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Prognostic Factors to Reduce ICU Overtriage in Elderly Patients with Isolated Mild Traumatic Brain Injury

Surgical Science 2023年第7期14卷 517-532页

作者： tomas jacome Chris LaBorde Richard Lewis Danielle Tatum Our Lady of the Lake Regional Medical Center Baton Rouge LA USA LSU Health-Baton Rouge Baton Rouge LA USA

Introduction: Elderly patients with mild traumatic brain injury (mTBI) are frequently admitted to an intensive care unit (ICU), which is potentially both harmful and unnecessary. It is not known which patients may be safely observed in a non-ICU setting, potentially improving ICU utilization. The purpose of this study was to identify factors that predict which geriatric patients with traumatic brain injury may be admitted to a level of care other than the ICU. Methods: Adults ≥65+ years admitted with positive radiologic study demonstrating isolated mTBI (defined as Glasgow Coma Scale (GCS) 13 - 15) that was initially managed nonoperatively between January 2011-December 2016 were identified. Primary outcomes evaluated included over triage and Glasgow Outcome Scale (GOS). Results: 207 were identified. Most patients presented with GCS 15 (77.8%) and were admitted to ICU (85.5%). 27% (n = 55) met overtriage criteria. The most common TBI was subdural hemorrhage (SDH) (48.8%) followed by subarachnoid hemorrhage (SAH) (22.2%). Hemorrhage progression developed in 8.7% of subjects, but there was no difference across TBI type. 21.7% of patients developed a ≥2 point decrease in GCS during their hospital stay. Upon discharge, 89.9% had a GOS ≥ 4 - 5. Presence/type of a single intracranial hemorrhage (ICH) was not significantly associated with outcome, but presence of bilateral or multiple lesions was significantly associated with poor outcome (p = 0.04). Conclusions: Overtriage of patients to an ICU is costly, resource intensive, and avoidable. Here, we suggest a conservative framework to assist the determination of which patients can be safely observed in non-ICU setting. Future studies should determine if this framework is generalizable to the entire geriatric population who present with mTBI.

关键词： Traumatic Brain Injury Geriatric Trauma Overtriage Intensive Care Unit Outcomes

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创立一家基于相对优势的厄瓜多尔进口手工艺品公司

创立一家基于相对优势的厄瓜多尔进口手工艺品公司

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作者： MAYA jacome,FABIAN ANDRES 宁波大学

学位级别：硕士

在过去的几十年里，中国在国际社会的重要性日益提高。为谋求发展，与其建立有力合作对各国十分重要。为此，厄瓜多尔政府做出了很多努力来发展厄瓜多尔生产商和出口商业务。然而，由于文化的差异和经济的不平衡，此过程对厄瓜多尔来说... 详细信息

在过去的几十年里，中国在国际社会的重要性日益提高。为谋求发展，与其建立有力合作对各国十分重要。为此，厄瓜多尔政府做出了很多努力来发展厄瓜多尔生产商和出口商业务。然而，由于文化的差异和经济的不平衡，此过程对厄瓜多尔来说尤为困难。由于中厄之间的不平衡，不仅在人口规模方面，还在经济和技术方面，两国之间的贸易对厄方产生了消极影响。因此，相对优势理论似乎成为了纠正此不平衡的正确途径。它指出，尽管一方在许多方面有着突出优势，但双方可以通过关注他们有竞争力的产品来发展经济和提高人民生活水平。本文的目的就是为创立一家作为中国市场和厄瓜多尔生产商桥梁的公司建立规划和方向，来避免做大量投资，并能为投资和生产给出正确的指导。最后，我们认为创立一家能够让厄瓜多尔出口商受益并能长期盈利的公司是有理可循的。它的影响和管理来源于厄瓜多尔的投资者。短中期出口中国的产品将有利于公平贸易，尤其是象牙坚果和象牙果钮空白。

关键词：进口企业手工艺品相对优势理论市场竞争力

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Can Emerging Market Central Banks Bail Out Banks?——A Cautionary Tale from Latin America

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China's Foreign Trade 2012年第2期 70-71页

作者： Luis I. jacome H. Tahsin Saadi Sedik Simon Townsend the International Monetary Fund

The recent financial crisis in mature markets has put the role of central banks in financial stability in the spotlight. In the large advanced economies, central banks played an active role to prevent the collapse of their financial systems. Central banks initially provided aggregate liquidity in money markets without expanding their balance sheets as they were able to mop up excess of liquidity. Later, they granted large amounts of financial support to individual illiquid and even insolvent, banks and reserve

关键词：中央银行市场拉丁美洲 systems 故事金融危机资产负债表聚光灯

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An Unexpected Presentation of Tuberculosis in the Surgical Field with a Preventable Disease Transmission

