Catalogue Search | MBRL
Are you sure you want to remove the book from the shelf?
{{itemTitle}}
69
result(s) for
"Delaney, Luke"
Sort by:
Cold killing
Detective Inspector Sean Corrigan takes on a case that seems to be a straightforward domestic homicide. He soon finds several other linked victims, however, and that leads him to the most dangerous serial killer he's ever encountered.
Book
Ultrasound-Guided Needle Technique Accuracy: Prospective Comparison of Passive Magnetic Tracking Versus Unassisted Echogenic Needle Localization
BACKGROUND AND OBJECTIVESUltrasound-guided regional anesthesia facilitates an approach to sensitive targets such as nerve clusters without contact or inadvertent puncture. We compared accuracy of needle placement with a novel passive magnetic ultrasound needle guidance technology (NGT) versus conventional ultrasound (CU) with echogenic needles.
METHODSSixteen anesthesiologists and 19 residents performed a series of 16 needle insertion tasks each, 8 using NGT (n = 280) and 8 using CU (n = 280), in high-fidelity porcine phantoms. Tasks were stratified based on aiming to contact (target-contact) or place in close proximity with (target-proximity) targets, needle gauge (no. 18/no. 22), and in-plane (IP) or out-of-plane (OOP) approach. Distance to the target, task completion by aim, number of passes, and number of tasks completed on the first pass were reported.
RESULTSNeedle guidance technology significantly improved distance, task completion, number of passes, and completion on the first pass compared with CU for both IP and OOP approaches (P ≤ 0.001). Average NGT distance to target was lower by 57.1% overall (n = 560, 1.5 ± 2.4 vs 3.5 ± 3.7 mm), 38.5% IP (n = 140, 1.6 ± 2.6 vs 2.6 ± 2.8 mm), and 68.2% OOP (n = 140, 1.4 ± 2.2 vs 4.4 ± 4.3 mm) (all P ≤ 0.01). Subgroup analyses revealed accuracy gains were largest among target-proximity tasks performed by residents and for OOP approaches. Needle guidance technology improved first-pass completion from 214 (76.4%) per 280 to 249 (88.9%) per 280, a significant improvement of 16.4% (P = 0.001).
CONCLUSIONSPassive magnetic NGT can improve accuracy of needle procedures, particularly among OOP procedures requiring close approach to sensitive targets, such as nerve blocks in anesthesiology practice.
Journal Article
Lighting the way to safety; School Newspaper
TRAFFIC lights were recently installed lights on the New England Highway between Arthur and Alexandra streets at Rutherford in a bid to improve pedestrian safety.
Newspaper Article
Lighting the way to safety; School Newspaper
TRAFFIC lights were recently installed lights on the New England Highway between Arthur and Alexandra streets at Rutherford in a bid to improve pedestrian safety.
Newspaper Article
The Policy Alliance Between Hospitals and Debt Collection Agencies: Content Analysis of Public Comments on Regulations on Billing and Collections
Significant debate persists about the obligations of nonprofit hospitals toward low-income patients. Many issues pertaining to this subject were discussed during the rulemaking process following the passage of the Affordable Care Act of 2010, which set forth rules for hospital billing and collection. In public comments, hospitals, debt collectors, and patient advocates debated what constituted \"reasonable efforts\" to determine whether a patient qualified for hospital financial assistance before resorting to extraordinary collection actions including lawsuits, wage garnishments, and adverse credit reporting. This study analyzes public comments to the proposed Internal Revenue Service rule on section 501(r)(6). After an initial review of the data, 5 commonly mentioned issues were identified. Respondents were organized into commenter types, and the opinion of each respondent to each issue was coded by 2 separate reviewers. Discrepancies between reviewer determinations were resolved by consensus during follow-up discussions. This analysis revealed a set of common concerns: whether reporting delinquent medical debt to credit bureaus and selling debt to third party buyers should be considered extraordinary collection actions; whether hospitals should be able to use presumptive eligibility to rule patients either eligible or ineligible for financial assistance; and whether hospitals should be held legally liable for the actions of third-party debt collectors. Hospitals and debt collection agencies were allied on most issues, particularly in their shared belief that reporting debt to credit bureaus and selling debt to third parties should not be tightly regulated. Patient advocacy organizations and hospitals had divergent opinions on most issues. The alliance of hospitals and debt collectors in advocating for fewer regulations around collections is part of a history of hospital lobbying to maintain tax-exemption with fewer charity care mandates. This alignment helps explain why third-party debt collection agencies, and aggressive collection tactics, have become commonplace in hospital billing.
