Air pollution and health: bridging the gap from sources to health outcomes: conference summary

Air Pollution and Health: Bridging the Gap from Sources to Health Outcomes, an international specialty conference sponsored by the American Association for Aerosol Research, was held to address key uncertainties in our understanding of adverse health effects related to air pollution and to integrate and disseminate results from recent scientific studies that cut across a range of air pollution-related disciplines. The Conference addressed the science of air pollution and health within a multipollutant framework (herein "multipollutant" refers to gases and particulate matter mass, components, and physical properties), focusing on five key science areas: sources, atmospheric sciences, exposure, dose, and health effects. Eight key policy-relevant science questions integrated across various parts of the five science areas and a ninth question regarding findings that provide policy-relevant insights served as the framework for the meeting. Results synthesized from this Conference provide new evidence, reaffirm past findings, and offer guidance for future research efforts that will continue to incrementally advance the science required for reducing uncertainties in linking sources, air pollutants, human exposure, and health effects. This paper summarizes the Conference findings organized around the science questions. A number of key points emerged from the Conference findings. First, there is a need for greater focus on multipollutant science and management approaches that include more direct studies of the mixture of pollutants from sources with an emphasis on health studies at ambient concentrations. Further, a number of research groups reaffirmed a need for better understanding of biological mechanisms and apparent associations of various health effects with components of particulate matter (PM), such as elemental carbon, certain organic species, ultrafine particles, and certain trace elements such as Ni, V, and Fe(II), as well as some gaseous pollutants. Although much debate continues in this area, generation of reactive oxygen species induced by these and other species present in air pollution and the resulting oxidative stress and inflammation were reiterated as key pathways leading to respiratory and cardiovascular outcomes. The Conference also underscored significant advances in understanding the susceptibility of populations, including the role of genetics and epigenetics and the influence of socioeconomic and other confounding factors and their synergistic interactions with air pollutants. Participants also pointed out that short-and long-term intervention episodes that reduce pollution from sources and improve air quality continue to indicate that when pollution decreases so do reported adverse health effects. In the limited number of cases where specific sources or PM2.5 species were included in investigations, specific species are often associated with the decrease in effects. Other recent advances for improved exposure estimates for epidemiological studies included using new technologies such as microsensors combined with cell phone and integrated into real-time communications, hybrid air quality modeling such as combined receptor-and emission-based models, and surface observations used with remote sensing such as satellite data.

Servicios y visualización web para el control de simulaciones

[ES] La realización de los nuevos estudios de gestión de la demanda requiere nuevas aproximaciones en las que la red eléctrica se analiza como un sistema complejo. Estos están formados por un gran número de entidades fuertemente enlazadas entre sí. Se afronta el reto de añadir la capacidad de interacción sobre una simulación de sistemas complejos en tiempo de ejecución. Pero, ¿Cómo abordar la representación de un sistema complejo de tal manera que sea fácilmente gestionable por una persona?, o ¿Cómo ofrecer una manera sencilla de alterar la simulación?. Con esta idea nace Simulation Gateway Interface, un framework que permite hacer accesibles las simulaciones a través de una interfaz gráfica.

Toward optimal early management after whiplash injury to lessen the rate of transition to chronicity: discussion paper 5

Expert debate and synthesis of research to inform future management approaches for acute whiplash disorders.

Novel approaches to therapy of hypereosinophilic syndromes

There has been recent progress in the understanding of the pathogenesis of the hypereosinophilic syndromes (HES). This led to the distinction of subgroups, in which the underlying cause has been identified. Consequently, new treatment options became available, such as imatinib and mepolizumab, which proved to be promising. This article summarizes these new pharmacologic approaches to the therapy of HES.

