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Sample records for emergent realist evaluation

  1. Improving the performance of community health workers in humanitarian emergencies: a realist evaluation protocol for the PIECES programme

    PubMed Central

    Gilmore, Brynne; Adams, Ben Jack; Bartoloni, Alex; Alhaydar, Bana; McAuliffe, Eilish; Raven, Joanna; Taegtmeyer, Miriam; Vallières, Frédérique

    2016-01-01

    Introduction Understanding what enhances the motivation and performance of community health workers (CHWs) in humanitarian emergencies represents a key research gap within the field of human resources for health. This paper presents the research protocol for the Performance ImprovEment of CHWs in Emergency Settings (PIECES) research programme. Enhancing Learning and Research in Humanitarian Action (ELRHA) funded the development of this protocol as part of their Health in Humanitarian Crises (R2HC) call (No.19839). PIECES aims to understand what factors improve the performance of CHWs in level III humanitarian emergencies. Methods and analysis The suggested protocol uses a realist evaluation with multiple cases across the 3 country sites: Turkey, Iraq and Lebanon. Working with International Medical Corps (IMC), an initial programme theory was elicited through literature and document reviews, semistructured interviews and focus groups with IMC programme managers and CHWs. Based on this initial theory, this protocol proposes a combination of semistructured interviews, life histories and critical incident narratives, surveys and latent variable modelling of key constructs to explain how contextual factors work to trigger mechanisms for specific outcomes relating to IMC's 300+ CHWs' performance. Participants will also include programme staff, CHWs and programme beneficiaries. Realist approaches will be used to better understand ‘what works, for whom and under what conditions’ for improving CHW performance within humanitarian contexts. Ethics and dissemination Trinity College Dublin's Health Policy and Management/Centre for Global Health Research Ethics Committee gave ethical approval for the protocol development phase. For the full research project, additional ethical approval will be sought from: Université St. Joseph (Lebanon), the Ethics Committee of the Ministry of Health in Baghdad (Iraq) and the Middle East Technical University (Turkey). Dissemination

  2. Realist evaluation: an immanent critique.

    PubMed

    Porter, Sam

    2015-10-01

    This paper critically analyses realist evaluation, focussing on its primary analytical concepts: mechanisms, contexts, and outcomes. Noting that nursing investigators have had difficulty in operationalizing the concepts of mechanism and context, it is argued that their confusion is at least partially the result of ambiguities, inconsistencies, and contradictions in the realist evaluation model. Problematic issues include the adoption of empiricist and idealist positions, oscillation between determinism and voluntarism, subsumption of agency under structure, and categorical confusion between context and mechanism. In relation to outcomes, it is argued that realist evaluation's adoption of the fact/value distinction prevents it from taking into account the concerns of those affected by interventions. The aim of the paper is to use these immanent critiques of realist evaluation to construct an internally consistent realist approach to evaluation that is more amenable to being operationalized by nursing researchers. PMID:26392234

  3. Faculty Development for Educators: A Realist Evaluation

    ERIC Educational Resources Information Center

    Sorinola, Olanrewaju O.; Thistlethwaite, Jill; Davies, David; Peile, Ed

    2015-01-01

    The effectiveness of faculty development (FD) activities for educators in UK medical schools remains underexplored. This study used a realist approach to evaluate FD and to test the hypothesis that motivation, engagement and perception are key mechanisms of effective FD activities. The authors observed and interviewed 33 course participants at one…

  4. Emergent properties from organisms to ecosystems: towards a realistic approach

    PubMed Central

    Ponge, Jean-François

    2005-01-01

    More realistic approaches are needed to understand the complexity of ecological systems. Emergent properties of real systems can be used as a basis for a new, neither reductionist nor holistic, approach. Three systems, termed here BUBBLEs, WAVEs and CRYSTALs, have been identified as exhibiting emergent properties. They are non-hierarchical assemblages of individual components, with amplification and connectedness being two main principles that govern their build-up, maintenance and mutual relationships. Examples from various fields of biological and ecological science are referred to, ranging from individual organisms to landscapes. PMID:16094806

  5. A realistic evaluation: the case of protocol-based care

    PubMed Central

    2010-01-01

    Background 'Protocol based care' was envisioned by policy makers as a mechanism for delivering on the service improvement agenda in England. Realistic evaluation is an increasingly popular approach, but few published examples exist, particularly in implementation research. To fill this gap, within this paper we describe the application of a realistic evaluation approach to the study of protocol-based care, whilst sharing findings of relevance about standardising care through the use of protocols, guidelines, and pathways. Methods Situated between positivism and relativism, realistic evaluation is concerned with the identification of underlying causal mechanisms, how they work, and under what conditions. Fundamentally it focuses attention on finding out what works, for whom, how, and in what circumstances. Results In this research, we were interested in understanding the relationships between the type and nature of particular approaches to protocol-based care (mechanisms), within different clinical settings (context), and what impacts this resulted in (outcomes). An evidence review using the principles of realist synthesis resulted in a number of propositions, i.e., context, mechanism, and outcome threads (CMOs). These propositions were then 'tested' through multiple case studies, using multiple methods including non-participant observation, interviews, and document analysis through an iterative analysis process. The initial propositions (conjectured CMOs) only partially corresponded to the findings that emerged during analysis. From the iterative analysis process of scrutinising mechanisms, context, and outcomes we were able to draw out some theoretically generalisable features about what works, for whom, how, and what circumstances in relation to the use of standardised care approaches (refined CMOs). Conclusions As one of the first studies to apply realistic evaluation in implementation research, it was a good fit, particularly given the growing emphasis on

  6. Remembering and Celebrating a Realistic Evaluation Visionary

    ERIC Educational Resources Information Center

    Patton, Michael Quinn

    2013-01-01

    In this article, Michael Quinn Patton pays tribute to Carol Hirschon Weiss, a woman who brought passion to evaluation use. She also brought attention to it, publishing the first article on evaluation in 1967. Weiss' many contributions have come into evaluation currency and overtaken formerly taken-for-granted assumptions. Indeed, her insights…

  7. The use and limitation of realistic evaluation as a tool for evidence-based practice: a critical realist perspective.

    PubMed

    Porter, Sam; O'Halloran, Peter

    2012-03-01

    The use and limitation of realistic evaluation as a tool for evidence-based practice: a critical realist perspective In this paper, we assess realistic evaluation's articulation with evidence-based practice (EBP) from the perspective of critical realism. We argue that the adoption by realistic evaluation of a realist causal ontology means that it is better placed to explain complex healthcare interventions than the traditional method used by EBP, the randomized controlled trial (RCT). However, we do not conclude from this that the use of RCTs is without merit, arguing that it is possible to use both methods in combination under the rubric of realist theory. More negatively, we contend that the rejection of critical theory and utopianism by realistic evaluation in favour of the pragmatism of piecemeal social engineering means that it is vulnerable to accusations that it promotes technocratic interpretations of human problems. We conclude that, insofar as realistic evaluation adheres to the ontology of critical realism, it provides a sound contribution to EBP, but insofar as it rejects the critical turn of Bhaskar's realism, it replicates the technocratic tendencies inherent in EBP. PMID:22212367

  8. A realist evaluation of the management of a well- performing regional hospital in Ghana

    PubMed Central

    2010-01-01

    Background Realist evaluation offers an interesting approach to evaluation of interventions in complex settings, but has been little applied in health care. We report on a realist case study of a well performing hospital in Ghana and show how such a realist evaluation design can help to overcome the limited external validity of a traditional case study. Methods We developed a realist evaluation framework for hypothesis formulation, data collection, data analysis and synthesis of the findings. Focusing on the role of human resource management in hospital performance, we formulated our hypothesis around the high commitment management concept. Mixed methods were used in data collection, including individual and group interviews, observations and document reviews. Results We found that the human resource management approach (the actual intervention) included induction of new staff, training and personal development, good communication and information sharing, and decentralised decision-making. We identified 3 additional practices: ensuring optimal physical working conditions, access to top managers and managers' involvement on the work floor. Teamwork, recognition and trust emerged as key elements of the organisational climate. Interviewees reported high levels of organisational commitment. The analysis unearthed perceived organisational support and reciprocity as underlying mechanisms that link the management practices with commitment. Methodologically, we found that realist evaluation can be fruitfully used to develop detailed case studies that analyse how management interventions work and in which conditions. Analysing the links between intervention, mechanism and outcome increases the explaining power, while identification of essential context elements improves the usefulness of the findings for decision-makers in other settings (external validity). We also identified a number of practical difficulties and priorities for further methodological development

  9. Considerations for realistic ECCS evaluation methodology for LWRs

    SciTech Connect

    Rohatgi, U.S.; Saha, P.; Chexal, V.K.

    1985-01-01

    This paper identifies the various phenomena which govern the course of large and small break LOCAs in LWRs, and affect the key parameters such as Peak Clad Temperature (PCT) and timing of the end of blowdown, beginning of reflood, PCT, and complete quench. A review of the best-estimate models and correlations for these phenomena in the current literature has been presented. Finally, a set of models have been recommended which may be incorporated in a present best-estimate code such as TRAC or RELAP5 in order to develop a realistic ECCS evaluation methodology for future LWRs and have also been compared with the requirements of current ECCS evaluation methodology as outlined in Appendix K of 10CFR50. 58 refs.

  10. Towards Modeling Realistic Mobility for Performance Evaluations in MANET

    NASA Astrophysics Data System (ADS)

    Aravind, Alex; Tahir, Hassan

    Simulation modeling plays crucial role in conducting research on complex dynamic systems like mobile ad hoc networks and often the only way. Simulation has been successfully applied in MANET for more than two decades. In several recent studies, it is observed that the credibility of the simulation results in the field has decreased while the use of simulation has steadily increased. Part of this credibility crisis has been attributed to the simulation of mobility of the nodes in the system. Mobility has such a fundamental influence on the behavior and performance of mobile ad hoc networks. Accurate modeling and knowledge of mobility of the nodes in the system is not only helpful but also essential for the understanding and interpretation of the performance of the system under study. Several ideas, mostly in isolation, have been proposed in the literature to infuse realism in the mobility of nodes. In this paper, we attempt a holistic analysis of creating realistic mobility models and then demonstrate creation and analysis of realistic mobility models using a software tool we have developed. Using our software tool, desired mobility of the nodes in the system can be specified, generated, analyzed, and then the trace can be exported to be used in the performance studies of proposed algorithms or systems.

  11. Evaluation of health promotion in schools: a realistic evaluation approach using mixed methods

    PubMed Central

    2010-01-01

    Background Schools are key settings for health promotion (HP) but the development of suitable approaches for evaluating HP in schools is still a major topic of discussion. This article presents a research protocol of a program developed to evaluate HP. After reviewing HP evaluation issues, the various possible approaches are analyzed and the importance of a realistic evaluation framework and a mixed methods (MM) design are demonstrated. Methods/Design The design is based on a systemic approach to evaluation, taking into account the mechanisms, context and outcomes, as defined in realistic evaluation, adjusted to our own French context using an MM approach. The characteristics of the design are illustrated through the evaluation of a nationwide HP program in French primary schools designed to enhance children's social, emotional and physical health by improving teachers' HP practices and promoting a healthy school environment. An embedded MM design is used in which a qualitative data set plays a supportive, secondary role in a study based primarily on a different quantitative data set. The way the qualitative and quantitative approaches are combined through the entire evaluation framework is detailed. Discussion This study is a contribution towards the development of suitable approaches for evaluating HP programs in schools. The systemic approach of the evaluation carried out in this research is appropriate since it takes account of the limitations of traditional evaluation approaches and considers suggestions made by the HP research community. PMID:20109202

  12. Realist complex intervention science: Applying realist principles across all phases of the Medical Research Council framework for developing and evaluating complex interventions

    PubMed Central

    Fletcher, Adam; Jamal, Farah; Moore, Graham; Evans, Rhiannon E.; Murphy, Simon; Bonell, Chris

    2016-01-01

    The integration of realist evaluation principles within randomised controlled trials (‘realist RCTs’) enables evaluations of complex interventions to answer questions about what works, for whom and under what circumstances. This allows evaluators to better develop and refine mid-level programme theories. However, this is only one phase in the process of developing and evaluating complex interventions. We describe and exemplify how social scientists can integrate realist principles across all phases of the Medical Research Council framework. Intervention development, modelling, and feasibility and pilot studies need to theorise the contextual conditions necessary for intervention mechanisms to be activated. Where interventions are scaled up and translated into routine practice, realist principles also have much to offer in facilitating knowledge about longer-term sustainability, benefits and harms. Integrating a realist approach across all phases of complex intervention science is vital for considering the feasibility and likely effects of interventions for different localities and population subgroups. PMID:27478401

  13. Evaluating Action Learning: A Critical Realist Complex Network Theory Approach

    ERIC Educational Resources Information Center

    Burgoyne, John G.

    2010-01-01

    This largely theoretical paper will argue the case for the usefulness of applying network and complex adaptive systems theory to an understanding of action learning and the challenge it is evaluating. This approach, it will be argued, is particularly helpful in the context of improving capability in dealing with wicked problems spread around…

  14. Basic requirements for realistic and unprejudiced evaluation of musical instruments

    NASA Astrophysics Data System (ADS)

    Wogram, Klaus

    2003-10-01

    In the past, the laboratory of musical acoustics of the PTB had to develop methods of subjective and objective evaluations of all kinds of musical instruments for a competition which was launched by the German ministry of economics. For this work the following questions had to be answered: (1) What makes a musical instrument play well from physical and subjective viewpoints? (2) How does the musician play the instrument, and what does he think when playing? (3) What is the influence of room acoustical parameters on sound quality? (4) How strong is the influence of prejudices concerning the brand, color, and type? (5) How can we measure the main acoustical parameters objectively? (6) What is the correlation between objective and subjective results? This presentation will give answers to these questions based on 10 years of experience with such evaluations by the author.

  15. A realist evaluation of the role of communities of practice in changing healthcare practice

    PubMed Central

    2011-01-01

    Background Healthcare organisations seeking to manage knowledge and improve organisational performance are increasingly investing in communities of practice (CoPs). Such investments are being made in the absence of empirical evidence demonstrating the impact of CoPs in improving the delivery of healthcare. A realist evaluation is proposed to address this knowledge gap. Underpinned by the principle that outcomes are determined by the context in which an intervention is implemented, a realist evaluation is well suited to understand the role of CoPs in improving healthcare practice. By applying a realist approach, this study will explore the following questions: What outcomes do CoPs achieve in healthcare? Do these outcomes translate into improved practice in healthcare? What are the contexts and mechanisms by which CoPs improve healthcare? Methods The realist evaluation will be conducted by developing, testing, and refining theories on how, why, and when CoPs improve healthcare practice. When collecting data, context will be defined as the setting in which the CoP operates; mechanisms will be the factors and resources that the community offers to influence a change in behaviour or action; and outcomes will be defined as a change in behaviour or work practice that occurs as a result of accessing resources provided by the CoP. Discussion Realist evaluation is being used increasingly to study social interventions where context plays an important role in determining outcomes. This study further enhances the value of realist evaluations by incorporating a social network analysis component to quantify the structural context associated with CoPs. By identifying key mechanisms and contexts that optimise the effectiveness of CoPs, this study will contribute to creating a framework that will guide future establishment and evaluation of CoPs in healthcare. PMID:21600057

  16. Protocol—the RAMESES II study: developing guidance and reporting standards for realist evaluation

    PubMed Central

    Greenhalgh, Trisha; Wong, Geoff; Jagosh, Justin; Greenhalgh, Joanne; Manzano, Ana; Westhorp, Gill; Pawson, Ray

    2015-01-01

    Introduction Realist evaluation is an increasingly popular methodology in health services research. For realist evaluations (RE) this project aims to: develop quality and reporting standards and training materials; build capacity for undertaking and critically evaluating them; produce resources and training materials for lay participants, and those seeking to involve them. Methods To achieve our aims, we will: (1) Establish management and governance infrastructure; (2) Recruit an interdisciplinary Delphi panel of 35 participants with diverse relevant experience of RE; (3) Summarise current literature and expert opinion on best practice in RE; (4) Run an online Delphi panel to generate and refine items for quality and reporting standards; (5) Capture ‘real world’ experiences and challenges of RE—for example, by providing ongoing support to realist evaluations, hosting the RAMESES JISCmail list on realist research, and feeding problems and insights from these into the deliberations of the Delphi panel; (6) Produce quality and reporting standards; (7) Collate examples of the learning and training needs of researchers, students, reviewers and lay members in relation to RE; (8) Develop, deliver and evaluate training materials for RE and deliver training workshops; and (9) Develop and evaluate information and resources for patients and other lay participants in RE (eg, draft template information sheets and model consent forms) and; (10) Disseminate training materials and other resources. Planned outputs: (1) Quality and reporting standards and training materials for RE. (2) Methodological support for RE. (3) Increase in capacity to support and evaluate RE. (4) Accessible, plain-English resources for patients and the public participating in RE. Discussion The realist evaluation is a relatively new approach to evaluation and its overall place in the is not yet fully established. As with all primary research approaches, guidance on quality assurance and uniform

  17. A New Realistic Evaluation Analysis Method: Linked Coding of Context, Mechanism, and Outcome Relationships

    ERIC Educational Resources Information Center

    Jackson, Suzanne F.; Kolla, Gillian

    2012-01-01

    In attempting to use a realistic evaluation approach to explore the role of Community Parents in early parenting programs in Toronto, a novel technique was developed to analyze the links between contexts (C), mechanisms (M) and outcomes (O) directly from experienced practitioner interviews. Rather than coding the interviews into themes in terms of…

  18. Realist Evaluation in Wraparound: A New Approach in Social Work Evidence-Based Practice

    ERIC Educational Resources Information Center

    Kazi, Mansoor A. F.; Pagkos, Brian; Milch, Heidi A.

    2011-01-01

    Objectives: The purpose of this study was to develop a realist evaluation paradigm in social work evidence-based practice. Method: Wraparound (at Gateway-Longview Inc., New York) used a reliable outcome measure and an electronic database to systematically collect and analyze data on the interventions, the client demographics and circumstances, and…

  19. Lessons learned in using realist evaluation to assess maternal and newborn health programming in rural Bangladesh.

    PubMed

    Adams, Alayne; Sedalia, Saroj; McNab, Shanon; Sarker, Malabika

    2016-03-01

    Realist evaluation furnishes valuable insight to public health practitioners and policy makers about how and why interventions work or don't work. Moving beyond binary measures of success or failure, it provides a systematic approach to understanding what goes on in the 'Black Box' and how implementation decisions in real life contexts can affect intervention effectiveness. This paper reflects on an experience in applying the tenets of realist evaluation to identify optimal implementation strategies for scale-up of Maternal and Newborn Health (MNH) programmes in rural Bangladesh. Supported by UNICEF, the three MNH programmes under consideration employed different implementation models to deliver similar services and meet similar MNH goals. Programme targets included adoption of recommended antenatal, post-natal and essential newborn care practices; health systems strengthening through improved referral, accountability and administrative systems, and increased community knowledge. Drawing on focused examples from this research, seven steps for operationalizing the realist evaluation approach are offered, while emphasizing the need to iterate and innovate in terms of methods and analysis strategies. The paper concludes by reflecting on lessons learned in applying realist evaluation, and the unique insights it yields regarding implementation strategies for successful MNH programming. PMID:26104820

  20. How Do You Modernize a Health Service? A Realist Evaluation of Whole-Scale Transformation in London

    PubMed Central

    Greenhalgh, Trisha; Humphrey, Charlotte; Hughes, Jane; Macfarlane, Fraser; Butler, Ceri; Pawson, Ray

    2009-01-01

    Context: Large-scale, whole-systems interventions in health care require imaginative approaches to evaluation that go beyond assessing progress against predefined goals and milestones. This project evaluated a major change effort in inner London, funded by a charitable donation of approximately $21 million, which spanned four large health care organizations, covered three services (stroke, kidney, and sexual health), and sought to “modernize” these services with a view to making health care more efficient, effective, and patient centered. Methods: This organizational case study draws on the principles of realist evaluation, a largely qualitative approach that is centrally concerned with testing and refining program theories by exploring the complex and dynamic interaction among context, mechanism, and outcome. This approach used multiple data sources and methods in a pragmatic and reflexive manner to build a picture of the case and follow its fortunes over the three-year study period. The methods included ethnographic observation, semistructured interviews, and scrutiny of documents and other contemporaneous materials. As well as providing ongoing formative feedback to the change teams in specific areas of activity, we undertook a more abstract, interpretive analysis, which explored the context-mechanism-outcome relationship using the guiding question “what works, for whom, under what circumstances?” Findings: In this example of large-scale service transformation, numerous projects and subprojects emerged, fed into one another, and evolved over time. Six broad mechanisms appeared to be driving the efforts of change agents: integrating services across providers, finding and using evidence, involving service users in the modernization effort, supporting self-care, developing the workforce, and extending the range of services. Within each of these mechanisms, different teams chose widely differing approaches and met with differing success. The realist analysis

  1. Realistic numerical simulations of solar convection: emerging flux, pores, and Stokes spectra

    NASA Astrophysics Data System (ADS)

    Georgobiani, D.; Stein, R.; Nordlund, A.

    2012-12-01

    We report on magneto-convection simulations of magnetic flux emerging through the upper layers of the solar convection zone into the photosphere. Simulations by Georgobiani, Stein and Nordlund start from minimally structured, uniform, untwisted horizontal field advected into the computational domain by supergranule scale inflows at 20 Mm depth. At the opposite extreme, simulations by Cheung (2007, 2008, 2011) start with a coherent flux tube inserted into or forced into the bottom of the computational domain. Several robust results have emerged from the comparison of results from these two very different initial states. First, rising magnetic flux gets deformed into undulating, serpentine shapes by the influence of the convective up- and down-flows. The flux develops fine structure and appears at the surface first as a "pepper and salt" pattern of mixed polarity. Where magnetic flux approaches the surface, granules become darker and elongated in the direction of the field. Subsequently, the underlying large scale magnetic structures make the field collect into unipolar regions. Magneto-convection produces a complex, small-scale magnetic field topology, whatever the initial state. A heirarchy of magnetic loops corresponding to the different scales of convective motions are produced. Vertical vortex tubes form at intergranule lane vertices which can lead to tornado-like magnetic fields in the photosphere. Gradients in field strength and velocity produce asymmetric Stokes spectra. Where emerging Omega loops leave behind nearly vertical legs, long lived pores can spontaneously form. The field in the pores first becomes concentrated and evacuated near the surface and the evacuated flux concentration then extends downward.

  2. How does capacity building of health managers work? A realist evaluation study protocol

    PubMed Central

    Marchal, Bruno; Hoeree, Tom; Devadasan, Narayanan; Macq, Jean; Kegels, Guy; Criel, Bart

    2012-01-01

    Introduction There has been a lot of attention on the role of human resource management interventions to improve delivery of health services in low- and middle-income countries. However, studies on this subject are few due to limited research on implementation of programmes and methodological difficulties in conducting experimental studies on human resource interventions. The authors present the protocol of an evaluation of a district-level capacity-building intervention to identify the determinants of performance of health workers in managerial positions and to understand how changes (if any) are brought about. Methods and analysis The aim of this study is to understand how capacity building works. The authors will use realist evaluation to evaluate an intervention in Karnataka, India. The intervention is a capacity-building programme that seeks to improve management capacities of health managers at district and subdistrict levels through periodic classroom-based teaching and mentoring support at the workplace. The authors conducted interviews and reviewed literature on capacity building in health to draw out the programme theory of the intervention. Based on this, the authors formulated hypothetical pathways connecting the expected outcomes of the intervention (planning and supervision) to the inputs (contact classes and mentoring). The authors prepared a questionnaire to assess elements of the programme theory—organisational culture, self-efficacy and supervision. The authors shall conduct a survey among health managers as well as collect qualitative data through interviews with participants and non-participants selected purposively based on their planning and supervision performance. The authors will construct explanations in the form of context–mechanism–outcome configurations from the results. This will be iterative and the authors will use a realist evaluation framework to refine the explanatory theories that are based on the findings to explain and

  3. Conditions for production of interdisciplinary teamwork outcomes in oncology teams: protocol for a realist evaluation

    PubMed Central

    2014-01-01

    Background Interdisciplinary teamwork (ITW) is designed to promote the active participation of several disciplines in delivering comprehensive cancer care to patients. ITW provides mechanisms to support continuous communication among care providers, optimize professionals’ participation in clinical decision-making within and across disciplines, and foster care coordination along the cancer trajectory. However, ITW mechanisms are not activated optimally by all teams, resulting in a gap between desired outcomes of ITW and actual outcomes observed. The aim of the present study is to identify the conditions underlying outcome production by ITW in local oncology teams. Methods This retrospective multiple case study will draw upon realist evaluation principles to explore associations among context, mechanisms and outcomes (CMO). The cases are nine interdisciplinary cancer teams that participated in a previous study evaluating ITW outcomes. Qualitative data sources will be used to construct a picture of CMO associations in each case. For data collection, reflexive focus groups will be held to capture patients’ and professionals’ perspectives on ITW, using the guiding question, ‘What works, for whom, and under what circumstances?’ Intra-case analysis will be used to trace associations between context, ITW mechanisms, and patient outcomes. Inter-case analysis will be used to compare the different cases’ CMO associations for a better understanding of the phenomenon under study. Discussion This multiple case study will use realist evaluation principles to draw lessons about how certain contexts are more or less likely to produce particular outcomes. The results will make it possible to target more specifically the actions required to optimize structures and to activate the best mechanisms to meet the needs of cancer patients. This project could also contribute significantly to the development of improved research methods for conducting realist evaluations of

  4. Emergency Exercise Participation and Evaluation

    ERIC Educational Resources Information Center

    Smith, Julie; Black, Lynette; Williams, Linda

    2012-01-01

    Extension is uniquely positioned to participate in emergency exercises, formally or informally, with the goal of engaging community members in emergency and disaster preparedness. With their knowledge of community needs, Extension personnel are valuable resources and can assist emergency managers in the process of identifying local risks and…

  5. The management challenge for household waste in emerging economies like Brazil: realistic source separation and activation of reverse logistics.

    PubMed

    Fehr, M

    2014-09-01

    Business opportunities in the household waste sector in emerging economies still evolve around the activities of bulk collection and tipping with an open material balance. This research, conducted in Brazil, pursued the objective of shifting opportunities from tipping to reverse logistics in order to close the balance. To do this, it illustrated how specific knowledge of sorted waste composition and reverse logistics operations can be used to determine realistic temporal and quantitative landfill diversion targets in an emerging economy context. Experimentation constructed and confirmed the recycling trilogy that consists of source separation, collection infrastructure and reverse logistics. The study on source separation demonstrated the vital difference between raw and sorted waste compositions. Raw waste contained 70% biodegradable and 30% inert matter. Source separation produced 47% biodegradable, 20% inert and 33% mixed material. The study on collection infrastructure developed the necessary receiving facilities. The study on reverse logistics identified private operators capable of collecting and processing all separated inert items. Recycling activities for biodegradable material were scarce and erratic. Only farmers would take the material as animal feed. No composting initiatives existed. The management challenge was identified as stimulating these activities in order to complete the trilogy and divert the 47% source-separated biodegradable discards from the landfills. PMID:24990590

  6. Online Assessment, Measurement and Evaluation: Emerging Practices

    ERIC Educational Resources Information Center

    Williams, David, Ed.; Hricko, Mary, Ed.; Howell, Scott, Ed.

    2006-01-01

    "Online Assessment, Measurement and Evaluation: Emerging Practices" provides a view of the possibilities and challenges facing online educators and evaluators in the 21st Century. As technology evolves and online measurement and assessment follow, "Online Assessment, Measurement and Evaluation: Emerging Practices" uses established evaluation…

  7. The power of the context map: Designing realistic outcome evaluation strategies and other unanticipated benefits.

    PubMed

    Renger, Ralph; Foltysova, Jirina; Becker, Karin L; Souvannasacd, Eric

    2015-10-01

    Developing a feasible evaluation plan is challenging when multiple activities, often sponsored by multiple agencies, work together toward a common goal. Often, resources are limited and not every agency's interest can be represented in the final evaluation plan. The article illustrates how the Antecedent Target Measurement (ATM) approach to logic modeling was adapted to meet this challenge. The key adaptation is the context map generated in the first step of the ATM approach. The context map makes visually explicit many of the underlying conditions contributing to a problem as possible. The article also shares how a prioritization matrix can assist the evaluator in filtering through the context map to prioritize the outcomes to be included in the final evaluation plan as well as creating realistic outcomes. This transparent prioritization process can be especially helpful in managing evaluation expectations of multiple agencies with competing interests. Additional strategic planning benefits of the context map include pinpointing redundancies caused by overlapping collaborative efforts, identifying gaps in coverage, and assisting the coordination of multiple stakeholders. PMID:26036610

  8. Mechanisms for achieving adolescent-friendly services in Ecuador: a realist evaluation approach

    PubMed Central

    Goicolea, Isabel; Coe, Anna-Britt; Hurtig, Anna-Karin; San Sebastian, Miguel

    2012-01-01

    Background Despite evidence showing that adolescent-friendly health services (AFSs) increase young people's access to these services, health systems across the world are failing to integrate this approach. In Latin America, policies aimed at strengthening AFS abound. However, such services are offered only in a limited number of sites, and providers’ attitudes and respect for confidentiality have not been addressed to a sufficient extent. Methods The aim of this study was to explore the mechanisms that triggered the transformation of an ‘ordinary’ health care facility into an AFS in Ecuador. For this purpose, a realist evaluation approach was used in order to analyse three well-functioning AFSs. Information was gathered at the national level and from each of the settings including: (i) statistical information and unpublished reports; (ii) in-depth interviews and focus group discussions with policy makers, health care providers, users and adolescents participating in youth organisations and (iii) observations at the health care facilities. Thematic analysis was carried out, driven by the realist evaluation approach, namely exploring the connections between mechanisms, contexts and outcomes. Results The results highlighted that the development of the AFSs was mediated by four mechanisms: grounded self-confidence in trying new things, legitimacy, a transformative process and an integral approach to adolescents. Along this process, contextual factors at the national and institutional levels were further explored. Conclusion The Ministry of Health of Ecuador, based on the New Guidelines for Comprehensive Care of Adolescent Health, has started the scaling up of AFSs. Our research points towards the need to recognise and incorporate these mechanisms as part of the implementation strategy from the very beginning of the process. Although contextually limited to Ecuador, many mechanisms and good practices in these AFS may be relevant to the Latin American setting and

  9. The Toxicological Evaluation of Realistic Emissions of Source Aerosols Study: Statistical Methods

    PubMed Central

    Coull, Brent A.; Wellenius, Gregory A.; Gonzalez-Flecha, Beatriz; Diaz, Edgar; Koutrakis, Petros; Godleski, John J.

    2013-01-01

    The Toxicological Evaluation of Realistic Emissions of Source Aerosols (TERESA) study involved withdrawal, aging, and atmospheric transformation of emissions of three coal-fired power plants. Toxicological evaluations were carried out in rats exposed to different emission scenarios with extensive exposure characterization. Data generated had multiple levels of resolution: exposure, scenario and constituent chemical composition. Here, we outline a multilayered approach to analyze the associations between exposure and health effects beginning with standard ANOVA models that treat exposure as a categorical variable. The model assessed differences in exposure effects across scenarios (by plant). To assess unadjusted associations between pollutant concentrations and health, univariate analyses were conducted using the difference between the response means under exposed and control conditions and a single constituent concentration as the predictor. Then, a novel multivariate analysis of exposure composition and health was used based on random forests, a recent extension of classification and regression trees that were applied to the outcome differences. For each exposure constituent, this approach yielded a nonparametric measure of the importance of that constituent in predicting differences in response on a given day, controlling for the other measured constituent concentrations in the model. Finally, an R2 analysis compared the relative importance of exposure scenario, plant, and constituent concentrations on each outcome. Peak expiratory flow is used to demonstrate how the multiple levels of the analysis complement each other to assess constituents most strongly associated with health effects. PMID:21913820

  10. How do primary health care teams learn to integrate intimate partner violence (IPV) management? A realist evaluation protocol

    PubMed Central

    2013-01-01

    Background Despite the existence of ample literature dealing, on the one hand, with the integration of innovations within health systems and team learning, and, on the other hand, with different aspects of the detection and management of intimate partner violence (IPV) within healthcare facilities, research that explores how health innovations that go beyond biomedical issues—such as IPV management—get integrated into health systems, and that focuses on healthcare teams’ learning processes is, to the best of our knowledge, very scarce if not absent. This realist evaluation protocol aims to ascertain: why, how, and under what circumstances primary healthcare teams engage (if at all) in a learning process to integrate IPV management in their practices; and why, how, and under what circumstances team learning processes lead to the development of organizational culture and values regarding IPV management, and the delivery of IPV management services. Methods This study will be conducted in Spain using a multiple-case study design. Data will be collected from selected cases (primary healthcare teams) through different methods: individual and group interviews, routinely collected statistical data, documentary review, and observation. Cases will be purposively selected in order to enable testing the initial middle-range theory (MRT). After in-depth exploration of a limited number of cases, additional cases will be chosen for their ability to contribute to refining the emerging MRT to explain how primary healthcare learn to integrate intimate partner violence management. Discussion Evaluations of health sector responses to IPV are scarce, and even fewer focus on why, how, and when the healthcare services integrate IPV management. There is a consensus that healthcare professionals and healthcare teams play a key role in this integration, and that training is important in order to realize changes. However, little is known about team learning of IPV management, both in

  11. Toxicological Evaluation of Realistic Emission Source Aerosols (TERESA): Introduction and overview

    PubMed Central

    Godleski, John J.; Rohr, Annette C.; Kang, Choong M.; Diaz, Edgar A.; Ruiz, Pablo A.; Koutrakis, Petros

    2013-01-01

    Determining the health impacts of sources and components of fine particulate matter (PM2.5) is an important scientific goal. PM2.5 is a complex mixture of inorganic and organic constituents that are likely to differ in their potential to cause adverse health outcomes. The Toxicological Evaluation of Realistic Emissions of Source Aerosols (TERESA) study focused on two PM sources—coal-fired power plants and mobile sources—and sought to investigate the toxicological effects of exposure to emissions from these sources. The set of papers published here document the power plant experiments. TERESA attempted to delineate health effects of primary particles, secondary (aged) particles, and mixtures of these with common atmospheric constituents. TERESA involved withdrawal of emissions from the stacks of three coal-fired power plants in the United States. The emissions were aged and atmospherically transformed in a mobile laboratory simulating downwind power plant plume processing. Toxicological evaluations were carried out in laboratory rats exposed to different emission scenarios with extensive exposure characterization. The approach employed in TERESA was ambitious and innovative. Technical challenges included the development of stack sampling technology that prevented condensation of water vapor from the power plant exhaust during sampling and transfer, while minimizing losses of primary particles; development and optimization of a photochemical chamber to provide an aged aerosol for animal exposures; development and evaluation of a denuder system to remove excess gaseous components; and development of a mobile toxicology laboratory. This paper provides an overview of the conceptual framework, design, and methods employed in the study. PMID:21639692

  12. Evaluation of EEG localization methods using realistic simulations of interictal spikes.

    PubMed

    Grova, C; Daunizeau, J; Lina, J-M; Bénar, C G; Benali, H; Gotman, J

    2006-02-01

    Performing an accurate localization of sources of interictal spikes from EEG scalp measurements is of particular interest during the presurgical investigation of epilepsy. The purpose of this paper is to study the ability of six distributed source localization methods to recover extended sources of activated cortex. Due to the frequent lack of a gold standard to evaluate source localization methods, our evaluation was performed in a controlled environment using realistic simulations of EEG interictal spikes, involving several anatomical locations with several spatial extents. Simulated data were corrupted by physiological EEG noise. Simulations involving pairs of sources with the same amplitude were also studied. In addition to standard validation criteria (e.g., geodesic distance or mean square error), we proposed an original criterion dedicated to assess detection accuracy, based on receiver operating characteristic (ROC) analysis. Six source localization methods were evaluated: the minimum norm, the minimum norm weighted by multivariate source prelocalization (MSP), cortical LORETA with or without additional minimum norm regularization, and two derivations of the maximum entropy on the mean (MEM) approach. Results showed that LORETA-based and MEM-based methods were able to accurately recover sources of different spatial extents, with the exception of sources in temporo-mesial and fronto-mesial regions. Several spurious sources were generated by those methods, however, whereas methods using the MSP always located very accurately the maximum of activity but not its spatial extent. These findings suggest that one should always take into account the results from different localization methods when analyzing real interictal spikes. PMID:16271483

  13. Action learning sets in a nursing and midwifery practice learning context: a realistic evaluation.

    PubMed

    Machin, Alison I; Pearson, Pauline

    2014-08-01

    Action learning sets (ALS) are used widely for organisational and workforce development, including in nursing (Anderson and Thorpe, 2004; Pounder, 2009; Young et al., 2010). In the United Kingdom, a multi-faceted educational Pilot programme for new nurses and midwives was implemented to accelerate their clinical practice and leadership development (NHS Education Scotland, 2010). Action Learning Sets were provided for peer support and personal development. The Realistic Evaluation study reported in this paper explored issues of context, mechanism and outcome (Pawson and Tilley, 1997) influencing the action learning experiences of: programme participants (recently qualified nurses and midwives, from different practice settings); and programme supporters. A range of data were collected via: online questionnaires from 66 participants and 29 supporters; three focus groups, each comprising between eight and 10 programme participants; and one focus group with three action learning facilitators. The qualitative data pertaining to the ALS are presented in this paper. Thematic data analysis of context, mechanism and outcome configurations, generated five themes: creating and sustaining a collective learning environment; challenging constructively; collective support; the role of feedback; and effectiveness of ALS. Study outcomes suggest nursing and midwifery action learning should (a) be facilitated positively to improve participants' experience; (b) be renamed to avoid learning methodology confusion; and (c) be outcome focused to evidence impact on practice. PMID:24480095

  14. Exposing the impact of Citizens Advice Bureau services on health: a realist evaluation protocol

    PubMed Central

    Forster, N; Dalkin, S M; Lhussier, M; Hodgson, P; Carr, S M

    2016-01-01

    Introduction Welfare advice services can be used to address health inequalities, for example, through Citizens Advice Bureau (CAB). Recent reviews highlight evidence for the impact of advice services in improving people's financial position and improving mental health and well-being, daily living and social relationships. There is also some evidence for the impact of advice services in increasing accessibility of health services, and reducing general practitioner appointments and prescriptions. However, direct evidence for the impact of advice services on lifestyle behaviour and physical health is currently much less well established. There is a need for greater empirical testing of theories around the specific mechanisms through which advice services and associated financial or non-financial benefits may generate health improvements. Methods and analysis A realist evaluation will be conducted, operationalised in 5 phases: building the explanatory framework; refining the explanatory framework; testing the explanatory framework through empirical data (mixed methods); development of a bespoke data recording template to capture longer term impact; and verification of findings with a range of CAB services. This research will therefore aim to build, refine and test an explanatory framework about how CAB services can be optimally implemented to achieve health improvement. Ethics and dissemination The study was approved by the ethics committee at Northumbria University, UK. Project-related ethical issues are described and quality control aspects of the study are considered. A stakeholder mapping exercise will inform the dissemination of results in order to ensure all relevant institutions and organisations are targeted. PMID:26792219

  15. Evaluation of automated emergency response systems

    SciTech Connect

    Addis, R.P.

    1988-12-31

    Automated Emergency Response (ER) systems are playing a greater role in providing prompt and reliable predictions of the impact of inadvertent releases of hazardous materials to the environment. Observed and forecast environmental and accident source term data are input into environmental transport and dispersion models to provide dosimetry estimates used as decision making aids for responding to emergencies. Several automated ER systems have been developed for US Federal Government facilities and many are available commercially. For such systems to be useful, they must reliably and consistently deliver a timely product to the decision makers. Evaluation of the entire ER system is essential to determine the performance that can be expected from the system during an emergency. Unfortunately, seldom are ER systems evaluated as a whole. Usually Quality Assurance programs evaluate the performance of individual components of the system. Most atmospheric pollution model evaluation methods usually involve an evaluation of the predictive performance of the transport and dispersion model when compared either with experimental tracer results or results from other models. Rarely, however, is the ability of the ER system to provide timely, reliable and consistent information evaluated. Such an evaluation is vital to determine the system performance during an emergency and to provide valuable information to aid in improving the system.

  16. Toxicological Evaluation of Realistic Emission Source Aerosols (TERESA)-power plant studies: assessment of cellular responses

    PubMed Central

    Godleski, John J.; Diaz, Edgar A.; Lemos, Miriam; Long, Mark; Ruiz, Pablo; Gupta, Tarun; Kang, Choong-Min; Coull, Brent

    2013-01-01

    The Toxicological Evaluation of Realistic Emission Source Aerosols (TERESA) project assessed primary and secondary particulate by simulating the chemical reactions that a plume from a source might undergo during atmospheric transport and added other atmospheric constituents that might interact with it. Three coal-fired power plants with different coal and different emission controls were used. Male Sprague-Dawley rats were exposed for 6 h to either filtered air or aged aerosol from the power plant. Four exposure scenarios were studied: primary particles (P); primary + secondary (oxidized) particles (PO); primary + secondary (oxidized) particles + SOA (POS); and primary + secondary (oxidized) particles neutralized + SOA (PONS). Exposure concentrations varied by scenario to a maximum concentration of 257.1 ± 10.0 µg/m3. Twenty-four hours after exposure, pulmonary cellular responses were assessed by bronchoalveolar lavage (BAL), complete blood count (CBC), and histopathology. Exposure to the PONS and POS scenarios produced significant increases in BAL total cells and macrophage numbers at two plants. The PONS and P scenarios were associated with significant increases in BAL neutrophils and the presence of occasional neutrophils and increased macrophages in the airways and alveoli of exposed animals. Univariate analyses and random forest analyses showed that increases in total cell count and macrophage cell count were significantly associated with neutralized sulfate and several correlated measurements. Increases in neutrophils in BAL were associated with zinc. There were no significant differences in CBC parameters or blood vessel wall thickness by histopathology. The association between neutrophils increases and zinc raises the possibility that metals play a role in this response. PMID:21466245

  17. The organisation of interagency training to safeguard children in England: a case study using realistic evaluation

    PubMed Central

    Patsios, Demi; Carpenter, John

    2010-01-01

    Background Joint training for interagency working is carried out by Local Safeguarding Children Boards in England to promote effective local working to safeguard and promote the welfare of children. Purpose This paper reports on the findings of the outputs and outcomes of interagency training to safeguard children in eight Local Safeguarding Children Boards. Methods A review of Local Safeguarding Children Board documentation, observations of Local Safeguarding Children Board training sub-group meetings and a series of interviews with training key stakeholders in each Local Safeguarding Children Board were used to assess how partner agencies in the Local Safeguarding Children Boards carried out their statutory responsibilities to organise interagency training. ‘Realistic Evaluation’ was used to evaluate the mechanisms by which a central government mandate produced particular inter-agency training outputs (number of courses, training days) and joint working outcomes (effective partnerships), within particular Local Safeguarding Children Board contexts. Results The ‘mandated partnership’ imposed on Local Safeguarding Children Boards by central government left little choice but for partner agencies to work together to deliver joint training, which in turn affected the dynamics of working partnerships across the various sites. The effectiveness of the training sub group determined the success of the organisation and delivery of training for joint working. Despite having a central mandate, Local Safeguarding Children Boards had heterogeneous funding and training arrangements. These resulted in significant variations in the outputs in terms of the number of courses per ‘children in need’ in the locality and in the cost per course. Conclusions Interagency training which takes account of the context of the Local Safeguarding Children Board is more likely to produce better trained staff, effective partnership working, and lead to better integrated safeguarding

  18. Imaging hemorrhagic stroke with magnetic induction tomography: realistic simulation and evaluation.

    PubMed

    Chen, Yinan; Yan, Ming; Chen, Dayu; Hamsch, Matthias; Liu, Hui; Jin, Hua; Vauhkonen, Marko; Igney, Claudia H; Kahlert, Joachim; Wang, Yuanyuan

    2010-06-01

    Magnetic induction tomography (MIT) is a noncontact method for detecting the internal conductivity distribution of an object. This technology has the potential to be used in the biomedical area to check bio-impedance change inside the human body, for example to detect hemorrhage in the human brain. In this study the hemorrhagic stroke detectability with a 16-channel MIT system operating at 10 MHz was evaluated. Since the conductivity distribution is changed by the hemorrhagic stroke as well as the squeezed brain tissue around the stroke, deformation of the brain tissue is also considered and simulated with the help of a FEM-based linear bio-mechanical model in this paper. To simulate the raw measurement data as realistically as possible, the noise estimated from the experimental MIT system with hypothesis testing methods at 95% confidence level is added to the simulated measurements. Stroke images of 600 noisy samples for each detection assignment are reconstructed by the one-step Tikhonov-regularized inverse eddy current solution. Under the statistical framework, the detection failure is in control of a high false negative rate which represents a large artifact visualized in the reconstruction domain. The qualitative detectability of 18 detecting assignments, with three hemorrhagic positions (shallow, medial and center of the cerebrum) and two volume values (10 ml and 20 ml), overlaid by noise with three levels (standard deviation of phase change at 5 x 10(-3) degrees , 2.5 x 10(-3) degrees , 10 x 10(-3) degrees ), are investigated. These detecting assignments are compared with each other to find out which volumes of deformed spherical hemorrhagic stroke can be detected by the modeled MIT system. PMID:20453292

  19. Implementing accountability for reasonableness framework at district level in Tanzania: a realist evaluation

    PubMed Central

    2011-01-01

    Background Despite the growing importance of the Accountability for Reasonableness (A4R) framework in priority setting worldwide, there is still an inadequate understanding of the processes and mechanisms underlying its influence on legitimacy and fairness, as conceived and reflected in service management processes and outcomes. As a result, the ability to draw scientifically sound lessons for the application of the framework to services and interventions is limited. This paper evaluates the experiences of implementing the A4R approach in Mbarali District, Tanzania, in order to find out how the innovation was shaped, enabled, and constrained by the interaction between contexts, mechanisms and outcomes. Methods This study draws on the principles of realist evaluation -- a largely qualitative approach, chiefly concerned with testing and refining programme theories by exploring the complex interactions of contexts, mechanisms, and outcomes. Mixed methods were used in data collection, including individual interviews, non-participant observation, and document reviews. A thematic framework approach was adopted for the data analysis. Results The study found that while the A4R approach to priority setting was helpful in strengthening transparency, accountability, stakeholder engagement, and fairness, the efforts at integrating it into the current district health system were challenging. Participatory structures under the decentralisation framework, central government's call for partnership in district-level planning and priority setting, perceived needs of stakeholders, as well as active engagement between researchers and decision makers all facilitated the adoption and implementation of the innovation. In contrast, however, limited local autonomy, low level of public awareness, unreliable and untimely funding, inadequate accountability mechanisms, and limited local resources were the major contextual factors that hampered the full implementation. Conclusion This study

  20. The Emergency School Assistance Program: An Evaluation.

    ERIC Educational Resources Information Center

    American Friends Service Committee, Washington, DC.

    This report, prepared by a group of private organizations concerned with the problems of race, education, and poverty, is an evaluation of the first months of the administration of the Emergency School Assistance Program (ESAP). The report is based upon personal visits to nearly 300 school districts receiving ESAP grants by attorneys and other…

  1. Simulation Evaluation of Controller-Managed Spacing Tools under Realistic Operational Conditions

    NASA Technical Reports Server (NTRS)

    Callantine, Todd J.; Hunt, Sarah M.; Prevot, Thomas

    2014-01-01

    Controller-Managed Spacing (CMS) tools have been developed to aid air traffic controllers in managing high volumes of arriving aircraft according to a schedule while enabling them to fly efficient descent profiles. The CMS tools are undergoing refinement in preparation for field demonstration as part of NASA's Air Traffic Management (ATM) Technology Demonstration-1 (ATD-1). System-level ATD-1 simulations have been conducted to quantify expected efficiency and capacity gains under realistic operational conditions. This paper presents simulation results with a focus on CMS-tool human factors. The results suggest experienced controllers new to the tools find them acceptable and can use them effectively in ATD-1 operations.

  2. Cardiac autonomic functions and the emergence of violence in a highly realistic model of social conflict in humans

    PubMed Central

    Haller, Jozsef; Raczkevy-Deak, Gabriella; Gyimesine, Katalin P.; Szakmary, Andras; Farkas, Istvan; Vegh, Jozsef

    2014-01-01

    Among the multitude of factors that can transform human social interactions into violent conflicts, biological features received much attention in recent years as correlates of decision making and aggressiveness especially in critical situations. We present here a highly realistic new model of human aggression and violence, where genuine acts of aggression are readily performed and which at the same time allows the parallel recording of biological concomitants. Particularly, we studied police officers trained at the International Training Centre (Budapest, Hungary), who are prepared to perform operations under extreme conditions of stress. We found that aggressive arousal can transform a basically peaceful social encounter into a violent conflict. Autonomic recordings show that this change is accompanied by increased heart rates, which was associated earlier with reduced cognitive complexity of perceptions (“attentional myopia”) and promotes a bias toward hostile attributions and aggression. We also observed reduced heart rate variability in violent subjects, which is believed to signal a poor functioning of prefrontal-subcortical inhibitory circuits and reduces self-control. Importantly, these autonomic particularities were observed already at the beginning of social encounters i.e., before aggressive acts were initiated, suggesting that individual characteristics of the stress-response define the way in which social pressure affects social behavior, particularly the way in which this develops into violence. Taken together, these findings suggest that cardiac autonomic functions are valuable external symptoms of internal motivational states and decision making processes, and raise the possibility that behavior under social pressure can be predicted by the individual characteristics of stress responsiveness. PMID:25374519

  3. Evaluating real-time image reconstruction in diffuse optical tomography using physiologically realistic test data

    PubMed Central

    Brigadoi, Sabrina; Powell, Samuel; Cooper, Robert J.; Dempsey, Laura A.; Arridge, Simon; Everdell, Nick; Hebden, Jeremy; Gibson, Adam P.

    2015-01-01

    In diffuse optical tomography (DOT), real-time image reconstruction of oxy- and deoxy-haemoglobin changes occurring in the brain could give valuable information in clinical care settings. Although non-linear reconstruction techniques could provide more accurate results, their computational burden makes them unsuitable for real-time applications. Linear techniques can be employed under the assumption that the expected change in absorption is small. Several approaches exist, differing primarily in their handling of regularization and the noise statistics. In real experiments, it is impossible to compute the true noise statistics, because of the presence of physiological oscillations in the measured data. This is even more critical in real-time applications, where no off-line filtering and averaging can be performed to reduce the noise level. Therefore, many studies substitute the noise covariance matrix with the identity matrix. In this paper, we examined two questions: does using the noise model with realistic, imperfect data yield an improvement in image quality compared to using the identity matrix; and what is the difference in quality between online and offline reconstructions. Bespoke test data were created using a novel process through which simulated changes in absorption were added to real resting-state DOT data. A realistic multi-layer head model was used as the geometry for the reconstruction. Results validated our assumptions, highlighting the validity of computing the noise statistics from the measured data for online image reconstruction, which was performed at 2 Hz. Our results can be directly extended to a real application where real-time imaging is required. PMID:26713189

  4. Evaluation of an Emerging Research Center: Lessons Learned.

    PubMed

    Nigg, C R; Qureshi, K; Inouye, J; Sy, A; Sullivan, K; Boland, M G

    2012-02-01

    PROBLEM STATEMENT: Rigorous evaluation assures that research endeavors meet their purpose and achieve stated goals. This is especially true for federally funded exploratory research centers, which tend to be more complex due to the involvement of multiple, interdisciplinary investigators. This study provides an overview of the approach used to develop an evaluation strategy and reports the lessons learned during the initial development of the Center for Ohana Self-Management of Chronic Illness (COSMCI) at the University of Hawai'i at Mānoa School of Nursing and Dental Hygiene. The COSMCI is composed of an interdisciplinary team of researchers and practitioners and aims to advance knowledge in the field of self management of chronic disease in the community setting. APPROACH: A systematic approach was utilized that included formative and summative strategies for ongoing evaluation. The problem was solved by addressing five key concerns: (1) development of research structure, (2) observing the process of the research pilot projects, (3) scholarly activity of COSMCI faculty, (4) dissemination and translation and (5) sustainability prospects. The method of research included formulating process strategies and determine if the plans for developing the Center were followed and whether these plans were effective. Interviews were also conducted at year one and at mid-point though the project. RESULTS: Themes that emerged from our evaluation included inclusion, timelines, realistic expectations, ongoing evaluation and preparing for changes in the team. This provided timely recognition of successes and challenges and facilitated a rapid response for interventions especially during the early development stage of the center. CONCLUSION/RECOMMENDATIONS: Effective development of a successful Center is highly dependent upon having a strong evaluation process in place that can inform ongoing development. An exploratory research center requires ongoing evaluation that allows for

  5. Use of a realistic breathing lung phantom to evaluate dose delivery errors

    SciTech Connect

    Court, Laurence E.; Seco, Joao; Lu Xingqi; Ebe, Kazuyu; Mayo, Charles; Ionascu, Dan; Winey, Brian; Giakoumakis, Nikos; Aristophanous, Michalis; Berbeco, Ross; Rottman, Joerg; Bogdanov, Madeleine; Schofield, Deborah; Lingos, Tania

    2010-11-15

    Purpose: To compare the effect of respiration-induced motion on delivered dose (the interplay effect) for different treatment techniques under realistic clinical conditions. Methods: A flexible resin tumor model was created using rapid prototyping techniques based on a computed tomography (CT) image of an actual tumor. Twenty micro-MOSFETs were inserted into the tumor model and the tumor model was inserted into an anthropomorphic breathing phantom. Phantom motion was programed using the motion trajectory of an actual patient. A four-dimensional CT image was obtained and several treatment plans were created using different treatment techniques and planning systems: Conformal (Eclipse), step-and-shoot intensity-modulated radiation therapy (IMRT) (Pinnacle), step-and-shoot IMRT (XiO), dynamic IMRT (Eclipse), complex dynamic IMRT (Eclipse), hybrid IMRT [60% conformal, 40% dynamic IMRT (Eclipse)], volume-modulated arc therapy (VMAT) [single-arc (Eclipse)], VMAT [double-arc (Eclipse)], and complex VMAT (Eclipse). The complex plans were created by artificially pushing the optimizer to give complex multileaf collimator sequences. Each IMRT field was irradiated five times and each VMAT field was irradiated ten times, with each irradiation starting at a random point in the respiratory cycle. The effect of fractionation was calculated by randomly summing the measured doses. The maximum deviation for each measurement point per fraction and the probability that 95% of the model tumor had dose deviations less than 2% and 5% were calculated as a function of the number of fractions. Tumor control probabilities for each treatment plan were calculated and compared. Results: After five fractions, measured dose deviations were less than 2% for more than 95% of measurement points within the tumor model for all plans, except the complex dynamic IMRT, step-and-shoot IMRT (XiO), complex VMAT, and single-arc VMAT plans. Reducing the dose rate of the complex IMRT plans from 600 to 200 MU

  6. Realistic evaluation of hull performance for rowing shells, canoes, and kayaks in unsteady flow.

    PubMed

    Day, Alexander; Campbell, Ian; Clelland, David; Doctors, Lawrence J; Cichowicz, Jakub

    2011-07-01

    In this study, we investigated the effect of hull dynamics in shallow water on the hydrodynamic performance of rowing shells as well as canoes and kayaks. An approach was developed to generate data in a towing tank using a test rig capable of reproducing realistic speed profiles. The impact of unsteady shallow-water effects on wave-making resistance was examined via experimental measurements on a benchmark hull. The data generated were used to explore the validity of a computational approach developed to predict unsteady shallow-water wave resistance. Comparison of measured and predicted results showed that the computational approach correctly predicted complex unsteady wave-resistance phenomena at low oscillation frequency and speed, but that total resistance was substantially under-predicted at moderate oscillation frequency and speed. It was postulated that this discrepancy arose from unsteady viscous effects. This was investigated via hot-film measurements for a full-scale single scull in unsteady flow in both towing-tank and field-trial conditions. Results suggested a strong link between acceleration and turbulence and demonstrated that the measured real-world viscous-flow behaviour could be successfully reproduced in the tank. Thus a suitable tank-test approach could provide a reliable guide to hull performance characterization in unsteady flow. PMID:21756127

  7. Evaluation of three-dimensional anisotropic head model for mapping realistic electromagnetic fields of brain tissues

    NASA Astrophysics Data System (ADS)

    Jeong, Woo Chul; Wi, Hun; Sajib, Saurav Z. K.; Oh, Tong In; Kim, Hyung Joong; Kwon, Oh In; Woo, Eung Je

    2015-08-01

    Electromagnetic fields provide fundamental data for the imaging of electrical tissue properties, such as conductivity and permittivity, in recent magnetic resonance (MR)-based tissue property mapping. The induced voltage, current density, and magnetic flux density caused by externally injected current are critical factors for determining the image quality of electrical tissue conductivity. As a useful tool to identify bio-electromagnetic phenomena, precise approaches are required to understand the exact responses inside the human body subject to an injected currents. In this study, we provide the numerical simulation results of electromagnetic field mapping of brain tissues using a MR-based conductivity imaging method. First, we implemented a realistic three-dimensional human anisotropic head model using high-resolution anatomical and diffusion tensor MR images. The voltage, current density, and magnetic flux density of brain tissues were imaged by injecting 1 mA of current through pairs of electrodes on the surface of our head model. The current density map of anisotropic brain tissues was calculated from the measured magnetic flux density based on the linear relationship between the water diffusion tensor and the electrical conductivity tensor. Comparing the current density to the previous isotropic model, the anisotropic model clearly showed the differences between the brain tissues. This originates from the enhanced signals by the inherent conductivity contrast as well as the actual tissue condition resulting from the injected currents.

  8. Advocacy evaluation: challenges and emerging trends.

    PubMed

    Devlin-Foltz, David; Fagen, Michael C; Reed, Ehren; Medina, Robert; Neiger, Brad L

    2012-09-01

    Devising, promoting, and implementing changes in policies and regulations are important components of population-level health promotion. Whether advocating for changes in school meal nutrition standards or restrictions on secondhand smoke, policy change can create environments conducive to healthier choices. Such policy changes often result from complex advocacy efforts that do not lend themselves to traditional evaluation approaches. In a challenging fiscal environment, allocating scarce resources to policy advocacy may be particularly difficult. A well-designed evaluation that moves beyond inventorying advocacy activities can help make the case for funding advocacy and policy change efforts. Although it is one thing to catalog meetings held, position papers drafted, and pamphlets distributed, it is quite another to demonstrate that these outputs resulted in useful policy change outcomes. This is where the emerging field of advocacy evaluation fits in by assessing (among other things) strategic learning, capacity building, and community organizing. Based on recent developments, this article highlights several challenges advocacy evaluators are currently facing and provides new resources for addressing them. PMID:22773623

  9. Emergency building temperature restrictions. Final evaluation

    SciTech Connect

    1980-11-01

    On July 5, 1979, DOE promulgated final regulations of the Emergency Building Temperature Restrictions program, placing emergency restrictions on thermostat settings for space heating, space cooling, and hot water in commercial, industrial, and nonresidential public buildings. The final regulations restricted space heating to a maximum of 65/sup 0/F, hot water temperature to a maximum of 105/sup 0/F, and cooling temperature to a minimum of 78/sup 0/F. A comprehensive evaluation of the entire EBTF program for a nine-month period from July 16, 1979 is presented. In Chapter 1, an estimate of the population of buildings covered by EBTR is presented. In Chapter 2, EBTR compliance by building type and region is reported. Exemptions are also discussed. In Chapter 3, the simulations of building energy use are explained and the relative impact of various building characteristics and effectiveness of different control strategies are estimated. Finally, in Chapter 4, the methodology for scaling the individual building energy savings to the national level is described, and estimated national energy savings are presented.

  10. INTRINSIC EVALUATION OF TEXT MINING TOOLS MAY NOT PREDICT PERFORMANCE ON REALISTIC TASKS

    PubMed Central

    CAPORASO, J. GREGORY; DESHPANDE, NITA; FINK, J. LYNN; BOURNE, PHILIP E.; COHEN, K. BRETONNEL; HUNTER, LAWRENCE

    2008-01-01

    Biomedical text mining and other automated techniques are beginning to achieve performance which suggests that they could be applied to aid database curators. However, few studies have evaluated how these systems might work in practice. In this article we focus on the problem of annotating mutations in Protein Data Bank (PDB) entries, and evaluate the relationship between performance of two automated techniques, a text-mining-based approach (MutationFinder) and an alignment-based approach, in intrinsic versus extrinsic evaluations. We find that high performance on gold standard data (an intrinsic evaluation) does not necessarily translate to high performance for database annotation (an extrinsic evaluation). We show that this is in part a result of lack of access to the full text of journal articles, which appears to be critical for comprehensive database annotation by text mining. Additionally, we evaluate the accuracy and completeness of manually annotated mutation data in the PDB, and find that it is far from perfect. We conclude that currently the most cost-effective and reliable approach for database annotation might incorporate manual and automatic annotation methods. PMID:18229722

  11. A Realist Evaluation Approach to Unpacking the Impacts of the Sentencing Guidelines

    ERIC Educational Resources Information Center

    Hunt, Kim Steven; Sridharan, Sanjeev

    2010-01-01

    Evaluations of complex interventions such as sentencing guidelines provide an opportunity to understand the mechanisms by which policies and programs can impact intermediate and long-term outcomes. There is limited previous discussion of the underlying frameworks by which sentencing guidelines can impact outcomes such as crime rates. Guided by a…

  12. Evaluation of an improved algorithm for producing realistic 3D breast software phantoms: Application for mammography

    SciTech Connect

    Bliznakova, K.; Suryanarayanan, S.; Karellas, A.; Pallikarakis, N.

    2010-11-15

    Purpose: This work presents an improved algorithm for the generation of 3D breast software phantoms and its evaluation for mammography. Methods: The improved methodology has evolved from a previously presented 3D noncompressed breast modeling method used for the creation of breast models of different size, shape, and composition. The breast phantom is composed of breast surface, duct system and terminal ductal lobular units, Cooper's ligaments, lymphatic and blood vessel systems, pectoral muscle, skin, 3D mammographic background texture, and breast abnormalities. The key improvement is the development of a new algorithm for 3D mammographic texture generation. Simulated images of the enhanced 3D breast model without lesions were produced by simulating mammographic image acquisition and were evaluated subjectively and quantitatively. For evaluation purposes, a database with regions of interest taken from simulated and real mammograms was created. Four experienced radiologists participated in a visual subjective evaluation trial, as they judged the quality of the simulated mammograms, using the new algorithm compared to mammograms, obtained with the old modeling approach. In addition, extensive quantitative evaluation included power spectral analysis and calculation of fractal dimension, skewness, and kurtosis of simulated and real mammograms from the database. Results: The results from the subjective evaluation strongly suggest that the new methodology for mammographic breast texture creates improved breast models compared to the old approach. Calculated parameters on simulated images such as {beta} exponent deducted from the power law spectral analysis and fractal dimension are similar to those calculated on real mammograms. The results for the kurtosis and skewness are also in good coincidence with those calculated from clinical images. Comparison with similar calculations published in the literature showed good agreement in the majority of cases. Conclusions: The

  13. Using the Co-Production of Knowledge for Developing Realistic Natural Disaster Scenarios for Small-to-Medium Scale Emergency Management Exercises

    NASA Astrophysics Data System (ADS)

    Robinson, T.; Wilson, T. M.; Davies, T. R.; Orchiston, C.; Thompson, J.

