Absence Of Alarms Research Articles

Transgressing Criminology and Victimology

Transgressing Criminology and Victimology

Diagnostic Yield of Colonoscopy in Patients With Symptoms Compatible With Rome IV Functional Bowel Disorders

There is little data on the diagnostic yield of colonoscopy in patients with symptoms compatible with functional bowel disorders (FBDs). Previous studies have only focused on diagnostic outcomes of colonoscopy in those with suspected irritable bowel syndrome using historic Rome I-III criteria, whilst having partially assessed for alarm features and shown markedly conflicting results. There is also no colonoscopy outcome data for other FBDs, such as functional constipation or functional diarrhea. Using the contemporaneous Rome IV criteria we determined the diagnostic yield of colonoscopy in patients with symptoms compatible with a FBD, stratified diligently according to the presence or absence of alarm features. Basic demographics, alarm features, and bowel symptoms using the Rome IV diagnostic questionnaire were collected prospectively from adults attending out-patient colonoscopy in 2019. Endoscopists were blinded to the questionnaire data. Organic disease was defined as the presence of inflammatory bowel disease, colorectal cancer, or microscopic colitis. 646 patients fulfilled symptom-based criteria for the following Rome IV FBDs: IBS (56%), functional diarrhea (27%) and functional constipation (17%). Almost all had alarm features (98%). The combined prevalence of organic disease was 12%, being lowest for functional constipation and IBS-constipation (∼6% each), followed by IBS-mixed (∼9%), and highest amongst functional diarrhea and IBS-diarrhea (∼17% each); p = .005. The increased prevalence of organic disease in diarrheal versus constipation disorders was accounted for by microscopic colitis (5.7% vs. 0%, p < .001) but not inflammatory bowel disease (7.2% vs. 4.0%, p= .2) or colorectal cancer (4.2% vs. 2.3%, p = .2). However, 1-in-4 chronic diarrhea patients - conceivably at risk for microscopic colitis - did not have colonic biopsies taken. Finally, only 11 of 646 (2%) patients were without alarm features, in whom colonoscopy was normal. Most patients with symptoms of FBDs who are referred for colonoscopy have alarm features. The presence of organic disease is significantly higher in diarrheal versus constipation disorders, with microscopic colitis largely accounting for the difference whilst also being a missed diagnostic opportunity. In those patients without alarm features, the diagnostic yield of colonoscopy was nil.

Surgical Navigation System for Transsphenoidal Pituitary Surgery Applying U-Net-Based Automatic Segmentation and Bendable Devices

Conventional navigation systems used in transsphenoidal pituitary surgery have limitations that may lead to organ damage, including long image registration time, absence of alarms when approaching vital organs and lack of 3-D model information. To resolve the problems of conventional navigation systems, this study proposes a U-Net-based, automatic segmentation algorithm for optical nerves and internal carotid arteries, by training patient computed tomography angiography images. The authors have also developed a bendable endoscope and surgical tool to eliminate blind regions that occur when using straight, rigid, conventional endoscopes and surgical tools during transsphenoidal pituitary surgery. In this study, the effectiveness of a U-Net-based navigation system integrated with bendable surgical tools and a bendable endoscope has been demonstrated through phantom-based experiments. In order to measure the U-net performance, the Jaccard similarity, recall and precision were calculated. In addition, the fiducial and target registration errors of the navigation system and the accuracy of the alarm warning functions were measured in the phantom-based environment.

Intraoperative monitoring with visual evoked potentials for brain surgeries.

The goal of this study was to determine the performance of intraoperative visual evoked potentials (VEPs) in detecting visual field changes. Assessments of VEPs were performed with simultaneous retinal responses by using white light-emitting diodes protected from scialytic microscope lights. The alarm criterion was a reproducible decrease in amplitude of the VEP P100 wave of 20% or more. Visual fields were assessed preoperatively and 1 month postsurgery (Goldmann perimetry). The VEPs were analyzed for 29 patients undergoing resection of a brain lesion. In 89.7% of patients, steady VEP and retinal responses were obtained for monitoring. The absence of alarm was associated in 94.4% of cases with the absence of postoperative visual changes (specificity). The alarms correctly identified 66.7% of cases with any postoperative changes and 100% of cases with changes more severe than just a discrete quadrantanopia or deterioration of an existing quadrantanopia (sensitivity, new diffuse deterioration < 2 dB). In 11.5% of patients, a transitory VEP decrease with subsequent recovery was observed without postoperative defects. Intraoperative VEPs were performed with simultaneous recording of electroretinograms, with protection from lights of the operating room and with white light-emitting diodes. Intraoperative VEPs were shown to be reliable in predicting postoperative visual field changes. In this series of intraaxial brain procedures, reliable intraoperative VEP monitoring was achieved, allowing at minimum the detection of new quadrantanopia. The standardization of this technique appears to be a valuable effort in regard to the functional risks of homonymous hemianopia.

