STUDY OBJECTIVE
To develop guidelines for the stocking of antidotes at hospitals that accept emergency admissions using combined evidence-based and consensus methods.

METHODS
Study participants were 12 medical care providers from disciplines that are affected by insufficient stocking of emergency antidotes (clinical pharmacology, critical care, clinical pharmacy, emergency medicine, hospital pharmacy, internal medicine, managed care pharmacy, clinical toxicology, pediatrics, poison control centers, pulmonary medicine, regulatory medicine). Selection of individuals for the study panel was based on evidence of previous antidote research or perspective regarding the purchase and use of antidotes. The literature regarding each antidote was systematically amassed using pre-1966 literature files, current MEDLINE searches, the reference lists of major medical textbooks, and citations solicited from the consensus panel. Articles relevant to 4 defined core questions were included. These articles formed the basis of an evidence-based analysis performed by the principal investigator. After literature analysis, a literature summary and proposed guidelines for antidote stocking were submitted to the panel. Consensus was formed by electronic iterative presentation of alternatives to each panel member using a modified Delphi method. All panel members participated in 5 rounds of guideline analysis of 20 antidotes.

RESULTS
Of the 20 antidotes, 16 antidotes were ultimately recommended for stocking (N -acetylcysteine, atropine, Crotalid snake antivenin, calcium gluconate and chloride, cyanide antidote kit, deferoxamine, digoxin immune Fab, dimercaprol, ethanol, fomepizole, glucagon, methylene blue, naloxone, pralidoxime, physostigmine, sodium bicarbonate), 2 were not recommended for stocking (black widow antivenin, ethylenediamine tetraacetic acid), and consensus could not be reached for 2 antidotes (flumazenil, physostigmine).

CONCLUSION
These guidelines provide a tool to be used in revising or creating policies and procedures with regard to the stocking of antidotes in hospitals that accept emergency patients.


While the BRICS countries--Brazil, Russia, India, China, and South Africa--gain most of the global publicity about emerging economies, other nations have joined the race to harness technology and thereby join the club of developed nations. One such country is Malaysia. In the past, it has served as a source of low-cost manufacturing for the computer and communications industries. But now it has higher ambitions. Early this year, Prime Minister Najib Abdul Razak announced the creation of a series of programs and initiatives to increase per capita income significantly over the next decade. The Southeast Asian nation will develop the programs with a little help from its friends, old and new. A council of experts--many of them American--will advise the country on its pursuit of a "green, high-income economy" based on improved education, particularly in science and technology, and mentoring efforts to encourage small and medium-sized science and technology-related enterprises. The plan has the goal of more than doubling the Malaysian population's per capita income, from the 2009 figure of $6,700 to $15,000, by the year 2020, with the primary vehicle for that expansion a series of innovative science and technology initiatives. "Malaysia's ambitious goal is to simultaneously reduce poverty and achieve a green economy," Prime Minister Razak said in announcing the plan. "We see science and technology innovation as key to achieving that goal, guided by the advice and active support of some of the world's most distinguished entrepreneurial, scientific, and economic experts." The "fifth Asian tiger" The planned initiatives, many of them related to environmental advances, will build on the country's current development programs, programs that have already persuaded some analysts to group Malaysia with Hong Kong, Singapore, South Korea, and Taiwan as the "fifth Asian tiger." Nevertheless, the task ahead is daunting. Malaysia is not even one of what James O'Neill--the chairman of Goldman Sachs Asset Management and the man who coined the term BRIC--calls the "next eleven" nations, those with the potential to follow the BRICS in becoming powerful global economies in this century. However, the country has garnered help through the New York Academy of Sciences (NYAS), an organization that promotes links between science and society. That effort includes working with national governments to create roadmaps to innovation economies. "The vice president of the Malaysian Academy of Science was aware of what we were doing with Mexico and the Russians," says Ellis Rubinstein, NYAS's president and CEO. "He thought our unique capacity would be useful to the Prime Minister." In September 2010, after preparatory talks with Razak's science advisor, Zakri Abdul Hamid, Rubinstein and Razak began discussions on a joint project to facilitate the rapid growth of the Malaysian economy. [ILLUSTRATION OMITTED] To start the project, an NYAS staffer visited the Malaysian capital of Kuala Lumpur "to see opportunities where we could be useful," in Rubinstein's words. "The Malaysians aren't short of great plans," he continues. "They have been very aggressive in learning what the most ambitious ideas are out there to help development. The issue is learning how to work together to create synergies for change." The visit revealed three sectors that could provide the thrust necessary to fulfill the country's economic and social ambitions: the IT sector, human capacity building, and the palm oil industry. Once the sectors had been identified, Rubinstein says, "we thought about people who would be most visionary and most likely to give advice in one or more of these areas." Council of experts Using its academic, industrial, and international contacts, the New York academy assembled a 35-person council of experts, bringing together 10 Malaysians and 25 international members. The group includes such notables as Nobel laureates Richard Roberts and Torsten Wiesel, former National Science Foundation director Rita Coldwell, Columbia University economist Jeffrey Sachs, and Rajendra K. …


