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Search Results: 1 - 10 of 850 matches for " Gareth Grier "
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Scenario based outdoor simulation in pre-hospital trauma care using a simple mannequin model
Per P Bredmose, Karel Habig, Gareth Davies, Gareth Grier, David J Lockey
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine , 2010, DOI: 10.1186/1757-7241-18-13
Abstract: A simple intubatable mannequin or student volunteers are used together with a training version of the equipment used on a routine basis by the pre-hospital care team (doctor + paramedic).Training is conducted outdoors at the base location all year round. The scenarios are led by scenario facilitators who are predominantly senior physicians. Their role is to brief the training team and guide the scenario, results of patient assessment and the simulated responses to interventions and treatment. Pilots, fire-fighters and medical students are utilised in scenarios to enhance realism by taking up roles as bystanders, additional ambulance staff and police. These scenario participants are briefed and introduced to the scene in a realistic manner. After completion of the scenario, the training team would usually be invited to prepare and deliver a hospital handover as they would in a real mission. A formal structured debrief then takes place.This training method technique has been used for the training of all London Helicopter Emergency Medical Service (London HEMS) doctors and paramedics over the last 24 months. Informal participant feedback suggests that this is a very useful teaching method, both for improving motor skills, critical decision-making, scene management and team interaction. Although formal assessment of this technique has not yet taken place we describe how this type of training is conducted in a busy operational pre-hospital trauma service.The teaching and maintenance of pre-hospital care skills is essential to an effective pre-hospital trauma care system. Simple mannequin based scenario training is feasible on a day-to-day basis and has the advantages of low cost, rapid set up and turn around. The scope of scenarios is limited only by the imagination of the trainers. Significant effort is made to put the participants into "the Zone" - the psychological mindset, where they believe they are in a realistic setting and treating a real patient, so that they ga
Deciding the Winner of an Arbitrary Finite Poset Game is PSPACE-Complete
Daniel Grier
Computer Science , 2012, DOI: 10.1007/978-3-642-39206-1_42
Abstract: A poset game is a two-player game played over a partially ordered set (poset) in which the players alternate choosing an element of the poset, removing it and all elements greater than it. The first player unable to select an element of the poset loses. Polynomial time algorithms exist for certain restricted classes of poset games, such as the game of Nim. However, until recently the complexity of arbitrary finite poset games was only known to exist somewhere between NC^1 and PSPACE. We resolve this discrepancy by showing that deciding the winner of an arbitrary finite poset game is PSPACE-complete. To this end, we give an explicit reduction from Node Kayles, a PSPACE-complete game in which players vie to chose an independent set in a graph.
A Brief Follow-Up Report on 228 Medial Rotation Total Knee Replacements at a Mean of 8.5 Years (0 - 19)  [PDF]
Sarah McMahon, Gareth Scott
International Journal of Clinical Medicine (IJCM) , 2015, DOI: 10.4236/ijcm.2015.612121
Abstract: We present an update in our earlier report on the Medial Rotation Total Knee Arthroplasty (TKA) when a cohort of 228 TKAs in 189 patients (78 M; 111 F) with a mean age of 67.9 years (28 - 90) was reported at a mean follow-up of six years (1 - 13). At that time, the ten-year survivorship for revision for any reason was 94.5% (95% confidence interval (CI): 85.1 - 100), but only 21 knees were at risk at that tenth year. The 10th annual report of the National Joint Registry (NJR) of England, Wales and Northern Ireland reported a deterioration in survivorship of the Medial Rotation TKA beyond the seventh year of follow-up. This implant previously had enjoyed the lowest rate of revision for any reported brand of prosthesis. As a result, we undertook a comprehensive audit of our original cohort at a mean follow-up of 8.5 years (0 - 19). With revision for aseptic loosening, and revision for any reason as the endpoints, with 125 prostheses at risk at ten years, the ten-year survivorship was 96.7% (95% CI: 93.3 - 100) and 92.3% (95% CI: 87.7 - 93.7) respectively. We have confirmed a decline in survivorship at ten years compared to our initial report. We believe that our results probably provide a more accurate picture of the longevity of the implant than figures available from the NJR, as they are based on detailed contemporary enquiries into each patient’s circumstances. Only ten knees in seven patients were lost to follow-up in our review.
