Despite the use of ILE for multiple substances in the treatment of patients with poisoning and overdose, the effect of ILE in various non-local anesthetic poisonings is heterogenous, and the quality of evidence remains low to very low.
ILE appears to be effective for reversal of cardiovascular or neurological features in some cases of LA toxicity, but there is currently no convincing evidence showing that ILE is more effective than vasopressors or to indicate which treatment should be instituted as first line therapy in severe LA toxicity.
The measurements of a number of common analytes can be markedly affected by the lipemia produced by lipid emulsions such that they cannot always be interpreted in the way that most physicians use this information in typical clinical situations. In fact, a lack of appreciation of this effect may lead to unintentional treatment errors. Because the effect of the lipemia produced is dependent on the reagents and laboratory platform used, it would be useful for all future reports to clearly document sample handling, reagents and laboratory platform used, as well as any procedures employed to reduce the lipid content.
Purpose
– The purpose of this paper is to explore the effect of an electronic noise-monitoring device (NoiseSign) at reducing noise levels in quiet study areas in an academic library.
Design/methodology/approach
– Surveys and decibel-level measurements were used to measure the perceived and objective noise levels, respectively, in both an intervention and a control area of two major branch libraries. Patrons’ perception of noise was measured with a passive paper and online survey, which asked patrons to rate the current noise level and their desired noise level. The actual noise measurements were collected twice a day with a hand-held decibel reader for 60 seconds and then corroborated after the intervention with automatically logged decibel readings from the noise monitor device in the two intervention areas. The authors conducted one-way ANOVA’s to determine if the results were significant.
Findings
– The NoiseSign had no statistically significant effect on either actual noise levels or user perceptions of noise in the library. The surveys comments and anecdotal observation of the spaces while doing measurements did reveal that noise in the quiet study areas was not the primary source of complaints.
Originality/value
– In spite of many proposed solutions to reducing noise in libraries, there has been very little research in this area. This is the first study to examine the effectiveness of using a noise-monitoring device in reducing noise levels at an academic library.
Intravenous lipid emulsion (ILE) therapy is a novel treatment that was discovered in the last decade. Despite unclear understanding of its mechanisms of action, numerous and diverse publications attested to its clinical use. However, current evidence supporting its use is unclear and recommendations are inconsistent. To assist clinicians in decision-making, the American Academy of Clinical Toxicology created a workgroup composed of international experts from various clinical specialties, which includes representatives of major clinical toxicology associations. Rigorous methodology using the Appraisal of Guidelines for Research and Evaluation or AGREE II instrument was developed to provide a framework for the systematic reviews for this project and to formulate evidence-based recommendations on the use of ILE in poisoning. Systematic reviews on the efficacy of ILE in local anesthetic toxicity and non-local anesthetic poisonings as well as adverse effects of ILE are planned. A comprehensive review of lipid analytical interferences and a survey of ILE costs will be developed. The evidence will be appraised using the GRADE system. A thorough and transparent process for consensus statements will be performed to provide recommendations, using a modified Delphi method with two rounds of voting. This process will allow for the production of useful practice recommendations for this therapy.
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