    2014-12-01

    Disaster scenarios for Emergency Management (EM) exercises are a widely-used and effective tool for communicating hazard information to policy makers, EM personnel, lifelines operators and communities in general. It is crucial that the scenarios are as realistic as possible. Major disasters however, contain a series of cascading consequences, both environmental and social, which are difficult to model. Consequently, only recently have large-scale exercises included such processes; incorporating these in small- and medium-scale scenarios has yet to be attempted. This study details work undertaken in a recent medium-scale earthquake exercise in New Zealand to introduce such cascading processes into the disaster scenario. Given limited time, data, and funding, we show that the co-production of knowledge between natural disaster scientists, EM personnel, and governance and lifelines organisations can yield detailed, realistic scenarios. Using the co-production process, scenario development was able to identify where the pre-exercise state of knowledge was insufficient. This enabled a focussed research response driven by end-user needs. This found that in general, seismic hazard (ground shaking) and its likely impacts were well known and understood by all parties. However, subsequent landsliding and associated effects were poorly known and understood and their potential impacts unconsidered. Scenario development therefore focussed primarily on understanding these processes and their potential effects. This resulted in cascading hazards being included in a medium-scale NZ exercise for the first time. Further, all participants were able to focus on the potential impacts on their specific sectors, increasing the level of knowledge of cascading processes across all parties. Using group based discussions throughout the design process allowed a detailed scenario to be created, fostered stronger inter-disciplinary relationships, and identified areas for further research

  14. Toward a comprehensive and realistic risk evaluation of engineered nanomaterials in the urban water system

    PubMed Central

    Duester, Lars; Burkhardt, Michael; Gutleb, Arno C.; Kaegi, Ralf; Macken, Ailbhe; Meermann, Björn; von der Kammer, Frank

    2014-01-01

    The European COoperation in Science and Technology (COST) Action ES1205 on the transfer of Engineered Nano materials from wastewater Treatment and stormwatEr to Rivers (ENTER) aims to create and to maintain a trans European network among scientists. This perspective article delivers a brief overview on the status quo at the beginning of the project by addressing the following aspects on engineered nano materials (ENMs) in the urban systems: (1) ENMs that need to be considered on a European level; (2) uncertainties on production-volume estimations; (3) fate of selected ENMs during waste water transport and treatment; (4) analytical strategies for ENM analysis; (5) ecotoxicity of ENMs, and (6) future needs. These six step stones deliver the derivation of the position of the ES1205 network at the beginning of the projects runtime, by defining six fundamental aspects that should be considered in future discussions on risk evaluation of ENMs in urban water systems. PMID:25003102

  15. Challenges in Integrating Nondestructive Evaluation and Finite Element Methods for Realistic Structural Analysis

    NASA Technical Reports Server (NTRS)

    Abdul-Aziz, Ali; Baaklini, George Y.; Zagidulin, Dmitri; Rauser, Richard W.

    2000-01-01

    Capabilities and expertise related to the development of links between nondestructive evaluation (NDE) and finite element analysis (FEA) at Glenn Research Center (GRC) are demonstrated. Current tools to analyze data produced by computed tomography (CT) scans are exercised to help assess the damage state in high temperature structural composite materials. A utility translator was written to convert velocity (an image processing software) STL data file to a suitable CAD-FEA type file. Finite element analyses are carried out with MARC, a commercial nonlinear finite element code, and the analytical results are discussed. Modeling was established by building MSC/Patran (a pre and post processing finite element package) generated model and comparing it to a model generated by Velocity in conjunction with MSC/Patran Graphics. Modeling issues and results are discussed in this paper. The entire process that outlines the tie between the data extracted via NDE and the finite element modeling and analysis is fully described.

  16. Realistic Subscale Evaluations of the Mechanical Properties of Advanced Disk Superalloys

    NASA Technical Reports Server (NTRS)

    Gabb, Timothy P.; Gayda, John; Telesman, Jack; Kantzos, Peter T.; Konkel, William A.

    2003-01-01

    A series of experimental powder metallurgy disk alloys were evaluated for their processing characteristics and high temperature mechanical properties. Powder of each alloy was hot compacted, extruded, and isothermally forged into subscale disks. Disks were subsolvus and supersolvus heat treated, then quenched using procedures designed to reproduce the cooling paths expected in large-scale disks. Mechanical tests were then performed at 538, 704, and 815 C. Several alloys had superior tensile and creep properties at 704 C and higher temperatures, but were difficult to process and prone to quench cracking, chiefly due to their high gamma prime solvus temperature. Several other alloys had more favorable processing characteristics due to their lower gamma prime solvus temperature and balanced time-dependent properties at 704 C. Results indicate an experimental low solvus, high refractory alloy can build upon the best attributes of all these alloys, giving exceptional tensile and creep properties at high temperatures with good processing characteristics due to a low gamma prime solvus.

  17. Implementing health research through academic and clinical partnerships: a realistic evaluation of the Collaborations for Leadership in Applied Health Research and Care (CLAHRC)

    PubMed Central

    2011-01-01

    Background The English National Health Service has made a major investment in nine partnerships between higher education institutions and local health services called Collaborations for Leadership in Applied Health Research and Care (CLAHRC). They have been funded to increase capacity and capability to produce and implement research through sustained interactions between academics and health services. CLAHRCs provide a natural 'test bed' for exploring questions about research implementation within a partnership model of delivery. This protocol describes an externally funded evaluation that focuses on implementation mechanisms and processes within three CLAHRCs. It seeks to uncover what works, for whom, how, and in what circumstances. Design and methods This study is a longitudinal three-phase, multi-method realistic evaluation, which deliberately aims to explore the boundaries around knowledge use in context. The evaluation funder wishes to see it conducted for the process of learning, not for judging performance. The study is underpinned by a conceptual framework that combines the Promoting Action on Research Implementation in Health Services and Knowledge to Action frameworks to reflect the complexities of implementation. Three participating CLARHCS will provide in-depth comparative case studies of research implementation using multiple data collection methods including interviews, observation, documents, and publicly available data to test and refine hypotheses over four rounds of data collection. We will test the wider applicability of emerging findings with a wider community using an interpretative forum. Discussion The idea that collaboration between academics and services might lead to more applicable health research that is actually used in practice is theoretically and intuitively appealing; however the evidence for it is limited. Our evaluation is designed to capture the processes and impacts of collaborative approaches for implementing research, and

  18. Emergency birth hybrid simulation with standardized patients in midwifery education: implementation and evaluation.

    PubMed

    Lindsay Miller, Jane; Avery, Melissa D; Larson, Karin; Woll, Anne; VonAchen, Alison; Mortenson, Angela

    2015-01-01

    Structured simulations have become a critical part of health professions education at every level, particularly for high-risk, low-incidence scenarios. This article describes the implementation and evaluation of a hybrid simulation of emergency birth situations in a graduate midwifery program. In the fall of 2011 and spring of 2012, nurse-midwifery students twice participated in 2 simulated emergencies-shoulder dystocia and postpartum hemorrhage-using hybrid simulation (a standardized patient paired with a birth task trainer). Students found the simulations to be realistic. The use of best practices (ie, repetitive practice, team learning, small group debriefing, and large group debriefing) enhanced the quality of the simulation experience and the learners' reflection about their professional skills, strengths, weaknesses, and confidence in managing these 2 obstetric emergencies. This article is part of a special series of articles that address midwifery innovations in clinical practice, education, interprofessional collaboration, health policy, and global health. PMID:25963413

  19. TOXICOLOGICAL EVALUATION OF REALISTIC EMISSIONS OF SOURCE AEROSOLS (TERESA): APPLICATION TO POWER PLANT-DERIVED PM2.5

    SciTech Connect

    Annette Rohr

    2006-03-01

    TERESA (Toxicological Evaluation of Realistic Emissions of Source Aerosols) involves exposing laboratory rats to realistic coal-fired power plant and mobile source emissions to help determine the relative toxicity of these PM sources. There are three coal-fired power plants in the TERESA program; this report describes the results of fieldwork conducted at the first plant, located in the Upper Midwest. The project was technically challenging by virtue of its novel design and requirement for the development of new techniques. By examining aged, atmospherically transformed aerosol derived from power plant stack emissions, we were able to evaluate the toxicity of PM derived from coal combustion in a manner that more accurately reflects the exposure of concern than existing methodologies. TERESA also involves assessment of actual plant emissions in a field setting--an important strength since it reduces the question of representativeness of emissions. A sampling system was developed and assembled to draw emissions from the stack; stack sampling conducted according to standard EPA protocol suggested that the sampled emissions are representative of those exiting the stack into the atmosphere. Two mobile laboratories were then outfitted for the study: (1) a chemical laboratory in which the atmospheric aging was conducted and which housed the bulk of the analytical equipment; and (2) a toxicological laboratory, which contained animal caging and the exposure apparatus. Animal exposures were carried out from May-November 2004 to a number of simulated atmospheric scenarios. Toxicological endpoints included (1) pulmonary function and breathing pattern; (2) bronchoalveolar lavage fluid cytological and biochemical analyses; (3) blood cytological analyses; (4) in vivo oxidative stress in heart and lung tissue; and (5) heart and lung histopathology. Results indicated no differences between exposed and control animals in any of the endpoints examined. Exposure concentrations for the

  20. Turning around an ailing district hospital: a realist evaluation of strategic changes at Ho Municipal Hospital (Ghana)

    PubMed Central

    2010-01-01

    as the core mechanisms underlying the changes taking place at Ho Municipal Hospital. Conclusions This study shows how a hospital management team in Ghana succeeded in resuscitating an ailing hospital. Their high commitment management approach led to the active involvement and empowerment of staff. It also showed how a realist evaluation approach such as this, could be used in the research of the management of health care organisations to explain how management interventions may or may not work. PMID:21184678

  1. Bedside pediatric emergency evaluation through ultrasonography.

    PubMed

    Dietrich, Ann M; Coley, Brian D

    2008-11-01

    Bedside US has emerged as a valuable technology for the emergency department physician. It impacts clinical decision-making and the safety of procedures, and it decreases the time and increases the efficiency for completion of procedures. The portability, accuracy and noninvasive nature of US make it an ideal tool for the trained clinician. Bedside US can improve clinical decision-making for the pediatric patient by helping the clinician to identify critical pathology, direct therapeutic maneuvers and determine the futility of resuscitations. Many pediatric procedures, such as vascular access, lumbar puncture and bladder catheterization, are typically performed blindly. Bedside US enhances the success of procedures, minimizes complications and limits the number of attempts necessary to complete a procedure. Bedside US can be a valuable adjunct for complicated and time-sensitive disease processes such as ectopic pregnancy, testicular torsion and hypovolemia by providing information to guide diagnostic and therapeutic interventions that subsequently improve outcomes. PMID:18810417

  2. Chest pain evaluation in the emergency department.

    PubMed

    Foy, Andrew J; Filippone, Lisa

    2015-07-01

    Chest pain is a common complaint in the emergency department. Recognition of chest pain symptoms and electrocardiographic changes consistent with acute coronary syndrome (ACS) can lead to prompt initiation of goal-directed therapy. Cardiac troponin testing confirms the diagnosis of acute myocardial infarction, but does not reveal the mechanism of injury. When patients with chest pain rule out for ACS the use of advanced, noninvasive testing has not been found to be associated with better patient outcomes. PMID:26042885

  3. More than a checklist: a realist evaluation of supervision of mid-level health workers in rural Guatemala

    PubMed Central

    2014-01-01

    Background Mid-level health workers (MLHWs) form the front-line of service delivery in many low- and middle-income countries. Supervision is a critical institutional intervention linking their work to the health system, and it consists of activities intended to support health workers’ motivation and enable them to perform. However its impact depends not only on the frequency of these activities but also how they are carried out and received. This study aims to deepen understanding of the mechanisms through which supervision activities support the performance of auxiliary nurses, a cadre of MLHWs, in rural Guatemala. Methods A multiple case study was conducted to examine the operation of supervision of five health posts using a realist evaluation approach. A program theory was formulated describing local understanding of how supervision activities are intended to work. Data was collected through interviews and document review to test the theory. Analysis focused on comparison of activities, outcomes, mechanisms and the influence of context across cases, leading to revision of the program theory. Results The supervisor’s orientation was identified as the main mechanism contributing to variation observed in activities and their outcomes. Managerial control was the dominant orientation, reflecting the influence of standardized performance criteria and institutional culture. Humanized support was present in one case where the auxiliary nurse was motivated by the sense that the full scope of her work was valued. This orientation reflected the supervisor’s integration of her professional identity as a nurse. Conclusions The nature of the support health workers received was shaped by supervisors’ orientation, and in this study, nursing principles were central to humanized support. Efforts to strengthen the support that supervision provides to MLHWs should promote professional ethos as a means of developing shared performance goals and orient supervisors to a more

  4. Adnexal mass evaluation in the emergency department.

    PubMed

    Morgan, A

    2001-08-01

    Female patients who have stable vital signs presenting to the emergency department with abdominopelvic pain and an adnexal mass can be extremely difficult to manage. However, by performing a rapid problem-oriented history and physical with emphasis on the age of patient, menstrual history, and pelvic exam, a detailed differential diagnosis can be compiled. With the addition of a complete blood count and HCG, if appropriate, and a CA-125 for your consultant, additional information can be obtained while a ultrasound examination is being performed. With the above information, consultation and disposition should be readily accomplished. PMID:11554288

  5. Evaluation with an Experimental Design: The Emergency School Assistance Program.

    ERIC Educational Resources Information Center

    Crain, Robert L.; York, Robert L.

    The Evaluation of the Emergency School Assistance Program (ESAP) for the 1971-72 school year is the first application of full-blown experimental design with randomized experimental and control cases in a federal evaluation of a large scale program. It is also one of the very few evaluations which has shown that federal programs can raise tested…

  6. Integration of robotic surgery into routine practice and impacts on communication, collaboration, and decision making: a realist process evaluation protocol

    PubMed Central

    2014-01-01

    Background Robotic surgery offers many potential benefits for patients. While an increasing number of healthcare providers are purchasing surgical robots, there are reports that the technology is failing to be introduced into routine practice. Additionally, in robotic surgery, the surgeon is physically separated from the patient and the rest of the team, with the potential to negatively impact teamwork in the operating theatre. The aim of this study is to ascertain: how and under what circumstances robotic surgery is effectively introduced into routine practice; and how and under what circumstances robotic surgery impacts teamwork, communication and decision making, and subsequent patient outcomes. Methods and design We will undertake a process evaluation alongside a randomised controlled trial comparing laparoscopic and robotic surgery for the curative treatment of rectal cancer. Realist evaluation provides an overall framework for the study. The study will be in three phases. In Phase I, grey literature will be reviewed to identify stakeholders’ theories concerning how robotic surgery becomes embedded into surgical practice and its impacts. These theories will be refined and added to through interviews conducted across English hospitals that are using robotic surgery for rectal cancer resection with staff at different levels of the organisation, along with a review of documentation associated with the introduction of robotic surgery. In Phase II, a multi-site case study will be conducted across four English hospitals to test and refine the candidate theories. Data will be collected using multiple methods: the structured observation tool OTAS (Observational Teamwork Assessment for Surgery); video recordings of operations; ethnographic observation; and interviews. In Phase III, interviews will be conducted at the four case sites with staff representing a range of surgical disciplines, to assess the extent to which the results of Phase II are generalisable and to

  7. Stroke patients’ utilisation of extrinsic feedback from computer-based technology in the home: a multiple case study realistic evaluation

    PubMed Central

    2014-01-01

    Background Evidence indicates that post − stroke rehabilitation improves function, independence and quality of life. A key aspect of rehabilitation is the provision of appropriate information and feedback to the learner. Advances in information and communications technology (ICT) have allowed for the development of various systems to complement stroke rehabilitation that could be used in the home setting. These systems may increase the provision of rehabilitation a stroke survivor receives and carries out, as well as providing a learning platform that facilitates long-term self-managed rehabilitation and behaviour change. This paper describes the application of an innovative evaluative methodology to explore the utilisation of feedback for post-stroke upper-limb rehabilitation in the home. Methods Using the principles of realistic evaluation, this study aimed to test and refine intervention theories by exploring the complex interactions of contexts, mechanisms and outcomes that arise from technology deployment in the home. Methods included focus groups followed by multi-method case studies (n = 5) before, during and after the use of computer-based equipment. Data were analysed in relation to the context-mechanism-outcome hypotheses case by case. This was followed by a synthesis of the findings to answer the question, ‘what works for whom and in what circumstances and respects?’ Results Data analysis reveals that to achieve desired outcomes through the use of ICT, key elements of computer feedback, such as accuracy, measurability, rewarding feedback, adaptability, and knowledge of results feedback, are required to trigger the theory-driven mechanisms underpinning the intervention. In addition, the pre-existing context and the personal and environmental contexts, such as previous experience of service delivery, personal goals, trust in the technology, and social circumstances may also enable or constrain the underpinning theory-driven mechanisms

  8. Emergency department evaluation and management of foot and ankle pain.

    PubMed

    Wedmore, Ian; Young, Scott; Franklin, Jill

    2015-05-01

    Foot and ankle injuries are a frequent cause for a visit to the Emergency Department. A thorough evaluation and treatment of these injuries needs to be an area of in-depth familiarity for the Emergency Medicine physician. The key to proper evaluation is first a history and physical examination that focuses on determining what, if any, imaging is required. Subsequently, a focused history, physical examination, and imaging will then determine if an injury is stable or unstable, requiring operative intervention. PMID:25892727

  9. Realist evaluation of the antiretroviral treatment adherence club programme in selected primary healthcare facilities in the metropolitan area of Western Cape Province, South Africa: a study protocol

    PubMed Central

    Mukumbang, Ferdinand C; Van Belle, Sara; Marchal, Bruno; Van Wyk, Brian

    2016-01-01

    Introduction Suboptimal retention in care and poor treatment adherence are key challenges to antiretroviral therapy (ART) in sub-Saharan Africa. Community-based approaches to HIV service delivery are recommended to improve patient retention in care and ART adherence. The implementation of the adherence clubs in the Western Cape province of South Africa was with variable success in terms of implementation and outcomes. The need for operational guidelines for its implementation has been identified. Therefore, understanding the contexts and mechanisms for successful implementation of the adherence clubs is crucial to inform the roll-out to the rest of South Africa. The protocol outlines an evaluation of adherence club intervention in selected primary healthcare facilities in the metropolitan area of the Western Cape Province, using the realist approach. Methods and analysis In the first phase, an exploratory study design will be used. Document review and key informant interviews will be used to elicit the programme theory. In phase two, a multiple case study design will be used to describe the adherence clubs in five contrastive sites. Semistructured interviews will be conducted with purposively selected programme implementers and members of the clubs to assess the context and mechanisms of the adherence clubs. For the programme's primary outcomes, a longitudinal retrospective cohort analysis will be conducted using routine patient data. Data analysis will involve classifying emerging themes using the context-mechanism-outcome (CMO) configuration, and refining the primary CMO configurations to conjectured CMO configurations. Finally, we will compare the conjectured CMO configurations from the cases with the initial programme theory. The final CMOs obtained will be translated into middle range theories. Ethics and dissemination The study will be conducted according to the principles of the declaration of Helsinki (1964). Ethics clearance was obtained from the

  10. TOXICOLOGICAL EVALUATION OF REALISTIC EMISSIONS OF SOURCE AEROSOLS (TERESA): APPLICATION TO POWER PLANT-DERIVED PM2.5

    SciTech Connect

    Annette C. Rohr; Petros Koutrakis; John Godleski

    2011-03-31

    Determining the health impacts of different sources and components of fine particulate matter (PM2.5) is an important scientific goal, because PM is a complex mixture of both inorganic and organic constituents that likely differ in their potential to cause adverse health outcomes. The TERESA (Toxicological Evaluation of Realistic Emissions of Source Aerosols) study focused on two PM sources - coal-fired power plants and mobile sources - and sought to investigate the toxicological effects of exposure to realistic emissions from these sources. The DOE-EPRI Cooperative Agreement covered the performance and analysis of field experiments at three power plants. The mobile source component consisted of experiments conducted at a traffic tunnel in Boston; these activities were funded through the Harvard-EPA Particulate Matter Research Center and will be reported separately in the peer-reviewed literature. TERESA attempted to delineate health effects of primary particles, secondary (aged) particles, and mixtures of these with common atmospheric constituents. The study involved withdrawal of emissions directly from power plant stacks, followed by aging and atmospheric transformation of emissions in a mobile laboratory in a manner that simulated downwind power plant plume processing. Secondary organic aerosol (SOA) derived from the biogenic volatile organic compound {alpha}-pinene was added in some experiments, and in others ammonia was added to neutralize strong acidity. Specifically, four scenarios were studied at each plant: primary particles (P); secondary (oxidized) particles (PO); oxidized particles + secondary organic aerosol (SOA) (POS); and oxidized and neutralized particles + SOA (PONS). Extensive exposure characterization was carried out, including gas-phase and particulate species. Male Sprague Dawley rats were exposed for 6 hours to filtered air or different atmospheric mixtures. Toxicological endpoints included (1) breathing pattern; (2) bronchoalveolar lavage

  11. Development of a versatile experimental setup for the evaluation of the photocatalytic properties of construction materials under realistic outdoor conditions.

    PubMed

    Suárez, S; Portela, R; Hernández-Alonso, M D; Sánchez, B

    2014-10-01

    samples at the same time. The suitability of the system for the evaluation of the DeNO x properties of construction elements at realistic outdoor conditions was demonstrated. The designed experimental device can be used 24/7 for testing materials under real fluctuations of NO x concentration, temperature, UV irradiation, and relative humidity and the presence of other outdoor air pollutants such as VOCs, SO x , or NH3. The chamber-based design allows comparing a photocatalytic material with respect to a reference substrate without the photoactive phase, or even the comparison of several outdoor elements at the same time. PMID:24652575

  12. Evaluation of semidecentralized emergency drinking water treatment.

    PubMed

    Eloidin, Océane; Dorea, Caetano C

    2015-01-01

    This study evaluates the potential for a novel semidecentralized approach that uses coagulant disinfectant products (CDPs) for humanitarian water treatment, by testing two commercially available products (CDP-W and CDP-T). Their performances were evaluated against the relevant water quality treatment objectives (The Sphere Project) under laboratory conditions, using a standardized testing protocol with both synthetic and natural surface test waters. Tests indicated a satisfactory performance by one of the products (CDP-W) with respect to humanitarian water quality objectives, (i.e., free chlorine residual, pH, and turbidity) that was dependent on initial water quality characteristics. Adequate bacterial inactivation (final thermotolerant coliform concentration of < 1 cfu/100 mL) was always attained and log reductions of up to 5 were achieved. The other product (CDP-T) did not exhibit any measurable coagulation and disinfection properties, indicating the variability of product quality and the need to conduct evaluations such as the ones presented in this study. Such results are of relevance to relief agencies delivering water supply interventions. PMID:26121019

  13. An Emerging Model for Student Feedback: Electronic Distributed Evaluation

    ERIC Educational Resources Information Center

    Brunk-Chavez, Beth; Arrigucci, Annette

    2012-01-01

    In this article we address several issues and challenges that the evaluation of writing presents individual instructors and composition programs as a whole. We present electronic distributed evaluation, or EDE, as an emerging model for feedback on student writing and describe how it was integrated into our program's course redesign. Because the…

  14. Towards a Holistic Framework for the Evaluation of Emergency Plans in Indoor Environments

    PubMed Central

    Serrano, Emilio; Poveda, Geovanny; Garijo, Mercedes

    2014-01-01

    One of the most promising fields for ambient intelligence is the implementation of intelligent emergency plans. Because the use of drills and living labs cannot reproduce social behaviors, such as panic attacks, that strongly affect these plans, the use of agent-based social simulation provides an approach to evaluate these plans more thoroughly. (1) The hypothesis presented in this paper is that there has been little interest in describing the key modules that these simulators must include, such as formally represented knowledge and a realistic simulated sensor model, and especially in providing researchers with tools to reuse, extend and interconnect modules from different works. This lack of interest hinders researchers from achieving a holistic framework for evaluating emergency plans and forces them to reconsider and to implement the same components from scratch over and over. In addition to supporting this hypothesis by considering over 150 simulators, this paper: (2) defines the main modules identified and proposes the use of semantic web technologies as a cornerstone for the aforementioned holistic framework; (3) provides a basic methodology to achieve the framework; (4) identifies the main challenges; and (5) presents an open and free software tool to hint at the potential of such a holistic view of emergency plan evaluation in indoor environments. PMID:24662453

  15. Towards a holistic framework for the evaluation of emergency plans in indoor environments.

    PubMed

    Serrano, Emilio; Poveda, Geovanny; Garijo, Mercedes

    2014-01-01

    One of the most promising fields for ambient intelligence is the implementation of intelligent emergency plans. Because the use of drills and living labs cannot reproduce social behaviors, such as panic attacks, that strongly affect these plans, the use of agent-based social simulation provides an approach to evaluate these plans more thoroughly. (1) The hypothesis presented in this paper is that there has been little interest in describing the key modules that these simulators must include, such as formally represented knowledge and a realistic simulated sensor model, and especially in providing researchers with tools to reuse, extend and interconnect modules from different works. This lack of interest hinders researchers from achieving a holistic framework for evaluating emergency plans and forces them to reconsider and to implement the same components from scratch over and over. In addition to supporting this hypothesis by considering over 150 simulators, this paper: (2) defines the main modules identified and proposes the use of semantic web technologies as a cornerstone for the aforementioned holistic framework; (3) provides a basic methodology to achieve the framework; (4) identifies the main challenges; and (5) presents an open and free software tool to hint at the potential of such a holistic view of emergency plan evaluation in indoor environments. PMID:24662453

  16. TOXICOLOGICAL EVALUATION OF REALISTIC EMISSIONS OF SOURCE AEROSOLS (TERESA): APPLICATION TO POWER PLANT-DERIVED PM2.5

    SciTech Connect

    Annette Rohr

    2004-12-02

    slightly higher. Exposure concentrations were about 249 {micro}g/m{sup 3} PM, of which 87 {micro}g/m{sup 3} was sulfate and approximately 110 {micro}g/m{sup 3} was secondary organic material ({approx}44%). Results indicated subtle differences in breathing pattern between exposed and control (sham) animals, but no differences in other endpoints (in vivo chemiluminescence, blood cytology, bronchoalveolar lavage fluid analysis). It was suspected that primary particle losses may have been occurring in the venturi aspirator/orifice sampler; therefore, the stack sampling system was redesigned. The modified system resulted in no substantial increase in particle concentration in the emissions, leading us to conclude that the electrostatic precipitator at the power plant has high efficiency, and that the sampled emissions are representative of those exiting the stack into the atmosphere. This is important, since the objective of the Project is to carry out exposures to realistic coal combustion-derived secondary PM arising from power plants. During the next reporting period, we will document and describe the remainder of the fieldwork at Plant 0, which we expect to be complete by mid-November 2004. This report will include detailed Phase I toxicological findings for all scenarios run, and Phase II toxicological findings for one selected scenario. Depending upon the outcome of the ongoing fieldwork at Plant 0 (i.e. the biological effects observed), not all the proposed scenarios may be evaluated. The next report is also expected to include preliminary field data for Plant 1, located in the Southeast.

  17. Can "realist" randomised controlled trials be genuinely realist?

    PubMed

    Van Belle, Sara; Wong, Geoff; Westhorp, Gill; Pearson, Mark; Emmel, Nick; Manzano, Ana; Marchal, Bruno

    2016-01-01

    In this paper, we respond to a paper by Jamal and colleagues published in Trials in October 2015 and take an opportunity to continue the much-needed debate about what applied scientific realism is. The paper by Jamal et al. is useful because it exposes the challenges of combining a realist evaluation approach (as developed by Pawson and Tilley) with the randomised controlled trial (RCT) design.We identified three fundamental differences that are related to paradigmatic differences in the treatment of causation between post-positivist and realist logic: (1) the construct of mechanism, (2) the relation between mediators and moderators on one hand and mechanisms and contexts on the other hand, and (3) the variable-oriented approach to analysis of causation versus the configurational approach.We show how Jamal et al. consider mechanisms as observable, external treatments and how their approach reduces complex causal processes to variables. We argue that their proposed RCT design cannot provide a truly realist understanding. Not only does the proposed realist RCT design not deal with the RCT's inherent inability to "unpack" complex interventions, it also does not enable the identification of the dynamic interplay among the intervention, actors, context, mechanisms and outcomes, which is at the core of realist research. As a result, the proposed realist RCT design is not, as we understand it, genuinely realist in nature. PMID:27387202

  18. The New Mexico School Nurse and Emergency Medical Services Emergency Preparedness Course: Program Description and Evaluation

    ERIC Educational Resources Information Center

    Elgie, Robert; Sapien, Robert E.; Fullerton-Gleason, Lynne

    2005-01-01

    Illness and injuries are common among students and school staff. Therefore, school nurses must be prepared. In this study, a 16-hour scenario-based emergency preparedness course for school nurses was evaluated for its effectiveness. Effectiveness was measured by (a) traditional methods (written exams and confidence surveys) and (b) skills and…

  19. Realist RCTs of complex interventions - an oxymoron.

    PubMed

    Marchal, Bruno; Westhorp, Gill; Wong, Geoff; Van Belle, Sara; Greenhalgh, Trisha; Kegels, Guy; Pawson, Ray

    2013-10-01

    Bonell et al. discuss the challenges of carrying out randomised controlled trials (RCTs) to evaluate complex interventions in public health, and consider the role of realist evaluation in enhancing this design (Bonell, Fletcher, Morton, Lorenc, & Moore, 2012). They argue for a "synergistic, rather than oppositional relationship between realist and randomised evaluation" and that "it is possible to benefit from the insights provided by realist evaluation without relinquishing the RCT as the best means of examining intervention causality." We present counter-arguments to their analysis of realist evaluation and their recommendations for realist RCTs. Bonell et al. are right to question whether and how (quasi-)experimental designs can be improved to better evaluate complex public health interventions. However, the paper does not explain how a research design that is fundamentally built upon a positivist ontological and epistemological position can be meaningfully adapted to allow it to be used from within a realist paradigm. The recommendations for "realist RCTs" do not sufficiently take into account important elements of complexity that pose major challenges for the RCT design. They also ignore key tenets of the realist evaluation approach. We propose that the adjective 'realist' should continue to be used only for studies based on a realist philosophy and whose analytic approach follows the established principles of realist analysis. It seems more correct to call the approach proposed by Bonell and colleagues 'theory informed RCT', which indeed can help in enhancing RCTs. PMID:23850482

  20. Evaluation of the Emergency Response Dose Assessment System(ERDAS)

    NASA Technical Reports Server (NTRS)

    Evans, Randolph J.; Lambert, Winifred C.; Manobianco, John T.; Taylor, Gregory E.; Wheeler, Mark M.; Yersavich, Ann M.

    1996-01-01

    The emergency response dose assessment system (ERDAS) is a protype software and hardware system configured to produce routine mesoscale meteorological forecasts and enhanced dispersion estimates on an operational basis for the Kennedy Space Center (KSC)/Cape Canaveral Air Station (CCAS) region. ERDAS provides emergency response guidance to operations at KSC/CCAS in the case of an accidental hazardous material release or an aborted vehicle launch. This report describes the evaluation of ERDAS including: evaluation of sea breeze predictions, comparison of launch plume location and concentration predictions, case study of a toxic release, evaluation of model sensitivity to varying input parameters, evaluation of the user interface, assessment of ERDA's operational capabilities, and a comparison of ERDAS models to the ocean breeze dry gultch diffusion model.

  1. Toxicological Evaluation of Realistic Emissions of Source Aerosols (TERESA): Application to Power Plant-Derived PM2.5

    SciTech Connect

    Annette Rohr

    2004-02-29

    This report documents progress made on the subject project during the period of September 1, 2003 through February 28, 2004. The TERESA Study is designed to investigate the role played by specific emissions sources and components in the induction of adverse health effects by examining the relative toxicity of coal combustion and mobile source (gasoline and/or diesel engine) emissions and their oxidative products. The study involves on-site sampling, dilution, and aging of coal combustion emissions at three coal-fired power plants, as well as mobile source emissions, followed by animal exposures incorporating a number of toxicological endpoints. The DOE-EPRI Cooperative Agreement (henceforth referred to as ''the Agreement'') for which this technical progress report has been prepared covers the analysis and interpretation of the field data collected at the first power plant (located in the Upper Midwest), followed by the performance and analysis of similar field experiments at two additional coal-fired power plants utilizing different coal types and with different plant configurations. Modifications to the original study design, which will improve the atmospheric aging component of the project and ensure that emissions are as realistic as possible, have resulted in project delays, and, at the time of report preparation, fieldwork at the Upper Midwest plant had not begun. However, such activities are imminent. This report therefore does not present data for activities covered by the Agreement, but does present results for the laboratory methods development work. This work is critical for the future success of the project. In particular, the atmospheric reaction simulation system is of paramount importance to the TERESA study design, since the basis for the toxicity assessment lies in the generation of realistic exposure atmospheres. The formation, composition, and toxicity of particles will be related to different atmospheric conditions and plume dilution scenarios

  2. Evaluation of a metabolic cotton seedling emergence model

    Technology Transfer Automated Retrieval System (TEKTRAN)

    A model for cotton seedling emergence (MaGi) based on malate synthase kinetics was evaluated in the field at two locations, Lubbock and Big Spring, TX. Cotton, cvar. DP 444, was planted through the early spring and into typical planting times for the areas. Soil temperatures at seed depth was used a...

  3. Engineering Coronaviruses to Evaluate Emergence and Pathogenic Potential.

    PubMed

    Lau, Susanna K P; Woo, Patrick C Y

    2016-06-01

    A recent study provides a platform for generating infectious coronavirus genomes using sequence data, examining their capabilities of replicating in human cells and causing diseases in animal models, and evaluating therapeutics and vaccines. Similar approaches could be used to assess the potential of human emergence and pathogenicity for other viruses. PMID:27095615

  4. Evaluating phenological indicators for predicting giant foxtail (Setaria faberi) emergence

    Technology Transfer Automated Retrieval System (TEKTRAN)

    We evaluated the use of ornamental plants as phenological indicators for predicting giant foxtail emergence, and compared their performance with predictions based upon calendar date, cumulative growing degree-days (GDD) and the WeedCast program. From 1997 to 2001, we monitored giant foxtail emergenc...

  5. Understanding the motivation and performance of community health volunteers involved in the delivery of health programmes in Kampala, Uganda: a realist evaluation protocol

    PubMed Central

    Vareilles, Gaëlle; Pommier, Jeanine; Kane, Sumit; Pictet, Gabriel; Marchal, Bruno

    2015-01-01

    Introduction The recruitment of community health volunteers to support the delivery of health programmes is a well-established approach in many countries, particularly where health services are not readily available. However, studies on management of volunteers are scarce and current research on human resource management of volunteers faces methodological challenges. This paper presents the protocol of a realist evaluation that aims at identifying the factors influencing the performance of community health volunteers involved in the delivery of a Red Cross immunisation programme in Kampala (Uganda) with a specific focus on motivation. Methods and analysis The realist evaluation cycle structures the protocol. To develop the theoretical basis for the evaluation, the authors conducted interviews and reviewed the literature on community health volunteers’ performance, management and organisational behaviour. This led to the formulation of the initial programme theory, which links the intervention inputs (capacity-building strategies) to the expected outcomes (positive work behaviour) with mechanisms that point in the direction of drivers of motivation. The contextual elements include components such as organisational culture, resource availability, etc. A case study design will be adopted. We define a case as a Red Cross branch, run by a programme manager, and will select two cases at the district level in Kampala. Mixed methods will be used in data collection, including individual interviews of volunteers, participant observation and document review. The thematic analysis will be based on the initial programme theory and will seek for context-mechanism-outcome configurations. Findings from the two cases will be compared. Discussion We discuss the scope for applying realist evaluation and the methodological challenges we encountered in developing this protocol. Ethics and dissemination The study was approved by the Ethical Committee at Rennes University Hospital

  6. Avertable dose intervention applied in emergency response dose evaluation system for nuclear emergency preparedness in Taiwan

    NASA Astrophysics Data System (ADS)

    Lu, Chung-hsin; Teng, Jen-hsin; Yang, Yung-muh; Chang, Bor-jing

    2010-06-01

    In Taiwan the new guides for the nuclear emergency public protective action were laid down by the Atomic Energy Council (AEC) of Executive Yuan, Taiwan, ROC on July 15th, 2005. The main modifications of the guides are that the avertable dose is applied as the intervention levels and suggests the public protective actions. The emergency response dose evaluation system named RPDOSE, which was developed in 2005, was employed in this work to enhance the capability of the avertable dose evaluation for the villages in the emergency planning zone (EPZ). The period of the long-term weather forecasting data was extended from 4 to 8 days to satisfy the requirement of avertable dose computing. According to the intervention levels, the RPDOSE system is used to calculate the avertable dose and suggest appropriate public protective actions such as sheltering, evacuation or iodine prophylaxis as well as the proposed acting times for each village in the EPZ. This system was employed and examined in the annual nuclear emergency exercise of 2008 in the Maanshan nuclear power plant.

  7. Development of a realistic photonic modeling for the evaluation of infrared reflections in the metallic environment of ITER

    SciTech Connect

    Aumeunier, M.-H.; Travere, J.-M.

    2010-10-15

    In nuclear fusion experiments, the plasma facing components are exposed to high heat fluxes and infrared (IR) imaging diagnostics are routinely used for surveying their surface temperature for preventing damages. However the future use of metallic components in the ITER tokamak adds complications in temperature estimation. Indeed, low and variable emissivity of the observed surface and the multiple reflections of the light coming from hot regions will have to be understood and then taken into account. In this paper, a realistic photonic modeling based on Monte Carlo ray-tracing codes is used to predict the global response of the complete IR survey system. This also includes the complex vessel geometry and the thermal and optical surface properties using the bidirectional reflectivity distribution function that models the photon-material interactions. The first results of this simulation applied to a reference torus are presented and are used as a benchmark to investigate the validity of the global model. Finally the most critical key model parameters in the reflected signals are identified and their contribution is discussed.

  8. Diversion to the mental health system: emergency psychiatric evaluations.

    PubMed

    Janofsky, Jeffrey S; Tamburello, Anthony C

    2006-01-01

    In Maryland, any citizen may petition to have individuals brought against their will for an examination by a physician. In this retrospective chart review, we evaluated the characteristics of 300 persons referred to the Johns Hopkins Hospital on emergency petitions. Sixty-one percent of petitions described individuals who made verbal or physical threats of self-harm. Forty-seven percent of the petitions described individuals who could have been arrested based on dangerousness to others or property, but were instead diverted to the emergency room for psychiatric evaluation. Although not promoted as a jail diversion program, this process has the potential to direct mentally ill citizens appropriately from the criminal justice system into the mental health system. Greater involvement of mental health professionals at all stages, including police training and participation in crisis response teams in the community, may improve this process. PMID:17032950

  9. What works in ‘real life’ to facilitate home deaths and fewer hospital admissions for those at end of life?: results from a realist evaluation of new palliative care services in two English counties

    PubMed Central

    2014-01-01

    Background We evaluated end of life care services in two English counties including: coordination centres, telephone advice line, ‘Discharge in Reach’ nurses, a specialist community personal care team and community nurse educators. Elsewhere, we published findings detailing high family carer satisfaction and fewer hospital admissions, Accident and Emergency attendances and hospital deaths for service users compared to controls. The aim of this paper is to discuss what contributed to those outcomes. Methods Using realist evaluation, data collection included documentation (e.g. referral databases), 15 observations of services and interviews with 43 family carers and 105 professionals. Data were analysed using framework analysis, applying realist evaluation concepts. Findings were discussed at successive team meetings and further data was collected until team consensus was reached. Results Services ‘worked’ primarily for those with cancer with ‘fast track’ funding who were close to death. Factors contributing to success included services staffed with experienced palliative care professionals with dedicated (and sufficient) time for difficult conversations with family carers, patients and/or clinical colleagues about death and the practicalities of caring for the dying. Using their formal and informal knowledge of the local healthcare system, they accessed community resources to support homecare and delivered excellent services. This engendered confidence and reassurance for staff, family carers and patients, possibly contributing to less hospital admissions and A&E attendances and more home deaths. Conclusions With demand for 24-hour end of life care growing and care provision fragmented across health and social care boundaries, services like these that cut across organisational sectors may become more important. They offer an overview to help navigate those desiring a home death through the system. PMID:25075202

  10. The Development and Initial Evaluation of a Realistic Simulated SPECT Dataset with Simultaneous Respiratory and Cardiac Motion for Gated Myocardial Perfusion SPECT

    PubMed Central

    Lee, Taek-Soo; Tsui, Benjamin M. W.

    2015-01-01

    We developed a realistic simulation dataset for simultaneous respiratory and cardiac (R&C) gated SPECT/CT using the 4D NURBS-based Cardiac-Torso (NCAT) Phantom and Monte Carlo simulation methods, and evaluated it for a sample application study. The 4D NCAT phantom included realistic respiratory motion and beating heart motion based on respiratory gated CT and cardiac tagged MRI data of normal human subjects. To model the respiratory motion, a set of 24 separate 3D NCAT phantoms excluding the heart was generated over a respiratory cycle. The beating heart motion was modelled separately with 48 frames per cardiac cycle for each of the 24 respiratory phases. The resultant set of 24×48 3D NCAT phantoms provides a realistic model of a normal human subject at different phases of combined R&C motions. An almost noise-free SPECT projection dataset for each of the 1,152 3D NCAT phantoms was generated using Monte Carlo simulation techniques and the radioactivity uptake distribution of 99mTc sestamibi in different organs. By grouping and summing the separate projection datasets, separate or simultaneous R&C gated acquired data with different gating schemes could be simulated. In the initial evaluation, we combined the projection datasets into no gating, 6 respiratory-gates only, 8 cardiac-gates only, and combined 6 respiratory-gates & 8 cardiac-gates projection datasets. Each dataset was reconstructed using 3D OS-EM without and with attenuation correction using the averaged and respiratory-gated attenuation maps, and the resulting reconstructed images were compared. These results were used to demonstrate the effects of R&C motions and the reduction of image artifact due to R&C motions by gating and attenuation corrections. We concluded that the realistic 4D NCAT phantom and Monte Carlo simulated SPECT projection datasets with R&C motions are powerful tools in the study of the effects of R&C motions, as well as in the development of R&C gating schemes and motion correction

  11. The development and initial evaluation of a realistic simulated SPECT dataset with simultaneous respiratory and cardiac motion for gated myocardial perfusion SPECT

    NASA Astrophysics Data System (ADS)

    Lee, Taek-Soo; Tsui, Benjamin M. W.

    2015-02-01

    We developed a realistic simulation dataset for simultaneous respiratory and cardiac (R&C) gated SPECT/CT using the 4D NURBS-based Cardiac-Torso (NCAT) Phantom and Monte Carlo simulation methods, and evaluated it for a sample application study. The 4D NCAT phantom included realistic respiratory motion and beating heart motion based on respiratory gated CT and cardiac tagged MRI data of normal human subjects. To model the respiratory motion, a set of 24 separate 3D NCAT phantoms excluding the heart was generated over a respiratory cycle. The beating heart motion was modeled separately with 48 frames per cardiac cycle for each of the 24 respiratory phases. The resultant set of 24  ×  48 3D NCAT phantoms provides a realistic model of a normal human subject at different phases of combined R&C motions. An almost noise-free SPECT projection dataset for each of the 1152 3D NCAT phantoms was generated using Monte Carlo simulation techniques and the radioactivity uptake distribution of 99mTc sestamibi in different organs. By grouping and summing the separate projection datasets, separate or simultaneous R&C gated acquired data with different gating schemes could be simulated. In the initial evaluation, we combined the projection datasets into ungated, 6 respiratory-gates only, 8 cardiac-gates only, and combined 6 respiratory-gates & 8 cardiac-gates projection datasets. Each dataset was reconstructed using 3D OS-EM without and with attenuation correction using the averaged and respiratory-gated attenuation maps, and the resulting reconstructed images were compared. These results were used to demonstrate the effects of R&C motions and the reduction of image artifact due to R&C motions by gating and attenuation corrections. We concluded that the realistic 4D NCAT phantom and Monte Carlo simulated SPECT projection datasets with R&C motions are powerful tools in the study of the effects of R&C motions, as well as in the development of R&C gating schemes and motion

  12. The development and initial evaluation of a realistic simulated SPECT dataset with simultaneous respiratory and cardiac motion for gated myocardial perfusion SPECT.

    PubMed

    Lee, Taek-Soo; Tsui, Benjamin M W

    2015-02-21

    We developed a realistic simulation dataset for simultaneous respiratory and cardiac (R&C) gated SPECT/CT using the 4D NURBS-based Cardiac-Torso (NCAT) Phantom and Monte Carlo simulation methods, and evaluated it for a sample application study. The 4D NCAT phantom included realistic respiratory motion and beating heart motion based on respiratory gated CT and cardiac tagged MRI data of normal human subjects. To model the respiratory motion, a set of 24 separate 3D NCAT phantoms excluding the heart was generated over a respiratory cycle. The beating heart motion was modeled separately with 48 frames per cardiac cycle for each of the 24 respiratory phases. The resultant set of 24  ×  48 3D NCAT phantoms provides a realistic model of a normal human subject at different phases of combined R&C motions. An almost noise-free SPECT projection dataset for each of the 1152 3D NCAT phantoms was generated using Monte Carlo simulation techniques and the radioactivity uptake distribution of (99m)Tc sestamibi in different organs. By grouping and summing the separate projection datasets, separate or simultaneous R&C gated acquired data with different gating schemes could be simulated. In the initial evaluation, we combined the projection datasets into ungated, 6 respiratory-gates only, 8 cardiac-gates only, and combined 6 respiratory-gates & 8 cardiac-gates projection datasets. Each dataset was reconstructed using 3D OS-EM without and with attenuation correction using the averaged and respiratory-gated attenuation maps, and the resulting reconstructed images were compared. These results were used to demonstrate the effects of R&C motions and the reduction of image artifact due to R&C motions by gating and attenuation corrections. We concluded that the realistic 4D NCAT phantom and Monte Carlo simulated SPECT projection datasets with R&C motions are powerful tools in the study of the effects of R&C motions, as well as in the development of R&C gating schemes and motion

  13. Information technology model for evaluating emergency medicine teaching

    NASA Astrophysics Data System (ADS)

    Vorbach, James; Ryan, James

    1996-02-01

    This paper describes work in progress to develop an Information Technology (IT) model and supporting information system for the evaluation of clinical teaching in the Emergency Medicine (EM) Department of North Shore University Hospital. In the academic hospital setting student physicians, i.e. residents, and faculty function daily in their dual roles as teachers and students respectively, and as health care providers. Databases exist that are used to evaluate both groups in either academic or clinical performance, but rarely has this information been integrated to analyze the relationship between academic performance and the ability to care for patients. The goal of the IT model is to improve the quality of teaching of EM physicians by enabling the development of integrable metrics for faculty and resident evaluation. The IT model will include (1) methods for tracking residents in order to develop experimental databases; (2) methods to integrate lecture evaluation, clinical performance, resident evaluation, and quality assurance databases; and (3) a patient flow system to monitor patient rooms and the waiting area in the Emergency Medicine Department, to record and display status of medical orders, and to collect data for analyses.

  14. Establishing Fair and Realistic Entry and Exit Criteria Using the General Evaluation Matrix (GEM), a Special Education Decision Making Tool.

    ERIC Educational Resources Information Center

    Maxwell, Kenneth G.

    The paper describes the development and use of a General Evaluation Matrix (GEM), a profile technique by which major handicaps are graphically presented along with school grades and achievements in basic skills. The approach lends itself to establishing entry level criteria for special education suited to the needs of specific communities.…

  15. Toxicological Evaluation of Realistic Emission Source Aerosols (TERESA)—Power plant studies: assessment of breathing pattern

    PubMed Central

    Diaz, Edgar A.; Lemos, Miriam; Coull, Brent; Long, Mark S.; Rohr, Annette C.; Ruiz, Pablo; Gupta, Tarun; Kang, Choong-Min; Godleski, John J.

    2013-01-01

    Our approach to study multi-pollutant aerosols isolates a single emissions source, evaluates the toxicity of primary and secondary particles derived from this source, and simulates chemical reactions that occur in the atmosphere after emission. Three U.S. coal-fired power plants utilizing different coals and with different emission controls were evaluated. Secondary organic aerosol (SOA) derived from α-pinene and/or ammonia was added in some experiments. Male Sprague-Dawley rats were exposed for 6 h to filtered air or different atmospheric mixtures. Scenarios studied at each plant included the following: primary particles (P); secondary (oxidized) particles (PO); oxidized particles + SOA (POS); and oxidized and neutralized particles + SOA (PONS); additional control scenarios were also studied. Continuous respiratory data were obtained during exposures using whole body plethysmography chambers. Of the 12 respiratory outcomes assessed, each had statistically significant changes at some plant and with some of the 4 scenarios. The most robust outcomes were found with exposure to the PO scenario (increased respiratory frequency with decreases in inspiratory and expiratory time); and the PONS scenario (decreased peak expiratory flow and expiratory flow at 50%). PONS findings were most strongly associated with ammonium, neutralized sulfate, and elemental carbon (EC) in univariate analyses, but only with EC in multivariate analyses. Control scenario O (oxidized without primary particles) had similar changes to PO. Adjusted R2 analyses showed that scenario was a better predictor of respiratory responses than individual components, suggesting that the complex atmospheric mixture was responsible for respiratory effects. PMID:21639693

  16. Understanding the motivation and performance of community health volunteers involved in the delivery of health programmes in Kampala, Uganda: a realist evaluation

    PubMed Central

    Vareilles, Gaëlle; Marchal, Bruno; Kane, Sumit; Petrič, Taja; Pictet, Gabriel; Pommier, Jeanine

    2015-01-01

    Objectives This paper presents the results of a realist evaluation that aimed to understand how, why and under what circumstances a Red Cross (RC) capacity-building intervention influences the motivation and the performance of RC community health volunteers involved in the delivery of an immunisation programme in Kampala, Uganda. Method Given the complexity of the intervention, we adopted realist evaluation as our methodological approach and the case study as our study design. Data collection included document review, participant observation and interviews. The constant comparative method was used for the analysis. Two contrasted cases were selected within the five Kampala districts. Each case covers the management of the immunisation programme implemented at a RC branch. In each case, a programme manager and 15 RC volunteers were interviewed. The selection of the volunteers was purposive. Results We found that a capacity-building programme including supervision supportive of autonomy, skills and knowledge enhancement, and adapted to the different subgroups of volunteers, leads to satisfaction of the three key drivers of volunteer motivation: feelings of autonomy, competence and connectedness. This contributes to higher retention, and better task performance and well-being among the volunteers. Enabling contextual conditions include the responsiveness of the Uganda Red Cross Society (URCS) to community needs, and recognition of the work of the volunteers, from the URCS and the community. Conclusions A management approach that caters for the different motivational states and changing needs of the volunteers will lead to better performance. The findings will inform not only the management of community health volunteers, but also the management of all kinds of health workers. PMID:26525721

  17. 75 FR 22817 - Emerging Infectious Diseases: Evaluation to Implementation for Transfusion and Transplantation...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-04-30

    ... HUMAN SERVICES Food and Drug Administration Emerging Infectious Diseases: Evaluation to Implementation... Infectious Diseases: Evaluation to Implementation for Transfusion and Transplantation Safety'' (EID public... of risk from, and prioritization of response to, emerging infectious diseases relevant to...

  18. An evaluation into the efficiency and effectiveness of machine learning algorithms in realistic traffic pattern prediction using field data

    NASA Astrophysics Data System (ADS)

    Ekedebe, Nnanna; Yu, Wei; Lu, Chao; Moulema, Paul

    2015-05-01

    Accurate and timely knowledge is critical in intelligent transportation system (ITS) as it leads to improved traffic flow management. The knowledge of the past can be useful for the future as traffic patterns normally follow a predictable pattern with respect to time of day, and day of week. In this paper, we systematically evaluated the prediction accuracy and speed of several supervised machine learning algorithms towards congestion identification based on six weeks real-world traffic data from August 1st, 2012 to September 12th, 2012 in the Maryland (MD)/Washington DC, and Virginia (VA) area. Our dataset consists of six months traffic data pattern from July 1, 2012 to December 31, 2012, of which 6 weeks was used as a representative sample for the purposes of this study on our reference roadway - I-270. Our experimental data shows that with respect to classification, classification tree (Ctree) could provide the best prediction accuracy with an accuracy rate of 100% and prediction speed of 0.34 seconds. It is pertinent to note that variations exist respecting prediction accuracy and prediction speed; hence, a tradeoff is often necessary respecting the priority of the applications in question. It is also imperative to note from the outset that, algorithm design and calibration are important factors in determining their effectiveness.

  19. Evaluation of a micro-scale wind model's performance over realistic building clusters using wind tunnel experiments

    NASA Astrophysics Data System (ADS)

    Zhang, Ning; Du, Yunsong; Miao, Shiguang; Fang, Xiaoyi

    2016-08-01

    The simulation performance over complex building clusters of a wind simulation model (Wind Information Field Fast Analysis model, WIFFA) in a micro-scale air pollutant dispersion model system (Urban Microscale Air Pollution dispersion Simulation model, UMAPS) is evaluated using various wind tunnel experimental data including the CEDVAL (Compilation of Experimental Data for Validation of Micro-Scale Dispersion Models) wind tunnel experiment data and the NJU-FZ experiment data (Nanjing University-Fang Zhuang neighborhood wind tunnel experiment data). The results show that the wind model can reproduce the vortexes triggered by urban buildings well, and the flow patterns in urban street canyons and building clusters can also be represented. Due to the complex shapes of buildings and their distributions, the simulation deviations/discrepancies from the measurements are usually caused by the simplification of the building shapes and the determination of the key zone sizes. The computational efficiencies of different cases are also discussed in this paper. The model has a high computational efficiency compared to traditional numerical models that solve the Navier-Stokes equations, and can produce very high-resolution (1-5 m) wind fields of a complex neighborhood scale urban building canopy (~ 1 km ×1 km) in less than 3 min when run on a personal computer.

  20. Evaluation of the dentists' knowledge on medical urgency and emergency.

    PubMed

    Stafuzza, Tássia Carina; Carrara, Cleide Felício Carvalho; Oliveira, Fernanda Veronese; Santos, Carlos Ferreira; Oliveira, Thais Marchini

    2014-01-01

    This study aimed at evaluating how well dentists understand medical emergency/urgency procedures and issues during dental treatment at a hospital specialized in cleft lip and palate. It comprised a hundred dentists from the Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo (HRAC/USP), Brazil, from different dental specialties. A questionnaire was applied to evaluate their knowledge of medical emergencies/urgencies from June through September 2011. The questionnaire was anonymous, confidential and constructed with closed questions and either yes-no or multiple-choice responses. Results showed that most professionals (87%) were trained in basic life support (BLS), but only 43% considered themselves capable of providing first aid and performing the necessary maneuvers. Most participants (94%) claimed that they knew the difference between medical urgencies and emergencies, and 69% had BLS training in their undergraduate courses, as opposed to 37%, during their specialization. Some participants (23%) mentioned that they had received knowledge of the subject during extracurricular courses and/or graduate courses (12%). Only 9% had not been educated on the subject; however, all participants showed interest in attending a course in BLS. In regard to assessing training that dentists who attended BLS courses received, 49% were satisfied and 42% were dissatisfied. Results of the present study emphasize that dentists from HRAC/USP have little knowledge about BLS procedures to perform them. Dentists must gain adequate education and training to minimize possible technical, ethical and legal problems associated with dental practice. It is necessary to improve both knowledge and practice in order to become well-qualified practitioners. PMID:25141014

  1. TOXICOLOGICAL EVALUATION OF REALISTIC EMISSIONS OF SOURCE AEROSOLS (TERESA): APPLICATION TO POWER PLANT-DERIVED PM2.5

    SciTech Connect

    Annette Rohr

    2005-03-31

    emissions were performed. Stage I toxicological assessments were carried out in Sprague-Dawley rats. Biological endpoints included breathing pattern/pulmonary function; in vivo chemiluminescence (an indicator of oxidative stress); blood cytology; bronchoalveolar lavage (BAL) fluid analysis; and histopathology. No significant differences between exposed animals and sham animals (exposed to filtered air) were observed for any of the endpoints; histopathological results are pending and will be reported in the next semiannual report. The scenarios evaluated during this reporting period were slightly modified from those originally proposed. We substituted a new scenario, secondary aerosol + SOA, to investigate the effects of a strongly acidic aerosol with a biogenic component. Since we did not observe any biological response to this scenario, the neutralized secondary aerosol scenario (i.e., oxidized emissions + ammonia) was deemed unnecessary. Moreover, in light of the lack of response observed in the Stage I assessment, it was decided that a Stage II assessment (evaluation of cardiac function in a compromised rat model) was unlikely to provide useful information. However, this model will be employed at Plant 1 and/or 2. During this reporting period, significant progress was made in planning for fieldwork at Plant 1. Stack sampling was carried out at the plant in mid-December to determine the concentration of primary particles. It was found that PM{sub 2.5} mass concentrations were approximately three times higher than those observed at Plant 0. In mid-February, installation and setup for the mobile laboratories began. Animal exposures are scheduled to begin at this plant on March 21, 2005. During the next reporting period, we will initiate fieldwork at Plant 1. At either or both Plants 1 and 2, a detailed Stage II assessment will be performed, even if no significant findings are observed in Stage I. The next semiannual report is expected to include a detailed description of

  2. Can a sustainability and health scenario provide a realistic challenge to student nurses and provoke changes in practice? An evaluation of a training intervention.

    PubMed

    Grose, J; Richardson, J

    2016-06-01

    Climate change and limited natural resources will impact on the sustainable supply and disposal of materials used in health care. Healthcare students need opportunities to reflect on the ecological footprint of health services to mitigate against negative effects on service delivery. In order to raise awareness of these issues, there is a need for evidence-based teaching tools which are relevant and meaningful to nursing practice. An evidence-based sustainability skills teaching session was delivered to 293 nursing students from child and adult health disciplines. Following the sessions, evaluation sheets were distributed to the participants, of which 290 responded. The majority of nurses valued both the delivery and the content of the training and some were motivated to complete further study. The evaluation provided valuable information on how to deliver sustainability education and important insights into where more information and support was needed in order to change practice. Embedding sustainability teaching in skill sessions appears to be a realistic way of informing and motivating learners to consider current and best practice. Following training, further evaluation of practice-based behaviour is needed. PMID:26354719

  3. Evaluation of phytotoxicity and ecotoxicity potentials of a cyanobacterial extract containing microcystins under realistic environmental concentrations and in a soil-plant system.

    PubMed

    Corbel, Sylvain; Mougin, Christian; Martin-Laurent, Fabrice; Crouzet, Olivier; Bru, David; Nélieu, Sylvie; Bouaïcha, Noureddine

    2015-06-01

    The impact of a crude extract of Microcystis aeruginosa (PCC7820) containing 14 microcystin variants was investigated on seeds germination and radicles development of four agricultural plants: two tomato varieties Solanum lycopersicum (MicroTom and Saint-Pierre), the wheat Triticum aestivum and the lettuce Lactuca sativa. In addition, the effect of 14 d-exposure to irrigation water containing realistic concentrations of microcystins (0-0.1 mg eq. microcystin-LRL(-1)) on the tomato MicroTom seedling growth was further evaluated on roots and aerial part biomasses. Impacts on soil bacterial parameters, as such extracellular enzymatic activities, nitrification activity and abundances of ammonia-oxidizing microorganisms were also investigated. In germination-test, the cyanobacterial extract inhibited only the germination of the wheat seeds, with an EC50 of 11 mg eq. microcystin-LRL(-1); which is 13 times lower than that of the cadmium chloride (EC50 of 145 mg L(-1)). Moreover, the cyanobacterial extract containing low concentrations of microcystins increased the growth of primary roots; however, high concentrations decreased it for all plants except for the wheat. In the soil-plant approach, only aerial part biomass of the tomato MicroTom was enhanced significantly. In addition, only soil nitrification potential and ammonia-oxidizing bacterial abundances were consistently impacted. A significant positive correlation (r=0.56) was found between the increase of nitrification potential and abundances of ammonia-oxidizing bacteria. This work suggested, that exposure to a cyanobacterial extract containing realistic environmental microcystins concentrations could affect seed germination, depending plant species. It was also highlighted, for the first time, disturbances in soil bacteria functioning, evidences on soil nitrification process. PMID:25754013

  4. Performance evaluation of two emerging media processors: VIRAM and imagine

    SciTech Connect

    Oliker, Leonid; Duell, Jason; Narayanan, Manikandan; Chatterji, Sourav

    2003-01-01

    This work presents two emerging media microprocessors, VIRAM and Imagine, and compares the implementation strategies and performance results of these unique architectures. VIRAM is a complete system on a chip which uses PIM technology to combine vector processing with embedded DRAM. Imagine is a programmable streaming architecture with a specialized memory hierarchy designed for computationally intensive data-parallel codes. First, we present a simple and effective approach for understanding and optimizing vector/stream applications. Performance results are then presented from a number of multimedia benchmarks and a computationally intensive scientific kernel. We explore the complex interact ions between programming paradigms, the architectural support at the ISA lever and the underlying microarchitecture of these two systems. Our long term goal is to evaluate leading media microprocessors as possible building blocks for future high performance systems.

  5. Evaluation of quantitative imaging methods for organ activity and residence time estimation using a population of phantoms having realistic variations in anatomy and uptake

    PubMed Central

    He, Bin; Du, Yong; Segars, W. Paul; Wahl, Richard L.; Sgouros, George; Jacene, Heather; Frey, Eric C.

    2009-01-01

    Estimating organ residence times is an essential part of patient-specific dosimetry for radioimmunotherapy (RIT). Quantitative imaging methods for RIT are often evaluated using a single physical or simulated phantom but are intended to be applied clinically where there is variability in patient anatomy, biodistribution, and biokinetics. To provide a more relevant evaluation, the authors have thus developed a population of phantoms with realistic variations in these factors and applied it to the evaluation of quantitative imaging methods both to find the best method and to demonstrate the effects of these variations. Using whole body scans and SPECT∕CT images, organ shapes and time-activity curves of 111In ibritumomab tiuxetan were measured in dosimetrically important organs in seven patients undergoing a high dose therapy regimen. Based on these measurements, we created a 3D NURBS-based cardiac-torso (NCAT)-based phantom population. SPECT and planar data at realistic count levels were then simulated using previously validated Monte Carlo simulation tools. The projections from the population were used to evaluate the accuracy and variation in accuracy of residence time estimation methods that used a time series of SPECT and planar scans. Quantitative SPECT (QSPECT) reconstruction methods were used that compensated for attenuation, scatter, and the collimator-detector response. Planar images were processed with a conventional (CPlanar) method that used geometric mean attenuation and triple-energy window scatter compensation and a quantitative planar (QPlanar) processing method that used model-based compensation for image degrading effects. Residence times were estimated from activity estimates made at each of five time points. The authors also evaluated hybrid methods that used CPlanar or QPlanar time-activity curves rescaled to the activity estimated from a single QSPECT image. The methods were evaluated in terms of mean relative error and standard deviation of

  6. Evaluation of quantitative imaging methods for organ activity and residence time estimation using a population of phantoms having realistic variations in anatomy and uptake

    SciTech Connect

    He Bin; Du Yong; Segars, W. Paul; Wahl, Richard L.; Sgouros, George; Jacene, Heather; Frey, Eric C.

