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Fairy tales of Ireland
A collection of Irish fairy tales, with a concentration on the fairies themselves, including \"The Stolen Child,\" \"The Witches' Excursion,\" and \"The Horned Women.\"
Book
Training to improve emergency management decision-making: What the research literature tells us
The importance of training for effective performance in high-stakes, high-risk work settings is well-known. Successful training is the systematic acquisition of skills, rules, concepts or attitudes that result in improved work performance. Simply exposing people to training situations is not sufficient for them to develop knowledge and skills. This will only occur if the activity results in learning. While much training focuses on the development of technical skills, it is important to train people in non-technical skills, such as decision-making. This paper presents the results of a literature review of 95 peer-reviewed articles that consider the current training and exercise practices used to develop emergency management decision-making capability. The different approaches to training can be categorised into 4 types: discussion-based, operation-based, E-based and post-incident debriefs. This paper discusses current practice in emergency management decision-making training in each of these categories together with studies that have evaluated their effectiveness noting the generally limited nature of evaluation studies. To promote evaluation of training, several studies have developed tools to assess the effectiveness of training. Finally, key takeaway points related to emergency management organisational training and exercise programs are provided.
Journal Article
Multi-energy spectral photon-counting computed tomography (MARS) for detection of arthroplasty implant failure
To determine whether state-of-the-art multi-energy spectral photon-counting computed tomography (MARS) can detect knee arthroplasty implant failure not detected by standard pre-operative imaging techniques. A total knee arthroplasty (TKA) removed from a patient was reviewed. The extracted prosthesis [NexGen Legacy Posterior Stabilized (LPS) TKA] was analyzed as were pre-operative imaging examination and compared with a MARS-CT examination obtained of the extracted TKA prosthesis. Radiographs, fluoroscopy, ultrasound and MRI preoperatively did not reveal the cause of the implant failure. MARS CT images of the extracted prosthesis clearly showed the presence of posteromedial polyethylene and tibial tray wear which is compatible with the clinical appearance of the extracted TKA. MARS can identify polyethylene insert and metallic tibial tray wear as a cause of TKA failure, that could not be identified with on standard pre-operative imaging. Although clinical MARS CT system is still under development, this case does illustrate its potential clinical usefulness. This is the first study to document how MARS CT imaging can detect orthopedic implant failure not detected by standard current imaging techniques. This system has a potential clinical application in orthopedic patients.
Journal Article
A review of cognitive aids and their application to emergency management in Australia
Decision-making in disasters and major crises faced by emergency services globally is a difficult combination of science and art to master. To assist decision-makers in these environments, a number of cognitive aids have been developed and subsequently adopted by individuals and organisations alike. However, these aids vary according to their intent and the context in which they are intended to be applied. This review explores the use of cognitive aids in the context of emergency management and explores how existing knowledge regarding the use of cognitive aids from other industries may be translated to emergency management. An iterative literature review of academic and industry material related to cognitive aids during incident and crisis response across a broad range of international emergency service and other industries within the last 20 years was completed. Ultimately, cognitive aids are not a silver bullet when it comes to decision-making in the emergency management context. The correct tool (that is correctly designed) must be correctly applied by trained and competent end users. The Australian emergency management sector may benefit from future research exploring how these existing tools adhere to the good practice principles identified in this study.
Journal Article
Emergency management decision-making in a changing world: 3 key challenges
Managing emergencies is taxing for individuals due to the stress of making decisions in dangerous, high-stakes and time-constrained environments. These complex, dynamic environments also make it difficult to coordinate as other responders perform different roles that may have conflicting goals. This study explored some of the challenges faced by emergency management decision-makers through a literature review of 70 papers identified from SCOPUS and EBSCO database searches. Three major challenges for emergency management were identified: stress and fatigue, interoperability and ethical decision-making. Each of these challenges is examined to explore their nature and how they are likely to evolve in the future. This paper provides helpful advice on how to mitigate these challenges. We argue that to better meet these challenges, emergency services organisations need to develop and maintain appropriate doctrine and training, develop a supportive organisational culture and effectively learn the lessons of previous critical incidents.
Journal Article
Spectral Hounsfield units: a new radiological concept
Objective
Computed tomography (CT) uses radiographical density to depict different materials; although different elements have different absorption fingerprints across the range of diagnostic X-ray energies, this spectral absorption information is lost in conventional CT. The recent development of dual energy CT (DECT) allows extraction of this information to a useful but limited extent. However, the advent of new photon counting chips that have energy resolution capabilities has put multi-energy or spectral CT (SCT) on the clinical horizon.
Methods
This paper uses a prototype SCT system to demonstrate how CT density measurements vary with kilovoltage.
Results
While radiologists learn about linear attenuation curves during radiology training, they do not usually need a detailed understanding of this phenomenon in their clinical practice. However SCT requires a paradigm shift in how radiologists think about CT density.
