112 research outputs found
Editor's Choice -- European Society for Vascular Surgery (ESVS) 2025 Clinical Practice Guidelines on the Management of Vascular Trauma
No full textOBJECTIVE: The European Society for Vascular Surgery (ESVS) has developed clinical practice guidelines for the care of patients with vascular trauma with the aim of assisting physicians in selecting the optimal management strategy.METHODS: The guidelines are based on scientific evidence completed with expert opinion. By summarising and evaluating the best available evidence, recommendations for the evaluation and treatment of patients have been formulated. The recommendations are graded according to the ESVS evidence grading system, where the strength (class) of each recommendation is graded from I to III, and the letters A to C mark the level of evidence.RESULTS: A total of 105 recommendations have been issued on the following topics: general principles for vascular trauma care and resuscitation including technical skill sets, bleeding control and restoration of perfusion, graft materials, and imaging; management of vascular trauma in the neck, thoracic aorta and thoracic outlet, abdomen, and upper and lower extremities; post-operative considerations after vascular trauma; and paediatric vascular trauma. In addition, unresolved vascular trauma issues and the patients' perspectives are discussed.CONCLUSION: The ESVS clinical practice guidelines provide the most comprehensive, up to date, evidence based advice to clinicians on the management of vascular trauma
Editor's choice : European Society for Vascular Surgery (ESVS) 2023 Clinical Practice Guidelines on antithrombotic therapy for vascular diseases
No full textThe European Society for Vascular Surgery (ESVS) has developed a series of clinical practice guidelines for clinicians caring for patients with vascular diseases. This is the first guideline specifically examining antithrombotic therapy. The aim of the guideline is to assist clinicians and patients in selecting an optimal antithrombotic strategy.</p
Editor's Choice -- European Society for Vascular Surgery (ESVS) 2024 Clinical Practice Guidelines on the Management of Abdominal Aorto-Iliac Artery Aneurysms.
No full textpeer reviewedOBJECTIVE: The European Society for Vascular Surgery (ESVS) has developed clinical practice guidelines for the care of patients with aneurysms of the abdominal aorta and iliac arteries in succession to the 2011 and 2019 versions, with the aim of assisting physicians and patients in selecting the best management strategy. METHODS: The guideline is based on scientific evidence completed with expert opinion on the matter. By summarising and evaluating the best available evidence, recommendations for the evaluation and treatment of patients have been formulated. The recommendations are graded according to a modified European Society of Cardiology grading system, where the strength (class) of each recommendation is graded from I to III and the letters A to C mark the level of evidence. RESULTS: A total of 160 recommendations have been issued on the following topics: Service standards, including surgical volume and training; Epidemiology, diagnosis, and screening; Management of patients with small abdominal aortic aneurysm (AAA), including surveillance, cardiovascular risk reduction, and indication for repair; Elective AAA repair, including operative risk assessment, open and endovascular repair, and early complications; Ruptured and symptomatic AAA, including peri-operative management, such as permissive hypotension and use of aortic occlusion balloon, open and endovascular repair, and early complications, such as abdominal compartment syndrome and colonic ischaemia; Long term outcome and follow up after AAA repair, including graft infection, endoleaks and follow up routines; Management of complex AAA, including open and endovascular repair; Management of iliac artery aneurysm, including indication for repair and open and endovascular repair; and Miscellaneous aortic problems, including mycotic, inflammatory, and saccular aortic aneurysm. In addition, Shared decision making is being addressed, with supporting information for patients, and Unresolved issues are discussed. CONCLUSION: The ESVS Clinical Practice Guidelines provide the most comprehensive, up to date, and unbiased advice to clinicians and patients on the management of abdominal aorto-iliac artery aneurysms
The monitoring of the rights of the child: a child rights-based approach
No full textPhDDue to the lacunae between legal obligations to human rights and the actual situation,
monitoring is an essential component of the international and national human rights system.