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Surgical Science 2018年第11期9卷 407-411页

作者： Hector M. Lopez Paloma M. Lugo Francisco J. jacome School of Medicine University of Medicine and Health Sciences Basseterre Saint Kitts and Nevis Department of Surgery Doctors Hospital Augusta GA USA Department of Surgery University Hospital Summerville Augusta GA USA

Tuberculosis (TB) incidence within Healthcare workers remains one of the lowest occupation specific rates in the United States. We report a case of a 33-year-old African American male presented with a right chest mass and without fever, chills or cough. Bacterial and Fungal cultures were sent during the initial visit and were negative throughout the entire management of his care. After several months of surgical interventions, the patient appeared positive for TB;however a staff member contracted the disease. The patient was managed successfully with the four-drug regimen of Isoniazid, Rifampin, Pyrazinamide and Ethambutol and recovered well from his surgeries.

关键词： Tuberculosis Transmission Surgical Field Prevention

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Evaluation of Three Dynamic Models for Aerated Facultative Lagoons

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Journal of Water Resource and Protection 2015年第14期7卷 1131-1142页

作者： Carlos Joel Abrego-Gongora Roberto Briones-Gallardo Luis Armando Bernal-jacome Antoni Escalas-Canellas Programa Multidisciplinario de Posgrado en Ciencias Ambientales Universidad Autonoma de San Luis PotosiSan Luis PotosiMexico Instituto de Metalurgia-Facultad de Ingenieria Universidad Autonoma de San Luis PotosiSan Luis PotosiMexico Centro de Investigacion y Estudios de Posgrado Facultad de IngenieriaUniversidad Autonoma de San Luis PotosiSan Luis PotosiMexico Department of Chemical Engineering&Terrassa School of Engineering Universitat Politecnica de CatalunyaTerrassaSpain Laboratory of Control of Environmental Contamination Institute of Textile Research and Industrial Cooperation of Terrassa(INTEXTER)Universitat Politecnica de CatalunyaTerrassaSpain

In this research, three existing dynamic mathematical models for aerated lagoons were applied to an aerated facultative lagoon (AFL) plant for municipal wastewater treatment. The models’ ability to describe the behavior of the primary lagoon was evaluated, and the advantages and limitations of the three models were compared. For this purpose, 7-year operational data from the municipal WWTP were collected and processed;other necessary data—like dynamic temperature values— were estimated. A 2-year period was used for model calibration, while the remaining 5 years served as validation period. One of the models showed poor calibration fit values in the effluent concentration description (R2 of 0.242 and RMSE of 16.8 mg/L);however, with some modifications the adjust was enhanced (R2 of 0.409 and RMSE of 14.0 mg/L);a second model displayed a poor to moderate adjust (0.489 and 13.0 mg/L, respectively), and the third model achieved a moderate fit (0.528 and 11.9 mg/L), though it provided an overestimation of effluent concentration, especially in periods of heavy and frequent rain;this model with some adaptations the adjust was enhanced (R2 of 0.575 and RMSE of 11.4 mg/L). The validation fits are even lower, illustrating the inability of these models to properly describe the AFL behavior. The possible causes of the models’ inadequacy are discussed. Finally, it is established that in terms of AFL behavior description more research and model development are needed.

关键词： Aerated Facultative Lagoons Oxygen Demand Mathematical Modeling

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童年在红树林的根系上奔跑另一种童年生活纪实摄影

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摄影之友 2015年第8期 56-61页

作者： Felipe jacome 游泳的云

在厄瓜多尔西部的海岸线上有着世界上最茂密高大的红树林,它们的枝桠和树叶中间是鸟类的栖息地,而错综坚韧的根系下生活着多种鱼类和蚌类,海边生活的孩子们就是靠捡拾这些蚌类来贴补家用,世代如此,纪实摄影师Felipe jacome用自己的镜头... 详细信息

在厄瓜多尔西部的海岸线上有着世界上最茂密高大的红树林,它们的枝桠和树叶中间是鸟类的栖息地,而错综坚韧的根系下生活着多种鱼类和蚌类,海边生活的孩子们就是靠捡拾这些蚌类来贴补家用,世代如此,纪实摄影师Felipe jacome用自己的镜头给大家讲述了这样一则红树林中的成长秘事。红树林不是红色的如果你以为红树林是红色的树林,那你就错了,其实红树林是一种生长在潮间带的高大乔木,它们拥有着奇特的呼吸根和支柱根,很多支柱根自树干的基部长出,牢牢扎入淤泥中形成稳固的支架,使红树林可以在海浪的冲击下屹立不动。

关键词：支柱根纪实摄影呼吸根蚌类潮间带童年生活高大乔木黑白摄影贝壳类基部

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Polymorphism in cardiovascular diseases(CVD)susceptibility loci in the azores islands(Portugal)