    2009-02-15

    Estimating organ residence times is an essential part of patient-specific dosimetry for radioimmunotherapy (RIT). Quantitative imaging methods for RIT are often evaluated using a single physical or simulated phantom but are intended to be applied clinically where there is variability in patient anatomy, biodistribution, and biokinetics. To provide a more relevant evaluation, the authors have thus developed a population of phantoms with realistic variations in these factors and applied it to the evaluation of quantitative imaging methods both to find the best method and to demonstrate the effects of these variations. Using whole body scans and SPECT/CT images, organ shapes and time-activity curves of 111In ibritumomab tiuxetan were measured in dosimetrically important organs in seven patients undergoing a high dose therapy regimen. Based on these measurements, we created a 3D NURBS-based cardiac-torso (NCAT)-based phantom population. SPECT and planar data at realistic count levels were then simulated using previously validated Monte Carlo simulation tools. The projections from the population were used to evaluate the accuracy and variation in accuracy of residence time estimation methods that used a time series of SPECT and planar scans. Quantitative SPECT (QSPECT) reconstruction methods were used that compensated for attenuation, scatter, and the collimator-detector response. Planar images were processed with a conventional (CPlanar) method that used geometric mean attenuation and triple-energy window scatter compensation and a quantitative planar (QPlanar) processing method that used model-based compensation for image degrading effects. Residence times were estimated from activity estimates made at each of five time points. The authors also evaluated hybrid methods that used CPlanar or QPlanar time-activity curves rescaled to the activity estimated from a single QSPECT image. The methods were evaluated in terms of mean relative error and standard deviation of the

  7. Evaluation of quantitative imaging methods for organ activity and residence time estimation using a population of phantoms having realistic variations in anatomy and uptake.

    PubMed

    He, Bin; Du, Yong; Segars, W Paul; Wahl, Richard L; Sgouros, George; Jacene, Heather; Frey, Eric C

    2009-02-01

    Estimating organ residence times is an essential part of patient-specific dosimetry for radioimmunotherapy (RIT). Quantitative imaging methods for RIT are often evaluated using a single physical or simulated phantom but are intended to be applied clinically where there is variability in patient anatomy, biodistribution, and biokinetics. To provide a more relevant evaluation, the authors have thus developed a population of phantoms with realistic variations in these factors and applied it to the evaluation of quantitative imaging methods both to find the best method and to demonstrate the effects of these variations. Using whole body scans and SPECT/CT images, organ shapes and time-activity curves of 111In ibritumomab tiuxetan were measured in dosimetrically important organs in seven patients undergoing a high dose therapy regimen. Based on these measurements, we created a 3D NURBS-based cardiac-torso (NCAT)-based phantom population. SPECT and planar data at realistic count levels were then simulated using previously validated Monte Carlo simulation tools. The projections from the population were used to evaluate the accuracy and variation in accuracy of residence time estimation methods that used a time series of SPECT and planar scans, Quantitative SPECT (QSPECT) reconstruction methods were used that compensated for attenuation, scatter, and the collimator-detector response. Planar images were processed with a conventional (CPlanar) method that used geometric mean attenuation and triple-energy window scatter compensation and a quantitative planar (QPlanar) processing method that used model-based compensation for image degrading effects. Residence times were estimated from activity estimates made at each of five time points. The authors also evaluated hybrid methods that used CPlanar or QPlanar time-activity curves rescaled to the activity estimated from a single QSPECT image. The methods were evaluated in terms of mean relative error and standard deviation of the

  8. Evaluation of Rugged Wireless Mesh Nodes for Use In Emergency Response

    SciTech Connect

    Kevin L Young; Alan M Snyder

    2007-11-01

    During the summer of 2007, engineers at the Idaho National Laboratory (INL) conducted a two-day evaluation of commercially available battery powered, wireless, self-forming mesh nodes for use in emergency response. In this paper, the author describes the fundamentals of this emerging technology, applciations for emergency response and specific results of the technology evaluation conducted at the Idaho National Laboratory.

  9. Emergency contraception: preliminary report of a demonstration and evaluation project.

    PubMed

    Petitti, D B; Harvey, S M; Preskill, D; Beckman, L J; Postlethwaite, D; Switzky, H; Sherman, C

    1998-01-01

    Kaiser Permanente Southern California and the Pacific Institute for Women's Health began a demonstration and evaluation project on emergency contraceptive pills (ECPs) in the summer of 1996 with the goal of evaluating the feasibility and acceptability of ECPs in a large health maintenance organization and developing institutional templates, provider training and patient education materials that could be used to replicate the project. The ECP program had six components: repackaging of oral contraceptives in an ECP "kit," development of provider education materials, development of patient education materials, in-service training, making ECPs kits available in convenient locations, and development of materials to support replication of the project inside and outside Kaiser Permanente. Although data are still being analyzed, preliminary results are promising. The success of the project within this relatively conservative, but well-established medical care organization provides a model for others. The development of a standard set of educational materials and approaches to implementation should facilitate dispensing ECPs in other settings. PMID:9859634

  10. How shall we examine and learn about public-private partnerships (PPPs) in the health sector? Realist evaluation of PPPs in Hong Kong.

    PubMed

    Wong, Eliza L Y; Yeoh, Eng-Kiong; Chau, Patsy Y K; Yam, Carrie H K; Cheung, Annie W L; Fung, Hong

    2015-12-01

    The World Health Organization advocates the goal of universal coverage of health systems to ensure that everyone can avail the services they need and are protected from the associated financial risks. Governments are increasingly engaging and interacting with the private sector in initiatives collectively referred to as public-private partnerships (PPPs) to enhance the capacity of health systems to meet this objective. Understanding the values that motivate partners and demonstrating commitment for building relationships were found to be key lessons in building effective PPPs; however there, remain many research gaps. This study focusses on the practice of PPPs at the inter-organisational (meso) level and interpersonal (micro) level in Hong Kong Special Administrative Region (HKSAR). The influence of the structural components of different PPPs on stakeholder interpretation and actions, as well as the eventual outcomes of the PPPs, is examined, in terms of a realist evaluation, which applies a context-mechanism-outcome configuration as the research methodology. Seven key factors initiating commitment in a partnership, critical for sustainable PPPs, were identified as follows: (1) building of trust; (2) clearly defined objectives and roles; (3) time commitment; (4) transparency and candid information, particularly in relation to risk and benefit; (5) contract flexibility; (6) technical assistance or financial incentive behind procedural arrangements; and (7) the awareness and acceptability of structural changes related to responsibility and decisions (power and authority). PMID:26605970

  11. Realistic collective nuclear Hamiltonian

    SciTech Connect

    Dufour, M.; Zuker, A.P.

    1996-10-01

    The residual part of the realistic forces{emdash}obtained after extracting the monopole terms responsible for bulk properties{emdash}is strongly dominated by pairing and quadrupole interactions, with important {sigma}{tau}{center_dot}{sigma}{tau}, octupole, and hexadecapole contributions. Their forms retain the simplicity of the traditional pairing plus multipole models, while eliminating their flaws through a normalization mechanism dictated by a universal {ital A}{sup {minus}1/3} scaling. Coupling strengths and effective charges are calculated and shown to agree with empirical values. Comparisons between different realistic interactions confirm the claim that they are very similar. {copyright} {ital 1996 The American Physical Society.}

  12. Performance Evaluation of Emerging High Performance Computing Technologies using WRF

    NASA Astrophysics Data System (ADS)

    Newby, G. B.; Morton, D.

    2008-12-01

    The Arctic Region Supercomputing Center (ARSC) has evaluated multicore processors and other emerging processor technologies for a variety of high performance computing applications in the earth and space sciences, especially climate and weather applications. A flagship effort has been to assess dual core processor nodes on ARSC's Midnight supercomputer, in which two-socket systems were compared to eight-socket systems. Midnight is utilized for ARSC's twice-daily weather research and forecasting (WRF) model runs, available at weather.arsc.edu. Among other findings on Midnight, it was found that the Hypertransport system for interconnecting Opteron processors, memory, and other subsystems does not scale as well on eight-socket (sixteen processor) systems as well as two-socket (four processor) systems. A fundamental limitation is the cache snooping operation performed whenever a computational thread accesses main memory. This increases memory latency as the number of processor sockets increases. This is particularly noticeable on applications such as WRF that are primarily CPU-bound, versus applications that are bound by input/output or communication. The new Cray XT5 supercomputer at ARSC features quad core processors, and will host a variety of scaling experiments for WRF, CCSM4, and other models. Early results will be presented, including a series of WRF runs for Alaska with grid resolutions under 2km. ARSC will discuss a set of standardized test cases for the Alaska domain, similar to existing test cases for CONUS. These test cases will provide different configuration sizes and resolutions, suitable for single processors up to thousands. Beyond multi-core Opteron-based supercomputers, ARSC has examined WRF and other applications on additional emerging technologies. One such technology is the graphics processing unit, or GPU. The 9800-series nVidia GPU was evaluated with the cuBLAS software library. While in-socket GPUs might be forthcoming in the future, current

  13. Supporting Sustainable Markets Through Life Cycle Assessment: Evaluating emerging technologies, incorporating uncertainty and the consumer perspective

    NASA Astrophysics Data System (ADS)

    Merugula, Laura

    As civilization's collective knowledge grows, we are met with the realization that human-induced physical and biological transformations influenced by exogenous psychosocial and economic factors affect virtually every ecosystem on the planet. Despite improvements in energy generation and efficiencies, demand of material goods and energy services increases with no sign of a slowing pace. Sustainable development requires a multi-prong approach that involves reshaping demand, consumer education, sustainability-oriented policy, and supply chain management that does not serve the expansionist mentality. Thus, decision support tools are needed that inform developers, consumers, and policy-makers for short-term and long-term planning. These tools should incorporate uncertainty through quantitative methods as well as qualitatively informing the nature of the model as imperfect but necessary and adequate. A case study is presented of the manufacture and deployment of utility-scale wind turbines evaluated for a proposed change in blade manufacturing. It provides the first life cycle assessment (LCA) evaluating impact of carbon nanofibers, an emerging material, proposed for integration to wind power generation systems as blade reinforcement. Few LCAs of nanoproducts are available in scientific literature due to research and development (R&D) for applications that continues to outpace R&D for environmental, health, and safety (EHS) and life cycle impacts. LCAs of emerging technologies are crucial for informing developers of potential impacts, especially where market growth is swift and dissipative. A second case study is presented that evaluates consumer choice between disposable and reusable beverage cups. While there are a few studies that attempt to make the comparison using LCA, none adequately address uncertainty, nor are they representative for the typical American consumer. By disaggregating U.S. power generation into 26 subregional grid production mixes and evaluating

  14. Realistic and Schematic Visuals.

    ERIC Educational Resources Information Center

    Heuvelman, Ard

    1996-01-01

    A study examined three different visual formats (studio presenter only, realistic visuals, or schematic visuals) of an educational television program. Recognition and recall of the abstract subject matter were measured in 101 adult viewers directly after the program and 3 months later. The schematic version yielded better recall of the program,…

  15. Improving emergency department flow through Rapid Medical Evaluation unit

    PubMed Central

    Chartier, Lucas; Josephson, Timothy; Bates, Kathy; Kuipers, Meredith

    2015-01-01

    The Toronto Western Hospital is an academic hospital in Toronto, Canada, with an annual Emergency Department (ED) volume of 64,000 patients. Despite increases in patient volumes of almost six percent per annum over the last decade, there have been no commensurate increases in resources, infrastructure, and staffing. This has led to substantial increase in patient wait times, most specifically for those patients with lower acuity presentations. Despite requiring only minimal care, these patients contribute disproportionately to ED congestion, which can adversely impact resource utilization and quality of care for all patients. We undertook a retrospective evaluation of a quality improvement initiative aimed at improving wait times experienced by patients with lower acuity presentations. A rapid improvement event was organized by frontline workers to rapidly overhaul processes of care, leading to the creation of the Rapid Medical Evaluation (RME) unit – a new pathway of care for patients with lower acuity presentations. The RME unit was designed by re-purposing existing resources and re-assigning one physician and one nurse towards the specific care of these patients. We evaluated the performance of the RME unit through measurement of physician initial assessment (PIA) times and total length of stay (LOS) times for multiple groups of patients assigned to various ED care pathways, during three periods lasting three months each. Weekly measurements of mean and 90th percentile of PIA and LOS times showed special cause variation in all targeted patient groups. Of note, the patients seen in the RME unit saw their median PIA and LOS times decrease from 98min to 70min and from 165min to 130min, respectively, from baseline. Despite ever-growing numbers of patient visits, wait times for all patients with lower acuity presentations remained low, and wait times of patients with higher acuity presentations assigned to other ED care pathways were not adversely affected. By

  16. Investigating the organisational impacts of quality improvement: a protocol for a realist evaluation of improvement approaches drawing on the Resource Based View of the Firm

    PubMed Central

    Burton, Christopher R; Rycroft Malone, Jo; Robert, Glenn; Willson, Alan; Hopkins, Angela

    2014-01-01

    Introduction Little is understood about the role of quality improvement in enabling health organisations to survive and thrive in the contemporary context of financial and economic challenges. We will draw on the theoretical foundations of the ‘Resource Based View of the Firm’ (RBV) to develop insights into why health organisations engage in improvement work, how impacts are conceptualised, and ‘what works’ in delivering these impacts. Specifically, RBV theorises that the mix and use of resources across different organisations may explain differences in performance. Whether improvement work influences these resources is unclear. Methods and analysis Case study research will be conducted across health organisations participating in four approaches to improvement, including: a national improvement programme; a multiorganisational partnership around implementation; an organisational strategy for quality improvement; and a coproduction project designed to enhance the experience of a clinical service from the perspective of patients. Data will comprise in-depth interviews with key informants, observation of key events and documents; analysed within and then across cases. Adopting a realist perspective, the core tenets of RBV will be evaluated as a programme theory, focusing on the interplay between organisational conditions and behavioural or resource responses that are reported through engagement in improvement. Ethics and dissemination The study has been approved by Bangor University Ethics Committee. The investigation will not judge the relative merits of different approaches to healthcare quality improvement. Rather, we will develop unique insights into the organisational consequences, and dependencies of quality improvement, providing an opportunity to add to the explanatory potential of RBV in this and other contexts. In addition to scientific and lay reports of the study findings, research outputs will include a framework for constructing the economic

  17. Advancing the application of systems thinking in health: realist evaluation of the Leadership Development Programme for district manager decision-making in Ghana

    PubMed Central

    2014-01-01

    Background Although there is widespread agreement that strong district manager decision-making improves health systems, understanding about how the design and implementation of capacity-strengthening interventions work is limited. The Ghana Health Service has adopted the Leadership Development Programme (LDP) as one intervention to support the development of management and leadership within district teams. This paper seeks to address how and why the LDP ‘works’ when it is introduced into a district health system in Ghana, and whether or not it supports systems thinking in district teams. Methods We undertook a realist evaluation to investigate the outcomes, contexts, and mechanisms of the intervention. Building on two working hypotheses developed from our earlier work, we developed an explanatory case study of one rural district in the Greater Accra Region of Ghana. Data collection included participant observation, document review, and semi-structured interviews with district managers prior to, during, and after the intervention. Working backwards from an in-depth analysis of the context and observed short- and medium-term outcomes, we drew a causal loop diagram to explain interactions between contexts, outcomes, and mechanisms. Results The LDP was a valuable experience for district managers and teams were able to attain short-term outcomes because the novel approach supported teamwork, initiative-building, and improved prioritisation. However, the LDP was not institutionalised in district teams and did not lead to increased systems thinking. This was related to the context of high uncertainty within the district, and hierarchical authority of the system, which triggered the LDP’s underlying goal of organisational control. Conclusions Consideration of organisational context is important when trying to sustain complex interventions, as it seems to influence the gap between short- and medium-term outcomes. More explicit focus on systems thinking principles that

  18. Low-severity Musculoskeletal Complaints Evaluated in the Emergency Department

    PubMed Central

    Mehta, Samir; Hollander, Judd E.; Shofer, Frances; Bernstein, Joseph

    2008-01-01

    Patients with musculoskeletal disorders represent a considerable percentage of emergency department volume. Although patients with acute or high-severity conditions are encouraged to seek care in the emergency department, patients with nonacute, low-severity conditions may be better served elsewhere. This study prospectively assessed patients presenting to the emergency department with nonacute, low-severity musculoskeletal conditions to test the hypothesis that these patients have access to care outside the emergency department. One thousand ten adult patients with a musculoskeletal complaint were identified, and a detailed questionnaire was completed by 862 (85.3%) during their emergency department stay. Three hundred fifty (40.6%) patients presented with nonacute, low-severity conditions. Patients with nonacute, low-severity problems were less likely to have a primary care physician (62.5% versus 72.3%) or to have medical insurance (82.5% versus 87.7%), but a majority had both (59.3%). Only 14.3% had neither. Forty-four percent of all patients with primary care physicians believed their primary care physician was incapable of managing musculoskeletal problems. Appropriate use of the emergency department by patients with musculoskeletal disorders may require not only increased access to insurance and primary care, but also improved public understanding of the scope of care offered by primary care physicians and the conflicting demands placed on emergency department providers. Level of Evidence: Level I, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence. PMID:18496728

  19. Simulation of realistic retinoscopic measurement

    NASA Astrophysics Data System (ADS)

    Tan, Bo; Chen, Ying-Ling; Baker, K.; Lewis, J. W.; Swartz, T.; Jiang, Y.; Wang, M.

    2007-03-01

    Realistic simulation of ophthalmic measurements on normal and diseased eyes is presented. We use clinical data of ametropic and keratoconus patients to construct anatomically accurate three-dimensional eye models and simulate the measurement of a streak retinoscope with all the optical elements. The results show the clinical observations including the anomalous motion in high myopia and the scissors reflex in keratoconus. The demonstrated technique can be applied to other ophthalmic instruments and to other and more extensively abnormal eye conditions. It provides promising features for medical training and for evaluating and developing ocular instruments.

  20. Realistic Solar Surface Convection Simulations

    NASA Technical Reports Server (NTRS)

    Stein, Robert F.; Nordlund, Ake

    2000-01-01

    We perform essentially parameter free simulations with realistic physics of convection near the solar surface. We summarize the physics that is included and compare the simulation results with observations. Excellent agreement is obtained for the depth of the convection zone, the p-mode frequencies, the p-mode excitation rate, the distribution of the emergent continuum intensity, and the profiles of weak photospheric lines. We describe how solar convection is nonlocal. It is driven from a thin surface thermal boundary layer where radiative cooling produces low entropy gas which forms the cores of the downdrafts in which most of the buoyancy work occurs. We show that turbulence and vorticity are mostly confined to the intergranular lanes and underlying downdrafts. Finally, we illustrate our current work on magneto-convection.

  1. Time/Loss Analysis in the development and evaluation of emergency response procedures

    SciTech Connect

    Francis, A.A.

    1994-08-01

    Time/Loss Analysis (T/LA) provides a standard for conducting technically consistent and objective evaluations of emergency response planning and procedures. T/LA is also a sound tool for evaluating the performance of safeguards and procedures.

  2. 1992 UPDATE OF U.S. EPA'S SUPERFUND INNOVATIVE TECHNOLOGY EVALUATION (SITE) EMERGING TECHNOLOGY PROGRAM

    EPA Science Inventory

    The Superfund Innovative Technology Evaluation (SITE) Emerging Technology Program (ETP) has encouraged and financially supported further development of bench- and pilot-scale testing and evaluation of innovative technologies suitable for use at hazardous waste sites for five year...

  3. Evaluation of a Tabletop Emergency Preparedness Exercise for Pharmacy Students.

    PubMed

    Pate, Adam; Bratberg, Jeffrey P; Robertson, Courtney; Smith, Gregory

    2016-04-25

    Objective. To describe the implementation and effect of an emergency preparedness laboratory activity on student knowledge, willingness to participate in emergency preparedness training, current level of preparedness, and the importance of a pharmacist's role in disaster response. Design. Second-year pharmacy students in the infectious disease module participated in a laboratory activity based on a basic disaster response tabletop exercise format. Three case-based scenarios involving infectious diseases were created by participating faculty members. Assessment. Surveys before and after the laboratory were used to assess the activity's effect on student knowledge, willingness to participate in emergency preparedness training, current level of preparedness, and the importance of a pharmacist's role in disaster response. In addition, the postsurvey assessed student perceptions of the activity's success at accomplishing faculty-specified outcomes from Appendix B of the Accreditation Council for Pharmacy Education's (ACPE) Standards. Conclusion. Implementation of an emergency response laboratory activity may improve overall students' knowledge of, confidence in, and understanding of their role as pharmacists in an emergency response, while incorporating a variety of skills and knowledge outcomes. PMID:27170821

  4. Evaluation of a Tabletop Emergency Preparedness Exercise for Pharmacy Students

    PubMed Central

    Bratberg, Jeffrey P.; Robertson, Courtney; Smith, Gregory

    2016-01-01

    Objective. To describe the implementation and effect of an emergency preparedness laboratory activity on student knowledge, willingness to participate in emergency preparedness training, current level of preparedness, and the importance of a pharmacist’s role in disaster response. Design. Second-year pharmacy students in the infectious disease module participated in a laboratory activity based on a basic disaster response tabletop exercise format. Three case-based scenarios involving infectious diseases were created by participating faculty members. Assessment. Surveys before and after the laboratory were used to assess the activity’s effect on student knowledge, willingness to participate in emergency preparedness training, current level of preparedness, and the importance of a pharmacist’s role in disaster response. In addition, the postsurvey assessed student perceptions of the activity’s success at accomplishing faculty-specified outcomes from Appendix B of the Accreditation Council for Pharmacy Education’s (ACPE) Standards. Conclusion. Implementation of an emergency response laboratory activity may improve overall students’ knowledge of, confidence in, and understanding of their role as pharmacists in an emergency response, while incorporating a variety of skills and knowledge outcomes. PMID:27170821

  5. A realistic lattice example

    SciTech Connect

    Courant, E.D.; Garren, A.A.

    1985-10-01

    A realistic, distributed interaction region (IR) lattice has been designed that includes new components discussed in the June 1985 lattice workshop. Unlike the test lattices, the lattice presented here includes utility straights and the mechanism for crossing the beams in the experimental straights. Moreover, both the phase trombones and the dispersion suppressors contain the same bending as the normal cells. Vertically separated beams and 6 Tesla, 1-in-1 magnets are assumed. Since the cells are 200 meters long, and have 60 degree phase advance, this lattice has been named RLD1, in analogy with the corresponding test lattice, TLD1. The quadrupole gradient is 136 tesla/meter in the cells, and has similar values in other quadrupoles except in those in the IR`s, where the maximum gradient is 245 tesla/meter. RLD1 has distributed IR`s; however, clustered realistic lattices can easily be assembled from the same components, as was recently done in a version that utilizes the same type of experimental and utility straights as those of RLD1.

  6. Retrospective evaluation of urological admissions to emergency service of a training and research hospital

    PubMed Central

    Topaktaş, Ramazan; Altın, Selçuk; Aydın, Cemil; Akkoç, Ali; Yılmaz, Yakup

    2014-01-01

    Objective: Many patients consult emergency services with urological complaints. The aim of this study was to investigate the epidemiology, clinical presentation and treatments of urological emergency cases in a training and research hospital. Material and methods: We retrospectively evaluated urological emergency patients referred to the emergency unit between July 2012 and July 2013 according to age, gender, affected organ, radiological imaging techniques and treatment. Results: Among 141.844 emergency cases, 3.113 (2.19%) were urological emergencies and 53.2% of the patients were male (mean age: 49.1), and 46.8% of them were female (median age: 42.8). The most frequent illness was genitourinary infection constituting 41.2% of the cases followed by renal colic (36.9%). Among the urological emergencies 483 (15.5%) patients were hospitalized and 152 surgical operations were performed. The mostly performed procedure was the placement of a suprapubic catheter in 34 patients constituting (22.3%) of the cases. Totally eight patients were referred to another experienced health center due to different reasons. Conclusion: Most of the urological emergency patients do not require emergency surgical interventions however, timely identification and management of urological emergencies with in-depth clinical evaluation are important to prevent late complications. Therefore the doctors working in emergency services must be heedful of urological emergencies. PMID:26328181

  7. Small bowel wall thickening: MDCT evaluation in the emergency room.

    PubMed

    Akcalar, Seray; Turkbey, Baris; Karcaaltincaba, Musturay; Akpinar, Erhan; Akhan, Okan

    2011-10-01

    Small bowel wall thickening detected on computed tomography is a frequent finding in patients referring to emergency room with acute abdominal pain. In this pictorial review, we aim to discuss patterns of small bowel wall thickening and to explain hints for differential diagnosis with imaging findings. PMID:21681404

  8. Project Emerge, Dayton, Ohio. 1973-74 Final Evaluation Report.

    ERIC Educational Resources Information Center

    Crawford, James

    Project Emerge was initiated in reaction to a high dropout rate at Roosevelt High School, which was attributed to low self-concept, low motivation, underachievement and the internalization of failure, irregular attendance, health problems, and disruptive classroom behavior. The enrollment of Roosevelt High School is 1395 students, of whom…

  9. Training Teachers to Evaluate Emerging Bilingual Students' Biliterate Writing

    ERIC Educational Resources Information Center

    Butvilofsky, Sandra Adriana; Sparrow, Wendy Lynn

    2012-01-01

    The purpose of this mixed-methods study was to explore and identify issues related to training teachers to use a bilingual writing rubric designed to examine the biliterate writing of emerging bilingual students who are participating in a biliteracy model. Findings indicate the need to provide clarifications on the rubric rating criteria and the…

  10. Evaluating the Emergence of Reverse Intraverbals in Children with Autism

    ERIC Educational Resources Information Center

    Allan, Alicia C.; Vladescu, Jason C.; Kisamore, April N.; Reeve, Sharon A.; Sidener, Tina M.

    2015-01-01

    Verbal behavior plays a fundamental role in the development of complex social and communication skills. Many children diagnosed with autism spectrum disorder exhibit profound deficiencies in intraverbal repertoires and the development of social relationships. Recent studies that investigated the effects of intraverbal training on the emergence of…

  11. An evaluation of coordination relationships during earthquake emergency rescue using entropy theory.

    PubMed

    Rong, Huang; Xuedong, Liang; Guizhi, Zeng; Yulin, Ye; Da, Wang

    2015-05-01

    Emergency rescue after an earthquake is complex work which requires the participation of relief and social organizations. Studying earthquake emergency coordination efficiency can not only help rescue organizations to define their own rescue missions, but also strengthens inter-organizational communication and collaboration tasks, improves the efficiency of emergency rescue, and reduces loss. In this paper, collaborative entropy is introduced to study earthquake emergency rescue operations. To study the emergency rescue coordination relationship, collaborative matrices and collaborative entropy functions are established between emergency relief work and relief organizations, and the collaborative efficiency of the emergency rescue elements is determined based on this entropy function. Finally, the Lushan earthquake is used as an example to evaluate earthquake emergency rescue coordination efficiency. PMID:26083170

  12. A Preliminary Evaluation of the Emergence of Novel Mand Forms

    PubMed Central

    Hernandez, Emma; Hanley, Gregory P; Ingvarsson, Einar T; Tiger, Jeffrey H

    2007-01-01

    Strategies that produce generalized responding are valuable, especially with regard to language acquisition, because relatively little training may result in large behavior changes. Conditions that result in generalized manding were analyzed in the current study. We demonstrated in reversal designs that undesirable or single-word responses were the predominant mand forms of 3 preschool children. Multiple baseline designs with 2 participants and a reversal design with 1 participant were then used to demonstrate the extent to which differential reinforcement of single-word mands (e.g., “cars”) or framed mands (e.g., “I want the cars, please”) would result in the emergence of other single-word and framed mands for different items (e.g., mands for music, puppets, or puzzles). Results showed that prompting and differential reinforcement of one or two mand frames resulted in the emergence of other framed mands for all participants. PMID:17471798

  13. Evaluation of the shock index in dogs presenting as emergencies

    PubMed Central

    Porter, Adam E.; Rozanski, Elizabeth A.; Sharp, Claire R.; Dixon, Kursten L.; Lyn Price, Lori; Shaw, Scott P.

    2013-01-01

    Objectives To 1) determine the normal range for Shock Index (SI) [defined as heart rate (HR)/systolic blood pressure (SBP)], in healthy dogs, and 2) compare SI in healthy dogs with dogs presenting to the emergency room (ER) deemed to be in or not in a state of shock. Design Prospective study. Animals 68 clinically normal dogs,,18 dogs that were presented to the ER deemed to be in shock and 19 dogs presenting to the ER not deemed to be in shock. Setting University teaching hospital. Interventions Peripheral or central venous blood sampling. Measurements and Main Results Heart rate and SBP were recorded on simulated presentation (healthy dogs), and emergency presentations for both dogs deemed to be in shock and dogs not deemed in shock. Dogs in shock had a median SI of 1.37 (0.87–3.13), which was significantly higher than both other groups; dogs not deemed in shock had median SI 0.73 (0.56–1.20), P<0.0001 and healthy dogs had median SI 0.78 (0.37–1.30) P<0.0001), respectively. Receiver operator characteristic curve analysis suggested a SI cut-off of 1.0, yielding an area under the receiver operator characteristic (AUROC) of 0.89 (Specificity (Sp) 89, Sensitivity (Sn) 90) when comparing dogs deemed in shock with healthy dogs, and 0.92 (Sp 95, Sn 89) when comparing dogs in shock with to dogs not deemed in shock. Conclusions The SI is an easy and non-invasive patient parameter that is higher in dogs that are deemed to be in shock than both healthy dogs and dogs presented as emergencies but not deemed to be in a state of shock. The measurement of SI may have some benefit in clinical assessment of emergency patients. PMID:23855723

  14. Emergent Evaluation and Educational Reforms in Latin America

    ERIC Educational Resources Information Center

    Martinic, Sergio

    2012-01-01

    The aim of this chapter is to characterize educational reforms in Latin America over the last 25 years, and the way they reflect the role, method, and use of evaluation processes. The main theoretical and methodological tensions that are created by the development of evaluations will be reviewed, concluding with the identification of some of the…

  15. Secondary Analysis of the Emergency School Assistance Program. Executive Summary, Planning/Evaluation Study.

    ERIC Educational Resources Information Center

    Office of Education (DHEW), Washington, DC. Office of Planning, Budgeting, and Evaluation.

    A 1973 evaluation of the Emergency School Assistance Program (ESAP) showed that it was effective in improving the academic achievement of tenth grade black male students. This study further analyzes this important result with the aim of finding useful information for the operation of the Emergency School Aid Act (ESAA) which replaced ESAP. Several…

  16. Assessment and Evaluation of National Human Resource Development System Competitiveness in Emerging Countries

    ERIC Educational Resources Information Center

    Oh, HunSeok; Seo, DongIn; Kim, JuSeuk; Yoo, SangOk; Seong, HeeChang

    2015-01-01

    This study assessed and evaluated the competitiveness of national human resource development (NHRD) systems in emerging countries with potential for growth. The literature on emerging countries and NHRD systems was reviewed. The study developed a model mechanism with forty-one indices and nine sub-components for the NHRD system assessment in…

  17. Transient Global Amnesia: Emergency Department Evaluation And Management.

    PubMed

    Faust, Jeremy Samuel; Nemes, Andreea

    2016-08-01

    Transient global amnesia is a clinically distinct syndrome characterized by the acute inability to form new memories. It can last up to 24 hours. The diagnosis is dependent on eliminating other more serious etiologies including toxic ingestions, acute strokes, complex partial seizures, and central nervous system infections. Transient global amnesia confers no known long-term risks; however, when abnormal signs or symptoms are present, they take precedence and guide the formulation of a differential diagnosis and investigation. In witnessed transient global amnesia with classic features, a minimalist approach is reasonable, avoiding overtesting, inappropriate medication, and medical interventions in favor of observation, ensuring patient safety, and reassuring patients and their families. This review provides a detailed framework for distinguishing transient global amnesia from its dangerous mimics and managing its course in the emergency department. PMID:27416582

  18. 1994 UPDATE OF U.S. EPA'S SUPERFUND INNOVATIVE TECHNOLOGY EVALUATION (SITE) EMERGING TECHNOLOGY PROGRAM

    EPA Science Inventory

    The U.S. Environmental Protection Agency's (EPA) Superfund Innovative Technology Evaluation (SITE), Emerging Technology Partnership (ETP) has initiated actions since 1987 that support the Clinton Administration's policy to foster and accelerate the research and development of inn...

  19. Special Emergency Education for the Disadvantaged. Final Evaluation Report.

    ERIC Educational Resources Information Center

    Greene; Mark M.; And Others

    This evaluation of Project Special Elementary Education for the Disadvantaged (SEED) sought to assess the impact of SEED instruction upon students enrolled in disadvantaged schools (grades three to six) in four major study areas: mathematics achievement, interest in math and other school subjects, motivation, and self concept. In addition, the…

  20. Evaluation of an emergency response model for the Rocky Flats Plant: Charter

    SciTech Connect

    Not Available

    1991-01-01

    This Charter provides a basis for a cooperative, interagency effort to evaluate the Terrain-Responsive Atmospheric Code for emergency response and emergency planning for the Rocky Flats Plant. This document establishes the foundation for the project entitled, Evaluation of an Emergency Response Model for the Rocky Flats Plant'' (to be referred to as the Project). This document meets the following objectives: Identify the Project; establish the project management structure, organizational responsibilities, and organizational commitments for reaching the goals of the Project, and identify a process for model revision and revelation for acceptance. 2 figs.

  1. The Evaluation of Time Performance in the Emergency Response Center to Provide Pre-Hospital Emergency Services in Kermanshah

    PubMed Central

    Mohammadi, Mohsen; Nasiripour Amir, Ashkan; Fakhri, Mahmood; Bakhtiari, Ahad; Azari, Samad; Akbarzadeh, Arash; Goli, Ali; Mahboubi, Mohammad

    2015-01-01

    This study evaluated the time performance in the emergency response center to provide pre-hospital emergency services in Kermanshah. This study was a descriptive retrospective cross-sectional study. In this study 500 cases of patients from Shahrivar (September) 2012 to the end of Shahrivar (September) 2013 were selected and studied by the non-probability quota method. The measuring tool included a preset cases record sheet and sampling method was completing the cases record sheet by referring to the patients’ cases. Data were analyzed using SPSS version 18 and the concepts of descriptive and inferential statistics (Kruskal-Wallis test, benchmark Eta (Eta), Games-Howell post hoc test). The results showed that the interval mean between receiving the mission to reaching the scene, between reaching the scene to moving from the scene, and between moving from the scene to a health center was 7.28, 16.73 and 7.28 minutes. The overall mean of time performance from the scene to the health center was 11.34 minutes. Any intervention in order to speed up service delivery, reduce response times, ambulance equipment and facilities required for accuracy, validity and reliability of the data recorded in the emergency dispatch department, Continuing Education of ambulance staffs, the use of manpower with higher specialize levels such as nurses, supply the job satisfaction, and increase the coordination with other departments that are somehow involved in this process can provide the ground for reducing the loss and disability resulting from traffic accidents. PMID:25560357

  2. The evaluation of time performance in the emergency response center to provide pre-hospital emergency services in Kermanshah.

    PubMed

    Mohammadi, Mohsen; Nasiripour, Amir Ashkan; Fakhri, Mahmood; Bakhtiari, Ahad; Azari, Samad; Akbarzadeh, Arash; Goli, Ali; Mahboubi, Mohammad

    2015-01-01

    This study evaluated the time performance in the emergency response center to provide pre-hospital emergency services in Kermanshah. This study was a descriptive retrospective cross-sectional study. In this study 500 cases of patients from Shahrivar (September) 2012 to the end of Shahrivar (September) 2013 were selected and studied by the non-probability quota method. The measuring tool included a preset cases record sheet and sampling method was completing the cases record sheet by referring to the patients' cases. Data were analyzed using SPSS version 18 and the concepts of descriptive and inferential statistics (Kruskal-Wallis test, benchmark Eta (Eta), Games-Howell post hoc test). The results showed that the interval mean between receiving the mission to reaching the scene, between reaching the scene to moving from the scene, and between moving from the scene to a health center was 7.28, 16.73 and 7.28 minutes. The overall mean of time performance from the scene to the health center was 11.34 minutes. Any intervention in order to speed up service delivery, reduce response times, ambulance equipment and facilities required for accuracy, validity and reliability of the data recorded in the emergency dispatch department, Continuing Education of ambulance staffs, the use of manpower with higher specialize levels such as nurses, supply the job satisfaction, and increase the coordination with other departments that are somehow involved in this process can provide the ground for reducing the loss and disability resulting from traffic accidents. PMID:25560357

  3. Outside Educational Evaluation of the Emergency School Assistance Program. Interim Report.

    ERIC Educational Resources Information Center

    RMC Research Corp., Arlington, VA.

    This progress report describes study objectives, research design, field survey activities, and analysis plans for the evaluation of the Emergency School Assistance Program (ESAP), a federal program to aid local educational agencies in bringing about racial desegregation of their public school systems. A need for evaluation is explained in terms of…

  4. The Emergence of Contesting Motives for Student Feedback-Based Evaluation in Australian Higher Education

    ERIC Educational Resources Information Center

    Darwin, Stephen

    2016-01-01

    Student feedback-based evaluation performs a significant social role in framing perceptions of the quality of teaching in contemporary Australian higher education. Yet its emergence is a relatively recent phenomenon, having only been in widespread application since the mid-1980s. The early manifestations of student feedback-based evaluation came…

  5. Protected clinical teaching time and a bedside clinical evaluation instrument in an emergency medicine training program.

    PubMed

    Shayne, Philip; Heilpern, Katherine; Ander, Douglas; Palmer-Smith, Victoria

    2002-11-01

    In a process that has evolved over the last four years, the Emory University Emergency Medicine Education Committee has developed an "academic attending" teaching shift incorporating a formatted lecture series with a clinical evaluation exercise (CEE). The program structures the approach to clinical teaching at the bedside, provides an objective clinical evaluation tool specific to emergency medicine residents, and provides targeted learning for medical students and residents rotating in the emergency department (ED). The CEE instrument was designed to be quick and efficient, satisfy requirements of assessment of the Accreditation Council for Graduate Medical Education (ACGME) general competencies, and incorporate the language of the "Model of the Clinical Practice of Emergency Medicine." The original program called for unstructured bedside teaching three days a week, by faculty freed from clinical duties, combined with a limited series of introductory emergency medicine lectures. The program proved more successful when concentrated in a once weekly structured educational program. The prepared, repeating lecture series has been expanded to include many of the most common ED presenting chief complaints and has significantly advanced a curriculum for medical students and visiting interns. A CEE was developed to evaluate and provide immediate feedback to residents on many of the core ACGME competencies. The CEE has been successfully used to structure the bedside educational encounter. This dedicated non-clinical "teaching" shift appears effective in meeting the educational goals of the authors' academic ED. This is a description of the program and its evolution; the program has not been formally evaluated. PMID:12414493

  6. Generating realistic images using Kray

    NASA Astrophysics Data System (ADS)

    Tanski, Grzegorz

    2004-07-01

    Kray is an application for creating realistic images. It is written in C++ programming language, has a text-based interface, solves global illumination problem using techniques such as radiosity, path tracing and photon mapping.

  7. RAMESES publication standards: realist syntheses

    PubMed Central

    2013-01-01

    Background There is growing interest in realist synthesis as an alternative systematic review method. This approach offers the potential to expand the knowledge base in policy-relevant areas - for example, by explaining the success, failure or mixed fortunes of complex interventions. No previous publication standards exist for reporting realist syntheses. This standard was developed as part of the RAMESES (Realist And MEta-narrative Evidence Syntheses: Evolving Standards) project. The project's aim is to produce preliminary publication standards for realist systematic reviews. Methods We (a) collated and summarized existing literature on the principles of good practice in realist syntheses; (b) considered the extent to which these principles had been followed by published syntheses, thereby identifying how rigor may be lost and how existing methods could be improved; (c) used a three-round online Delphi method with an interdisciplinary panel of national and international experts in evidence synthesis, realist research, policy and/or publishing to produce and iteratively refine a draft set of methodological steps and publication standards; (d) provided real-time support to ongoing realist syntheses and the open-access RAMESES online discussion list so as to capture problems and questions as they arose; and (e) synthesized expert input, evidence syntheses and real-time problem analysis into a definitive set of standards. Results We identified 35 published realist syntheses, provided real-time support to 9 on-going syntheses and captured questions raised in the RAMESES discussion list. Through analysis and discussion within the project team, we summarized the published literature and common questions and challenges into briefing materials for the Delphi panel, comprising 37 members. Within three rounds this panel had reached consensus on 19 key publication standards, with an overall response rate of 91%. Conclusion This project used multiple sources to develop and

  8. Measuring quality of care in psychiatric emergencies: construction and evaluation of a Bayesian index.

    PubMed Central

    Gustafson, D H; Sainfort, F; Johnson, S W; Sateia, M

    1993-01-01

    OBJECTIVE. This study was conducted to determine whether an index for measuring quality of care for psychiatric emergencies is reliable and valid. DATA SOURCES/STUDY SETTING. The study used primary data collected over a 12-month period from two urban hospitals in the Northeast. One had 700 inpatient beds, an inpatient psychiatric unit, and community mental health personnel located in the emergency department. The other had 300 beds but none of the other hospital's features. STUDY DESIGN. The index was developed by a panel of experts in emergency psychiatry using a subjective Bayesian statistical methodology and was evaluated in terms of its ability to: (1) predict a second panel's judgments of quality; (2) predict a specific quality-related patient outcome, i.e., compliance with follow-up recommendations; (3) provide a reliable measurement procedure; and (4) detect variations in patterns of emergency department practices. DATA COLLECTION/EXTRACTION METHODS. Data were collected on 2,231 randomly selected emergency psychiatric patients (psychiatric diagnosis, alcohol abuse, nonverbal patients experiencing a psychiatric emergency, and patients with somatic complaints such as life crisis) treated in the emergency departments of the two hospitals. PRINCIPAL FINDINGS. The index predicted physician judgments of quality, was reliable, exhibited sufficient variation in scores, and was strongly associated with patient compliance. CONCLUSIONS. The study demonstrated that a subjective Bayesian model can be used to develop a reliable and valid index for measuring quality of care, with potential for practical application in management of health services. PMID:8514497

  9. Mentoring Australian Emerging Researchers in Aging: Evaluation of a Pilot Mentoring Scheme

    ERIC Educational Resources Information Center

    Henwood, Tim; Bartlett, Helen; Carroll, Matthew

    2011-01-01

    A survey of Australian emerging researchers in aging identified the need for greater professional development and networking opportunities. To address this, a formal mentorship scheme was developed and evaluated. Fourteen postgraduate researchers (proteges) were matched by discipline and research interest to experienced academics (mentors).…

  10. Asbestos in Schools: Evaluation of the Asbestos Hazard Emergency Response Act (AHERA): A Fact Sheet.

    ERIC Educational Resources Information Center

    Environmental Protection Agency, Washington, DC. Office of Toxic Substances.

    The U.S. Environmental Protection Agency recently completed an evaluation of the Asbestos Hazard Emergency Response Act (AHERA) regulatory program in schools. The purpose of the fact sheet is to inform schools of their initial AHERA successes, note areas for improvement, and provide additional guidance. Major findings pertaining to school building…

  11. EVALUATING AND TESTING EMERGENCY TESTING MONITORING DEVICES IN EXTREME COLD TEMPERATURES

    EPA Science Inventory

    EPA Identifier: F8P11070
    Title: Evaluating and Testing Emergency Testing Monitoring Devices in Extreme Cold Temperatures
    Fellow (Principal Investigator): Tyler S. O’Dell
    Institution: Lake Superior State University
    EPA GRANT Represent...

  12. 77 FR 50546 - Agency Information Collection: Emergency Submission for OMB Review (CEPACT (Center for Evaluation...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-08-21

    ... of PACT) Demographic Questionnaire and Patient Focus Group); Comment Request AGENCY: Veterans Health... U.S.C. 3507(j)(1)). An emergency clearance is being requested for information needed to focus on... Evaluation of PACT) Demographic Questionnaire, VA Form 10-0534 and Patient Focus Group. OMB Control...

  13. Evaluation of Access, a Primary Care Program for Indigent Patients: Inpatient and Emergency Room Utilization.

    ERIC Educational Resources Information Center

    Davidson, Richard A.; Giancola, Angela; Gast, Andrea; Ho, Janice; Waddell, Rhondda

    2003-01-01

    Evaluated the impact of Accessing Community Care through Eastside Social Services (ACCESS), a program that provided indigent patients with free primary care, on inpatient admissions, emergency room (ER) visits, and subsequent charges. Data on 19 people before and after program enrollment showed significant decreases in ER visits following…

  14. Evaluation of the Emergency School Assistance Program. Volume I: Summary. Final Report.

    ERIC Educational Resources Information Center

    RMC Research Corp., Arlington, VA.

    The Emergency School Assistance Program (ESAP) was developed as a Federal program to aid local education agencies (LEAs) in achieving and adjusting to recent racial desegregation of their public school systems. This is one of three volumes that constitute the final report of the evaluation of the ESAP. In Volume I, a summary of the overall study…

  15. Design for the Evaluation of the San Francisco Home Health Services. Emergency Family Care Services Program.

    ERIC Educational Resources Information Center

    Remy, Linda L.

    This is a design for the evaluation of emergency family care programs of the San Francisco, California Home Health Services administration. The design objectives are qiven as the promotion of the health and welfare of the family unit and the reduction of the number of out-of-home placements of children and subsequent crises. The objectives of the…

  16. The emergency system for the town of Milano: evaluation of an help point.

    PubMed

    Steffan, Isabella Tiziana

    2012-01-01

    The article presents a complex work of which the author has been asked by the Municipality of Milan an its Service Company (AEM, now A2A) to apply Ergonomics to evaluate a product designed for asking information and emergency, with particular attention to vulnerable city users. PMID:22316814

  17. Trauma in elderly patients evaluated in a hospital emergency department in Konya, Turkey: a retrospective study

    PubMed Central

    Kara, Hasan; Bayir, Aysegul; Ak, Ahmet; Akinci, Murat; Tufekci, Necmettin; Degirmenci, Selim; Azap, Melih

    2014-01-01

    Purpose Trauma is a common cause of admission to the hospital emergency department. The purpose of this study was to evaluate the cause of admission, clinical characteristics, and outcomes of patients aged ≥65 years admitted to an emergency department in Turkey because of blunt trauma. Materials and methods Medical records were retrospectively reviewed for 568 patients (314 women and 254 men) aged ≥65 years who were admitted to an emergency department of a tertiary care hospital. Results Trauma was caused by low-energy fall in 379 patients (67%), traffic accident in 79 patients (14%), high-energy fall in 69 patients (12%), and other causes in 41 patients (7%). The most frequent sites of injury were the lower extremity, thorax, upper extremity, and head. The femur was the most frequent fracture site. After evaluation in the emergency department, 377 patients (66%) were hospitalized. There were 31 patients (5%) who died. Risk of hospitalization after trauma was significantly associated with trauma to the lower extremity, thorax, and spine; fractures of the femur and rib; and intracranial injury. Conclusion Emergency department admission after trauma in patients aged ≥65 years is common after low-energy falls, and most injuries occur to the extremities. It is important to focus on prevention of falls to decrease the frequency of trauma in the elderly. PMID:24376346

  18. Preliminary evaluation of the use of a CDMA-based emergency telemedicine system.

    PubMed

    Kang, Jaemin; Chun, Honggu; Shin, Il Hyung; Shin, Sang Do; Suh, Gil Joon; Kim, Hee Chan

    2006-01-01

    We have conducted a preliminary evaluation of the use of a code division multiple access (CDMA)-based emergency telemedicine system to be used by emergency rescuers providing first-aid treatment for patients. The prototype system included five instrumentation modules for measuring non-invasive arterial blood pressure (NIBP), arterial oxygen saturation (SpO(2)), six-channel electrocardiogram (ECG), blood glucose concentration and body temperature. The patient data were transferred to a doctor's PC through CDMA and TCP/IP networks using an embedded personal digital assistant (PDA) phone. Performance tests in the laboratory showed that the system provided reliable values with error ranges within +/-1% for heart rate, +/-5 mmHg for NIBP, +/-2% for SpO(2) and +/-1% for glucose. The feasibility of the prototype system was then evaluated with 15 real emergency patients on Jeju Island over a two-month period. Measured data were transmitted from a moving ambulance to the emergency medical centre without significant CDMA connection loss or transmission errors. The average transfer time was 8 min. Four emergency doctors and 11 rescuers completed a questionnaire. There were favourable reviews from the users. PMID:17227609

  19. Realistic Radio Communications in Pilot Simulator Training

    NASA Technical Reports Server (NTRS)

    Burki-Cohen, Judith; Kendra, Andrew J.; Kanki, Barbara G.; Lee, Alfred T.

    2000-01-01

    Simulators used for total training and evaluation of airline pilots must satisfy stringent criteria in order to assure their adequacy for training and checking maneuvers. Air traffic control and company radio communications simulation, however, may still be left to role-play by the already taxed instructor/evaluators in spite of their central importance in every aspect of the flight environment. The underlying premise of this research is that providing a realistic radio communications environment would increase safety by enhancing pilot training and evaluation. This report summarizes the first-year efforts of assessing the requirement and feasibility of simulating radio communications automatically. A review of the training and crew resource/task management literature showed both practical and theoretical support for the need for realistic radio communications simulation. A survey of 29 instructor/evaluators from 14 airlines revealed that radio communications are mainly role-played by the instructor/evaluators. This increases instructor/evaluators' own workload while unrealistically lowering pilot communications load compared to actual operations, with a concomitant loss in training/evaluation effectiveness. A technology review searching for an automated means of providing radio communications to and from aircraft with minimal human effort showed that while promising, the technology is still immature. Further research and the need for establishing a proof-of-concept are also discussed.

  20. Mechanisms that Trigger a Good Health-Care Response to Intimate Partner Violence in Spain. Combining Realist Evaluation and Qualitative Comparative Analysis Approaches

    PubMed Central

    Goicolea, Isabel; Vives-Cases, Carmen; Hurtig, Anna-Karin; Marchal, Bruno; Briones-Vozmediano, Erica; Otero-García, Laura; García-Quinto, Marta; San Sebastian, Miguel

    2015-01-01

    Background Health care professionals, especially those working in primary health-care services, can play a key role in preventing and responding to intimate partner violence. However, there are huge variations in the way health care professionals and primary health care teams respond to intimate partner violence. In this study we tested a previously developed programme theory on 15 primary health care center teams located in four different Spanish regions: Murcia, C Valenciana, Castilla-León and Cantabria. The aim was to identify the key combinations of contextual factors and mechanisms that trigger a good primary health care center team response to intimate partner violence. Methods A multiple case-study design was used. Qualitative and quantitative information was collected from each of the 15 centers (cases). In order to handle the large amount of information without losing familiarity with each case, qualitative comparative analysis was undertaken. Conditions (context and mechanisms) and outcomes, were identified and assessed for each of the 15 cases, and solution formulae were calculated using qualitative comparative analysis software. Results The emerging programme theory highlighted the importance of the combination of each team’s self-efficacy, perceived preparation and women-centredness in generating a good team response to intimate partner violence. The use of the protocol and accumulated experience in primary health care were the most relevant contextual/intervention conditions to trigger a good response. However in order to achieve this, they must be combined with other conditions, such as an enabling team climate, having a champion social worker and having staff with training in intimate partner violence. Conclusions Interventions to improve primary health care teams’ response to intimate partner violence should focus on strengthening team’s self-efficacy, perceived preparation and the implementation of a woman-centred approach. The use of the

  1. Evaluation of local electric fields generated by transcranial direct current stimulation with an extracephalic reference electrode based on realistic 3D body modeling

    NASA Astrophysics Data System (ADS)

    Im, Chang-Hwan; Park, Ji-Hye; Shim, Miseon; Chang, Won Hyuk; Kim, Yun-Hee

    2012-04-01

    In this study, local electric field distributions generated by transcranial direct current stimulation (tDCS) with an extracephalic reference electrode were evaluated to address extracephalic tDCS safety issues. To this aim, we generated a numerical model of an adult male human upper body and applied the 3D finite element method to electric current conduction analysis. In our simulations, the active electrode was placed over the left primary motor cortex (M1) and the reference electrode was placed at six different locations: over the right temporal lobe, on the right supraorbital region, on the right deltoid, on the left deltoid, under the chin, and on the right buccinator muscle. The maximum current density and electric field intensity values in the brainstem generated by the extracephalic reference electrodes were comparable to, or even less than, those generated by the cephalic reference electrodes. These results suggest that extracephalic reference electrodes do not lead to unwanted modulation of the brainstem cardio-respiratory and autonomic centers, as indicated by recent experimental studies. The volume energy density was concentrated at the neck area by the use of deltoid reference electrodes, but was still smaller than that around the active electrode locations. In addition, the distributions of elicited cortical electric fields demonstrated that the use of extracephalic reference electrodes might allow for the robust prediction of cortical modulations with little dependence on the reference electrode locations.

  2. Evaluation of Emerging Fusarium mycotoxins beauvericin, Enniatins, Fusaproliferin and Moniliformin in Domestic Rice in Iran

    PubMed Central

    Nazari, Firouzeh; Sulyok, Michael; Kobarfard, Farzad; Yazdanpanah, Hassan; Krska, Rudolf

    2015-01-01

    The occurrence of emerging Fusarium mycotoxins beauvericin (BEA), enniatins (ENNs) (A, A1, B, B1), Fusaproliferin and moniliformin was evaluated by a liquid chromatography/electrospray ionization-tandem mass spectrometric (LC/ESI-MS/MS) technique in 65 domestic rice samples produced in Gilan and Mazandaran Provinces in Iran. The results showed that 46% of the samples were contaminated with at least one of the emerging mycotoxins. BEA was the most prevalent mycotoxin, which was found in 26 out of 65 rice samples at the concentrations up to 0.47 µg/Kg. Enniatin A1 which was the only member of ENNs was detected in the samples, occurred in 7.7% of samples with an average level of 0.06 μg/Kg. No detectable level of Fusaproliferin and moniliformin was found. This is the first report concerning the contamination of Iranian domestic rice samples with the emerging Fusarium mycotoxins. PMID:25901158

  3. Development and use of consolidated criteria for evaluation of emergency preparedness plans for DOE facilities

    SciTech Connect

    Lerner, K.; Kier, P.H.; Baldwin, T.E.

    1995-07-01

    Emergency preparedness at US Department of Energy (DOE) facilities is promoted by development and quality control of response plans. To promote quality control efforts, DOE has developed a review document that consolidates requirements and guidance pertaining to emergency response planning from various DOE and regulatory sources. The Criteria for Evaluation of Operational Emergency Plans (herein referred to as the Criteria document) has been constructed and arranged to maximize ease of use in reviewing DOE response plans. Although developed as a review instrument, the document also serves as a de facto guide for plan development, and could potentially be useful outside the scope of its original intended DOE clientele. As regulatory and DOE requirements are revised and added in the future, the document will be updated to stay current.

  4. Performance Evaluation of Mobile Ad Hoc Network Based Communications for Future Mobile Tele-Emergency System

    NASA Astrophysics Data System (ADS)

    Viswacheda, D. V.; Barukang, L.; Hamid, M. Y.; Arifianto, M. S.

    Sparked by awareness of the limitations to provide medical services in remote areas, researchers have perceived that developing telemedicine systems is inevitable. In most cases very remote areas and disaster struck areas lack telecommunication infrastructure. Telemedicine system operating in such areas must have advanced wireless technology supporting it in devastating situation, hence it is called as tele-emergency system. Our approach is on MANET combined with Mobile IP and MIPV6, is the basis of infrastructure for the mobile tele-emergency system. The tele-emergency system requires data, voice and video transmission in its network. In this investigation, evaluation is based on simulation of the various ITU-T standard CODECs of VoIP and video transmission over MANET using discrete event simulator NS-2. The results of simulation showed that ITU-T G723.1 worked well in the MANET environment than the other CODECs for VoIP in fixed and mobility tele-emergency environments. From the simulation of video CODEC performance evaluation, it was observed that H.263 performed to a great extent in random small scale environment and also in multiple video flow of 57.6kbps speed video transmission.

  5. The Evaluation Exchange: Emerging Strategies in Evaluating Child and Family Services, 2002.

    ERIC Educational Resources Information Center

    Lopez, M. Elena, Ed.

    2002-01-01

    This document is comprised of the three 2002 issues of a newsletter of the Harvard Family Research Project, designed to share new ideas and experiences in evaluating systems reform and comprehensive child and family services. The Spring issue focuses on family support evaluations and their role in advancing the field of family support and includes…

  6. The Evaluation Exchange: Emerging Strategies in Evaluating Child and Family Services, 2001.

    ERIC Educational Resources Information Center

    Goodyear, Leslie, Ed.; Bohan-Baker, Marielle, Ed.

    2001-01-01

    This document is comprised of the two 2001 issues of a newsletter of the Harvard Family Research Project, designed to share new ideas and experiences in evaluating systems reform and comprehensive child and family services. The first issue focuses on strategic communications and efforts of nonprofit agencies to evaluate strategic communication…

  7. Evaluation of the Xpert Flu Rapid PCR Assay in High-Risk Emergency Department Patients

    PubMed Central

    Valsamakis, Alexandra; Gaydos, Charlotte A.; Forman, Michael; Hardick, Justin; Kidambi, Pranav; Amin, Sharmeen; Gupta, Alisha; Rothman, Richard E.

    2014-01-01

    We prospectively evaluated the performance of Cepheid's GeneXpert Xpert Flu assay in a target population of 281 adults presenting to the emergency department with an acute respiratory illness who met Centers for Disease Control and Prevention (CDC) criteria for recommended antiviral treatment. Compared with the Prodesse ProFlu+ assay, Xpert Flu had an overall sensitivity of 95.3% and specificity of 99.2%. PMID:25253792

  8. The Potential and Challenges of Critical Realist Ethnography

    ERIC Educational Resources Information Center

    Barron, Ian

    2013-01-01

    This article revisits the critical realist ethnographic process that was adopted in my doctoral thesis, which was concerned with the experiences of ethnic identity of white British and Pakistani British children as they started kindergarten in the northwest of England. The article focuses on the ethnography that emerged from the visits that I…

  9. Evaluator/controller practicum for US Department of Energy emergency exercises

    SciTech Connect

    Lacher, L.; Converse, R.; Gasper, W.; Mitrani, J.

    1996-12-31

    Argonne National Laboratory has designed a practicum to help ensure that exercises at Department of Energy (DOE) facilities provide results that will be useful in maintaining or improving emergency preparedness while ensuring the safety of the public and the exercise participants. Participants in the first two offerings of the practicum came from DOE facilities nationwide. The practicum augments the usual forms of controller and evaluator training with actual practice in carrying out controller and evaluator roles. Feedback from participants indicated substantial benefit from the training. Many of the participants expressed a desire to present such training to others at their home facilities.

  10. Teaching and evaluating multitasking ability in emergency medicine residents - what is the best practice?

    PubMed Central

    2014-01-01

    Multitasking is an essential skill to develop during Emergency Medicine (EM) residency. Residents who struggle to cope in a multitasking environment risk fatigue, stress, and burnout. Improper management of interruption has been causally linked with medical errors. Formal teaching and evaluation of multitasking is often lacking in EM residency programs. This article reviewed the literature on multitasking in EM to identify best practices for teaching and evaluating multitasking amongst EM residents. With the advancement in understanding of what multitasking is, deliberate attempts should be made to teach residents pitfalls and coping strategies. This can be taught through a formal curriculum, role modeling by faculty, and simulation training. The best way to evaluate multitasking ability in residents is by direct observation. The EM Milestone Project provides a framework by which multitasking can be evaluated. EM residents should be deployed in work environments commiserate with their multitasking ability and their progress should be graduated after identified deficiencies are remediated. PMID:25635201

  11. State-of-the-Art Evaluation of Emergency Department Patients Presenting With Potential Acute Coronary Syndromes.

    PubMed

    Hollander, Judd E; Than, Martin; Mueller, Christian

    2016-08-16

    It is well established that clinicians cannot use clinical judgment alone to determine whether an individual patient who presents to the emergency department has an acute coronary syndrome. The history and physical examination do not distinguish sufficiently between the many conditions that can cause acute chest pain syndromes. Cardiac risk factors do not have sufficient discriminatory ability in symptomatic patients presenting to the emergency department. Most patients with non-ST-segment-elevation myocardial infarction do not present with electrocardiographic evidence of active ischemia. The improvement in cardiac troponin assays, especially in conjunction with well-validated clinical decision algorithms, now enables the clinician to rapidly exclude myocardial infarction. In patients in whom unstable angina remains a concern or there is a desire to evaluate for underlying coronary artery disease, coronary computed tomography angiography can be used in the emergency department. Once a process that took ≥24 hours, computed tomography angiography now can rapidly exclude myocardial infarction and coronary artery disease in patients in the emergency department. PMID:27528647

  12. Evaluation of Pharmacists' Services for Dispensing Emergency Contraceptive Pills in Delhi, India: A Mystery Shopper Study

    PubMed Central

    Saxena, Pikee; Mishra, Archana; Nigam, Aruna

    2016-01-01

    Background: Although emergency contraceptive pills are available over the counter, the quality of consultation, including key areas of contraceptive counseling and prevention of sexually transmitted infections (STI), has not been well documented. Objective: To evaluate actual pharmacist services while dispensing emergency contraception through a mystery shopper technique. Material and Methods: This cross-sectional study was conducted in 81 pharmacies situated in Delhi by 4 trained mystery shoppers posed as customers over a period of 6 months. Results: None of the pharmacists asked about the time lapsed since last unprotected sexual intercourse or last menstrual period before deciding the eligibility of the customer. The majority were unclear about side effects associated with emergency contraception (78.57%) or with anticipated changes in menstrual flow (78.57%); 85.71% did not know whether subsequent unprotected intercourse would be protected. Only 15.71% counseled shoppers regarding risk of STI on asking leading questions and 88.5% did not provide any contraceptive advice. Conclusion: There is a huge gap in the technical knowledge and mindset of the pharmacists when it comes to checking for the eligibility of the client and providing advice regarding use of regular contraception and barrier for protection from STI, which needs to be addressed in order to realize the full benefit of making emergency contraceptive pills available over the counter. PMID:27385872

  13. ANALYSIS OF EMERGING NDE TECHNIQUES: METHODS FOR EVALUATING AND IMPLEMENTING CONTINUOUS ONLINE MONITORING

    SciTech Connect

    Cumblidge, Stephen E.; Doctor, Steven R.; Bond, Leonard J.; Taylor, Theodore T.; Lupold, Timothy R.; Hull, Amy; Malik, Shah

    2009-08-05

    One of the goals of the program for the proactive management of materials degradation (PMMD) is to manage proactively the in-service degradation of metallic components in aging NPPs. As some forms of degradation, such as stress corrosion cracking, are characterized by a long initiation time followed by a rapid growth phase, new inspection or monitoring technologies may be required. New nondestructive evaluation (NDE) techniques that may be needed include techniques to find stress corrosion cracking (SCC) precursors, on-line monitoring techniques to detect cracks as they initiate and grow, as well as advances in NDE technologies. This paper reports on the first part of the development of a methodology to determine the effectiveness of these emerging NDE techniques for managing metallic degradation. This methodology will draw from experience derived from evaluating techniques that have "emerged" in the past. The methodology will follow five stages: a definition of inspection parameters, a technical evaluation, laboratory testing, round robin testing, and the design of a performance demonstration program. This methodology will formalize the path taken for previous techniques and set a predictable course for future NDE techniques. This paper then applies the expert review section of the methodology to the acoustic emission technique to evaluate the use of acoustic emission in performing continuous online monitoring of reactor components.

