life support protocol. This review gives a brief overview of the system.
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INTRODUCTION: The incidence of bloodstream infection (BSI) in extracorporeal life support (ECLS) is reported between 0.9 and 19.5%. In January 2006, the Extracorporeal Life Support Organization (ELSO) reported an overall incidence of 8.78% distributed as follows: respiratory: 6.5% (neonatal), 20.8% (pediatric); cardiac: 8.2% (neonatal) and 12.6% (pediatric). METHOD: At BC Children's Hospital (BCCH) daily surveillance blood cultures (BC) are performed and antibiotic prophylaxis is not routinely recommended. Positive BC (BC+) were reviewed, including resistance profiles, collection time of BC+, time to positivity and mortality. White blood cell count, absolute neutrophile count, immature/total ratio, platelet count, fibrinogen and lactate were analyzed 48, 24 and 0 h prior to BSI. A univariate linear regression analysis was performed. RESULTS: From 1999 to 2005, 89 patients underwent ECLS. After exclusion, 84 patients were reviewed. The attack rate was 22.6% (19 BSI) and 13.1% after exclusion of coagulase-negative staphylococci (n = 8). BSI patients were significantly longer on ECLS (157 h) compared to the no-BSI group (127 h, 95% CI: 106-148). Six BSI patients died on ECLS (35%; 4 congenital diaphragmatic hernias, 1 hypoplastic left heart syndrome and 1 after a tetralogy repair). BCCH survival on ECLS was 71 and 58% at discharge, which is comparable to previous reports. No patient died primarily because of BSI. No BSI predictor was identified, although lactate may show a decreasing trend before BSI (P = 0.102). CONCLUSION: Compared with ELSO, the studied BSI incidence was higher with a comparable mortality. We speculate that our BSI rate is explained by underreporting of "contaminants" in the literature, the use of broad-spectrum antibiotic prophylaxis and a higher yield with daily monitoring BC. We support daily surveillance blood cultures as an alternative to antibiotic prophylaxis in the management of patients on ECLS.
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ABSTRACT: BACKGROUND: Pelvic x-ray is a routine part of the primary survey of polytraumatized patients according to Advanced Trauma Life Support (ATLS) guidelines. However, pelvic CT is the gold standard imaging technique in the diagnosis of pelvic fractures. This study was conducted to confirm the safety of a modified ATLS algorithm omitting pelvic x-ray in hemodynamically stable polytraumatized patients with clinically stable pelvis in favour of later pelvic examination by CT scan. METHODS: We conducted a retrospective analysis of all polytraumatized patients in our emergency room between 01.07.2004 and 31.01.2006. Inclusion criteria were blunt abdominal trauma, initial hemodynamic stability and a stable pelvis on clinical examination. We excluded patients requiring immediate intervention because of hemodynamic instability. RESULTS: We reviewed the records of n = 452 polytraumatized patients, of which n = 91 fulfilled inclusion criteria (56% male, mean age = 45 years). The mechanism of trauma included 43% road traffic accidents, 47% falls. In 68/91 (75%) patients, both a pelvic x-ray and a CT examination were performed; the remainder had only pelvic CT. In 6/68 (9%) patients, pelvic fracture was diagnosed by pelvic x-ray. None of these 6 patients was found having a false positive pelvic x-ray, i.e. there was no fracture on pelvic CT scan. In 3/68 (4%) cases a fracture was missed in the pelvic x-ray, but confirmed on CT (false negative on x-ray). None of the diagnosed fractures needed an immediate therapeutic intervention. 5 (56%) were classified type A fractures, and another 4 (44%) B 2.1 in computed tomography (AO classification). One A 2.1 fracture was found in a clinically stable patient who only received CT scan (1/23). CONCLUSION: While pelvic x-ray is an integral part of ATLS assessment, this retrospective study suggests that in hemodynamically stable patients with clinically stable pevis, its sensitivity is only 67% and it may safely be omitted in favor of a pelvic CT examination if such is planned in adjunct assessment and available. The results support the safety and utility of our modified ATLS algorithm. A randomized controlled trial using the algorithm can safely be conducted to confirm the results.
