Reliability Focused Maintenance System - A Case Study.

Tutorialpg. 189-194A case study of how a large organization is utilizing the combined strengths of commercial off-the-shelf software packages to implement a corporate-wide reliability focused maintenance initiative is presented. The integrated package meets the needs of information systems staff and is most valuable in implementing the work process and cultural changes needed to meet the company's goal of incident free operations. A new work maintenance system allows users to more easily record extensive maintenance and repair data. A powerful centralized equipment database pulls together information from many different systems and makes it available to everyone participating in the program. A new reliability software system makes use of real-time data gathered through the work management system and uses them to perform analysis, trending, and reporting. Alone, each system is a powerful tool. Used together, the analysis tools of the reliability system work hand in hand with the tracking features of the work management system, allowing each to function at its maximum potential and provide true bottom line savings

Identification of Sonographic B-lines with Linear Transducer Predicts Elevated B-Type Natriuretic Peptide Level

Objective: This study sought to correlate the presence of pleural-based B-lines seen by emergency department ultrasound performed with the linear transducer with B-type natriuretic peptide (BNP) level in patients with suspected congestive heart failure.Methods: The study was a prospective convenience sample on adult patients in an academic, urban emergency department with over 100,000 annual patient visits. Adult patients with a BNP level ordered by the treating physician were prospectively enrolled by one of four physicians, blinded to the BNP level. The enrolling physicians included an emergency ultrasound director, two emergency ultrasound fellows, and a senior emergency medicine resident. Bedside ultrasound was performed using a 3-12 MHz linear broadband transducer in four lung fields. The serum BNP level was correlated with bilateral B-lines, defined as three or more comet-tail artifacts arising from the pleural line extending to the far field without a decrease in intensity on the right and left thorax.Results: Sixty three patients were consented and enrolled during a four-month period. Fifteen patients had the presence of bilateral B-lines. The median BNP in patients with bilateral B-lines was 1560 pg/mL (95% confidence interval (CI) 1141-3706 pg/mL), compared with 538 pg/mL (95% confidence interval 310-1917 pg/mL) in patients without B-lines. The distributions in the two groups differed significantly (p=0.0006). Based on the threshold level of BNP 500 pg/mL, the sensitivity of finding bilateral B-lines on ultrasound was 33.3% (95% CI: 0.19-0.50), and the specificity was 91.7% (95% CI: 0.73-0.99). In addition, bilateral B-lines were absent in all patients with a BNP<100 pg/mL.Conclusion: The presence of bilateral B-lines identified with the linear probe is associated with significantly higher BNP levels than patients without B-lines. In our patient population, the presence of B-lines was specific but not sensitive for BNP>500. Further research may show that it can be applied to quickly assess patients with undifferentiated dyspnea. [West J Emerg Med. 2011;12(1):102-106.

Influencia de las Carencias Afectivas en las Relaciones de Pareja en Mujeres Universitarias del turno matutino de FAREM-Estelí, período 2018/2019.

La investigación surge a partir del fenómeno social sobre la carencia afectiva en la niñez, y como afectan de manera impactante en una relación de pareja, se realizó para determinar la influencia de las carencias afectivas en las relaciones de pareja en Mujeres Universitarias, a partir del análisis de las vivencias que experimentan en su entorno amoroso y de esta manera dar a conocer las múltiples afectaciones que viven. La metodología de dicha investigación está basada en un estudio mixto de tipo exploratorio, la muestra estuvo conformada por 20 mujeres universitarias seleccionadas mediante un muestreo no probabilístico intencional. Las técnicas de recolección de datos fueron, entrevista y encuesta. Los datos se procesaron de acuerdo a los objetivos formulados en el paquete estadístico SPSS y Microsoft Word. Entre los resultados más relevantes se encontró, que un 55% de las entrevistadas, expresan no haber compartido sus vivencias y experiencias en el hogar, y esto ha afectado notoriamente su falta de iniciativa y a la hora de expresarse con sus parejas. A sí mismo, se encontró por medio de la entrevista, que la mayoría de las estudiantes consideran que la formación brindada por sus padres, no les ha sido de gran ayuda en la actualidad con su pareja; ya que son mujeres dependientes e inseguras en su relación