PayLoad Utilization Modeler (PLUM) is a statistical-modeling computer program used to evaluate the effectiveness of utilization of the International Space Station (ISS) in terms of the number of research facilities that can be operated within a specified interval of time. PLUM is designed to balance the requirements of research facilities aboard the ISS against the resources available on the ISS. PLUM comprises three parts: an interface for the entry of data on constraints and on required and available resources, a database that stores these data as well as the program output, and a modeler. The modeler comprises two subparts: one that generates tens of thousands of random combinations of research facilities and another that calculates the usage of resources for each of those combinations. The results of these calculations are used to generate graphical and tabular reports to determine which facilities are most likely to be operable on the ISS, to identify which ISS resources are inadequate to satisfy the demands upon them, and to generate other data useful in allocation of and planning of resources.


This application report presents a solution to control a permanent magnet synchronous motor (PMSM) using the control law accelerator (CLA), which is a small footprint coprocessor that is present on some of the microcontrollers from the C2000TM family of MCU. TMS320F2803x devices are part of the family of C2000 microcontrollers, which enables the cost-effective design of intelligent controllers for three phase motors by reducing system components and increasing efficiency. With these devices, it is possible to realize far more precise digital vector control algorithms like the field orientated control (FOC). This algorithm's implementation is discussed in this document. The FOC algorithm maintains efficiency in a wide range of speeds and takes into consideration torque changes with transient phases by processing a dynamic model of the motor. Among the solutions proposed are ways to eliminate the phase current sensors and use an observer for speed sensorless control.


Sera from 10 patients with AIDP and 10 age-matched controls were microinjected into the tibial division of rat sciatic nerve using improved microinjection techniques and coded sera. No statistically significant changes in conduction velocity or amplitude of the compound muscle action potential (CMAP) or in the monophasic compound action potential (CAP) parameters was found at 1 week. In nerves studied with serial recording over 1 h a small but significantly greater reduction in CMAP amplitude was observed at 60 min in the AIDP group and at both 30 and 60 min when only sera from very severely affected (bed-ridden) patients were considered. A similar reduction was found following microinjection into focally demyelinated nerves. The finding of a small reduction in CMAP amplitude in the first hour suggests the presence in some AIDP patients of serum blocking or demyelinating factors but the clinical significance of this small reduction is uncertain.


The 'average consumer' is referred to as a standard in regulatory contexts when attempts are made to benchmark how consumers are expected to reason while decoding food labels. An attempt is made to operationalize this hypothetical 'average consumer' by proposing a tool for measuring the level of informedness of an individual consumer against the national median at any time. Informedness, i.e. the individual consumer's ability to interpret correctly the meaning of the words and signs on a food label is isolated as one essential dimension for dividing consumers into three groups: less-informed, informed, and highly informed consumers. Consumer informedness is assessed using a 60-question test related to information found on a variety of Danish everyday food products and divided into factual questions and informedness about signpost labels. A test was made with 407 respondents who participated in four independent studies on fairness in consumer communication, and the average score for all was 57.6% of correct answers. A score of 64% and beyond would place a consumer in the upper quartile (the group of highly informed consumers), whereas a score of 52% or below would place the individual in the lower quartile (the group of less-informed consumers). Female respondents performed better than males on label recognition, and those around 40 years of age irrespective of gender performed best on factual knowledge, whereas those aged around 30 performed best on label recognition. It is foreseen that independent future studies of consumer behavior and decision making in relation to food products in different contexts could benefit from this type of benchmarking tool.