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BACKGROUND: Lodox-Statscan is a whole-body, skeletal and soft-tissue, low-dose X-ray scanner Anterior-posterior and lateral thoraco-abdominal studies are obtained in 3-5 minutes with only about one-third of the radiation required for conventional radiography. Since its approval by the Food and Drug Administration (FDA) in the USA, several trauma centers have incorporated this technology into their Advanced Trauma Life Support protocols. This review provides a brief overview of the system, and describes the authors' own experience with the system. METHODS: We performed a PubMed search to retrieve all references with 'Lodox' and 'Stat-scan' used as search terms. We furthermore used the google search engine to identify existing alternatives. To the best of our knowledge, this is the only FDA-approved device of its kind currently used in trauma. RESULTS AND CONCLUSION: The intention of our review has been to sensitize the readership that such alternative devices exist. The key message is that low dosage full body radiography may be an alternative to conventional resuscitation room radiography which is usually a prelude to CT scanning (ATLS algorithm). The combination of both is radiation intensive and therefore we consider any reduction of radiation a success. But only the future will show whether LS will survive in the face of low-dose radiation CT scanners and magnetic resonance imaging devices that may eventually completely replace conventional radiography.
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Hypoxic-ischaemic encephalopathy (HIE) is of major importance in neonatal and paediatric intensive care with regard to mortality and long-term morbidity. Our aim was to analyse our data in full-term neonates and children with special regard to withdrawal of life support and bad outcome. PATIENTS: All patients with HIE admitted to our unit from 1992-96 were analysed. Criteria for HIE were presence of a hypoxic insult followed by coma or altered consciousness with or without convulsions. Severity of HIE was assessed in neonates using Sarnat stages, and in children the duration of coma. In the majority of cases staging was completed with electrophysiological studies. Outcome was described using the Glasgow Outcome Scale. Bad outcome was defined as death, permanent vegetative state or severe disability, good outcome as moderate disability or good recovery. RESULTS: In the neonatal group (n = 38) outcome was significantly associated with Sarnat stages, presence of convulsions, severely abnormal EEG, cardiovascular failure, and multiple organ dysfunction (MOD). A bad outcome was observed in 27 cases with 14 deaths and 13 survivors. Supportive treatment was withdrawn in 14 cases with 9 subsequent deaths. In the older age group (n = 45) outcome was related to persistent coma of 24-48 h, severely abnormal EEG, cardiovascular failure, liver dysfunction and MOD. A bad outcome was found in 36 cases with 33 deaths and 3 survivors. Supportive treatment was withdrawn in 15 instances, all followed by death. CONCLUSIONS: Overall, neonates and older patients did not differ with regard to good or bad outcome. However, in the neonatal group there were significantly more survivors with bad outcome, either overall or after withdrawal of support. Possible explanations for this difference include variability of hypoxic insult, maturational and metabolic differences, and the more compliant neonatal skull, which prevents brainstem herniation.
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Current guidelines for the treatment of hypothermic cardiocirculatory arrest recommend extracorporeal life support and rewarming, using cardiopulmonary bypass or extracorporeal membrane oxygenation circuits. Both have design-related shortcomings which may result in prolonged reperfusion time or insufficient oxygen delivery to vital organs. This article describes clear advantages of minimally invasive extracorporeal circulation systems during emergency extracorporeal life support in hypothermic arrest. The technique of minimally invasive extracorporeal circulation for reperfusion and rewarming is represented by the case of a 59-year-old patient in hypothermic cardiocirculatory arrest at 25.3°C core temperature, with multiple trauma. With femoro-femoral cannulation performed under sonographic and echocardiographic guidance, extracorporeal life support was initiated using a minimally invasive extracorporeal circulation system. Perfusing rhythm was restored at 28°C. During rewarming on the mobile circuit, trauma surveys were completed and the treatment initiated. Normothermic weaning was successful on the first attempt, trauma surgery was completed and the patient survived neurologically intact. For extracorporeal resuscitation from hypothermic arrest, minimally invasive extracorporeal circulation offers all the advantages of conventional cardiopulmonary bypass and extracorporeal membrane oxygenation systems without their shortcomings.
