15 results on '"Ornelas D"'
Search Results
2. Offshore oil and gas exploration and production in Brazil: a proposal for integrated actions for operational, occupational and environmental safety
- Author
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Ornelas, D. L., primary, Mendes, P. A. S., additional, Magrini, A., additional, and Arouca, M. C., additional
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- 2014
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3. PMD28 - Economic Impact of A Volumetric Infusion Pump (Infusomat® Space) + Central Alarm Management (One View), In The Risk Prevention In Infusion Therapy In The Intensive Care Unit (Icu) In Mexico
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Escobedo, P, Ornelas, D, Pozo, L, Rosas, R, Nazario-Nemesio, J, and Paladio-Hernández, JÁ
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- 2015
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4. Graphic interface for the operation of an induction motor controlled by a commercial adjustable speed drive
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Anzurez-Marin, J., primary, Zavala-Romero, P., additional, Espinosa-Juarez, E., additional, Ramirez-Zavala, S., additional, and Zepeda-Ornelas, D., additional
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- 2011
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5. YAV-8B Harrier
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Ornelas, D
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Aircraft Design, Testing And Performance - Abstract
The objective of the YAV-8B flight research program is to develop and validate the technologies required for V/STOL aircraft to effectively operate in all mission phases. Specifically, inflight dynamics, controls and guidance, and propulsive lift technologies that will contribute to an improved adverse weather launch and recovery operation capability will be developed and evaluated. The cockpit panel is measured and reproduced for integration into a flight simulator.
- Published
- 1985
6. PMD28 Economic Impact of A Volumetric Infusion Pump (Infusomat® Space) + Central Alarm Management (One View), In The Risk Prevention In Infusion Therapy In The Intensive Care Unit (Icu) In Mexico
- Author
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Escobedo, P, Ornelas, D, Pozo, L, Rosas, R, Nazario-Nemesio, J, and Paladio-Hernández, JÁ
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7. Strokes Averted by Intravenous Thrombolysis: A Secondary Analysis of a Prospective, Multicenter, Controlled Trial of Mobile Stroke Units.
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Navi BB, Bach I, Czap AL, Wang M, Yamal JM, Jacob AP, Parker SA, Rajan SS, Mir S, Sherman C, Willey JZ, Saver JL, Gonzalez MO, Singh N, Jones WJ, Ornelas D, Gonzales NR, Alexandrov AW, Alexandrov AV, Nour M, Spokoyny I, Mackey J, Collins SQ, Silnes K, Fink ME, English J, Barazangi N, Bratina PL, Volpi J, Rao CPV, Griffin L, Persse D, and Grotta JC
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- Humans, Female, Tissue Plasminogen Activator therapeutic use, Fibrinolytic Agents therapeutic use, Prospective Studies, Hemorrhage complications, Thrombolytic Therapy methods, Treatment Outcome, Stroke diagnostic imaging, Stroke drug therapy, Stroke complications, Brain Ischemia drug therapy
- Abstract
Objective: This study was undertaken to examine averted stroke in optimized stroke systems., Methods: This secondary analysis of a multicenter trial from 2014 to 2020 compared patients treated by mobile stroke unit (MSU) versus standard management. The analytical cohort consisted of participants with suspected stroke treated with intravenous thrombolysis. The main outcome was a tissue-defined averted stroke, defined as a final diagnosis of stroke with resolution of presenting symptoms/signs by 24 hours attributed to thrombolysis and no acute infarction/hemorrhage on imaging. An additional outcome was stroke with early symptom resolution, defined as a final diagnosis of stroke with resolution of presenting symptoms/signs by 24 hours attributed to thrombolysis., Results: Among 1,009 patients with a median last known well to thrombolysis time of 87 minutes, 159 (16%) had tissue-defined averted stroke and 276 (27%) had stroke with early symptom resolution. Compared with standard management, MSU care was associated with more tissue-defined averted stroke (18% vs 11%, adjusted odds ratio [aOR] = 1.82, 95% confidence interval [CI] = 1.13-2.98) and stroke with early symptom resolution (31% vs 21%, aOR = 1.74, 95% CI = 1.12-2.61). The relationships between thrombolysis treatment time and averted/early recovered stroke appeared nonlinear. Most models indicated increased odds for stroke with early symptom resolution but not tissue-defined averted stroke with earlier treatment. Additionally, younger age, female gender, hyperlipidemia, lower National Institutes of Health Stroke Scale, lower blood pressure, and no large vessel occlusion were associated with both tissue-defined averted stroke and stroke with early symptom resolution., Interpretation: In optimized stroke systems, 1 in 4 patients treated with thrombolysis recovered within 24 hours and 1 in 6 had no demonstrable brain injury on imaging. ANN NEUROL 2024;95:347-361., (© 2023 American Neurological Association.)