  14. What Can Emergency Medicine Learn From Kinetics: Introducing an Alternative Evaluation and a Universal Criterion Standard for Emergency Department Performance

    PubMed Central

    Pan, Chih-Long; Chang, Chin-Fu; Chiu, Chun-Wen; Chi, Chih-Hsien; Tian, Zhong; Wen, Jyh-Horng; Wen, Jet-Chau

    2016-01-01

    Abstract This research focuses on developing an improved and robust measurement for emergency department (ED) performance and a criterion standard for global use via kinetic analysis. Based on kinetic approach, the input-throughput-output conceptual model of ED crowding is compared to the procedure of enzyme catalysis. All in average, the retented patients in EDs are defined as substrate ( ), whereas the patients who depart the EDs as product ( ). Therefore, the average ED departure velocity ( ) can be presented as   divided by a given time (t) of the ED length of stay (LOS). The   and   plots are depicted hourly for the kinetic analysis. The long-term stability of the kinetic parameters is ascertained by the method of coefficient of variation (CV). The participants collected for this study are from the EDs of Changhua Christian Medical Center and the five branched hospitals, all located in Taiwan. Based on the   plot analysis, the results clearly show 2 curves, an upper and a lower curve. The timeline of the lower curve includes approximately the total ED busy hours, and thus it can be used for the subsequent kinetic analysis. In order to explore the adequate kinetic parameters for ED performance, the try-and-error process was followed in this study. As a result, the   plots adapted from the lower curves show the best linear regression of   on   with a good coefficient of determination (R2). The Pan-Wen constant (PW), which is the slope of the liner regression line, and the ED medical personnel unit turnover number (EDMPU TON) were deduced from the kinetic meanings of   plots. In this research, the 2 kinetic parameters, PW and EDMPU TON were applied for the ED performance evaluations. An innovative relationship between the ED retented patients and the ED departure velocity is verified as PW; whereas, a feasible kinetic parameter, the EDMPU TON explicates the teamwork efficiency of the ED providers. Moreover, the EDMPU TON may not only be a reliable

  15. What Can Emergency Medicine Learn From Kinetics: Introducing an Alternative Evaluation and a Universal Criterion Standard for Emergency Department Performance.

    PubMed

    Pan, Chih-Long; Chang, Chin-Fu; Chiu, Chun-Wen; Chi, Chih-Hsien; Tian, Zhong; Wen, Jyh-Horng; Wen, Jet-Chau

    2016-03-01

    This research focuses on developing an improved and robust measurement for emergency department (ED) performance and a criterion standard for global use via kinetic analysis. Based on kinetic approach, the input-throughput-output conceptual model of ED crowding is compared to the procedure of enzyme catalysis. All in average, the retented patients in EDs are defined as substrate (S), whereas the patients who depart the EDs as product (P). Therefore, the average ED departure velocity (V) can be presented as (P)divided by a given time (t) of the ED length of stay (LOS). The S-V and S²-P plots are depicted hourly for the kinetic analysis. The long-term stability of the kinetic parameters is ascertained by the method of coefficient of variation (CV). The participants collected for this study are from the EDs of Changhua Christian Medical Center and the five branched hospitals, all located in Taiwan. Based on the S-V plot analysis, the results clearly show 2 curves, an upper and a lower curve. The timeline of the lower curve includes approximately the total ED busy hours, and thus it can be used for the subsequent kinetic analysis. In order to explore the adequate kinetic parameters for ED performance, the try-and-error process was followed in this study. As a result, the S²-V plots adapted from the lower curves show the best linear regression of S² on V with a good coefficient of determination (R). The Pan-Wen constant (PW), which is the slope of the liner regression line, and the ED medical personnel unit turnover number (EDMPU TON) were deduced from the kinetic meanings of (Equation is included in full-text article.)plots. In this research, the 2 kinetic parameters, PW and EDMPU TON were applied for the ED performance evaluations. An innovative relationship between the ED retented patients and the ED departure velocity is verified as PW; whereas, a feasible kinetic parameter, the EDMPU TON explicates the teamwork efficiency of the ED providers. Moreover, the EDMPU

  16. Emergency medical services data for cardiovascular disease surveillance, program planning, and evaluation in Maine.

    PubMed

    Meyer, Katie A; Decker, Kathy; Mervis, Cynthia A; Louder, Danielle; Bradshaw, Jay; DeVader, Shannon; Wigand, Debra

    2008-04-01

    Rapid access to medical treatment is a key determinant of outcomes for cardiovascular events. Emergency medical services (EMS) play an important role in delivering early treatment for acute cardiovascular events. Attention has increased on the potential for EMS data to contribute to our understanding of prehospital treatment. Maine recently began to explore the possible role of EMS data in cardiovascular disease surveillance and cardiovascular health program planning and evaluation. We describe the Maine EMS data system, discuss findings on ease of data use and data quality, provide a sample of findings, and share how we plan to use EMS data for program planning and evaluation of community-level interventions and to partner with EMS provider organizations to improve treatment. Our objective is to increase understanding of the promise and limitations of using EMS data for cardiovascular disease surveillance and program planning and evaluation. PMID:18341789

  17. Maternal Evaluations of Children's Emergent Literacy Level, Maternal Mediation in Book Reading, and Children's Emergent Literacy Level: A Comparison Between SES Groups

    ERIC Educational Resources Information Center

    Korat, Ofra; Haglili, Sharon

    2007-01-01

    This study examined whether maternal evaluations of children's emergent literacy (EL) levels, maternal mediation during a book-reading activity with children, and the children's EL levels differ as a function of socioeconomic status (SES; low vs. high), and whether the relationships between these variables differ as a function of SES levels. Study…

  18. Electromagnetic Scattering from Realistic Targets

    NASA Technical Reports Server (NTRS)

    Lee, Shung- Wu; Jin, Jian-Ming

    1997-01-01

    The general goal of the project is to develop computational tools for calculating radar signature of realistic targets. A hybrid technique that combines the shooting-and-bouncing-ray (SBR) method and the finite-element method (FEM) for the radiation characterization of microstrip patch antennas in a complex geometry was developed. In addition, a hybridization procedure to combine moment method (MoM) solution and the SBR method to treat the scattering of waveguide slot arrays on an aircraft was developed. A list of journal articles and conference papers is included.

  19. Evaluation of emergency drug releases from the Centers for Disease Control and Prevention Quarantine Stations.

    PubMed

    Roohi, Shahrokh; Grinnell, Margaret; Sandoval, Michelle; Cohen, Nicole J; Crocker, Kimberly; Allen, Christopher; Dougherty, Cindy; Jolly, Julian; Pesik, Nicki

    2015-01-01

    The Centers for Disease Control and Prevention (CDC) Quarantine Stations distribute select lifesaving drug products that are not commercially available or are in limited supply in the United States for emergency treatment of certain health conditions. Following a retrospective analysis of shipment records, the authors estimated an average of 6.66 hours saved per shipment when drug products were distributed from quarantine stations compared to a hypothetical centralized site from CDC headquarters in Atlanta, GA. This evaluation supports the continued use of a decentralized model which leverages CDC's regional presence and maximizes efficiency in the distribution of lifesaving drugs. PMID:25779896

  20. Evaluation and management of acute abdominal pain in the emergency department

    PubMed Central

    Macaluso, Christopher R; McNamara, Robert M

    2012-01-01

    Evaluation of the emergency department patient with acute abdominal pain is sometimes difficult. Various factors can obscure the presentation, delaying or preventing the correct diagnosis, with subsequent adverse patient outcomes. Clinicians must consider multiple diagnoses, especially those life-threatening conditions that require timely intervention to limit morbidity and mortality. This article will review general information on abdominal pain and discuss the clinical approach by review of the history and the physical examination. Additionally, this article will discuss the approach to unstable patients with abdominal pain. PMID:23055768

  1. Evaluation of emergency-locator-transmitter performance in real and simulated crash tests

    NASA Technical Reports Server (NTRS)

    Carden, H. D.

    1981-01-01

    Emergency locator transmitter (ELT) activation problems were investigated by testing a sampling of ELT units in actual airplane crashes and in a special test apparatus which simulated longitudinal crash pulses with superimposed local structural resonances. Probable causes of excessive false alarms and nonactivations of ELT's during crash situations were determined and solutions to the current operational and technical problems were obtained. The results, which considered placement, mounting, and activation of ELT's under simulated crash impacts, and an evaluation of the sensitivity of ELT impact switches to orientation and to local structural vibrations are discussed.

  2. How Does Emergency Department Crowding Affect Medical Student Test Scores and Clerkship Evaluations?

    PubMed Central

    Wei, Grant; Arya, Rajiv; Ritz, Z. Trevor; He, Albert S.; Ohman-Strickland, Pamela A.; McCoy, Jonathan V.

    2015-01-01

    Introduction The effect of emergency department (ED) crowding has been recognized as a concern for more than 20 years; its effect on productivity, medical errors, and patient satisfaction has been studied extensively. Little research has reviewed the effect of ED crowding on medical education. Prior studies that have considered this effect have shown no correlation between ED crowding and resident perception of quality of medical education. Objective To determine whether ED crowding, as measured by the National ED Overcrowding Scale (NEDOCS) score, has a quantifiable effect on medical student objective and subjective experiences during emergency medicine (EM) clerkship rotations. Methods We collected end-of-rotation examinations and medical student evaluations for 21 EM rotation blocks between July 2010 and May 2012, with a total of 211 students. NEDOCS scores were calculated for each corresponding period. Weighted regression analyses examined the correlation between components of the medical student evaluation, student test scores, and the NEDOCS score for each period. Results When all 21 rotations are included in the analysis, NEDOCS scores showed a negative correlation with medical student tests scores (regression coefficient= −0.16, p=0.04) and three elements of the rotation evaluation (attending teaching, communication, and systems-based practice; p<0.05). We excluded an outlying NEDOCS score from the analysis and obtained similar results. When the data were controlled for effect of month of the year, only student test score remained significantly correlated with NEDOCS score (p=0.011). No part of the medical student rotation evaluation attained significant correlation with the NEDOCS score (p≥0.34 in all cases). Conclusion ED overcrowding does demonstrate a small but negative association with medical student performance on end-of-rotation examinations. Additional studies are recommended to further evaluate this effect. PMID:26594289

  3. Electrokinetic transport in realistic nanochannels

    NASA Astrophysics Data System (ADS)

    Wang, Moran; Liu, Jin; Kang, Qinjun

    2009-11-01

    When an electrolyte solution contacts with a solid surface, the surface will likely be charged through an electrochemical adsorption process. The surface charge in general varies with the local bulk ionic concentration, the pH value and the temperature of the solution, and even with the double layer interactions in the narrow channel. Most of the previous studies are based on a constant zeta potential or surface charge density assumption, which does not reflect the realistic charge status at interfaces and may lead to inaccurate predictions. In this work, we first develop a generalized model for electrochemical boundary conditions on solid-liquid interfaces, which can closely approximate the known experimental properties. We further present nonequilibrium molecular dynamic (NEMD) simulations of electrokinetic transport in nanochannels. We take silica and carbon as examples of channel materials. Both monovalent and multivalent ionic solutions are considered. The electrokinetic transport properties for realistic nanochannels are therefore studied and a multiscale analysis for a new energy conversion device is performed.

  4. Logic Modeling as a Tool to Prepare to Evaluate Disaster and Emergency Preparedness, Response, and Recovery in Schools

    ERIC Educational Resources Information Center

    Zantal-Wiener, Kathy; Horwood, Thomas J.

    2010-01-01

    The authors propose a comprehensive evaluation framework to prepare for evaluating school emergency management programs. This framework involves a logic model that incorporates Government Performance and Results Act (GPRA) measures as a foundation for comprehensive evaluation that complements performance monitoring used by the U.S. Department of…

  5. A process for evaluation and state approval of an emergency response atmospheric dispersion model for Rocky Flats, Colorado

    SciTech Connect

    Hodgin, C.R.

    1991-11-06

    This document contains copies of the vugraphs used by C. R. Hodgin for the November 6, 1991 presentation summarizing the process to be used for evaluation of the Emergency Response Dispersion Model. (MHB)

  6. Developing and implementing an intervention. Evaluation of an emergency department pilot on partner abuse.

    PubMed

    Spinola, C; Stewart, L; Fanslow, J; Norton, R

    1998-03-01

    This article discusses the role of formative and process evaluation in the development and implementation of a pilot intervention to improve the identification, treatment, and referral of women abused by their partners who present to an emergency department (ED). These evaluations were undertaken in conjunction with an outcome evaluation of training in and use of a five-step protocol of care piloted in a New Zealand public hospital. The outcome evaluation showed there was an improvement in identification and acute care of abused women following the intervention. The article highlights key factors that were relevant to the intervention's development and implementation, including social context, development processes, appropriateness for the setting, and level of support from key stakeholders. Factors identified as key to intervention effectiveness included its appropriateness for abused women and responsiveness to specific hospital, department, and staff needs. The key role of formative and process evaluation in the development and implementation of pilot interventions is highlighted, and the particular lessons gained from this study have relevance and application to other interventions. PMID:10183341

  7. Multidetector computed tomography in the evaluation of pediatric acute abdominal pain in the emergency department.

    PubMed

    Lin, Wei-Ching; Lin, Chien-Heng

    2016-06-01

    The accurate diagnosis of pediatric acute abdominal pain is one of the most challenging tasks in the emergency department (ED) due to its unclear clinical presentation and non-specific findings in physical examinations, laboratory data, and plain radiographs. The objective of this study was to evaluate the impact of abdominal multidetector computed tomography (MDCT) performed in the ED on pediatric patients presenting with acute abdominal pain. A retrospective chart review of children aged <18 years with acute abdominal pain who visited the emergency department and underwent MDCT between September 2004 and June 2007 was conducted. Patients with a history of trauma were excluded. A total of 156 patients with acute abdominal pain (85 males and 71 females, age 1-17 years; mean age 10.9 ± 4.6 years) who underwent abdominal MDCT in the pediatric ED during this 3-year period were enrolled in the study. One hundred and eighteen patients with suspected appendicitis underwent abdominal MDCT. Sixty four (54.2%) of them had appendicitis, which was proven by histopathology. The sensitivity of abdominal MDCT for appendicitis was found to be 98.5% and the specificity was 84.9%. In this study, the other two common causes of nontraumatic abdominal emergencies were gastrointestinal tract (GI) infections and ovarian cysts. The most common etiology of abdominal pain in children that requires imaging with abdominal MDCT is appendicitis. MDCT has become a preferred and invaluable imaging modality in evaluating uncertain cases of pediatric acute abdominal pain in ED, in particular for suspected appendicitis, neoplasms, and gastrointestinal abnormalities. PMID:27154197

  8. Evaluation of a Sickle Cell Disease Educational Website for Emergency Providers.

    PubMed

    Kayle, Mariam; Brennan-Cook, Jill; Carter, Brigit M; Derouin, Anne L; Silva, Susan G; Tanabe, Paula

    2016-01-01

    Sickle cell disease (SCD) is a complex multisystem debilitating disease. Despite its complexity, health care providers who are not SCD experts receive little formal education on SCD. An open-access, educational website, "Emergency Department Sickle Cell Disease: Crisis Management and Beyond," was created to provide education about SCD to emergency department (ED) providers who are not SCD experts but who provide care for patients with SCD. Electronic surveys were used to conduct a formal evaluation of the accuracy and relevance of the website's content, as well as the effectiveness of the education modules in improving knowledge among health care providers. The evaluation consisted of (1) individual module pre- and post-knowledge assessment, (2) content validity assessment of educational modules, (3) overall website content assessment, and (4) overall website assessment (Health on the Net core principles). A convenient sample of ED providers, accelerated bachelor of science in nursing students, SCD experts, and website experts completed the anonymous surveys. Descriptive statistics and paired t tests were used to compare mean difference in post- minus pre-knowledge test scores. Knowledge scores statistically improved for nursing students (p value less than 0.0001). Emergency department providers showed a mean improvement of 3.2 points on the eight-item knowledge assessment. Both SCD experts and ED providers agreed that the module content was clear and easy to understand, accurate, comprehensive, relevant, and met module objectives. Participants agreed that the website was clear, easy to navigate, and visually appealing. Website experts stated that the website met much of the Health on the Net criteria. The website is a useful resource for providers and nursing students, especially those who serve or plan to serve in EDs. PMID:27139134

  9. Optomechanical considerations for realistic tolerancing

    NASA Astrophysics Data System (ADS)

    Herman, Eric; Sasián, José; Youngworth, Richard N.

    2013-09-01

    Optical tolerancing simulation has improved so that the modeling of optomechanical accuracy can better predict as-built performance. A key refinement being proposed within this paper is monitoring formal interference fits and checking lens elements within their mechanical housings. Without proper checks, simulations may become physically unrealizable and pessimistic, thereby resulting in lower simulated yields. An improved simulation method has been defined and demonstrated in this paper with systems that do not have barrel constraints. The demonstration cases clearly show the trend of the beneficial impact with yield results, as a yield increase of 36.3% to 39.2% is garnered by one example. Considerations in simulating the realistic optomechanical system will assist in controlling cost and providing more accurate simulation results.

  10. Realistic Ground Motion Scenarios: Methodological Approach

    SciTech Connect

    Nunziata, C.; Peresan, A.; Romanelli, F.; Vaccari, F.; Zuccolo, E.; Panza, G. F.

    2008-07-08

    The definition of realistic seismic input can be obtained from the computation of a wide set of time histories, corresponding to possible seismotectonic scenarios. The propagation of the waves in the bedrock from the source to the local laterally varying structure is computed with the modal summation technique, while in the laterally heterogeneous structure the finite difference method is used. The definition of shear wave velocities within the soil cover is obtained from the non-linear inversion of the dispersion curve of group velocities of Rayleigh waves, artificially or naturally generated. Information about the possible focal mechanisms of the sources can be obtained from historical seismicity, based on earthquake catalogues and inversion of isoseismal maps. In addition, morphostructural zonation and pattern recognition of seismogenic nodes is useful to identify areas prone to strong earthquakes, based on the combined analysis of topographic, tectonic, geological maps and satellite photos. We show that the quantitative knowledge of regional geological structures and the computation of realistic ground motion can be a powerful tool for a preventive definition of the seismic hazard in Italy. Then, the formulation of reliable building codes, based on the evaluation of the main potential earthquakes, will have a great impact on the effective reduction of the seismic vulnerability of Italian urban areas, validating or improving the national building code.

  11. Realistic modeling of neurons and networks: towards brain simulation

    PubMed Central

    D’Angelo, Egidio; Solinas, Sergio; Garrido, Jesus; Casellato, Claudia; Pedrocchi, Alessandra; Mapelli, Jonathan; Gandolfi, Daniela; Prestori, Francesca

    Summary Realistic modeling is a new advanced methodology for investigating brain functions. Realistic modeling is based on a detailed biophysical description of neurons and synapses, which can be integrated into microcircuits. The latter can, in turn, be further integrated to form large-scale brain networks and eventually to reconstruct complex brain systems. Here we provide a review of the realistic simulation strategy and use the cerebellar network as an example. This network has been carefully investigated at molecular and cellular level and has been the object of intense theoretical investigation. The cerebellum is thought to lie at the core of the forward controller operations of the brain and to implement timing and sensory prediction functions. The cerebellum is well described and provides a challenging field in which one of the most advanced realistic microcircuit models has been generated. We illustrate how these models can be elaborated and embedded into robotic control systems to gain insight into how the cellular properties of cerebellar neurons emerge in integrated behaviors. Realistic network modeling opens up new perspectives for the investigation of brain pathologies and for the neurorobotic field. PMID:24139652

  12. Emergency and backup power supplies at Department of Energy facilities: Augmented Evaluation Team -- Final report

    SciTech Connect

    Not Available

    1993-11-01

    This report documents the results of the Defense Programs (DP) Augmented Evaluation Team (AET) review of emergency and backup power supplies (i.e., generator, uninterruptible power supply, and battery systems) at DP facilities. The review was conducted in response to concerns expressed by former Secretary of Energy James D. Watkins over the number of incidents where backup power sources failed to provide electrical power during tests or actual demands. The AET conducted a series of on-site reviews for the purpose of understanding the design, operation, maintenance, and safety significance of emergency and backup power (E&BP) supplies. The AET found that the quality of programs related to maintenance of backup power systems varies greatly among the sites visited, and often among facilities at the same site. No major safety issues were identified. However, there are areas where the AET believes the reliability of emergency and backup power systems can and should be improved. Recommendations for improving the performance of E&BP systems are provided in this report. The report also discusses progress made by Management and Operating (M&O) contractors to improve the reliability of backup sources used in safety significant applications. One area that requires further attention is the analysis and understanding of the safety implications of backup power equipment. This understanding is needed for proper graded-approach implementation of Department of Energy (DOE) Orders, and to help ensure that equipment important to the safety of DOE workers, the public, and the environment is identified, classified, recognized, and treated as such by designers, users, and maintainers. Another area considered important for improving E&BP system performance is the assignment of overall ownership responsibility and authority for ensuring that E&BP equipment performs adequately and that reliability and availability are maintained at acceptable levels.

  13. Evaluation of Emerging Energy-Efficient Heterogeneous Computing Platforms for Biomolecular and Cellular Simulation Workloads

    PubMed Central

    Stone, John E.; Hallock, Michael J.; Phillips, James C.; Peterson, Joseph R.; Luthey-Schulten, Zaida; Schulten, Klaus

    2016-01-01

    Many of the continuing scientific advances achieved through computational biology are predicated on the availability of ongoing increases in computational power required for detailed simulation and analysis of cellular processes on biologically-relevant timescales. A critical challenge facing the development of future exascale supercomputer systems is the development of new computing hardware and associated scientific applications that dramatically improve upon the energy efficiency of existing solutions, while providing increased simulation, analysis, and visualization performance. Mobile computing platforms have recently become powerful enough to support interactive molecular visualization tasks that were previously only possible on laptops and workstations, creating future opportunities for their convenient use for meetings, remote collaboration, and as head mounted displays for immersive stereoscopic viewing. We describe early experiences adapting several biomolecular simulation and analysis applications for emerging heterogeneous computing platforms that combine power-efficient system-on-chip multi-core CPUs with high-performance massively parallel GPUs. We present low-cost power monitoring instrumentation that provides sufficient temporal resolution to evaluate the power consumption of individual CPU algorithms and GPU kernels. We compare the performance and energy efficiency of scientific applications running on emerging platforms with results obtained on traditional platforms, identify hardware and algorithmic performance bottlenecks that affect the usability of these platforms, and describe avenues for improving both the hardware and applications in pursuit of the needs of molecular modeling tasks on mobile devices and future exascale computers. PMID:27516922

  14. Simulator Evaluation of Simplified Propulsion-Only Emergency Flight Control Systems on Transport Aircraft

    NASA Technical Reports Server (NTRS)

    Burcham, Frank W., Jr.; Kaneshige, John; Bull, John; Maine, Trindel A.

    1999-01-01

    With the advent of digital engine control systems, considering the use of engine thrust for emergency flight control has become feasible. Many incidents have occurred in which engine thrust supplemented or replaced normal aircraft flight controls. In most of these cases, a crash has resulted, and more than 1100 lives have been lost. The NASA Dryden Flight Research Center has developed a propulsion-controlled aircraft (PCA) system in which computer-controlled engine thrust provides emergency flight control capability. Using this PCA system, an F-15 and an MD-11 airplane have been landed without using any flight controls. In simulations, C-17, B-757, and B-747 PCA systems have also been evaluated successfully. These tests used full-authority digital electronic control systems on the engines. Developing simpler PCA systems that can operate without full-authority engine control, thus allowing PCA technology to be installed on less capable airplanes or at lower cost, is also a desire. Studies have examined simplified ?PCA Ultralite? concepts in which thrust control is provided using an autothrottle system supplemented by manual differential throttle control. Some of these concepts have worked well. The PCA Ultralite study results are presented for simulation tests of MD-11, B-757, C-17, and B-747 aircraft.

  15. UAV Deployment Exercise for Mapping Purposes: Evaluation of Emergency Response Applications.

    PubMed

    Boccardo, Piero; Chiabrando, Filiberto; Dutto, Furio; Tonolo, Fabio Giulio; Lingua, Andrea

    2015-01-01

    Exploiting the decrease of costs related to UAV technology, the humanitarian community started piloting the use of similar systems in humanitarian crises several years ago in different application fields, i.e., disaster mapping and information gathering, community capacity building, logistics and even transportation of goods. Part of the author's group, composed of researchers in the field of applied geomatics, has been piloting the use of UAVs since 2006, with a specific focus on disaster management application. In the framework of such activities, a UAV deployment exercise was jointly organized with the Regional Civil Protection authority, mainly aimed at assessing the operational procedures to deploy UAVs for mapping purposes and the usability of the acquired data in an emergency response context. In the paper the technical features of the UAV platforms will be described, comparing the main advantages/disadvantages of fixed-wing versus rotor platforms. The main phases of the adopted operational procedure will be discussed and assessed especially in terms of time required to carry out each step, highlighting potential bottlenecks and in view of the national regulation framework, which is rapidly evolving. Different methodologies for the processing of the acquired data will be described and discussed, evaluating the fitness for emergency response applications. PMID:26147728

  16. Users' experiences of an emergency department patient admission predictive tool: A qualitative evaluation.

    PubMed

    Jessup, Melanie; Crilly, Julia; Boyle, Justin; Wallis, Marianne; Lind, James; Green, David; Fitzgerald, Gerard

    2016-09-01

    Emergency department overcrowding is an increasing issue impacting patients, staff and quality of care, resulting in poor patient and system outcomes. In order to facilitate better management of emergency department resources, a patient admission predictive tool was developed and implemented. Evaluation of the tool's accuracy and efficacy was complemented with a qualitative component that explicated the experiences of users and its impact upon their management strategies, and is the focus of this article. Semi-structured interviews were conducted with 15 pertinent users, including bed managers, after-hours managers, specialty department heads, nurse unit managers and hospital executives. Analysis realised dynamics of accuracy, facilitating communication and enabling group decision-making Users generally welcomed the enhanced potential to predict and plan following the incorporation of the patient admission predictive tool into their daily and weekly decision-making processes. They offered astute feedback with regard to their responses when faced with issues of capacity and communication. Participants reported an growing confidence in making informed decisions in a cultural context that is continually moving from reactive to proactive. This information will inform further patient admission predictive tool development specifically and implementation processes generally. PMID:25916833

  17. UAV Deployment Exercise for Mapping Purposes: Evaluation of Emergency Response Applications

    PubMed Central

    Boccardo, Piero; Chiabrando, Filiberto; Dutto, Furio; Giulio Tonolo, Fabio; Lingua, Andrea

    2015-01-01

    Exploiting the decrease of costs related to UAV technology, the humanitarian community started piloting the use of similar systems in humanitarian crises several years ago in different application fields, i.e., disaster mapping and information gathering, community capacity building, logistics and even transportation of goods. Part of the author’s group, composed of researchers in the field of applied geomatics, has been piloting the use of UAVs since 2006, with a specific focus on disaster management application. In the framework of such activities, a UAV deployment exercise was jointly organized with the Regional Civil Protection authority, mainly aimed at assessing the operational procedures to deploy UAVs for mapping purposes and the usability of the acquired data in an emergency response context. In the paper the technical features of the UAV platforms will be described, comparing the main advantages/disadvantages of fixed-wing versus rotor platforms. The main phases of the adopted operational procedure will be discussed and assessed especially in terms of time required to carry out each step, highlighting potential bottlenecks and in view of the national regulation framework, which is rapidly evolving. Different methodologies for the processing of the acquired data will be described and discussed, evaluating the fitness for emergency response applications. PMID:26147728

  18. Study Designs and Evaluation Models for Emergency Department Public Health Research

    PubMed Central

    Broderick, Kerry B.; Ranney, Megan L.; Vaca, Federico E.; D’Onofrio, Gail; Rothman, Richard E.; Rhodes, Karin V.; Becker, Bruce; Haukoos, Jason S.

    2011-01-01

    Public health research requires sound design and thoughtful consideration of potential biases that may influence the validity of results. It also requires careful implementation of protocols and procedures that are likely to translate from the research environment to actual clinical practice. This article is the product of a breakout session from the 2009 Academic Emergency Medicine consensus conference entitled “Public Health in the ED: Screening, Surveillance, and Intervention” and serves to describe in detail aspects of performing emergency department (ED)-based public health research, while serving as a resource for current and future researchers. In doing so, the authors describe methodologic features of study design, participant selection and retention, and measurements and analyses pertinent to public health research. In addition, a number of recommendations related to research methods and future investigations related to public health work in the ED are provided. Public health investigators are poised to make substantial contributions to this important area of research, but this will only be accomplished by employing sound research methodology in the context of rigorous program evaluation. PMID:20053232

  19. Implementation and performance evaluation of mobile ad hoc network for Emergency Telemedicine System in disaster areas.

    PubMed

    Kim, J C; Kim, D Y; Jung, S M; Lee, M H; Kim, K S; Lee, C K; Nah, J Y; Lee, S H; Kim, J H; Choi, W J; Yoo, S K

    2009-01-01

    So far we have developed Emergency Telemedicine System (ETS) which is a robust system using heterogeneous networks. In disaster areas, however, ETS cannot be used if the primary network channel is disabled due to damages on the network infrastructures. Thus we designed network management software for disaster communication network by combination of Mobile Ad hoc Network (MANET) and Wireless LAN (WLAN). This software maintains routes to a Backbone Gateway Node in dynamic network topologies. In this paper, we introduce the proposed disaster communication network with management software, and evaluate its performance using ETS between Medical Center and simulated disaster areas. We also present the results of network performance analysis which identifies the possibility of actual Telemedicine Service in disaster areas via MANET and mobile network (e.g. HSDPA, WiBro). PMID:19964544

  20. Emergency Department Evaluation and Management of Children With Simple Febrile Seizures.

    PubMed

    Carapetian, Stephanie; Hageman, Joseph; Lyons, Evelyn; Leonard, Daniel; Janies, Kathryn; Kelley, Kent; Fuchs, Susan

    2015-09-01

    Workup of simple febrile seizures (SFS) has changed as the American Academy of Pediatrics made revisions to practice guidelines. In 2011, revisions were made regarding need for lumbar puncture (LP) as part of the SFS workup. This study surveyed more than 100 emergency departments regarding workup of children with SFS and performed a medical record review of workup that was performed. The survey shows that laboratory workup is done routinely and LP is done infrequently. The majority documents a complete exam. The medical record review demonstrates documentation of the examination, frequent laboratory and infrequent LP evaluation. Consistent with the American Academy of Pediatrics' revisions, survey and record reviews demonstrate that LP testing is infrequent. Contrary to the guideline, laboratory studies are routinely performed. This study suggests there is an opportunity to improve management of SFS by directing efforts toward finding the source of the fever and away from laboratory workup. PMID:25667312

  1. Headache in Pregnancy: An Approach to Emergency Department Evaluation and Management

    PubMed Central

    Schoen, Jessica C.; Campbell, Ronna L.; Sadosty, Annie T.

    2015-01-01

    Headache is a common presenting complaint in the emergency department. The differential diagnosis is broad and includes benign primary causes as well as ominous secondary causes. The diagnosis and management of headache in the pregnant patient presents several challenges. There are important unique considerations regarding the differential diagnosis, imaging options, and medical management. Physiologic changes induced by pregnancy increase the risk of cerebral venous thrombosis, dissection, and pituitary apoplexy. Preeclampsia, a serious condition unique to pregnancy, must also be considered. A high index of suspicion for carbon monoxide toxicity should be maintained. Primary headaches should be a diagnosis of exclusion. When advanced imaging is indicated, magnetic resonance imaging (MRI) should be used, if available, to reduce radiation exposure. Contrast agents should be avoided unless absolutely necessary. Medical therapy should be selected with careful consideration of adverse fetal effects. Herein, we present a review of the literature and discuss an approach to the evaluation and management of headache in pregnancy PMID:25834672

  2. Microfluidic technology as an emerging clinical tool to evaluate thrombosis and hemostasis

    PubMed Central

    Branchford, Brian R.; Ng, Christopher J.; Neeves, Keith B.; Di Paola, Jorge

    2015-01-01

    Assessment of platelet function and coagulation under flow conditions can augment traditional static assays used to evaluate patients with suspected hemostatic or thrombotic disorders. Among the available flow-based assays, microfluidic devices require the smallest blood volume and provide multiple output options. These assays are based on the presence of wall shear stress that mimics in vivo interactions between blood components and vessel walls. Microfluidic devices can generate essential information regarding homeostatic regulation of platelet activation and subsequent engagement of the coagulation cascade leading to fibrin deposition and clot formation. Emerging data suggest that microfluidic assays may also reveal consistent patterns of hemostatic or thrombotic pathology, and could aid in assessing and monitoring patient-specific effects of coagulation-modifying therapies. PMID:26014643

  3. Flight Simulator Evaluation of Enhanced Propulsion Control Modes for Emergency Operation

    NASA Technical Reports Server (NTRS)

    Litt, Jonathan, S; Sowers, T.; Owen, A., Karl; Fulton, Christopher, E.; Chicatelli, Amy, K.

    2012-01-01

    This paper describes piloted evaluation of enhanced propulsion control modes for emergency operation of aircraft. Fast Response and Overthrust modes were implemented to assess their ability to help avoid or mitigate potentially catastrophic situations, both on the ground and in flight. Tests were conducted to determine the reduction in takeoff distance achievable using the Overthrust mode. Also, improvements in Dutch roll damping, enabled by using yaw rate feedback to the engines to replace the function of a stuck rudder, were investigated. Finally, pilot workload and ability to handle the impaired aircraft on approach and landing were studied. The results showed that improvement in all aspects is possible with these enhanced propulsion control modes, but the way in which they are initiated and incorporated is important for pilot comfort and perceived benefit.

  4. Tracking Pertussis and Evaluating Control Measures through Enhanced Pertussis Surveillance, Emerging Infections Program, United States.

    PubMed

    Skoff, Tami H; Baumbach, Joan; Cieslak, Paul R

    2015-09-01

    Despite high coverage with pertussis-containing vaccines, pertussis remains endemic to the United States. There have been increases in reported cases in recent years, punctuated by striking epidemics and shifting epidemiology, both of which raise questions about current policies regarding its prevention and control. Limited data on pertussis reported through the National Notifiable Disease Surveillance System have proved insufficient to answer these questions. To address shortcomings of national pertussis data, the Emerging Infections Program at the US Centers for Disease Control and Prevention launched Enhanced Pertussis Surveillance (EPS), which is characterized by systematic case ascertainment, augmented data collection, and collection of Bordetella pertussis isolates. Data collected through EPS have been instrumental in understanding the rapidly evolving epidemiology and molecular epidemiology of pertussis and have contributed essential information regarding pertussis vaccines. EPS also serves as a platform for conducting critical and timely evaluations of pertussis prevention and control strategies, including targeting of vaccinations and antimicrobial prophylaxis. PMID:26291475

  5. New methods for improved evaluation of patients with suspected acute coronary syndrome in the emergency department

    PubMed Central

    Ekelund, U; Forberg, J L

    2007-01-01

    This paper aims to identify and review new and unproven emergency department (ED) methods for improved evaluation in cases of suspected acute coronary syndrome (ACS). Systematic news coverage through PubMed from 2000 to 2006 identified papers on new methods for ED assessment of patients with suspected ACS. Articles found described decision support models, new ECG methods, new biomarkers and point‐of‐care testing, cardiac imaging, immediate exercise tests and the chest pain unit concept. None of these new methods is likely to be the perfect solution, and the best strategy today is therefore a combination of modern methods, where the optimal protocol depends on local resources and expertise. With a suitable combination of new methods, it is likely that more patients can be managed as outpatients, that length of stay can be shortened for those admitted, and that some patients with ACS can get earlier treatment. PMID:18029508

  6. Tracking Pertussis and Evaluating Control Measures through Enhanced Pertussis Surveillance, Emerging Infections Program, United States

    PubMed Central

    Baumbach, Joan; Cieslak, Paul R.

    2015-01-01

    Despite high coverage with pertussis-containing vaccines, pertussis remains endemic to the United States. There have been increases in reported cases in recent years, punctuated by striking epidemics and shifting epidemiology, both of which raise questions about current policies regarding its prevention and control. Limited data on pertussis reported through the National Notifiable Disease Surveillance System have proved insufficient to answer these questions. To address shortcomings of national pertussis data, the Emerging Infections Program at the US Centers for Disease Control and Prevention launched Enhanced Pertussis Surveillance (EPS), which is characterized by systematic case ascertainment, augmented data collection, and collection of Bordetella pertussis isolates. Data collected through EPS have been instrumental in understanding the rapidly evolving epidemiology and molecular epidemiology of pertussis and have contributed essential information regarding pertussis vaccines. EPS also serves as a platform for conducting critical and timely evaluations of pertussis prevention and control strategies, including targeting of vaccinations and antimicrobial prophylaxis. PMID:26291475

  7. Allergy evaluation after emergency treatment: anaphylaxis to the over-the-counter medication clobutinol.

    PubMed

    Seitz, Cornelia S; Bröcker, Eva-B; Trautmann, Axel

    2007-03-01

    Anaphylaxis is traditionally diagnosed and treated as an acute emergency but should be always followed by a search for specific triggers, resulting in avoidance strategies. This case report highlights the relevance of a detailed evaluation after anaphylaxis for diagnosis of a rare but potentially life-threatening allergy. Considering the high frequency of clobutinol application, IgE-mediated allergic hypersensitivity seems extremely rare and has to be distinguished from infection-associated urticaria and angioedema as well as non-specific summation effects. Accidental re-exposure has to be strictly avoided and therefore after identification of clobutinol as the anaphylaxis trigger, the patient received detailed allergy documents including international non-proprietary and trade names of the culprit drug. PMID:17351213

  8. Allergy evaluation after emergency treatment: anaphylaxis to the over‐the‐counter medication clobutinol

    PubMed Central

    Seitz, Cornelia S; Bröcker, Eva‐B; Trautmann, Axel

    2007-01-01

    Anaphylaxis is traditionally diagnosed and treated as an acute emergency but should be always followed by a search for specific triggers, resulting in avoidance strategies. This case report highlights the relevance of a detailed evaluation after anaphylaxis for diagnosis of a rare but potentially life‐threatening allergy. Considering the high frequency of clobutinol application, IgE‐mediated allergic hypersensitivity seems extremely rare and has to be distinguished from infection‐associated urticaria and angioedema as well as non‐specific summation effects. Accidental re‐exposure has to be strictly avoided and therefore after identification of clobutinol as the anaphylaxis trigger, the patient received detailed allergy documents including international non‐proprietary and trade names of the culprit drug. PMID:17351213

  9. Recruitment strategies. Pharmacists' participation in an evaluation project to dispense emergency contraception.

    PubMed

    Cockerill, Rhonda; Cohen, Marsha; Dunn, Sheila; Brown, Thomas

    2004-03-01

    The objective of this article was to describe the effectiveness of a multifocus recruitment strategy to a pilot project allowing direct provision of emergency contraception (EC) in a community pharmacy through collaborative agreements between pharmacists and physicians. The project recruited pharmacies through direct appeals to pharmacists, pharmacy managers and/or owners, and corporate pharmacy chains. The evaluation project was successful in recruiting sufficient numbers of pharmacies to warrant proceeding with the project. The most successful component of the recruitment strategy was reference to the opportunities that participation offered to expand the pharmacist's role in patient-focused care. The importance of peer influence was also noted in terms of encouraging pharmacy involvement. PMID:14994560

  10. Emergent Expertise?

    ERIC Educational Resources Information Center

    McGivern, Patrick

    2014-01-01

    The concept of emergence appears in various places within the literature on expertise and expert practice. Here, I examine some of these applications of emergence in the light of two prominent accounts of emergence from the philosophy of science and philosophy of mind. I evaluate these accounts with respect to several specific contexts in which…

  11. Evaluation of BWR emergency procedure guidelines for BWR ATWS using RAMONA-3B code

    SciTech Connect

    Neymotin, L.; Slovik, G.; Cazzoli, E.; Saha, P.

    1985-01-01

    An MSIV Closure ATWS calculation for a typical BWR/4 (Browns Ferry, Unit 1) was performed using the RAMONA-3B code which is a BWR systems transient code combining three-dimensional neutronic core representation with multi-channel one-dimensional thermal hydraulics. The main objective of the study was to perform a best-estimate evaluation of the recently proposed Emergency Procedure Guidelines for Anticipated Transients Without Scram (ATWS). Emphasis was placed on evaluating the effects of lowering the downcomer water level to the Top of Active Fuel (TAF) and vessel depressurization. The calculation was run up to approximately 1200 seconds. Both actions, namely, lowering the water level and vessel depressurization, lowered the reactor power to some extent. However, the pressure suppression pool water temperature still reached approximately 90/sup 0/C (potential High Pressure Coolant Injection (HPCI) pump seal failure temperature) in twenty minutes. Thus, other actions such as boron injection and/or manual control rod insertion are necessary to mitigate a BWR/4 Main Steam Isolation Valve (MSIV) closure ATWS. 19 refs., 14 figs., 3 tabs.

  12. Evaluation of emerging factors blocking filtration of high-adjunct-ratio wort.

    PubMed

    Ma, Ting; Zhu, Linjiang; Zheng, Feiyun; Li, Yongxian; Li, Qi

    2014-08-20

    Corn starch has become a common adjunct for beer brewing in Chinese breweries. However, with increasing ratio of corn starch, problems like poor wort filtration performance arise, which will decrease production capacity of breweries. To solve this problem, factors affecting wort filtration were evaluated, such as the size of corn starch particle, special yellow floats formed during liquefaction of corn starch, and residual substance after liquefaction. The effects of different enzyme preparations including β-amylase and β-glucanase on filtration rate were also evaluated. The results indicate that the emerging yellow floats do not severely block filtration, while the fine and uniform-shape corn starch particle and its incompletely hydrolyzed residue after liquefaction are responsible for filtration blocking. Application of β-amylase preparation increased the filtration rate of liquefied corn starch. This study is useful for our insight into the filtration blocking problem arising in the process of high-adjunct-ratio beer brewing and also provides a feasible solution using enzyme preparations. PMID:25088033

  13. Evaluation of PACS at Hammersmith Hospital: assessment of radiology performance in the accident and emergency department

    NASA Astrophysics Data System (ADS)

    Weatherburn, Gwyneth C.; Bryan, Stirling; Cocks, Robert

    1993-09-01

    In the Accident and Emergency Department (A&E) x-ray images are used to assist in the initial diagnosis and management of the patient. It is therefore expected that the main benefits of PACS in A&E will arise from the ability of clinicians to manipulate the digital image and thus potentially improve their diagnostic performance. In order to evaluate whether this benefit is realized or not a case-study evaluation has been undertaken; this has three components: (a) monitoring the extent of misdiagnosis by A&E clinicians before and after the PACS implementation; (b) an examination of the decision performance of the clinician-image combination for the visualization of the lower cervical spine/upper thoracic spine and of fracture of the head of the radius; and (c) a more general monitoring of the impact of the image archiving and communication aspects of PACS. In this paper the study of the impact of PACS on misdiagnosis by A&E clinicians at the Hammersmith Hospital, London, is described and pre-PACS results for the period 31 March 1992 to 30 September 1992 are presented.

  14. A new head phantom with realistic shape and spatially varying skull resistivity distribution.

    PubMed

    Li, Jian-Bo; Tang, Chi; Dai, Meng; Liu, Geng; Shi, Xue-Tao; Yang, Bin; Xu, Can-Hua; Fu, Feng; You, Fu-Sheng; Tang, Meng-Xing; Dong, Xiu-Zhen

    2014-02-01

    Brain electrical impedance tomography (EIT) is an emerging method for monitoring brain injuries. To effectively evaluate brain EIT systems and reconstruction algorithms, we have developed a novel head phantom that features realistic anatomy and spatially varying skull resistivity. The head phantom was created with three layers, representing scalp, skull, and brain tissues. The fabrication process entailed 3-D printing of the anatomical geometry for mold creation followed by casting to ensure high geometrical precision and accuracy of the resistivity distribution. We evaluated the accuracy and stability of the phantom. Results showed that the head phantom achieved high geometric accuracy, accurate skull resistivity values, and good stability over time and in the frequency domain. Experimental impedance reconstructions performed using the head phantom and computer simulations were found to be consistent for the same perturbation object. In conclusion, this new phantom could provide a more accurate test platform for brain EIT research. PMID:24196845

  15. Gravity waves in a realistic atmosphere.

    NASA Technical Reports Server (NTRS)

    Liemohn, H. B.; Midgley, J. E.

    1966-01-01

    Internal atmospheric gravity waves in isothermal medium, solving hydrodynamic equations, determining wave propagation in realistic atmosphere for range of wave parameters, wind amplitude, reflected energy, etc

  16. Medical Operations Console Procedure Evaluation: BME Response to Crew Call Down for an Emergency

    NASA Technical Reports Server (NTRS)

    Johnson-Troop; Pettys, Marianne; Hurst, Victor, IV; Smaka, Todd; Paul, Bonnie; Rosenquist, Kevin; Gast, Karin; Gillis, David; McCulley, Phyllis

    2006-01-01

    International Space Station (ISS) Mission Operations are managed by multiple flight control disciplines located at the lead Mission Control Center (MCC) at NASA-Johnson Space Center (JSC). ISS Medical Operations are supported by the complementary roles of Flight Surgeons (Surgeon) and Biomedical Engineer (BME) flight controllers. The Surgeon, a board certified physician, oversees all medical concerns of the crew and the BME provides operational and engineering support for Medical Operations Crew Health Care System. ISS Medical Operations is currently addressing the coordinated response to a crew call down for an emergent medical event, in particular when the BME is the only Medical Operations representative in MCC. In this case, the console procedure BME Response to Crew Call Down for an Emergency will be used. The procedure instructs the BME to contact a Surgeon as soon as possible, coordinate with other flight disciplines to establish a Private Medical Conference (PMC) for the crew and Surgeon, gather information from the crew if time permits, and provide Surgeon with pertinent console resources. It is paramount that this procedure is clearly written and easily navigated to assist the BME to respond consistently and efficiently. A total of five BME flight controllers participated in the study. Each BME participant sat in a simulated MCC environment at a console configured with resources specific to the BME MCC console and was presented with two scripted emergency call downs from an ISS crew member. Each participant used the procedure while interacting with analog MCC disciplines to respond to the crew call down. Audio and video recordings of the simulations were analyzed and each BME participant's actions were compared to the procedure. Structured debriefs were conducted at the conclusion of both simulations. The procedure was evaluated for its ability to elicit consistent responses from each BME participant. Trials were examined for deviations in procedure task

  17. 1992 update of US EPA's Superfund Innovative Technology Evaluation (SITE) Emerging Technology Program

    SciTech Connect

    Lewis, N.M.; Barkley, N.P.; Williams, T. )

    1992-12-01

    The Superfund Innovative Technology Evaluation (SITE) Emerging Technology Program (ETP) has financially supported further development of bench- and pilot-scale testing and evaluation of innovative technologies for use at hazardous waste sites for five years. The ETP was established under the Superfund Amendments and Reauthorization Act (SARA) of 1986. The ETP complies with the goal of the SITE Program to promote, accelerate and make commercially available the development of alternative/innovative treatment technologies for use at Superfund sites. Technologies are submitted to the ETP through yearly solicitations for Preproposals. Applicants are asked to submit a detailed project proposal and a cooperative agreement application that requires Developer/EPA cost sharing. EPA co-funds selected Developers for one to two years. Second-year funding requires documentation of significant progress during the first year. Facilities, equipment, data collection, performance and development are monitored throughout the project. The US Department of Energy (DOE) and the US Air Force (USAF) are participants in the ETP. DOE has co-funded ETP projects since 1990 and the USAF since 1991. A goal of the ETP is to move developed technologies to the field-demonstration stage. A developer may be considered for participation in the SITE Demonstration Program if performance in the ETP indicates the technology is field-ready for evaluation. Six technology categories: biological, chemical, materials handling, physical, solidification/stabilization and thermal, are presently in the ETP. Technologies of primary interest to EPA are those that can treat complex mixtures of hazardous organic and inorganic contaminants and provide improved solids handling and/or pretreatment. An account of the background and progress of the ETP's first five years is presented in this paper. Technologies currently in the ETP are noted, and developers and EPA Project Managers, are listed. 4 refs., 11 figs., 6 tabs.

  18. Protective Action Evaluator for Chemical Emergencies: A user's manual (MS-DOS reg sign Version 1. 0)

    SciTech Connect

    Rogers, G.O.; Sharp, R.D.

    1990-10-01

    The protective action evaluator for chemical emergencies (PAECE) is a package of computer programs developed to simulate an emergency response to airborne release of chemical agents. This user's manual documents the use of PAECE in the evaluation of chemical agent emergencies in areas potentially affected by the Chemical Stockpile Emergency Planning Program (CSEPP). This research documents the development and use of a method for the evaluation of protective action alternatives in conjunction with potential chemical agent emergencies. The user's manual highlights the development of the PAECE model, the selection of appropriate parameters to represent various scenarios, generate results and interpret them in the analysis of protective action alternatives during the planning and preparedness phases of the CSEPP. The PAECE model is designed to evaluate protective actions in the context of potential accidents, the emergency management systems required to implement protective actions, and the anticipated consequences for human receptors. The implications and uncertainties of the model are discussed to provide potential users with insight into the use, limitations, and uncertainties associated with evaluating the effectiveness of protective action alternatives. While PAECE represents a unique and powerful tool to evaluate protective actions, the user must exercise caution when interpreting the results to avoid misrepresentation. The expected value interpretation of the PAECE results biases the results toward extreme values. Hence, the PAECE results have to be interpreted in the context exposures similar to those represented by the unprotected exposure and the protection capacity that tend to be associated with people completing the implementation of the required actions later than and earlier than average, respectively. 16 refs., 24 figs., 1 tab. (JF)

  19. An Independent Human Factors Analysis and Evaluation of the Emergency Medical Protocol Checklist for the International Space Station

    NASA Technical Reports Server (NTRS)

    Marshburn, Thomas; Whitmore, Mihriban; Ortiz, Rosie; Segal, Michele; Smart, Kieran; Hughes, Catherine

    2003-01-01

    Emergency medical capabilities aboard the ISS include a Crew Medical Officer (CMO) (not necessarily a physician), and back-up, resuscitation equipment, and a medical checklist. It is essential that CMOs have reliable, usable and informative medical protocols that can be carried out independently in flight. The study evaluates the existing ISS Medical Checklist layout against a checklist updated to reflect a human factors approach to structure and organization. Method: The ISS Medical checklist was divided into non-emergency and emergency sections, and re-organized based on alphabetical and a body systems approach. A desk-top evaluation examined the ability of subjects to navigate to specific medical problems identified as representative of likely non-emergency events. A second evaluation aims to focus on the emergency section of the Medical Checklist, based on the preliminary findings of the first. The final evaluation will use Astronaut CMOs as subjects comparing the original checklist against the updated layout in the task of caring for a "downed crewmember" using a Human Patient Simulator [Medical Education Technologies, Inc.]. Results: Initial results have demonstrated a clear improvement of the re-organized sections to determine the solution to the medical problems. There was no distinct advantage for either alternative, although subjects stated having a preference for the body systems approach. In the second evaluation, subjects will be asked to identify emergency medical conditions, with measures including correct diagnosis, time to completion and solution strategy. The third evaluation will compare the original and fully updated checklists in clinical situations. Conclusions: Initial findings indicate that the ISS Medical Checklist will benefit from a reorganization. The present structure of the checklist has evolved over recent years without systematic testing of crewmember ability to diagnose medical problems. The improvements are expected to enable ISS

  20. Bosonic condensates in realistic supersymmetric GUT cosmic strings

    NASA Astrophysics Data System (ADS)

    Allys, Erwan

    2016-04-01

    We study the realistic structure of F-term Nambu-Goto cosmic strings forming in a general supersymmetric Grand Unified Theory implementation, assuming standard hybrid inflation. Examining the symmetry breaking of the unification gauge group down to the Standard Model, we discuss the minimal field content necessary to describe abelian cosmic strings appearing at the end of inflation. We find that several fields will condense in most theories, questioning the plausible occurrence of associated currents (bosonic and fermionic). We perturbatively evaluate the modification of their energy per unit length due to the condensates. We provide a criterion for comparing the usual abelian Higgs approximation used in cosmology to realistic situations.

  1. Evaluation of immunochromatographic tests for the rapid detection of the emerging GII.17 norovirus in stool samples, January 2016.

    PubMed

    Théry, Lucie; Bidalot, Maxime; Pothier, Pierre; Ambert-Balay, Katia

    2016-01-01

    A novel GII.17 norovirus emerged in Asia in the winter of 2014/15. A worldwide spread is conceivable and norovirus diagnostic assays need to be evaluated to investigate if they adequately detect this emerging genotype. Seven immunochromatographic kits commercially available in Europe were evaluated on ten stool samples where GII.17 virus had been quantified by real-time reverse transcription-polymerase chain reaction. All the kits detected GII.17 with various sensitivities, partly depending on the virus titre. PMID:26848594

  2. Realistic Control of Network Dynamics

    PubMed Central

    Cornelius, Sean P.; Kath, William L.; Motter, Adilson E.

    2014-01-01

    The control of complex networks is of paramount importance in areas as diverse as ecosystem management, emergency response, and cell reprogramming. A fundamental property of networks is that perturbations to one node can affect other nodes, potentially causing the entire system to change behavior or fail. Here, we show that it is possible to exploit the same principle to control network behavior. Our approach accounts for the nonlinear dynamics inherent to real systems, and allows bringing the system to a desired target state even when this state is not directly accessible due to constraints that limit the allowed interventions. Applications show that this framework permits reprogramming a network to a desired task as well as rescuing networks from the brink of failure—which we illustrate through the mitigation of cascading failures in a power-grid network and the identification of potential drug targets in a signaling network of human cancer. PMID:23803966

  3. Developing and evaluating an automated appendicitis risk stratification algorithm for pediatric patients in the emergency department

    PubMed Central

    Deleger, Louise; Brodzinski, Holly; Zhai, Haijun; Li, Qi; Lingren, Todd; Kirkendall, Eric S; Alessandrini, Evaline; Solti, Imre

    2013-01-01

    Objective To evaluate a proposed natural language processing (NLP) and machine-learning based automated method to risk stratify abdominal pain patients by analyzing the content of the electronic health record (EHR). Methods We analyzed the EHRs of a random sample of 2100 pediatric emergency department (ED) patients with abdominal pain, including all with a final diagnosis of appendicitis. We developed an automated system to extract relevant elements from ED physician notes and lab values and to automatically assign a risk category for acute appendicitis (high, equivocal, or low), based on the Pediatric Appendicitis Score. We evaluated the performance of the system against a manually created gold standard (chart reviews by ED physicians) for recall, specificity, and precision. Results The system achieved an average F-measure of 0.867 (0.869 recall and 0.863 precision) for risk classification, which was comparable to physician experts. Recall/precision were 0.897/0.952 in the low-risk category, 0.855/0.886 in the high-risk category, and 0.854/0.766 in the equivocal-risk category. The information that the system required as input to achieve high F-measure was available within the first 4 h of the ED visit. Conclusions Automated appendicitis risk categorization based on EHR content, including information from clinical notes, shows comparable performance to physician chart reviewers as measured by their inter-annotator agreement and represents a promising new approach for computerized decision support to promote application of evidence-based medicine at the point of care. PMID:24130231

  4. Role of presepsin for the evaluation of sepsis in the emergency department.

    PubMed

    Pizzolato, Elisa; Ulla, Marco; Galluzzo, Claudia; Lucchiari, Manuela; Manetta, Tilde; Lupia, Enrico; Mengozzi, Giulio; Battista, Stefania

    2014-10-01

    Sepsis, severe sepsis and septic shock are among the most common conditions handled in the emergency department (ED). According to new Sepsis Guidelines, early diagnosis and treatment are the keys to improve survival. Plasma C-reactive protein (CRP) and procalcitonin (PCT) levels, when associated with documented or suspected infection, are now part of the definitions of sepsis. Blood culture is the gold standard method for detecting microorganisms but it requires too much time for results to be known. Sensitive biomarkers are required for early diagnosis and as indexes of prognosis sepsis. CRP is one of the acute phase proteins synthesized by the liver: it has a great sensitivity but a very poor specificity for bacterial infections. Moreover, the evolution of sepsis does not correlate with CRP plasma changes. In recent years PCT has been widely used for sepsis differential diagnosis, because of its close correlation with infections, but it still retains some limitations and false positivity (such as in multiple trauma and burns). Soluble CD14 subtype (sCD14-ST), also known as presepsin, is a novel and promising biomarker that has been shown to increase significantly in patients with sepsis, in comparison to the healthy population. Studies pointed out the capability of this biomarker for diagnosing sepsis, assessing the severity of the disease and providing a prognostic evaluation of patient outcome. In this mini review we mainly focused on presepsin: we evaluate its diagnostic and prognostic roles in patients presenting to the ED with systemic inflammatory response syndrome (SIRS), suspected sepsis or septic shock. PMID:24897403

  5. Emergency department imaging protocol for suspected acute renal colic: re-evaluating our service

    PubMed Central

    Patatas, K; Panditaratne, N; Wah, T M; Weston, M J; Irving, H C

    2012-01-01

    Objectives The objective of our study is to determine the positive rate for urolithiasis in male and female patients, and evaluate whether there has been any change at our institution in the use and outcome of unenhanced multidetector CT (CT KUB) performed in the emergency department (ER) for patients presenting with suspected acute renal colic. Methods A retrospective review of all 1357 consecutive cases between August 2007 and August 2009 admitted to the ER and investigated with CT KUB. Results The positive rate for urolithiasis was 47.5% and the rate of other significant findings was 10%. Female patients had a significantly lower positive rate than male patients (26.8% vs 61.6%, p<0.001). Urological intervention was required in 37% and these patients had a larger average stone size. In young female patients with a significantly sized ureteric calculus (>4 mm), the presence of hydronephrosis vs no hydronephrosis was 83% vs 17%, respectively. Among them, only three patients required ureteroscopy for stone removal. Conclusion Contrary to other studies there has been no “indication creep” in the use of CT KUB at our institution. However, the young female patient presenting with suspected urolithiasis presents a particular diagnostic problem, and the significant percentage of negative examinations in females implies that an improvement in current practice is needed. The indiscriminate use of CT KUB in all female patients with flank pain should be avoided, and it is suggested that they should be initially evaluated with ultrasound to detect the presence of hydronephrosis. PMID:22496069

  6. An evaluation of hospital emergency department (HED) adherence to universal precautions.

    PubMed

    Rydman, R J; Tannebaum, R D; Zalenski, R J

    1994-08-01

    A longitudinal cross sectional study of Hospital Emergency Department (HED) procedures over a nine month period was conducted. A total of 1,541 procedures were observed on 56 randomly selected 8-h work shifts. Shifts were distributed: 34% day shift; 34% evening shift; and 32% on the night shift. Observations on the evening shift were oversampled to capture an adequate number of trauma patients. Observations were distributed: 33% day shift; 39% evening shift; and 28% on the night shift. Measurements included: type of procedure; adherence to specific barrier technique, i.e., use of gloves, gowns, masks, and eye protection; and occurrence of adverse exposure. Ten types of HED procedures were documented and analyzed. Computerized tracking of study observations established periodic rates of HED health care worker (HCW) adherence to universal precautions. These data are important for internal quality control/assurance programs and rate comparisons within and across institutions over time. The longitudinal evaluation of the database revealed that glove compliance increased over the period of the study and adverse exposure decreased. Conducting ongoing or periodic observational studies of this kind are important and necessary in order to gauge HED response to the epidemiologic challenges of urban society. PMID:7829982

  7. Evaluation of emerging contaminants in a drinking water treatment plant using electrodialysis reversal technology.

    PubMed

    Gabarrón, S; Gernjak, W; Valero, F; Barceló, A; Petrovic, M; Rodríguez-Roda, I

    2016-05-15

    Emerging contaminants (EC) have gained much attention with globally increasing consumption and detection in aquatic ecosystems during the last two decades from ng/L to lower ug/L. The aim of this study was to evaluate the occurrence and removal of pharmaceutically active compounds (PhACs), endocrine disrupting chemicals (EDCs) and related compounds in a Drinking Water Treatment Plant (DWTP) treating raw water from the Mediterranean Llobregat River. The DWTP combined conventional treatment steps with the world's largest electrodialysis reversal (EDR) facility. 49 different PhACs, EDCs and related compounds were found above their limit of quantification in the influent of the DWTP, summing up to a total concentration of ECs between 1600-4200 ng/L. As expected, oxidation using chlorine dioxide and granular activated carbon filters were the most efficient technologies for EC removal. However, despite the low concentration detected in the influent of the EDR process, it was also possible to demonstrate that this process partially removed ionized compounds, thereby constituting an additional barrier against EC pollution in the product. In the product of the EDR system, only 18 out of 49 compounds were quantifiable in at least one of the four experimental campaigns, showing in all cases removals higher than 65% and often beyond 90% for the overall DWTP process. PMID:26894293

  8. Medical Team Evaluation: Effect on Emergency Department Waiting Time and Length of Stay

    PubMed Central

    Lauks, Juliane; Mramor, Blaz; Baumgartl, Klaus; Maier, Heinrich; Nickel, Christian H.; Bingisser, Roland

    2016-01-01

    Emergency Departments (ED) are trying to alleviate crowding using various interventions. We assessed the effect of an alternative model of care, the Medical Team Evaluation (MTE) concept, encompassing team triage, quick registration, redesign of triage rooms and electronic medical records (EMR) on door-to-doctor (waiting) time and ED length of stay (LOS). We conducted an observational, before-and-after study at an urban academic tertiary care centre. On July 17th 2014, MTE was initiated from 9:00 a.m. to 10 p.m., 7 days a week. A registered triage nurse was teamed with an additional senior ED physician. Data of the 5-month pre-MTE and the 5-month MTE period were analysed. A matched comparison of waiting times and ED LOS of discharged and admitted patients pertaining to various Emergency Severity Index (ESI) triage categories was performed based on propensity scores. With MTE, the median waiting times improved from 41.2 (24.8–66.6) to 10.2 (5.7–18.1) minutes (min; P < 0.01). Though being beneficial for all strata, the improvement was somewhat greater for discharged, than for admitted patients. With a reduction from 54.3 (34.2–84.7) to 10.5 (5.9–18.4) min (P < 0.01), in terms of waiting times, MTE was most advantageous for ESI4 patients. The overall median ED LOS increased for about 15 min (P < 0.01), increasing from 3.4 (2.1–5.3) to 3.7 (2.3–5.6) hours. A significant increase was observed for all the strata, except for ESI5 patients. Their median ED LOS dropped by 73% from 1.2 (0.8–1.8) to 0.3 (0.2–0.5) hours (P < 0.01). In the same period the total orders for diagnostic radiology increased by 1,178 (11%) from 10,924 to 12,102 orders, with more imaging tests being ordered for ESI 2, 3 and 4 patients. Despite improved waiting times a decrease of ED LOS was only seen in ESI level 5 patients, whereas in all the other strata ED LOS increased. We speculate that this was brought about by the tendency of triage physicians to order more diagnostic radiology

  9. Problems and Issues in Using Emerging Computer Technologies To Manage and Evaluate Instructional Programs 1, 2, 3.

    ERIC Educational Resources Information Center

    Atwood, Nancy K.