Conclusion
Because radiologists are already familiar with the Hounsfield Unit (HU), it is proposed that a modified HU be used that includes the mean energy used to obtain the image, as a conceptual bridge between conventional CT and SCT. A suggested format would be: HU
keV
.
Key Points
•
Spectral computed tomography uses K-edge and slope effects to identify element signatures
.
•
New visualisation tools will be required to efficiently display spectral CT information
.
•
This paper demonstrates HU variation with keV using the Medipix3 chip
.
•
HU
keV
is a suggested format when stating spectral HU measurements
.
Journal Article
Development of a behavioural marker system for incident command in the UK fire and rescue service: THINCS
Non-technical skills in high-reliability industries include decision making, interpersonal communication and personal resilience. It has been argued that these skills are key to effective performance, safety and welfare. However, there is no agreed upon set of such skills or formal means to identify and assess them for incident commanders in the UK fire and rescue service (FRS). The aim of this research was to identify the non-technical skills that underpin effective incident command in the UK FRS, and to develop a behavioural marker system that captures these skills. Our research assessed the current range of training offered in non-technical skills across the UK FRS, and identified the non-technical skills of incident command within the UK FRS through interviews with incident commanders, and workshops with subject-matter experts. The six non-technical skills were: assertive, effective and safe leadership; effective decision making and planning; interpersonal communication; personal resilience; situational awareness; and teamwork and interoperability. A bespoke behavioural marker system, called THINCS, was developed with exemplary behaviours for each skill.
Journal Article
Metabolic Hydrolysis of Aromatic Amides in Selected Rat, Minipig, and Human In Vitro Systems
The release of aromatic amines from drugs and other xenobiotics resulting from the hydrolysis of metabolically labile amide bonds presents a safety risk through several mechanisms, including geno-, hepato- and nephrotoxicity. Whilst multiple
in vitro
systems used for studying metabolic stability display serine hydrolase activity, responsible for the hydrolysis of amide bonds, they vary in their efficiency and selectivity. Using a range of amide-containing probe compounds (0.5–10 µM), we have investigated the hydrolytic activity of several rat, minipig and human-derived
in vitro
systems - including Supersomes, microsomes, S9 fractions and hepatocytes - with respect to their previously observed human
in vivo
metabolism. In our hands, human carboxylesterase Supersomes and rat S9 fractions systems showed relatively poor prediction of human
in vivo
metabolism. Rat S9 fractions, which are commonly utilised in the Ames test to assess mutagenicity, may be limited in the detection of genotoxic metabolites from aromatic amides due to their poor concordance with human
in vivo
amide hydrolysis. In this study, human liver microsomes and minipig subcellular fractions provided more representative models of human
in vivo
hydrolytic metabolism of the aromatic amide compounds tested.
Journal Article
A Hybrid 2D/3D User Interface for Radiological Diagnosis
This paper presents a novel 2D/3D desktop virtual reality hybrid user interface for radiology that focuses on improving 3D manipulation required in some diagnostic tasks. An evaluation of our system revealed that our hybrid interface is more efficient for novice users and more accurate for both novice and experienced users when compared to traditional 2D only interfaces. This is a significant finding because it indicates, as the techniques mature, that hybrid interfaces can provide significant benefit to image evaluation. Our hybrid system combines a zSpace stereoscopic display with 2D displays, and mouse and keyboard input. It allows the use of 2D and 3D components interchangeably, or simultaneously. The system was evaluated against a 2D only interface with a user study that involved performing a scoliosis diagnosis task. There were two user groups: medical students and radiology residents. We found improvements in completion time for medical students, and in accuracy for both groups. In particular, the accuracy of medical students improved to match that of the residents.
Journal Article
Progesterone Metabolism by Human and Rat Hepatic and Intestinal Tissue
Following oral administration, the bioavailability of progesterone is low and highly variable. As a result, no clinically relevant, natural progesterone oral formulation is available. After oral delivery, first-pass metabolism initially occurs in the intestines; however, very little information on progesterone metabolism in this organ currently exists. The aim of this study is to investigate the contributions of liver and intestine to progesterone clearance. In the presence of NADPH, a rapid clearance of progesterone was observed in human and rat liver samples (t1/2 2.7 and 2.72 min, respectively). The rate of progesterone depletion in intestine was statistically similar between rat and human (t1/2 197.6 min in rat and 157.2 min in human). However, in the absence of NADPH, progesterone was depleted at a significantly lower rate in rat intestine compared to human. The roles of aldo keto reductases (AKR), xanthine oxidase (XAO) and aldehyde oxidase (AOX) in progesterone metabolism were also investigated. The rate of progesterone depletion was found to be significantly reduced by AKR1C, 1D1 and 1B1 in human liver and by AKR1B1 in human intestine. The inhibition of AOX also caused a significant reduction in progesterone degradation in human liver, whereas no change was observed in the presence of an XAO inhibitor. Understanding the kinetics of intestinal as well as liver metabolism is important for the future development of progesterone oral formulations. This novel information can inform decisions on the development of targeted formulations and help predict dosage regimens.
Journal Article