Journal Article
Long-Term Effectiveness of a Multi-Strategy Choice Architecture Intervention in Increasing Healthy Food Choices of High-School Students From Online Canteens (Click & Crunch High Schools): Cluster Randomized Controlled Trial
School canteens are a recommended setting to influence adolescent nutrition due to their scope to improve student food choices. Online lunch ordering systems (\"online canteens\") are increasingly used and represent attractive infrastructure to implement choice architecture interventions that nudge users toward healthier food choices. A recent cluster randomized controlled trial demonstrated the short-term effectiveness (2-month follow-up) of a choice architecture intervention to increase the healthiness of foods purchased by high school students from online canteens. However, there is little evidence regarding the long-term effectiveness of choice architecture interventions targeting adolescent food purchases, particularly those delivered online.
This study aimed to determine the long-term effectiveness of a multi-strategy choice architecture intervention embedded within online canteen infrastructure in high schools at a 15-month follow-up.
A cluster randomized controlled trial was undertaken with 1331 students (from 9 high schools) in New South Wales, Australia. Schools were randomized to receive the automated choice architecture intervention (including menu labeling, positioning, feedback, and prompting strategies) or the control (standard online ordering). The foods purchased were classified according to the New South Wales Healthy Canteen strategy as either \"everyday,\" \"occasional,\" or \"should not be sold.\" Primary outcomes were the average proportion of \"everyday,\" \"occasional,\" and \"should not be sold\" items purchased per student. Secondary outcomes were the mean energy, saturated fat, sugar, and sodium content of purchases. Outcomes were assessed using routine data collected by the online canteen.
From baseline to 15-month follow-up, on average, students in the intervention group ordered significantly more \"everyday\" items (+11.5%, 95% CI 7.3% to 15.6%; P<.001), and significantly fewer \"occasional\" (-5.4%, 95% CI -9.4% to -1.5%; P=.007) and \"should not be sold\" items (-6%, 95% CI -9.1% to -2.9%; P<.001), relative to controls. There were no between-group differences over time in the mean energy, saturated fat, sugar, or sodium content of lunch orders.
Given their longer-term effectiveness, choice architecture interventions delivered via online canteens may represent a promising option for policy makers to support healthy eating among high school students.
Australian Clinical Trials ACTRN12620001338954, https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380546 ; Open Science Framework osf.io/h8zfr, https://osf.io/h8zfr/.
Journal Article
Is there a right tool for the job? Decision aids and altered mental status in the emergency department
In recognition of this reality, a recent article in JACEP Open by Simkins et al brought us a clinical decision tool that attempts to use objective findings to help risk-stratify patients on the predicted need for admission. 2 THE NOT-SO-SHORT CUT Although the idea of using a rapid decision tool to risk-stratify altered patients is potential practice changing, the reality looks somewhat problematic. Simkins et al report that patients in the low-risk cohort all had stable vital signs, were often altered as a result of a chronic underlying condition and had a 1-year mortality rate of <2%. A bigger potential pitfall could come from the association between the presence of an underlying mental health disorder and the label of “low risk.”
Journal Article
The Effectiveness of Interventions Delivered Using Digital Food Environments to Encourage Healthy Food Choices: A Systematic Review and Meta-Analysis
Digital food environments are now commonplace across many food service and retail settings, influencing how the population orders and accesses foods. As such, digital food environments represent a novel platform to deliver strategies to improve public health nutrition. The purpose of this review was to explore the impact of dietary interventions embedded within online food ordering systems, on user selection and purchase of healthier foods and beverages. A systematic search of eight electronic databases and grey literature sources was conducted up to October 2020. Eligible studies were randomized controlled trials and controlled trials, designed to encourage the selection and purchase of healthier products and/or discourage the selection and purchase of less-healthy products using strategies delivered via real-world online food ordering systems. A total of 9441 articles underwent title and abstract screening, 140 full-text articles were assessed for eligibility, and 11 articles were included in the review. Meta-analysis of seven studies indicated that interventions delivered via online food ordering systems are effective in reducing the energy content of online food purchases (standardized mean difference (SMD): −0.34, p = 0.01). Meta-analyses including three studies each suggest that these interventions may also be effective in reducing the fat (SMD: −0.83, p = 0.04), saturated fat (SMD: −0.7, p = 0.008) and sodium content (SMD: −0.43, p = 0.01) of online food purchases. Given the ongoing growth in the use of online food ordering systems, future research to determine how we can best utilize these systems to support public health nutrition is warranted.
Journal Article
Urine pregnancy testing: When does no mean maybe?
The first and likely most common situation involves a case of early pregnancy when a pregnant patient may not produce enough human chorionic gonadotropin (hCG) to trigger a positive test, a threshold that reportedly ranges from 15 to 100 mIU/mL. 2 The potentially more concerning scenario involves patients who are further along in their pregnancy and experience what has been called the “hook effect” describing a situation where elevated or excessive levels of hCG essentially overwhelm the UPT, resulting in a false negative. In this patient population, once cases of early pregnancy with serum hCG levels below the 25 IU/mL threshold for UPT detection were excluded, the actual false negative rate was 0.19%. 5 The authors reported 12 ectopic pregnancies in patients with negative UPT with 83% of cases occurring in the high-risk group.
Journal Article