Aluminium Release and Fluid Warming: Provocational Setting and Devices at Risk

2021 ◽  
Author(s):  
Thorsten Perl ◽  
Kunze-Szikszay Nils ◽  
Anselm Bräuer ◽  
Quintel Michael ◽  
Terrance Roy ◽  
...  
Keyword(s):  
At Risk ◽  
Organic Acids ◽  
Saline Solution ◽  
Management Strategies ◽  
High Volume ◽  
Temperature Management ◽  
Fluid Composition ◽  
Warming Devices ◽  
Warming Device ◽  
High Aluminum

Abstract BACKGROUND: Fluid warming, recommended for fluid rates of > 500 ml h-1, is an integral part of patient temperature management strategies. Fluid warming devices using an uncoated aluminum containing heating element have been reported to liberate aluminum resulting in critical aluminum concentrations in heated fluids. We investigated saline solution (0.9%), artificially spiked with organic acids to determine the influence of fluid composition on aluminum liberation using the uncoated enFlow® device. Additionally the Level1® as a high volume fluid warming device and the ThermoSens® device were investigated. RESULTS: Saline solution spiked with lactate more than acetate, especially at a non acid pH, led to high aluminum liberation. Next to the enFlow® device, aluminum liberation was observed for the Level1® device, but not for the coated TermoSens®-device. CONCLUSION: Uncoated aluminum containing fluid warming devices lead to potential toxic levels of aluminum in heated fluids, especially in non acid fluids containing organic acids and their salts.

scholarly journals Aluminium release and fluid warming: provocational setting and devices at risk

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Thorsten Perl ◽  
N. Kunze-Szikszay ◽  
A. Bräuer ◽  
M. Quintel ◽  
T. Roy ◽  
...  
Keyword(s):  
Organic Acids ◽  
Saline Solution ◽  
Management Strategies ◽  
High Volume ◽  
Electrolyte Solutions ◽  
Temperature Management ◽  
Fluid Composition ◽  
Neutral Ph ◽  
Warming Devices ◽  
High Aluminium

Abstract Background Fluid warming, recommended for fluid rates of > 500 ml h-1, is an integral part of patient temperature management strategies. Fluid warming devices using an uncoated aluminium containing heating element have been reported to liberate aluminium resulting in critical aluminium concentrations in heated fluids. We investigated saline solution (0.9%), artificially spiked with organic acids to determine the influence of fluid composition on aluminium release using the uncoated enFlow® device. Additionally, the Level1® as a high volume fluid warming device and the ThermoSens® device were investigated with artificial spiked fluid at high risk for aluminum release and a clinically used crystalloid solution. Results Saline solution spiked with lactate more than acetate, especially at a non neutral pH, led to high aluminium release. Next to the enFlow® device, aluminium release was observed for the Level1® device, but not for the coated ThermoSens®-device. Conclusion Uncoated aluminium containing fluid warming devices lead to potentially toxic levels of aluminium in heated fluids, especially in fluids with non-neutral pH containing organic acids and their salts like balanced electrolyte solutions.

Risk factors for glaucoma: what do they really mean?

2011 ◽  
Vol 17 (3) ◽  
pp. 233 ◽  
Author(s):  
Anthea Worley ◽  
Karen Grimmer-Somers
Keyword(s):  
Risk Factors ◽  
At Risk ◽  
Risk Factor ◽  
Health Care Providers ◽  
Management Strategies ◽  
Care Providers ◽  
Reference Guide ◽  
Future Assessment ◽  
Primary Health Care Providers ◽  
Patient’S History

Glaucoma is an insidious eye disease, potentially putting 4% of older Australians at risk of blindness, unless detected sufficiently early for initiation of effective treatment. This paper reports on the strengths of evidence and glaucoma risk factors that can be identified by primary health care providers from a patient’s history. A comprehensive search of peer-reviewed databases identified relevant secondary evidence published between 2002 and 2007. Risk factors that could be determined from a patient’s history were identified. A novel glaucoma risk factor reference guide was constructed according to evidence strength and level of concern regarding risk of developing glaucoma. The evidence is strong and consistent regarding the risk of developing glaucoma, and elevated intraocular pressure, advancing age, non-Caucasian ethnicity and family history of glaucoma. There is moderate evidence of association with glaucoma, and migraine, eye injury, myopia and long-term use of corticosteroids. There is conflicting evidence for living in a rural location, high blood pressure, diabetes and smoking. Early detection of people at risk of developing glaucoma can be initiated using our risk factor guide coupled with a comprehensive patient history. Timely future assessment and subsequent management strategies for at-risk individuals can then be effectively and efficiently actioned.