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- 2024
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8. Outcomes of patients with pre-existing disability managed by mobile stroke units: A sub-analysis of the BEST-MSU study.
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Pirlog BO, Jacob AP, Rajan SS, Yamal JM, Parker SA, Wang M, Bowry R, Czap A, Bratina PL, Gonzalez MO, Singh N, Zou J, Gonzales NR, Jones WJ, Alexandrov AW, Alexandrov AV, Navi BB, Nour M, Spokoyny I, Mackey J, Silnes K, Fink ME, Pisarro Sherman C, Willey J, Saver JL, English J, Barazangi N, Ornelas D, Volpi J, Pv Rao C, Griffin L, Persse D, and Grotta JC
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- Humans, Fibrinolytic Agents therapeutic use, Quality of Life, Tissue Plasminogen Activator therapeutic use, Treatment Outcome, Clinical Trials as Topic, Emergency Medical Services, Stroke drug therapy
- Abstract
Background: Few data exist on acute stroke treatment in patients with pre-existing disability (PD) since they are usually excluded from clinical trials. A recent trial of mobile stroke units (MSUs) demonstrated faster treatment and improved outcomes, and included PD patients., Aim: To determine outcomes with tissue plasminogen activator (tPA), and benefit of MSU versus management by emergency medical services (EMS), for PD patients., Methods: Primary outcomes were utility-weighted modified Rankin Scale (uw-mRS). Linear and logistic regression models compared outcomes in patients with versus without PD, and PD patients treated by MSU versus standard management by EMS. Time metrics, safety, quality of life, and health-care utilization were compared., Results: Of the 1047 tPA-eligible ischemic stroke patients, 254 were with PD (baseline mRS 2-5) and 793 were without PD (baseline mRS 0-1). Although PD patients had worse 90-day uw-mRS, higher mortality, more health-care utilization, and worse quality of life than non-disabled patients, 53% returned to at least their baseline mRS, those treated faster had better outcome, and there was no increased bleeding risk. Comparing PD patients treated by MSU versus EMS, 90-day uw-mRS was 0.42 versus 0.36 (p = 0.07) and 57% versus 46% returned to at least their baseline mRS. There was no interaction between disability status and MSU versus EMS group assignment (p = 0.67) for 90-day uw-mRS., Conclusion: PD did not prevent the benefit of faster treatment with tPA in the BEST-MSU study. Our data support inclusion of PD patients in the MSU management paradigm., Competing Interests: Declaration of conflicting interestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: J.C. Grotta has received grants from Patient-Centered Outcomes Research Institute (PCORI), NIH, Genentech, CSL Behring, and Chiesi; is a consultant for Frazer, advison the scientific advisory board for Haemonetics and Acticor, and on the DSMB for Prolong Pharma. J.L. Saver receives contracted hourly payments from Bayer, Biogen, Roche, Genentech, Medtronic, Novo Nordisk, and Occlutech for service on clinical trial steering committees and DSMBs. The remaining authors have no disclosures.
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- 2023
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9. Venous Thromboembolism in Metastatic Uterine Leiomyosarcoma: A Case Report and Review of the Literature.
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Swisher AR, Ornelas D, Ornelas D, Namazi G, Theodory B, Chitkara A, Desai A, and Sethi P
- Abstract
We report an unusual case of extensive deep vein thrombosis (DVT) and pulmonary embolism (PE) in the setting of metastatic uterine leiomyosarcoma. Recognition of the associated sequelae of this condition may improve short- and long-term outcomes. A 56-year-old black female with a history of uterine leiomyosarcoma diagnosed incidentally after total abdominal hysterectomy for fibroid uterus without initiation of chemoradiation treatment presented to the emergency department complaining of generalized weakness and progressively worsening stridor for 2 weeks. The patient was experiencing shortness of breath, dysphagia, and hoarseness. Physical exam was remarkable for rhonchi but was otherwise normal. Diagnostic imaging via CT of the abdomen, pelvis, and chest revealed DVTs of the left common and external iliac veins, the superior mesenteric artery, multiple pulmonary emboli of the right pulmonary artery, several nodular lesions within the lungs, and scattered peritoneal necrotic lesions, which were suspicious for metastatic disease. Additionally, CT of the neck showed an exophytic mass protruding into the airway from the subglottic region and thyromegaly with bilateral thyroid lobe nodules. The patient was subsequently started on Eliquis and chemotherapy. The rarity of this case is rooted in the extent of the patient's DVTs and PEs secondary to hypercoagulability in metastatic cancer. This presentation should be further evaluated to exclude thrombophilias or underlying malignancies. Drawing from the lessons of this case will help guide future clinical management regarding the care of metastatic uterine leiomyosarcoma., Competing Interests: The authors declare that they have no conflicts of interest., (© 2023 The Author(s). Published by S. Karger AG, Basel.)
