Medical Emergencies: Risk Assessment and Management.

Dental practitioners need to have knowledge of the risk assessment, diagnosis and management of medical emergencies. This paper deals with risk assessment and basic management principles, applicable to all emergencies. More specific aspects of medical emergency management are also discussed.

Partnership working as liberation psychology: Forced labor among UK Chinese migrant workers.

In this article we seek to reflect critically on some recent research we have carried out, in collaboration with a Chinese welfare NGO, on the experience of forced labor among Chinese migrant workers in the UK. We will (a) locate briefly the wider political context of migrant work (both regular and irregular) in the UK; (b) explore how and why the actual research methods and process of the research deviated in practice from those that were planned; and

Development of a Sensitive Outcome for Economical Drug Screening for Progressive Multiple Sclerosis Treatment.

Therapeutic advance in progressive multiple sclerosis (MS) has been very slow. Based on the transformative role magnetic resonance imaging (MRI) contrast-enhancing lesions had on drug development for relapsing-remitting MS, we consider the lack of sensitive outcomes to be the greatest barrier for developing new treatments for progressive MS. The purpose of this study was to compare 58 prospectively acquired candidate outcomes in the real-world situation of progressive MS trials to select and validate the best-performing outcome. The 1-year pre-treatment period of adaptively designed IPPoMS (ClinicalTrials.gov #NCT00950248) and RIVITaLISe (ClinicalTrials.gov #NCT01212094) Phase II trials served to determine the primary outcome for the subsequent blinded treatment phase by comparing 8 clinical, 1 electrophysiological, 1 optical coherence tomography, 7 MRI volumetric, 9 quantitative T1 MRI, and 32 diffusion tensor imaging MRI outcomes. Fifteen outcomes demonstrated significant progression over 1 year (Δ) in the predetermined analysis and seven out of these were validated in two independent cohorts. Validated MRI outcomes had limited correlations with clinical scales, relatively poor signal-to-noise ratios (SNR) and recorded overlapping values between healthy subjects and MS patients with moderate-severe disability. Clinical measures correlated better, even though each reflects a somewhat different disability domain. Therefore, using machine-learning techniques, we developed a combinatorial weight-adjusted disability score (CombiWISE) that integrates four clinical scales: expanded disability status scale (EDSS), Scripps neurological rating scale, 25 foot walk and 9 hole peg test. CombiWISE outperformed all clinical scales (Δ = 9.10%; p = 0.0003) and all MRI outcomes. CombiWISE recorded no overlapping values between healthy subjects and disabled MS patients, had high SNR, and predicted changes in EDSS in a longitudinal assessment of 98 progressive MS patients and in a cross-sectional cohort of 303 untreated subjects. One point change in EDSS corresponds on average to 7.50 point change in CombiWISE with a standard error of 0.10. The novel validated clinical outcome, CombiWISE, outperforms the current broadly utilized MRI brain atrophy outcome and more than doubles sensitivity in detecting clinical deterioration in progressive MS in comparison to the scale traditionally used for regulatory approval, EDSS.

Assessment of Arctic community wastewater impacts on marine benthic invertebrates.

This study sought to understand the performance of arctic treatment systems and the impact of wastewater effluent on benthic invertebrate communities in arctic receiving water habitats. Effluent quality and benthic impacts were monitored in the receiving water of five communities across Nunavut that differed in the type and level of treatment achieved by wastewater infrastructure, the volume of effluent and receiving water mixing environment. We detected minimal impacts to benthic communities (<225 m linear distance from the effluent source) in four out of the five communities (Grise Fiord, Kugaaruk, Pond Inlet, and Pangnirtung), where the population was <2000 people. In these small communities impacts were characterized by increases or decreases in species richness, diversity, evenness, and density, and some differences in benthic species composition. This was in contrast to benthic sediments in Iqaluit (population 6699), which were devoid of benthic fauna up to 580 m from the effluent source in response to sediment anoxia. Variation in benthic community response between sampling locations was attributed primarily to differences in effluent volume, with effluent quality and receiving water hydrodynamics playing secondary roles. The results of this study will help to inform the development of northern specific treatment performance standards which will aid in prioritizing community wastewater system upgrades in arctic communities.

Immunity protection and delayed transfer of patient care by EMS providers: a medical-legal analysis.

In emergency medical service (EMS) systems, the transfer of patient care to persons at the receiving facility is delayed when EMS providers stop en route to the facility, or postpone entering after arrival, to perform tasks. When these tasks are prolonged and inessential, the delay in transferring care is judged to be inappropriate. When transfer of care is inappropriately delayed, EMS providers, supervisors, and medical directors may lose the immunity provided by their state's EMS Act. This article analyzes the legal issues surrounding inappropriate delays in transfer of care by EMS providers. Loss of statutory immunity may occur for reasons of public policy, as reflected in case law and under the reasonableness standard. Without immunity, persons involved in the transfer of patients to receiving facilities may be subject to liability under ordinary rather than gross negligence standards.