scholarly journals Executive Summary: 2016 Infectious Diseases Society of America (IDSA) Clinical Practice Guideline for the Treatment of Coccidioidomycosis

2016 ◽  
Vol 63 (6) ◽  
pp. 717-722 ◽  
Author(s):  
John N. Galgiani ◽  
Neil M. Ampel ◽  
Janis E. Blair ◽  
Antonino Catanzaro ◽  
Francesca Geertsma ◽  
...  
Keyword(s):  
At Risk ◽  
Infectious Diseases ◽  
Practice Guideline ◽  
Management Strategies ◽  
Systemic Infection ◽  
Western Hemisphere ◽  
Executive Summary ◽  
Valley Fever ◽  
Critical Elements ◽  
At Risk Populations

Abstract It is important to realize that guidelines cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations. Infectious Diseases Society of America considers adherence to these guidelines to be voluntary, with the ultimate determination regarding their application to be made by the physician in the light of each patient's individual circumstances. Coccidioidomycosis, also known as San Joaquin Valley fever, is a systemic infection endemic to parts of the southwestern United States and elsewhere in the Western Hemisphere. Residence in and recent travel to these areas are critical elements for the accurate recognition of patients who develop this infection. In this practice guideline, we have organized our recommendations to address actionable questions concerning the entire spectrum of clinical syndromes. These can range from initial pulmonary infection, which eventually resolves whether or not antifungal therapy is administered, to a variety of pulmonary and extrapulmonary complications. Additional recommendations address management of coccidioidomycosis occurring for special at-risk populations. Finally, preemptive management strategies are outlined in certain at-risk populations and after unintentional laboratory exposure.

scholarly journals Work Stress among Professionals in Building Construction Industry in Nigeria

2011 ◽  
Vol 11 (3) ◽  
pp. 45-57 ◽  
Author(s):  
Eziyi Offia Ibem ◽  
Michael Nwabueze Anosike ◽  
Dominic Ezenwa Azuh ◽  
Tim O. Mosaku
Keyword(s):  
Construction Industry ◽  
Work Stress ◽  
Management Strategies ◽  
High Volume ◽  
Time Frame ◽  
Building Construction ◽  
Stress Factors ◽  
Project Delivery ◽  
Building Projects ◽  
Structural Engineers

This study was undertaken to identify key stress factors among professionals in building construction industry in Nigeria. This is in view of the fact that to date, very little is known about work stress among professionals in building construction industry in this country. The study involved the administration of questionnaire to 107 professionals including architects, builders, civil/structural engineers and quantity surveyors randomly selected from 60 ongoing building projects in Anambra, Ogun and Kaduna States, Nigeria. The data was analysed using descriptive statistics, and findings show that the principal sources of stress were high volume of work, uncomfortable site office environment, lack of feedback on previous and ongoing building projects, and variations in the scope of work in ongoing building projects. The paper suggests that taking responsibility for work which one has adequate capacity to handle, establishing realistic budgets and time frame for project delivery, provision of spatially adequate, visually and thermally comfortable site offices, adoption of appropriate job design practice and education of professionals on stress management strategies will reduce the incidence of stress among professionals in building industry in Nigeria. 

scholarly journals Mixtures as a Fungicide Resistance Management Tactic

2014 ◽  
Vol 104 (12) ◽  
pp. 1264-1273 ◽  
Author(s):  
Frank van den Bosch ◽  
Neil Paveley ◽  
Femke van den Berg ◽  
Peter Hobbelen ◽  
Richard Oliver
Keyword(s):  
At Risk ◽  
Disease Control ◽  
Fungicide Resistance ◽  
Management Strategies ◽  
Resistance Management ◽  
Relative Effect ◽  
Resistance Evolution ◽  
Modes Of Action ◽  
Selection For ◽  
Effective Life