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La tesis que se presenta tiene como propósito la construcción automática de ontologías a partir de textos, enmarcándose en el área denominada Ontology Learning. Esta disciplina tiene como objetivo automatizar la elaboración de modelos de dominio a partir de fuentes información estructurada o no estructurada, y tuvo su origen con el comienzo del milenio, a raíz del crecimiento exponencial del volumen de información accesible en Internet. Debido a que la mayoría de información se presenta en la web en forma de texto, el aprendizaje automático de ontologías se ha centrado en el análisis de este tipo de fuente, nutriéndose a lo largo de los años de técnicas muy diversas provenientes de áreas como la Recuperación de Información, Extracción de Información, Sumarización y, en general, de áreas relacionadas con el procesamiento del lenguaje natural. La principal contribución de esta tesis consiste en que, a diferencia de la mayoría de las técnicas actuales, el método que se propone no analiza la estructura sintáctica superficial del lenguaje, sino que estudia su nivel semántico profundo. Su objetivo, por tanto, es tratar de deducir el modelo del dominio a partir de la forma con la que se articulan los significados de las oraciones en lenguaje natural. Debido a que el nivel semántico profundo es independiente de la lengua, el método permitirá operar en escenarios multilingües, en los que es necesario combinar información proveniente de textos en diferentes idiomas. Para acceder a este nivel del lenguaje, el método utiliza el modelo de las interlinguas. Estos formalismos, provenientes del área de la traducción automática, permiten representar el significado de las oraciones de forma independiente de la lengua. Se utilizará en concreto UNL (Universal Networking Language), considerado como la única interlingua de propósito general que está normalizada. La aproximación utilizada en esta tesis supone la continuación de trabajos previos realizados tanto por su autor como por el equipo de investigación del que forma parte, en los que se estudió cómo utilizar el modelo de las interlinguas en las áreas de extracción y recuperación de información multilingüe. Básicamente, el procedimiento definido en el método trata de identificar, en la representación UNL de los textos, ciertas regularidades que permiten deducir las piezas de la ontología del dominio. Debido a que UNL es un formalismo basado en redes semánticas, estas regularidades se presentan en forma de grafos, generalizándose en estructuras denominadas patrones lingüísticos. Por otra parte, UNL aún conserva ciertos mecanismos de cohesión del discurso procedentes de los lenguajes naturales, como el fenómeno de la anáfora. Con el fin de aumentar la efectividad en la comprensión de las expresiones, el método provee, como otra contribución relevante, la definición de un algoritmo para la resolución de la anáfora pronominal circunscrita al modelo de la interlingua, limitada al caso de pronombres personales de tercera persona cuando su antecedente es un nombre propio. El método propuesto se sustenta en la definición de un marco formal, que ha debido elaborarse adaptando ciertas definiciones provenientes de la teoría de grafos e incorporando otras nuevas, con el objetivo de ubicar las nociones de expresión UNL, patrón lingüístico y las operaciones de encaje de patrones, que son la base de los procesos del método. Tanto el marco formal como todos los procesos que define el método se han implementado con el fin de realizar la experimentación, aplicándose sobre un artículo de la colección EOLSS “Encyclopedia of Life Support Systems” de la UNESCO. ABSTRACT The purpose of this thesis is the automatic construction of ontologies from texts. This thesis is set within the area of Ontology Learning. This discipline aims to automatize domain models from structured or unstructured information sources, and had its origin with the beginning of the millennium, as a result of the exponential growth in the volume of information accessible on the Internet. Since most information is presented on the web in the form of text, the automatic ontology learning is focused on the analysis of this type of source, nourished over the years by very different techniques from areas such as Information Retrieval, Information Extraction, Summarization and, in general, by areas related to natural language processing. The main contribution of this thesis consists of, in contrast with the majority of current techniques, the fact that the method proposed does not analyze the syntactic surface structure of the language, but explores his deep semantic level. Its objective, therefore, is trying to infer the domain model from the way the meanings of the sentences are articulated in natural language. Since the deep semantic level does not depend on the language, the method will allow to operate in multilingual scenarios, where it is necessary to combine information from texts in different languages. To access to this level of the language, the method uses the interlingua model. These formalisms, coming from the area of machine translation, allow to represent the meaning of the sentences independently of the language. In this particular case, UNL (Universal Networking Language) will be used, which considered to be the only interlingua of general purpose that is standardized. The approach used in this thesis corresponds to the continuation of previous works carried out both by the author of this thesis and by the research group of which he is part, in which it is studied how to use the interlingua model in the areas of multilingual information extraction and retrieval. Basically, the procedure defined in the method tries to identify certain regularities at the UNL representation of texts that allow the deduction of the parts of the ontology of the domain. Since UNL is a formalism based on semantic networks, these regularities are presented in the form of graphs, generalizing in structures called linguistic patterns. On the other hand, UNL still preserves certain mechanisms of discourse cohesion from natural languages, such as the phenomenon of the anaphora. In order to increase the effectiveness in the understanding of expressions, the method provides, as another significant contribution, the definition of an algorithm for the resolution of pronominal anaphora limited to the model of the interlingua, in the case of third person personal pronouns when its antecedent is a proper noun. The proposed method is based on the definition of a formal framework, adapting some definitions from Graph Theory and incorporating new ones, in order to locate the notions of UNL expression and linguistic pattern, as well as the operations of pattern matching, which are the basis of the method processes. Both the formal framework and all the processes that define the method have been implemented in order to carry out the experimentation, applying on an article of the "Encyclopedia of Life Support Systems" of the UNESCO-EOLSS collection.