The KRAS-variant is a biologically functional, microRNA binding site variant, which predicts increased cancer risk especially for women. Because external exposures, such as chemotherapy, differentially impact the effect of this mutation, we evaluated the association of estrogen exposures, breast cancer (BC) risk and tumor biology in women with the KRAS-variant. Women with BC (n = 1712), the subset with the KRAS-variant (n = 286) and KRAS-variant unaffected controls (n = 80) were evaluated, and hormonal exposures, KRAS-variant status, and pathology were compared. The impact of estrogen withdrawal on transformation of isogenic normal breast cell lines with or without the KRAS-variant was studied. Finally, the association and presentation characteristics of the KRAS-variant and multiple primary breast cancer (MPBC) were evaluated. KRAS-variant BC patients were more likely to have ovarian removal pre-BC diagnosis than non-variant BC patients (p = 0.033). In addition, KRAS-variant BC patients also appeared to have a lower estrogen state than KRAS-variant unaffected controls, with a lower BMI (P < 0.001). Finally, hormone replacement therapy (HRT) discontinuation in KRAS-variant patients was associated with a diagnosis of triple negative BC (P < 0.001). Biologically confirming our clinical findings, acute estrogen withdrawal led to oncogenic transformation in KRAS-variant positive isogenic cell lines. Finally, KRAS-variant BC patients had greater than an 11-fold increased risk of presenting with MPBC compared to non-variant patients (45.39% vs 6.78%, OR 11.44 [3.42–37.87], P < 0.001). Thus, estrogen withdrawal and a low estrogen state appear to increase BC risk and to predict aggressive tumor biology in women with the KRAS-variant, who are also significantly more likely to present with multiple primary breast cancer.


This study investigates how the culminating teacher preparation program (TPP) experience (either student teaching assignment or internship) influences the perceptions teachers report about their ability to perform instructional tasks required of teachers. A multivariate ANOVA test (N = 502) was conducted to compare perceptions of student teachers (those who taught 15 weeks) and interns (those who taught a full academic year) at two points in time—once at the conclusion of their TPP and again after their first year of teaching. Results indicate that overall, student teachers report higher perceptions of their ability to perform instructional tasks than interns do at both the preservice and inservice teacher stages. Interns reported higher scores at the inservice stage on only the mathematics subscale, suggesting that there is some change in self-efficacy as teachers gain teaching experience. Findings suggest that the student teaching context provides more modeling and verbal support and produces teachers with higher perceptions of teaching ability than those who complete an internship.


Objective We attempted to estimate the excess annual costs that a US private employer may attribute to employing an individual who smokes tobacco as compared to a non-smoking employee. Design Reviewing and synthesising previous literature estimating certain discrete costs associated with smoking employees, we developed a cost estimation approach that approximates the total of such costs for US employers. We examined absenteeism, presenteesim, smoking breaks, healthcare costs and pension benefits for smokers. Results Our best estimate of the annual excess cost to employ a smoker is $5816. This estimate should be taken as a general indicator of the extent of excess costs, not as a predictive point value. Conclusions Employees who smoke impose significant excess costs on private employers. The results of this study may help inform employer decisions about tobacco-related policies.


"Gas Market Integration in the Southern Cone" is part of a larger effort by the Inter-American Development Bank (IDB) to promote integration of energy markets in South America's Southern Cone region. This book offers a comprehensive analysis of the gas industry's evolution in the region, highlighting the drivers of and obstacles to regional market integration. The authors identify barriers to integration and also present a concrete proposal based on a wealth of experience in other world regions, for overcoming these barriers to advance toward regional integration.