Water contamination of the central air supply: Out of sight, out of mind!

Water in flowmeters may cause bobbin malfunction, deliver inaccurate flows, and lead to hypoxia.[123] Remote location of medical gas pipeline system (MGPS) can deter anesthesiologist from being routinely involved in its day-to-day maintenance and thus, being caught unaware in the case of malfunction. We faced a harrowing incident wherein sudden influx of water column in air flow meter of anesthesia workstation (Datex Ohmeda Aestiva 5) was noticed due to faulty compressed air delivery system. A 35-week-old preterm neonate was posted for emergency laparotomy under general anesthesia for duodenal atresia. The anesthesia workstation in our emergency OT passed the pre-use check. After rapid sequence induction, the baby was intubated with 3.5 mm I.D. endotracheal tube and control knob of air flow meter was opened for the maintenance of anesthesia. To our great surprise, there was a sudden influx of water in the air flow meter from the needle valve and its level was rising fast. The bobbin got stuck at the bottom and stopped rotating. The circuit was disconnected and ventilation commenced with bag mask device. The pipeline was disconnected from the anesthesia workstation, and sevoflurane in 100% oxygen (from cylinder in the standby anesthesia machine) was used for anesthesia maintenance. Water is a usual contaminant in a compressed air system, and its amount may air vary from 2.5 g/m3 to over 40 g/m3 depending on climatic condition.[1] Air gets heated during the compression process and condensed moisture during cooling is removed in the after cooler. However, about 20 g/m3 may still remain in the compressed air unless removed by a dryer.[1] The probable causes of water contaminating the MGPS include manual water drain operated at longer time interval or drain clogging, absence of desiccant air dryer, exposure of central air pipeline to atmosphere and absence of alarms for water level.[2345] Fortunately, we noticed the water column in air flow meter immediately before it could contaminate the fresh gas flow. Detailed investigation revealed that there were reports of ventilator malfunction in the Pediatric Intensive Care Unit earlier due to faulty automatic drain of the compressed air system which was replaced. Subsequently, following a recent ventilator malfunction, fault in desiccant dryer was detected and repaired. Probably, this time purging of some of the “risers and branch lines” was not done. Hence, the water accumulated in the branch line (of emergency OT) as a result of dryer malfunction and exposure of air pipeline to the humid atmosphere (due to rainy season) during the repair of air dryer were probably the main culprits. All components of MGPS were checked by the service engineer; the pipeline was flushed thoroughly and to guard against such events in future checkups for medical air quality of pipeline were made more frequent. Technical engineer of the anesthesia workstation also confirmed the presence of water in the air flow meter tubing and dried all the channels properly. In conclusion, maintenance of MGPS should be directly supervised by anesthetists and medical air quality should be checked after maintenance work before its reconnection to the anesthesia machines after though purging. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

The state of the union: Nationwide absence of uniform guidelines for the prehospital use of tourniquets to control extremity exsanguination.

After the Sandy Hook shootings and the resulting Hartford Consensus, as well as the recent Boston Marathon bombing, the need for a uniform, detailed, and aggressive prehospital extremity exsanguination control protocol became clear. We hypothesized that most states within the United States lack a detailed uniform protocol. We performed a systematic nationwide assessment of emergency medical services (EMS) prehospital extremity exsanguination control protocols. An online search (updated February 7, 2015) identified state-, region-, or county-specific EMS protocols in all 50 states. If unavailable online, protocols were retrieved directly by contacting each state's Department of Public Health (or other appropriate agency). Two investigators independently screened each extremity exsanguination control protocol. Protocols were first grouped into three categories: I, tourniquet not mentioned; II, tourniquet mentioned, without specific guidance; III, tourniquet mentioned, with specific guidance related to type, indications, application technique, and safety concerns. Each protocol was then scored on a five-point scale for comparison. Forty-two states (84%) had statewide and 14 (28%) had at least one county-specific protocol. Seven states (16%) had no statewide protocol but at least one county-specific protocol (range, 1-10). Mississippi had neither statewide nor county-specific protocols. Of statewide protocols, 4 (9.5%) were in Category I, 23 (54.8%) in Category II, and 15 (35.7%) in Category III. The mean score for statewide tourniquets was 2.4/5 (SD, 1.25; range, 0-5). Thirteen (31%) statewide protocols referred to "commercial" or "approved" tourniquets; only three (7%) recommended a particular commercial device. The mean score for the county-specific protocols of states with no statewide protocol was 3.10 (SD, 1.56; range, 0-5) CONCLUSIONS: Throughout the United States, there is considerable variability in EMS protocols addressing the management of extremity exsanguination and an alarming absence of specific guidance for tourniquet use. Most states do not have a uniform, detailed, and aggressive prehospital extremity exsanguination control protocol. Epidemiologic and prognostic study, level III.

