A mobile missile brigade for a power projection role: Prepared for the Defense Nuclear Agency
In: Rand Note, N-1507-DNA
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In: Rand Note, N-1507-DNA
World Affairs Online
In: Africa insight: development through knowledge, Band 39, Heft 3
ISSN: 1995-641X
In: Africa insight: development through knowledge, Band 39, Heft 3, S. 94-107
ISSN: 0256-2804
World Affairs Online
In: Peace research abstracts journal, Band 44, Heft 3, S. 119
ISSN: 0031-3599
In: Rand Note, N-1871-AF
World Affairs Online
World Affairs Online
BACKGROUND: In South Africa (SA), intensive care is faced with the challenge of resource scarcity as well as an increasing demand for intensive care unit (ICU) services. ICU services are expensive, and practitioners in low- to middle-income countries experience daily the consequences of limited resources. Critically limited resources necessitate that rationing and triage (prioritisation) decisions are frequently necessary in SA, particularly in the publicly funded health sector. PURPOSE: The purpose of this consensus statement is to examine key questions that arise when considering the status of ICU resources in SA, and more specifically ICU admission, rationing and triage decisions. The accompanying guideline in this issue is intended to guide frontline triage policy and ensure the best utilisation of intensive care in SA, while maintaining a fair distribution of available resources. Fair and efficient triage is important to ensure the ongoing provision of high-quality care to adult patients referred for intensive care. RECOMMENDATIONS: In response to 14 key questions developed using a modified Delphi technique, 29 recommendations were formulated and graded using an adapted GRADE score. The 14 key questions addressed the status of the provision of ICU services in SA, the degree of resource restriction, the efficiency of resource management, the need for triage, and how triage could be most justly implemented. Important recommendations included the need to formally recognise and accurately quantify the provision of ICU services in SA by national audit; actively seek additional resources from governmental bodies; consider methods to maximise the efficiency of ICU care; evaluate lower level of care alternatives; develop a triage guideline to assist policy-makers and frontline practitioners to implement triage decisions in an efficient and fair way; measure and audit the consequence of triage; and promote research to improve the accuracy and consistency of triage decisions. The consensus document and guideline ...
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BACKGROUND. Appropriate critical care admissions are an important component of surgical care. However, there are few data describing postoperative critical care admission in resource-limited low- and middle-income countries. OBJECTIVE. To describe the demographics, organ failures, organ support and outcomes of non-cardiac surgical patients admitted to critical care units in South Africa (SA). METHODS. The SA Surgical Outcomes Study (SASOS) was a 7-day national, multicentre, prospective, observational cohort study of all patients ≥16 years of age undergoing inpatient non-cardiac surgery between 19 and 26 May 2014 at 50 government-funded hospitals. All patients admitted to critical care units during this study were included for analysis. RESULTS. Of the 3 927 SASOS patients, 255 (6.5%) were admitted to critical care units; of these admissions, 144 (56.5%) were planned, and 111 (43.5%) unplanned. The incidence of confirmed or strongly suspected infection at the time of admission was 35.4%, with a significantly higher incidence in unplanned admissions (49.1 v. 24.8%, p<0.001). Unplanned admission cases were more frequently hypovolaemic, had septic shock, and required significantly more inotropic, ventilatory and renal support in the first 48 hours after admission. Overall mortality was 22.4%, with unplanned admissions having a significantly longer critical care length of stay and overall mortality (33.3 v. 13.9%, p<0.001). CONCLUSION. The outcome of patients admitted to public sector critical care units in SA is strongly associated with unplanned admissions. Adequate 'high care-dependency units' for postoperative care of elective surgical patients could potentially decrease the burden on critical care resources in SA by 23%. This study was registered on ClinicalTrials.gov (NCT02141867). ; SASA and the Vascular Association of SA (VASSA). ; http://www.samj.org.za ; am2017 ; Surgery
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Over the last few decades, increasing attention has been paid to understanding the pathophysiology, aetiology, prognosis, and treatment of elevated intra-abdominal pressure (IAP) in trauma, surgical, and medical patients. However, there is presently a relatively poor understanding of intra-abdominal volume (IAV) and the relationship between IAV and IAP (i.e. abdominal compliance). Consensus definitions on C ab were discussed during the 5 th World Congress on Abdominal Compartment Syndrome and a writing committee was formed to develop this article. During the writing process, a systematic and structured Medline and PubMed search was conducted to identify relevant studies relating to the topic. According to the recently updated consensus definitions of the World Society on Abdominal Compartment Syndrome (WSACS), abdominal compliance (C ab ) is defined as a measure of the ease of abdominal expansion, which is determined by the elasticity of the abdominal wall and diaphragm. It should be expressed as the change in IAV per change in IAP (mL [mm Hg] -1 ). Importantly, C ab is measured differently than IAP and the abdominal wall (and its compliance) is only a part of the total abdominal pressure-volume (PV) relationship. During an increase in IAV, different phases are encountered: the reshaping, stretching, and pressurisation phases. The first part of this review article starts with a comprehensive list of the different definitions related to IAP (at baseline, during respiratory variations, at maximal IAV), IAV (at baseline, additional volume, abdominal workspace, maximal and unadapted volume), and abdominal compliance and elastance (i.e. the relationship between IAV and IAP). An historical background on the pathophysiology related to IAP, IAV and C ab follows this. Measurement of C ab is difficult at the bedside and can only be done in a case of change (removal or addition) in IAV. The C ab is one of the most neglected parameters in critically ill patients, although it plays a key role in understanding the deleterious effects of unadapted IAV on IAP and end-organ perfusion. The definitions presented herein will help to understand the key me