Fuel cells are high efficient energy production systems producing heat and electrical power. Especially PEM fuel cells (Polymeric Electrolyte Membrane) require pure hydrogen for operation. Hydrogen is produced e.g. by reforming of hydrocarbons like natural gas or ethanol. During the production of hydrogen carbon monoxide is formed. CO is a harmful poison for the platinum catalsyst of the fuel cell electrodes. Therefore hydrogen has to be purified. The goal of this work was to develop a pressure swing adsorption for small scale fuel cell systems. The hydrogen to be purified is produced by reforming bio-ethanol. The PSA is designed for a quite low adsorption pressure of 7 bar and a small thermal hydrogen power for fuel cell systems in a range of 1 kW electrical. For the design of the PSA a simplified method of calculating the bed height of the adsorbers was developed. Most scientists working in the field of pressure swing adsorption use mathematical models of breakthrough curves for PSA calculations. But these models can only be solved numerically. The results of these simulations are approved by performing test at lab-scale PSA. Main focus on the tests is set to the breakthrough time and the shape of the breakthrough curves. The calculation method developed in this work is also verified by test. But no breakthrough curves were taken up and no breakthrough time of the unwished gas component (CO) was measured. Only the hydrogen quality and the hydrogen recovery rate even after several adsorption cycles were the dominating criteria for the approval of the calculation model. The PSA tests showed that the required hydrogen quality (less than 10 ppmv CO in hydrogen) for PEM-fuel cells was reached even after a 20 adsorption cycles (one cycle lasted 12 minutes with 3 minutes adsorption). The tests were performed on several days in series without changing the adsorbents or purging them for a longer time.


Riverbed under the influence of natural and anthropogenic factors is constantly being transformed. The changes of the channel parameters related to natural phenomena are rarely dynamic. Contrarily it is in the case of human activity. The introduction of river engineering structures to the riverbed aims to quickly adapt the river to the requirements. If construction of such forms is designed taking account of natural conditions prevailing in the riverbed, then negative effects cannot be observed. The situation is different when the river's characteristics were not considered in the design process. The article discusses the changes that the riverbed has undergone due to its intensive contraction at the ferry crossing at km 488 of Vistula, in Gassy. Current and archival aerial photographs were analyzed in terms of the transformation of the riverbed width, as well as the size of the mid-channel islands. The focus was concentrated on a section of the river 2 km above and 4 km below the ferry crossing. In particular, the parameters of the channel bar located directly below the narrowing and their change over the last decades were analyzed. Conclusions were drawn regarding the case study and recommendations for designing analogous solutions ensuing from the analysis were formulated.


Algorithmic trading refers to the automatic and rapid trading of large quantities with orders specified and implemented by an algorithm. Roughly speaking, algorithmic trading is based on two different time scales: the daily or weekly scale and a smaller (10to 100-second) time scale. These two time scales essentially reflect the two steps by which the traders slice and place orders. The first step is to optimally slice big orders into smaller ones on a daily basis with the goal to minimize the price impact and/or to maximize the expected utility; the second step is to optimally place the orders within seconds. The former is the well-known optimal execution problem, and the latter is the much less studied optimal placement problem. This paper reviews several simple models and approaches for the optimal placement problem. Several most relevant statistical issues are presented, together with a brief discussion on the key differences between the system of limit order book and the multiclass queues with reneging.


Understanding components that influence students' enjoyment of distance higher education is increasingly important to enhance academic performance and retention. Although there is a growing body of research about students' engagement with online learning, a research gap exists concerning whether fun affect students' enjoyment. A contributing factor to this situation is that the meaning of fun in learning is unclear, and its possible role is controversial. This research is original in examining students' views about fun and online learning, and influential components and connections. This study investigated the beliefs and attitudes of a sample of 551 distance education students including pre-services and in-service teachers, consultants and education professionals using a mixed-method approach. Quantitative and Qualitative data were generated through a self-reflective instrument during the COVID-19 pandemic. The findings revealed that 88.77% of participants valued fun in online learning; linked to well-being, motivation and performance. However, 16.66% mentioned that fun within online learning could take the focus off their studies and result in distraction or loss of time. Principal component analysis revealed three groups of students who found (1) fun relevant in socio-constructivist learning (2) no fun in traditional transmissive learning and (3) disturbing fun in constructivist learning. This study also provides key recommendations extracted from participants' views supported by consensual review for course teams, teaching staff and students to enhance online learning experiences with enjoyment and fun.