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- 2023
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10. Rapid Activation of Neuroinflammation in Stroke: Plasma and Extracellular Vesicles Obtained on a Mobile Stroke Unit.
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Kowalski RG, Ledreux A, Violette JE, Neumann RT, Ornelas D, Yu X, Griffiths SG, Lewis S, Nash P, Monte AA, Coughlan CM, Deighan C, Grotta JC, Jones WJ, and Graner MW
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- Adult, Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Interleukin-6, Neuroinflammatory Diseases, Tissue Plasminogen Activator therapeutic use, Treatment Outcome, Brain Ischemia drug therapy, Ischemic Attack, Transient drug therapy, Stroke therapy
- Abstract
Background: Neuroinflammation is ubiquitous in acute stroke and worsens outcome. However, the precise timing of the inflammatory response is unknown, hindering the design of acute anti-inflammatory therapeutic interventions. We sought to identify the onset of the neuroinflammatory cascade using a mobile stroke unit., Methods: The study is a proof-of-concept, cohort investigation of ultra-early blood- and extracellular vesicle-derived markers of neuroinflammation and outcome in acute stroke. Blood was obtained, prehospital, on an mobile stroke unit. Outcomes were biomarker concentrations, modified Rankin Scale score, and National Institutes of Health Stroke Scale score., Results: Forty-one adults were analyzed, including 15 patients treated on the mobile stroke unit between August 2021 and April 2022, and 26 healthy controls to establish biomarker reference levels. Median patient age was 74 (range, 36-97) years, 60% were female, and 80% White. Ten (67%) were diagnosed as stroke, with 8 (53%) confirmed and 2 likely transient ischemic attack or stroke averted by thrombolysis; 5 were stroke mimics. For strokes, median initial National Institutes of Health Stroke Scale score was 11 (range, 4-19) and 6 (75%) received tPA (tissue-type plasminogen activator). Blood was obtained a median of 58 (range, 36-133) minutes after symptom onset. Within 36 minutes after stroke, plasma IL-6 (interleukin-6), neurofilament light chain, UCH-L1 (ubiquitin C-terminal hydrolase L1), and GFAP (glial fibrillary acidic protein) were elevated by as much as 10 times normal. In EVs, MMP-9 (matrix metalloproteinase-9), CXCL4 (chemokine (C-X-C motif) ligand 4), CRP (C-reactive protein), IL-6, OPN (osteopontin), and PECAM1 (platelet and endothelial cell adhesion molecule 1) were elevated. Inflammatory markers increased rapidly in the first 2 hours and continued rising for 24 hours., Conclusions: The neuroinflammatory cascade was found to be activated within 36 to 133 minutes after stroke and progresses rapidly. This is earlier than observed previously in humans and suggests injury from neuroinflammation occurs faster than had been surmised. These findings could inform development of acute immunomodulatory stroke therapies and lead to new diagnostic tools and improved outcomes.
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- 2023
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11. Immune Monitoring of Paediatric Patients Infected with Rickettsia rickettsii , Ehrlichia canis and Coinfected.
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Garcia-Rosales L, Escarcega-Avila A, Ramirez-Lopez M, Manzanera-Ornelas D, Guevara-Macias E, Vaquera-Arteaga M, Alvarado-Gonzlaez C, Estrada BE, Jimenez-Vega F, Donis-Maturano L, and Espino-Solis GP
- Abstract
In 2021, 273 Rocky Mountain spotted fever cases were reported nationwide in Mexico. In Chihuahua City, fourteen samples were obtained from children suspected of rickettsial infection. The analysis of samples (January to December 2021) showed prevalence rates of 28.5%, 43%, and 28.5% for Rickettsia rickettsii, Ehrlichia canis, and both pathogens in coinfection, respectively. The analysis of clinical haematological and biochemistry analytes showed alterations; 100% of the children had elevated liver enzymes and coagulation times, 64% showed leukocytosis due to neutrophilia, 55% had thrombocytopenia, lymphopenia, and hypoalbuminemia, and 45% showed normocytic normochromic anaemia. Statistically significant differences were observed in the expression of the chemokines IL-8, RANTES, CXCL9/MIG, and CXCL10/IP-10 across the coinfected and control groups, and the difference in IP-10 expression was significant for patients infected by R. rickettsii compared to the control group. Additionally, significant differences were observed for expression levels of IL-1β, IL-6, IL-17, IFNγ, and TNFα among the R. rickettsii-positive group compared to the control group. On the other hand, the coinfected group exhibited modified levels of IL-6, IL-8, and IL-10 compared with the control group. Finally, significant differences were observed for CD8+ T lymphocyte subpopulations between individuals positive for R. rickettsii and those positive for E. canis.
