Search results for: Jerome Bourjea

Authors: Jerome Joshi

Abstract:

The paper presents the modelling of financial markets using the Stochastic Pi Calculus model. The Stochastic Pi Calculus model is mainly used for biological applications; however, the feature of this model promotes its use in financial markets, more prominently in high frequency trading. The trading system can be broadly classified into exchange, market makers or intermediary traders and fundamental traders. The exchange is where the action of the trade is executed, and the two types of traders act as market participants in the exchange. High frequency trading, with its complex networks and numerous market participants (intermediary and fundamental traders) poses a difficulty while modelling. It involves the participants to seek the advantage of complex trading algorithms and high execution speeds to carry out large volumes of trades. To earn profits from each trade, the trader must be at the top of the order book quite frequently by executing or processing multiple trades simultaneously. This would require highly automated systems as well as the right sentiment to outperform other traders. However, always being at the top of the book is also not best for the trader, since it was the reason for the outbreak of the ‘Hot – Potato Effect,’ which in turn demands for a better and more efficient model. The characteristics of the model should be such that it should be flexible and have diverse applications. Therefore, a model which has its application in a similar field characterized by such difficulty should be chosen. It should also be flexible in its simulation so that it can be further extended and adapted for future research as well as be equipped with certain tools so that it can be perfectly used in the field of finance. In this case, the Stochastic Pi Calculus model seems to be an ideal fit for financial applications, owing to its expertise in the field of biology. It is an extension of the original Pi Calculus model and acts as a solution and an alternative to the previously flawed algorithm, provided the application of this model is further extended. This model would focus on solving the problem which led to the ‘Flash Crash’ which is the ‘Hot –Potato Effect.’ The model consists of small sub-systems, which can be integrated to form a large system. It is designed in way such that the behavior of ‘noise traders’ is considered as a random process or noise in the system. While modelling, to get a better understanding of the problem, a broader picture is taken into consideration with the trader, the system, and the market participants. The paper goes on to explain trading in exchanges, types of traders, high frequency trading, ‘Flash Crash,’ ‘Hot-Potato Effect,’ evaluation of orders and time delay in further detail. For the future, there is a need to focus on the calibration of the module so that they would interact perfectly with other modules. This model, with its application extended, would provide a basis for researchers for further research in the field of finance and computing.

Keywords: concurrent computing, high frequency trading, financial markets, stochastic pi calculus

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Authors: Fouad M. Bendimerad, Jerome B. Zayas, Michael Adrian T. Padilla

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With the increasing scale of severity and frequency of disasters worldwide, the performance of governance systems for disaster risk reduction and management in many countries are being put to the test. In the Philippines, the Disaster Risk Reduction and Management (DRRM) Act of 2010 (Republic Act 10121 or RA 10121) as the framework for disaster risk reduction and management was tested when Super Typhoon Haiyan hit the eastern provinces of the Philippines in November 2013. Typhoon Haiyan is considered to be the strongest recorded typhoon in history to make landfall with winds exceeding 252 km/hr. In assessing the performance of RA 10121 the authors conducted document reviews of related policies, plans, programs, and key interviews and focus groups with representatives of 21 national government departments, two (2) local government units, six (6) private sector and civil society organizations, and five (5) development agencies. Our analysis will argue that enhancements are needed in RA 10121 in order to meet the challenges of large-scale disasters. The current structure where government agencies and departments organize along DRRM thematic areas such response and relief, preparedness, prevention and mitigation, and recovery and response proved to be inefficient in coordinating response and recovery and in mobilizing resources on the ground. However, experience from various disasters has shown the Philippine government’s tendency to organize major recovery programs along development sectors such as infrastructure, livelihood, shelter, and social services, which is consistent with the concept of DRM mainstreaming. We will argue that this sectoral approach is more effective than the thematic approach to DRRM. The council-type arrangement for coordination has also been rendered inoperable by Typhoon Haiyan because the agency responsible for coordination does not have decision-making authority to mobilize action and resources of other agencies which are members of the council. Resources have been devolved to agencies responsible for each thematic area and there is no clear command and direction structure for decision-making. However, experience also shows that the Philippine government has appointed ad-hoc bodies with authority over other agencies to coordinate and mobilize action and resources in recovering from large-scale disasters. We will argue that this approach be institutionalized within the government structure to enable a more efficient and effective disaster risk reduction and management system.