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Smiling individuals are usually perceived more favorably than non-smiling ones—they are judged as happier, more attractive, competent, and friendly. These seemingly clear and obvious consequences of smiling are assumed to be culturally universal, however most of the psychological research is carried out in WEIRD societies (Western, Educated, Industrialized, Rich, and Democratic) and the influence of culture on social perception of nonverbal behavior is still understudied. Here we show that a smiling individual may be judged as less intelligent than the same non-smiling individual in cultures low on the GLOBE's uncertainty avoidance dimension. Furthermore, we show that corruption at the societal level may undermine the prosocial perception of smiling—in societies with high corruption indicators, trust toward smiling individuals is reduced. This research fosters understanding of the cultural framework surrounding nonverbal communication processes and reveals that in some cultures smiling may lead to negative attributions. ; info:eu-repo/semantics/publishedVersion
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In: Analecta Husserliana, The Yearbook of Phenomenological Research 80
Phenomenology is the philosophy of our times. Through the entire twentieth century this philosophy unfolded and flourished, following stepwise the intrinsic logic and dynamism of its original project as proposed by its founder Edmund Husserl. Now its seminal ideas have been handed over to a new era. The worldwide contributors to this volume make it manifest that phenomenological inspiration knows no cultural barriers. It penetrates and invigorates not only philosophical disciplines but also most of the sectors of knowledge, transforming our way of seeing the world, our actions toward others, and our lives. Phenomenology's universal spread has, however, oftentimes diluted its original sense, even beyond recognition, and led to a weakening of its dynamics. There is at present an urgent need to retrieve the original understanding of phenomenology, to awaken its dormant forces and redirect them. This is the aim of the present book: resourcement and reinvigoration. It is meant to be not only a reference work but also a guide for research and study. To restore the authentic vision of phenomenology, we propose returning to its foundational source in Husserl's project of a `universal science', unpacking all its creative capacities. In the three parts of this work there are traced the stages of this philosophy's progressive uncovering of the grounding levels of reality: ideal structures, constitutive consciousness, the intersubjective lifeworld, and beyond. The key concepts and phases of Husserl's thought are here exfoliated. Then the thought of the movement's classical figures and of representative thinkers in succeeding generations is elucidated. Phenomenology's geographic spread is reviewed. We then proceed to the culminating work of this philosophy, to the phenomenological life engagements so vigorously advocated by Husserl, to the life-significant issues phenomenology addresses and to how it has enriched the human sciences. Lastly the phenomenological project's new horizons on the plane of life are limned, horizons with so powerful a draw that they may be said not to beckon but to summon. Here is the movement's vanguard. This collection has 71 entries. Each entry is followed by a relevant bibliography. There is a helpful Glossary of Terms and an Index of Names
Background: The COVID-19 pandemic has disrupted routine hospital services globally. This study estimated the total number of adult elective operations that would be cancelled worldwide during the 12 weeks of peak disruption due to COVID-19. Methods: A global expert response study was conducted to elicit projections for the proportion of elective surgery that would be cancelled or postponed during the 12 weeks of peak disruption. A Bayesian β-regression model was used to estimate 12-week cancellation rates for 190 countries. Elective surgical case-mix data, stratified by specialty and indication (surgery for cancer versus benign disease), were determined. This case mix was applied to country-level surgical volumes. The 12-week cancellation rates were then applied to these figures to calculate the total number of cancelled operations. Results: The best estimate was that 28 404 603 operations would be cancelled or postponed during the peak 12 weeks of disruption due to COVID-19 (2 367 050 operations per week). Most would be operations for benign disease (90·2 per cent, 25 638 922 of 28 404 603). The overall 12-week cancellation rate would be 72·3 per cent. Globally, 81·7 per cent of operations for benign conditions (25 638 922 of 31 378 062), 37·7 per cent of cancer operations (2 324 070 of 6 162 311) and 25·4 per cent of elective caesarean sections (441 611 of 1 735 483) would be cancelled or postponed. If countries increased their normal surgical volume by 20 per cent after the pandemic, it would take a median of 45 weeks to clear the backlog of operations resulting from COVID-19 disruption. Conclusion: A very large number of operations will be cancelled or postponed owing to disruption caused by COVID-19. Governments should mitigate against this major burden on patients by developing recovery plans and implementing strategies to restore surgical activity safely.
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