Influencia de las carencias afectivas en las relaciones de pareja en mujeres universitarias

The objective of this study is to determine the influence of affective deficiencies on relationships in university women. The document is part of a research conducted on 20 university women of FAREM-Estelí, in the period October 2018-April 2019. The research is mixed and exploratory. 20 women were selected to meet the criteria set out in the study. Interviews and surveys were conducted. Among the most relevant results was a negative association linked to the lack of affection of their family, reflecting that 40% did not have the necessary affective education, 55% did not express their feelings and experiences in their childhood, and 40% did not shared quality time between fathers and daughters, referring to the emotional changes that women suffer due to the influence of affective deficiencies, as well as the damage that patterns of behaviors have exerted on the emotional development of affecting their safety and self-esteem necessary to achieve their personal autonomy. Understanding how the lack of distortion presented by participants has had a negative impact, with women currently being unsafe, dependent and unstable; and with difficulties in their relationships.El objetivo del presente estudio es determinar la influencia de las carencias afectivas en las relaciones de pareja en mujeres universitarias. El documento se enmarca en una investigación realizada a 20 mujeres universitarias de FAREM-Estelí, en el período octubre 2018-abril 2019. La investigación es mixta y exploratoria. Se seleccionaron a 20 mujeres que cumplen los criterios establecidos en el estudio. Se aplicaron entrevistas y encuesta. Entre los resultados más relevantes se encontró una asociación negativa vinculada a la falta de afecto de su familia, reflejando que el 40% no tuvieron la educación afectiva necesaria, un 55% no expresaban sus sentimientos y experiencias en su infancia, y el 40% no compartieron tiempo de calidad entre padres-madres e hijas, refieren a los cambios emocionales que sufren las mujeres debido a la influencia de las carencias afectivas, así mismo, el daño que han ejercido los patrones de conductas en el desarrollo emocional de las participantes, afectándoles su seguridad y autoestima necesaria para alcanzar su autonomía personal. Dando por entendido cómo la carencia por distorsión que presentan las participantes ha influido de modo negativo, siendo actualmente mujeres inseguras, dependientes e inestables; y con dificultades en sus relaciones de pareja

Ensuring equity in mental health and psychosocial support during the COVID-19 pandemic and beyond

Populations affected by armed conflict and other humanitarian crises are at elevated risk for mental health problems. While the COVID-19 pandemic has had broadly deleterious effects on livelihoods, economic well-being, and population health worldwide, vulnerable groups have been disproportionately impacted by the pandemic. Providing mental health and psychosocial support (MHPSS) services during these times to vulnerable groups, especially in low- and middle-income countries and humanitarian settings, is essential. In an effort to comply with the public health response to the pandemic and mitigate COVID-19 transmission, significant implementation adaptations were made to service delivery during the pandemic. This short report describes several strategies to ensure that equity was central to these adaptations and public health responses, and provides recommendations for ensuring continuity of this progress post-pandemic. Examples and key lessons learned are given related to strategies to increase access to MHPSS services, improve meaningful stakeholder engagement, develop and support community networks, and implement community-based psychosocial support groups. They come from diverse settings of Bangladesh, Colombia, Ecuador, and Lebanon. The COVID-19 pandemic has highlighted the importance of preventing and treating MHPSS issues. It also has created opportunities for innovative programming to address overlooked problems, improve the quality of services provided, and increase focus on equity. It is vital that we use the momentum and attention generated around MHPSS services during the COVID-19 pandemic to continue to build and improve existing MHPSS services in more equitable ways for vulnerable populations

Triple antiplatelet therapy for preventing vascular events: a systematic review and meta-analysis