Systematic review of outcome measures in trials of pediatric anaphylaxis treatment.

BackgroundConsiderable heterogeneity has been observed in the selection and reporting of disease-specific pediatric outcome measures in randomized controlled trials (RCTs). This makes interpretation of results and comparison across trials challenging. Outcome measures in pediatric anaphylaxis trials have never previously been systematically assessed. This systematic review (SR) identified and assessed outcome measures used in RCTs of anaphylaxis treatment in children. As a secondary objective, this SR assessed the evidence for current treatment modalities for anaphylaxis in the pediatric population.MethodsWe searched MEDLINE, EMBASE, The Cochrane Library, Cochrane Central Register of Controlled Trials (CENTRAL), and CINAHL from 2001 until December 2012. We also searched websites listing ongoing trials. We included randomized and controlled trials of anaphylaxis treatment in patients 0–18 years of age. Two authors independently assessed articles for inclusion.ResultsNo published studies fulfilled the inclusion criteria.ConclusionsThere is an alarming absence of RCTs evaluating the treatments for anaphylaxis in children. High quality studies are needed and are possible to design, despite the severe and acute nature of this condition. Consensus about the selection and validation of appropriate outcome measures will enhance the quality of research and improve the care of children with anaphylaxis.Trial registrationCRD42012002685

Systematic review of outcome measures in trials of pediatric anaphylaxis treatment

Background: Considerable heterogeneity has been observed in the selection and reporting of disease-specific pediatric outcome measures in randomized controlled trials (RCTs). This makes interpretation of results and comparison across trials challenging. Outcome measures in pediatric anaphylaxis trials have never previously been systematically assessed. This systematic review (SR) identified and assessed outcome measures used in RCTs of anaphylaxis treatment in children. As a secondary objective, this SR assessed the evidence for current treatment modalities for anaphylaxis in the pediatric population. Methods: We searched MEDLINE, EMBASE, The Cochrane Library, Cochrane Central Register of Controlled Trials (CENTRAL), and CINAHL from 2001 until December 2012. We also searched websites listing ongoing trials. We included randomized and controlled trials of anaphylaxis treatment in patients 0–18 years of age. Two authors independently assessed articles for inclusion. Results: No published studies fulfilled the inclusion criteria. Conclusions: There is an alarming absence of RCTs evaluating the treatments for anaphylaxis in children. High quality studies are needed and are possible to design, despite the severe and acute nature of this condition. Consensus about the selection and validation of appropriate outcome measures will enhance the quality of research and improve the care o fc hildren with anaphylaxis. Trial registration: CRD42012002685

Thrombosis and failure of a HeartMate II Device in the absence of alarms

Next-generation left ventricular assist devices such as the HeartMate II (Thoratec Corporation, Pleasanton, CA) have significantly improved patient outcomes. In particular, the incidence of thromboembolic events appears to be significantly reduced. Pump thrombosis has occurred, however, and is well reported in the literature. The thromboses reported with next-generation devices have generally been partial thromboses associated with significant abnormalities in the system performance data as displayed on the system monitor. We describe a case of complete thrombosis of a HeartMate II axial-flow pump resulting in cardiac arrest but in the absence of alarms or significant aberrations in the performance data.

On his terms: representations of sexuality in women's magazines and the implications for negotiating safe sex

Research on sexual content in women's magazines has identified dominant ideologies that promote sexual role stereotypes and privilege masculinity. We extend this analysis in a thematic analysis to examine representations of sex in two best selling Australian women's magazines and to examine how such ideologies may reduce women's abilities to negotiate safe sex. One main theme – hetero monogamy – and six subsidiary themes emerged. Being in a monogamous heterosexual relationship was presented as essential for every woman's happiness, with sex as the means for achieving and maintaining this state. Five subsidiary themes, labelled gender differences, great sex, reaching orgasm, appearance and single women, reinforced the message that, for women, sex was work and required instruction. The final theme, sexual health, revealed an alarming absence of information on negotiating safe sex, apart from referring to it as an ‘awkward conversation’, whereas unprotected sex was a sign of trust and commitment. Throughout the themes, there was a lack of recognition of women's sexual desires and sexual agency. We argue that these discourses have serious implications for women's sexual health.