Monitoring illuminates the situation of human rights commitments and ensures the relevancy
of instruments. The thesis explores monitoring in relation to the rights of the child and
submits that a child rights-based approach is essential. Monitoring should not only consider
the status and nature of child rights, but a child rights-based approach should also guide
efforts so that they improve as well as reflect and respect children's rights.
The study defines monitoring and describes a child rights-based approach. As a subject of
legal investigation, the thesis then addresses several questions. How do international and
national monitoring efforts respect child rights? How have the supervision of international
conference agreements supported child rights? Furthermore, how do different countries
monitor? National activities are examined through case studies of two Commonwealth
countries: Canada and South Africa. Then, analysis is presented about how actors interpret
and execute monitoring and the significance of different approaches. Lastly, the rationale,
challenges and existing support of a child rights-based approach are discussed. In sum, a
child rights-based approach is not generally utilised and the implications of child rights upon
the monitoring process are not yet realised. Most monitors, whether international, regional
or domestic, inadequately consider the demands of child rights upon the process of
ascertaining the situation of children's rights. Proposed guidelines are appended to support
a child rights-based approach to monitoring
Do UK based weight management programmes cause weight loss maintenance in adults? A systematic review
No full textThe aim of this dissertation was to examine whether UK based weight management programmes promote weight loss maintenance (follow up of 12 months to assess effectiveness of intervention in weight loss) in adults through the process of a systematic review. The World Health Organisation (WHO) has described obesity as a "global epidemic". Weight management comprises two phases; weight loss and weight loss maintenance. The latter phase is the true goal for obesity and the most difficult element of weight management to achieve. However much less is know about this as compared with the weight loss phase. There is little purpose in committing time and money to reducing obesity if the weight is regained. This is counter-productive and weight loss maintenance is essential to combat the obesity epidemic. Searches were made for relevant information from a variety of scientific online databases and journals,. Seven articles met the inclusion criteria and were analysed in the review. All studies incorporated a multi-component (diet, exercise, behaviur modification) intervention approach. All control and internvetion groups reported weight loss at 12 months when compared with baseline. All groups recieved an intervention. One study reported a significant difference (P<0.05) between groups. Four studies reported on at least one component (diet, physical activity, behaviour modification) however there was not enough information to conclude whether they complied with national guidelines (NICE CG43 and SIGN 115). High attrition rates and loss to follow up are problematic for each study except one. Analysis on an intention to treat basis was common however this is problematic and there are alternative methods which may be more suitable for dealing with missing data
Editor's choice : European Society for Vascular Surgery (ESVS) 2023 Clinical Practice Guidelines on antithrombotic therapy for vascular diseases
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Prevention of RhD alloimmunization in Northern British Columbia
No full textDespite best practice guidelines, international evidence suggests that the provision of anti-D prophylaxis to RhD negative pregnant women is suboptimal. Missing from the literature is research exploring the factors that perpetuate suboptimal care and continue to put RhD negative pregnant women at risk for RhD alloimmunization. The purpose of this study was to understand why RhD negative pregnant women continue to be at risk for RhD alloimmunization in northern BC. The specific research questions were: How do healthcare providers make decisions regarding the care of RhD negative pregnancies in northern BC? How do RhD negative women in northern BC experience pregnancy?