    School districts have begun examining the feasibility of, and in some cases are developing and implementing automated systems for, managing and evaluating instructional programs. This paper describes and analyzes the issues and problems that emerged over the course of three projects--a large suburban school in the West, a consortium of five small…

  10. Novel effects-based monitoring approaches to evaluate chemicals of emerging concern in Great Lakes areas of concern

    EPA Science Inventory

    As part of an on-going program of research in support of the Great Lakes Restoration Initiative, we have been developing effects-based biomonitoring tools to evaluate the occurrence and potential hazards associated with Chemicals of Emerging Concern (CECs). Over three field seaso...

  11. Evaluation and risk stratification of patients with chest pain in the emergency department. Predictors of life-threatening events.

    PubMed

    Zalenski, R J; Shamsa, F; Pede, K J

    1998-08-01

    While assessing chest pain in the emergency department, physicians must first estimate the probability of acute ischemic states in the patient. This first estimate is based on the patient's history, physical examination, and electrocardiogram. Patients who meet the threshold for acute cardiac ischemia are further evaluated to confirm or exclude this diagnosis, while other life-threatening factors are excluded. PMID:9739772

  12. Novel effects-based monitoring approaches to evaluate chemicals of emerging concern in the St. Louis River estuary

    EPA Science Inventory

    As part of an on-going program of research in support of the Great Lakes Restoration Initiative, the US EPA MED laboratory has been developing effects-based biomonitoring tools to evaluate the occurrence and potential hazards associated with Chemicals of Emerging Concern (CECs). ...

  13. Evaluation of the Emergency School Assistance Program. Volume II: Design and Findings of Phase I Survey. Final Report.

    ERIC Educational Resources Information Center

    RMC Research Corp., Arlington, VA.

    An effort by the Office of Education to assist some 900 school districts, through financial aid, with the problems attendant with the final stages of their desegregation plan or the carrying out of a court-ordered plan is discussed. This effort, the Emergency School Assistance Program (ESAP), was evaluated to determine: (1) overall effectiveness,…

  14. Evaluating Crisis Intervention Services for Youth within an Emergency Department: A View from within

    ERIC Educational Resources Information Center

    Dion, Jacinthe; Kennedy, Allison; Cloutier, Paula; Gray, Clare

    2010-01-01

    An innovative crisis intervention programme was created at the Children's Hospital of Eastern Ontario in Canada in order to provide emergency assessments for youth presenting with mental health crises. The current investigation presents an overview of the programme and examines the emergency staff's perception and satisfaction with it.…

  15. Evaluating Contaminants of Emerging Concern as tracers of wastewater from septic systems.

    PubMed

    James, C Andrew; Miller-Schulze, Justin P; Ultican, Shawn; Gipe, Alex D; Baker, Joel E

    2016-09-15

    Bacterial and nutrient contamination from anthropogenic sources impacts fresh and marine waters, reducing water quality and restricting recreational and commercial activities. In many cases the source of this contamination is ambiguous, and a tracer or set of tracers linking contamination to source would be valuable. In this work, the effectiveness of utilizing a suite of Contaminants of Emerging Concern (CECs) as tracers of bacteria from human septic system effluent is investigated. Field sampling was performed at more than 20 locations over approximately 18 months and analyzed for a suite of CECs and fecal coliform bacteria. The sampling locations included seeps and small freshwater discharges to the shoreline. Sites were selected and grouped according to level of impact by septic systems as determined by previous field sampling programs. A subset of selected locations had been positively identified as being impacted by effluent from failing septic systems through dye testing. The CECs were selected based on their predominant use, their frequency of use, and putative fate and transport properties. In addition, two rounds of focused sampling were performed at selected sites to characterize short-term variations in CEC and fecal coliform concentrations, and to evaluate environmental persistence following source correction activities. The results indicate that a suite of common use compounds are suitable as generalized tracers of bacterial contamination from septic systems and that fate and transport properties are important in tracer selection. Highly recalcitrant or highly labile compounds likely follow different loss profiles in the subsurface compared to fecal bacteria and are not suitable tracers. The use of more than one tracer compound is recommended due to source variability of septic systems and to account for variations in the subsurface condition. In addition, concentrations of some CECs were measured in receiving waters at levels which suggested the

  16. Experimental evaluation of an interactive information processing aid for an emergency poison center.

    PubMed

    Robertson, C K

    1981-07-01

    In the recent literature, many studies have addressed the evaluation of the user interface in interactive systems. However, there are few theoretically based methodologies for this purpose. This study is an attempt to develop a methodology for examining the complex division of information processing labor between user and computer. A special concern was the computer-naive user searching for information using a self-teaching system. Our test bed was an emergency poison information center whose functioning depended on fast, accurate processing of patient and antidote data by a nurse. We augmented the nurses' traditional information support--a manual card file and reference books--with an interactive software system which summarized and suggested inferences from data on past successful treatment of patients. Analysis of recordings of user comments and user-system interactions showed that: (1) the support system should be more robust and have more "reasoning" power; and (2) the users' expressed information needs changed after the new support was introduced. From the results, we abstracted elements of an effective naive user-support system division of labor: (1) the support system should "actively" help the user's error recovery; (2) the system should have a sufficient knowledge base to allow "intelligent" conversation about the problem domain; and (3) the support system should allow the user to reconceptualize his information problem as his environment changes. Our method of recording user-system interactions and verbal protocols was time consuming, but did yield significant insight into the user-system division of labor. Also, considering the poison center as a living system, analysis of processing by the nurse and the traditional, the new, or an envisioned information support system showed that a highly dispersed associator and effective internal transducer promoted the functioning of the entire group. PMID:7247908

  17. [Evaluation of emergency services of the hospitals from the QualiSUS program].

    PubMed

    O'Dwyer, Gisele Oliveira; de Oliveira, Sergio Pacheco; de Seta, Marismary Horsth

    2009-01-01

    The aid lent by the emergency services is the object of this paper, which aims to assess the emergency service of the QualiSUS program. The study is descriptive with the application of a questionnaire to the responsible of the emergency services in eight hospitals. The emergency services were always overcrowded, and the causes pointed were the low resolutivity of basic attention and the precariousness of the hospital network. Contributing to this there is the primary care decreased resolutivity and the precariousness of the hospital network. Six hospitals do not manage the emergency service. The entrance system is not organized and only three hospitals work with risk classification. All of them refer difficulties with internal and external services. The hardest pathologies to refer to other services are the chronicles, neurological and social. The professionals do not have specific qualification and the precariousness job contracts do not contribute neither for the professional's fixation nor for his qualification. Clinical protocols are used by one service. It was noticed the influence of the QualiSUS in the hospitals. The failure of the health services network interferes with the emergency patient's profile. The investment of the QualiSUS cannot be restrained to the hospital. Emergency should be more integrated to the system and hospital. The qualification of human resources is indispensable as well as the bed's regulation. PMID:19851601

  18. Evaluation of child maltreatment in the emergency department setting: an overview for behavioral health providers.

    PubMed

    Leetch, Aaron N; Leipsic, John; Woolridge, Dale P

    2015-01-01

    Emergency providers are confronted with medical, social, and legal dilemmas with each case of possible child maltreatment. Keeping a high clinical suspicion is key to diagnosing latent abuse. Child abuse, especially sexual abuse, is best handled by a multidisciplinary team including emergency providers, nurses, social workers, and law enforcement trained in caring for victims and handling forensic evidence. The role of the emergency provider in such cases is to identify abuse, facilitate a thorough investigation, treat medical needs, protect the patient, provide an unbiased medical consultation to law enforcement, and provide an ethical testimony if called to court. PMID:25455575

  19. Evaluating the Pediatric Early Warning Score (PEWS) System for Admitted Patients in the Pediatric Emergency Department

    PubMed Central

    Gold, Delia L.; Mihalov, Leslie K.; Cohen, Daniel M.

    2015-01-01

    Objectives The Pediatric Early Warning Score (PEWS) systems were developed to provide a reproducible assessment of a child’s clinical status while hospitalized. Most studies investigating the PEWS evaluate its usefulness in the inpatient setting. Limited studies evaluate the effectiveness and integration of PEWS in the pediatric emergency department (ED). The goal of this study was to explore the test characteristics of an ED-assigned PEWS score for intensive care unit (ICU) admission or clinical deterioration in admitted patients. Methods This was a prospective 12-month observational study of patients, aged 0 to 21 years, admitted from the ED of an urban, tertiary care children’s hospital. ED nurses were instructed in PEWS assignment and electronic medical record (EMR) documentation. Interrater reliability between nurses was evaluated. PEWS scores were measured at initial assessment (P0) and time of admission (P1). Patients were stratified into outcome groups: those admitted to the ICU either from the ED or as transfers from the floor and those admitted to the floor only. Clinical deterioration was defined as transfer to the ICU within 6 hours or within 6 to 24 hours of admission. PEWS scores and receiver operating characteristic (ROC) curves were compared for patients admitted to the floor, ICU, and with clinical deterioration. Results The authors evaluated 12,306 consecutively admitted patients, with 99% having a PEWS documented in the EMR. Interrater reliability was excellent (intraclass coefficient 0.91). A total of 1,300 (10.6%) patients were admitted to the ICU and 11,066 (89.4%) were admitted to the floor. PEWS scores were higher for patients in the ICU group (P0 = 2.8, SD ± 2.4; P1 = 3.2, SD ± 2.4; p < 0.0001) versus floor patients (P0 = 0.7, SD ± 1.2; P1 = 0.5, SD ± 0.9; p < 0.0001). To predict the need for ICU admission, the optimal cutoff points on the ROC are P0 = 1 and P1 = 2, with areas under the ROC curve (AUCs) of 0.79 and 0

  20. Vibration signaling in mobile devices for emergency alerting: a study with deaf evaluators.

    PubMed

    Harkins, Judith; Tucker, Paula E; Williams, Norman; Sauro, Jeff

    2010-01-01

    In the United States, a nationwide Commercial Mobile Alert Service (CMAS) is being planned to alert cellular mobile device subscribers to emergencies occurring near the location of the mobile device. The plan specifies a unique audio attention signal as well as a unique vibration attention signal (for mobile devices set to vibrate) to identify that the incoming message pertains to an emergency. Ratings of vibration signals of varying lengths and patterns were obtained from 44 deaf users of mobile devices for the perceived effectiveness of the signal in getting their attention in an emergency situation. Longer signals received higher ratings than shorter ones, and three signals with temporal on-off patterns were rated significantly better than a constant vibration. The U.S. government's recommended vibration signal for the CMAS, an important feature for access to emergency alerts by deaf persons, is supported by the results of the study. PMID:20511351

  1. Systems approach to detect and evaluate contaminants of emerging concern in the Great Lakes

    EPA Science Inventory

    The release of chemicals of emerging concern threatens near shore health in the Great Lakes, particularly in regions already suffering from degradation of water and environmental quality due to past and present anthropogenic activities. Critical issues remain in delisting Areas ...

  2. Identifying preschool children at risk of later reading difficulties: evaluation of two emergent literacy screening tools.

    PubMed

    Wilson, Shauna B; Lonigan, Christopher J

    2010-01-01

    Emergent literacy skills are predictive of children's early reading success, and literacy achievement in early schooling declines more rapidly for children who are below-average readers. It is therefore important for teachers to identify accurately children at risk for later reading difficulty so children can be exposed to effective emergent literacy interventions. In this study, 176 preschoolers were administered two screening tools, the Revised Get Ready to Read! (GRTR-R) and the Individual Growth and Development Indicators (IGDIs), and a diagnostic measure at two time points. Receiver operating characteristic curve analyses revealed that, at optimal cut scores, GRTR-R provided more accurate classification of children's overall emergent literacy skills than did IGDIs. However, neither measure was particularly good at classifying specific emergent literacy skills. PMID:19822699

  3. Marine Corps Recruit Training Attrition: The Effect of Realistic Job Preview and Stress-Coping Films.

    ERIC Educational Resources Information Center

    Githens, William H.; Zalinski, James

    Two films were evaluated to determine their effectiveness in reducing attrition among Marine Corps recruits. The films were a realistic job preview of military training and a stress-coping film. Platoons of Marine recruits were randomly assigned to four treatment groups: viewing the realistic job preview film, viewing the stress-coping film,…

  4. An evidence-based approach to the evaluation and treatment of low back pain in the emergency department.

    PubMed

    Borczuk, Pierre

    2013-07-01

    Low back pain is the most common musculoskeletal complaint that results in a visit to the emergency department, and it is 1 of the top 5 most common complaints in emergency medicine. Estimates of annual healthcare expenditures for low back pain in the United States exceed $90 billion annually, not even taking lost productivity and business costs into account. This review explores an evidence-based rationale for the evaluation of the patient with low back pain, and it provides guidance on risk stratification pertaining to laboratory assessment and radiologic imaging in the emergency department. Published guidelines from the American College of Physicians and American Pain Society are reviewed, with emphasis on best evidence for pharmacologic treatments, self-care interventions, and more invasive procedures and surgery in management of low back pain. Utilizing effective and proven strategies will avoid medical errors, provide better care for patients, and help manage healthcare resources and costs. PMID:24044786

  5. Echocardiography, nuclear scintigraphy, and stress testing in the emergency department evaluation of acute coronary syndrome.

    PubMed

    Mather, P J; Shah, R

    2001-05-01

    There are between 3 and 5 million visits to EDs each year for complaints of chest pain. Of these, about one half of the patients have a noncardiac cause for their chest pain. Of the remainder, about 30% to 50% have significant coronary disease. It is quite clear that patients who are at high risk for a coronary event should be admitted to the hospital. For the low-to-moderate risk patients, the decision to admit or discharge the patient from the ED is not quite so easy. The emergency physician has to decide which tests can be helpful in the decision-making process, this can be undertaken in conjunction with a consultative cardiologist. It can be argued that if a patient does not have a normal test result whichever that evaluatory test is), then the patient should be admitted for further work-up and evaluation. The easiest test to perform in the ED setting is an echocardiogram. The images can be sent by telecommunication to a qualified echocardiogram reader for interpretation. This also has a reasonable NPV, although not necessarily as good as some of the other modalities available, unless interpreted in light of cardiac enzyme test results. If the index of suspicion is still high, then a stress echocardiogram can be considered. This has an excellent NPV and can be easily performed in [table: see text] most patients. This should not be undertaken in the face of an evolving MI, and patients should be observed for at least 8 hours after their initial presentation to the ED prior to undergoing a provocative test. Nuclear scintigraphy, another modality available for cardiac risk stratification, can be a logistical nightmare. The nuclear isotopes are strictly regulated by the Nuclear Regulatory Commission. The emergency physician may inject the isotopes, provided that he or she has undergone the necessary radiation training. Also, the patient must be removed from the ED to a radioisotope-approved area for the duration of the scan. One of the most difficult questions left

  6. Evaluation of the cytotoxicity, mutagenicity and antimutagenicity of emerging edible plants.

    PubMed

    Yen, G C; Chen, H Y; Peng, H H

    2001-11-01

    This study evaluates the toxic, mutagenic and antimutagenic effects of emerging edible plants that are consumed as new leafy vegetables in Taiwan. Among eight plant extracts, only the extracts of Sol (Solanum nigrum L.) showed cytotoxicity to Salmonella typhimurium TA100 in the absence of S9 mix. The toxicity of extracts from different parts of the Sol plant, such as leaf and stem, immature fruit and mature fruit, towards S. typhimurium TA100 and human lymphocytes was also assayed. The immature fruit extracts of Sol exhibited strong cytotoxicity with dose dependence and induced significant DNA damage in human lymphocytes based on the comet assay. However, no mutagenicity was found in eight plant extracts to TA98 or TA100 either with or without the S9 mixture. Sol and Sec [Sechium edule (Jacq.) Swartz] extracts showed the strongest inhibitory effect towards the mutagenicity of 2-amino-3-methyl-imidazo[4,5-f]quinoline (IQ) in S. typhimurium TA98 and TA100; the ID(50) was less then 1 mg/plate. Cra [Crassocephalum creidioides (Benth.) S. Moore] extracts also expressed moderate antimutagenic activities towards IQ and benzo[a]pyrene (B[a]P) either in TA98 or in TA100; the ID(50) was 1.63-2.41 mg/plate. The extracts from Bas (Basella alba L.), Bou (Boussingaultia gracilis Miers var. pseudobaselloides Bailey), Cen (Centella asiatica L. Urban), Cor (Corchorus olitorius L.) and Por (Portulaca oleracea L.) showed weak to moderate inhibition of mutagenicity of IQ. However, the potential antimutagenicity of these plant extracts towards B[a]P was weaker than that towards IQ. For a direct mutagen, 4-nitroquinoline-N-oxide (NQNO), only the Sol extracts showed strong inhibitory effects in the TA100 system. The antimutagenic activity of water extracts of Sec was partly reduced by heating at 100 degrees C for 20 min. The heat-stable antimutagens in Sec extracts could be produced in the plant extract preparation process. Fractions with molecular weights above 30,000 showed the

  7. Thallium myocardial scanning in the emergency department evaluation of chest pain

    SciTech Connect

    Mace, S.E.

    1989-05-01

    Chest pain is a common complaint of patients seen in the emergency department. The causes are legion, and range from the non-life threatening to the potentially catastrophic. Thallium heart scanning was done prospectively in 20 patients with a ''classic'' history for myocardial infarction (eight patients) or atypical chest pain and/or associated symptoms plus an abnormal ECG (12 patients) to discern a subset of patients from whom thallium scintography may be indicated in the emergency department. Although further investigation is needed, our preliminary study suggests that myocardial scanning with thallium can be a safe, fairly rapid, and useful objective parameter in the emergency department detection of suspected myocardial infarction, and in differential diagnosis of chest pain when other data such as the history, physical examination, ECG, or enzymes are inconclusive.

  8. Blend Shape Interpolation and FACS for Realistic Avatar

    NASA Astrophysics Data System (ADS)

    Alkawaz, Mohammed Hazim; Mohamad, Dzulkifli; Basori, Ahmad Hoirul; Saba, Tanzila

    2015-03-01

    The quest of developing realistic facial animation is ever-growing. The emergence of sophisticated algorithms, new graphical user interfaces, laser scans and advanced 3D tools imparted further impetus towards the rapid advancement of complex virtual human facial model. Face-to-face communication being the most natural way of human interaction, the facial animation systems became more attractive in the information technology era for sundry applications. The production of computer-animated movies using synthetic actors are still challenging issues. Proposed facial expression carries the signature of happiness, sadness, angry or cheerful, etc. The mood of a particular person in the midst of a large group can immediately be identified via very subtle changes in facial expressions. Facial expressions being very complex as well as important nonverbal communication channel are tricky to synthesize realistically using computer graphics. Computer synthesis of practical facial expressions must deal with the geometric representation of the human face and the control of the facial animation. We developed a new approach by integrating blend shape interpolation (BSI) and facial action coding system (FACS) to create a realistic and expressive computer facial animation design. The BSI is used to generate the natural face while the FACS is employed to reflect the exact facial muscle movements for four basic natural emotional expressions such as angry, happy, sad and fear with high fidelity. The results in perceiving the realistic facial expression for virtual human emotions based on facial skin color and texture may contribute towards the development of virtual reality and game environment of computer aided graphics animation systems.

  9. Development of a realistic human airway model.

    PubMed

    Lizal, Frantisek; Elcner, Jakub; Hopke, Philip K; Jedelsky, Jan; Jicha, Miroslav

    2012-03-01

    Numerous models of human lungs with various levels of idealization have been reported in the literature; consequently, results acquired using these models are difficult to compare to in vivo measurements. We have developed a set of model components based on realistic geometries, which permits the analysis of the effects of subsequent model simplification. A realistic digital upper airway geometry except for the lack of an oral cavity has been created which proved suitable both for computational fluid dynamics (CFD) simulations and for the fabrication of physical models. Subsequently, an oral cavity was added to the tracheobronchial geometry. The airway geometry including the oral cavity was adjusted to enable fabrication of a semi-realistic model. Five physical models were created based on these three digital geometries. Two optically transparent models, one with and one without the oral cavity, were constructed for flow velocity measurements, two realistic segmented models, one with and one without the oral cavity, were constructed for particle deposition measurements, and a semi-realistic model with glass cylindrical airways was developed for optical measurements of flow velocity and in situ particle size measurements. One-dimensional phase doppler anemometry measurements were made and compared to the CFD calculations for this model and good agreement was obtained. PMID:22558834

  10. Investigating Attitudes towards an Emerging Standard of English: Evaluations of Newscasters' Accents in Trinidad

    ERIC Educational Resources Information Center

    Deuber, Dagmar; Leung, Glenda-Alicia

    2013-01-01

    This paper addresses the issue of the emergence of new standards of English in the postcolonial world by means of a language attitude study conducted in the Caribbean island of Trinidad that involved rating the accents of newscasters. Accents represented in the clips played to respondents comprised various local as well as non-local ones. The…

  11. Vibration Signaling in Mobile Devices for Emergency Alerting: A Study with Deaf Evaluators

    ERIC Educational Resources Information Center

    Harkins, Judith; Tucker, Paula E.; Williams, Norman; Sauro, Jeff

    2010-01-01

    In the United States, a nationwide Commercial Mobile Alert Service (CMAS) is being planned to alert cellular mobile device subscribers to emergencies occurring near the location of the mobile device. The plan specifies a unique audio attention signal as well as a unique vibration attention signal (for mobile devices set to vibrate) to identify…

  12. Evaluation and correlation of sensory attributes and chemical compositions of emerging fresh produce: Microgreens

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Microgreens are an emerging healthy food product with vivid colors and diverse flavors. However, information pertaining to their sensory attributes is scarce. In this study, six microgreen varieties were specifically selected from 25 varieties to represent five distinct flavor groups: 1) mustard (Di...

  13. Emergency Contraception Education for Health and Human Service Professionals: An Evaluation of Knowledge and Attitudes

    ERIC Educational Resources Information Center

    Colarossi, Lisa; Billowitz, Marissa; Breitbart, Vicki

    2010-01-01

    Objective: To assess the knowledge and attitudes of health care providers, health educators, and social service providers before and after a training session on emergency contraceptive pills. Design: A survey study using pre-post training measurements. Setting: Two hundred and twenty-three medical, social service, and health education providers in…

  14. Pilot testing and preliminary evaluation of a suicide prevention education program for emergency department personnel.

    PubMed

    Shim, Ruth S; Compton, Michael T

    2010-12-01

    Emergency department personnel play an important role in recognizing individuals with suicidality and intervening to prevent completed suicide. An educational program was designed to be offered to emergency department personnel, and was piloted with a convenience sample of 54 clinicians. Pre-test and post-test measures showed an increase in knowledge scores (from 7.9 ± 1.9 to 13.6 ± 2.1, P < .001) and self-efficacy scores (from 24.0 ± 9.1 to 32.3 ± 9.2, P < .001) regarding management of suicidal patients or those at elevated risk for suicide in the emergency department immediately after participating in the training session. In addition, participants favorably rated the training session, and would recommend it to others. With further development and refinement, this program could be implemented on a statewide level and targeted at emergency department personnel to enhance their ability to provide appropriate resources, support, and treatment for individuals identified as being at risk for suicide. PMID:19731019

  15. Evaluation of Emerging Alternative Chemicals for Control of Pathogens and Weeds.

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Several emerging chemicals were tested in 2 field trials in combination with metham sodium as replacements for methyl bromide. These included 2-bromoethanol, dimethyl disulfide, furfural, propylene oxide, and sodium azide. Populations of weed and pathogens were measured after chemical application....

  16. Evaluating the Components of an Emergent Literacy Intervention for Preschool Children at Risk for Reading Difficulties

    ERIC Educational Resources Information Center

    Lonigan, Christopher J.; Purpura, David J.; Wilson, Shauna B.; Walker, Patricia M.; Clancy-Menchetti, Jeanine

    2013-01-01

    Many preschool children are at risk for reading problems because of inadequate emergent literacy skills. Evidence supports the effectiveness of interventions to promote these skills, but questions remain about which intervention components work and whether combining intervention components will result in larger gains. In this study, 324…

  17. [Evaluation of a Legionella outbreak emerged in a recently opening hotel].

    PubMed

    Erdoğan, Haluk; Arslan, Hande

    2013-04-01

    Legionnaires' disease (LD) is a systemic infection caused by Legionella species especially colonized in the water systems. Hotels are common locations in which waterwork-associated sporadic or epidemic legionellosis can be detected. The aim of this study was to evaluate a small Legionella outbreak emerged in a recently opened 600-bed hotel in Alanya, a touristic county in Mediterranean part of Turkey. A 66 years old male patient who stayed in this hotel opened on May 15th, 2009, was admitted to our hospital on May 21st, 2009 with the complaints of high fever, headache and diarrhea lasting for three days. Since chest X-ray revealed non-homogenous density increase in left middle and inferior zone, the patient was diagnosed as atypical pneumoniae and LD was confirmed by positive urinary Legionella antigen test (Card test, BinaxNOW®Legionella Urinary Antigen Test; Alere Co, USA) result. Following the identification of the index case, the records of our hospital were reviewed and revealed another case being treated with the diagnosis of community acquired pneumonia who was also the guest of the same hotel. This patient was then diagnosed as LD by positive urinary antigen test. Since new cases were identified during the following days (May 22, 25 and 26) the Antalya County Health Department and hotel management were informed about a cluster of LD. In addition subsequent investigation for environmental surveillance and water sampling were conducted. The LD diagnosis and environmental inspections were performed according to the procedure described in the guideline from "Turkish Ministry of Health Travel-Associated Legionnaires' Disease Control Programme". Five definitive cases and one presumptive case of LD were identified during the outbreak period (May 20-26, 2009). All of the cases were successfully treated (intravenous ciprofloxacin or levofloxacin or clarithromycin), however one patient died due to sudden death during sleep after being discharged. Since sputum

  18. Research on ultra-realistic communications

    NASA Astrophysics Data System (ADS)

    Enami, Kazumasa

    2009-05-01

    A future communication method enabled by information communications technology- ultra-realistic communication - is now being investigated in Japan and research and development of the various technologies required for its realization is being conducted, such as ultra-high definition TV, 3DTV, super surround sound reproduction and multi-sensory communication including touch and smell. An organization called the Ultra-Realistic Communications Forum (URCF) was also established for the effective promotion of R&D and the standardization of relating technologies. This document explains the activities of the URCF by industry, academia and government, and introduces researches on ultra-realistic communications in the National Institute of Information and Communications Technology (NICT).

  19. Evaluation of Maternal-Fetal Outcomes After Emergency Vaginal Cerclage Performed With Shirodkar-McDonald Combined Modified Technique

    PubMed Central

    Ciancimino, Leonarda; Laganà, Antonio Simone; Imbesi, Giovanna; Chiofalo, Benito; Mancuso, Alfredo; Triolo, Onofrio

    2015-01-01

    Background Several techniques of emergency vaginal cerclage have been proposed in case of unexpected and abrupt cervical incompetence (CI), in order to prolong the pregnancy as much as possible and to reduce the adverse maternal-fetal outcomes. The aim of our study was to evaluate the effectiveness of emergency cervical cerclage, performed with the combined modified Shirodkar-McDonald technique. Methods We selected 12 cases of emergency vaginal cerclage, performed between January 1, 2008 and June 30, 2013. The age of the patients was between 20 and 38 years (mean 29.0 ± standard deviation (SD) 5.69), parity between 0 and 2 (mean 0.7 ± SD 0.65), and gestational age at the time of admission ranged between 17 and 26 weeks (mean 21.0 ± SD 3.44). In all these cases, we used a combined modified Shirodkar-McDonald technique to perform the procedure. Results The neonatal survival rate was 83.3%. The cesarean section rate was 16.7%. The average pregnancy prolongation was 89.9 days, higher than that reported for other studies in the literature. Conclusions We can assume that the emergency vaginal cerclage performed with the combined modified Shirodkar-McDonald technique is the best option of surgical therapy for the treatment of unexpected and abrupt CI. PMID:25780480

  20. Clinical policy: Critical issues in the initial evaluation and management of patients presenting to the emergency department in early pregnancy.

    PubMed

    Hahn, Sigrid A; Lavonas, Eric J; Mace, Sharon E; Napoli, Anthony M; Fesmire, Francis M

    2012-09-01

    This clinical policy from the American College of Emergency Physicians is the revision of the 2003 Clinical Policy: Critical Issues in the Initial Evaluation and Management of Patients Presenting to the Emergency Department in Early Pregnancy.(1) A writing subcommittee reviewed the literature to derive evidence-based recommendations to help clinicians answer the following critical questions: (1) Should the emergency physician obtain a pelvic ultrasound in a clinically stable pregnant patient who presents to the emergency department (ED) with abdominal pain and/or vaginal bleeding and a beta human chorionic gonadotropin (β-hCG) level below a discriminatory threshold? (2) In patients who have an indeterminate transvaginal ultrasound, what is the diagnostic utility of β-hCG for predicting possible ectopic pregnancy? (3) In patients receiving methotrexate for confirmed or suspected ectopic pregnancy, what are the implications for ED management? Evidence was graded and recommendations were developed based on the strength of the available data in the medical literature. A literature search was also performed for a critical question from the 2003 clinical policy.(1) Is the administration of anti-D immunoglobulin indicated among Rh-negative women during the first trimester of pregnancy with threatened abortion, complete abortion, ectopic pregnancy, or minor abdominal trauma? Because no new, high-quality articles were found, the management recommendations from the previous policy are discussed in the introduction. PMID:22921048

  1. "easyMine" - realistic and systematic mine detection simulation tooltion

    NASA Astrophysics Data System (ADS)

    Böttger, U.; Beier, K.; Biering, B.; Müller, C.; Peichl, M.; Spyra, W.

    2004-05-01

    Mine detection is to date mainly performed with metal detectors, although new methods for UXO detection are explored worldwide. The main problem for the mine detection to date is, that there exist some ideas of which sensor combinations could yield a high score, but until now there is no systematic analysis of mine detection methods together with realistic environmental conditions to conclude on a physically and technically optimized sensor combination. This gap will be removed by a project "easyMine" (Realistic and systematic Mine Detection Simulation Tool) which will result in a simulation tool for optimizing land mine detection in a realistic mine field. The project idea for this software tool is presented, that will simulate the closed chain of mine detection, including the mine in its natural environment, the sensor, the evaluation and application of the measurements by an user. The tool will be modularly designed. Each chain link will be an independent, exchangeable sub- module and will describe a stand alone part of the whole mine detection procedure. The advantage of the tool will be the evaluation of very different kinds of sensor combinations in relation of their real potential for mine detection. Three detection methods (metal detector, GPR and imaging IR-radiometry) will be explained to be introduced into the easyMine software tool in a first step. An actual example for land mine detection problem will be presented and approaches for solutions with easyMine will be shown.

  2. A Virtual Emergency Telemedicine Serious Game in Medical Training: A Quantitative, Professional Feedback-Informed Evaluation Study

    PubMed Central

    Constantinou, Riana; Marangos, Charis; Kyriacou, Efthyvoulos; Bamidis, Panagiotis; Dafli, Eleni; Pattichis, Constantinos S

    2015-01-01

    Background Serious games involving virtual patients in medical education can provide a controlled setting within which players can learn in an engaging way, while avoiding the risks associated with real patients. Moreover, serious games align with medical students’ preferred learning styles. The Virtual Emergency TeleMedicine (VETM) game is a simulation-based game that was developed in collaboration with the mEducator Best Practice network in response to calls to integrate serious games in medical education and training. The VETM game makes use of data from an electrocardiogram to train practicing doctors, nurses, or medical students for problem-solving in real-life clinical scenarios through a telemedicine system and virtual patients. The study responds to two gaps: the limited number of games in emergency cardiology and the lack of evaluations by professionals. Objective The objective of this study is a quantitative, professional feedback-informed evaluation of one scenario of VETM, involving cardiovascular complications. The study has the following research question: “What are professionals’ perceptions of the potential of the Virtual Emergency Telemedicine game for training people involved in the assessment and management of emergency cases?” Methods The evaluation of the VETM game was conducted with 90 professional ambulance crew nursing personnel specializing in the assessment and management of emergency cases. After collaboratively trying out one VETM scenario, participants individually completed an evaluation of the game (36 questions on a 5-point Likert scale) and provided written and verbal comments. The instrument assessed six dimensions of the game: (1) user interface, (2) difficulty level, (3) feedback, (4) educational value, (5) user engagement, and (6) terminology. Data sources of the study were 90 questionnaires, including written comments from 51 participants, 24 interviews with 55 participants, and 379 log files of their interaction with

  3. Realistic Parameters for the Description of Organic Metals

    NASA Astrophysics Data System (ADS)

    Dolfen, Andreas; Koch, Erik; Blum, Volker; Cano-Cortés, Laura; Merino, Jaime

    2009-03-01

    In molecular crystals correlation effects are often significant. For a non-perturbative description of the full Coulomb interaction we have therefore to resort to a model description in terms of generalized Hubbard models. The derivation of parameters for such models is crucial for realistic simulations. While hopping parameters are easily derived from density-functional theory (DFT) the Coulomb parameters pose a significant problem due to screening processes. We decompose their contributions into intra- and inter-molecular parts. The intra-molecularly screened Coulomb parameters are treated within DFT whereas the inter-molecular corrections are evaluated using classical electrostatics with DFT-derived polarizabilities and the distributed-dipole approach in combination with a Ewald summation. Even for simple lattices of polarizable point dipoles we find intriguing screening phenomena. As realistic applications we discuss the one- and two-dimensional organic metals TTF-TCNQ and θ-(BEDT-TTF)2I3.

  4. Evaluation of Drug Utilization Patterns during Initial Treatment in the Emergency Room: A Retroprospective Pharmacoepidemiological Study

    PubMed Central

    Cheekavolu, Chakrapani; Pathapati, Rama Mohan; Babasaheb Laxmansingh, Kudagi; Saginela, Satish Kumar; Makineedi, Veera Prasad; Siddalingappa; Kumar, Amitabh

    2011-01-01

    Background. We assessed the prescribing trends, average number of drugs per prescription, and cost per prescription during the initial contact of the patient with the physician in emergency room. Methods. This retro-prospective study was conducted over a period of six months. Medical records of two hundred patients were reviewed for prescribing patterns. Results. 52 different types of drugs (996 drugs) were prescribed in total 200 prescriptions during the mean time spent in emergency room of 2.8 ± 1.4 hours. The average number of drugs per prescription was 4.2 ± 1.2. 95% of drugs were prescribed by trade name. Average drugs cost per prescription was 784 ± 134 rupees (17USD). Conclusion. Polypharmacy remains the main form of irrational prescribing. Prescribing patterns of drugs were knowledge based rather than WHO criteria for rational use of drugs. PMID:22242208

  5. Keeping It Real: How Realistic Does Realistic Fiction for Children Need to Be?

    ERIC Educational Resources Information Center

    O'Connor, Barbara

    2010-01-01

    O'Connor, an author of realistic fiction for children, shares her attempts to strike a balance between carefree, uncensored, authentic, realistic writing and age-appropriate writing. Of course, complicating that balancing act is the fact that what seems age-appropriate to her might not seem so to everyone. O'Connor suggests that while it may be…

  6. Evaluation of Emergency-Locator-Transmitter performance in real and simulated crash tests

    NASA Technical Reports Server (NTRS)

    Carden, H. D.

    1981-01-01

    Emergency locator transmitter (ELT) activation problems were investigated by testing a sampling of ELT units in actual crashes and in a special test apparatus which simulated longitudinal crash pulses with superimposed local structural resonances. The probable causes of excessive false alarms and nonactivation of ELT's during crash situations were determined. Solutions to operational and technical problems were also examined as well as the sensitivity of ELT impact switches to orientation and to local structural vibrations.

  7. Emergency evacuation/transportation plan update: Traffic model development and evaluation of early closure procedures. Final report

    SciTech Connect

    1993-10-28

    Prolonged delays in traffic experienced by Laboratory personnel during a recent early dismissal in inclement weather, coupled with reconstruction efforts along NM 502 east of the White Rock Wye for the next 1 to 2 years, has prompted Los Alamos National Laboratory (LANL) to re-evaluate and improve the present transportation plan and its integration with contingency plans maintained in other organizations. Facilities planners and emergency operations staff need to evaluate the transportation system`s capability to inefficiently and safely evacuate LANL under different low-level emergency conditions. A variety of potential procedures governing the release of employees from the different technical areas (TAs) requires evaluation, perhaps with regard to multiple emergency-condition scenarios, with one or more optimal procedures ultimately presented for adoption by Lab Management. The work undertaken in this project will hopefully lay a foundation for an on-going, progressive transportation system analysis capability. It utilizes microscale simulation techniques to affirm, reassess and validate the Laboratory`s Early Dismissal/Closure/Delayed Opening Plan. The Laboratory is required by Federal guidelines, and compelled by prudent practice and conscientious regard for the welfare of employees and nearby residents, to maintain plans and operating procedures for evacuation if the need arises. The tools developed during this process can be used outside of contingency planning. It is anticipated that the traffic models developed will allow site planners to evaluate changes to the traffic network which could better serve the normal traffic levels. Changes in roadway configuration, control strategies (signalization and signing), response strategies to traffic accidents, and patterns of demand can be modelled using the analysis tools developed during this project. Such scenarios typically are important considerations in master planning and facilities programming.

  8. Some thoughts on the evaluation of long-range dispersion models in the context of emergency response

    SciTech Connect

    Rodriguez, D.; Walker, H.; Klepikova, N.; Kostrikov, A.

    1993-05-14

    The Chernobyl reactor accident and the possibility of a similar event of equal or greater magnitude in the future suggest the need for long-range atmospheric transport and diffusion models. Assuming their ability to accurately predict the temporal and spatial distributions of a complex mixture of radionuclides, these models can provide indispensable information to emergency planners and responders as well as information to a concerned and increasingly well-informed public. Models designed for use in real-time, emergency response situations can be evaluated on the basis of accuracy, responsiveness, costs, and growth potential. Among these criteria, accuracy is paramount; without the ability to accurately determine the patterns of concentration in both space and time, all other critical measures of performance become irrelevant. The authors are in the process of evaluating the accuracy of two long-range, emergency response models -- one based on the particle-in-cell method of pollutant representation (ADPIC/US) and the other based on the superposition of Gaussian puffs released periodically in time (EXPRESS/Russia) -- using data obtained from 20 releases of perfluorocarbon tracers in January, 1987, during the Across North America Tracer Experiment (ANATEX). The purpose is to assess the current capabilities for stimulating continental-scale dispersion processes and to use these assessments as a means to improve the modeling tools. The model evaluations discussed here utilize performance measures tailored to the ANATEX field experiment. The design of a sampling network, programmatic requirements and resource limitations associated with a field experiment affect the choice of evaluation techniques. Several appropriate measures, many of which depend on the characterization of surface concentration {open_quotes}footprints,{close_quotes} have been identified or devised.

  9. Summative service and stakeholder evaluation of an NHS-funded community Pharmacy Emergency Repeat Medication Supply Service (PERMSS)

    PubMed Central

    Nazar, Hamde; Nazar, Zachariah; Simpson, Jill; Yeung, Andre; Whittlesea, Cate

    2016-01-01

    Objectives Service and stakeholder evaluation of an NHS-funded service providing out-ofhours (OOH) emergency repeat medications to patients self-presenting at community pharmacies. Setting Community pharmacies across the North East of England accredited to provide this service. Participants Patients self-presenting to community pharmacies during OOH periods with emergency repeat medication supply requests. Intervention Community pharmacists assessed each request for clinical appropriateness and when suitable provide an emergency repeat medication supply, with additional pharmaceutical advice and services if required. Primary outcomes Number of emergency repeat medication supplies, time of request, reason for access, medication(s), pharmaceutical advice and services provided. Secondary outcomes were community pharmacist and patient satisfaction. Results A total of 2485 patients were managed across 227 community pharmacies (15 December 2014 to 7 April 2015). Most patients presented on Saturdays, with increased activity over national holidays. Older age was associated with increased service use. Of the 3226 medications provided, 439 were classified as high risk. Patients found this service easy to access and were willing to access the community pharmacy in the future for medication-related issues. In the absence of this service, 50% of patients would have missed their medication(s) until they saw their doctor and a further 46% would have accessed an alternative service. The cost of National Health Service (NHS) service(s) for patients who would have accessed an alternative OOH service was estimated as 37 times that of the community pharmacy service provided. Community pharmacists were happy to provide this service despite increased consultation times and workload. Conclusions Community pharmacists were able to manage patients’ OOH requests for emergency repeat medication and patients were happy with the service provided. Since the service cost was favourable when

  10. Spatial Visualization by Realistic 3D Views

    ERIC Educational Resources Information Center

    Yue, Jianping

    2008-01-01

    In this study, the popular Purdue Spatial Visualization Test-Visualization by Rotations (PSVT-R) in isometric drawings was recreated with CAD software that allows 3D solid modeling and rendering to provide more realistic pictorial views. Both the original and the modified PSVT-R tests were given to students and their scores on the two tests were…

  11. Making a Literature Methods Course "Realistic."

    ERIC Educational Resources Information Center

    Lewis, William J.

    Recognizing that it can be a challenge to make an undergraduate literature methods course realistic, a methods instructor at a Michigan university has developed three major and several minor activities that have proven effective in preparing pre-student teachers for the "real world" of teaching and, at the same time, have been challenging and…

  12. Satellite Maps Deliver More Realistic Gaming

    NASA Technical Reports Server (NTRS)

    2013-01-01

    When Redwood City, California-based Electronic Arts (EA) decided to make SSX, its latest snowboarding video game, it faced challenges in creating realistic-looking mountains. The solution was NASA's ASTER Global Digital Elevation Map, made available by the Jet Propulsion Laboratory, which EA used to create 28 real-life mountains from 9 different ranges for its award-winning game.

  13. Improving Intuition Skills with Realistic Mathematics Education

    ERIC Educational Resources Information Center

    Hirza, Bonita; Kusumah, Yaya S.; Darhim; Zulkardi

    2014-01-01

    The intention of the present study was to see the improvement of students' intuitive skills. This improvement was seen by comparing the Realistic Mathematics Education (RME)-based instruction with the conventional mathematics instruction. The subject of this study was 164 fifth graders of elementary school in Palembang. The design of this study…

  14. Project REALISTIC: Determining Literacy Demands of Jobs.

    ERIC Educational Resources Information Center

    Sticht, Thomas C.; Kern, Richard P.

    1971-01-01

    REALISTIC is an acronym based upon the three literacy skills areas studied--REAding, LIStening, and ArithmeTIC. The general objectives of the project are: (1) to provide information concerning the demands for reading, listening, and arithmetic skills in several major military occupational specialties (MOSS), and (2) to provide information and…

  15. Realistic Portrayal of Aging. An Annotated Bibliography.

    ERIC Educational Resources Information Center

    Dodson, Anita E.; Hause, Judith B.

    This annotated bibliography cites selected reading materials for all age levels that present aging and the aged realistically with a full range of human behaviors. The listing is meant to serve as a resource to educators who wish to develop positive attitudes in children and in adolescents about the elderly and about themselves. Educators should…

  16. [General practice consultation in a hospital emergency department. History, evaluation and prospects].

    PubMed

    Lafay, Vincent; Giraud, Christiane; Bel, Corinne; Giovannetti, Olivier

    2002-10-26

    INSTALLATION OF A GENERAL MEDICINE CONSULTATION: In 1995, in reaction to an increase of more than 35% over three years, related essentially to out-patient consultations, the installation of a general medicine consultation (GMC) near the emergency unit reception area (EUR) was envisaged. The project, developed over 5 years and based on an epidemiological study, was finally set-up in January 2000. The aims of the GMC are to supply information to the patients, help them in their administrative rights, and their subsequent follow-up by an external physician; the benefits expected by the EUR is the re-concentration on heavier and more urgent pathologies. THE FUNCTION OF THE GMC: Exclusively reserved for CCMU 1 patients (level 1 of the clinical classification of emergency unit patients), the GMC relies on general practice, with the presence of general practitioners installed in the SAU (emergency unit) sector, a double admission method (either via the emergency unit, or directly), a means of payment for the consultation and the absence of priority access to the technical network of the hospital. A social services worker is present. RECRUITMENT: After 18 months of activity, the GMC had managed more than 4500 patients and the method of referral via the SAU, almost exclusive at the beginning, has been reduced to a minority. The patients are generally young; socially close to the underprivileged population surrounding the SAU, but not in a situation of precariousness. The four principle motives for consultation are benign traumas, ENT infections, dermatological affections and pain. A DYNAMIC STRUCTURE: The rapid progress in the context of general medicine, and the observations of the physicians and non-physicians participating in this experience, has progressively modified the aim and mission of this GMC, which is gradually becoming a real structure of permanent care. Its originality is its close link between the town and the hospital, whilst permitting the various actors to

  17. Evaluation of emerging parallel optical link technology for high energy physics

    SciTech Connect

    Chramowicz, J.; Kwan, S.; Prosser, A.; Winchell, M.; /Fermilab

    2012-01-01

    Modern particle detectors utilize optical fiber links to deliver event data to upstream trigger and data processing systems. Future detector systems can benefit from the development of dense arrangements of high speed optical links emerging from industry advancements in transceiver technology. Supporting data transfers of up to 120 Gbps in each direction, optical engines permit assembly of the optical transceivers in close proximity to ASICs and FPGAs. Test results of some of these parallel components will be presented including the development of pluggable FPGA Mezzanine Cards equipped with optical engines to provide to collaborators on the Versatile Link Common Project for the HI-LHC at CERN.

  18. Evaluation of knowledge and attitude of school teachers about emergency management of traumatic dental injury

    PubMed Central

    Singh, Mala; Ingle, Navin Anand; Kaur, Navpreet; Yadav, Pramod

    2015-01-01

    Introduction: Traumatic dental injuries (TDIs) are widespread in the population and are a serious dental public health problem among children. Dental trauma may cause both functional and esthetic problems, with possible impacts on the patient's quality of life. Aim: To investigate teacher's knowledge and attitudes of Mathura city about emergency management of TDIs in children. Materials and Methods: A total of 352 teachers from total 23 schools of Mathura city were included in the study. Data were collected through a survey, which included a self-administered questionnaire. The questionnaire consisted of three major parts containing multiple-choice questions. Results: Among the teachers 51.1% were males and 48.9% were females. Majority of the respondents, that is, 33.5% were between 31 and 40 years of age. Most respondents (34%) had more than 10 years of teaching experience. Majority of the teachers (39.2%) had educational qualification other than B.Ed. and M.Ed. degrees. Physical education teachers comprised the largest group of school teachers. Regarding knowledge and attitude, the teachers with 10–20 years of teaching experience, physical education teachers, and the teachers other than B.Ed. and M.Ed. qualifications had given more correct answers to the questions when compared with other groups. Conclusion: For the teachers having a low level of knowledge, there is a need for greater awareness to improve teachers’ knowledge and attitudes related to the emergency management of TDIs in children by organizing educative and motivational programs. PMID:25992335

  19. [Evaluation of emergency medicine knowledge and procedures after finishing the course "resuscitation specialty"].

    PubMed

    Sefrin, P; Sagmeister, U

    2002-01-01

    Emergency medical services are an indispensable part of out-patient medical care. For this purpose, special qualifications are necessary and these are taught within the framework of a course entitled "Certificate for Emergency Medical Services". These courses are organized either as a block course, that is a one-week course, or as weekend courses in progression. These two types of courses are compared here. Three block courses with 546 participants and five weekend courses with 599 participants were examined. The practical examination took the form of four practice stages, with 95 people from the courses taking the examination. The examination focussed on certain areas such as ECG diagnostics in the case of cardiac arrest, early defibrillation, removing helmets, immobilizing a fractured tibia, respiration with emergency equipment, vein punctures and volume substitution. Of the doctors attending the courses, 59.7% were residents, 35.7% were senior house officers and 4.6% were specialists or general practitioners. Thirty-nine (or 41.1%) of those examined attended a block course and 56 (58.9%) weekend courses. In diagnosing cardiac arrest, those attending a block course were more reliable (92.3% diagnosed correctly, compared with 67.9% in the other group). Fifteen per cent from both groups were not able to correctly diagnose ventricular fibrillation from the ECG. Of the block course participants, 39.1% chose defibrillation with the correct energy, compared with 24.2% of those attending weekend courses. One out of two participants recognized a deliberate fault in the ECG equipment. Thirty-seven per cent of participants of the block course and 35.9% from the weekend courses failed to choose the right size splint for neck immobilization. Regarding respiration, 67.2% of participants of the block course group and 71.4% of the weekend course group carried out manual artificial respiration. When using respirator equipment, 90% from the block course and 72.2% of the other

  20. Near-realistic mobile exergames with wireless wearable sensors.

    PubMed

    Mortazavi, Bobak; Nyamathi, Suneil; Lee, Sunghoon Ivan; Wilkerson, Thomas; Ghasemzadeh, Hassan; Sarrafzadeh, Majid

    2014-03-01

    Exergaming is expanding as an option for sedentary behavior in childhood/adult obesity and for extra exercise for gamers. This paper presents the development process for a mobile active sports exergame with near-realistic motions through the usage of body-wearable sensors. The process begins by collecting a dataset specifically targeted to mapping real-world activities directly to the games, then, developing the recognition system in a fashion to produce an enjoyable game. The classification algorithm in this paper has precision and recall of 77% and 77% respectively, compared with 40% and 19% precision and recall on current activity monitoring algorithms intended for general daily living activities. Aside from classification, the user experience must be strong enough to be a successful system for adoption. Indeed, fast and intense activities as well as competitive, multiplayer environments make for a successful, enjoyable exergame. This enjoyment is evaluated through a 30 person user study. Multiple aspects of the exergaming user experience trials have been merged into a comprehensive survey, called ExerSurvey. All but one user thought the motions in the game were realistic and difficult to cheat. Ultimately, a game with near-realistic motions was shown to be an enjoyable, active video exergame for any environment. PMID:24608050

  1. An anatomically realistic temperature phantom for radiofrequency heating measurements

    PubMed Central

    Graedel, Nadine N.; Polimeni, Jonathan R.; Guerin, Bastien; Gagoski, Borjan; Wald, Lawrence L.

    2014-01-01

    Purpose An anthropomorphic phantom with realistic electrical properties allows for a more accurate reproduction of tissue current patterns during excitation. A temperature map can then probe the worst-case heating expected in the un-perfused case. We describe an anatomically realistic human head phantom that allows rapid 3D temperature mapping at 7 T. Methods The phantom was based on hand-labeled anatomical imaging data and consists of four compartments matching the corresponding human tissues in geometry and electrical properties. The increases in temperature resulting from radiofrequency excitation were measured with MR thermometry using a temperature sensitive contrast agent (TmDOTMA−) validated by direct fiber optic temperature measurements. Results Acquisition of 3D temperature maps of the full phantom with a temperature accuracy better than 0.1°C was achieved with an isotropic resolution of 5 mm and acquisition times of 2–4 minutes. Conclusion Our results demonstrate the feasibility of constructing anatomically realistic phantoms with complex geometries incorporating the ability to measure accurate temperature maps in the phantom. The anthropomorphic temperature phantom is expected to provide a useful tool for the evaluation of the heating effects of both conventional and parallel transmit pulses and help validate electromagnetic and temperature simulations. PMID:24549755

  2. Emergency department evaluation and management of blunt chest and lung trauma (Trauma CME).

    PubMed

    Morley, Eric J; Johnson, Scott; Leibner, Evan; Shahid, Jawad

    2016-06-01

    The majority of blunt chest injuries are minor contusions or abrasions; however, life-threatening injuries, including tension pneumothorax, hemothorax, and aortic rupture can occur and must be recognized early. This review focuses on the diagnosis, management, and disposition of patients with blunt injuries to the ribs and lung. Utilization of decision rules for chest x-ray and computed tomography are discussed, along with the emerging role of bedside lung ultrasonography. Management controversies presented include the limitations of needle thoracostomy us¬ing standard needle, chest tube placement, and chest tube size. Finally, a discussion is provided related to airway and ventilation management to assist in the timing and type of interventions needed to maintain oxygenation. PMID:27177417

  3. Characterization and Monitoring Data for Evaluating Constructed Emergent Sandbar Habitat in the Missouri River Mainstem

    SciTech Connect

    Duberstein, Corey A.; Downs, Janelle L.

    2008-11-06

    Emergent sandbar habitat (ESH) in the Missouri River Mainstem System is a critical habitat element for several federally listed bird species: the endangered interior least tern (Sterna antillarum) and the threatened Northern Great Plains piping plover (Charadrius melodus). The Army Corps of Engineers (Corps) provides the primary operational management of the Missouri River and is responsible under the Endangered Species Act (ESA) to take actions within its authorities to conserve listed species. To comply with the 2000 USFWS BiOp and the 2003 amended USFWS BiOp, the Corps has created habitats below Gavins Point Dam using mechanical means. Initial monitoring indicates that constructed sandbars provide suitable habitat features for nesting and foraging least terns and piping plovers. Terns and plovers are using constructed sandbars and successfully reproducing at or above levels stipulated in the BiOp. However, whether such positive impacts will persist cannot yet be adequately assessed at this time.

  4. Evaluation of preventable trauma death in emergency department of Imam Reza hospital

    PubMed Central

    Gholipour, Changiz; Rad, Bahram Samadi; Vahdati, Samad Shams; Ghaffarzad, Amir; Masoud, Armita

    2016-01-01

    BACKGROUND: Trauma is considered as a worldwide problem despite socio-economic development. Motor vehicle accidents (MVAs) are the most important cause of trauma. Trauma related deaths are mostly preventable. This study aimed to investigate the causes and prevention of death in trauma patients. METHODS: This retrospective, descriptive-analytic study assessed 100 trauma patients referred to our emergency department (ED) from January 2013 to Januanry 2015. The included patients were those with trauma died after arrival at our ED. Age, sex, cause of trauma, clinical causes of death, causes of death defined by autopsy, way of transfer to the ED, time of ambulance arrival at the scene of trauma, and time elapsed to enter the ED from the scene of trauma were studied. RESULTS: In the 100 patients, 21 (21%) patients were female and 79 (79%) male. Forty-three patients were older than 60 years. Trauma was largely due to pedestrian accidents in 31% of the patients, and 33% had a hypo-volemic shock. About 80% of deaths were due to intra-cranial hemorrhage (ICH) or intra-ventricular hemorrhage (IVH), and spinal injuries were not preventable. Autopsy revealed that 28% of the patients suffered from internal injuries. Autopsy revealed that 19% of the deaths were not preventable and 81% were considered preventable. In our patients, 76 were transferred to the hospital by emergency medicine services (EMS). Analysis of time for ambulance arrival to the scene and frequency of death revealed that 52.2% of the deaths occurred between 11 and 15 minutes. Analysis of time for admission to the ED from the scene of trauma showed that 74.6% deaths occurred between 6 and 10 minutes. CONCLUSIONS: The rate of hospital preventable deaths is about 80%, a high mortality rate, which denotes a lack of proper diagnosis and treatment. The time for arrival of EMS at the scene of trauma is longer than that in other countries. PMID:27313809

  5. Spectral tunability of realistic plasmonic nanoantennas

    SciTech Connect

    Portela, Alejandro; Matsui, Hiroaki; Tabata, Hitoshi; Yano, Takaaki; Hayashi, Tomohiro; Hara, Masahiko; Santschi, Christian; Martin, Olivier J. F.

    2014-09-01

    Single nanoantenna spectroscopy was carried out on realistic dipole nanoantennas with various arm lengths and gap sizes fabricated by electron-beam lithography. A significant difference in resonance wavelength between realistic and ideal nanoantennas was found by comparing their spectral response. Consequently, the spectral tunability (96 nm) of the structures was significantly lower than that of simulated ideal nanoantennas. These observations, attributed to the nanofabrication process, are related to imperfections in the geometry, added metal adhesion layer, and shape modifications, which are analyzed in this work. Our results provide important information for the design of dipole nanoantennas clarifying the role of the structural modifications on the resonance spectra, as supported by calculations.

  6. Realistic molecular model of kerogen's nanostructure

    NASA Astrophysics Data System (ADS)

    Bousige, Colin; Ghimbeu, Camélia Matei; Vix-Guterl, Cathie; Pomerantz, Andrew E.; Suleimenova, Assiya; Vaughan, Gavin; Garbarino, Gaston; Feygenson, Mikhail; Wildgruber, Christoph; Ulm, Franz-Josef; Pellenq, Roland J.-M.; Coasne, Benoit

    2016-05-01

    Despite kerogen's importance as the organic backbone for hydrocarbon production from source rocks such as gas shale, the interplay between kerogen's chemistry, morphology and mechanics remains unexplored. As the environmental impact of shale gas rises, identifying functional relations between its geochemical, transport, elastic and fracture properties from realistic molecular models of kerogens becomes all the more important. Here, by using a hybrid experimental-simulation method, we propose a panel of realistic molecular models of mature and immature kerogens that provide a detailed picture of kerogen's nanostructure without considering the presence of clays and other minerals in shales. We probe the models' strengths and limitations, and show that they predict essential features amenable to experimental validation, including pore distribution, vibrational density of states and stiffness. We also show that kerogen's maturation, which manifests itself as an increase in the sp2/sp3 hybridization ratio, entails a crossover from plastic-to-brittle rupture mechanisms.

  7. The Challenge of Realistic TPV System Modeling

    NASA Astrophysics Data System (ADS)

    Aschaber, J.; Hebling, C.; Luther, J.

    2003-01-01

    Realistic modeling of a TPV system is a very demanding task. For a rough estimation of system limits many of assumptions simplify the complexity of a thermophotovoltaic converter. It's obvious that real systems can not be described by this way. An alternative approach that can deal with all these complexities like arbitrary geometries, participating media, temperature distributions etc. is the Monte Carlo method (MCM). This statistical method simulates radiative energy transfer by tracking the histories of a number of photons beginning with the emission by a radiating surface and ending with absorption on a surface or in a medium. All interactions in this way are considered. The disadvantage of large computation time compared to other methods is not longer a weakness with the speed of todays computers. This article points out different ways for realistic TPV system simulation focusing on statistical methods.

  8. Realistic molecular model of kerogen's nanostructure.

    PubMed

    Bousige, Colin; Ghimbeu, Camélia Matei; Vix-Guterl, Cathie; Pomerantz, Andrew E; Suleimenova, Assiya; Vaughan, Gavin; Garbarino, Gaston; Feygenson, Mikhail; Wildgruber, Christoph; Ulm, Franz-Josef; Pellenq, Roland J-M; Coasne, Benoit

    2016-05-01

    Despite kerogen's importance as the organic backbone for hydrocarbon production from source rocks such as gas shale, the interplay between kerogen's chemistry, morphology and mechanics remains unexplored. As the environmental impact of shale gas rises, identifying functional relations between its geochemical, transport, elastic and fracture properties from realistic molecular models of kerogens becomes all the more important. Here, by using a hybrid experimental-simulation method, we propose a panel of realistic molecular models of mature and immature kerogens that provide a detailed picture of kerogen's nanostructure without considering the presence of clays and other minerals in shales. We probe the models' strengths and limitations, and show that they predict essential features amenable to experimental validation, including pore distribution, vibrational density of states and stiffness. We also show that kerogen's maturation, which manifests itself as an increase in the sp(2)/sp(3) hybridization ratio, entails a crossover from plastic-to-brittle rupture mechanisms. PMID:26828313

  9. Thruster Options for Microspacecraft: A Review and Evaluation of State-of-the-Art and Emerging Technologies

    NASA Astrophysics Data System (ADS)

    Mueller, Juergen

    Introduction Recent Microspacecraft Developments Background and Motivation Recent Microspacecraft Design Trends Preliminary Set of Micropropulsion Requirements for Microspacecraft System Integration Requirements Minimum Impulse Bit and Thrust Requirements Review of Chemical Propulsion Technologies Bipropellant Engines Monopropellant Thrusters: Hydrazine Monopropellant Thrusters: HAN-Based Monopropellant Thrusters: Hydrogen Peroxide Cold Gas Thrusters Tripropellant and Other Warm Gas Thrusters Solid Rocket Motors Hybrid Rocket Motors Review of Electric Propulsion Technologies Ion Engines Hall Thrusters FEEP Colloid Thrusters Pulsed Plasma Thrusters (PPTs) Resistojets Emerging Technologies: MEMS and MEMS-Hybrid Propulsion Concepts Case for MEMS Propulsion and Its Challenges Brief History of MEMS Propulsion MEMS-Based FEEP and Colloid Thruster Concepts Micro-Ion Engine Concepts MEMS-Based Microresistojet Concepts MEMS-Based Subliming Solid Microthruster Concept MEMS-Based Cold Gas Thruster Concept MEMS-Based Bipropellant Thruster Concept Digital Microthruster Array Concepts Evaluation of Existing Propulsion Technologies and Identification - of Future Technology Needs Evaluation of Existing Propulsion Technologies Identification of Technology Needs Conclusions References

  10. Development and Flight Evaluation of an Emergency Digital Flight Control System Using Only Engine Thrust on an F-15 Airplane

    NASA Technical Reports Server (NTRS)

    Burcham, Frank W., Jr.; Maine, Trindel A.; Fullerton, C. Gordon; Webb, Lannie Dean

    1996-01-01

    A propulsion-controlled aircraft (PCA) system for emergency flight control of aircraft with no flight controls was developed and flight tested on an F-15 aircraft at the NASA Dryden Flight Research Center. The airplane has been flown in a throttles-only manual mode and with an augmented system called PCA in which pilot thumbwheel commands and aircraft feedback parameters were used to drive the throttles. Results from a 36-flight evaluation showed that the PCA system can be used to safety land an airplane that has suffered a major flight control system failure. The PCA system was used to recover from a severe upset condition, descend, and land. Guest pilots have also evaluated the PCA system. This paper describes the principles of throttles-only flight control; a history of loss-of-control accidents; a description of the F-15 aircraft; the PCA system operation, simulation, and flight testing; and the pilot comments.

  11. PLATO Simulator: Realistic simulations of expected observations

    NASA Astrophysics Data System (ADS)

    Marcos-Arenal, P.; Zima, W.; De Ridder, J.; Aerts, C.; Huygen, R.; Samadi, R.; Green, J.; Piotto, G.; Salmon, S.; Catala, C.; Rauer, H.

    2015-06-01

    PLATO Simulator is an end-to-end simulation software tool designed for the performance of realistic simulations of the expected observations of the PLATO mission but easily adaptable to similar types of missions. It models and simulates photometric time-series of CCD images by including models of the CCD and its electronics, the telescope optics, the stellar field, the jitter movements of the spacecraft, and all important natural noise sources.