Funktionelle Ursachen chronischer Bauchschmerzen - Das Reizdarmsyndrom besser verstehen

The irritable bowel syndrome (IBS) is characterized by abdominal pain with altered bowel habits (diarrhea, constipation), usually accompanied by bloating and abdominal distension. The symptoms may persist for several years, often decades. The diagnosis of the syndrome is based on the typical symptom pattern, together with the absence of signs of organic causes (in particular absence of alarm” symptoms). In addition, a focused and rational differential and exclusion diagnostic program is required initially to establish and ascertain the diagnosis. For potential differential diagnoses, it is important to exclude organic diseases as well as chronic intestinal motor disorders. Treatment requires reliable diagnosis including careful exclusion of differential diagnoses for mutual reassurance, together with the development of a plausible disease model comprehensible for the patient. Medical therapy aims to symptomatically treat the dominant complaints and disturbances. Overall, our better understanding of the pathomechanisms of the syndrome over the last years has influenced the rational management of these disturbances as well as stimulated the development of new therapeutic options.

Design and Democracy

I shall present a few thoughts about the relationship between democracy and design, and about the relationship between critical humanism and operational humanism. This issue leads to the question of the role of technology and industrialization as a procedure for democratizing the consumption of goods and services, and finally to the ambivalent role of esthetics as the domain of freedom and manipulation. The main theme of my lecture is the relationship between design—in the sense of projecting—and autonomy. My reflections are open-ended, and do not pretend to give quick and immediate answers. The university still offers a place to pursue these questions that normally will not be addressed in professional practice, with its pressures and contingencies. Looking at the present design discourse, one notes a surprising—and I would say alarming—absence of questioning design activities. Concepts such as branding, competitiveness, globalization, comparative advantages, lifestyle design, differentiation, strategic design, fun design, emotion design, experience design, and smart design prevail in design magazines and the all too few books about design. Sometimes, one gets the impression that a designer aspiring to two minutes of fame feels obliged to invent a new label for setting herself or himself apart from the rest of what professional service offers. I leave aside “coffee table” books on design that abound in pictures and exempt the reader from intellectual efforts. The issue of design and democracy doesn’t enjoy popularity—apart from a few laudable exceptions. If we look at the social history of the meaning of the term “design,” we note on the one side a popularization that is a horizontal extension, and on the other side a contraction that is a vertical reduction. The architectural critic Witold Rybczynski recently commented on this phenomenon: “Not so long ago, the term ‘designer’ described someone such as Eliot Noyes, who was responsible for the IBM Selectric typewriter in the 1960s, or Henry Dreyfuss, whose clients included Lockheed Aircraft and the Bell Telephone Company ... or Dieter Rams, who created a range of austere-looking, but very practical, products for the German company Braun. Today, ‘designer’ is more likely to bring to mind Ralph Lauren or Giorgio Armani, that is, a fashion designer. While fashion designers usually start as couturiers, they—or at least their names—often are associated with a wide variety of consumer products including cosmetics, perfume, luggage, home furnishings, and even house

The optimal age threshold for screening upper endoscopy for uninvestigated dyspepsia in Taiwan, an area with a higher prevalence of gastric cancer in young adults