A qualitative approach utilizing interpretive description was used to address the need for the development of rural centric clinical guidelines. Interviews were conducted with RhD negative women about pregnancy and healthcare providers’ experiences in caring for RhD negative pregnancies in northern BC. A Stakeholder Committee guided the research process and provided insight into data analysis to ensure applicability to practice. A qualitative approach with these two populations has provided a greater understanding into the depth of quality of care for RhD negative pregnancies and the decisions that inform patient safety by revealing nuances of care that lead to potential miscommunication and near misses. Recommendations into guideline adaptation, decision-making and health literacy in rural healthcare settings are presented.RhD alloimmunizationRhD negativepregnant womenrural healthcar
Key issues in determining the ethics of research subject payment: the special case of drug abuse epidemiology
No full textThe authors identify key issues that researchers, funding bodies, ethics committees and ethicists might consider in contemplating research subject payment ethics. They argue that what is missing from the broader debate is due consideration of ethics committee decision processes; research subject reasons for participation; and current research practices. The authors explore these issues and how they relate to existing guidelines on voluntary consent, and arguments that have been proposed for and against research subject payments. (non- author abstract
Cast Glass Restoration of Marble Monuments
No full textHistorical monuments are one of the best-preserved memories of our past as human species. Despite this, the conservation of these monuments is slowly being put under pressure by rapid economic development and the desire to make as much profit as possible. This development has raised awareness through the world of conservation about the importance of preserving and conserving our heritage. It is, however, hard to obey all the stated values and guidelines with existing materials and techniques. Many guidelines contradict each other, resulting in fierce debates about how monuments can be restored in the best and most appropriate way or whether they should not be preserved at all. Introducing cast glass as a new material into the field of reconstruction and conservation could bring the extremes of this ongoing debate closer together. By introducing a transparent material, in the form of cast glass, it becomes possible to safeguard the structural and mechanical stability of marble monuments and simultaneously allow for observing both its original and damaged state. Moreover, with cast glass, it is possible to re-shape these missing elements of monumental structures very easily and its texture and transparency can be easily altered to give them either a fully transparent appearance or one that resembles of the original material. In this research. the possibilities of using cast glass in restoration projects have been explored by creating a design and production line starting at the analysis of the case study and ending when the final piece is assembled. Using key conservation values like preserving authenticity, minimising visual impact and allowing for reversibility has resulted in a cast glass reconstruction design which is according to the conservation guidelines and feasible with the existing production methods of cast glass. The development of new techniques in 3D scanning and additive manufactured moulds allows this process to become more time and cost-effective than currently used conventional methods. By scanning damaged surfaces of the monument in combination with the use of 3D printed sand moulds, glass can be easily cast into complex shapes to fill up the missing parts of the monument. The key to designing these glass shapes lies in understanding and respecting the monument’s structural and mechanical behaviour. If these characteristics are translated into the connections, shape and composition of the reconstructed cast glass elements, transparent restoration could become a serious contender for conventional materials in the conservation of monuments.Architecture, Urbanism and Building Sciences | Building Technology | Sustainable Desig
Taking up the Slack: Lessons from a Cap-and-Trade Program in Chicago
No full textThe Emissions Reduction Market System (ERMS), an emissions-trading program for volatile organic materials (VOMs) in Chicago, Illinois, has been characterized by emissions significantly below the annual allocation of emission allowances, allowance prices much lower than predicted, limited trading, and emission allowances that expire unused. Essentially, it appears that a fundamental prerequisite for a tradable allowance program is missing—there is no scarcity of allowances. We evaluate a variety of hypotheses that may explain why the ERMS cap does not appear to be affecting abatement behavior and identify three that contributed to the lack of scarcity in the ERMS program: (1) a baseline process that inflated the cap; (2) hazardous air pollutant regulations that contributed to VOM reductions at some sources; and (3) numerous facility shutdowns. We conclude that the ERMS experience illustrates the inherent unpredictability of economic, regulatory, and other factors when setting an emissions target; a conclusion that resonates with the recent experience of the European Union Emissions Trading Scheme. This argues for gathering reliable emissions data, developing sophisticated emissions projections, and making transparent assumptions about the impacts of other policies and regulations during the program planning and design phase. However, even with all these attributes, it is still difficult to anticipate every possible outcome. Thus, it is desirable to have robust mechanisms to address the uncertainties of emissions-trading markets and to make midcourse corrections if necessary. Finally, we offer some comments on how to think about the results of ERMS versus a hypothetical command and control program that might have been designed to reach the same environmental outcome.emissions-trading, ERMS, European Union, climate change
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