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Enquadramento – A Early Warning Scores é uma escala de alerta, baseada num sistema de atribuição de pontos (scores) aos parâmetros vitais e deterioração do SNC, sendo a sua principal finalidade a identificação precoce do risco de deterioração fisiológica do doente. Objetivos – Determinar os parâmetros da escala que foram avaliados; identificar a periodicidade de avaliação dos parâmetros da escala; determinar as situações identificadas como risco de deterioração fisiológica; avaliar as propriedades psicométricas da escala Early Warning Scores (validade e fiabilidade). Material e Método – Estudo quantitativo e descritivo-correlacional, cuja população alvo consistiu nos doentes vítimas de acidente ou doença súbita, submetidos a atendimentos por parte de enfermeiros afetos ao INEM, nomeadamente nas ambulâncias de Suporte Imediato de Vida, mediante ativação via 112. O instrumento de avaliação utilizado consiste na Escala Early Warning Scores. Resultados – Verificou-se que o índice de fiabilidade se traduziu num valor de alfa de Cronbach, para a globalidade da escala, fraco (α=0.462). Concluiu-se que houve uma redução progressiva dos scores, em termos de risco, indicando a ocorrência de uma deteção precoce da degradação clínica dos 214 doentes, o que se traduziu numa atuação mais eficaz no pré-hospitalar. Conclusão - A redução progressiva dos scores, em termos de risco ao longo dos três momentos de avaliação com a Early Warning Scores, sugere que houve uma deteção precoce da degradação clínica dos doentes, resultando numa atuação mais eficaz no pré-hospitalar. Palavras-chave: Pré-hospitalar; Risco de deterioração fisiológica; Early Warning Scores.
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Mode of access: Internet.
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"NASA grant NGT 44-005-114."
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" Report ; no. TDR-269 (4560-50)-2)."
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Thesis (Ph.D.)--University of Washington, 2016-06
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In order for policy makers to plan effectively for sustainable development, there is a need for measures of welfare that consider changes in the natural capital stock. Current measures based on conventional national accounting are flawed because they are based solely on flow measures and do not account for environmental effects. In this paper, we use an expanded measure of wealth to estimate the value of natural capital for Queensland. The state's stock of natural capital is valued at A$355.6 billion, of which non-timber forest resources account for 45.3%, ecosystem services 20.0%, and mineral resources 17.6%. This figure is a conservative estimate of the true value since some significant components such as the ecological and life-support functions of the environment are excluded. The estimates highlight the relative importance of different forms of natural capital and can be used to draw the attention of policymakers to the need to give adequate weight to the value of such services in decision-making processes. (c) 2005 Elsevier Ltd. All rights reserved.
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A growing proportion of women reach older age without having married or having children. Assumptions that these older women are lonely, impoverished, and high users of social and health services are based on little evidence. This paper uses data from the Older cohort of the Australian Longitudinal Study on Women's Health to describe self-reported demographics, physical and emotional health, and use of services among 10,108 women aged 73-78, of whom 2.7% are never-married and childless. The most striking characteristic of this group is their high levels of education, which are associated with fewer reported financial difficulties and higher rates of private health insurance. There are few differences in self-reported physical or emotional health or use of health services between these and other groups of older women. Compared with older married women with children, they make higher use of formal services such as home maintenance and meal services, and are also more likely to provide volunteer services and belong to social groups. Overall, there is no evidence to suggest that these women are a problem group. Rather, it seems that their life experiences and opportunities prepare them for a successful and productive older age. (c) 2005 Elsevier Ltd. All rights reserved.