Performance Availability and Anticipatory Change Planning of Intralogistics Systems: A Simulation-Based Approach

In recent years, the ability to respond to real time changes in operations and reconfigurability in equipment are likely to become essential characteristics for next generation intralogistics systems as well as the level of automation, cost effectiveness and maximum throughput. In order to cope with turbulences and the increasing level of dynamic conditions, future intralogistics systems have to feature short reaction times, high flexibility in processes and the ability to adapt to frequent changes. The increasing autonomy and complexity in processes of today’s intralogistics systems requires new and innovative management approaches, which allow a fast response to (un)anticipated events and adaptation to changing environment in order to reduce the negative consequences of these events. The ability of a system to respond effectively a disruption depends more on the decisions taken before the event than those taken during or after. In this context, anticipatory change planning can be a usable approach for managers to make contingency plans for intralogistics systems to deal with the rapidly changing marketplace. This paper proposes a simulation-based decision making framework for the anticipatory change planning of intralogistics systems. This approach includes the quantitative assessments based on the simulation in defined scenarios as well as the analysis of performance availability that combines the flexibility corridors of different performance dimensions. The implementation of the approach is illustrated on a new intralogistics technology called the Cellular Transport System.

Physician perceptions of risk regarding mood disorders and pharmacological management during pregnancy: What is current practice?

Mood disorders are the most common form of mental illness and one of the leading causes of morbidity worldwide. Major depressive disorder and bipolar disorder have a lifetime prevalence of 16.2% and 4.4%, respectively. Women comprise a substantial proportion of this population, and an estimated 500,000 pregnancies each year involve women with a psychiatric condition. Management with psychotropic medications is considered standard of care for most patients with mood disorders. However, many of these medications are known human teratogens. Because pregnant women with mood disorders face a high risk of relapse if unmanaged, the obstetrician faces a unique challenge in providing the best care to both mother and baby. It has been suggested that many obstetricians overestimate the teratogenic risks associated with psychotropic medications, while concurrently underestimating the risks associated with unmanaged mood disorders. This may be due a knowledge gap regarding the most current teratogen information, and lack of official management guidelines. Therefore, the purpose of this study is to determine the current knowledge base of obstetricians regarding the teratogenic effects of common psychotropic medications, as wells as to capture current management practices for pregnant women with mood disorders. A total of 117 Texas obstetricians responded to a survey regarding teratogen knowledge and management practice. It was common for respondents to encounter women who disclose both having a mood disorder and taking a psychotropic medication during pregnancy. Many respondents did not utilize up-to-date drug counseling resources, and were unaware of or over-estimated the teratogenic risks of common medications used to treat mood disorders. Finally, many respondents reported wanting to refer pregnant patients with mood disorders to psychiatrists for co-management, but are reportedly restricted in doing so due to accessibility or insurance issues. This study demonstrates that there is a knowledge gap among obstetricians regarding the teratogenicity of common psychotropic medications utilized to manage a patient population they frequently encounter. Further, obstetricians have vastly different risk perceptions of these medications, resulting in various management approaches and recommendations. Future research should focus on establishing standard practice guidelines, as well as better accessibility to psychiatric services for pregnant women.

Update on skin allergy.

Skin diseases with an allergic background such as atopic dermatitis, allergic contact dermatitis, and urticaria are very common. Moreover, diseases arising from a dysfunction of immune cells and/or their products often manifest with skin symptoms. This review aims to summarize recently published articles in order to highlight novel research findings, clinical trial results, and current guidelines on disease management. In recent years, an immense progress has been made in understanding the link between skin barrier dysfunction and allergic sensitization initiating the atopic march. In consequence, new strategies for treatment and prevention have been developed. Novel pathogenic insights, for example, into urticaria, angioedema, mastocytosis, led to the development of new therapeutic approaches and their implementation in daily patient care. By understanding distinct pathomechanisms, for example, the role of IL-1, novel entities such as autoinflammatory diseases have been described. Considerable effort has been made to improve and harmonize patient management as documented in several guidelines and position papers.

Towards a new model of care: integrating mental health, substance use, and somatic care

Although research and clinical interventions for patients with dual disorders have been described since as early as the 1980s, the day-to-day treatment of these patients remains problematic and challenging in many countries. Throughout this book, many approaches and possible pathways have been outlined. Based upon these experiences, some key points can be extracted in order to guide to future developments. (1) New diagnostic approaches are warranted when dealing with patients who have multiple problems, given the limitations of the current categorical systems. (2) Greater emphasis should be placed on secondary prevention and early intervention for children and adolescents at an increased risk of later-life dual disorders. (3) Mental, addiction, and somatic care systems can be integrated, adopting a patient-focused approach to care delivery. (4) Recovery should be taken into consideration when defining treatment intervention and outcome goals. (5) It is important to reduce societal risk factors, such as poverty and early childhood adversity. (6) More resources are needed to provide adequate mental health care in the various countries. The development of European guidance initiatives would provide benefits in many of these areas, making it possible to ensure a more harmonized standard of care for patients with dual disorders.