Keywords: risk reduction and management, recovery, governance, typhoon haiyan response and recovery

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Authors: A. L. Verret, N. Prince, Y. Jerome, A. Bras

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The effects of housing design on the health and well-being of populations are quite intangible. In fact, healthy housing parameters are generally difficult to establish scientifically. It is often unclear the direction of a cause-and-effect relationship between health variables and housing. However, the lack of clear and definite measurements does not entail the absence of relationship between housing, health, and well-being. Research has thus been conducted. It has mostly aimed the physical rather than the psychological or social well-being of a population, given the difficulties to establish cause-effect relationships because of the subjectivity of the psychological symptoms and of the challenge in determining the influence of other factors. That said, a strong relationship has been exposed between light and physiology. Both the nervous and endocrine systems, amongst others, are affected by different wavelengths of natural light within a building. Daylight in the workplace is indeed associated to decreased absenteeism, errors and product defects, fatigue, eyestrain, increased productivity and positive attitude. Similar associations can also be made to residential housing. Lower levels of sunlight within the home have been proven to result in impaired cognition in depressed participants of a cross-sectional case study. Moreover, minimum space (area and volume) has been linked to healthy housing and quality of life, resulting in norms and regulations for such parameters for home constructions. As a matter of fact, it is estimated that people spend the two-thirds of their lives within the home and its immediate environment. Therefore, it is possible to deduct that the health and well-being of the occupants are potentially at risk in an unhealthy housing situation. While the impact of architecture on health and well-being is acknowledged and considered somewhat crucial in various countries of the north and the south, this issue is barely raised in Haiti. In fact, little importance is given to architecture for many reasons (lack of information, lack of means, societal reflex, poverty…). However, the middle-class is known for its residential strategies and trajectories in search of better-quality homes and environments. For this reason, it would be pertinent to use this group and its strategies and trajectories to isolate the impact of housing design on the overall health and well-being. This research aims to analyze the impact of housing architecture on the health and well-being of middle-class families in the metropolitan region of Port-au-Prince. It is a case study which uses semi-structured interviews and observations as research methods. Although at an early stage, this research anticipates that homes affect their occupants both psychologically and physiologically, and consequently, public policies and the population should take into account the architectural design in the planning and construction of housing and, furthermore, cities.

Keywords: architectural design, health and well-being, middle-class housing, Port-au-Prince, Haiti

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Authors: Peter Burggräf, Matthias Dannapfel, Hanno Voet, Patrick-Benjamin Bök, Jérôme Uelpenich, Julian Hoppe

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The increasing digitalization of value chains can help companies to handle rising complexity in their processes and thereby reduce the steadily increasing planning and control effort in order to raise performance limits. Due to technological advances, companies face the challenge of smart value chains for the purpose of improvements in productivity, handling the increasing time and cost pressure and the need of individualized production. Therefore, companies need to ensure quick and flexible decisions to create self-optimizing processes and, consequently, to make their production more efficient. Lean production, as the most commonly used paradigm for complexity reduction, reaches its limits when it comes to variant flexible production and constantly changing market and environmental conditions. To lift performance limits, which are inbuilt in current value chains, new methods and tools must be applied. Digitalization provides the potential to derive these new methods and tools. However, companies lack the experience to harmonize different digital technologies. There is no practicable framework, which instructs the transformation of current value chains into digital pervasive value chains. Current research shows that a connection between lean production and digitalization exists. This link is based on factors such as people, technology and organization. In this paper, the introduced method for the determination of digitally pervasive value chains takes the factors people, technology and organization into account and extends existing approaches by a new dimension. It is the first systematic approach for the digital transformation of lean production and consists of four steps: The first step of ‘target definition’ describes the target situation and defines the depth of the analysis with regards to the inspection area and the level of detail. The second step of ‘analysis of the value chain’ verifies the lean-ability of processes and lies in a special focus on the integration capacity of digital technologies in order to raise the limits of lean production. Furthermore, the ‘digital evaluation process’ ensures the usefulness of digital adaptions regarding their practicability and their integrability into the existing production system. Finally, the method defines actions to be performed based on the evaluation process and in accordance with the target situation. As a result, the validation and optimization of the proposed method in a German company from the electronics industry shows that the digital transformation of current value chains based on lean production achieves a raise of their inbuilt performance limits.