We have reviewed the experimental and modeling evidence on the use of mixtures of fungicides of differing modes of action as a resistance management tactic. The evidence supports the following conclusions. 1. Adding a mixing partner to a fungicide that is at-risk of resistance (without lowering the dose of the at-risk fungicide) reduces the rate of selection for fungicide resistance. This holds for the use of mixing partner fungicides that have either multi-site or single-site modes of action. The resulting predicted increase in the effective life of the at-risk fungicide can be large enough to be of practical relevance. The more effective the mixing partner (due to inherent activity and/or dose), the larger the reduction in selection and the larger the increase in effective life of the at-risk fungicide. 2. Adding a mixing partner while lowering the dose of the at-risk fungicide reduces the selection for fungicide resistance, without compromising effective disease control. The very few studies existing suggest that the reduction in selection is more sensitive to lowering the dose of the at-risk fungicide than to increasing the dose of the mixing partner. 3. Although there are very few studies, the existing evidence suggests that mixing two at-risk fungicides is also a useful resistance management tactic. The aspects that have received too little attention to draw generic conclusions about the effectiveness of fungicide mixtures as resistance management strategies are as follows: (i) the relative effect of the dose of the two mixing partners on selection for fungicide resistance, (ii) the effect of mixing on the effective life of a fungicide (the time from introduction of the fungicide mode of action to the time point where the fungicide can no longer maintain effective disease control), (iii) polygenically determined resistance, (iv) mixtures of two at-risk fungicides, (v) the emergence phase of resistance evolution and the effects of mixtures during this phase, and (vi) monocyclic diseases and nonfoliar diseases. The lack of studies on these aspects of mixture use of fungicides should be a warning against overinterpreting the findings in this review.

A multiparametric ICD algorithm for heart failure risk stratification and management: an analysis in clinical practice

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
L Calo" ◽  
V Bianchi ◽  
D Ferraioli ◽  
L Santini ◽  
A Dello Russo ◽  
...  
Keyword(s):  
Heart Failure ◽  
At Risk ◽  
Clinical Practice ◽  
Risk Stratification ◽  
Management Strategies ◽  
Cardiac Resynchronization ◽  
Office Visits ◽  
Increased Risk ◽  
Patients At Risk ◽  
Observation Period

Abstract Funding Acknowledgements Type of funding sources: None. Introduction The HeartLogic algorithm combines multiple implantable cardioverter defibrillator (ICD) sensors to identify patients at risk of heart failure (HF) events. Purpose We sought to evaluate the risk stratification ability of this algorithm in clinical practice. We also analyzed the alert management strategies adopted in the study group and their association with the occurrence of HF events. Methods The HeartLogic feature was activated in 366 ICD and cardiac resynchronization therapy ICD patients at 22 centers. The HeartLogic algorithm automatically calculates a daily HF index and identifies periods IN or OUT of an alert state on the basis of a configurable threshold (in this analysis set to 16). Results The HeartLogic index crossed the threshold value 273 times (0.76 alerts/patient-year) in 150 patients over a median follow-up of 11 months [25-75 percentile: 6-16]. Overall, the time IN the alert state was 11% of the total observation period. Patients experienced 36 HF hospitalizations and 8 patients died of HF (rate: 0.12 events/patient-year) during the observation period. Thirty-five events were associated with the IN alert state (0.92 events/patient-year versus 0.03 events/patient-year in the OUT of alert state). The hazard ratio in the IN/OUT of alert state comparison was (HR: 24.53, 95% CI: 8.55-70.38, p < 0.001), after adjustment for baseline clinical confounders. Alerts followed by clinical actions were associated with a lower rate of HF events (HR: 0.37, 95% CI: 0.14-0.99, p = 0.047). No differences in event rates were observed between in-office and remote alert management. By contrast, verification of HF symptoms during post-alert examination was associated with a higher risk of HF events (HR: 5.23, 95% CI: 1.98-13.83, p < 0.001). Conclusions This multiparametric ICD algorithm identifies patients during periods of significantly increased risk of HF events. The rate of HF events seemed lower when clinical actions were undertaken in response to alerts. Extra in-office visits did not seem to be required in order to effectively manage HeartLogic alerts, while post-alert verification of symptoms seemed useful in order to better stratify patients at risk of HF events.

scholarly journals Evaluation of compliance with the 2017 Canadian Paediatric Society Position Statement for the management of newborns at risk for early-onset sepsis: A retrospective cohort study

2020 ◽  
Author(s):  
Marina Simeonova ◽  
Jolanta Piszczek ◽  
Sannifer Hoi ◽  
Curtis Harder ◽  
Gustavo Pelligra
Keyword(s):  
Risk Factors ◽  
At Risk ◽  
Early Onset ◽  
Management Strategies ◽  
Retrospective Chart Review ◽  
Position Statement ◽  
Paediatric Society ◽  
Early Onset Sepsis ◽  
Inappropriate Antibiotics ◽  
Culture Positive