It is estimated that 1% to 2% of patients with dyspepsia are associated with gastric cancer. To avoid missing gastric cancer, most guidelines recommend that patients over 45 years old should undergo EGD for uninvestigated dyspepsia. In Taiwan, however, the prevalence of gastric cancer in younger patients is higher than that of Western countries. The optimal age threshold for endoscopy in patients with uninvestigated dyspepsia in Taiwan remains controversial. Therefore, we aimed to determine an optimal age threshold for screening endoscopy in patients with uninvestigated dyspepsia to avoid missing gastric cancer in Taiwan. We reviewed the findings in all adult patients who underwent upper endoscopy because of uninvestigated dyspepsia at the National Taiwan University Hospital. In those patients with confirmed gastric cancer histology, further analysis was performed. Cumulative age frequency distributions for gastric cancer were calculated according to gender and to the presence or the absence of alarm features. The stages of gastric cancer also were analyzed according to the presence or the absence of alarm symptoms. During the 5-year period, a total of 17,894 patients received upper endoscopy caused by uninvestigated dyspepsia. Gastric cancer was found in 225 (12.6 cases per 1000 EGDs) patients who presented with uninvestigated dyspepsia, 135 men and 90 women. Thirty-one (13.7%) and 17 (7.6%) patients were aged less than 45 and 40 years old, respectively. Among these 225 patients with gastric cancer, 114 (50.7%) patients did not have alarm symptoms (simple dyspepsia), whereas 111 (49.3%) had alarm symptoms. About 5.3% (12/225) of gastric cancer cases would have been missed if endoscopy had been omitted in patients without alarm symptoms and aged less than 45 years. The cumulative age relative frequencies of patients with gastric cancer who presented with simple dyspepsia were 1.8 (12/6720), 1.02 (5/4920), and 0.59 (2/3411) cases per 1000 EGDs for uninvestigated dyspepsia in patients aged less than 45, 40, and 35 years, respectively. When the frequencies of gastric cancer were stratified by age and gender, we found a trend of male predominance in older patients but not in younger patients. The cutoff age was 60 years old ( p < 0.05). Early gastric cancer was detected in 9.9% (11/111) and 26.3% (30/114) of patients with and without alarm symptoms, respectively (p = 0.002). Gastric cancer is not uncommon in patients with dyspepsia aged less than 45 years in Taiwan. The age threshold of screening endoscopy for uninvestigated dyspepsia should be the same for both genders in view of comparable frequencies of gastric cancer in a young age population. Because more than 5% of gastric cancer cases would be missed in Taiwan if endoscopy was omitted in simple dyspeptic patients who were aged less than 45 years, we recommend that 40 years old might be an optimal age threshold for screening endoscopy for uninvestigated dyspepsia in Taiwan, in both men and women patients.

“What, me worry?” Businesses and AIDS at Davos

At the Davos Summit in February, 2005, the World Economic Forum released its current survey on businesses and HIV/AIDS.1 In 1996, we outlined the case for business in Asia to play a pivotal role in preventing the epidemic.2 At that time, an estimated 3 million people in Asia had been infected with HIV. Today that number is estimated at 8·2 million.3 AIDS is a preventable disease. The survey finds an absence of alarm in the business sector which, if true, bodes poorly for success in controlling this epidemic.

Firms fill antiretroviral gap in South Africa

In South Africa, where less than 3% of people who need antiretroviral treatment actually get it, 1 WHO/UNAIDS. South Africa, UNAIDS2004http://www.unaids.org/html/pub/publications/fact-sheets01/southafrica_en_pdf.pdf Google Scholar private-sector companies are stepping in to fill the need. A growing number are supplying such drugs directly to employees who are HIV-positive or are facilitating access to drugs via third parties such as non-governmental organisations. While businesses in the rest of the world are becoming less concerned about AIDS, the contradictory trend in South Africa is being driven, on the face of it, by two imperatives. The first is heightened social awareness in the postapartheid society. The second is more bankable: an often-compelling economic argument. “What, me worry?” Businesses and AIDS at DavosAt the Davos Summit in February, 2005, the World Economic Forum released its current survey on businesses and HIV/AIDS.1 In 1996, we outlined the case for business in Asia to play a pivotal role in preventing the epidemic.2 At that time, an estimated 3 million people in Asia had been infected with HIV. Today that number is estimated at 8·2 million.3 AIDS is a preventable disease. The survey finds an absence of alarm in the business sector which, if true, bodes poorly for success in controlling this epidemic. Full-Text PDF

Organizational crisis experience and public relations roles

In theory a function of management, the practice of public relations assumes various roles in different organizations, ranging from technician to manager. Crises present organizations with significant financial, social and ethical challenges. This article suggests a relationship between organizational crisis experience and the placement of the public relations function. A relationship between organizational size and crisis experience is noted. It also uncovers an alarming absence of crisis planning and training in organizations.

South African Sociology during the eighties as mirrored in the South African Journal of Sociology

Van Staden and Visser have done the contributors to the South African Journal of Sociology (SAJS) a favour by showing them in very vivid terms what they collectively conttibuted towards the development of sociology in South Africa during the eighties. The analysis of the contents of the SAJS reveals a distinct preference for review articles, little interest in the development of sociological theory as such, an alarming absence of methodological sophistication as far as empirical research is concerned and a sttong tendency towards intracultural in stead of cross-cultural research. Most of these are cause for grave concern about the state of sociology in South Africa and must be addressed in the nineties if South African sociologists wish to be taken seriously by their colleagues in the international sociological community.