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Open Journal of Genetics 2011年第3期1卷 48-53页

作者： Mafalda Raposo Paul Sousa Stefan Nemeth Ana Rita Couto Margarida Rodrigues Santos Joao Paulo Pinheiro Maria Joao Peixoto Christian Oberkanins Nadiya Kazachkova Teresa Cymbron Manuela Lima jacome Bruges-Armas Center of Research in Natural Resources(CIRN)and Department of Biology University of the AzoresPonta DelgadaPortugal Specialized Service of Epidemiology and Molecular Biology(SEEBMO) Hospital of Santo EspiritoAngra do HeroismoPortugal Institute for Molecular and Cell Biology(IBMC) University of PortoPortoPortugal ViennaLab Diagnostics GmbH ViennaAustria

Background: Atherosclerosis and thrombosis are the major manifestations underlying cardiovascular diseases (CVD), which are the leading cause of mortality and morbidity worldwide. Both result from an interaction between genetic and environmental risk factors. The goal of our study was to evaluate several polymorphisms identified as predisposing factors to atherosclerosis and thrombosis. Material and Methods: A series of 155 healthy unrelated individuals of Azorean origin were analyzed using the CVD StripAssay (ViennaLab Diagnostics, Austria) for the most established polymorphisms involved in blood coagulation (F2, F5, F13A1, FGB), fibrinolitic system (SERPINE1), platelet adhesion (ITGB3), homocysteine metabolism (MTHFR), reninangio-tensin system (ACE) and lipid metabolism (APOE). Results: No significant differences were observed in allelic frequencies when comparing our data to mainland Portugal. Group stratification according to the number of “increased” risk alleles, demonstrated that 116/155 (75%) individuals belong to the moderate risk group (5 - 10 risk alleles). Conclusions: Although acknowledging the fact that the allelic states at the analysed loci lack predictive value, the fact that a high frequency of individuals presents at least 5 risk alleles (124/155;80%) is important for the establishment of the appropriate preventive measures in the Azorean population.

关键词： Atherosclerosis Thrombosis Cardiovascular Diseases Susceptibility Genes Genetic Risk Poly-morphism

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Evaluation of participants' feedback after a simulation-based training in neonatal resuscitation using a realistic delivery room

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Open Journal of Pediatrics 2012年第4期2卷 281-287页

作者： Alejandro Avila-Alvarez Iria Gonzalez-Rivera Jose L.Fernandez-Trisac Maria I.Taboada-Perianes Bruno Rodriguez-Gonzalez Alberto Centeno-Cortes Maria Diaz-Gomez Teresa Rei-Serra Rita jacome-Feijoo Unidade de Neonatoloxia Servizo de PediatriaComplexo Hospitalario Universitario A CorunaA CorunaSpain Unidade de Cuidados Intensivos Pediatricos Servizo de PediatriaComplexo Hospitalario Universitario A CorunaA CorunaSpain Servizo de Urxencias Hospital Arquitecto MarcideFerrolSpain Centro Tecnoloxico de Formacion Complexo Hospitalario Universitario de A CorunaA CorunaSpain Servizo de Xinecoloxia e Obstetricia Complexo Hospitalario Universitario de A CorunaA CorunaSpain

BACKGROUND: Low-frequency and high-risk situations, such as neonatal resuscitation, are the ideal targets for simulation-based learning. The aim of this paper is to present the structure of our internal neonatal resuscitation training program, using a realistic, simulated delivery room, and to present the participants' opinions about teamwork, emotional stress, and their subjective ability to face a resuscitation. METHODS: We administered a training course to 24 doctors and midwives. One of the simulation classrooms was modified to appear similar to a real delivery room. Four scenarios were conducted using a previously designed checklist of primary and secondary goals. Upon completion, all students participated in a debriefing session with the help of a video review. RESULTS: Students rated the achievement of their previously defined goals on a scale of 1 to 5. Grouping together the percentages of the highest ratings (Categories 4 and 5), 83.4% (20/24) of the students considered the course useful for acquiring clinical skills. For 87.5% (21/24) of the students, the scenarios simulated real clinical situations, the room properly simulated a real delivery room, and the course improved the students' ability to work in a team. For 66.6% (16/24) of the students, the course improved their stress in confronting neonatal resuscitation. Initially, only 33.3% (8/24) of the students considered themselves very capable or fully able to cope with a resuscitation. After the course, that percentage rose to 62.5% (15/24). CONCLUSIONS: The incorporation of simulation-based learning into neonatal resuscitation teaching programs, using realistic scenarios, is useful and offers the possibility of acquiring technical skills, but it also allows for the improvement of teamwork and the adoption of different roles and positive attitudes towards emotional stress.

关键词： Neonatal Resuscitation Simulation Training

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