<p>Abstract</p> <p>Background</p> <p>Dual antiplatelet therapy is usually superior to mono therapy in preventing recurrent vascular events (VEs). This systematic review assesses the safety and efficacy of triple antiplatelet therapy in comparison with dual therapy in reducing recurrent vascular events.</p> <p>Methods</p> <p>Completed randomized controlled trials investigating the effect of triple versus dual antiplatelet therapy in patients with ischaemic heart disease (IHD), cerebrovascular disease or peripheral vascular disease were identified using electronic bibliographic searches. Data were extracted on composite VEs, myocardial infarction (MI), stroke, death and bleeding and analysed with Cochrane Review Manager software. Odds ratios (OR) and 95% confidence intervals (CI) were calculated using random effects models.</p> <p>Results</p> <p>Twenty-five completed randomized trials (17,383 patients with IHD) were included which involving the use of intravenous (iv) GP IIb/IIIa inhibitors (abciximab, eptifibatide, tirofiban), aspirin, clopidogrel and/or cilostazol. In comparison with aspirin-based therapy, triple therapy using an intravenous GP IIb/IIIa inhibitor significantly reduced composite VEs and MI in patients with non-ST elevation acute coronary syndromes (NSTE-ACS) (VE: OR 0.69, 95% CI 0.55-0.86; MI: OR 0.70, 95% CI 0.56-0.88) and ST elevation myocardial infarction (STEMI) (VE: OR 0.39, 95% CI 0.30-0.51; MI: OR 0.26, 95% CI 0.17-0.38). A significant reduction in death was also noted in STEMI patients treated with GP IIb/IIIa based triple therapy (OR 0.69, 95% CI 0.49-0.99). Increased minor bleeding was noted in STEMI and elective percutaneous coronary intervention (PCI) patients treated with GP IIb/IIIa based triple therapy. Stroke events were too infrequent for us to be able to identify meaningful trends and no data were available for patients recruited into trials on the basis of stroke or peripheral vascular disease.</p> <p>Conclusions</p> <p>Triple antiplatelet therapy based on iv GPIIb/IIIa inhibitors was more effective than aspirin-based dual therapy in reducing VEs in patients with acute coronary syndromes (STEMI and NSTEMI). Minor bleeding was increased among STEMI and elective PCI patients treated with a GP IIb/IIIa based triple therapy. In patients undergoing elective PCI, triple therapy had no beneficial effect and was associated with an 80% increase in transfusions and an eightfold increase in thrombocytopenia. Insufficient data exist for patients with prior ischaemic stroke and peripheral vascular disease and further research is needed in these groups of patients.</p

Integrating mental health and psychosocial support into economic inclusion programming for displaced families in Ecuador

Background Poverty is a key social determinant of mental health among forcibly displaced persons. This study aimed to design and pilot test a strategy to integrate existing mental health and economic inclusion interventions for displaced families in Ecuador. Methods We conducted a series of qualitative interviews (n = 30), focus groups (n = 6), and workshops (n = 3) to develop a set of strategies for integrating cross-cutting and focused mental health and psychosocial support (MHPSS) strategies into an existing economic inclusion program for displaced families in Quito. We non-randomly assigned two field offices in Quito to (1) integrate cross-cutting strategies focused on improving economic outcomes or (2) integrate both those cross-cutting strategies plus focused MHPSS strategies into an economic inclusion program. We measured site-level implementation outcomes (adoption, appropriateness, acceptability, feasibility, fidelity, reach, retention, usability) and participant-level psychosocial (wellbeing, depressive symptoms, anxiety symptoms, functioning) and economic inclusion outcomes (financial resources, diet diversity, social capital/networks, self-reliance) over six months. We conducted a mixed-methods analysis to explore the acceptability and feasibility of the integration strategies and the ability to evaluate their effects in a future cluster randomized trial. Results We developed a toolkit that included 10 strategies for integrating MHPSS into economic inclusion interventions. Fifty displaced persons participating in an existing economic inclusion program (25 per study condition) were enrolled and 88% remained in the study through the six-month follow-up. Participants and implementers reported that the integration strategy was appropriate, acceptable, feasible, and usable. Implementers, including people without prior experience in delivering mental health services, were able to deliver the intervention with high fidelity. Integration of focused MHPSS intervention components into an economic inclusion program appeared to improve MHPSS outcomes, the strength of social capital and networks, and engagement in economic and other programs. Conclusions This study provides preliminary evidence of the acceptability and feasibility of integrating MHPSS into economic inclusion programs for displaced people. We found evidence supporting evaluation methods that can be employed in a future study to definitively test the added value of integrated approaches to mental health and economic wellbeing for displaced persons