Políticas culturales: Francia y Europa del Sur Políticas culturales: Francia y Europa del Sur
Emmanuel Négrier
Política y Sociedad , 2008, DOI: -
Abstract: In this paper, we propose a comparative analysis of five national models of cultural policy. The four first ones constitute Southern Europe: Greece, Italy, Portugal and Spain. The fifth one is France. These countries share a tradition of direct intervention in the cultural field, contrary to anglo-saxon or Scandinavian countries. The aim of such a comparison is to assess convergences but also disparities between these countries, in spite of their common traditions. We focus on the historical paths, the ways of institutionalization of the cultural public domain, and the different kinds of territorial management of cultural policies. France, which is often considered as a singular model the other countries would have try to imitate, is also analyzed in a comparative perspective. The assessment of convergences and divergences allows, in conclusion, to establish the common goals that share these five countries, as well as the major part of occidental countries in order to define the cultural policy for the 21st century. En este artículo ofrecemos un análisis comparado de cinco modelos nacionales de política cultural. Los cuatro primeros pertenecen a la Europa del sur: Espa a, Grecia, Italia, Portugal; Francia es el quinto. A diferencia de los países anglosajones o escandinavos, los países mencionados tienen en común una tradición de intervención directa en materia de cultura. Nuestra comparación se propone demostrar las convergencias y las diferencias en las trayectorias históricas de dichas políticas culturales, su forma de institucionalización y su modo de gestión territorial. Abordamos el caso francés aparte y desde una perspectiva comparada, pues suele constituir un modelo que los otros cuatro países han intentado imitar. A modo de conclusión, el balance de las convergencias y divergencias permite establecer retos comunes para el conjunto de dichos países, y quizá también para todos los países occidentales, de cara a definir las políticas culturales del siglo XXI.
La diversité, nouveau paradigme des politiques culturelles? Une comparaison européenne
Emmanuel Négrier
Revista de Investigaciones Políticas y Sociológicas (RIPS) , 2008,
Abstract: The emergence of cultural diversity as a new standard of public policy seems to induce that cultural policies would be its privileged area of diffusion. Following the ratification of Unesco′s Charter on cultural diversity, Western ministries of Culture have integrated this dimension to their discourses. But we can assess considerable distortions in the way through which this issue is actually integrated into public policy. A comparison of national diversity policies in Europe requires at first a cultural assessment of the content of this concept and an analysis of the multiple dimensions to which it concretely refers.
Lafargue de Grangeneuve Lo c, Politique du hip-hop. Action publique et cultures urbaines
Emmanuel Négrier
Métropoles , 2010,
Abstract: L’ouvrage de Lo c Lafargue de Grangeneuve s’inscrit dans une recherche amorcée dans le cadre de sa thèse, qui portait sur les processus d’institutionnalisation des cultures urbaines dans le champ des politiques culturelles. Son travail est centré sur l’interaction entre, d’une part, les représentants de la culture hip-hop (rap, slam, danse hip-hop, graffiti…) et d’autre part les institutions publiques : directions régionales des affaires culturelles (DRAC), responsables de la politique de la ...
Best use of targeted agents for the treatment of advanced renal cell carcinoma
Sylvie Négrier
European Journal of Oncology Pharmacy , 2009,
Abstract: The advent of targeted therapies has substantially improved the prognosis of patients with metastatic renal cell carcinoma. Clinical outcomes can be optimised by patient education, close patient monitoring, appropriate dosing and prompt adverse event management by a multidisciplinary healthcare team.