Desarrollo de un Modelo de Gestión de Riesgos Operacionales basado en las Directrices del Comité de Basilea

La presente investigación tiene como objetivo principal diseñar un Modelo de Gestión de Riesgos Operacionales (MGRO) según las Directrices de los Acuerdos II y III del Comité de Supervisión Bancaria de Basilea del Banco de Pagos Internacionales (CSBB-BPI). Se considera importante realizar un estudio sobre este tema dado que son los riesgos operacionales (OpR) los responsables en gran medida de las últimas crisis financieras mundiales y por la dificultad para detectarlos en las organizaciones. Se ha planteado un modelo de gestión subdividido en dos vías de influencias. La primera acoge el paradigma holístico en el que se considera que hay múltiples maneras de percibir un proceso cíclico, así como las herramientas para observar, conocer y entender el objeto o sujeto percibido. La segunda vía la representa el paradigma totalizante, en el que se obtienen datos tanto cualitativos como cuantitativos, los cuales son complementarios entre si. Por otra parte, este trabajo plantea el diseño de un programa informático de OpR Cualitativo, que ha sido diseñado para determinar la raíz de los riesgos en las organizaciones y su Valor en Riesgo Operacional (OpVaR) basado en el método del indicador básico. Aplicando el ciclo holístico al caso de estudio, se obtuvo el siguiente diseño de investigación: no experimental, univariable, transversal descriptiva, contemporánea, retrospectiva, de fuente mixta, cualitativa (fenomenológica y etnográfica) y cuantitativa (descriptiva y analítica). La toma de decisiones y recolección de información se realizó en dos fases en la unidad de estudio. En la primera se tomó en cuenta la totalidad de la empresa Corpoelec-EDELCA, en la que se presentó un universo estadístico de 4271 personas, una población de 2390 personas y una unidad de muestreo de 87 personas. Se repitió el proceso en una segunda fase, para la Central Hidroeléctrica Simón Bolívar, y se determinó un segundo universo estadístico de 300 trabajadores, una población de 191 personas y una muestra de 58 profesionales. Como fuentes de recolección de información se utilizaron fuentes primarias y secundarias. Para recabar la información primaria se realizaron observaciones directas, dos encuestas para detectar las áreas y procesos con mayor nivel de riesgos y se diseñó un cuestionario combinado con otra encuesta (ad hoc) para establecer las estimaciones de frecuencia y severidad de pérdidas operacionales. La información de fuentes secundarias se extrajo de las bases de datos de Corpoelec-EDELCA, de la IEA, del Banco Mundial, del CSBB-BPI, de la UPM y de la UC at Berkeley, entre otras. Se establecieron las distribuciones de frecuencia y de severidad de pérdidas operacionales como las variables independientes y el OpVaR como la variable dependiente. No se realizó ningún tipo de seguimiento o control a las variables bajo análisis, ya que se consideraron estas para un instante especifico y solo se determinan con la finalidad de establecer la existencia y valoración puntual de los OpR en la unidad de estudio. El análisis cualitativo planteado en el MGRO, permitió detectar que en la unidad de investigación, el 67% de los OpR detectados provienen de dos fuentes principales: procesos (32%) y eventos externos (35%). Adicionalmente, la validación del MGRO en Corpoelec-EDELCA, permitió detectar que el 63% de los OpR en la organización provienen de tres categorías principales, siendo los fraudes externos los presentes con mayor regularidad y severidad de pérdidas en la organización. La exposición al riesgo se determinó fundamentándose en la adaptación del concepto de OpVaR que generalmente se utiliza para series temporales y que en el caso de estudio presenta la primicia de aplicarlo a datos cualitativos transformados con la escala Likert. La posibilidad de utilizar distribuciones de probabilidad típicas para datos cuantitativos en distribuciones de frecuencia y severidad de pérdidas con datos de origen cualitativo fueron analizadas. Para el 64% de los OpR estudiados se obtuvo que la frecuencia tiene un comportamiento semejante al de la distribución de probabilidad de Poisson y en un 55% de los casos para la severidad de pérdidas se obtuvo a las log-normal como las distribuciones de probabilidad más comunes, con lo que se concluyó que los enfoques sugeridos por el BCBS-BIS para series de tiempo son aplicables a los datos cualitativos. Obtenidas las distribuciones de frecuencia y severidad de pérdidas, se convolucionaron estas implementando el método de Montecarlo, con lo que se obtuvieron los enfoques de distribuciones de pérdidas (LDA) para cada uno de los OpR. El OpVaR se dedujo como lo sugiere el CSBB-BPI del percentil 99,9 o 99% de cada una de las LDA, obteniéndose que los OpR presentan un comportamiento similar al sistema financiero, resultando como los de mayor peligrosidad los que se ubican con baja frecuencia y alto impacto, por su dificultad para ser detectados y monitoreados. Finalmente, se considera que el MGRO permitirá a los agentes del mercado y sus grupos