Keywords: digitalization, digital transformation, Industrie 4.0, lean production, value chain

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Authors: Hugo Lefeuvre, Jerôme Donnard, Michael Descostes, Sophie Billon, Samuel Duval, Tugdual Oger, Herve Toubon, Paul Sardini

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Spectroscopic autoradiography is a method of interest for geological sample analysis. Indeed, researchers may face different issues such as radioelement identification and quantification in the field of environmental studies. Imaging gaseous ionization detectors find their place in geosciences for conducting specific measurements of radioactivity to improve the monitoring of natural processes using naturally-occurring radioactive tracers, but also for the nuclear industry linked to the mining sector. In geological samples, the location and identification of the radioactive-bearing minerals at the thin-section scale remains a major challenge as the detection limit of the usual elementary microprobe techniques is far higher than the concentration of most of the natural radioactive decay products. The spatial distribution of each decay product in the case of uranium in a geomaterial is interesting for relating radionuclides concentration to the mineralogy. The present study aims to provide spectroscopic autoradiography analysis method for measuring the initial energy of alpha particles with a parallel ionization multiplier gaseous detector. The analysis method has been developed thanks to Geant4 modelling of the detector. The track of alpha particles recorded in the gas detector allow the simultaneous measurement of the initial point of emission and the reconstruction of the initial particle energy by a selection based on the linear energy distribution. This spectroscopic autoradiography method was successfully used to reproduce the alpha spectra from a 238U decay chain on a geological sample at the thin-section scale. The characteristics of this measurement are an energy spectrum resolution of 17.2% (FWHM) at 4647 keV and a spatial resolution of at least 50 µm. Even if the efficiency of energy spectrum reconstruction is low (4.4%) compared to the efficiency of a simple autoradiograph (50%), this novel measurement approach offers the opportunity to select areas on an autoradiograph to perform an energy spectrum analysis within that area. This opens up possibilities for the detailed analysis of heterogeneous geological samples containing natural alpha emitters such as uranium-238 and radium-226. This measurement will allow the study of the spatial distribution of uranium and its descendants in geo-materials by coupling scanning electron microscope characterizations. The direct application of this dual modality (energy-position) of analysis will be the subject of future developments. The measurement of the radioactive equilibrium state of heterogeneous geological structures, and the quantitative mapping of 226Ra radioactivity are now being actively studied.

Keywords: alpha spectroscopy, digital autoradiography, mining activities, natural decay products

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Authors: Jérôme de Reffye, Marc Antoni

