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[en] The rapid growth in the use of ultrasound as a diagnostic imaging technology over the past forty years, has led to a demand for a workforce with the appropriate skills to perform and interpret the scans. In the UK, ultrasound investigations now comprise the largest group of all diagnostic imaging examinations.1 However, there remains no statutory regulation of the practice of sonography in the UK, and little recognition of the considerable training that many practitioners have undertaken to obtain the skills to become safe and competent sonographers. Many in the field consider that this should change, and are working to obtain professional status for the practice of sonography.2–5 Although the Health Care Professions Council (HCPC) has recommended regulation of sonography practice, this is unlikely to happen in the near future. This paper discusses the evolution of sonography practice and explores some of the complex issues associated with the professionalisation of sonography
[en] Aim: To systematically review the currently available high quality evidence evaluating treatments for moist desquamation in radiotherapy patients. Design: Systematic literature review. Methods: Electronic databases, websites, reference lists, key journals and conference proceedings were searched. Attempts were also made to uncover unpublished material. Relevant studies proceeded to data extraction and quality assessment. Results: Twenty studies were found; 10 were eligible for inclusion. Although many studies were small, none had unacceptably poor quality. No meta-analysis was undertaken as the studies were not homogenous in their interventions or methods. No convincing evidence for any intervention was found. Conclusion: Despite being recommended by many guidelines (College of Radiographers Summary of Intervention for Acute Radiotherapy Induced Skin Reactions in Cancer Patients (London, 2001); NHS Quality Improvement Scotland Best Practice Statement: Skincare of Patients Receiving Radiotherapy (Edinburgh, 2004)); there is mixed evidence concerning the use of hydrogels and hydrocolloid dressings. However, improved patient comfort was sometimes seen, which is arguably equally important. There was limited evidence to support other interventions. Further research is urgently needed.
[en] Cost-effective protected area networks require that decision makers have sufficient information to allocate investments in ways that generate the greatest positive impacts. With applications in more than 50 countries, the Rapid Assessment and Prioritization of Protected Area Management (RAPPAM) method is arguably the tool used most widely to assist such prioritization. The extent to which its indicators provide useful measures of a protected area’s capacity to achieve its conservation objectives, however, has seldom been subject to empirical scrutiny. We use a rich spatial dataset and time series data from 66 forest protected areas in the Brazilian Amazon to examine whether RAPPAM scores are associated with success in avoiding deforestation. We find no statistically significant association between avoided deforestation and indicators that reflect preferential targets of conservation investments, including budget, staff, equipment, management plans and stakeholder collaboration. Instead, we find that the absence of unsettled land tenure conflicts is consistently associated strongly with success in reducing deforestation pressures. Our results underscore the importance of tracking and resolving land tenure in protected area management, and lead us to call for more rigorous assessments of existing strategies for assessing and prioritizing management interventions in protected areas. (letter)
Background and PurposeData on safety and efficacy of periprocedural use of heparin are limited during treatment of acute ischemic stroke patients with anterior circulation tandem occlusion. This study aimed to investigate the impact of heparin use during endovascular therapy of anterior circulation tandem occlusions on the functional and safety outcomes.
MethodsA retrospective analysis of the multicenter observational TITAN registry was performed. Patients with anterior circulation tandem occlusion and treated with endovascular therapy (EVT) were included, with or without extracranial carotid intervention. We divided patients into two groups based on periprocedural heparin use (heparin vs. non-heparin). The dose of intravenous unfractionated heparin ranged from 1500 to 2500 I.U. Primary study endpoint was 90-day Modified Rankin Scale (mRS). Secondary study endpoint included angiographic and safety endpoints such as hemorrhagic complications. A propensity-score-matched analysis was performed.
ResultsAmong 369 patients, heparin was used in 68 patients (18.4%). In the propensity-score-matched cohort, favorable outcome (mRS 0–2) occurred in 51.3% in heparin group and 58.0% in non-heparin group (matched OR, 0.76; 95% CI, 0.32–1.78; P = 0.52). Similar result was found in propensity-score-adjusted cohort (adjusted OR, 0.72; 95%CI, 0.39–1.32; P = 0.28). Likewise, there was no difference in the rate of successful reperfusion (mTICI 2b-3) (propensity-score-adjusted OR, 1.03; 95%CI, 0.50–2.09; P = 0.93) neither in safety endpoints between the two groups.
ConclusionsPeriprocedural heparin use during EVT of anterior circulation tandem occlusions was not associated with better functional, angiographic or safety outcomes. These findings are applicable for low doses of heparin, and further studies are warranted.
[en] Thanks to recent theoretical progresses and to the test bench of SN1987A, it has been possible to improve our ability to extract information from the future observations. In this paper we discuss a parameterized model of the neutrino emission. Two applications of this model are considered: 1) the investigation of the scientific potential of a future supernova for the study of the astrophysical parameters; 2) the expectations regarding the diffuse supernova neutrino background, namely, the relic supernova neutrinos
[en] A new approach to scenarios focused on environmental concerns, changes and challenges, i.e. so-called 'environmental scenarios', is necessary if global environmental changes are to be more effectively appreciated and addressed through sustained and collaborative action. On the basis of a comparison of previous approaches to global environmental scenarios and a review of existing scenario typologies, we propose a new scenario typology to help guide scenario-based interventions. This typology makes explicit the types of and/or the approaches to knowledge ('the epistemologies') which underpin a scenario approach. Drawing on previous environmental scenario projects, we distinguish and describe two main types in this new typology: 'problem-focused' and 'actor-centric'. This leads in turn to our suggestion for a third type, which we call 'RIMA'-'reflexive interventionist or multi-agent based'. This approach to scenarios emphasizes the importance of the involvement of different epistemologies in a scenario-based process of action learning in the public interest. We suggest that, by combining the epistemologies apparent in the previous two types, this approach can create a more effective bridge between longer-term thinking and more immediate actions. Our description is aimed at scenario practitioners in general, as well as those who work with (environmental) scenarios that address global challenges.
[en] The purpose of this paper is to explain how the regulatory environment created by planning and building regulations interacts with land and property markets. Since this regulatory environment operates as a form of intervention within property markets in general and the development process in particular, it is essential first to understand the nature, structure and operation of land and property markets. These are covered in the first section. The second section identifies the aims and components of the planning system and building regulations. From this basis, four broad types of policy intervention are reviewed in the third section. These cover policies that seek to shape, regulate or stimulate market activity, and those that aim to build state or market capacity to produce desired outcomes. The final section uses the private residential development process as a case study to explore the extent to which state intervention can influence producer-consumer relationships in one important market sector. The paper argues that effective intervention in land and property markets requires the creation of a broad range of policy tools and their appropriate deployment to suit particular market circumstances. (author)