  12. Dynamical Symmetries Reflected in Realistic Interactions

    SciTech Connect

    Sviratcheva, K.D.; Draayer, J.P.; Vary, J.P.; /Iowa State U. /LLNL, Livermore /SLAC

    2007-04-06

    Realistic nucleon-nucleon (NN) interactions, derived within the framework of meson theory or more recently in terms of chiral effective field theory, yield new possibilities for achieving a unified microscopic description of atomic nuclei. Based on spectral distribution methods, a comparison of these interactions to a most general Sp(4) dynamically symmetric interaction, which previously we found to reproduce well that part of the interaction that is responsible for shaping pairing-governed isobaric analog 0{sup +} states, can determine the extent to which this significantly simpler model Hamiltonian can be used to obtain an approximate, yet very good description of low-lying nuclear structure. And furthermore, one can apply this model in situations that would otherwise be prohibitive because of the size of the model space. In addition, we introduce a Sp(4) symmetry breaking term by including the quadrupole-quadrupole interaction in the analysis and examining the capacity of this extended model interaction to imitate realistic interactions. This provides a further step towards gaining a better understanding of the underlying foundation of realistic interactions and their ability to reproduce striking features of nuclei such as strong pairing correlations or collective rotational motion.

  13. Identification and evaluation of competencies of health professionals in the hospital emergency management of the radiation accident victim

    SciTech Connect

    Berger, M.E.

    1982-01-01

    A preliminary list of ten competency and forty-six sub-competency statements derived from literature and consultation with experts and based on the general areas of clinical performance defined by the National Board of Medical Examiners were the concern of Phase I of this study. Forty-eight experts in nuclear medicine, radiology, radiotherapy, health physics, medical physics, radiation biology, public and occupational health, surgery, and emergency medicine and nursing considered this preliminary list of competencies and sub-competencies to determine which were essential for health professionals who may be caring for radiation accident victims in hospital emergency departments. Eight competencies and thirty-three sub-competencies were rated as Essential competencies. Competencies dealing with establishing priorities in patient care and initiating treatment, assessment, contamination control, and decontamination were highly rated. In the second part of this study, the Essential competencies were utilized in the development of an original evaluation instrument designed to identify deficiencies and continuing education needs during radiation accident drills or exercises. The instrument was designed for use in sixteen possible patient care situations in which the radiation accident victims have varying medical and radiological conditions. Development of the evaluation instrument was described.

  14. The Educative Function of Teaching: An Emerging Paradigm for the Evaluation of Teaching.

    ERIC Educational Resources Information Center

    Rowold, Milam C.; And Others

    Perhaps the most crucial education question of the late 1980s involves the assessment and evaluation of teaching quality. To help identify quality of teaching issues, this paper poses three questions: (1) Why have teachers found research-based teaching quality indicators so hollow and unacceptable? (2) What role, if any, can the accumulated…

  15. Dynamic apeerture in damping rings with realistic wigglers

    SciTech Connect

    Cai, Yunhai; /SLAC

    2005-05-04

    The International Linear Collider based on superconducting RF cavities requires the damping rings to have extremely small equilibrium emittance, huge circumference, fast damping time, and large acceptance. To achieve all of these requirements is a very challenging task. In this paper, we will present a systematic approach to designing the damping rings using simple cells and non-interlaced sextupoles. The designs of the damping rings with various circumferences and shapes, including dogbone, are presented. To model realistic wigglers, we have developed a new hybrid symplectic integrator for faster and accurate evaluation of dynamic aperture of the lattices.

  16. Evaluation of sensor types and environmental controls on mapping biomass of coastal marsh emergent vegetation

    USGS Publications Warehouse

    Byrd, Kristin B.; O'Connell, Jessica L.; Di Tommaso, Stefania; Kelly, Maggi

    2014-01-01

    There is a need to quantify large-scale plant productivity in coastal marshes to understand marsh resilience to sea level rise, to help define eligibility for carbon offset credits, and to monitor impacts from land use, eutrophication and contamination. Remote monitoring of aboveground biomass of emergent wetland vegetation will help address this need. Differences in sensor spatial resolution, bandwidth, temporal frequency and cost constrain the accuracy of biomass maps produced for management applications. In addition the use of vegetation indices to map biomass may not be effective in wetlands due to confounding effects of water inundation on spectral reflectance. To address these challenges, we used partial least squares regression to select optimal spectral features in situ and with satellite reflectance data to develop predictive models of aboveground biomass for common emergent freshwater marsh species, Typha spp. and Schoenoplectus acutus, at two restored marshes in the Sacramento–San Joaquin River Delta, California, USA. We used field spectrometer data to test model errors associated with hyperspectral narrowbands and multispectral broadbands, the influence of water inundation on prediction accuracy, and the ability to develop species specific models. We used Hyperion data, Digital Globe World View-2 (WV-2) data, and Landsat 7 data to scale up the best statistical models of biomass. Field spectrometer-based models of the full dataset showed that narrowband reflectance data predicted biomass somewhat, though not significantly better than broadband reflectance data [R2 = 0.46 and percent normalized RMSE (%RMSE) = 16% for narrowband models]. However hyperspectral first derivative reflectance spectra best predicted biomass for plots where water levels were less than 15 cm (R2 = 0.69, %RMSE = 12.6%). In species-specific models, error rates differed by species (Typha spp.: %RMSE = 18.5%; S. acutus: %RMSE = 24.9%), likely due to the more vertical structure and

  17. Evaluation of Social Media Use by Emergency Medicine Residents and Faculty

    PubMed Central

    Pearson, David; Bond, Michael C.; Kegg, Jason; Pillow, Tyson; Hopson, Laura; Cooney, Robert; Garg, Manish; Khadpe, Jay; Runyon, Michael; Patterson, Leigh

    2015-01-01

    Introduction Clinicians and residency programs are increasing their use of social media (SM) websites for educational and promotional uses, yet little is known about the use of these sites by residents and faculty. The objective of the study is to assess patterns of SM use for personal and professional purposes among emergency medicine (EM) residents and faculty. Methods In this multi-site study, an 18-question survey was sent by e-mail to the residents and faculty in 14 EM programs and to the Council of Emergency Medicine Residency Directors (CORD) listserv via the online tool SurveyMonkey™. We compiled descriptive statistics, including assessment with the chi-square test or Fisher’s exact test. StatsDirect software (v 2.8.0, StatsDirect, Cheshire, UK) was used for all analyses. Results We received 1,314 responses: 63% of respondents were male, 40% were <30 years of age, 39% were between the ages 31 and 40, and 21% were older than 40. The study group consisted of 772 residents and 542 faculty members (15% were program directors, 21% were assistant or associate PDs, 45% were core faculty, and 19% held other faculty positions. Forty-four percent of respondents completed residency more than 10 years ago. Residents used SM markedly more than faculty for social interactions with family and friends (83% vs 65% [p<0.0001]), entertainment (61% vs 47% [p<0.0001]), and videos (42% vs 23% [p=0.0006]). Residents used Facebook™ and YouTube™ more often than faculty (86% vs 67% [p<0.001]; 53% vs 46% [p=0.01]), whereas residents used Twitter™ (19% vs 26% [p=0.005]) and LinkedIn™ (15% vs 32% [p<0.0001]) less than faculty. Overall, residents used SM sites more than faculty, notably in daily use (30% vs 24% [p<0.001]). For professional use, residents were most interested in its use for open positions/hiring (30% vs 18% [p<0.0001]) and videos (33% vs 26% [p=0.005]) and less interested than faculty with award postings (22% vs 33% [p<0.0001]) or publications (30% vs 38% [p

  18. The Practical Challenges of Evaluating a Blanket Emergency Feeding Programme in Northern Kenya

    PubMed Central

    Hall, Andrew; Oirere, Moragwa; Thurstans, Susan; Ndumi, Assumpta; Sibson, Victoria

    2011-01-01

    A blanket supplementary feeding programme for young children was implemented for four months in five northern districts of Kenya from January 2010 because of fears of food insecurity exacerbated by drought. An attempt to evaluate the impact of the food on children's anthropometric status was put in place in three districts. The main aim of the analysis was to assess the quality of the data on the cohort of children studied in the evaluation and to propose methods by which it could be improved to evaluate future blanket feeding programmes. Data on the name, age, sex, weight and height of a systematic sample of children recruited at 61 food distribution sites were collected at the first, second and third rounds and again at an extra, fifth food distribution, offered only to the evaluation subjects. Of the 3,544 children enrolled, 483 (13.63%) did not collect a fifth ration. Of the 2,640 children who were considered by their name to be the same at the first and fifth food distribution (13% were different), data on only 902 children (34.17%) were considered acceptable based on their age (an arbitrary ±3 months different) and their length or height (between >−1 or ≤4 cm different) at the two instances they were seen. Data on nearly two thirds of children were of questionable quality. The main reasons for the poor quality data were inconsistencies in estimating age or because caretakers may have brought different children. Recommendations are made about how to improve data quality including ensuring that entry to a blanket feeding programme is clearly based on height, not age, to avoid misreporting age; careful identification of subjects at all contacts; and using well-trained, specialist evaluation staff. PMID:22073119

  19. The practical challenges of evaluating a blanket emergency feeding programme in northern Kenya.

    PubMed

    Hall, Andrew; Oirere, Moragwa; Thurstans, Susan; Ndumi, Assumpta; Sibson, Victoria

    2011-01-01

    A blanket supplementary feeding programme for young children was implemented for four months in five northern districts of Kenya from January 2010 because of fears of food insecurity exacerbated by drought. An attempt to evaluate the impact of the food on children's anthropometric status was put in place in three districts. The main aim of the analysis was to assess the quality of the data on the cohort of children studied in the evaluation and to propose methods by which it could be improved to evaluate future blanket feeding programmes. Data on the name, age, sex, weight and height of a systematic sample of children recruited at 61 food distribution sites were collected at the first, second and third rounds and again at an extra, fifth food distribution, offered only to the evaluation subjects. Of the 3,544 children enrolled, 483 (13.63%) did not collect a fifth ration. Of the 2,640 children who were considered by their name to be the same at the first and fifth food distribution (13% were different), data on only 902 children (34.17%) were considered acceptable based on their age (an arbitrary ±3 months different) and their length or height (between >-1 or ≤4 cm different) at the two instances they were seen. Data on nearly two thirds of children were of questionable quality. The main reasons for the poor quality data were inconsistencies in estimating age or because caretakers may have brought different children. Recommendations are made about how to improve data quality including ensuring that entry to a blanket feeding programme is clearly based on height, not age, to avoid misreporting age; careful identification of subjects at all contacts; and using well-trained, specialist evaluation staff. PMID:22073119

  20. Evaluation of Injuries Caused by Penetrating Chest Traumas in Patients Referred to the Emergency Room.

    PubMed

    Aghaei Afshar, M; Mangeli, F; Nakhaei, A

    2015-06-01

    The aim of the study was to determine the frequency of different injuries caused by penetrating chest traumas, and also the cause and type of trauma and its accompanying injuries. This is a cross-sectional descriptive study, carried out on all patients referred to the emergency room of Shahid Bahonar Hospital, Kerman, from March 2000 to September 2008, due to penetrating chest trauma. The required information including age, sex, cause of trauma, type and site of injury, and accompanying injury was obtained and used to fill out a questionnaire and then was analyzed. 828 patients were included in the study; most of them were in the age range of 20-29. Of the patients, 97.6 % were males. The most frequent cause of trauma was stabbing, and the most frequent injuries following the trauma were pneumothorax and hemothorax. Orthopedic trauma was the most frequent accompanying injury. The most commonly used diagnostic method was plain chest radiography. In 93 % of the patients, the chest tube was placed and thoracotomy was performed for 97 % of the patients. Shahid Bahonar Hospital is a referral Trauma Centre and treats large number of chest trauma patients. Most patients need only chest tube placement as a definitive treatment. PMID:26246700

  1. Evaluation of community-acquired sepsis by PIRO system in the emergency department.

    PubMed

    Chen, Yun-Xia; Li, Chun-Sheng

    2013-09-01

    The predisposition, infection/insult, response, and organ dysfunction (PIRO) staging system for septic patients allows grouping of heterogeneous patients into homogeneous subgroups. The purposes of this single-center, prospective, observational cohort study were to create a PIRO system for patients with community-acquired sepsis (CAS) presenting to the emergency department (ED) and assess its prognostic and stratification capabilities. Septic patients were enrolled and allocated to derivation (n = 831) or validation (n = 860) cohorts according to their enrollment dates. The derivation cohort was used to identify independent predictors of mortality and create a PIRO system by binary logistic regression analysis, and the prognostic performance of PIRO was investigated in the validation cohort by receiver operator characteristic (ROC) curve. Ten independent predictors of 28-day mortality were identified. The PIRO system combined the components of predisposition (age, chronic obstructive pulmonary disease, hypoalbuminemia), infection (central nervous system infection), response (temperature, procalcitonin), and organ dysfunction (brain natriuretic peptide, troponin I, mean arterial pressure, Glasgow coma scale score). The area under the ROC of PIRO was 0.833 for the derivation cohort and 0.813 for the validation cohort. There was a stepwise increase in 28-day mortality with increasing PIRO score and the differences between the low- (PIRO 0-10), intermediate- (11-20), and high- (>20) risk groups were very significant in both cohorts (p < 0.01). The present study demonstrates that this PIRO system is valuable for prognosis and risk stratification in patients with CAS in the ED. PMID:23771270

  2. Overview and Evaluation of Bluetooth Low Energy: An Emerging Low-Power Wireless Technology

    PubMed Central

    Gomez, Carles; Oller, Joaquim; Paradells, Josep

    2012-01-01

    Bluetooth Low Energy (BLE) is an emerging low-power wireless technology developed for short-range control and monitoring applications that is expected to be incorporated into billions of devices in the next few years. This paper describes the main features of BLE, explores its potential applications, and investigates the impact of various critical parameters on its performance. BLE represents a trade-off between energy consumption, latency, piconet size, and throughput that mainly depends on parameters such as connInterval and connSlaveLatency. According to theoretical results, the lifetime of a BLE device powered by a coin cell battery ranges between 2.0 days and 14.1 years. The number of simultaneous slaves per master ranges between 2 and 5,917. The minimum latency for a master to obtain a sensor reading is 676 μs, although simulation results show that, under high bit error rate, average latency increases by up to three orders of magnitude. The paper provides experimental results that complement the theoretical and simulation findings, and indicates implementation constraints that may reduce BLE performance.

  3. Evaluating the components of an emergent literacy intervention for preschool children at risk for reading difficulties.

    PubMed

    Lonigan, Christopher J; Purpura, David J; Wilson, Shauna B; Walker, Patricia M; Clancy-Menchetti, Jeanine

    2013-01-01

    Many preschool children are at risk for reading problems because of inadequate emergent literacy skills. Evidence supports the effectiveness of interventions to promote these skills, but questions remain about which intervention components work and whether combining intervention components will result in larger gains. In this study, 324 preschoolers (mean age=54.32 months, SD=5.88) from low-income backgrounds (46% girls and 54% boys; 82% African American, 14% White, and 4% other) were randomized to combinations of meaning-focused (dialogic reading or shared reading) and code-focused (phonological awareness, letter knowledge, or both) interventions or a control group. Interventions had statistically significant positive impacts only on measures of their respective skill domains. Combinations of interventions did not enhance outcomes across domains, indicating instructional needs in all areas of weakness for young children at risk for later reading difficulties. Less time for each intervention in the combined phonological awareness and letter knowledge intervention conditions, however, did not result in reduced effects relative to nearly twice as much time for each intervention when children received either only the phonological awareness intervention or only the letter knowledge intervention. This finding suggests that a relatively compact code-focused intervention can address the needs of children with weaknesses in both domains. PMID:23073367

  4. Successful Evaluation of Biphasic T-wave of Wellens Syndrome in the Emergency Department

    PubMed Central

    Aydin, Ali Attila; Ulutas, Kemal Türker; Aydin, Cemile; Kaya, Murtaza; Akar, Umut; Ture, Tayfun

    2016-01-01

    Introduction: Wellens Syndrome (WS) is a condition characterized by typical changes in ECG, which are biphasic T-wave inversions (less common) or symmetric and deeply inverted T waves (including 75%) in lead V2–V3 chest derivations. WS is considered important because it has not only diagnostic value but also prognostic value. Case report: A 52-year-old male patient without cardiovascular disease or risk factors was admitted to the emergency department (ED) suffering with chest pain and syncope, just after having been involved in a discussion at work. Chest pain was radiating to the left arm and was not precipitated by exertion. Shortness of breath was not accompanied by angina. The patient underwent cardiac catheterization at Department of Cardiology. Stents were positioned in both LADA and a severe lesion in the left main coronary artery. The patient was discharged two days following catheterization, due to no chest pain and hemodynamic instability during the hospitalization. The patient has approved the inform consent for to be used for this case report. PMID:27041816

  5. Advanced biosensing methodologies developed for evaluating performance quality and safety of emerging biophotonics technologies and medical devices (Conference Presentation)

    NASA Astrophysics Data System (ADS)

    Ilev, Ilko K.; Walker, Bennett; Calhoun, William; Hassan, Moinuddin

    2016-03-01

    Biophotonics is an emerging field in modern biomedical technology that has opened up new horizons for transfer of state-of-the-art techniques from the areas of lasers, fiber optics and biomedical optics to the life sciences and medicine. This field continues to vastly expand with advanced developments across the entire spectrum of biomedical applications ranging from fundamental "bench" laboratory studies to clinical patient "bedside" diagnostics and therapeutics. However, in order to translate these technologies to clinical device applications, the scientific and industrial community, and FDA are facing the requirement for a thorough evaluation and review of laser radiation safety and efficacy concerns. In many cases, however, the review process is complicated due the lack of effective means and standard test methods to precisely analyze safety and effectiveness of some of the newly developed biophotonics techniques and devices. There is, therefore, an immediate public health need for new test protocols, guidance documents and standard test methods to precisely evaluate fundamental characteristics, performance quality and safety of these technologies and devices. Here, we will overview our recent developments of novel test methodologies for safety and efficacy evaluation of some emerging biophotonics technologies and medical devices. These methodologies are based on integrating the advanced features of state-of-the-art optical sensor technologies and approaches such as high-resolution fiber-optic sensing, confocal and optical coherence tomography imaging, and infrared spectroscopy. The presentation will also illustrate some methodologies developed and implemented for testing intraocular lens implants, biochemical contaminations of medical devices, ultrahigh-resolution nanoscopy, and femtosecond laser therapeutics.

  6. Cost-Effectiveness Evaluation of EHR: Simulation of an Abdominal Aortic Aneurysm in the Emergency Department.

    PubMed

    Ben-Assuli, Ofir; Ziv, Amitai; Sagi, Doron; Ironi, Avinoah; Leshno, Moshe

    2016-06-01

    Health care organizations have installed electronic systems to increase efficiency in health care. Empirically assessing the cost-effectiveness of technologies to the health care system is a challenging and complex task. This study examined cost-effectiveness of additional clinical information supplied via an EHR system by simulating a case of abdominal aortic aneurysm devised and acted professionally by the Israel Center of Medical Simulation. We conducted a simulation-based study on physicians who were asked to treat a simulated patient for the prevalent medical scenario of hip and leg pain that actually corresponded to an abdominal aortic aneurysm. Half of the participating physicians from the Department of Emergency Medicine at Tel-Hashomer Hospital - Israel's largest - had access to an EHR system that integrates medical data from multiple health providers (community and hospitals) in addition to the local health record, and half did not. To model medical decision making, the results of the simulation were combined with a Markov Model within a decision tree. Cost-effectiveness was analyzed by comparing the effects of the admission/discharge decision in units of quality adjusted life years (QALYs) to the estimated costs. The results showed that using EHR in the ED increases the QALY of the patient and improves medical decision-making. The expenditure per patient for one QALY unit as a result of using the EHR was $1229, which is very cost-effective according to many accepted threshold values (less than all these values). Thus, using the EHR contributes to making a cost-effective decision in this specific but prevalent case. PMID:27114352

  7. An Evaluation of a Dog Bite Prevention Intervention in the Pediatric Emergency Department

    PubMed Central

    Dixon, Cinnamon A.; Pomerantz, Wendy J.; Hart, Kimberly W.; Lindsell, Christopher J.; Mahabee-Gittens, E. Melinda

    2013-01-01

    Objectives To determine the efficacy of a video-based dog bite prevention intervention at increasing child knowledge and describe any associated factors; and to assess the acceptability of providing this intervention in a pediatric emergency department (PED). Methods This cross-sectional, quasi experimental study enrolled a convenience sample of 5–9 year old patients and their parents, presenting to a PED with non-urgent complaints or dog bites. Children completed a 14-point simulated scenario test used to measure knowledge about safe dog interactions pre-/post- a video intervention. Based on previous research, a passing score (≥11/14) was defined a priori. Parents completed surveys regarding sociodemographics, dog-related experiential history and the intervention. Results There were 120 child/parent pairs. Mean child age was 7 (SD 1) and 55% were male. Of parents, 70% were white, 2/3 had more than high school education, and half had incomes <$40,000. Current dog ownership was 77%; only 6% of children had received prior dog bite prevention education. Test pass rate was 58% pre-intervention; 90% post-intervention. Knowledge score increased in 83% of children; greatest increases were in questions involving stray dogs or dogs that were fenced or eating. Younger child age was the only predictor of failing the post-test (p<0.001). Nearly all parents found the intervention informative; 93% supported providing the intervention in the PED. Conclusions Child knowledge of dog bite prevention is poor. The video-based intervention we tested appears efficacious at increasing short-term knowledge in 5–9 year old children and is acceptable to parents. Parents strongly supported providing this education. PMID:24061505

  8. Evaluation of performance quality of an advanced scope physiotherapy role in a hospital emergency department

    PubMed Central

    Morris, J; Vine, K; Grimmer, K

    2015-01-01

    Background Physiotherapists working in advanced and extended scope roles internationally make a difference to workflow, performance targets, and patient satisfaction in areas traditionally served by medicine and nursing. Aim To assess the impact of an advanced scope of practice physiotherapist (ASoP-PT) service in a large Australian hospital emergency department (ED) by measuring national service and triage category indicators, patient and staff satisfaction. Methods Consecutive patients consulting the ASoP-PT were recruited over 53 weeks following service inception. Descriptions of ASoP-PT activities and patients were collected. Performance was assessed against national ED indicators for length of stay and wait. Patient and staff perspectives were assessed independently by semi-structured interviews. The physiotherapist was formally trained to extended scope of practice including competency in medicines, prescription and application. The legislation prevented him from applying these skills, therefore he worked in an ASoP-PT role in ED. Results The ASoP-PT treated on average, 72 patients per month in ten shifts per fortnight, consulting patients aged from 1 to 88 years. Patients largely presented with musculoskeletal problems in triage Categories 4 and 5. There were shorter length of wait and length of stay, when the ASoP-PT was on shift. However overall compliance with national performance targets was similar with and without the ASoP-PT. Staff and patient satisfaction was high, particularly valuing the ASoP-PT’s expertise in musculoskeletal injuries. Conclusion The ASoP-PT performed at least as well as other ED health care providers in meeting national triage targets. Had the legislation permitted his independent prescription of medicines, the ASoP-PT could have worked in an extended scope role, and his performance in meeting targets may have been better. PMID:26229515

  9. Evaluation of California's Alcohol and Drug Screening and Brief Intervention Project for Emergency Department Patients

    PubMed Central

    Woodruff, Susan I.; Eisenberg, Kimberly; McCabe, Cameron T.; Clapp, John D.; Hohman, Melinda

    2013-01-01

    Introduction: Visits to settings such as emergency departments (EDs) may present a “teachable moment” in that a patient may be more open to feedback and suggestions regarding their risky alcohol and illicit drug-use behaviors. Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an 'opportunistic' public health approach that targets low-risk users, in addition to those already dependent on alcohol and/or drugs. SBIRT programs provide patients with comprehensive screening and assessments, and deliver interventions of appropriate intensity to reduce risks related to alcohol and drug use. Methods: This study used a single group pre-post test design to assess the effect of the California SBIRT service program (i.e., CASBIRT) on 6 substance-use outcomes (past-month prevalence and number of days of binge drinking, illegal drug use, and marijuana use). Trained bilingual/bicultural Health Educators attempted to screen all adult patients in 12 EDs/trauma centers (regardless of the reason for the patient's visit) using a short instrument, and then delivered a brief motivational intervention matched to the patient's risk level. A total of 2,436 randomly selected patients who screened positive for alcohol and/or drug use consented to be in a 6-month telephone follow-up interview. Because of the high loss to follow-up rate, we used an intention-to-treat approach for the data analysis. Results: Results of generalized linear mixed models showed modest reductions in all 6 drug-and alcohol-use outcomes. Men (versus women), those at relatively higher risk status (versus lower risk), and those with only one substance of misuse (versus both alcohol and illicit drug misuse) tended to show more positive change. Conclusion: These results suggest that SBIRT services provided in acute care settings are associated with modest changes in self-reported recent alcohol and illicit drug use. PMID:23687546

  10. An outcomes evaluation of an emergency department early pregnancy assessment service and early pregnancy assessment protocol

    PubMed Central

    Wendt, Kim; Crilly, Julia; May, Chris; Bates, Kym; Saxena, Rakhee

    2014-01-01

    Background Complications in early pregnancy, such as threatened or actual miscarriage is a common occurrence resulting in many women presenting to the emergency department (ED). Early pregnancy service delivery models described in the literature vary in terms of approach, setting and outcomes. Our objective was to determine outcomes of women who presented to an Australian regional ED with diagnoses consistent with early pregnancy complications following the implementation of an early pregnancy assessment service (EPAS) and early pregnancy assessment protocol (EPAP) in July 2011. Methods A descriptive, comparative (6 months before and after) study was undertaken. Data were extracted from the hospital ED information system and medical healthcare records. Outcome measures included: time to see a clinician, ED length of stay, admission rate, re-presentation rate, hospital admission and types of pathology tests ordered. Results Over the 12 -month period, 584 ED presentations were made to the ED with complications of early pregnancy (268 PRE and 316 POST EPAS–EPAP). Outcomes that improved statistically and clinically following implementation included: time to see a clinician (decreased by 6 min from 35 to 29 min), admission rate (decreased 6% from 14.5% to 8.5%), increase in β-human chorionic gonadotrophin ordering by 10% (up to 80% POST), increase in ultrasound (USS) performed by 10% (up to 73% POST) and increase in pain score documentation by 23% (up to 36% POST). Conclusions The results indicate that patient and service delivery improvements can be achieved following the implementation of targeted service delivery models such as EPAS and EPAP in the ED. PMID:24136123

  11. Large-System Transformation in Health Care: A Realist Review

    PubMed Central

    Best, Allan; Greenhalgh, Trisha; Lewis, Steven; Saul, Jessie E; Carroll, Simon; Bitz, Jennifer

    2012-01-01

    Context An evidence base that addresses issues of complexity and context is urgently needed for large-system transformation (LST) and health care reform. Fundamental conceptual and methodological challenges also must be addressed. The Saskatchewan Ministry of Health in Canada requested a six-month synthesis project to guide four major policy development and strategy initiatives focused on patient- and family-centered care, primary health care renewal, quality improvement, and surgical wait lists. The aims of the review were to analyze examples of successful and less successful transformation initiatives, to synthesize knowledge of the underlying mechanisms, to clarify the role of government, and to outline options for evaluation. Methods We used realist review, whose working assumption is that a particular intervention triggers particular mechanisms of change. Mechanisms may be more or less effective in producing their intended outcomes, depending on their interaction with various contextual factors. We explain the variations in outcome as the interplay between context and mechanisms. We nested this analytic approach in a macro framing of complex adaptive systems (CAS). Findings Our rapid realist review identified five “simple rules” of LST that were likely to enhance the success of the target initiatives: (1) blend designated leadership with distributed leadership; (2) establish feedback loops; (3) attend to history; (4) engage physicians; and (5) include patients and families. These principles play out differently in different contexts affecting human behavior (and thereby contributing to change) through a wide range of different mechanisms. Conclusions Realist review methodology can be applied in combination with a complex system lens on published literature to produce a knowledge synthesis that informs a prospective change effort in large-system transformation. A collaborative process engaging both research producers and research users contributes to local

  12. Comparison of visual analogue and Likert scales in evaluation of an emergency department bedside teaching programme.

    PubMed

    Celenza, Antonio; Rogers, Ian R

    2011-02-01

    The present study compares visual analogue scale (VAS) to Likert-type scale (LTS) instruments in evaluating perceptions of an ED bedside clinical teaching programme. A prospective study was conducted in the ED of an urban, adult tertiary hospital. Prospective pairing occurred of a teaching consultant and registrar who were relatively quarantined from normal clinical duties. Registrars received 3 months of the teaching intervention, and 3 months without the intervention in a cross-over fashion. Evaluation questionnaires were completed using both the LTS and 100 mm horizontal VAS for each question. Correlation between VAS and LTS gave a measure of validity, and test-retest stability and internal consistency gave measures of reliability. Registrar perceptions of the teaching programme were positive, but no differences were found between the pre- and post-intervention groups. The test-retest reliabilities (intraclass correlation coefficient) for the questionnaires were 0.51 and 0.54 for the VAS, and 0.58 and 0.58 for the LTS. Cronbach's alpha varied between 0.79 and 0.91 for the VAS, and 0.79 and 0.81 for the LTS. Correlations between the two methods varied from 0.35 to 0.94 for each question. A linear regression equation describing the relationship approximated VAS = 19.5 × LTS-9 with overall r= 0.89. An ED bedside teaching programme is perceived to be a beneficial educational intervention. The VAS is a reliable and valid alternative to the LTS for educational evaluation and might provide advantages in educational measurement. Further research into the significance of extreme values and educationally important changes in scores is required. PMID:21284816

  13. Identification and Evaluation of Human Factors Issues Associated with Emerging Nuclear Plant Technology

    SciTech Connect

    O'Hara,J.M.; Higgins,J.; Brown, William S.

    2009-04-01

    This study has identified human performance research issues associated with the implementation of new technology in nuclear power plants (NPPs). To identify the research issues, current industry developments and trends were evaluated in the areas of reactor technology, instrumentation and control technology, human-system integration technology, and human factors engineering (HFE) methods and tools. The issues were prioritized into four categories based on evaluations provided by 14 independent subject matter experts representing vendors, utilities, research organizations and regulators. Twenty issues were categorized into the top priority category. The study also identifies the priority of each issue and the rationale for those in the top priority category. The top priority issues were then organized into research program areas of: New Concepts of Operation using Multi-agent Teams, Human-system Interface Design, Complexity Issues in Advanced Systems, Operating Experience of New and Modernized Plants, and HFE Methods and Tools. The results can serve as input to the development of a long-term strategy and plan for addressing human performance in these areas to support the safe operation of new NPPs.

  14. Role of Echocardiography in the Evaluation of Left Ventricular Assist Devices: the Importance of Emerging Technologies.

    PubMed

    Longobardo, Luca; Kramer, Christopher; Carerj, Scipione; Zito, Concetta; Jain, Renuka; Suma, Valentin; Thohan, Vinay; Sulemanjee, Nasir; Downey, Frank X; Khandheria, Bijoy K

    2016-07-01

    The role of left ventricular assist devices (LVAD) in patients with end-stage heart failure is well known, both as a temporary treatment before transplantation and as destination therapy, in a scenario of a relative shortage of donors to satisfy the increasing requests for transplantation. The increased population of LVAD patients needs careful imaging assessment before, during, and after LVAD implantation; echocardiography is the best tool for their evaluation and is considered the diagnostic technique of choice for the assessment before, during, and after device implantation. Although the conventional echocardiographic assessment is quite effective in evaluating the main critical issues, the role of new technologies like three-dimensional echocardiography and myocardial deformation measurements is still not properly clarified. In this review, we aim to provide an overview of the main elements that should be considered in the assessment of these patients, underlining the role that could be played by new techniques to improve the diagnostic and prognostic effectiveness of echocardiography in this setting. PMID:27216842

  15. Realistic and efficient 2D crack simulation

    NASA Astrophysics Data System (ADS)

    Yadegar, Jacob; Liu, Xiaoqing; Singh, Abhishek

    2010-04-01

    Although numerical algorithms for 2D crack simulation have been studied in Modeling and Simulation (M&S) and computer graphics for decades, realism and computational efficiency are still major challenges. In this paper, we introduce a high-fidelity, scalable, adaptive and efficient/runtime 2D crack/fracture simulation system by applying the mathematically elegant Peano-Cesaro triangular meshing/remeshing technique to model the generation of shards/fragments. The recursive fractal sweep associated with the Peano-Cesaro triangulation provides efficient local multi-resolution refinement to any level-of-detail. The generated binary decomposition tree also provides efficient neighbor retrieval mechanism used for mesh element splitting and merging with minimal memory requirements essential for realistic 2D fragment formation. Upon load impact/contact/penetration, a number of factors including impact angle, impact energy, and material properties are all taken into account to produce the criteria of crack initialization, propagation, and termination leading to realistic fractal-like rubble/fragments formation. The aforementioned parameters are used as variables of probabilistic models of cracks/shards formation, making the proposed solution highly adaptive by allowing machine learning mechanisms learn the optimal values for the variables/parameters based on prior benchmark data generated by off-line physics based simulation solutions that produce accurate fractures/shards though at highly non-real time paste. Crack/fracture simulation has been conducted on various load impacts with different initial locations at various impulse scales. The simulation results demonstrate that the proposed system has the capability to realistically and efficiently simulate 2D crack phenomena (such as window shattering and shards generation) with diverse potentials in military and civil M&S applications such as training and mission planning.

  16. Anderson localization for chemically realistic systems

    NASA Astrophysics Data System (ADS)

    Terletska, Hanna

    2015-03-01

    Disorder which is ubiquitous for most materials can strongly effect their properties. It may change their electronic structures or even cause their localization, known as Anderson localization. Although, substantial progress has been achieved in the description of the Anderson localization, a proper mean-field theory of this phenomenon for more realistic systems remains elusive. Commonly used theoretical methods such as the coherent potential approximation and its cluster extensions fail to describe the Anderson transition, as the average density of states (DOS) employed in such theories is not critical at the transition. However, near the transition, due to the spatial confinement of carriers, the local DOS becomes highly skewed with a log-normal distribution, for which the most probable and the typical values differ noticeably from the average value. Dobrosavljevic et.al., incorporated such ideas in their typical medium theory (TMT), and showed that the typical (not average) DOS is critical at the transition. While the TMT is able to capture the localized states, as a local single site theory it still has several drawbacks. For the disorder Anderson model in three dimension it underestimates the critical disorder strength, and fails to capture the re-entrance behavior of the mobility edge. We have recently developed a cluster extension of the TMT, which addresses these drawbacks by systematically incorporating non-local corrections. This approach converges quickly with cluster size and allows us to incorporate the effect of interactions and realistic electronic structure. As the first steps towards realistic material modeling, we extended our TMDCA formalisms to systems with the off diagonal disorder and multiple bands structures. We also applied our TMDCA scheme to systems with both disorder and interactions and found that correlations effects tend to stabilize the metallic behavior even in two dimensions. This work was supported by DOE SciDAC Grant No. DE-FC02

  17. Adiabatic Hyperspherical Analysis of Realistic Nuclear Potentials

    NASA Astrophysics Data System (ADS)

    Daily, K. M.; Kievsky, Alejandro; Greene, Chris H.

    2015-12-01

    Using the hyperspherical adiabatic method with the realistic nuclear potentials Argonne V14, Argonne V18, and Argonne V18 with the Urbana IX three-body potential, we calculate the adiabatic potentials and the triton bound state energies. We find that a discrete variable representation with the slow variable discretization method along the hyperradial degree of freedom results in energies consistent with the literature. However, using a Laguerre basis results in missing energy, even when extrapolated to an infinite number of basis functions and channels. We do not include the isospin T = 3/2 contribution in our analysis.

  18. Quantum states prepared by realistic entanglement swapping

    SciTech Connect

    Scherer, Artur; Howard, Regina B.; Sanders, Barry C.; Tittel, Wolfgang

    2009-12-15

    Entanglement swapping between photon pairs is a fundamental building block in schemes using quantum relays or quantum repeaters to overcome the range limits of long-distance quantum key distribution. We develop a closed-form solution for the actual quantum states prepared by realistic entanglement swapping, which takes into account experimental deficiencies due to inefficient detectors, detector dark counts, and multiphoton-pair contributions of parametric down-conversion sources. We investigate how the entanglement present in the final state of the remaining modes is affected by the real-world imperfections. To test the predictions of our theory, comparison with previously published experimental entanglement swapping is provided.

  19. Realist model approach to quantum mechanics

    NASA Astrophysics Data System (ADS)

    Hájíček, P.

    2013-06-01

    The paper proves that quantum mechanics is compatible with the constructive realism of modern philosophy of science. The proof is based on the observation that properties of quantum systems that are uniquely determined by their preparations can be assumed objective without the difficulties that are encountered by the same assumption about values of observables. The resulting realist interpretation of quantum mechanics is made rigorous by studying the space of quantum states—the convex set of state operators. Prepared states are classified according to their statistical structure into indecomposable and decomposable instead of pure and mixed. Simple objective properties are defined and showed to form a Boolean lattice.

  20. A realistic renormalizable supersymmetric E₆ model

    SciTech Connect

    Bajc, Borut; Susič, Vasja

    2014-01-01

    A complete realistic model based on the supersymmetric version of E₆ is presented. It consists of three copies of matter 27, and a Higgs sector made of 2×(27+27⁻)+351´+351´⁻ representations. An analytic solution to the equations of motion is found which spontaneously breaks the gauge group into the Standard Model. The light fermion mass matrices are written down explicitly as non-linear functions of three Yukawa matrices. This contribution is based on Ref. [1].

  1. Model Selection and Evaluation Based on Emerging Infectious Disease Data Sets including A/H1N1 and Ebola

    PubMed Central

    Liu, Wendi; Tang, Sanyi; Xiao, Yanni

    2015-01-01

    The aim of the present study is to apply simple ODE models in the area of modeling the spread of emerging infectious diseases and show the importance of model selection in estimating parameters, the basic reproduction number, turning point, and final size. To quantify the plausibility of each model, given the data and the set of four models including Logistic, Gompertz, Rosenzweg, and Richards models, the Bayes factors are calculated and the precise estimates of the best fitted model parameters and key epidemic characteristics have been obtained. In particular, for Ebola the basic reproduction numbers are 1.3522 (95% CI (1.3506, 1.3537)), 1.2101 (95% CI (1.2084, 1.2119)), 3.0234 (95% CI (2.6063, 3.4881)), and 1.9018 (95% CI (1.8565, 1.9478)), the turning points are November 7,November 17, October 2, and November 3, 2014, and the final sizes until December 2015 are 25794 (95% CI (25630, 25958)), 3916 (95% CI (3865, 3967)), 9886 (95% CI (9740, 10031)), and 12633 (95% CI (12515, 12750)) for West Africa, Guinea, Liberia, and Sierra Leone, respectively. The main results confirm that model selection is crucial in evaluating and predicting the important quantities describing the emerging infectious diseases, and arbitrarily picking a model without any consideration of alternatives is problematic. PMID:26451161

  2. Emerging role of cardiovascular CT and MRI in the evaluation of stroke.

    PubMed

    Pagán, Ricardo J; Parikh, Pragnesh P; Mergo, Patricia J; Gerber, Thomas C; Mankad, Rekha; Freeman, William D; Shapiro, Brian P

    2015-02-01

    OBJECTIVE. The purposes of this article are to explore the potential for use of CT angiography and MRI and to highlight data suggestive of their usefulness in specific cardiovascular abnormalities. CONCLUSION. The evaluation of stroke requires comprehensive assessment of potential stroke mechanisms, including cardiac sources. Despite an exhaustive search for secondary causes, the precise cause of many strokes remains unknown (cryptogenic). It is well recognized, however, that some of these potential causes occur as a result of embolism from the heart or great vessels. Thus, echocardiography, in particular transesophageal echocardiography, is instrumental in a careful assessment of cardiac causes in selected individuals. Unfortunately, transesophageal echocardiography is invasive, and some patients may have relative or absolute contraindications. Cardiovascular CT angiography and MRI have growing potential compared with conventional cardiovascular echography. PMID:25615749

  3. Merits of random forests emerge in evaluation of chemometric classifiers by external validation.

    PubMed

    Scott, I M; Lin, W; Liakata, M; Wood, J E; Vermeer, C P; Allaway, D; Ward, J L; Draper, J; Beale, M H; Corol, D I; Baker, J M; King, R D

    2013-11-01

    Real-world applications will inevitably entail divergence between samples on which chemometric classifiers are trained and the unknowns requiring classification. This has long been recognized, but there is a shortage of empirical studies on which classifiers perform best in 'external validation' (EV), where the unknown samples are subject to sources of variation relative to the population used to train the classifier. Survey of 286 classification studies in analytical chemistry found only 6.6% that stated elements of variance between training and test samples. Instead, most tested classifiers using hold-outs or resampling (usually cross-validation) from the same population used in training. The present study evaluated a wide range of classifiers on NMR and mass spectra of plant and food materials, from four projects with different data properties (e.g., different numbers and prevalence of classes) and classification objectives. Use of cross-validation was found to be optimistic relative to EV on samples of different provenance to the training set (e.g., different genotypes, different growth conditions, different seasons of crop harvest). For classifier evaluations across the diverse tasks, we used ranks-based non-parametric comparisons, and permutation-based significance tests. Although latent variable methods (e.g., PLSDA) were used in 64% of the surveyed papers, they were among the less successful classifiers in EV, and orthogonal signal correction was counterproductive. Instead, the best EV performances were obtained with machine learning schemes that coped with the high dimensionality (914-1898 features). Random forests confirmed their resilience to high dimensionality, as best overall performers on the full data, despite being used in only 4.5% of the surveyed papers. Most other machine learning classifiers were improved by a feature selection filter (ReliefF), but still did not out-perform random forests. PMID:24139571

  4. Lung Emergencies

    MedlinePlus

    ... Emergencies Cardiac Emergencies Eye Emergencies Lung Emergencies Surgeries Lung Emergencies People with Marfan syndrome can be at ... should be considered an emergency. Symptoms of sudden lung collapse (pneumothorax) Symptoms of a sudden lung collapse ...

  5. Ready for Discharge? A Survey of Discharge Transition-of-Care Education and Evaluation in Emergency Medicine Residency Programs.

    PubMed

    Gallahue, Fiona E; Betz, Amy E; Druck, Jeffrey; Jones, Jonathan S; Burns, Boyd; Hern, Gene

    2015-11-01

    This study aimed to assess current education and practices of emergency medicine (EM) residents as perceived by EM program directors to determine if there are deficits in resident discharge handoff training. This survey study was guided by the Kern model for medical curriculum development. A six-member Council of EM Residency Directors (CORD) Transitions of Care task force of EM physicians performed these steps and constructed a survey. The survey was distributed to program residency directors via the CORD listserve and/or direct contact. There were 119 responses to the survey, which were collected using an online survey tool. Over 71% of the 167 American College of Graduate Medical Education (ACGME) accredited EM residency programs were represented. Of those responding, 42.9% of programs reported formal training regarding discharges during initial orientation and 5.9% reported structured curriculum outside of orientation. A majority (73.9%) of programs reported that EM residents were not routinely evaluated on their discharge proficiency. Despite the ACGME requirements requiring formal handoff curriculum and evaluation, many programs do not provide formal curriculum on the discharge transition of care or evaluate EM residents on their discharge proficiency. PMID:26594283

  6. Evaluation of cardiac troponin I in dogs presenting to the emergency room using a point-of-care assay.

    PubMed

    Porter, Adam; Rozanski, Elizabeth; Price, Lori Lyn; Shaw, Scott

    2016-06-01

    We used a point-of-care assay to evaluate cardiac troponin I (cTnI) in clinically normal dogs and a heterogeneous population of dogs presenting to the emergency room (ER) and to determine whether cTnI has prognostic capabilities in an ER population. Fourteen clinically normal dogs and 129 dogs presented to the ER were evaluated. Of the study group, 88 dogs had normal cTnI (< 0.1 ng/mL), 29 had elevated cTnI (0.1 to 1.0 ng/mL), and 12 had high cTnI (> 1.0 ng/mL). Dogs with elevated cTnI had 8 times the odds of mortality compared to dogs with normal cTnI [odds ratio (OR): 8.2, 95% confidence interval (CI): 3.0, 22.3]. Dogs with high cTnI had 17 times higher odds of mortality compared to dogs with normal cTnI (OR: 17.6, 95% CI: 4.4, 70.1). We conclude that cTnI shows promise as a prognostic indicator for dogs presenting to the ER and can be easily evaluated using a point-of-care assay. PMID:27247465

  7. Training the powerful: issues that emerged during the evaluation of a communication skills training programme for senior cancer care professionals.

    PubMed

    Bibila, S; Rabiee, F

    2014-07-01

    'Connected' is the name of the national advanced communication skills training programme developed in 2008 for cancer care professionals in the NHS. A 3-day training course combining didactic and experiential learning elements is run by two facilitators with course participants expected to engage fully in simulated consultations with trained actors. In 2011, and as a result of participant feedback on the length of the course and increasing pressures on budgets and clinical time, the Connected team developed and piloted an alternative 2-day training course. Before its roll-out in 2012, Birmingham City University was commissioned to evaluate the effectiveness and quality of the 2-day course vis-à-vis the 'traditional' 3-day one. This article is written by the two evaluators and it discusses some of the issues that emerged during the evaluation. We broadly grouped these issues into two overlapping categories: the mandatory nature of the course and the different professional background and seniority of participants. In our discussion we consider the implications these issues have for communication skills training policy and practice and put forward suggestions for further research. PMID:24373021

  8. Computer Simulation in Mass Emergency and Disaster Response: An Evaluation of Its Effectiveness as a Tool for Demonstrating Strategic Competency in Emergency Department Medical Responders

    ERIC Educational Resources Information Center

    O'Reilly, Daniel J.

    2011-01-01

    This study examined the capability of computer simulation as a tool for assessing the strategic competency of emergency department nurses as they responded to authentically computer simulated biohazard-exposed patient case studies. Thirty registered nurses from a large, urban hospital completed a series of computer-simulated case studies of…

  9. Hypertensive emergencies.

    PubMed

    Murphy, C

    1995-11-01

    Hypertensive emergencies are uncommon and physiologically diverse. Consequently, it is difficult for most physicians to develop a familiarity with all the different hypertensive crises and with all drugs available for treating them (Table 4). Clinicians should not agonize over which is the perfect therapeutic agent for a particular emergency, but instead, they should focus on scrupulous monitoring and familiarize themselves with a few agents that will serve in most situations. Generally, these agents will be sodium nitroprusside and nitroglycerin. Vigilant neurologic monitoring is mandatory in all hypertensive emergencies. The early symptoms and signs of cerebral hypoperfusion can be vague and subtle, but if recognized, serious complications of therapy can be avoided. Remember, the patient may still be hypertensive. Avoid acute (during the first hour) reductions in MAP of more than 20% whenever possible; subsequent reductions should be gradual. In patients known to have markedly elevated ICP and who need acute reductions in their BP, serious consideration should be given to direct monitoring of the ICP so that CPP can be maintained within safe limits. In general, oral agents should not be used for the treatment of hypertensive emergencies. Intravenous Labetalol and intravenous nicardipine are not suitable for general use in hypertensive emergencies. In special situations (e.g., perioperative hypertension and subarachnoid hemorrhage), however, they may be employed. Their role may expand with further study. Trimethaphan may be superior to nitroprusside for hypertension complicated by elevated ICP or cerebral dysfunction. Realistically, most physicians will continue to use nitroprusside. Intense neurologic monitoring is more important than the specific agent used. Nitroglycerin is the agent of choice for acute ischemic heart disease complicated by severe hypertension; if it fails, use nitroprusside. For aortic dissection, the combination of nitroprusside and IV

  10. Governmental re-evaluation of the committed effective dose received by emergency workers at the TEPCO Fukushima Daiichi NPP accident.

    PubMed

    Yasui, Shojiro

    2015-01-01

    In April 2013, the Ministry of Health, Labour and Welfare (MHLW) noticed that significant discrepancies were present between the committed effective dose (CED) data for emergency workers at the TEPCO Fukushima Daiichi Nuclear Power Plant provided by TEPCO and that reported by five primary contractors. The MHLW, based on re-evaluation of the data, provided administrative guidance which required TEPCO and the five primary contractors to readjust the CED data for 479 workers (2.5% of 19,346 emergency workers). Of these, data for 450 workers from the primary contractors were readjusted based on the change in assessment methods. Doses were readjusted to higher values for 431 workers and doses were readjusted to lower values for 19 workers, CED data were corrected due to calculation errors for 29 workers from seven contractors, 12 additional workers were found to have received more than 50 mSv but no more than 100 mSv, an increase of 1.7% over the previously established count of 723 workers who had received that dose. Six additional workers were found to have received more than 100 mSv, an increase of 3.6% compared with the previous count of 167 workers. Major issues addressed during re-evaluation included: a) selection of intake scenario for the calculation of the residual activity ratio; b) assumptions about the intake date; c) assessments of exposure to radiation from (132)I and (132)Te; and d) assumptions about (131)I exposure in cases where (131)I was undetectable. Regarding the divergent CED data of 138 workers, the MHLW also confirmed that the CEDs assessed by the primary contractors were valid. To prevent the recurrence of similar incidents, the MHLW issued administrative guidance documents to TEPCO and primary contractors to employ standardized CED assessment methods on July 5. 2013. PMID:25585203

  11. Kenya’s emergency-hire nursing programme: a pilot evaluation of health service delivery in two districts

    PubMed Central

    2014-01-01

    Objective To assess the feasibility of utilizing a small-scale, low-cost, pilot evaluation in assessing the short-term impact of Kenya’s emergency-hire nursing programme (EHP) on the delivery of health services (outpatient visits and maternal-child health indicators) in two underserved health districts with high HIV/AIDS prevalence. Methods Six primary outcomes were assessed through the collection of data from facility-level health management forms—total general outpatient visits, vaginal deliveries, caesarean sections, antenatal care (ANC) attendance, ANC clients tested for HIV, and deliveries to HIV-positive women. Data on outcome measures were assessed both pre-and post-emergency-hire nurse placement. Informal discussions were also conducted to obtain supporting qualitative data. Findings The majority of EHP nurses were placed in Suba (15.5%) and Siaya (13%) districts. At the time of the intervention, we describe an increase in total general outpatient visits, vaginal deliveries and caesarean sections within both districts. Similar significant increases were seen with ANC attendance and deliveries to HIV-positive women. Despite increases in the quantity of health services immediately following nurse placement, these levels were often not sustained. We identify several factors that challenge the long-term sustainability of these staffing enhancements. Conclusions There are multiple factors beyond increasing the supply of nurses that affect the delivery of health services. We believe this pilot evaluation sets the foundation for future, larger and more comprehensive studies further elaborating on the interface between interventions to alleviate nursing shortages and promote enhanced health service delivery. We also stress the importance of strong national and local relationships in conducting future studies. PMID:24636052

  12. Realistic magnetohydrodynamical simulation of solar local supergranulation

    NASA Astrophysics Data System (ADS)

    Ustyugov, Sergey D.

    2010-12-01

    Three-dimensional numerical simulations of solar surface magnetoconvection using realistic model physics are conducted. The thermal structure of convective motions into the upper radiative layers of the photosphere, the main scales of convective cells and the penetration depths of convection are investigated. We take part of the solar photosphere with a size of 60×60 Mm2 in the horizontal direction and of depth 20 Mm from the level of the visible solar surface. We use a realistic initial model of the sun and apply the equation of state and opacities of stellar matter. The equations of fully compressible radiation magnetohydrodynamics (MHD) with dynamical viscosity and gravity are solved. We apply (i) the conservative total variation diminishing (TVD) difference scheme for MHD, (ii) the diffusion approximation for radiative transfer and (iii) dynamical viscosity from subgrid-scale modeling. In simulation, we take a uniform two-dimensional grid in the horizontal plane and a nonuniform grid in the vertical direction with the number of cells being 600×600×204. We use 512 processors with distributed memory multiprocessors on the supercomputer MVS-100k at the Joint Computational Centre of the Russian Academy of Sciences.

  13. The realist interpretation of the atmosphere

    NASA Astrophysics Data System (ADS)

    Anduaga, Aitor

    The discovery of a clearly stratified structure of layers in the upper atmosphere has been--and still is--invoked too often as the great paradigm of atmospheric sciences in the 20th century. Behind this vision, an emphasis--or better, an overstatement--on the reality of the concept of layer lies. One of the few historians of physics who have not ignored this phenomenon of reification, C. Stewart Gillmor, attributed it to--somewhat ambiguous-- cultural (or perhaps, more generally, contextual) factors, though he never specified their nature. In this essay, I aim to demonstrate that, in the interwar years, most radiophysicists and some atomic physicists, for reasons principally related to extrinsic influences and to a lesser extent to internal developments of their own science, fervidly embraced a realist interpretation of the ionosphere. We will focus on the historical circumstances in which a specific social and commercial environment came to exert a strong influence on upper atmospheric physicists, and in which realism as a product validating the "truth" of certain practices and beliefs arose. This realist commitment I attribute to the mutual reinforcement of atmospheric physics and commercial and imperial interests in long-distance communications.

  14. Neurogenic orthostatic hypotension in Parkinson’s disease: evaluation, management, and emerging role of droxidopa

    PubMed Central

    Isaacson, Stuart H; Skettini, Julia

    2014-01-01

    Neurogenic orthostatic hypotension (nOH) is due to failure of the autonomic nervous system to regulate blood pressure in response to postural changes due to an inadequate release of norepinephrine, leading to orthostatic hypotension and supine hypertension. nOH is common in Parkinson’s disease (PD). Prevalence varies throughout the course of PD, ranging from 40% to 60%, and resulting in symptomatic nOH in approximately half. Symptomatic nOH, including lightheadedness, can limit daily activities and lead to falls. Symptomatic nOH can also limit therapeutic options for treating PD motor symptoms. Clinical evaluation should routinely include symptom assessment and blood pressure measurement of supine, sitting, and 3-minute standing; 24-hour ambulatory blood pressure monitoring can also be helpful. Non-pharmacological management of symptomatic nOH involves education, physical maneuvers, and adequate hydration. Current pharmacological treatment of symptomatic nOH includes salt supplement, fludrocortisone, midodrine, pyridostigmine, and other empiric medications. Despite these options, treatment of symptomatic nOH remains suboptimal, often limited by severe increases in supine blood pressure. Droxidopa, an oral prodrug converted by decarboxylation to norepinephrine, is a promising therapeutic option for symptomatic nOH in PD, improving symptoms of nOH, daily activities, falls, and standing systolic blood pressure in several recent trials. These trials demonstrated short-term efficacy and tolerability, with comparable increases in standing and supine blood pressures. Longer-term studies are ongoing to confirm durability of treatment effect. PMID:24729712

  15. The Emerging Role of Cardiovascular Magnetic Resonance Imaging in the Evaluation of Metabolic Cardiomyopathies.

    PubMed

    Mavrogeni, S; Markousis-Mavrogenis, G; Markussis, V; Kolovou, G

    2015-08-01

    The aim of this review is to discuss the role of Cardiovascular Magnetic Resonance (CMR) in the diagnosis, risk stratification, and follow-up of metabolic cardiomyopathies. The classification of myocardial diseases, proposed by WHO/ISFC task force, distinguished specific cardiomyopathies, caused by metabolic disorders, into 4 types: 1) endocrine disorders, 2) storage or infiltration disorders (amyloidosis, hemochromatosis and familial storage disorders), 3) nutritional disorders (Kwashiorkor, beri-beri, obesity, and alcohol), and 4) diabetic heart. Thyroid disease, pheochromocytoma, and growth hormone excess or deficiency may contribute to usually reversible dilated cardiomyopathy. Glucogen storage diseases can be presented with myopathy, liver, and heart failure. Lysosomal storage diseases can provoke cardiac hypertrophy, mimicking hypertrophic cardiomyopathy and arrhythmias. Hereditary hemochromatosis, an inherited disorder of iron metabolism, leads to tissue iron overload in different organs, including the heart. Cardiac amyloidosis is the result of amyloid deposition in the heart, formed from breakdown of normal or abnormal proteins that leads to increased heart stiffness, restrictive cardiomyopathy, and heart failure. Finally, nutritional disturbances and metabolic diseases, such as Kwashiorkor, beri-beri, obesity, alcohol consumption, and diabetes mellitus may also lead to severe cardiac dysfunction. CMR, through its capability to reliably assess anatomy, function, inflammation, rest-stress myocardial perfusion, myocardial fibrosis, aortic distensibility, iron and/or fat deposition can serve as an excellent tool for early diagnosis of heart involvement, risk stratification, treatment evaluation, and long term follow-up of patients with metabolic cardiomyopathies. PMID:26197853

  16. Neurogenic orthostatic hypotension in Parkinson's disease: evaluation, management, and emerging role of droxidopa.

    PubMed

    Isaacson, Stuart H; Skettini, Julia

    2014-01-01

    Neurogenic orthostatic hypotension (nOH) is due to failure of the autonomic nervous system to regulate blood pressure in response to postural changes due to an inadequate release of norepinephrine, leading to orthostatic hypotension and supine hypertension. nOH is common in Parkinson's disease (PD). Prevalence varies throughout the course of PD, ranging from 40% to 60%, and resulting in symptomatic nOH in approximately half. Symptomatic nOH, including lightheadedness, can limit daily activities and lead to falls. Symptomatic nOH can also limit therapeutic options for treating PD motor symptoms. Clinical evaluation should routinely include symptom assessment and blood pressure measurement of supine, sitting, and 3-minute standing; 24-hour ambulatory blood pressure monitoring can also be helpful. Non-pharmacological management of symptomatic nOH involves education, physical maneuvers, and adequate hydration. Current pharmacological treatment of symptomatic nOH includes salt supplement, fludrocortisone, midodrine, pyridostigmine, and other empiric medications. Despite these options, treatment of symptomatic nOH remains suboptimal, often limited by severe increases in supine blood pressure. Droxidopa, an oral prodrug converted by decarboxylation to norepinephrine, is a promising therapeutic option for symptomatic nOH in PD, improving symptoms of nOH, daily activities, falls, and standing systolic blood pressure in several recent trials. These trials demonstrated short-term efficacy and tolerability, with comparable increases in standing and supine blood pressures. Longer-term studies are ongoing to confirm durability of treatment effect. PMID:24729712

  17. Realistic Mobility Modeling for Vehicular Ad Hoc Networks

    NASA Astrophysics Data System (ADS)

    Akay, Hilal; Tugcu, Tuna

    2009-08-01

    Simulations used for evaluating the performance of routing protocols for Vehicular Ad Hoc Networks (VANET) are mostly based on random mobility and fail to consider individual behaviors of the vehicles. Unrealistic assumptions about mobility produce misleading results about the behavior of routing protocols in real deployments. In this paper, a realistic mobility modeling tool, Mobility for Vehicles (MOVE), which considers the basic mobility behaviors of vehicles, is proposed for a more accurate evaluation. The proposed model is tested against the Random Waypoint (RWP) model using AODV and OLSR protocols. The results show that the mobility model significantly affects the number of nodes within the transmission range of a node, the volume of control traffic, and the number of collisions. It is shown that number of intersections, grid size, and node density are important parameters when dealing with VANET performance.

  18. Triple Rule Out versus CT Angiogram Plus Stress Test for Evaluation of Chest Pain in the Emergency Department

    PubMed Central

    Sawyer, Kelly N.; Shah, Payal; Qu, Lihua; Kurz, Michael C.; Clark, Carol L.; Swor, Robert A.

    2015-01-01

    Introduction Undifferentiated chest pain in the emergency department (ED) is a diagnostic challenge. One approach includes a dedicated chest computed tomography (CT) for pulmonary embolism or dissection followed by a cardiac stress test (TRAD). An alternative strategy is a coronary CT angiogram with concurrent chest CT (Triple Rule Out, TRO). The objective of this study was to describe the ED patient course and short-term safety for these evaluation methods. Methods This was a retrospective observational study of adult patients presenting to a large, community ED for acute chest pain who had non-diagnostic electrocardiograms (ECGs) and normal biomarkers. We collected demographics, ED length of stay, hospital costs, and estimated radiation exposures. We evaluated 30-day return visits for major adverse cardiac events. Results A total of 829 patients underwent TRAD, and 642 patients had TRO. Patients undergoing TRO tended to be younger (mean 52.3 vs 56.5 years) and were more likely to be male (42.4% vs. 30.4%). TRO patients tended to have a shorter ED length of stay (mean 14.45 vs. 21.86 hours), to incur less cost (median $449.83 vs. $1147.70), and to be exposed to less radiation (median 7.18 vs. 16.6mSv). No patient in either group had a related 30-day revisit. Conclusion Use of TRO is feasible for assessment of chest pain in the ED. Both TRAD and TRO safely evaluated patients. Prospective studies investigating this diagnostic strategy are needed to further assess this approach to ED chest pain evaluation. PMID:26587090

  19. Organization, execution and evaluation of the 2014 Academic Emergency Medicine consensus conference on Gender-Specific Research in Emergency Care - an executive summary.

    PubMed

    Safdar, Basmah; Greenberg, Marna R

    2014-12-01

    With the goal of reducing inequalities in patient care, the 2014 Academic Emergency Medicine (AEM) consensus conference, "Gender-Specific Research in Emergency Care: Investigate, Understand, and Translate How Gender Affects Patient Outcomes," convened a diverse group of researchers, clinicians, health care providers, patients, and representatives of federal agencies and policy-makers in Dallas, Texas, in May 2014. The executive and steering committees identified seven clinical domains as key to gender-specific emergency care: cardiovascular, neurological, trauma/injury, substance abuse, pain, mental health, and diagnostic imaging. The main aims of the conference were to: 1) summarize and consolidate current data related to sex- and gender-specific research for acute care and identify critical gender-related gaps in knowledge to inform an EM research agenda; 2) create a consensus-driven research agenda that advances sex- and gender-specific research in the prevention, diagnosis, and management of acute diseases and identify strategies to investigate them; and 3) build a multinational interdisciplinary consortium to disseminate and study the sex and gender medicine of acute conditions. Over a 2-year period, this collaborative network of stakeholders identified key areas where sex- and gender-specific research is most likely to improve clinical care and ultimately patient outcomes. The iterative consensus process culminated in a daylong conference on May 13, 2014, with a total of 133 registrants, with the majority being between ages 31 and 50 years (57%), females (71%), and whites (79%). Content experts led the consensus-building workshops at the conference and used the nominal group technique to consolidate consensus recommendations for priority research. In addition, panel sessions addressed funding mechanisms for gender-specific research as well as gender-specific regulatory challenges to product development and approval. This special issue of AEM reports the

  20. Modeling and Analysis of Realistic Fire Scenarios in Spacecraft

    NASA Technical Reports Server (NTRS)

    Brooker, J. E.; Dietrich, D. L.; Gokoglu, S. A.; Urban, D. L.; Ruff, G. A.