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Following the development of the ERTMS system, we think it is interesting to develop another software-based track circuit system which would fit secondary railway lines with an easy-to-work implementation and a low sensitivity to rail-wheel impedance variations. We called this track circuit 'Track Railway by Automatic Circuits.' To be internationally implemented, this system must not have any mechanical component and must be compatible with existing track circuit systems. For example, the system is independent from the French 'Joints Isolants Collés' that isolate track sections from one another, and it is equally independent from component used in Germany called 'Counting Axles,' in French 'compteur d’essieux.' This track circuit is fully interoperable. Such universality is obtained by replacing the train detection mechanical system with a space-time filtering of train position. The various track sections are defined by the frequency of a continuous signal. The set of frequencies related to the track sections is a set of orthogonal functions in a Hilbert Space. Thus the failure probability of track sections separation is precisely calculated on the basis of signal-to-noise ratio. SNR is a function of the level of traction current conducted by rails. This is the reason why we developed a very powerful algorithm to reject noise and jamming to obtain an SNR compatible with the precision required for the track circuit and SIL 4 level. The SIL 4 level is thus reachable by an adjustment of the set of orthogonal functions. Our major contributions to railway engineering signalling science are i) Train space localization is precisely defined by a calibration system. The operation bypasses the GSM-R radio system of the ERTMS system. Moreover, the track circuit is naturally protected against radio-type jammers. After the calibration operation, the track circuit is autonomous. ii) A mathematical topology adapted to train space localization by following the train through a linear time filtering of the received signal. Track sections are numerically defined and can be modified with a software update. The system was numerically simulated, and results were beyond our expectations. We achieved a precision of one meter. Rail-ground and rail-wheel impedance sensitivity analysis gave excellent results. Results are now complete and ready to be published. This work was initialised as a research project of the French Railways developed by the Pi-Ramses Company under SNCF contract and required five years to obtain the results. This track circuit is already at Level 3 of the ERTMS system, and it will be much cheaper to implement and to work. The traffic regulation is based on variable length track sections. As the traffic growths, the maximum speed is reduced, and the track section lengths are decreasing. It is possible if the elementary track section is correctly defined for the minimum speed and if every track section is able to emit with variable frequencies.

Keywords: track section, track circuits, space-time crossing, adaptive track section, automatic railway signalling

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Authors: Sarra Boukhari

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Refugee studies have lately emerged as a focused area of research, yet there is a vast knowledge gap vis-à-vis the integration experiences and socialization processes of diversified refugees in different educational settings. This research intends to study the diverse experiences of African refugee children in an Algerian mainstream secondary school. The study seeks to explore the nature and complexity of refugees’ experiences and their relevance to the integration processes. Highlighting these diverse perspectives will be for the sake of understanding ways by which integration could be facilitated amongst refugees within mainstream school classrooms. Subsequently, this study shall investigate the possibility of story-telling activities in exploring and dealing with different issues of integration met by refugees in the predefined context. Accordingly, stories and narratives will be used to discuss values designed by the Living Values Educational Programme (LVEP) that could change the negative effect of war and conflict. These stories can potentially develop young refugees’ understanding of the key social concepts that can facilitate acceptance and integration inside refugee communities and the host society. This study invokes the theoretical framework provided by Jerome Bruner’s works on constructing the narrative through real-life experiences. In practice, the idea is to voice children’ sense-making of their own world and integrate it with good values to help them construct a positive narrative. Qualitative methods will be integrated to investigate the readiness and acceptance of African refugee children to each other in an Algerian classroom. Two phases of data collection will be conducted. The first phase will attempt to answer the first research question about the challenges that refugee children encounter in their education in a host society. In this phase, classroom observation and semi-structured interviews will be held to explore the context regarding the research question. After issues and challenges have been identified in this phase, topics of discussion (values) that reflect these issues will be designed for the second phase. The use of participatory methods with children in the second stage of the data collection will help in discussing the core values by giving them the optionality of the arts-based tools through which they can express themselves. Story-telling was the idea behind the activities. It could help children express their thoughts and feelings about the discussed values freely. The methods used promoted a very integrating atmosphere in the classroom where both refugee and non-refugee students showed cohesion and integration. Children identified many issues in their integration processes that exceeded the classroom or the education setting. Political and economic opinions were openly shared in the class. Overall, the study is an attempt to reveal how refugee children in Algeria are experiencing integration in their education. The study will be unveiling the impact of the context on the integration of refugee children. The process of integration involved in this context helped to shape refugee experiences in a very unique way.