de interés conocer con efectividad, fiabilidad y eficiencia el status de sus entidades, lo que reducirá la incertidumbre de sus inversiones y les permitirá establecer una nueva cultura de gestión en sus organizaciones. ABSTRACT This research has as main objective the design of a Model for Operational Risk Management (MORM) according to the guidelines of Accords II and III of the Basel Committee on Banking Supervision of the Bank for International Settlements (BCBS- BIS). It is considered important to conduct a study on this issue since operational risks (OpR) are largely responsible for the recent world financial crisis and due to the difficulty in detecting them in organizations. A management model has been designed which is divided into two way of influences. The first supports the holistic paradigm in which it is considered that there are multiple ways of perceiving a cyclical process and contains the tools to observe, know and understand the subject or object perceived. The second way is the totalizing paradigm, in which both qualitative and quantitative data are obtained, which are complementary to each other. Moreover, this paper presents the design of qualitative OpR software which is designed to determine the root of risks in organizations and their Operational Value at Risk (OpVaR) based on the basic indicator approach. Applying the holistic cycle to the case study, the following research design was obtained: non- experimental, univariate, descriptive cross-sectional, contemporary, retrospective, mixed-source, qualitative (phenomenological and ethnographic) and quantitative (descriptive and analytical). Decision making and data collection was conducted in two phases in the study unit. The first took into account the totality of the Corpoelec-EDELCA company, which presented a statistical universe of 4271 individuals, a population of 2390 individuals and a sampling unit of 87 individuals. The process was repeated in a second phase to the Simon Bolivar Hydroelectric Power Plant, and a second statistical universe of 300 workers, a population of 191 people and a sample of 58 professionals was determined. As sources of information gathering primary and secondary sources were used. To obtain the primary information direct observations were conducted and two surveys to identify the areas and processes with higher risks were designed. A questionnaire was combined with an ad hoc survey to establish estimates of frequency and severity of operational losses was also considered. The secondary information was extracted from the databases of Corpoelec-EDELCA, IEA, the World Bank, the BCBS-BIS, UPM and UC at Berkeley, among others. The operational loss frequency distributions and the operational loss severity distributions were established as the independent variables and OpVaR as the dependent variable. No monitoring or control of the variables under analysis was performed, as these were considered for a specific time and are determined only for the purpose of establishing the existence and timely assessment of the OpR in the study unit. Qualitative analysis raised in the MORM made it possible to detect that in the research unit, 67% of detected OpR come from two main sources: external processes (32%) and external events (35%). Additionally, validation of the MORM in Corpoelec-EDELCA, enabled to estimate that 63% of OpR in the organization come from three main categories, with external fraud being present more regularly and greater severity of losses in the organization. Risk exposure is determined basing on adapting the concept of OpVaR generally used for time series and in the case study it presents the advantage of applying it to qualitative data transformed with the Likert scale. The possibility of using typical probability distributions for quantitative data in loss frequency and loss severity distributions with data of qualitative origin were analyzed. For the 64% of OpR studied it was found that the frequency has a similar behavior to that of the Poisson probability distribution and 55% of the cases for loss severity it was found that the log-normal were the most common probability distributions. It was concluded that the approach suggested by the BCBS-BIS for time series can be applied to qualitative data. Once obtained the distributions of loss frequency and severity have been obtained they were subjected to convolution implementing the Monte Carlo method. Thus the loss distribution approaches (LDA) were obtained for each of the OpR. The OpVaR was derived as suggested by the BCBS-BIS 99.9 percentile or 99% of each of the LDA. It was determined that the OpR exhibits a similar behavior to the financial system, being the most dangerous those with low frequency and high impact for their difficulty in being detected and monitored. Finally, it is considered that the MORM will allows market players and their stakeholders to know with effectiveness, efficiency and reliability the status of their entities, which will reduce the uncertainty of their investments and enable them to establish a new management culture in their organizations.