    2015-01-01

    An accidental fire inside a spacecraft is an unlikely, but very real emergency situation that can easily have dire consequences. While much has been learned over the past 25+ years of dedicated research on flame behavior in microgravity, a quantitative understanding of the initiation, spread, detection and extinguishment of a realistic fire aboard a spacecraft is lacking. Virtually all combustion experiments in microgravity have been small-scale, by necessity (hardware limitations in ground-based facilities and safety concerns in space-based facilities). Large-scale, realistic fire experiments are unlikely for the foreseeable future (unlike in terrestrial situations). Therefore, NASA will have to rely on scale modeling, extrapolation of small-scale experiments and detailed numerical modeling to provide the data necessary for vehicle and safety system design. This paper presents the results of parallel efforts to better model the initiation, spread, detection and extinguishment of fires aboard spacecraft. The first is a detailed numerical model using the freely available Fire Dynamics Simulator (FDS). FDS is a CFD code that numerically solves a large eddy simulation form of the Navier-Stokes equations. FDS provides a detailed treatment of the smoke and energy transport from a fire. The simulations provide a wealth of information, but are computationally intensive and not suitable for parametric studies where the detailed treatment of the mass and energy transport are unnecessary. The second path extends a model previously documented at ICES meetings that attempted to predict maximum survivable fires aboard space-craft. This one-dimensional model implies the heat and mass transfer as well as toxic species production from a fire. These simplifications result in a code that is faster and more suitable for parametric studies (having already been used to help in the hatch design of the Multi-Purpose Crew Vehicle, MPCV).

  1. HELIOSEISMOLOGY OF A REALISTIC MAGNETOCONVECTIVE SUNSPOT SIMULATION

    SciTech Connect

    Braun, D. C.; Birch, A. C.; Rempel, M.; Duvall, T. L. Jr. E-mail: aaronb@cora.nwra.com E-mail: Thomas.L.Duvall@nasa.gov

    2012-01-01

    We compare helioseismic travel-time shifts measured from a realistic magnetoconvective sunspot simulation using both helioseismic holography and time-distance helioseismology, and measured from real sunspots observed with the Helioseismic and Magnetic Imager instrument on board the Solar Dynamics Observatory and the Michelson Doppler Imager instrument on board the Solar and Heliospheric Observatory. We find remarkable similarities in the travel-time shifts measured between the methodologies applied and between the simulated and real sunspots. Forward modeling of the travel-time shifts using either Born or ray approximation kernels and the sound-speed perturbations present in the simulation indicates major disagreements with the measured travel-time shifts. These findings do not substantially change with the application of a correction for the reduction of wave amplitudes in the simulated and real sunspots. Overall, our findings demonstrate the need for new methods for inferring the subsurface structure of sunspots through helioseismic inversions.

  2. Helioseismology of a Realistic Magnetoconvective Sunspot Simulation

    NASA Technical Reports Server (NTRS)

    Braun, D. C.; Birch, A. C.; Rempel, M.; Duvall, T. L., Jr.

    2012-01-01

    We compare helioseismic travel-time shifts measured from a realistic magnetoconvective sunspot simulation using both helioseismic holography and time-distance helioseismology, and measured from real sunspots observed with the Helioseismic and Magnetic Imager instrument on board the Solar Dynamics Observatory and the Michelson Doppler Imager instrument on board the Solar and Heliospheric Observatory. We find remarkable similarities in the travel-time shifts measured between the methodologies applied and between the simulated and real sunspots. Forward modeling of the travel-time shifts using either Born or ray approximation kernels and the sound-speed perturbations present in the simulation indicates major disagreements with the measured travel-time shifts. These findings do not substantially change with the application of a correction for the reduction of wave amplitudes in the simulated and real sunspots. Overall, our findings demonstrate the need for new methods for inferring the subsurface structure of sunspots through helioseismic inversions.

  3. Field line resonances in a realistic magnetosphere

    SciTech Connect

    Mukherjee, G.K.; Rajaram, R. )

    1989-04-01

    An internally consistent theoretical framework is developed to study the field line oscillations in the realistic magnetospheric magnetic field using the Mead and Fairfield (1975) model. The nondipolar contributions are numerically computed for the fundamental period of the modes that would reduce to the localized toroidal and poloidal modes described by Cummings et al. (1969) in the dipole limit. It is shown that the nondipolar contributions are not significant at the geostationary orbit but become large further out in the magnetosphere. The nondipolar contributions are very different for the two modes. The situation becomes very much more complicated in the dawn/dusk region where a continuous range of periods exist depending on the orientation of the field line oscillation.

  4. Realistic page-turning of electronic books

    NASA Astrophysics Data System (ADS)

    Fan, Chaoran; Li, Haisheng; Bai, Yannan

    2014-01-01

    The booming electronic books (e-books), as an extension to the paper book, are popular with readers. Recently, many efforts are put into the realistic page-turning simulation o f e-book to improve its reading experience. This paper presents a new 3D page-turning simulation approach, which employs piecewise time-dependent cylindrical surfaces to describe the turning page and constructs smooth transition method between time-dependent cylinders. The page-turning animation is produced by sequentially mapping the turning page into the cylinders with different radii and positions. Compared to the previous approaches, our method is able to imitate various effects efficiently and obtains more natural animation of turning page.

  5. Realistic limits for subpixel movement detection.

    PubMed

    Mas, David; Perez, Jorge; Ferrer, Belen; Espinosa, Julian

    2016-07-01

    Object tracking with subpixel accuracy is of fundamental importance in many fields since it provides optimal performance at relatively low cost. Although there are many theoretical proposals that lead to resolution increments of several orders of magnitude, in practice this resolution is limited by the imaging systems. In this paper we propose and demonstrate through simple numerical models a realistic limit for subpixel accuracy. The final result is that maximum achievable resolution enhancement is connected with the dynamic range of the image, i.e., the detection limit is 1/2(nr.bits). The results here presented may aid in proper design of superresolution experiments in microscopy, surveillance, defense, and other fields. PMID:27409179

  6. Two Realistic Beagle Models for Dose Assessment.

    PubMed

    Stabin, Michael G; Kost, Susan D; Segars, William P; Guilmette, Raymond A

    2015-09-01

    Previously, the authors developed a series of eight realistic digital mouse and rat whole body phantoms based on NURBS technology to facilitate internal and external dose calculations in various species of rodents. In this paper, two body phantoms of adult beagles are described based on voxel images converted to NURBS models. Specific absorbed fractions for activity in 24 organs are presented in these models. CT images were acquired of an adult male and female beagle. The images were segmented, and the organs and structures were modeled using NURBS surfaces and polygon meshes. Each model was voxelized at a resolution of 0.75 × 0.75 × 2 mm. The voxel versions were implemented in GEANT4 radiation transport codes to calculate specific absorbed fractions (SAFs) using internal photon and electron sources. Photon and electron SAFs were then calculated for relevant organs in both models. The SAFs for photons and electrons were compatible with results observed by others. Absorbed fractions for electrons for organ self-irradiation were significantly less than 1.0 at energies above 0.5 MeV, as expected for many of these small-sized organs, and measurable cross irradiation was observed for many organ pairs for high-energy electrons (as would be emitted by nuclides like 32P, 90Y, or 188Re). The SAFs were used with standardized decay data to develop dose factors (DFs) for radiation dose calculations using the RADAR Method. These two new realistic models of male and female beagle dogs will be useful in radiation dosimetry calculations for external or internal simulated sources. PMID:26222214

  7. Realistic texture in simulated thermal infrared imagery

    NASA Astrophysics Data System (ADS)

    Ward, Jason T.

    Creating a visually-realistic yet radiometrically-accurate simulation of thermal infrared (TIR) imagery is a challenge that has plagued members of industry and academia alike. The goal of imagery simulation is to provide a practical alternative to the often staggering effort required to collect actual data. Previous attempts at simulating TIR imagery have suffered from a lack of texture---the simulated scenes generally failed to reproduce the natural variability seen in actual TIR images. Realistic synthetic TIR imagery requires modeling sources of variability including surface effects such as solar insolation and convective heat exchange as well as sub-surface effects such as density and water content. This research effort utilized the Digital Imaging and Remote Sensing Image Generation (DIRSIG) model, developed at the Rochester Institute of Technology, to investigate how these additional sources of variability could be modeled to correctly and accurately provide simulated TIR imagery. Actual thermal data were collected, analyzed, and exploited to determine the underlying thermodynamic phenomena and ascertain how these phenomena are best modeled. The underlying task was to determine how to apply texture in the thermal region to attain radiometrically-correct, visually-appealing simulated imagery. Three natural desert scenes were used to test the methodologies that were developed for estimating per-pixel thermal parameters which could then be used for TIR image simulation by DIRSIG. Additional metrics were devised and applied to the synthetic images to further quantify the success of this research. The resulting imagery demonstrated that these new methodologies for modeling TIR phenomena and the utilization of an improved DIRSIG tool improved the root mean-squared error (RMSE) of our synthetic TIR imagery by up to 88%.

  8. Demonstrating a Realistic IP Mission Prototype

    NASA Technical Reports Server (NTRS)

    Rash, James; Ferrer, Arturo B.; Goodman, Nancy; Ghazi-Tehrani, Samira; Polk, Joe; Johnson, Lorin; Menke, Greg; Miller, Bill; Criscuolo, Ed; Hogie, Keith

    2003-01-01

    Flight software and hardware and realistic space communications environments were elements of recent demonstrations of the Internet Protocol (IP) mission concept in the lab. The Operating Missions as Nodes on the Internet (OMNI) Project and the Flight Software Branch at NASA/GSFC collaborated to build the prototype of a representative space mission that employed unmodified off-the-shelf Internet protocols and technologies for end-to-end communications between the spacecraft/instruments and the ground system/users. The realistic elements used in the prototype included an RF communications link simulator and components of the TRIANA mission flight software and ground support system. A web-enabled camera connected to the spacecraft computer via an Ethernet LAN represented an on-board instrument creating image data. In addition to the protocols at the link layer (HDLC), transport layer (UDP, TCP), and network (IP) layer, a reliable file delivery protocol (MDP) at the application layer enabled reliable data delivery both to and from the spacecraft. The standard Network Time Protocol (NTP) performed on-board clock synchronization with a ground time standard. The demonstrations of the prototype mission illustrated some of the advantages of using Internet standards and technologies for space missions, but also helped identify issues that must be addressed. These issues include applicability to embedded real-time systems on flight-qualified hardware, range of applicability of TCP, and liability for and maintenance of commercial off-the-shelf (COTS) products. The NASA Earth Science Technology Office (ESTO) funded the collaboration to build and demonstrate the prototype IP mission.

  9. Compact entanglement distillery using realistic quantum memories

    NASA Astrophysics Data System (ADS)

    Chakhmakhchyan, Levon; Guérin, Stéphane; Nunn, Joshua; Datta, Animesh

    2013-10-01

    We adopt the beam-splitter model for losses to analyze the performance of a recent compact continuous-variable entanglement distillation protocol [A. Datta , Phys. Rev. Lett.PRLTAO0031-900710.1103/PhysRevLett.108.060502 108, 060502 (2012)] implemented using realistic quantum memories. We show that the decoherence undergone by a two-mode squeezed state while stored in a quantum memory can strongly modify the results of the preparatory step of the protocol. We find that the well-known method for locally increasing entanglement, phonon subtraction, may not result in entanglement gain when losses are taken into account. Thus, we investigate the critical number mc of phonon subtraction attempts from the matter modes of the quantum memory. If the initial state is not de-Gaussified within mc attempts, the protocol should be restarted to obtain any entanglement increase. Moreover, the condition mc>1 implies an additional constraint on the subtraction beam-splitter interaction transmissivity, viz., it should be about 50% for a wide range of protocol parameters. Additionally, we consider the average entanglement rate, which takes into account both the unavoidable probabilistic nature of the protocol and its possible failure as a result of a large number of unsuccessful subtraction attempts. We find that a higher value of the average entanglement can be achieved by increasing the subtraction beam-splitter interaction transmissivity. We conclude that the compact distillation protocol with the practical constraints coming from realistic quantum memories allows a feasible experimental realization within existing technologies.

  10. Evaluating legacy contaminants and emerging chemicals in marine environments using adverse outcome pathways and biological effects-directed analysis.

    PubMed

    Hutchinson, Thomas H; Lyons, Brett P; Thain, John E; Law, Robin J

    2013-09-30

    Natural and synthetic chemicals are essential to our daily lives, food supplies, health care, industries and safe sanitation. At the same time protecting marine ecosystems and seafood resources from the adverse effects of chemical contaminants remains an important issue. Since the 1970s, monitoring of persistent, bioaccumulative and toxic (PBT) chemicals using analytical chemistry has provided important spatial and temporal trend data in three important contexts; relating to human health protection from seafood contamination, addressing threats to marine top predators and finally providing essential evidence to better protect the biodiversity of commercial and non-commercial marine species. A number of regional conventions have led to controls on certain PBT chemicals over several years (termed 'legacy contaminants'; e.g. cadmium, lindane, polycyclic aromatic hydrocarbons [PAHs] and polychlorinated biphenyls [PCBs]). Analytical chemistry plays a key role in evaluating to what extent such regulatory steps have been effective in leading to reduced emissions of these legacy contaminants into marine environments. In parallel, the application of biomarkers (e.g. DNA adducts, CYP1A-EROD, vitellogenin) and bioassays integrated with analytical chemistry has strengthened the evidence base to support an ecosystem approach to manage marine pollution problems. In recent years, however,the increased sensitivity of analytical chemistry, toxicity alerts and wider environmental awareness has led to a focus on emerging chemical contaminants (defined as chemicals that have been detected in the environment, but which are currently not included in regulatory monitoring programmes and whose fate and biological impacts are poorly understood). It is also known that natural chemicals (e.g. algal biotoxins) may also pose a threat to marine species and seafood quality. Hence complex mixtures of legacy contaminants, emerging chemicals and natural biotoxins in marine ecosystems represent

  11. Electron percolation in realistic models of carbon nanotube networks

    NASA Astrophysics Data System (ADS)

    Simoneau, Louis-Philippe; Villeneuve, Jérémie; Rochefort, Alain

    2015-09-01

    The influence of penetrable and curved carbon nanotubes (CNT) on the charge percolation in three-dimensional disordered CNT networks have been studied with Monte-Carlo simulations. By considering carbon nanotubes as solid objects but where the overlap between their electron cloud can be controlled, we observed that the structural characteristics of networks containing lower aspect ratio CNT are highly sensitive to the degree of penetration between crossed nanotubes. Following our efficient strategy to displace CNT to different positions to create more realistic statistical models, we conclude that the connectivity between objects increases with the hard-core/soft-shell radii ratio. In contrast, the presence of curved CNT in the random networks leads to an increasing percolation threshold and to a decreasing electrical conductivity at saturation. The waviness of CNT decreases the effective distance between the nanotube extremities, hence reducing their connectivity and degrading their electrical properties. We present the results of our simulation in terms of thickness of the CNT network from which simple structural parameters such as the volume fraction or the carbon nanotube density can be accurately evaluated with our more realistic models.

  12. Simulating realistic predator signatures in quantitative fatty acid signature analysis

    USGS Publications Warehouse

    Bromaghin, Jeffrey F.

    2015-01-01

    Diet estimation is an important field within quantitative ecology, providing critical insights into many aspects of ecology and community dynamics. Quantitative fatty acid signature analysis (QFASA) is a prominent method of diet estimation, particularly for marine mammal and bird species. Investigators using QFASA commonly use computer simulation to evaluate statistical characteristics of diet estimators for the populations they study. Similar computer simulations have been used to explore and compare the performance of different variations of the original QFASA diet estimator. In both cases, computer simulations involve bootstrap sampling prey signature data to construct pseudo-predator signatures with known properties. However, bootstrap sample sizes have been selected arbitrarily and pseudo-predator signatures therefore may not have realistic properties. I develop an algorithm to objectively establish bootstrap sample sizes that generates pseudo-predator signatures with realistic properties, thereby enhancing the utility of computer simulation for assessing QFASA estimator performance. The algorithm also appears to be computationally efficient, resulting in bootstrap sample sizes that are smaller than those commonly used. I illustrate the algorithm with an example using data from Chukchi Sea polar bears (Ursus maritimus) and their marine mammal prey. The concepts underlying the approach may have value in other areas of quantitative ecology in which bootstrap samples are post-processed prior to their use.

  13. Electron percolation in realistic models of carbon nanotube networks

    SciTech Connect

    Simoneau, Louis-Philippe Villeneuve, Jérémie Rochefort, Alain

    2015-09-28

    The influence of penetrable and curved carbon nanotubes (CNT) on the charge percolation in three-dimensional disordered CNT networks have been studied with Monte-Carlo simulations. By considering carbon nanotubes as solid objects but where the overlap between their electron cloud can be controlled, we observed that the structural characteristics of networks containing lower aspect ratio CNT are highly sensitive to the degree of penetration between crossed nanotubes. Following our efficient strategy to displace CNT to different positions to create more realistic statistical models, we conclude that the connectivity between objects increases with the hard-core/soft-shell radii ratio. In contrast, the presence of curved CNT in the random networks leads to an increasing percolation threshold and to a decreasing electrical conductivity at saturation. The waviness of CNT decreases the effective distance between the nanotube extremities, hence reducing their connectivity and degrading their electrical properties. We present the results of our simulation in terms of thickness of the CNT network from which simple structural parameters such as the volume fraction or the carbon nanotube density can be accurately evaluated with our more realistic models.

  14. Functional consequences of realistic biodiversity changes in a marine ecosystem

    PubMed Central

    Bracken, Matthew E. S.; Friberg, Sara E.; Gonzalez-Dorantes, Cirse A.; Williams, Susan L.

    2008-01-01

    Declines in biodiversity have prompted concern over the consequences of species loss for the goods and services provided by natural ecosystems. However, relatively few studies have evaluated the functional consequences of realistic, nonrandom changes in biodiversity. Instead, most designs have used randomly selected assemblages from a local species pool to construct diversity gradients. It is therefore difficult, based on current evidence, to predict the functional consequences of realistic declines in biodiversity. In this study, we used tide pool microcosms to demonstrate that the effects of real-world changes in biodiversity may be very different from those of random diversity changes. Specifically, we measured the relationship between the diversity of a seaweed assemblage and its ability to use nitrogen, a key limiting nutrient in nearshore marine systems. We quantified nitrogen uptake using both experimental and model seaweed assemblages and found that natural increases in diversity resulted in enhanced rates of nitrogen use, whereas random diversity changes had no effect on nitrogen uptake. Our results suggest that understanding the real-world consequences of declining biodiversity will require addressing changes in species performance along natural diversity gradients and understanding the relationships between species' susceptibility to loss and their contributions to ecosystem functioning. PMID:18195375

  15. Effect of realistic vegetation variability on seasonal forecasts

    NASA Astrophysics Data System (ADS)

    Catalano, Franco; Alessandri, Andrea; De Felice, Matteo; Doblas-Reyes, Francisco J.

    2014-05-01

    A real predictability hindcast experiment with prescribed Leaf Area Index (LAI) has been performed using the state-of-the-art Earth System Model EC-Earth. LAI input to the climate model has been prescribed using a novel observational dataset based on the third generation GIMMS and MODIS satellite data. The LAI dataset has been pre-processed (monthly averaged, interpolated, gap-filled) to use it in the land surface scheme of EC-Earth (HTESSEL). The vegetation density is modeled by an exponential dependence on LAI, based on the Lambert-Beer formulation. Retrospective hindcasts have been performed with the following model setup: 7 months forecast length, 2 start dates (1st May and 1st November), 10 members, 28 years (1982-2009). Initial conditions were produced at IC3, based on ERA-40/ERA-Interim (atmosphere and land-surface) and NEMOVAR-ORAS4 (ocean and sea-ice) data. Model resolution is T159L62 for the atmosphere and the ORCA1 grid for the ocean. The effect of the realistic LAI prescribed from observation is evaluated with respect to a control experiment where LAI does not vary. Results of the retrospective hindcast experiment demonstrate that a realistic representation of vegetation has a significant effect on evaporation, temperature and precipitation. An improvement of model sensitivity to vegetation variability on the seasonal scale is also evidenced, especially during boreal winter. This may be attributed in particular to the effect of the high vegetation component on the snow cover.

  16. Evaluation of Publicly Financed and Privately Delivered Model of Emergency Referral Services for Maternal and Child Health Care in India

    PubMed Central

    Prinja, Shankar; Bahuguna, Pankaj; Lakshmi, P. V. M.; Mokashi, Tushar; Aggarwal, Arun Kumar; Kaur, Manmeet; Reddy, K. Rahul; Kumar, Rajesh

    2014-01-01

    Background Emergency referral services (ERS) are being strengthened in India to improve access for institutional delivery. We evaluated a publicly financed and privately delivered model of ERS in Punjab state, India, to assess its extent and pattern of utilization, impact on institutional delivery, quality and unit cost. Methods Data for almost 0.4 million calls received from April 2012 to March 2013 was analysed to assess the extent and pattern of utilization. Segmented linear regression was used to analyse month-wise data on number of institutional deliveries in public sector health facilities from 2008 to 2013. We inspected ambulances in 2 districts against the Basic Life Support (BLS) standards. Timeliness of ERS was assessed for determining quality. Finally, we computed economic cost of implementing ERS from a health system perspective. Results On an average, an ambulance transported 3–4 patients per day. Poor and those farther away from the health facility had a higher likelihood of using the ambulance. Although the ERS had an abrupt positive effect on increasing the institutional deliveries in the unadjusted model, there was no effect on institutional delivery after adjustment for autocorrelation. Cost of operating the ambulance service was INR 1361 (USD 22.7) per patient transported or INR 21 (USD 0.35) per km travelled. Conclusion Emergency referral services in Punjab did not result in a significant change in public sector institutional deliveries. This could be due to high baseline coverage of institutional delivery and low barriers to physical access. Choice of interventions for reduction in Maternal Mortality Ratio (MMR) should be context-specific to have high value for resources spent. The ERS in Punjab needs improvement in terms of quality and reduction of cost to health system. PMID:25360798

  17. Breast imaging after dark: patient outcomes following evaluation for breast abscess in the emergency department after hours.

    PubMed

    Bosma, Melissa S; Morden, Kasey L; Klein, Katherine A; Neal, Colleen H; Knoepp, Ursula S; Patterson, Stephanie K

    2016-02-01

    In our study, we sought to report the management, clinical outcomes, and follow-up rates of patients who presented for evaluation of breast abscess in the Emergency Department (ED) after hours. A retrospective search of ultrasound reports at our institution identified all patients from January 1, 2009 to June 30, 2013 who were scanned in the ED after hours to evaluate for breast abscess. Patient demographics, clinical information, imaging findings, follow-up rates, and outcomes were reviewed. One hundred eighty-five patients were included in the study. Forty-four percent (86/185) of the patients were diagnosed with abscess based on ultrasound findings in the ED. Twenty-seven percent (23/86) were recently post-operative, and 12 % (10/86) were postpartum/breastfeeding. Mastitis was the diagnosis in the remaining 54 % (99/185). Only 1/86 cases were associated with breast cancer. Seventy-seven percent (66/86) of patients were treated with an invasive procedure; 39 % (26/66) had surgical evacuation, 30 % (20/66) image-guided drainage, 23 % (15/66) bedside or clinic incision and drainage, and 8 % (5/66) palpation-guided fine needle aspiration (FNA). Seventy-seven percent (143/185) of patients had clinical and/or imaging follow-up. Forty-four percent (63/143) had long-term follow-up (≥ 3 months). Almost 50 % of the patients who presented to the ED for evaluation of abscess were diagnosed with abscess while the remaining patients were diagnosed with mastitis. Appropriate clinical and/or imaging follow-up occurred in 77 %. Long-term follow-up (≥ 3 months) occurred more frequently in patients older than 30 years of age. Appropriate follow-up does not occur in approximately one fourth of cases, suggesting that additional clinician and patient education is warranted. PMID:26433916

  18. Eye Emergencies

    MedlinePlus

    ... Emergencies Cardiac Emergencies Eye Emergencies Lung Emergencies Surgeries Eye Emergencies Marfan syndrome significantly increases your risk of ... light-sensitive membrane in the back of the eye (the retina) from its supporting layers. It is ...

  19. Evaluating the Role of Cellular Immune Responses in the Emergence of HCV NS3 Resistance Mutations During Protease Inhibitor Therapy.

    PubMed

    Abdel-Hameed, Enass A; Rouster, Susan D; Ji, Hong; Ulm, Ashley; Hetta, Helal F; Anwar, Nadeem; Sherman, Kenneth E; Shata, Mohamed Tarek M

    2016-05-01

    The efficacy of protease inhibitor drugs in hepatitis C virus (HCV) treatment is limited by the selection and expansion of drug-resistant mutations. HCV replication is error-prone and genetic variability within the dominant epitopes ensures its persistence. The aims of this study are to evaluate the role of cellular immune response in the emergence of HCV protease resistance mutations and its effects on treatment outcome. Ten chronically HCV-infected subjects were treated with boceprevir (BOC)-based triple therapy. HCV-RNA was tested for BOC resistance-associated viral variants. HCV protease resistance mutations were investigated pretreatment and 24 weeks post-treatment. Synthetic peptides representing the wild-type and the potential nonstructural (NS)3 variants were used to evaluate T cell responses and human leukocyte antigen binding. Sustained viral response was achieved in 70% of patients, two patients were treatment nonresponders (NRs) and one was classified as a relapse. Pretreatment, the proportion of drug-resistant variants within individuals was higher in sustained viral responders (SVRs) than in NR patients. However, resistance-associated variants increased in NRs after BOC combined triple therapy. In contrast to NR patients, significant stronger cell-mediated immune responses were observed at the baseline among those who achieved sustained viral response for all T cell epitopes tested. Despite the increase in cell-mediated immune responses at week 24 in NRs, they failed to control the virus replication, leading to development of overt drug-resistant variants. Our data suggest that strong NS3-specific T cell immune responses at the baseline may predict a positive outcome of directly acting antiviral-based therapy, and the presence of pre-existent resistance mutations does not play a significant role in the outcome of anti-HCV combined therapy. PMID:26885675

  20. Overuse of Computed Tomography Pulmonary Angiography in the Evaluation of Patients with Suspected Pulmonary Embolism in the Emergency Department

    PubMed Central

    Crichlow, Amanda; Cuker, Adam; Mills, Angela M.

    2012-01-01

    Background Clinical decision rules have been developed and validated for the evaluation of patients presenting with suspected pulmonary embolism (PE) to the emergency department (ED). Objectives To assess the percentage of computed tomographic pulmonary angiography (CT-PA) which could have been avoided by use of the Wells score coupled with D-dimer testing (Wells/D-dimer) or Pulmonary Embolism Rule-Out Criteria (PERC) in ED patients with suspected PE. Methods The authors conducted a prospective cohort study of adult ED patients undergoing CT-PA for suspected PE. Wells score and PERC were calculated. A research blood sample was obtained for D-dimer testing for subjects who did not undergo testing as part of their ED evaluation. The primary outcome was PE by CT-PA or 90-day follow-up. Secondary outcomes were ED length of stay (LOS) and CT-PA time as defined by time from order to initial radiologist interpretation. Results Of 152 suspected PE subjects available for analysis (mean age 46.3±15.6 years, 74% female, 59% black or African American, 11.8% diagnosed with PE), 14 (9.2%) met PERC, none of whom were diagnosed with PE. A low-risk Wells score (≤4) was assigned to 110 (72%) subjects, of whom only 38 (35%) underwent clinical D-dimer testing (elevated in 33/38). Of the 72 subjects with low-risk Wells scores who did not have D-dimers performed in the ED, archived research samples were negative in 16 (22%). All 21 subjects with low-risk Wells scores and negative D-dimers were PE-negative. CT-PA time (median 160 minutes) accounted for more than half of total ED LOS (median 295 minutes). Conclusions In total, 9.2% and 13.8% of CT-PA could have been avoided by use of PERC and Wells/D-dimer, respectively. PMID:23167851

  1. Use of the SONET Score to Evaluate High Volume Emergency Department Overcrowding: A Prospective Derivation and Validation Study.

    PubMed

    Wang, Hao; Robinson, Richard D; Garrett, John S; Bunch, Kellie; Huggins, Charles A; Watson, Katherine; Daniels, Joni; Banks, Brett; D'Etienne, James P; Zenarosa, Nestor R

    2015-01-01

    Background. The accuracy and utility of current Emergency Department (ED) crowding estimation tools remain uncertain in EDs with high annual volumes. We aimed at deriving a more accurate tool to evaluate overcrowding in a high volume ED setting and determine the association between ED overcrowding and patient care outcomes. Methods. A novel scoring tool (SONET: Severely overcrowded-Overcrowded-Not overcrowded Estimation Tool) was developed and validated in two EDs with both annual volumes exceeding 100,000. Patient care outcomes including the number of left without being seen (LWBS) patients, average length of ED stay, ED 72-hour returns, and mortality were compared under the different crowding statuses. Results. The total number of ED patients, the number of mechanically ventilated patients, and patient acuity levels were independent risk factors affecting ED overcrowding. SONET was derived and found to better differentiate severely overcrowded, overcrowded, and not overcrowded statuses with similar results validated externally. In addition, SONET scores correlated with increased length of ED stay, number of LWBS patients, and ED 72-hour returns. Conclusions. SONET might be a better fit to determine high volume ED overcrowding. ED overcrowding negatively impacts patient care operations and often produces poor patient perceptions of standardized care delivery. PMID:26167302

  2. Use of the SONET Score to Evaluate High Volume Emergency Department Overcrowding: A Prospective Derivation and Validation Study

    PubMed Central

    Wang, Hao; Robinson, Richard D.; Garrett, John S.; Bunch, Kellie; Huggins, Charles A.; Watson, Katherine; Daniels, Joni; Banks, Brett; D'Etienne, James P.; Zenarosa, Nestor R.

    2015-01-01

    Background. The accuracy and utility of current Emergency Department (ED) crowding estimation tools remain uncertain in EDs with high annual volumes. We aimed at deriving a more accurate tool to evaluate overcrowding in a high volume ED setting and determine the association between ED overcrowding and patient care outcomes. Methods. A novel scoring tool (SONET: Severely overcrowded-Overcrowded-Not overcrowded Estimation Tool) was developed and validated in two EDs with both annual volumes exceeding 100,000. Patient care outcomes including the number of left without being seen (LWBS) patients, average length of ED stay, ED 72-hour returns, and mortality were compared under the different crowding statuses. Results. The total number of ED patients, the number of mechanically ventilated patients, and patient acuity levels were independent risk factors affecting ED overcrowding. SONET was derived and found to better differentiate severely overcrowded, overcrowded, and not overcrowded statuses with similar results validated externally. In addition, SONET scores correlated with increased length of ED stay, number of LWBS patients, and ED 72-hour returns. Conclusions. SONET might be a better fit to determine high volume ED overcrowding. ED overcrowding negatively impacts patient care operations and often produces poor patient perceptions of standardized care delivery. PMID:26167302

  3. Impact evaluation of green-grey infrastructure interaction on built-space integrity: an emerging perspective to urban ecosystem service.

    PubMed

    Tiwary, Abhishek; Kumar, Prashant

    2014-07-15

    This paper evaluates the role of urban green infrastructure (GI) in maintaining integrity of built-space. The latter is considered as a lateral ecosystem function, worth including in future assessments of integrated ecosystem services. The basic tenet is that integrated green-grey infrastructures (GGIs) would have three influences on built-spaces: (i) reduced wind withering from flow deviation; (ii) reduced material corrosion/degeneration from pollution removal; and (iii) act as a biophysical buffer in altering the micro-climate. A case study is presented, combining the features of computational fluid dynamics (CFD) in micro-environmental modelling with the emerging science on interactions of GGIs. The coupled seasonal dynamics of the above three effects are assessed for two building materials (limestone and steel) using the following three scenarios: (i) business as usual (BAU), (ii) summer (REGEN-S), and (iii) winter (REGEN-W). Apparently, integrated ecosystem service from green-grey interaction, as scoped in this paper, has strong seasonal dependence. Compared to BAU our results suggest that REGEN-S leads to slight increment in limestone recession (<10%), mainly from exacerbation in ozone damage, while large reduction in steel recession (up to 37%) is observed. The selection of vegetation species, especially their bVOC emission potential and seasonal foliage profile, appears to play a vital role in determining the impact GI has on the integrity of the neighbouring built-up environment. PMID:24793331

  4. Development and pilot evaluation of user acceptance of advanced mass-gathering emergency medical services PDA support systems.

    PubMed

    Chang, Polun; Hsu, Yueh-Shuang; Tzeng, Yuann-Mei; Hou, I-Ching; Sang, Yiing-Yiing

    2004-01-01

    The support systems for the Emergency Medical Services (EMS) in the mass gatherings, such as the local marathon or the large international baseball games, had been underdeveloped. The purposes for this study were to develop triage-based EMS Personal Digital Assistant (PDA) support systems for the mass-gatherings and to evaluate users' perceived ease of use and usefulness of the systems in terms of Davis' Technology Acceptance Model (TAM). The systems were developed based on an established intelligent triage PDA support system and two other forms-the general EMS form from the Taipei EMT and the customer-made Mass Gathering Medical form used by a medical center. 23 nurses and 6 physicians in the medical center, who had ever served in the mass gatherings, were invited to examine the new systems and answered the TAM questionnaire. The results showed that the PDA systems included as many 450 information items inside 42 screens under 6 categories and the great potential of using triage-based PDA systems in the mass gatherings. Overall, most of the subjects agreed with that the systems were easy to use and useful for the mass gatherings, and they were willing to accept the systems. PMID:15361049

  5. Parallel Quality Assessment of Emergency Departments by European Foundation for Quality Management Model and Iranian National Program for Hospital Evaluation

    PubMed Central

    IMANI NASAB, Mohammad Hasan; MOHAGHEGH, Bahram; KHALESI, Nader; JAAFARIPOOYAN, Ebrahim

    2013-01-01

    Background European Foundation for Quality Management (EFQM) model is a widely used quality management system (QMS) worldwide, including Iran. Current study aims to verify the quality assessment results of Iranian National Program for Hospital Evaluation (INPHE) based on those of EFQM. Methods: This cross-sectional study was conducted in 2012 on a sample of emergency departments (EDs) affiliated with Tehran University of Medical Sciences (TUMS), Iran. The standard questionnaire of EFQM (V-2010) was used to gather appropriate data. The results were compared with those of INPHE. MS Excel was used to classify and display the findings. Results: The average assessment score of the EDs based on the INPHE and EFQM model were largely different (i.e. 86.4% and 31%, respectively). In addition, the variation range among five EDs’ scores according to each model was also considerable (22% for EFQM against 7% of INPHE), especially in the EDs with and without prior record of applying QMSs. Conclusion: The INPHE’s assessment results were not confirmed by EFQM model. Moreover, the higher variation range among EDs’ scores using EFQM model could allude to its more differentiation power in assessing the performance comparing with INPHE. Therefore, a need for improvement in the latter drawing on other QMSs’ (such as EFQM) strengths, given the results emanated from its comparison with EFQM seems indispensable. PMID:23967429

  6. Differentiability of correlations in realistic quantum mechanics

    SciTech Connect

    Cabrera, Alejandro; Faria, Edson de; Pujals, Enrique; Tresser, Charles

    2015-09-15

    We prove a version of Bell’s theorem in which the locality assumption is weakened. We start by assuming theoretical quantum mechanics and weak forms of relativistic causality and of realism (essentially the fact that observable values are well defined independently of whether or not they are measured). Under these hypotheses, we show that only one of the correlation functions that can be formulated in the framework of the usual Bell theorem is unknown. We prove that this unknown function must be differentiable at certain angular configuration points that include the origin. We also prove that, if this correlation is assumed to be twice differentiable at the origin, then we arrive at a version of Bell’s theorem. On the one hand, we are showing that any realistic theory of quantum mechanics which incorporates the kinematic aspects of relativity must lead to this type of rough correlation function that is once but not twice differentiable. On the other hand, this study brings us a single degree of differentiability away from a relativistic von Neumann no hidden variables theorem.

  7. Differentiability of correlations in realistic quantum mechanics

    NASA Astrophysics Data System (ADS)

    Cabrera, Alejandro; de Faria, Edson; Pujals, Enrique; Tresser, Charles

    2015-09-01

    We prove a version of Bell's theorem in which the locality assumption is weakened. We start by assuming theoretical quantum mechanics and weak forms of relativistic causality and of realism (essentially the fact that observable values are well defined independently of whether or not they are measured). Under these hypotheses, we show that only one of the correlation functions that can be formulated in the framework of the usual Bell theorem is unknown. We prove that this unknown function must be differentiable at certain angular configuration points that include the origin. We also prove that, if this correlation is assumed to be twice differentiable at the origin, then we arrive at a version of Bell's theorem. On the one hand, we are showing that any realistic theory of quantum mechanics which incorporates the kinematic aspects of relativity must lead to this type of rough correlation function that is once but not twice differentiable. On the other hand, this study brings us a single degree of differentiability away from a relativistic von Neumann no hidden variables theorem.

  8. Real-time realistic skin translucency.

    PubMed

    Jimenez, Jorge; Whelan, David; Sundstedt, Veronica; Gutierrez, Diego

    2010-01-01

    Diffusion theory allows the production of realistic skin renderings. The dipole and multipole models allow for solving challenging diffusion-theory equations efficiently. By using texture-space diffusion, a Gaussian-based approximation, and programmable graphics hardware, developers can create real-time, photorealistic skin renderings. Performing this diffusion in screen space offers advantages that make diffusion approximation practical in scenarios such as games, where having the best possible performance is crucial. However, unlike the texture-space counterpart, the screen-space approach can't simulate transmittance of light through thin geometry; it yields unrealistic results in those cases. A new transmittance algorithm turns the screen-space approach into an efficient global solution, capable of simulating both reflectance and transmittance of light through a multilayered skin model. The transmittance calculations are derived from physical equations, which are implemented through simple texture access. The method performs in real time, requiring no additional memory usage and only minimal additional processing power and memory bandwidth. Despite its simplicity, this practical model manages to reproduce the look of images rendered with other techniques (both offline and real time) such as photon mapping or diffusion approximation. PMID:20650726

  9. Alveolar mechanics using realistic acinar models

    NASA Astrophysics Data System (ADS)

    Kumar, Haribalan; Lin, Ching-Long; Tawhai, Merryn H.; Hoffman, Eric A.

    2009-11-01

    Accurate modeling of the mechanics in terminal airspaces of the lung is desirable for study of particle transport and pathology. The flow in the acinar region is traditionally studied by employing prescribed boundary conditions to represent rhythmic breathing and volumetric expansion. Conventional models utilize simplified spherical or polygonal units to represent the alveolar duct and sac. Accurate prediction of flow and transport characteristics may require geometries reconstructed from CT-based images and serve to understand the importance of physiologically realistic representation of the acinus. In this effort, we present a stabilized finite element framework, supplemented with appropriate boundary conditions at the alveolar mouth and septal borders for simulation of the alveolar mechanics and the resulting airflow. Results of material advection based on Lagrangian tracking are presented to complete the study of transport and compare the results with simplified acinar models. The current formulation provides improved understanding and realization of a dynamic framework for parenchymal mechanics with incorporation of alveolar pressure and traction stresses.

  10. Fast sawtooth reconnection at realistic Lundquist numbers

    NASA Astrophysics Data System (ADS)

    Günter, S.; Yu, Q.; Lackner, K.; Bhattacharjee, A.; Huang, Y.-M.

    2015-01-01

    Magnetic reconnection, a ubiquitous phenomenon in astrophysics, space science and magnetic confinement research, frequently proceeds much faster than predicted by simple resistive MHD theory. Acceleration can result from the break-up of the thin Sweet-Parker current sheet into plasmoids, or from two-fluid effects decoupling mass and magnetic flux transport over the ion inertial length {{v}A}/{ωci} or the drift scale \\sqrt{{{T}e}/{{m}i}}/{ωci}, depending on the absence or presence of a strong magnetic guide field. We describe new results on the modelling of sawtooth reconnection in a simple tokamak geometry (circular cylindrical equilibrium) pushed to realistic Lundquist numbers for present day tokamaks. For the resistive MHD case, the onset criteria and the influence of plasmoids on the reconnection process agree well with earlier results found in the case of vanishing magnetic guide fields. While plasmoids are also observed in two-fluid calculations, they do not dominate the reconnection process for the range of plasma parameters considered in this study. In the two-fluid case they form as a transient phenomenon only. The reconnection times become weakly dependent on the S-value and for the most complete model—including two-fluid effects and equilibrium temperature and density gradients—agree well with those experimentally found on ASDEX Upgrade ≤ft(≤slant 100 μ s\\right).

  11. Determination of Realistic Fire Scenarios in Spacecraft

    NASA Technical Reports Server (NTRS)

    Dietrich, Daniel L.; Ruff, Gary A.; Urban, David

    2013-01-01

    This paper expands on previous work that examined how large a fire a crew member could successfully survive and extinguish in the confines of a spacecraft. The hazards to the crew and equipment during an accidental fire include excessive pressure rise resulting in a catastrophic rupture of the vehicle skin, excessive temperatures that burn or incapacitate the crew (due to hyperthermia), carbon dioxide build-up or accumulation of other combustion products (e.g. carbon monoxide). The previous work introduced a simplified model that treated the fire primarily as a source of heat and combustion products and sink for oxygen prescribed (input to the model) based on terrestrial standards. The model further treated the spacecraft as a closed system with no capability to vent to the vacuum of space. The model in the present work extends this analysis to more realistically treat the pressure relief system(s) of the spacecraft, include more combustion products (e.g. HF) in the analysis and attempt to predict the fire spread and limiting fire size (based on knowledge of terrestrial fires and the known characteristics of microgravity fires) rather than prescribe them in the analysis. Including the characteristics of vehicle pressure relief systems has a dramatic mitigating effect by eliminating vehicle overpressure for all but very large fires and reducing average gas-phase temperatures.

  12. Realistic calculation of the hep astrophysical factor

    SciTech Connect

    L.E. Marcucci; R. Schiavilla; M. Viviani; A. Kievsky; S. Rosati

    2000-03-01

    The astrophysical factor for the proton weak capture on {sup 3}He is calculated with correlated-hyperspherical-harmonics bound and continuum wave functions corresponding to a realistic Hamiltonian consisting of the Argonne {nu}{sub 18} two-nucleon and Urbana-IX three-nucleon interactions. The nuclear weak charge and current operators have vector and axial-vector components, that include one- and many-body terms. All possible multipole transitions connecting any of the p{sup 3}He S- and P-wave channels to the {sup 4}He bound state are considered. The S-factor at a p{sup 3}He center-of-mass energy of 10 keV, close to the Gamow-peak energy, is predicted to be 10.1 x 10{sup {minus}20} keV b, a factor of five larger than the standard-solar-model value. The P-wave transitions are found to be important, contributing about 40 % of the calculated S-factor.

  13. Comparing Realistic Subthalamic Nucleus Neuron Models

    NASA Astrophysics Data System (ADS)

    Njap, Felix; Claussen, Jens C.; Moser, Andreas; Hofmann, Ulrich G.

    2011-06-01

    The mechanism of action of clinically effective electrical high frequency stimulation is still under debate. However, recent evidence points at the specific activation of GABA-ergic ion channels. Using a computational approach, we analyze temporal properties of the spike trains emitted by biologically realistic neurons of the subthalamic nucleus (STN) as a function of GABA-ergic synaptic input conductances. Our contribution is based on a model proposed by Rubin and Terman and exhibits a wide variety of different firing patterns, silent, low spiking, moderate spiking and intense spiking activity. We observed that most of the cells in our network turn to silent mode when we increase the GABAA input conductance above the threshold of 3.75 mS/cm2. On the other hand, insignificant changes in firing activity are observed when the input conductance is low or close to zero. We thus reproduce Rubin's model with vanishing synaptic conductances. To quantitatively compare spike trains from the original model with the modified model at different conductance levels, we apply four different (dis)similarity measures between them. We observe that Mahalanobis distance, Victor-Purpura metric, and Interspike Interval distribution are sensitive to different firing regimes, whereas Mutual Information seems undiscriminative for these functional changes.

  14. The Use of Facial CT for the Evaluation of a Suspected Simple Dentoalveolar Abscess in the Emergency Department

    PubMed Central

    Shuaib, Waqas; Hashmi, Mariyam; Vijayasarathi, Arvind; Arunkumar, Jay; Tiwana, Sabeen; Khosa, Faisal

    2015-01-01

    Introduction Facial computed tomography (CT) is often performed in the emergency department as a part of the diagnostic workup for patients presenting with the signs and symptoms of dentoalveolar abscess (DA). This investigation evaluated the diagnostic yield of the facial CT and its effects on management change in patients suspected of DA. Furthermore, we assessed secondary consequences of routine facial CT use in this population by using turn-around time (TAT), cost, and radiation exposure as the key parameters. Material and Methods We retrospectively reviewed records of suspected DA patients over a 5-year period, from June 2008 to June 2013. TAT was calculated for patients from the time the examination was ordered by the emergency department physician, to the time the report was finalized by the attending radiologist. Effective radiation dose for facial CT was calculated by multiplying dose length product by the standard conversion coefficient K (K = 0.0021 mSv/mGy x cm). CT cost was included for reference but was not analyzed extensively due to the lack of standardization of costs across the various institutions. Results Our investigation consisted of 117 patients; 75 males of average age 41 (±12) years and 42 females of average age 44 (±17) years. Out of the total 117 patients that underwent CT for the suspicion of a simple DA, only a single individual (0.85%) underwent a management change. Mean TAT of facial CT was 110 (±63) minutes, and a median TAT was 87 (±71) minutes. Average effective radiation dose for a facial CT was 2.4 (±0.4) mSv. Approximate estimated cost of a contrast enhanced facial CT was $253 and non-contrast facial CT was $209. Conclusion Our study shows that routine use of facial CT has a very limited diagnostic value in the workup of simple DA and rarely results in management change. The overall impact on patient management is miniscule in the context of prolonged TAT, radiation exposure, and adding to the rising medical costs. PMID

  15. EVALUATION OF DEMONSTRATED AND EMERGING TECHNOLOGIES FOR THE TREATMENT OF CONTAMINATED LAND AND GROUNDWATER (PHASE III) - 1999 SPECIAL SESSION ON MONITORED NATURAL ATTENUATION

    EPA Science Inventory

    This report includes the papers presented at the NATO/CCMS Pilot Study Meeting in Angers, France, May 9-14, 1999, for the special session on Monitored Natural Attenuation (MNA). This is the Phase III of the Evaluation of Demonstrated and Emerging Technologies for the Treatment a...

  16. Evaluation of seed coating formulations of Trichoderma harzianum on cucumber seeds against pre- and post-emergence damping-off caused by Pythium ultimum

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Seed coating formulations of Trichoderma harzianum were evaluated on cucumber seeds to control pre- and post-emergence damping-off caused by Pythium ultimum in greenhouse studies. Results showed that coating formulation H reduced the disease incidence significantly, and had the potential for commer...

  17. Evaluating and Measuring the Return on Investment of an Emergency Center Health Care Professional Picture Archiving and Communication Systems Training Program

    ERIC Educational Resources Information Center

    Roelandt, James P.

    2012-01-01

    Picture archiving and communication system (PACS) workflow directly affects the quality of emergency patient care through radiology exam turn-around times and the speed of delivery of diagnostic radiology results. This study was a mixed methods training and performance improvement study that evaluated the effectiveness and value of a hospital…

  18. What makes Health Demand-Side Financing Schemes Work in Low-and Middle-Income Countries? A Realist Review

    PubMed Central

    Gopalan, Saji S.; Das, Ashis; Mutasa, Ronald

    2014-01-01

    This realist review explored causal pathways of the possible consumer effects of health sector demand-side financial (DSF) incentives, their contextual factors and mechanisms in low-and-middle-income countries. We searched six electronic data bases and identified 659 abstracts with different evaluation designs. Based on methodological rigor and content relevance, only 24 studies published up to April 2013 were selected for the final review. A conceptual framework consisting of various program theories on potential context-mechanism-outcome (C-M-O) configuration of DSF initiative was designed, tested and adapted during the review. Synthesized results were presented as a C-M-O configuration for each of the consumer –side effect. DSF was effective to improve health seeking behaviour considerably and health status to some extent. The causal pathway of DSF’s functioning and effectiveness was not linear. Key demand-side contextual factors which affected DSF’s consumer-side effects were background characteristics of the beneficiaries including their socio-cultural beliefs, motivations, and level of health awareness. At the supply-side, service availability status and provider incentives were contextual determinants. The mechanisms which enabled the interaction of contextual influence were consumer and provider accountability and consumer trust on providers. In order to enhance DSF programs’ effectiveness, their design and implementation should carefully consider the potential contextual elements that may influence the causal pathways. Significance for public health This article focuses on a rare topic i.e. Realist Review, which is an emerging concept to explore causal factors behind every intervention that make it effective or ineffective. This manuscript is a first attempt on a Realist Review of health sector demand-side financing (DSF) in a number of low-and middle-income countries. DSF is a widely employed health promotion strategy in many countries to improve

  19. What makes Health Demand-Side Financing Schemes Work in Low-and Middle-Income Countries? A Realist Review.

    PubMed

    Gopalan, Saji S; Das, Ashis; Mutasa, Ronald

    2014-12-01

    This realist review explored causal pathways of the possible consumer effects of health sector demand-side financial (DSF) incentives, their contextual factors and mechanisms in low-and-middle-income countries. We searched six electronic data bases and identified 659 abstracts with different evaluation designs. Based on methodological rigor and content relevance, only 24 studies published up to April 2013 were selected for the final review. A conceptual framework consisting of various program theories on potential context-mechanism-outcome (C-M-O) configuration of DSF initiative was designed, tested and adapted during the review. Synthesized results were presented as a C-M-O configuration for each of the consumer -side effect. DSF was effective to improve health seeking behaviour considerably and health status to some extent. The causal pathway of DSF's functioning and effectiveness was not linear. Key demand-side contextual factors which affected DSF's consumer-side effects were background characteristics of the beneficiaries including their socio-cultural beliefs, motivations, and level of health awareness. At the supply-side, service availability status and provider incentives were contextual determinants. The mechanisms which enabled the interaction of contextual influence were consumer and provider accountability and consumer trust on providers. In order to enhance DSF programs' effectiveness, their design and implementation should carefully consider the potential contextual elements that may influence the causal pathways. Significance for public healthThis article focuses on a rare topic i.e. Realist Review, which is an emerging concept to explore causal factors behind every intervention that make it effective or ineffective. This manuscript is a first attempt on a Realist Review of health sector demand-side financing (DSF) in a number of low-and middle-income countries. DSF is a widely employed health promotion strategy in many countries to improve health

  20. Evaluation of natural language processing from emergency department computerized medical records for intra-hospital syndromic surveillance

    PubMed Central

    2011-01-01

    Background The identification of patients who pose an epidemic hazard when they are admitted to a health facility plays a role in preventing the risk of hospital acquired infection. An automated clinical decision support system to detect suspected cases, based on the principle of syndromic surveillance, is being developed at the University of Lyon's Hôpital de la Croix-Rousse. This tool will analyse structured data and narrative reports from computerized emergency department (ED) medical records. The first step consists of developing an application (UrgIndex) which automatically extracts and encodes information found in narrative reports. The purpose of the present article is to describe and evaluate this natural language processing system. Methods Narrative reports have to be pre-processed before utilizing the French-language medical multi-terminology indexer (ECMT) for standardized encoding. UrgIndex identifies and excludes syntagmas containing a negation and replaces non-standard terms (abbreviations, acronyms, spelling errors...). Then, the phrases are sent to the ECMT through an Internet connection. The indexer's reply, based on Extensible Markup Language, returns codes and literals corresponding to the concepts found in phrases. UrgIndex filters codes corresponding to suspected infections. Recall is defined as the number of relevant processed medical concepts divided by the number of concepts evaluated (coded manually by the medical epidemiologist). Precision is defined as the number of relevant processed concepts divided by the number of concepts proposed by UrgIndex. Recall and precision were assessed for respiratory and cutaneous syndromes. Results Evaluation of 1,674 processed medical concepts contained in 100 ED medical records (50 for respiratory syndromes and 50 for cutaneous syndromes) showed an overall recall of 85.8% (95% CI: 84.1-87.3). Recall varied from 84.5% for respiratory syndromes to 87.0% for cutaneous syndromes. The most frequent cause of

  1. Development and Evaluation of Senior High School Courses on Emerging Technology: A Case Study of a Course on Virtual Reality

    ERIC Educational Resources Information Center

    Chen, Chi-Tung

    2012-01-01

    In Taiwan, the National Science Council has implemented the High Scope Program (HSP) since 2006. The purpose of this study was to analyze the development and effectiveness of senior high school HSP courses on emerging technology. This study used a course on virtual reality as an example, to investigate the influence of emerging technology courses…

  2. A realistic molecular model of cement hydrates

    PubMed Central

    Pellenq, Roland J.-M.; Kushima, Akihiro; Shahsavari, Rouzbeh; Van Vliet, Krystyn J.; Buehler, Markus J.; Yip, Sidney; Ulm, Franz-Josef

    2009-01-01

    Despite decades of studies of calcium-silicate-hydrate (C-S-H), the structurally complex binder phase of concrete, the interplay between chemical composition and density remains essentially unexplored. Together these characteristics of C-S-H define and modulate the physical and mechanical properties of this “liquid stone” gel phase. With the recent determination of the calcium/silicon (C/S = 1.7) ratio and the density of the C-S-H particle (2.6 g/cm3) by neutron scattering measurements, there is new urgency to the challenge of explaining these essential properties. Here we propose a molecular model of C-S-H based on a bottom-up atomistic simulation approach that considers only the chemical specificity of the system as the overriding constraint. By allowing for short silica chains distributed as monomers, dimers, and pentamers, this C-S-H archetype of a molecular description of interacting CaO, SiO2, and H2O units provides not only realistic values of the C/S ratio and the density computed by grand canonical Monte Carlo simulation of water adsorption at 300 K. The model, with a chemical composition of (CaO)1.65(SiO2)(H2O)1.75, also predicts other essential structural features and fundamental physical properties amenable to experimental validation, which suggest that the C-S-H gel structure includes both glass-like short-range order and crystalline features of the mineral tobermorite. Additionally, we probe the mechanical stiffness, strength, and hydrolytic shear response of our molecular model, as compared to experimentally measured properties of C-S-H. The latter results illustrate the prospect of treating cement on equal footing with metals and ceramics in the current application of mechanism-based models and multiscale simulations to study inelastic deformation and cracking. PMID:19805265

  3. Realistic Detectability of Close Interstellar Comets

    NASA Astrophysics Data System (ADS)

    Cook, Nathaniel V.; Ragozzine, Darin; Granvik, Mikael; Stephens, Denise C.

    2016-07-01

    During the planet formation process, billions of comets are created and ejected into interstellar space. The detection and characterization of such interstellar comets (ICs) (also known as extra-solar planetesimals or extra-solar comets) would give us in situ information about the efficiency and properties of planet formation throughout the galaxy. However, no ICs have ever been detected, despite the fact that their hyperbolic orbits would make them readily identifiable as unrelated to the solar system. Moro-Martín et al. have made a detailed and reasonable estimate of the properties of the IC population. We extend their estimates of detectability with a numerical model that allows us to consider “close” ICs, e.g., those that come within the orbit of Jupiter. We include several constraints on a “detectable” object that allow for realistic estimates of the frequency of detections expected from the Large Synoptic Survey Telescope (LSST) and other surveys. The influence of several of the assumed model parameters on the frequency of detections is explored in detail. Based on the expectation from Moro-Martín et al., we expect that LSST will detect 0.001–10 ICs during its nominal 10 year lifetime, with most of the uncertainty from the unknown number density of small (nuclei of ∼0.1–1 km) ICs. Both asteroid and comet cases are considered, where the latter includes various empirical prescriptions of brightening. Using simulated LSST-like astrometric data, we study the problem of orbit determination for these bodies, finding that LSST could identify their orbits as hyperbolic and determine an ephemeris sufficiently accurate for follow-up in about 4–7 days. We give the hyperbolic orbital parameters of the most detectable ICs. Taking the results into consideration, we give recommendations to future searches for ICs.

  4. Realistic Detectability of Close Interstellar Comets

    NASA Astrophysics Data System (ADS)

    Cook, Nathaniel V.; Ragozzine, Darin; Granvik, Mikael; Stephens, Denise C.

    2016-07-01

    During the planet formation process, billions of comets are created and ejected into interstellar space. The detection and characterization of such interstellar comets (ICs) (also known as extra-solar planetesimals or extra-solar comets) would give us in situ information about the efficiency and properties of planet formation throughout the galaxy. However, no ICs have ever been detected, despite the fact that their hyperbolic orbits would make them readily identifiable as unrelated to the solar system. Moro-Martín et al. have made a detailed and reasonable estimate of the properties of the IC population. We extend their estimates of detectability with a numerical model that allows us to consider “close” ICs, e.g., those that come within the orbit of Jupiter. We include several constraints on a “detectable” object that allow for realistic estimates of the frequency of detections expected from the Large Synoptic Survey Telescope (LSST) and other surveys. The influence of several of the assumed model parameters on the frequency of detections is explored in detail. Based on the expectation from Moro-Martín et al., we expect that LSST will detect 0.001–10 ICs during its nominal 10 year lifetime, with most of the uncertainty from the unknown number density of small (nuclei of ˜0.1–1 km) ICs. Both asteroid and comet cases are considered, where the latter includes various empirical prescriptions of brightening. Using simulated LSST-like astrometric data, we study the problem of orbit determination for these bodies, finding that LSST could identify their orbits as hyperbolic and determine an ephemeris sufficiently accurate for follow-up in about 4–7 days. We give the hyperbolic orbital parameters of the most detectable ICs. Taking the results into consideration, we give recommendations to future searches for ICs.

  5. Evaluation of Risk for Late Language Emergence after In Utero Antiretroviral Drug Exposure in HIV-exposed Uninfected Infants

    PubMed Central

    Rice, Mabel L.; Zeldow, Bret; Siberry, George K.; Purswani, Murli; Malee, Kathleen; Hoffman, Howard J.; Frederick, Toni; Buchanan, Ashley; Sirois, Patricia A.; Allison, Susannah M.; Williams, Paige L

    2013-01-01

    Background Combination antiretroviral (cARV) regimens are recommended for pregnant women with HIV to prevent perinatal HIV transmission. Safety is a concern for infants who were HIV-exposed but uninfected (HEU), particularly for neurodevelopmental problems, such as language delays. Methods We studied late language emergence (LLE) in HEU children enrolled in a US-based prospective cohort study. LLE was defined as a caregiver-reported score ≤ 10th percentile in any of 4 domains of the MacArthur-Bates Communicative Development Inventory for one-year-olds and as ≥1 standard deviation below age-specific norms for the Ages and Stages Questionnaire for two-year-olds. Logistic regression models were used to evaluate associations of in utero cARV exposure with LLE, adjusting for infant, maternal, and environmental characteristics. Results 1,129 language assessments were conducted among 792 one- and two-year-olds (50% male, 62% black, and 37% Hispanic). Overall, 86% had in utero exposure to cARV and 83% to protease inhibitors. LLE was identified in 26% of one-year-olds and 23% of two-year-olds, with higher rates among boys. In adjusted models, LLE was not associated with maternal cARV or ARV drug classes in either age group. Among cARV-exposed one-year-olds, increased odds of LLE was observed for those exposed to atazanavir (aOR=1.83, 95% CI=1.10-3.04), particularly after the first trimester (aOR=3.56, p=0.001), compared to atazanavir-unexposed infants. No associations of individual ARV drugs with LLE were observed among two-year-olds. Conclusions In utero cARV exposure showed little association with LLE, except for a higher risk of language delay observed in one-year-old infants with atazanavir exposure. PMID:24067563

  6. The standing wave FEL/TBA: Realistic cavity geometry and energy extraction

    SciTech Connect

    Kim, Jin-Soo, Henke, H.; Sessler, A.M.; Sharp, W.M.

    1993-05-01

    A set of parameters for standing wave free electron laser two beam accelerators (SWFEL/TBA) is evaluated for realistic cavity geometry taking into account beam-break-up and the sensitivity of output power to imperfections. Also given is a power extraction system using cavity coupled wave guides.

  7. Standardized Patients Provide Realistic and Worthwhile Experiences for Athletic Training Students

    ERIC Educational Resources Information Center

    Walker, Stacy E.; Weidner, Thomas G.

    2010-01-01

    Context: Standardized patients are more prominently used to both teach and evaluate students' clinical skills and abilities. Objective: To investigate whether athletic training students perceived an encounter with a standardized patient (SP) as realistic and worthwhile and to determine their perceived comfort in future lower extremity evaluations…

  8. Evaluation of the Bladder Stimulation Technique to Collect Midstream Urine in Infants in a Pediatric Emergency Department

    PubMed Central

    Tran, Antoine; Demonchy, Diane; Caci, Hervé; Desmontils, Jonathan; Montaudie-Dumas, Isabelle; Bensaïd, Ronny; Haas, Hervé; Berard, Etienne

    2016-01-01

    Objective Midstream clean-catch urine is an accepted method to diagnose urinary tract infection but is impracticable in infants before potty training. We tested the bladder stimulation technique to obtain a clean-catch urine sample in infants. Materials and methods We included 142 infants under walking age who required a urine sample in a cross- sectional study carried out during a 3-months period, from September to November 2014, in the emergency department of the University Children’s Hospital of Nice (France). A technique based on bladder stimulation and lumbar stimulation maneuvers, with at least two attempts, was tested by four trained physicians. The success rate and time to obtain urine sample within 3 minutes were evaluated. Discomfort (EVENDOL score ≥4/15) was measured. We estimated the risk factors in the failure of the technique. Chi-square test or Fisher’s exact test were used to compare frequencies. T-test and Wilcoxon test were used to compare quantitative data according to the normality of the distribution. Risk factors for failure of the technique were evaluated using a multivariate logistic regression model. Results We obtained midstream clean-catch urine in 55.6% of infants with a median time of 52.0 s (10.0; 110.0). The success rate decreased with age from 88.9% (newborn) to 28.6% (>1 y) (p = 0.0001) and with weight, from 85.7% (<4kg) to 28.6% (>10kg) (p = 0.0004). The success rate was 60.8% for infants without discomfort (p<0.0001). Heavy weight and discomfort were associated with failure, with adjusted ORs of 1.47 [1.04–2.31] and 6.65 [2.85–15.54], respectively. Conclusion Bladder stimulation seems to be efficient in obtaining midstream urine with a moderate success rate in our study sample. This could be an alternative technique for infants before potty training but further randomized multicenter studies are needed to validate this procedure. PMID:27031953

  9. Identifying Preschool Children At-Risk of Later Reading Difficulties: Evaluation of two Emergent Literacy Screening Tools

    PubMed Central

    Wilson, Shauna B.; Lonigan, Christopher J.