Keywords: children’s agency, narrative construction, refugee children, refugee experiences, story-telling

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Authors: Till Fehlauer, Blanche Collin, Bernard Angeletti, Andrea Somogyi, Claire Lallemand, Perrine Chaurand, Cédric Dentant, Clement Levard, Jerome Rose

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Over the last decades, yttrium (Y) has gained importance in high-tech applications. It is an essential part of alloys and compounds used for lasers, displays, or cell phones, for example. Due to its chemical similarities with the lanthanides, Y is often considered a rare earth element (REE). Despite their increased usage, the environmental behavior of REEs remains poorly understood. Especially regarding their interactions with plants, many uncertainties exist. On the one hand, Y is known to have a negative effect on root development and germination, but on the other hand, it appears to promote plant growth at low concentrations. In order to understand these phenomena, a precise knowledge is necessary about how Y is absorbed by the plant and how it is handled once inside the organism. Contradictory studies exist, stating that due to a similar ionic radius, Y and the other REEs might be absorbed through Ca²⁺-channels, while others suspect that Y has a shared pathway with Al³⁺. In this study, laser ablation coupled ICP-MS, and synchrotron-based micro-X-ray fluorescence (µXRF, beamline Nanoscopium, SOLEIL, France) have been used in order to localize Y within the plant tissue and identify associated elements. The plant used in this study is Saxifraga paniculata, a rugged alpine plant that has shown an affinity for Y in previous studies (in prep.). Furthermore, Saxifraga paniculata performs guttation, which means that it possesses phloem sap secreting openings on the leaf surface that serve to regulate root pressure. These so-called hydathodes could provide special insights in elemental transport in plants. The plants have been grown on Y doped soil (500mg/kg DW) for four months. The results showed that Y was mainly concentrated in the roots of Saxifraga paniculata (260 ± 85mg/kg), and only a small amount was translocated to the leaves (10 ± 7.8mg/kg). µXRF analysis indicated that within the root transects, the majority of Y remained in the epidermis and hardly penetrated the stele. Laser ablation coupled ICP-MS confirmed this finding and showed a positive correlation in the roots between Y, Fe, Al, and to a lesser extent Ca. In the stem transect, Y was mainly detected in a hotspot of approximately 40µm in diameter situated in the endodermis area. Within the stem and especially in the hotspot, Y was highly colocalized with Al and Fe. Similar-sized Y hotspots have been detected in/on the leaves. All of them were strongly colocalized with Al and Fe, except for those situated within the hydathodes, which showed no colocalization with any of the measured elements. Accordingly, a relation between Y and Ca during root uptake remains possible, whereas a correlation to Fe and Al appears to be dominant in the aerial parts, suggesting common storage compartments, the formation of complexes, or a shared pathway during translocation.

Keywords: laser ablation inductively coupled plasma mass spectrometry (LA-ICP-MS), Phytoaccumulation, Rare earth elements, Saxifraga paniculata, Synchrotron-based micro-X-ray fluorescence, Yttrium

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Authors: Annalise Weckesser, Alex Wade, Clara Joergensen, Jerome Turner