Abstract Introduction Due to the nonspecific clinical presentation, clinicians often empirically treat newborns at risk of early-onset sepsis (EOS). Recently, the Canadian Paediatric Society (CPS) published updated recommendations that promote a more judicious approach to EOS management. Objective To examine the compliance with the CPS statement at a tertiary perinatal site and characterize the types of deviations. Methods A retrospective chart review was conducted for all term and late pre-term newborns at risk for sepsis, between January 1 and June 30, 2018. The prevalence of newborns with EOS risk factors was measured during the first month. Management strategies for eligible newborns during the 6-month period were compared to the CPS recommendations to establish the rate of noncompliance. The type of noncompliance, readmission rate, and rate of culture-positive EOS were examined. Results In the first month, 29% (66 of 228) of newborns had EOS risk factors. Among the 100 newborns born in the 6-month period for whom the CPS recommendations apply, 47 (47%) received noncompliant management. Of those, 51% (N=24) had inappropriately initiated investigations, 17% (N=8) had inappropriate antibiotics, and 32% (N=15) had both. The rate of readmission for a septic workup was 1.6% (N= 2). None had culture-positive sepsis while admitted. Conclusion A large proportion of term and late preterm newborns (29%) had EOS risk factors, but none had culture-confirmed EOS. The rate of noncompliance with the CPS recommendations was high (47%), mainly due to overzealous management. Future initiatives should aim at increasing compliance, particularly in newborns at lower EOS risk.

Clinical Considerations in the Management of Individuals at Risk for Hereditary Breast and Ovarian Cancer

2002 ◽  
Vol 9 (6) ◽  
pp. 457-465 ◽  
Author(s):  
Mark E. Robson
Keyword(s):  
Ovarian Cancer ◽  
At Risk ◽  
Clinical Management ◽  
Management Strategies ◽  
Breast And Ovarian Cancer ◽  
Brca1 And Brca2 ◽  
Hereditary Risk ◽  
Increased Risk ◽  
Post Test ◽  
Clinical Considerations

Background Hereditary predisposition to breast and ovarian cancer, most commonly due to germline mutations in BRCA1 and BRCA2, has been recognized for many years. The optimal clinical management of individuals with such a predisposition is not yet completely defined. Methods The current literature regarding the clinical management of individuals at risk for hereditary breast and ovarian cancer was reviewed. Results Women with germline BRCA1 or BRCA2 mutations are at substantially increased risk for breast and ovarian cancer, although the risks may not be as high as originally reported. Current surveillance options are restricted in their effectiveness by both host and tumor factors as well as limitations of the techniques. Surgical prevention options, while effective, may be complicated by physical or psychological morbidity. Nonsurgical prevention options are under development. Conclusions The ability to define women as being at hereditary risk for breast and ovarian cancer facilitates the use of specialized surveillance and prevention strategies. Genetic testing, which plays a role in defining risk, requires careful pre- and post-test counseling to discuss the limitations of testing itself and available management strategies.

Access Management

2005 ◽  
Vol 1931 (1) ◽  
pp. 117-128
Author(s):  
Jerome Gluck ◽  
Jean Michel ◽  
Michael Geiger ◽  
Maya Varughese
Keyword(s):  
New York ◽  
Traffic Congestion ◽  
Management Strategies ◽  
New York State ◽  
High Volume ◽  
York State Department ◽  
Department Of Transportation ◽  
Access Management ◽  
Accident Rate ◽  
Wide Range

This paper discusses issues encountered in developing a retrofit project for a roadway in a densely developed, commercialized area. The project was initiated, directed, and funded by the New York State Department of Transportation (NYSDOT). Numerous major shopping centers and a high volume of through traffic produce congestion and affect safety. NY-27, also known as Sunrise Highway, is a principal arterial in suburban Long Island. The conditions along NY-27 reflect what happens when development approvals are granted by local land use agencies without sufficient consideration of whether the transportation system can accommodate the associated traffic. NYSDOT, in this case, was put in the position of attempting to implement a retrofit project to mitigate the traffic and safety conditions. The proximity of shopping center driveways to each other and to nearby intersections results in weaving movements and heavy turning-movement volumes that block the through travel lanes and cause overlapping conflicts. The significant traffic congestion and high accident rate reflect the problems caused by inadequate access spacing and need for improved access management. The improvement options identified represented a wide range of access management strategies and configurations. The options were screened and modified to reflect community desires and business concerns. This paper reviews operational and safety problems, identifies a theoretical access configuration along the NY-27 corridor that could mitigate these problems, and reviews the alternative that was approved and is being progressed. The approved alternative reflects real-world considerations that affect a retrofit project.

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