The Exploration and Development of Alternative Management Strategies for Mining and Recreational Activities Atop Mount Antero and Mount White; Chaffee County, Colorado

The Mount Antero/White area is a popular prospecting area. Recent expansions in the recreation economy is drawing more visitors to the area. Consequently, visitors may be placing unsustainable pressures on the landscape. In order to help rectify this, the legal, ecological, geologic, aesthetic, recreational, historic, social, and economic character of the Antero/White area has been identified. Four feasible management alternatives have also been recognized. They are a) take no new management actions, b) prohibit motorized activities in the area, c) develop a mineralogical park, and d) a combination of options b and c. Option C has been defended, as it best balances the desires of area users with the underlying ecological and geological character of the area.

Infecção nosocomial por Clostridium difficile : caracterização da estirpe epidémica 027

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2014

Does terrestrial epidemiology apply to marine systems?

Most of epidemiological theory has been developed for terrestrial systems, but the significance of disease in the ocean is now being recognized. However, the extent to which terrestrial epidemiology can be directly transferred to marine systems is uncertain. Many broad types of disease-causing organism occur both on land and in the sea, and it is clear that some emergent disease problems in marine environments are caused by pathogens moving from terrestrial to marine systems. However, marine systems are qualitatively different from terrestrial environments, and these differences affect the application of modelling and management approaches that have been developed for terrestrial systems. Phyla and body plans are more diverse in marine environments and marine organisms have different life histories and probably different disease transmission modes than many of their terrestrial counterparts. Marine populations are typically more open than terrestrial ones, with the potential for long-distance dispersal of larvae. Potentially, this might enable unusually rapid propagation of epidemics in marine systems, and there are several examples of this. Taken together, these differences will require the development of new approaches to modelling and control of infectious disease in the ocean.

Antibiotic resistance in the intensive care unit: A primer in bacteriology

The clinical use of potent, well-tolerated, broad-spectrum antibiotics has been paralleled by the development of resistance in bacteria, and the prevalence of highly resistant bacteria in some intensive care units is despairingly commonplace. The intensive care community faces the realistic prospect of untreatable nosocomial infections and should be searching for new approaches to diagnose and manage resistant bacteria. In this review, we discuss some of the relevant underlying biology, with a particular focus on genetic transfer vehicles and the relationship of selection pressure to their movements. It is an attempt to demystify the relevant language and concepts for the anaesthetist and intensivist, to explain some of the reasons for the emergence of resistance in bacteria, and to provide a contextual basis for discussion of management approaches such as selective decontamination and antibiotic cycling.

A scaleless data model for direct and progressive spatial query processing

A progressive spatial query retrieves spatial data based on previous queries (e.g., to fetch data in a more restricted area with higher resolution). A direct query, on the other side, is defined as an isolated window query. A multi-resolution spatial database system should support both progressive queries and traditional direct queries. It is conceptually challenging to support both types of query at the same time, as direct queries favour location-based data clustering, whereas progressive queries require fragmented data clustered by resolutions. Two new scaleless data structures are proposed in this paper. Experimental results using both synthetic and real world datasets demonstrate that the query processing time based on the new multiresolution approaches is comparable and often better than multi-representation data structures for both types of queries.