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Introduction: Digital mobile technologies afford Generation M a number of opportunities in terms of communication, creativity and connectivity in their social interactions. Yet these young people’s use of such technologies is often the source of moral panic with accordant social anxiety especially prevalent in media representations of teen ‘sexting,’ or the sending of sexually explicit images via smartphones. Thus far, most responses to youth sexting have largely been ineffective or unjust with adult authorities sometimes blaming victims of non-consensual sexting, using child pornography laws to paradoxically criminalise those they are designed to protect, and/or advising teenagers to simply abstain from the practice. Prevention strategies are further skewed, with sex education initiatives often targeted at girls, implying that they shoulder the responsibility of minimising the risks associated with sexting (e.g. revenge porn and sexual predation). Purpose of Study: Despite increasing public interest and concern about ‘teen sexting,’ there remains a dearth of research with young people regarding their experiences of navigating sex and relationships in the current digital media landscape. Furthermore, young people's views on sexting are rarely solicited in the policy and educational strategies aimed at them. To address this research-policy-education gap, an interdisciplinary team of four researchers (from anthropology, media, sociology and education) have undertaken a peer-to-peer research project to co-create a sexual health intervention. Methods: In the winter of 2015-2016, the research team conducted serial group interviews with four cohorts of students (aged 13 to 15) from a secondary school in the West Midlands, UK. To facilitate open dialogue, girls and boys were interviewed separately, and each group consisted of no more than four pupils. The team employed a range of participatory techniques to elicit young people’s views on sexting, its consequences, and its interventions. A final focus group session was conducted with all 14 male and female participants to explore developing a peer-to-peer ‘safe sexting’ education intervention. Findings: This presentation will highlight the ongoing, ‘old school’ sexual double standards at work within this new digital frontier. In the sharing of ‘nudes’ (teens’ preferred term to ‘sexting’) via social media apps (e.g. Snapchat and WhatsApp), girls felt sharing images was inherently risky and feared being blamed and ‘slut-shamed.’ In contrast, boys were seen to gain in social status if they accumulated nudes of female peers. Further, if boys had nudes of themselves shared without consent, they felt they were expected to simply ‘tough it out.’ The presentation will also explore what forms of supports teens desire to help them in their day-to-day navigation of these digitally mediated, heteronormative performances of teen femininity and masculinity expected of them. Conclusion: This is the first research project, within UK, conducted with rather than about teens and the phenomenon of sexting. It marks a timely and important contribution to the nascent, but growing body of knowledge on gender, sexual politics and the digital mobility of sexual images created by and circulated amongst young people.

Keywords: teens, sexting, gender, sexual politics

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Authors: Danielle Slomberg, Jerome Labille, Riccardo Catalano, Jean-Claude Hubaud, Alexandra Lopes, Alice Tagliati, Teresa Fernandes

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In the assessment and management of cosmetics and personal care products, sunscreens are of emerging concern regarding both human and environmental health. Organic UV blockers in many sunscreens have been evidenced to undergo rapid photodegradation, induce dermal allergic reactions due to skin penetration, and to cause adverse effects on marine systems. While mineral UV-blockers may offer a safer alternative, their fate and impact and resulting regulation are still under consideration, largely related to the potential influence of nanotechnology-based products on both consumers and the environment. Nanometric titanium dioxide (TiO₂) UV-blockers have many advantages in terms of sun protection and asthetics (i.e., transparency). These UV-blockers typically consist of rutile nanoparticles coated with a primary mineral layer (silica or alumina) aimed at blocking the nanomaterial photoactivity and can include a secondary organic coating (e.g., stearic acid, methicone) aimed at favouring dispersion of the nanomaterial in the sunscreen formulation. The nanomaterials contained in the sunscreen can leave the skin either through a bathing of everyday usage, with subsequent release into rivers, lakes, seashores, and/or sewage treatment plants. The nanomaterial behaviour, fate and impact in these different systems is largely determined by its surface properties, (e.g. the nanomaterial coating type) and lifetime. The present work aims to develop the eco-design of sunscreens through the minimisation of risks associated with nanomaterials incorporated into the formulation. All stages of the sunscreen’s life cycle must be considered in this aspect, from its manufacture to its end-of-life, through its use by the consumer to its impact on the exposed environment. Reducing the potential release and/or toxicity of the nanomaterial from the sunscreen is a decisive criterion for its eco-design. TiO₂ UV-blockers of varied size and surface coating (e.g., stearic acid and silica) have been selected for this study. Hydrophobic TiO₂ UV-blockers (i.e., stearic acid-coated) were incorporated into a typical water-in-oil (w/o) formulation while hydrophilic, silica-coated TiO₂ UV-blockers were dispersed into an oil-in-water (o/w) formulation. The resulting sunscreens were characterised in terms of nanomaterial localisation, sun protection factor, and photo-passivation. The risk to the direct aquatic environment was assessed by evaluating the release of nanomaterials from the sunscreen through a simulated laboratory aging procedure. The size distribution, surface charge, and degradation state of the nano-composite by-products, as well as their nanomaterial concentration and colloidal behaviour were determined in a variety of aqueous environments (e.g., seawater and freshwater). Release of the hydrophobic nanocomposites into the aqueous environment was driven by oil droplet formation while hydrophilic nano-composites were readily dispersed. Ecotoxicity of the sunscreen by-products (from both w/o and o/w formulations) and their risk to marine organisms were assessed using coral symbiotes and tropical corals, evaluating both lethal and sublethal toxicities. The data dissemination and provided risk knowledge from the present work will help guide regulation related to nanomaterials in sunscreen, provide better information for consumers, and allow for easier decision-making for manufacturers.