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- 2022
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12. Prospective, Multicenter, Controlled Trial of Mobile Stroke Units.
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Grotta JC, Yamal JM, Parker SA, Rajan SS, Gonzales NR, Jones WJ, Alexandrov AW, Navi BB, Nour M, Spokoyny I, Mackey J, Persse D, Jacob AP, Wang M, Singh N, Alexandrov AV, Fink ME, Saver JL, English J, Barazangi N, Bratina PL, Gonzalez M, Schimpf BD, Ackerson K, Sherman C, Lerario M, Mir S, Im J, Willey JZ, Chiu D, Eisshofer M, Miller J, Ornelas D, Rhudy JP, Brown KM, Villareal BM, Gausche-Hill M, Bosson N, Gilbert G, Collins SQ, Silnes K, Volpi J, Misra V, McCarthy J, Flanagan T, Rao CPV, Kass JS, Griffin L, Rangel-Gutierrez N, Lechuga E, Stephenson J, Phan K, Sanders Y, Noser EA, and Bowry R
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- Aged, Disability Evaluation, Female, Humans, Ischemic Stroke complications, Ischemic Stroke diagnostic imaging, Male, Middle Aged, Odds Ratio, Severity of Illness Index, Tomography, X-Ray Computed, Ambulances, Emergency Medical Services, Ischemic Stroke drug therapy, Mobile Health Units, Time-to-Treatment, Tissue Plasminogen Activator therapeutic use
- Abstract
Background: Mobile stroke units (MSUs) are ambulances with staff and a computed tomographic scanner that may enable faster treatment with tissue plasminogen activator (t-PA) than standard management by emergency medical services (EMS). Whether and how much MSUs alter outcomes has not been extensively studied., Methods: In an observational, prospective, multicenter, alternating-week trial, we assessed outcomes from MSU or EMS management within 4.5 hours after onset of acute stroke symptoms. The primary outcome was the score on the utility-weighted modified Rankin scale (range, 0 to 1, with higher scores indicating better outcomes according to a patient value system, derived from scores on the modified Rankin scale of 0 to 6, with higher scores indicating more disability). The main analysis involved dichotomized scores on the utility-weighted modified Rankin scale (≥0.91 or <0.91, approximating scores on the modified Rankin scale of ≤1 or >1) at 90 days in patients eligible for t-PA. Analyses were also performed in all enrolled patients., Results: We enrolled 1515 patients, of whom 1047 were eligible to receive t-PA; 617 received care by MSU and 430 by EMS. The median time from onset of stroke to administration of t-PA was 72 minutes in the MSU group and 108 minutes in the EMS group. Of patients eligible for t-PA, 97.1% in the MSU group received t-PA, as compared with 79.5% in the EMS group. The mean score on the utility-weighted modified Rankin scale at 90 days in patients eligible for t-PA was 0.72 in the MSU group and 0.66 in the EMS group (adjusted odds ratio for a score of ≥0.91, 2.43; 95% confidence interval [CI], 1.75 to 3.36; P<0.001). Among the patients eligible for t-PA, 55.0% in the MSU group and 44.4% in the EMS group had a score of 0 or 1 on the modified Rankin scale at 90 days. Among all enrolled patients, the mean score on the utility-weighted modified Rankin scale at discharge was 0.57 in the MSU group and 0.51 in the EMS group (adjusted odds ratio for a score of ≥0.91, 1.82; 95% CI, 1.39 to 2.37; P<0.001). Secondary clinical outcomes generally favored MSUs. Mortality at 90 days was 8.9% in the MSU group and 11.9% in the EMS group., Conclusions: In patients with acute stroke who were eligible for t-PA, utility-weighted disability outcomes at 90 days were better with MSUs than with EMS. (Funded by the Patient-Centered Outcomes Research Institute; BEST-MSU ClinicalTrials.gov number, NCT02190500.)., (Copyright © 2021 Massachusetts Medical Society.)