Kei modules and unoriented link invariants
Mike Grier,Sam Nelson
Mathematics , 2011,
Abstract: We define invariants of unoriented knots and links by enhancing the integral kei counting invariant Phi_X^Z (K) for a finite kei X using representations of the kei algebra, Z_K[X], a quotient of the quandle algebra Z[X] defined by Andruskiewitsch and Grana. We give an example that demonstrates that the enhanced invariant is stronger than the unenhanced kei counting invariant. As an application, we use a quandle module over the Takasaki kei on Z_3 which is not a Z_K[X]-module to detect the non-invertibility of a virtual knot.
Recently published papers: Therapies failed, disputed, and beneficent
Gareth Williams
Critical Care , 2007, DOI: 10.1186/cc5931
Abstract: In 1976, Ashbaugh first described acute lung injury/acute respiratory distress syndrome. Our subsequent understanding of the underlying pathophysiology has grown enormously and led to the development of many novel therapies. However, the high mortality rate has changed little in 40 years. Inhaled nitric oxide (NO) was one such therapy. It seemed perfect, being a selective pulmonary vasodilator resulting in reversal of pulmonary shunt, reduction in pulmonary artery pressure and improved right ventricular function, not to mention its inhibition of platelet aggregation and neutrophil adhesion. The clever money was on NO.Sadly, all that sparkles is not gold. A multitude of studies have simply failed to demonstrate improved outcomes. Despite this, its clinical application has continued, albeit somewhat piecemeal.In April the British Medical Journal published a systematic review and meta-analysis on the effect of NO in acute lung injury [1]. Outcomes included oxygenation, pulmonary artery pressure, duration of ventilation, mortality and adverse effects. Twelve randomized controlled trials (n = 1,237) were selected. The results and conclusions do not make for happy reading. NO was found not to improve mortality, duration of ventilation, or number of ventilator-free days. It bestowed a small oxygenation benefit in the first few days of use. It did not significantly reduce mean pulmonary arterial pressure. High-dose NO (80 ppm) was associated with methaemoglobinaemia and raised blood nitrogen dioxide levels. Finally, a statistically significant risk for renal dysfunction was identified in patients receiving NO, although the authors stressed cautious interpretation of this finding.This was an assiduously conducted review and the results are in keeping with previous work [2]. It leaves one begrudgingly accepting the authors' conclusions that, 'given the best available evidence suggests no survival advantage and possible increased mortality and renal dysfunction with nitric oxi
Recently published papers: Curing, caring and follow-up
Gareth Williams
Critical Care , 2003, DOI: 10.1186/cc2381
Abstract: Following the success of the activated protein C trial in 2001 [1], interest in anticoagulant therapy for severe sepsis was heightened. A systemic imbalance between procoagulant and anticoagulant pathways exists in severe sepsis, leading to thrombus formation in the microvasculature and to subsequent end-organ injury. Endothelial injury occurring in severe sepsis is thought to be a trigger for this process, initiating the clotting cascade via the transmembrane receptor, known as tissue factor, and its interaction with factor VII. Inhibition of this interaction would block the coagulation pathway at its earliest point.With this concept in mind, July witnessed the publication of a large multicentre phase 3 randomised, double-blind, placebo-controlled, clinical trial investigating the efficacy and safety of recombinant tissue factor pathway inhibitor (TFPI) in severe sepsis [3]. Two subgroups of patients were randomised to either a 96-hour infusion of active drug or to placebo: a high International Normalised Ratio (INR) group (INR ≥ 1.2, 1754 patients), and a low INR group (INR ≤ 1.2, 201 patients). The study failed to demonstrate any survival benefit in the treatment groups, although there was a trend to improve survival in the small low INR subgroup. Furthermore, the study showed that TFPI administration was associated with an increased risk of bleeding, predominantly from gastrointestinal and respiratory tracts.One of the more striking peculiarities of this study is the reversal in fortunes of the treatment and placebo groups halfway through the enrollment period. At a planned interim analysis the mortality rates favoured the TFPI group (29.1% versus 38.9%). In the latter portion of the study, however, an increase in the TFPI group mortality and a decrease in the placebo group mortality totally reversed this effect. No satisfactory explanation for this phenomenon has been found despite exhaustive efforts. If the study had been stopped following the interim analysis
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