Keywords: alteration, environmental fate, sunscreens, titanium dioxide nanoparticles

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Authors: Jerome Dalphinis, Vishal Patel

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The Bailiwick of Jersey is an island British crown dependency situated off the coast of France. Jersey General Hospital’s emergency department sees approximately 40,000 patients a year. It’s outside the NHS, with secondary care being free at the point of care. Sedation is a continuum which extends from a normal conscious level to being fully unresponsive. Procedural sedation produces a minimally depressed level of consciousness in which the patient retains the ability to maintain an airway, and they respond appropriately to physical stimulation. The goals of it are to improve patient comfort and tolerance of the procedure and alleviate associated anxiety. Indications can be stratified by acuity, emergency (cardioversion for life-threatening dysrhythmia), and urgency (joint reduction). In the emergency department, this is most often achieved using a combination of opioids and benzodiazepines. Some departments also use ketamine to produce dissociative sedation, a cataleptic state of profound analgesia and amnesia. The response to pharmacological agents is highly individual, and the drugs used occasionally have unpredictable pharmacokinetics and pharmacodynamics, which can always result in progression between levels of sedation irrespective of the intention. Therefore, practitioners must be able to ‘rescue’ patients from deeper sedation. These practitioners need to be senior clinicians with advanced airway skills (AAS) training. It can lead to adverse effects such as dangerous hypoxia and unintended loss of consciousness if incorrectly undertaken; studies by the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) have reported avoidable deaths. The Royal College of Emergency Medicine, UK (RCEM) released an updated ‘Safe Sedation of Adults in the Emergency Department’ guidance in 2017 detailing a series of standards for staff competencies, and the required environment and equipment, which are required for each target sedation depth. The emergency department in Jersey undertook audit research in 2018 to assess their current practice. It showed gaps in clinical competency, the need for uniform care, and improved documentation. This spurred the development of a checklist incorporating the above RCEM standards, including contraindication for procedural sedation and difficult airway assessment. This was approved following discussion with the relevant heads of departments and the patient safety directorates. Following this, a second audit research was carried out in 2019 with 17 completed checklists (11 relocation of joints, 6 cardioversions). Data was obtained from looking at the controlled resuscitation drugs book containing documented use of ketamine, alfentanil, and fentanyl. TrakCare, which is the patient electronic record system, was then referenced to obtain further information. The results showed dramatic improvement compared to 2018, and they have been subdivided into six categories; pre-procedure assessment recording of significant medical history and ASA grade (2 fold increase), informed consent (100% documentation), pre-oxygenation (88%), staff (90% were AAS practitioners) and monitoring (92% use of non-invasive blood pressure, pulse oximetry, capnography, and cardiac rhythm monitoring) during procedure, and discharge instructions including the documented return of normal vitals and consciousness (82%). This procedural sedation checklist is a safe intervention that identifies pertinent information about the patient and provides a standardised checklist for the delivery of gold standard of care.

Keywords: advanced airway skills, checklist, procedural sedation, resuscitation

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