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- 2021
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13. Teaching Baccalaureate Nursing Students to Practice in Primary Care Settings.
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Martinez Rogers NE, Zamora H, and Ornelas D
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- Humans, Learning, Patient Protection and Affordable Care Act, Students, Nursing, Teaching, United States, Education, Nursing, Baccalaureate methods, Primary Health Care
- Abstract
Background: The Affordable Care Act of 2010 emphasized the importance of primary care and preventative services as core components to promote the health of the U.S., Method: A unique program was created for baccalaureate nursing students to provide learning and practice experiences in primary practice sites that emphasized chronic disease prevention and management, including mental health and substance abuse services. Students were selected using a holistic approach., Results: Students were selected to participate in the project. A community leadership advisory board was created. Students were assigned to the Veteran Administration's primary care clinics for their clinical experiences., Conclusion: This project is well-developed to increase the knowledge of present and future RNs, interprofessional providers and educators, researchers, and policy makers in community-oriented primary care. [J Nurs Educ. 2021;60(3):129-135.]., (Copyright 2021, SLACK Incorporated.)
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- 2021
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14. Successful conduct of an acute stroke clinical trial during COVID.
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Yamal JM, Parker SA, Jacob AP, Rajan SS, Bowry R, Bratina P, Wang M, Nour M, Mackey J, Collins S, Jones W, Schimpf B, Ornelas D, Spokoyny I, Im JF, Gilbert G, Eisshofer M, and Grotta JC
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- Aged, COVID-19 virology, Female, Humans, Male, Middle Aged, Mobile Health Units, Pandemics, Patient Discharge, SARS-CoV-2 physiology, Time Factors, Tissue Plasminogen Activator therapeutic use, COVID-19 epidemiology, Stroke drug therapy
- Abstract
Most clinical research stopped during COVID due to possible impact on data quality and personnel safety. We aimed to assess the impact of COVID on acute stroke clinical trial conduct at sites that continued to enroll patients during the pandemic. BEST-MSU is an ongoing study of Mobile Stroke Units (MSU) vs standard management of tPA-eligible acute stroke patients in the pre-hospital setting. MSU personnel include a vascular neurologist via telemedicine, and a nurse, CT technologist, paramedics and emergency medicine technicians on-board. During COVID, consent, 90-day modified Rankin Scale (mRS) and EQ5D were obtained by phone instead of in-person, but other aspects of management were similar to the pre-COVID period. We compared patient demographics, study metrics, and infection of study personnel during intra- vs pre-COVID eras. Five of 6 BEST-MSU sites continued to enroll during COVID. There were no differences in intra- (n = 57) vs pre- (n = 869) COVID enrolled tPA eligible patients' age, sex, race (38.6% vs 38.0% Black), ethnicity (15.8% vs 18.6% Hispanic), or NIHSS (median 11 vs 9). The percent of screened patients enrolled and adjudicated tPA eligible declined from 13.6% to 6.6% (p < .001); study enrollment correlated with local stay-at-home and reopening orders. There were no differences in alert to MSU arrival or arrival to tPA times, but MSU on-scene time was 5 min longer (p = .01). There were no differences in ED door to CT, tPA treatment or thrombectomy puncture times, hospital length of stay, discharge disposition, or remote vs in-person 90-day mRS or EQ5D. One MSU nurse tested positive but did not require hospitalization. Clinical research in the pre-hospital setting can be carried out accurately and safely during a pandemic. tPA eligibility rates declined, but otherwise there were no differences in patient demographics, deterioration of study processes, or serious infection of study staff. Trial registration: NCT02190500., Competing Interests: The authors have declared that no competing interests exist.
- Published
- 2021
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15. Health Jeopardy: a game to market school health services.
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Swanson MA and Ornelas D
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- Adolescent, Adult, Child, Health Promotion, Humans, Marketing of Health Services, Minnesota, Health Education, Play and Playthings, School Health Services, School Nursing
- Abstract
Health Jeopardy was developed by members of the School Nurse Organization of Minnesota to present information about health and to market the role of the school nurse. Although it was created for the Minnesota State Fair, it has been used in a variety of community settings. This interactive and fun game has been popular with both children and adults. Contestants were selected from the state fair audience, and each competed for prizes by answering questions about school health under the five categories of first aid and safety, nutrition, immunizations, communicable diseases, and school nurse facts. In addition to the state fair, Minnesota school nurses have used this game as both an informational and promotional tool in their school and community fairs.
- Published
- 2001
- Full Text
- View/download PDF
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