    2012-01-01

    Emergent literacy skills are predictive of children’s early reading success, and literacy achievement in early schooling declines more rapidly for children who are below-average readers. It is therefore important for teachers to identify accurately children at risk for later reading difficulty so children can be exposed to good emergent literacy interventions. In this study, 176 preschoolers were administered two screening tools, the Revised Get Ready to Read! (GRTR-R) and the Individual Growth and Development Indicators (IGDIs), and a diagnostic measure at two time points. Receiver operating characteristic curve analyses revealed that at optimal cut scores, GRTR-R provided more accurate classification of children’s overall emergent literacy skills than did IGDIs. However, neither measure was particularly good at classifying specific emergent literacy skills. PMID:19822699

  10. Use of a service evaluation and lean thinking transformation to redesign an NHS 111 refer to community Pharmacy for Emergency Repeat Medication Supply Service (PERMSS)

    PubMed Central

    Nazar, Hamde; Nazar, Zachariah; Simpson, Jill; Yeung, Andre; Whittlesea, Cate

    2016-01-01

    Objectives To demonstrate the contribution of community pharmacy from NHS 111 referrals out of hours (OOH) for emergency supply repeat medication requests via presentation of service activity, community pharmacist feedback and lean thinking transformation. Design Descriptive service evaluation using routine service activity data over the pilot period; survey of community pharmacists, and service redesign through lean thinking transformation. Setting North East of England NHS 111 provider and accredited community pharmacies across the North East of England. Participants Patients calling the North East of England NHS 111 provider during OOH with emergency repeat medication supply requests. Interventions NHS 111 referral to community pharmacies for assessment and if appropriate, supply of emergency repeat medication. Main outcome measures Number of emergency repeat medication supply referrals, completion rates, reasons for rejections, time of request, reason for access, medication(s), pharmaceutical advice and services provided. Secondary outcomes were community pharmacist feedback and lean thinking transformation of the patient pathway. Results NHS 111 referred 1468 patients to 114 community pharmacies (15/12/2014–7/4/2015). Most patients presented on Saturdays, with increased activity over national holidays. Community pharmacists completed 951 (64.8%) referrals providing 2297 medications; 412 were high risk. The most common reason for rejecting referrals was no medication in stock. Community pharmacists were positive about the provision of this service. The lean thinking transformation reduced the number of non-added value steps, waits and bottlenecks in the patient pathway. Conclusions NHS 111 can redirect callers OOH from urgent and emergency care services to community pharmacy for management of emergency repeat medication supply. Existing IT and community pharmacy regulations allowed patients to receive a medication supply and pharmaceutical advice. Community

  11. Emergency supply of prescription-only medicines to patients by community pharmacists: a mixed methods evaluation incorporating patient, pharmacist and GP perspectives

    PubMed Central

    Morecroft, Charles W; Mackridge, Adam J; Stokes, Elizabeth C; Gray, Nicola J; Wilson, Sarah E; Ashcroft, Darren M; Mensah, Noah; Pickup, Graham B

    2015-01-01

    Objective To evaluate and inform emergency supply of prescription-only medicines by community pharmacists (CPs), including how the service could form an integral component of established healthcare provision to maximise adherence. Design Mixed methods. 4 phases: prospective audit of emergency supply requests for prescribed medicines (October–November 2012 and April 2013); interviews with CPs (February–April 2013); follow-up interviews with patients (April–May 2013); interactive feedback sessions with general practice teams (October–November 2013). Setting 22 community pharmacies and 6 general practices in Northwest England. Participants 27 CPs with experience of dealing with requests for emergency supplies; 25 patients who received an emergency supply of a prescribed medicine; 58 staff at 6 general practices. Results Clinical audit in 22 pharmacies over two 4-week periods reported that 526 medicines were requested by 450 patients. Requests peaked over a bank holiday and around weekends. A significant number of supplies were made during practice opening hours. Most requests were for older patients and for medicines used in long-term conditions. Difficulty in renewing repeat medication (forgetting to order, or prescription delays) was the major reason for requests. The majority of medicines were ‘loaned’ in advance of a National Health Service (NHS) prescription. Interviews with CPs and patients indicated that continuous supply had a positive impact on medicines adherence, removing the need to access urgent care. General practice staff were surprised and concerned by the extent of emergency supply episodes. Conclusions CPs regularly provide emergency supplies to patients who run out of their repeat medication, including during practice opening hours. This may aid adherence. There is currently no feedback loop, however, to general practice. Patient care and interprofessional communication may be better served by the introduction of a formally structured

  12. Psychiatric Emergencies.

    PubMed

    Wheat, Santina; Dschida, Dorothy; Talen, Mary R

    2016-06-01

    Psychiatric emergencies are acute disturbances in thought, behavior, mood, or social relationship that require immediate intervention as defined by the patient, family, or social unit to save the patient and/or others from imminent danger. Ensuring the safety of the patient, surrounding persons, and the medical team is the first step of evaluation. Treatment focuses on stabilization of the patient, then on specific symptoms and ultimately the cause of symptoms. There are important legal considerations, particularly regarding involuntary admissions. It is important to debrief with the patient, surrounding family, and the health care team to ensure a continued therapeutic alliance and the emotional health of all involved. PMID:27262012

  13. Noninvasive continuous versus intermittent arterial pressure monitoring: evaluation of the vascular unloading technique (CNAP device) in the emergency department

    PubMed Central

    2014-01-01

    Background Monitoring cardiovascular function in acutely ill patients in the emergency department (ED) is of paramount importance. Arterial pressure (AP) is usually monitored using intermittent oscillometric measurements with an upper arm cuff. The vascular unloading technique (VUT) allows continuous noninvasive AP monitoring. In this study, we compare continuous AP measurements obtained by VUT with intermittent oscillometric AP measurements in ED patients. In addition, we aimed to investigate whether continuous noninvasive AP monitoring allows detection of relevant hypotensive episodes that might be missed with intermittent AP monitoring. Methods In a German university hospital, 130 ED patients who required AP monitoring were analyzed in this prospective method comparison study. Continuous AP monitoring was performed using VUT (CNAP technology; CNSystems Medizintechnik AG, Graz, Austria) over a 2-hour period. The oscillometric AP values were recorded simultaneously every 15 minutes for the comparison of both methods. For statistical evaluation, Bland-Altman plots accounting for repeated AP measurements per individual were used. Results The mean difference (±standard deviation) between AP measurements obtained by VUT and oscillometric AP measurements was -5 mmHg (±22 mmHg) for systolic AP (SAP), -2 mmHg (±15 mmHg) for diastolic AP (DAP), and -6 mmHg (±16 mmHg) for mean AP (MAP), respectively. In the interval between two oscillometric measurements, the VUT device detected hypotensive episodes (≥4 minutes) defined as either SAP <90 mmHg or MAP <65 mmHg in 30 patients and 16 patients, respectively. In 11 (SAP <90 mmHg) and 6 (MAP <65 mmHg) of these patients, hypotension was also detected by the subsequent intermittent oscillometric AP measurement. Conclusions VUT using the CNAP system for noninvasive continuous AP measurement shows reasonable agreement with intermittent oscillometric measurements in acutely ill ED patients. Continuous AP monitoring

  14. Evaluation of a stand-alone computer-aided detection system for acute intra-cranial hemorrhage in emergency environments

    NASA Astrophysics Data System (ADS)

    Fernandez, James; Deshpande, Ruchi; Wang, Ximing; Liu, Brent; Brazaitis, Michael; Munter, Fletcher; Liu, Margaret

    2011-03-01

    Acute intra-cranial hemorrhage (AIH) may result from traumatic brain injury (TBI). Successful management of AIH depends heavily on the speed and accuracy of diagnosis. Timely diagnosis in emergency environments in both civilian and military settings is difficult primarily due to severe time restraints and lack of resources. Often, diagnosis is performed by emergency physicians rather than trained radiologists. As a result, added support in the form of computer-aided detection (CAD) would greatly enhance the decision-making process and help in providing faster and more accurate diagnosis of AIH. This paper discusses the implementation of a CAD system in an emergency environment, and its efficacy in aiding in the detection of AIH.

  15. Psychiatric Advance Directives as a complex and multistage intervention: a realist systematic review.

    PubMed

    Nicaise, Pablo; Lorant, Vincent; Dubois, Vincent

    2013-01-01

    Psychiatric Advance Directives (PADs) are documents that allow users with severe and chronic mental illnesses to notify their treatment preferences for future crisis relapses and to appoint a surrogate decision-maker for a period of incompetence. Despite many supposed clinical and organisational benefits, their take-up rate has remained very low and their clinical evaluation has given contradictory results for organisational outcomes. Intermediary results are available, however, which rely on different theoretical views about how PADs are supposed to work. We carried out a realist systematic review that considered the PAD as a multistage intervention including the definition of the document, its completion and its access and honouring. We identified the theoretical frameworks underlying this kind of intervention and examined the available evidence that supported or contradicted the expectations at each stage of the intervention. Forty-seven references were retrieved, ranging from 1996 to 2009. Three frameworks underlie a PAD intervention: enhancement of the autonomy of the user, improvement of the therapeutic alliance and integration of care through partnership working. Although designed in the first place with a view to sustaining the user's autonomy, results indicate that the intervention is more efficient within a therapeutic alliance framework. Moreover, much is known about the completion process and the content of the document, but very little about its access and honouring. The mixture of expectations makes the purpose of PADs unclear, for example, crisis relapse prevention or management, advance planning of long-term or emergency care, or reduction in the resort to coercion. This may explain their low take-up rates. Hence, frameworks and purpose have to be clarified. The shape of the whole intervention at each stage relies on such clarification. More research is needed, particularly on the later stages of the intervention, as the evidence for how PADs should

  16. Towards realistic representation of hydrological processes in integrated WRF-urban modeling system

    NASA Astrophysics Data System (ADS)

    Yang, Jiachuan; Wang, Zhi-hua; Chen, Fei; Miao, Shiguang; Tewari, Mukul; Georgescu, Matei

    2014-05-01

    To meet the demand of the ever-increasing urbanized global population, substantial conversion of natural landscapes to urban terrains is expected in the next few decades. The landscape modification will emerge as the source of many adverse effects that challenge the environmental sustainability of cities under changing climatic patterns. To address these adverse effects and to develop corresponding adaptation/mitigation strategies, physically-based single layer urban canopy model (SLUCM) has been developed and implemented into the Weather Research and Forecasting (WRF) platform. However, due to the lack of realistic representation of urban hydrological processes, simulation of urban climatology by current coupled WRF/SLUCM is inevitably inadequate. Aiming at improving the accuracy of simulations, in this study we implement physically-based parameterization of urban hydrological processes into the model, including (1) anthropogenic latent heat, (2) urban irrigation, (3) evaporation over water-holding engineered pavements, (4) urban oasis effect, and (5) green roof. In addition, we use an advanced Monte Carlo approach to quantify the sensitivity of urban hydrological modeling to parameter uncertainties. Evaluated against field observations at four major metropolitan areas, results show that the enhanced model is significantly improved in accurately predicting turbulent fluxes arising from built surfaces, especially the latent heat flux. Case studies show that green roof is capable of reducing urban surface temperature and sensible heat flux effectively, and modifying local and regional hydroclimate. Meanwhile, it is efficient in decreasing energy loading of buildings, not only cooling demand in summers but also heating demand in winters, through the combined evaporative cooling and insulation effect. Effectiveness of green roof is found to be limited by availability of water resources and highly sensitive to surface roughness heights. The enhanced WRF/SLUCM model

  17. Chemical Emergency

    MedlinePlus

    ... Emergency App Find our Emergency App in the Apple Store or Google Play Aplicación de Emergencias - ahora ... Lifesaving Blood Get Assistance Types of Emergencies Be Red Cross Ready Mobile Apps Workplaces & Organizations Resources For ...

  18. Emergency Contraception

    MedlinePlus

    ... contraception are available: emergency contraceptive pills and the copper-containing intrauterine device (IUD). Emergency contraceptive pills include ... for emergency use, talk to your doctor. The copper-containing IUD (brand name: Paragard) is a small, ...

  19. Graphic products used in the evaluation of traditional and emerging remote sensing technologies for the detection of fugitive contamination at selected superfund hazardous waste sites

    USGS Publications Warehouse

    Slonecker, E. Terrence; Fisher, Gary B.

    2011-01-01

    This report presents the overhead imagery and field sampling results used to prepare U.S. Geological Survey Open-File Report 2011-1050, 'Evaluation of Traditional and Emerging Remote Sensing Technologies for the Detection of Fugitive Contamination at Selected Superfund Hazardous Waste Sites'. These graphic products were used in the evaluation of remote sensing technology in postclosure monitoring of hazardous waste sites and represent an ongoing research effort. Soil sampling results presented here were accomplished with field portable x-ray fluoresence (XRF) technology and are used as screening tools only representing the current conditions of metals and other contaminants at selected Superfund hazardous waste sites.

  20. Validation of a dose warping algorithm using clinically realistic scenarios

    PubMed Central

    Dehghani, H; Green, S; Webster, G J

    2015-01-01

    Objective: Dose warping following deformable image registration (DIR) has been proposed for interfractional dose accumulation. Robust evaluation workflows are vital to clinically implement such procedures. This study demonstrates such a workflow and quantifies the accuracy of a commercial DIR algorithm for this purpose under clinically realistic scenarios. Methods: 12 head and neck (H&N) patient data sets were used for this retrospective study. For each case, four clinically relevant anatomical changes have been manually generated. Dose distributions were then calculated on each artificially deformed image and warped back to the original anatomy following DIR by a commercial algorithm. Spatial registration was evaluated by quantitative comparison of the original and warped structure sets, using conformity index and mean distance to conformity (MDC) metrics. Dosimetric evaluation was performed by quantitative comparison of the dose–volume histograms generated for the calculated and warped dose distributions, which should be identical for the ideal “perfect” registration of mass-conserving deformations. Results: Spatial registration of the artificially deformed image back to the planning CT was accurate (MDC range of 1–2 voxels or 1.2–2.4 mm). Dosimetric discrepancies introduced by the DIR were low (0.02 ± 0.03 Gy per fraction in clinically relevant dose metrics) with no statistically significant difference found (Wilcoxon test, 0.6 ≥ p ≥ 0.2). Conclusion: The reliability of CT-to-CT DIR-based dose warping and image registration was demonstrated for a commercial algorithm with H&N patient data. Advances in knowledge: This study demonstrates a workflow for validation of dose warping following DIR that could assist physicists and physicians in quantifying the uncertainties associated with dose accumulation in clinical scenarios. PMID:25791569

  1. A novel two-stage evaluation system based on a Group-G1 approach to identify appropriate emergency treatment technology schemes in sudden water source pollution accidents.

    PubMed

    Qu, Jianhua; Meng, Xianlin; Hu, Qi; You, Hong

    2016-02-01

    Sudden water source pollution resulting from hazardous materials has gradually become a major threat to the safety of the urban water supply. Over the past years, various treatment techniques have been proposed for the removal of the pollutants to minimize the threat of such pollutions. Given the diversity of techniques available, the current challenge is how to scientifically select the most desirable alternative for different threat degrees. Therefore, a novel two-stage evaluation system was developed based on a circulation-correction improved Group-G1 method to determine the optimal emergency treatment technology scheme, considering the areas of contaminant elimination in both drinking water sources and water treatment plants. In stage 1, the threat degree caused by the pollution was predicted using a threat evaluation index system and was subdivided into four levels. Then, a technique evaluation index system containing four sets of criteria weights was constructed in stage 2 to obtain the optimum treatment schemes corresponding to the different threat levels. The applicability of the established evaluation system was tested by a practical cadmium-contaminated accident that occurred in 2012. The results show this system capable of facilitating scientific analysis in the evaluation and selection of emergency treatment technologies for drinking water source security. PMID:26449677

  2. Pediatric Emergency Department Suicidal Patients: Two-Site Evaluation of Suicide Ideators, Single Attempters, and Repeat Attempters

    ERIC Educational Resources Information Center

    Asarnow, Joan Rosenbaum; Baraff, Larry J.; Berk, Michele; Grob, Charles; Devich-Navarro, Mona; Suddath, Robert; Piacentini, John; Tang, Lingqi

    2008-01-01

    The study examines ideators, single attempters, and repeats attempters of suicide to clarify optimal strategies for emergency department management and risk assessment to help them in reducing youth suicide and suicide attempts. Depression was found to be a strong predictor of suicide/suicide attempts along with substance use, externalizing…

  3. Analysis of offsite emergency planning zones for the Rocky Flats Plant. Evaluation of radiological materials, Volume 1

    SciTech Connect

    Hodgin, C.R.; Daugherty, N.M.; Smith, M.L.; Bunch, D.; Toresdahl, J.; Verholek, M.G.

    1991-01-01

    The objective of this report is to fully document technical data and information that have been developed to support offsite emergency planning by the State of Colorado for potential accidents at the Rocky Flats Plant. Specifically, this report documents information and data that will assist the State of Colorado in upgrading its radiological emergency planning zones for Rocky Flats Plant. The Colorado Division of Disaster Emergency Services (DODES) and the Colorado Department of Health (CDH) represent the primary audience for this report. The secondary audience for this document includes the Rocky Flats Plant; federal, State, and local governmental agencies; the scientific community; and the interested public. Because the primary audience has a pre-existing background on the subject, this report assumes some exposure to emergency planning, health physics, and dispersion modeling on the part of the reader. The authors have limited their assumptions of background knowledge as much as possible, recognizing that the topics addressed in the report may be new to some secondary audiences.

  4. Understanding Sources of Contaminants of Emerging Concern: An Evaluation of Land Use with Occurrence of Aquatic Contaminants

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The occurrence of pharmaceuticals, antibiotics, hormones, and other contaminants of emerging concern (CEC) in surface waters, nationally and internationally, raises questions of their source, fate, and potential ecological and human health effects. A number of CECs have been shown to disrupt the nor...

  5. Effects of realistic tensor force on nuclear structure

    SciTech Connect

    Nakada, H.

    2012-10-20

    First-order tensor-force effects on nuclear structure are investigated in the self-consistent mean-field and RPA calculations with the M3Y-type semi-realistic interactions, which contain the realistic tensor force. The tensor force plays a key role in Z- or N-dependence of the shell structure, and in transitions involving spin degrees-of-freedom. It is demonstrated that the semi-realistic interactions successfully describe the N-dependence of the shell structure in the proton-magic nuclei (e.g. Ca and Sn), and the magnetic transitions (e.g. M1 transition in {sup 208}Pb).

  6. Unsteady transonic algorithm improvements for realistic aircraft applications

    NASA Technical Reports Server (NTRS)

    Batina, John T.

    1987-01-01

    Improvements to a time-accurate approximate factorization (AF) algorithm were implemented for steady and unsteady transonic analysis of realistic aircraft configurations. These algorithm improvements were made to the CAP-TSD (Computational Aeroelasticity Program - Transonic Small Disturbance) code developed at the Langley Research Center. The code permits the aeroelastic analysis of complete aircraft in the flutter critical transonic speed range. The AF algorithm of the CAP-TSD code solves the unsteady transonic small-disturbance equation. The algorithm improvements include: an Engquist-Osher (E-O) type-dependent switch to more accurately and efficiently treat regions of supersonic flow; extension of the E-O switch for second-order spatial accuracy in these regions; nonreflecting far field boundary conditions for more accurate unsteady applications; and several modifications which accelerate convergence to steady-state. Calculations are presented for several configurations including the General Dynamics one-ninth scale F-16C aircraft model to evaluate the algorithm modifications. The modifications have significantly improved the stability of the AF algorithm and hence the reliability of the CAP-TSD code in general.

  7. RADAR Realistic Animal Model Series for Dose Assessment

    PubMed Central

    Keenan, Mary A.; Stabin, Michael G.; Segars, William P.; Fernald, Michael J.

    2010-01-01

    Rodent species are widely used in the testing and approval of new radiopharmaceuticals, necessitating murine phantom models. As more therapy applications are being tested in animal models, calculating accurate dose estimates for the animals themselves becomes important to explain and control potential radiation toxicity or treatment efficacy. Historically, stylized and mathematically based models have been used for establishing doses to small animals. Recently, a series of anatomically realistic human phantoms was developed using body models based on nonuniform rational B-spline. Realistic digital mouse whole-body (MOBY) and rat whole-body (ROBY) phantoms were developed on the basis of the same NURBS technology and were used in this study to facilitate dose calculations in various species of rodents. Methods Voxel-based versions of scaled MOBY and ROBY models were used with the Vanderbilt multinode computing network (Advanced Computing Center for Research and Education), using geometry and tracking radiation transport codes to calculate specific absorbed fractions (SAFs) with internal photon and electron sources. Photon and electron SAFs were then calculated for relevant organs in all models. Results The SAF results were compared with values from similar studies found in reference literature. Also, the SAFs were used with standardized decay data to develop dose factors to be used in radiation dose calculations. Representative plots were made of photon electron SAFs, evaluating the traditional assumption that all electron energy is absorbed in the source organs. Conclusion The organ masses in the MOBY and ROBY models are in reasonable agreement with models presented by other investigators noting that considerable variation can occur between reported masses. Results consistent with those found by other investigators show that absorbed fractions for electrons for organ self-irradiation were significantly less than 1.0 at energies above 0.5 MeV, as expected for many of

  8. Construction of a technique plan repository and evaluation system based on AHP group decision-making for emergency treatment and disposal in chemical pollution accidents.

    PubMed

    Shi, Shenggang; Cao, Jingcan; Feng, Li; Liang, Wenyan; Zhang, Liqiu

    2014-07-15

    The environmental pollution resulting from chemical accidents has caused increasingly serious concerns. Therefore, it is very important to be able to determine in advance the appropriate emergency treatment and disposal technology for different types of chemical accidents. However, the formulation of an emergency plan for chemical pollution accidents is considerably difficult due to the substantial uncertainty and complexity of such accidents. This paper explains how the event tree method was used to create 54 different scenarios for chemical pollution accidents, based on the polluted medium, dangerous characteristics and properties of chemicals involved. For each type of chemical accident, feasible emergency treatment and disposal technology schemes were established, considering the areas of pollution source control, pollutant non-proliferation, contaminant elimination and waste disposal. Meanwhile, in order to obtain the optimum emergency disposal technology schemes as soon as the chemical pollution accident occurs from the plan repository, the technique evaluation index system was developed based on group decision-improved analytical hierarchy process (AHP), and has been tested by using a sudden aniline pollution accident that occurred in a river in December 2012. PMID:24887122

  9. Southern Schools: An Evaluation of the Effects of the Emergency School Assistance Program and of School Desegregation. Volume II.

    ERIC Educational Resources Information Center

    Crain, Robert L.

    Volume 2 of the evaluation report of the effects of ESAP comprises 5 working papers resulting from the evaluators' decision to explore the variety of research problems relevant to desegregation and policy making that they met with during the evaluation process. The first two papers deal with race relations in desegregated Southern schools: the…

  10. Toward a realistic low-field SSC lattice

    SciTech Connect

    Heifets, S.

    1985-10-01

    Three six-fold lattices for 3 T superferric SSC have been generated at TAC. The program based on the first order canonical transformation was used to compare lattices. On this basis the realistic race-track lattices were generated.

  11. Student Work Experience: A Realistic Approach to Merchandising Education.

    ERIC Educational Resources Information Center

    Horridge, Patricia; And Others

    1980-01-01

    Relevant and realistic experiences are needed to prepare the student for a future career. Addresses the results of a survey of colleges and universities in the United States in regard to their student work experience (SWE) in fashion merchandising. (Author)

  12. A Chimeric Virus-Mouse Model System for Evaluating the Function and Inhibition of Papain-Like Proteases of Emerging Coronaviruses

    PubMed Central

    Deng, Xufang; Agnihothram, Sudhakar; Mielech, Anna M.; Nichols, Daniel B.; Wilson, Michael W.; StJohn, Sarah E.; Larsen, Scott D.; Mesecar, Andrew D.; Lenschow, Deborah J.; Baric, Ralph S.

    2014-01-01

    ABSTRACT To combat emerging coronaviruses, developing safe and efficient platforms to evaluate viral protease activities and the efficacy of protease inhibitors is a high priority. Here, we exploit a biosafety level 2 (BSL-2) chimeric Sindbis virus system to evaluate protease activities and the efficacy of inhibitors directed against the papain-like protease (PLpro) of severe acute respiratory syndrome coronavirus (SARS-CoV), a biosafety level 3 (BSL-3) pathogen. We engineered Sindbis virus to coexpress PLpro and a substrate, murine interferon-stimulated gene 15 (ISG15), and found that PLpro mediates removal of ISG15 (deISGylation) from cellular proteins. Mutation of the catalytic cysteine residue of PLpro or addition of a PLpro inhibitor blocked deISGylation in virus-infected cells. Thus, deISGylation is a marker of PLpro activity. Infection of alpha/beta interferon receptor knockout (IFNAR−/−) mice with these chimeric viruses revealed that PLpro deISGylation activity removed ISG15-mediated protection during viral infection. Importantly, administration of a PLpro inhibitor protected these mice from lethal infection, demonstrating the efficacy of a coronavirus protease inhibitor in a mouse model. However, this PLpro inhibitor was not sufficient to protect the mice from lethal infection with SARS-CoV MA15, suggesting that further optimization of the delivery and stability of PLpro inhibitors is needed. We extended the chimeric-virus platform to evaluate the papain-like protease/deISGylating activity of Middle East respiratory syndrome coronavirus (MERS-CoV) to provide a small-animal model to evaluate PLpro inhibitors of this recently emerged pathogen. This platform has the potential to be universally adaptable to other viral and cellular enzymes that have deISGylating activities. IMPORTANCE Evaluating viral protease inhibitors in a small-animal model is a critical step in the path toward antiviral drug development. We modified a biosafety level 2 chimeric virus

  13. Evaluation of the seasonal performance of a water reclamation pond-constructed wetland system for removing emerging contaminants.

    PubMed

    Matamoros, Víctor; Salvadó, Victòria

    2012-01-01

    The capacity of a full-scale reclamation pond-constructed wetland (CW) system to eliminate 27 emerging contaminants (i.e. pharmaceuticals, sunscreen compounds, fragrances, antiseptics, fire retardants, pesticides, and plasticizers) and the seasonal occurrence of these contaminants is studied. The compounds with the highest concentrations in the secondary effluent are diclofenac, caffeine, ketoprofen, and carbamazepine. The results show that the constructed wetland (61%) removes emerging contaminants significantly more efficiently than the pond (51%), presumably due to the presence of plants (Phragmites and Thypa) as well as the higher hydraulic residence time (HRT) in the CW. A greater seasonal trend to the efficient removal of these compounds is observed in the pond than in the CW. The overall mass removal efficiency of each individual compound ranged from 27% to 93% (71% on average), which is comparable to reported data in advanced treatments (photo-fenton and membrane filtration). The seasonal average content of emerging contaminants in the river water (2488 ng L(-1)) next to the water reclamation plant is found to be higher than the content in the final reclaimed water (1490 ng L(-1)), suggesting that the chemical quality of the reclaimed water is better than available surface waters. PMID:22051341

  14. Emergence of Anisotropy in Flock Simulations and Its Computational Analysis

    NASA Astrophysics Data System (ADS)

    Makiguchi, Motohiro; Inoue, Jun-Ichi

    In real flocks, it was revealed that the angular density of nearest neighbors shows a strong anisotropic structure of individuals by very recent extensive field studies [Ballerini et al, Proceedings of the National Academy of Sciences USA, 105, pp. 1232-1237 (2008)]. In this paper, we show this structure of anisotropy also emerges in an artificial flock simulation, namely, Boid simulation. To quantify the anisotropy, we evaluate a useful statistics, that is to say, the so-called γ-value which is defined as an inner product between the vector in the direction of the lowest angular density of flocks and the vector in the direction of moving of the flock. Our results concerning the emergence of the anisotropy through the γ-value might enable us to judge whether an optimal flock simulation seems to be realistic or not.

  15. A critical evaluation of whether recombination in virus-resistant transgenic plants will lead to the emergence of novel viral diseases.

    PubMed

    Tepfer, Mark; Jacquemond, Mireille; García-Arenal, Fernando

    2015-08-01

    In the evaluation of the potential impacts of first-generation genetically modified (GM) crops, one of the most complex issues has been whether the expression of viral sequences would lead to the emergence of novel viruses, which could occur through recombination between transgene mRNA and that of an infecting non-target virus. Here, we examine this issue, focusing on Cucumber mosaic virus (CMV), which is a particularly pertinent choice, as it is both a major plant pathogen and also the virus with which this question has been studied in the most detail. Using recent results on recombination in CMV, we employ a novel framework giving particular prominence to the formulation of the risk hypothesis and to hypothesis testing via examination of the potential pathway to harm. This allows us to conclude with greater certainty that the likelihood of this potential harm, the emergence of novel viruses, is low. PMID:25982848

  16. An evaluation of the professional, social and demographic profile and quality of life of physicians working at the Prehospital Emergency Medical System (SAMU) in Brazil

    PubMed Central

    Tallo, Fernando Sabia; de Campos Vieira Abib, Simone; Baitello, André Luciano; Lopes, Renato Delascio

    2014-01-01

    OBJECTIVE: To describe the profile of physicians working at the Prehospital Emergency Medical System (SAMU) in Brazil and to evaluate their quality of life. METHODS: Both a semi-structured questionnaire with 57 questions and the SF-36 questionnaire were sent to research departments within SAMU in the Brazilian state capitals, the Federal District and inland towns in Brazil. RESULTS: Of a total of 902 physicians, including 644 (71.4%) males, 533 (59.1%) were between 30 and 45 years of age and 562 (62.4%) worked in a state capital. Regarding education level, 45.1% had graduated less than five years before and only 43% were specialists recognized by the Brazilian Medical Association. Regarding training, 95% did not report any specific training for their work at SAMU. The main weaknesses identified were psychiatric care and surgical emergencies in 57.2 and 42.9% of cases, respectively; traumatic pediatric emergencies, 48.9%; and medical emergencies, 42.9%. As for procedure-related skills, the physicians reported difficulties in pediatric advanced support (62.4%), airway surgical access (45.6%), pericardiocentesis (64.4%) and thoracentesis (29.9%). Difficulties in using an artificial ventilator (43.3%) and in transcutaneous pacing (42.2%) were also reported. Higher percentages of young physicians, aged 25-30 years (26.7 vs 19.0%; p<0.01), worked exclusively in prehospital care (18.0 vs 7.7%; p<0.001), with workloads >48 h per week (12.8 vs 8.6%; p<0.001), and were non-specialists with the shortest length of service (<1 year) at SAMU (30.1 vs 18.2%; p<0.001) who were hired without having to pass public service exams* (i.e., for a temporary job) (61.8 vs 46.2%; p<0.001). Regarding quality of life, the pain domain yielded the worst result among physicians at SAMU. CONCLUSIONS: The doctors in this sample were young and within a few years of graduation, and they had no specific training in prehospital emergencies. Deficiencies were mostly found in pediatrics and psychiatry

  17. A computer-controlled pump and realistic anthropomorphic respiratory phantom for validating image-guided systems

    NASA Astrophysics Data System (ADS)

    Lin, Ralph; Wilson, Emmanuel; Tang, Jonathan; Stoianovici, Dan; Cleary, Kevin

    2007-03-01

    The development of image-guided interventions requires validation studies to evaluate new protocols. So far, these validation studies have been limited to animal models and to software and physical phantoms that simulate respiratory motion but cannot accommodate needle punctures in a realistic manner. We have built a computer-controlled pump that drives an anthropomorphic respiratory phantom for simulating natural breathing patterns. This pump consists of a power supply, a motion controller with servo amplifier, linear actuator, and custom fabricated pump assembly. By generating several sample waveforms, we were able to simulate typical breathing patterns. Using this pump, we were able to produce chest wall movements similar to typical chest wall movements observed in humans. This system has potential applications for evaluating new respiratory compensation algorithms and may facilitate improved testing of image-guided protocols under realistic interventional conditions.

  18. The visualizable, the representable and the inconceivable: realist and non-realist mathematical models in physics and beyond.

    PubMed

    Plotnitsky, Arkady

    2016-01-13

    The project of this article is twofold. First, it aims to offer a new perspective on, and a new argument concerning, realist and non-realist mathematical models, and differences and affinities between them, using physics as a paradigmatic field of mathematical modelling in science. Most of the article is devoted to this topic. Second, the article aims to explore the implications of this argument for mathematical modelling in other fields, in particular in cognitive psychology and economics. PMID:26621990

  19. Prehospital Evaluation of Effusion, Pneumothorax, and Standstill (PEEPS): Point-of-care Ultrasound in Emergency Medical Services

    PubMed Central

    Bhat, Sundeep R.; Johnson, David A.; Pierog, Jessica E.; Zaia, Brita E.; Williams, Sarah R.; Gharahbaghian, Laleh

    2015-01-01

    Introduction In the United States, there are limited studies regarding use of prehospital ultrasound (US) by emergency medical service (EMS) providers. Field diagnosis of life-threatening conditions using US could be of great utility. This study assesses the ability of EMS providers and students to accurately interpret heart and lung US images. Methods We tested certified emergency medical technicians (EMT-B) and paramedics (EMT-P) as well as EMT-B and EMT-P students enrolled in prehospital training programs within two California counties. Participants completed a pre-test of sonographic imaging of normal findings and three pathologic findings: pericardial effusion, pneumothorax, and cardiac standstill. A focused one-hour lecture on emergency US imaging followed. Post-tests were given to all EMS providers immediately following the lecture and to a subgroup one week later. Results We enrolled 57 prehospital providers (19 EMT-B students, 16 EMT-P students, 18 certified EMT-B, and 4 certified EMT-P). The mean pre-test score was 65.2%±12.7% with mean immediate post-test score of 91.1%±7.9% (95% CI [22%–30%], p<0.001). Scores significantly improved for all three pathologic findings. Nineteen subjects took the one-week post-test. Their mean score remained significantly higher: pre-test 65.8%±10.7%; immediate post-test 90.5%±7.0% (95% CI [19%–31%], p<0.001), one-week post-test 93.1%±8.3% (95% CI [21%–34%], p<0.001). Conclusion Using a small sample of EMS providers and students, this study shows the potential feasibility for educating prehospital providers to accurately identify images of pericardial effusion, pneumothorax, and cardiac standstill after a focused lecture. PMID:26265961

  20. Characterization and Monitoring Data for Evaluating Constructed Emergent Sandbar Habitat in the Missouri River Mainstem 2004-2009

    SciTech Connect

    Duberstein, Corey A.

    2011-04-01

    The U.S. Army Corps of Engineers (Corps) provides the primary operational management of the Missouri River Main Stem Reservoir System. Management of the Missouri River has generally reduced peak river flows that form and maintain emergent sandbar habitat. Emergent sandbars provide non-vegetated nesting habitat for the endangered interior least tern (Sternula antillarum athalassos) and the threatened Northern Great Plains piping plover (Charadrius melodus). Since 2000, piping plover nesting habitat within the Gavins Point Reach, Garrison Reach, Lake Oahe, and Lake Sakakawea has fledged the majority of piping plovers produced along the Missouri River system. Habitats within Lewis and Clark Lake have also recently become important plover production areas. Mechanical construction of emergent sandbar habitat (ESH) within some of these reaches within the Missouri River began in 2004. Through 2009, 11 sandbar complexes had been constructed (10 in Gavins Point Reach, 1 in Lewis and Clarke Lake) totaling about 543 ac of piping plover and interior least tern nesting habitat. ESH Construction has resulted in a net gain of tern and plover nesting habitat. Both terns and plovers successfully nest and fledge young on constructed sandbars, and constructed habitats were preferred over natural habitats. Natural processes may limit the viability of constructed sandbars as nesting habitat. Continued research is needed to identify if changes in constructed sandbar engineering and management increase the length of time constructed habitats effectively function as nesting habitat. However, the transfer of information from researchers to planners through technical research reports may not be timely enough to effectively foster the feedback mechanisms of an adaptive management strategy.

  1. Quantitative and Qualitative Evaluation of Bio-Aerosols in Surgery Rooms and Emergency Department of an Educational Hospital

    PubMed Central

    Mirzaei, Ramazan; Shahriary, Esmat; Qureshi, Mazhar Iqbal; Rakhshkhorshid, Ataollah; Khammary, Abdolali; Mohammadi, Mahdi

    2014-01-01

    Background: Bio-aerosols are a potential hazard in hospitals and are mostly produced by hospital staff, patients and visitors. Bio-aerosols are solid or liquid particles pending in the air and they consist of aerosols accompanying micro-organisms or organic compounds of micro-organisms such as endotoxin, metabolite, toxin and other parts of organism. Those are a potential hazard in hospitals and are mostly produced by hospital staff, patients and visitors. Objectives: This study aimed to determine the types and amount of bacterial contamination in operating rooms and emergency department of an educational hospital in Zahedan, South-East of Iran. Materials and Methods: In this study, 72 samples were collected from three operating rooms and three rooms in the emergency department of an educational hospital during 2012. On the first day of every month, a sample was taken from each room during the morning shift; active sampling was done on plates consisting of blood agar and brain-heart infusion agar (BHI) for 10 minutes in the axis of a one-story Anderson impactor (flow rate 28.1 litter per minutes) and SIBATA air pump SIP 32-L and samples were then placed in a 35°C Incubator. Bacterial colonies were counted; warm coloring and differential tests were done and the data were analyzed using Mann-Whitney U and Kruskal-Wallis tests. Results: Seventeen types of bacteria were detected including Staphylococcus, Micrococcus, Viridians, Pneumococcus, Escherichia coli, Streptococcus, Bacillus cereus, B. subtilis, Klebsiella, Pseudomonas, Diphtheroid, Citrobacter and Enterobacter. Quantitative bacterial results showed that the number of observed bacteria in the emergency department with an average of 103.88 ± 33.84 cfu/m³ was more than that of the surgery rooms with an average of 63.32 ± 32.94 cfu/m³. Furthermore, the highest average number of all counted colonies (106 ± 28.45 cfu/m³) was determined in autumn. In all samples, S. aureus and Micrococcus were the most

  2. Boundary conditions towards realistic simulation of jet engine noise

    NASA Astrophysics Data System (ADS)

    Dhamankar, Nitin S.

    Strict noise regulations at major airports and increasing environmental concerns have made prediction and attenuation of jet noise an active research topic. Large eddy simulation coupled with computational aeroacoustics has the potential to be a significant research tool for this problem. With the emergence of petascale computer clusters, it is now computationally feasible to include the nozzle geometry in jet noise simulations. In high Reynolds number experiments on jet noise, the turbulent boundary layer on the inner surface of the nozzle separates into a turbulent free shear layer. Inclusion of a nozzle with turbulent inlet conditions is necessary to simulate this phenomenon realistically. This will allow a reasonable comparison of numerically computed noise levels with the experimental results. Two viscous wall boundary conditions are implemented for modeling the nozzle walls. A characteristic-based approach is compared with a computationally cheaper, extrapolation-based formulation. In viscous flow over a circular cylinder under two different regimes, excellent agreement is observed between the results of the two approaches. The results agree reasonably well with reference experimental and numerical results. Both the boundary conditions are thus found to be appropriate, the extrapolation-based formulation having an edge with its low cost. This is followed with the crucial step of generation of a turbulent boundary layer inside the nozzle. A digital filter-based turbulent inflow condition, extended in a new way to non-uniform curvilinear grids is implemented to achieve this. A zero pressure gradient flat plate turbulent boundary layer is simulated at a high Reynolds number to show that the method is capable of producing sustained turbulence. The length of the adjustment region necessary for synthetic inlet turbulence to recover from modeling errors is estimated. A low Reynolds number jet simulation including a round nozzle geometry is performed and the method

  3. A time-responsive tool for informing policy making: rapid realist review

    PubMed Central

    2013-01-01

    Background A realist synthesis attempts to provide policy makers with a transferable theory that suggests a certain program is more or less likely to work in certain respects, for particular subjects, in specific kinds of situations. Yet realist reviews can require considerable and sustained investment over time, which does not always suit the time-sensitive demands of many policy decisions. ‘Rapid Realist Review’ methodology (RRR) has been developed as a tool for applying a realist approach to a knowledge synthesis process in order to produce a product that is useful to policy makers in responding to time-sensitive and/or emerging issues, while preserving the core elements of realist methodology. Methods Using examples from completed RRRs, we describe key features of the RRR methodology, the resources required, and the strengths and limitations of the process. All aspects of an RRR are guided by both a local reference group, and a group of content experts. Involvement of knowledge users and external experts ensures both the usability of the review products, as well as their links to current practice. Results RRRs have proven useful in providing evidence for and making explicit what is known on a given topic, as well as articulating where knowledge gaps may exist. From the RRRs completed to date, findings broadly adhere to four (often overlapping) classifications: guiding rules for policy-making; knowledge quantification (i.e., the amount of literature available that identifies context, mechanisms, and outcomes for a given topic); understanding tensions/paradoxes in the evidence base; and, reinforcing or refuting beliefs and decisions taken. Conclusions ‘Traditional’ realist reviews and RRRs have some key differences, which allow policy makers to apply each type of methodology strategically to maximize its utility within a particular local constellation of history, goals, resources, politics and environment. In particular, the RRR methodology is explicitly

  4. Searching for the mechanisms of change: a protocol for a realist review of batterer treatment programmes

    PubMed Central

    Cheff, Rebecca; Finn, Debbie; Davloor, Whitney; O'Campo, Patricia

    2016-01-01

    Introduction Conflicting results reported by evaluations of typical batterer intervention programmes leave many judicial officials and policymakers uncertain about the best way to respond to domestic violence, and whether to recommend and fund these programmes. Traditional evaluations and systematic reviews tend to focus predominantly on whether the programmes ‘worked’ (eg, reduced recidivism) often at the exclusion of understanding for whom they may or may not have worked, under what circumstances, and why. Methods and analysis We are undertaking a realist review of the batterer treatment programme literature with the aim of addressing this gap. Keeping with the goals of realist review, our primary aims are to identify the theory that underlies these programmes, highlight the mechanisms that trigger changes in participant behaviour and finally explain why these programmes help some individuals reduce their use of violence and under what conditions they are effective or not effective. We begin by describing the process of perpetrator treatment, and by proposing an initial theoretical model of behaviour change that will be tested by our review. We then describe the criteria for inclusion of an evaluation into the review, the search strategy we will use to identify the studies, and the plan for data extraction and analysis. Ethics and dissemination The results of this review will be written up using the RAMESES Guidelines for Realist Synthesis, and disseminated through peer-reviewed publications aimed at the practitioner community as well as presented at community forums, and at violence against women conferences. Ethics approval was not needed. PMID:27053268

  5. Psychiatric Emergencies in Pregnant Women.

    PubMed

    Wilson, Michael P; Nordstrom, Kimberly; Shah, Asim A; Vilke, Gary M

    2015-11-01

    Psychiatric emergencies in pregnancy can be difficult to manage. The authors (both practicing psychiatrists and emergency clinicians) review the evaluation and treatment of common mental health diagnoses in pregnancy. PMID:26493527

  6. Evaluation/disposition of observations no. 6-17, 6-18, and 6-22 from site electrical assessment report, 300 area powerhouse and emergency sys.

    SciTech Connect

    Ahola, E.L.

    1996-09-30

    Disposition of Observations 6-17, 6-18, 6-22 of Site Electrical Assessment Report. Application of generator differential protection, and synchro-check relay rewiring for generators of building 3621-D. In 1990, the WHC Site Electrical Task Group issued a Site Electrical Assessment Report, ``300 Area Powerhouse and Emergency System.`` This report included numerous findings and observations relating to observed deficiencies or opportunities for improvement in maintenance of the inspected electrical systems. The purpose of this letter report is to provide an evaluation and proposed disposition of Observations No. 6-1 7, 6-1 8, and 6-22 of the Site Electrical Assessment Report.

  7. Foreword: In situ gas surface interactions: approaching realistic conditions

    NASA Astrophysics Data System (ADS)

    Lundgren, Edvin; Over, Herbert

    2008-03-01

    This special issue is devoted to the application of in situ surface-sensitive techniques in the elucidation of catalysed reactions at (model) catalyst surfaces. Both reaction intermediates and the nature of the catalytically active phase are the targets of these investigations. In situ surface science techniques are also used to study the interaction of water with surfaces under realistic conditions. Since 80% of all technical chemicals are manufactured by utilizing (heterogeneous) catalysis, scientific understanding and technological development of catalysis are of central practical importance in modern society [1]. Heterogeneously catalysed reactions take place at the gas/solid interface. Therefore one of the major topics in surface chemistry and physics is closely related to heterogeneous catalysis, with the aim of developing novel catalysts and to improve catalysts' performances on the basis of atomic scale based knowledge. Despite the economical and environmental rewards—if such a goal is achieved—and despite 40 years of intensive research, practical catalysis is still safely in a black box: the reactivity and selectivity of a catalyst are commercially still optimized on a trial and error basis, applying the high throughput screening approach. The reason for this discrepancy between ambition and reality lies in the inherent complexity of the catalytic system, consisting of the working catalyst and the interaction of the catalyst with the reactant mixture. Practical (solid) catalysts consist of metal or oxide nanoparticles which are dispersed and stabilized on a support and which may be promoted by means of additives. These particles catalyse a reaction in pressures as high as 100 bar. Practical catalysis is in general considered to be far too complex for gaining atomic-scale understanding of the mechanism of the catalysed reaction of an industrial catalyst during its operation. Therefore it has been necessary to introduce idealization and simplification of

  8. Realistic real-time outdoor rendering in augmented reality.

    PubMed

    Kolivand, Hoshang; Sunar, Mohd Shahrizal

    2014-01-01

    Realistic rendering techniques of outdoor Augmented Reality (AR) has been an attractive topic since the last two decades considering the sizeable amount of publications in computer graphics. Realistic virtual objects in outdoor rendering AR systems require sophisticated effects such as: shadows, daylight and interactions between sky colours and virtual as well as real objects. A few realistic rendering techniques have been designed to overcome this obstacle, most of which are related to non real-time rendering. However, the problem still remains, especially in outdoor rendering. This paper proposed a much newer, unique technique to achieve realistic real-time outdoor rendering, while taking into account the interaction between sky colours and objects in AR systems with respect to shadows in any specific location, date and time. This approach involves three main phases, which cover different outdoor AR rendering requirements. Firstly, sky colour was generated with respect to the position of the sun. Second step involves the shadow generation algorithm, Z-Partitioning: Gaussian and Fog Shadow Maps (Z-GaF Shadow Maps). Lastly, a technique to integrate sky colours and shadows through its effects on virtual objects in the AR system, is introduced. The experimental results reveal that the proposed technique has significantly improved the realism of real-time outdoor AR rendering, thus solving the problem of realistic AR systems. PMID:25268480

  9. Using polychromatic X-radiography to examine realistic imitation firearms.

    PubMed

    Austin, J C; Day, C R; Kearon, A T; Valussi, S; Haycock, P W

    2008-10-25

    Sections 36-41 of the Violent Crimes Reduction Act (2006), which came into force in England and Wales on 1st October 2007, have placed significant restrictions on the sale and possession of 'realistic imitation firearms'. This legislation attempts to produce a definition of a 'realistic imitation' which clearly differentiates these items from other imitation firearms (which are not covered by the legislation). This paper will go a stage further by demonstrating techniques by which blank firing realistic imitation firearms which may be suitable for illegal conversion to fire live rounds may be differentiated from other less 'suitable' (but visually identical) realistic imitations. The article reports on the use of X-radiography, utilizing the bremsstrahlung of a commercial broad spectrum X-ray source, to identify the differences between alloys constituting the barrels of distinct replica and/or blank firing handguns. The resulting pseudo-signatures are transmission spectra over a range from 20 to 75 kV, taken at 1 kV intervals, which are extracted from stacks of registered, field flattened images. It is shown that it is possible to quantify differences between transmission spectra for components of different realistic imitation fire arms, and apply the results to determine the suitability of particular gun barrels from blank firing imitation firearms for illegal conversion to fire live rounds, or related illegal modifications. PMID:18842365

  10. Realistic Real-Time Outdoor Rendering in Augmented Reality

    PubMed Central

    Kolivand, Hoshang; Sunar, Mohd Shahrizal

    2014-01-01

    Realistic rendering techniques of outdoor Augmented Reality (AR) has been an attractive topic since the last two decades considering the sizeable amount of publications in computer graphics. Realistic virtual objects in outdoor rendering AR systems require sophisticated effects such as: shadows, daylight and interactions between sky colours and virtual as well as real objects. A few realistic rendering techniques have been designed to overcome this obstacle, most of which are related to non real-time rendering. However, the problem still remains, especially in outdoor rendering. This paper proposed a much newer, unique technique to achieve realistic real-time outdoor rendering, while taking into account the interaction between sky colours and objects in AR systems with respect to shadows in any specific location, date and time. This approach involves three main phases, which cover different outdoor AR rendering requirements. Firstly, sky colour was generated with respect to the position of the sun. Second step involves the shadow generation algorithm, Z-Partitioning: Gaussian and Fog Shadow Maps (Z-GaF Shadow Maps). Lastly, a technique to integrate sky colours and shadows through its effects on virtual objects in the AR system, is introduced. The experimental results reveal that the proposed technique has significantly improved the realism of real-time outdoor AR rendering, thus solving the problem of realistic AR systems. PMID:25268480

  11. Emergency contraception

    MedlinePlus

    Morning-after pill; Postcoital contraception; Birth control - emergency; Plan B ... Emergency contraception most likely prevents pregnancy in the same way as regular birth control pills: By preventing or delaying ...

  12. Emergency Contraception

    MedlinePlus

    f AQ FREQUENTLY ASKED QUESTIONS FAQ114 CONTRACEPTION Emergency Contraception • What is emergency contraception (EC)? • How does EC work? • What are the different types of EC? • What is the most ...

  13. Radiation Emergencies

    MedlinePlus

    ... day from sources such as sunlight. A radiation emergency would involve larger amounts of radiation and could ... are no guarantees of safety during a radiation emergency, you can take actions to protect yourself. You ...

  14. Heat emergencies

    MedlinePlus

    Heat emergencies or illnesses are caused by exposure to extreme heat and sun. Heat illnesses can be prevented by ... to regulate the temperature, and make a heat emergency more likely: Drinking alcohol before or during exposure ...

  15. Higher Education Institutional and Program Evaluations in Taiwan and the Emerging Roles of Higher Education Evaluation and Accreditation Council of Taiwan (HEEACT)

    ERIC Educational Resources Information Center

    Lee, Lung-Sheng; Wei, Yen-Shun; Wang, Li-Yun

    2013-01-01

    Post-secondary education institutions in Taiwan are divided into two tracks, general higher education (HE) and technological and vocational education (TVE). The evaluation of all universities/colleges is mandated by the University Act. Higher education institutions receive mandated institutional evaluation every six years and program evaluation…

  16. An Evaluation of a Natural Language Processing Tool for Identifying and Encoding Allergy Information in Emergency Department Clinical Notes

    PubMed Central

    Goss, Foster R.; Plasek, Joseph M.; Lau, Jason J.; Seger, Diane L.; Chang, Frank Y.; Zhou, Li

    2014-01-01

    Emergency department (ED) visits due to allergic reactions are common. Allergy information is often recorded in free-text provider notes; however, this domain has not yet been widely studied by the natural language processing (NLP) community. We developed an allergy module built on the MTERMS NLP system to identify and encode food, drug, and environmental allergies and allergic reactions. The module included updates to our lexicon using standard terminologies, and novel disambiguation algorithms. We developed an annotation schema and annotated 400 ED notes that served as a gold standard for comparison to MTERMS output. MTERMS achieved an F-measure of 87.6% for the detection of allergen names and no known allergies, 90% for identifying true reactions in each allergy statement where true allergens were also identified, and 69% for linking reactions to their allergen. These preliminary results demonstrate the feasibility using NLP to extract and encode allergy information from clinical notes. PMID:25954363

  17. Retained Intra-Abdominal Surgical Clamp Complicating Emergency Laparotomy: Incidental Finding on Hysterosalpingogram for Evaluation of Tubal Infertility

    PubMed Central

    Adesiyun, Adebiyi Gbadebo; Ameh, Nkeiruka; Umar-Sullayman, Hajaratu; Avidime, Solomon; Aliyu, Rabia't

    2014-01-01

    The finding of intraperitoneal foreign body complicating surgical intervention broadly remains as an issue of safety in the operative room, a source of emotive concern for the patient, and an upsetting but equally embarrassing situation to the surgeon and the team. However, in the media world, it is a source of sumptuous and captivating headline on the newspaper and to the legal profession, an attractive case to prosecute. A middle age teacher presented with secondary infertility. She had emergency laparotomy fifteen years ago for ruptured tubal ectopic pregnancy in a private hospital and postoperative period was uneventful. Amongst other investigations to find out the cause of infertility, she had hysterosalpingography and a radio-opaque clamp was visualized on the films. She was counselled and had laparotomy. A pair of surgical Kocher clamps was retrieved buried in the mesentery. PMID:25436162

  18. Childhood Emergencies

    MedlinePlus

    ... Fitness Tracker Save Your Life in the ER? Abdominal Pain Resources Home Safety Checklist ACEP Coloring Book Download the Coloring Book » Emergency Care For You American College of Emergency Phycisians Copyright © American College of Emergency Physicians 2016 Privacy Policy Terms of Use

  19. Error Reduction and Performance Improvement in the Emergency Department through Formal Teamwork Training: Evaluation Results of the MedTeams Project

    PubMed Central

    Morey, John C; Simon, Robert; Jay, Gregory D; Wears, Robert L; Salisbury, Mary; Dukes, Kimberly A; Berns, Scott D

    2002-01-01

    Objective To evaluate the effectiveness of training and institutionalizing teamwork behaviors, drawn from aviation crew resource management (CRM) programs, on emergency department (ED) staff organized into caregiver teams. Study Setting Nine teaching and community hospital EDs. Study Design A prospective multicenter evaluation using a quasi-experimental, untreated control group design with one pretest and two posttests of the Emergency Team Coordination CourseTM (ETCC). The experimental group, comprised of 684 physicians, nurses, and technicians, received the ETCC and implemented formal teamwork structures and processes. Assessments occurred prior to training, and at intervals of four and eight months after training. Three outcome constructs were evaluated: team behavior, ED performance, and attitudes and opinions. Trained observers rated ED staff team behaviors and made observations of clinical errors, a measure of ED performance. Staff and patients in the EDs completed surveys measuring attitudes and opinions. Data Collection Hospital EDs were the units of analysis for the seven outcome measures. Prior to aggregating data at the hospital level, scale properties of surveys and event-related observations were evaluated at the respondent or case level. Principal Findings A statistically significant improvement in quality of team behaviors was shown between the experimental and control groups following training (p = .012). Subjective workload was not affected by the intervention (p = .668). The clinical error rate significantly decreased from 30.9 percent to 4.4 percent in the experimental group (p = .039). In the experimental group, the ED staffs' attitudes toward teamwork increased (p = .047) and staff assessments of institutional support showed a significant increase (p = .040). Conclusion Our findings point to the effectiveness of formal teamwork training for improving team behaviors, reducing errors, and improving staff attitudes among the ETCC-trained hospitals

  20. Wetland Biomass Production: emergent aquatic management options and evaluations. A final subcontract report. [Includes a bibliography containing 686 references on Typha from biological abstracts

    SciTech Connect

    Pratt, D.C.; Dubbe, D.R.; Garver, E.G.; Linton, P.J.

    1984-07-01

    The high yield potential and attractive chemical composition of Typha make it a particularly viable energy crop. The Minnesota research effort has demonstrated that total annual biomass yields equivalent to 30 dry tonnes/ha (13 tons/acre) are possible in planted stands. This compares with yields of total plant material between 9 and 16 dry tonnes/ha (4 to 7 tons/acre) in a typical Minnesota corn field. At least 50% of the Typha plant is comprised of a belowground rhizome system containing 40% starch and sugar. This high level of easily fermentable carbohydrate makes rhizomes an attractive feedstock for alcohol production. The aboveground portion of the plant is largely cellulose, and although it is not easily fermentable, it can be gasified or burned. This report is organized in a manner that focuses on the evaluation of the management options task. Results from stand management research performed at the University of Minnesota during 1982 and 1983 are integrated with findings from an extensive survey of relevant emergent aquatic plant research and utilization. These results and findings are then arranged in sections dealing with key steps and issues that need to be dealt with in the development of a managed emergent aquatic bio-energy system. A brief section evaluating the current status of rhizome harvesting is also included along with an indexed bibliography of the biology, ecology, and utilization of Typha which was completed with support from this SERI subcontract. 686 references, 11 figures, 17 tables.

  1. The implementation and evaluation of the Emergency Response Dose Assessment System (ERDAS) at Cape Canaveral Air Station/Kennedy Space Center

    SciTech Connect

    Evans, R.J.; Tremback, C.J.; Lyons, W.A.

    1996-12-31

    NASA and the Air Force at Kennedy Space Center/Cape Canaveral Air Station (KSC/CCAS) are attempting to upgrade and improve their capabilities for emergency response dispersion modeling and mesoscale meteorological forecasting. Their goal is to improve short range forecasts (up to 24 hours) for phenomena such as thunderstorms and sea breezes and to more accurately predict toxic diffusion concentrations in case of hazardous spills. To assist NASA and the Air Force in achieving this goal, the Applied Meteorology Unit (AMU) has been evaluating the Emergency Response Dose Assessment System (ERDAS). ERDAS is a prototype software and hardware system configured to produce routine mesoscale meteorological forecasts and enhanced dispersion estimates on an operational basis for the KSC/CCAS region. ERDAS includes two major software systems which is run and accessed through a graphical user interface. The first software system is the Regional Atmospheric Modeling System (RAMS), a three-dimensional, multiple nested grid prognostic mesoscale model. The second software system is the Hybrid Particle and Concentration Transport (HYPACT) model, a pollutant trajectory and concentration model. ERDAS also runs the Rocket Exhaust Effluent Diffusion Model (REEDM). This paper describes the system, the model evaluation, the process of transitioning ERDAS from a research project to an operational system, and also presents the results of the launch case studies.

  2. A Distributed Radiator, Heavy Ion Target with Realistic Ion Beams

    NASA Astrophysics Data System (ADS)

    Callahan, Debra A.; Tabak, Max

    1997-11-01

    Recent efforts in heavy ion target design have centered around the distributed radiator design of Tabak(M. Tabak, Bull. Am. Phys. Soc., Vol 41, No 7, 1996.). The initial distributed radiator target assumed beams with a uniform radial density distribution aimed directly along the z axis. Chamber propagation simulations indicate that the beam distribution is more nearly Gaussian at best focus. In addition, more than two beams will be necessary to carry the required current; this means that the beams must be angled to allow space for the final focusing systems upstream. We will describe our modifications to the distributed radiator target to allow realistic beams and realistic beam angles.

  3. The effects of realistic pancake solenoids on particle transport

    SciTech Connect

    Gu, X.; Okamura, M.; Pikin, A.; Fischer, W.; Luo, Y.

    2011-02-01

    Solenoids are widely used to transport or focus particle beams. Usually, they are assumed as being ideal solenoids with a high axial-symmetry magnetic field. Using the Vector Field Opera program, we modeled asymmetrical solenoids with realistic geometry defects, caused by finite conductor and current jumpers. Their multipole magnetic components were analyzed with the Fourier fit method; we present some possible optimized methods for them. We also discuss the effects of 'realistic' solenoids on low energy particle transport. The finding in this paper may be applicable to some lower energy particle transport system design.

  4. Southern Schools: An Evaluation of the Effects of the Emergency School Assistance Program and of School Desegregation. Volume I.

    ERIC Educational Resources Information Center

    Crain, Robert L., Ed.

    This evaluation sampled 150 pairs of schools (50 pairs of high schools and 100 pairs of elementary schools) eligible for ESAP funds, randomly designating one school from each pair as a control school to receive no ESAP funds and using a flip of the coin to so designate. The first volume of the report comprises four chapters and seven appendices.…

  5. Comparative Evaluation of Stroke Triage Algorithms for Emergency Medical Dispatchers (MeDS): Prospective Cohort Study Protocol

    PubMed Central

    2011-01-01

    Background Stroke is a major cause of death and leading cause of disability in the United States. To maximize a stroke patient's chances of receiving thrombolytic treatment for acute ischemic stroke, it is important to improve prehospital recognition of stroke. However, it is known from published reports that emergency medical dispatchers (EMDs) using Card 28 of the Medical Priority Dispatch System protocols recognize stroke poorly. Therefore, to improve EMD's recognition of stroke, the National Association of Emergency Medical Dispatchers recently designed a new diagnostic stroke tool (Cincinnati Stroke Scale -CSS) to be used with Card 28. The objective of this study is to determine whether the addition of CSS improves diagnostic accuracy of stroke triage. Methods/Design This prospective experimental study will be conducted during a one-year period in the 911 call center of Santa Clara County, CA. We will include callers aged ≥ 18 years with a chief complaint suggestive of stroke and second party callers (by-stander or family who are in close proximity to the patient and can administer the tool) ≥ 18 years of age. Life threatening calls will be excluded from the study. Card 28 questions will be administered to subjects who meet study criteria. After completion of Card 28, CSS tool will be administered to all calls. EMDs will record their initial assessment of a cerebro-vascular accident (stroke) after completion of Card 28 and their final assessment after completion of CSS. These assessments will be compared with the hospital discharge diagnosis (ICD-9 codes) recorded in the Office of Statewide Health Planning and Development (OSHPD) database after linking the EMD database and OSHPD database using probabilistic linkage. The primary analysis will compare the sensitivity of the two stroke protocols using logistic regression and generalizing estimating equations to account for clustering by EMDs. To detect a 15% difference in sensitivity between the two groups

  6. A New Scaling Approach for Calculating Realistic Energy, Water and Carbon Fluxes from GCM Grid Areas.

    NASA Astrophysics Data System (ADS)

    Sellers, P. J.; Baker, I. T.

    2014-12-01

    The calculation of grid-scale fluxes becomes a real problem whenever the dependent variable, e.g. evapotranspiration, is non-linearly dependent on a spatially-varying dependent variable, eg, soil moisture. A dynamic binning technique was previously developed that captured the spatial variablity of soil moisture using a small number of "bins" which are used to support a single grid-averaged calculation of evapotranspiration. This grid-averaged flux is then deconvolved to update the bin contents and thereby realistically model the resulting changes in the soil moisture distribution. This idea was previously demonstrated in a simple "toy" soil moisture-evaporation model ( Sellers et al , 2007). The approach has recently been implemented in a 1-d version of the Simple Biosphere (SiB-3) model and its performance is being evaluated. The approach is expected to provide more realistic grid-averaged calculations of enrgy, water and carbon fluxes.

  7. Rehand: Realistic electric prosthetic hand created with a 3D printer.

    PubMed

    Yoshikawa, Masahiro; Sato, Ryo; Higashihara, Takanori; Ogasawara, Tsukasa; Kawashima, Noritaka

    2015-08-01

    Myoelectric prosthetic hands provide an appearance with five fingers and a grasping function to forearm amputees. However, they have problems in weight, appearance, and cost. This paper reports on the Rehand, a realistic electric prosthetic hand created with a 3D printer. It provides a realistic appearance that is same as the cosmetic prosthetic hand and a grasping function. A simple link mechanism with one linear actuator for grasping and 3D printed parts achieve low cost, light weight, and ease of maintenance. An operating system based on a distance sensor provides a natural operability equivalent to the myoelectric control system. A supporter socket allows them to wear the prosthetic hand easily. An evaluation using the Southampton Hand Assessment Procedure (SHAP) demonstrated that an amputee was able to operate various objects and do everyday activities with the Rehand. PMID:26736794

  8. The importance of evaluating metal exposure and predicting human health risks in urban-periurban environments influenced by emerging industry.

    PubMed

    Yousaf, Balal; Amina; Liu, Guijian; Wang, Ruwei; Imtiaz, Muhammad; Rizwan, Muhammad Shahid; Zia-Ur-Rehman, Muhammad; Qadir, Abdul; Si, Youbin

    2016-05-01

    The human population boom, urbanization and rapid industrialization have either directly or indirectly resulted in the serious environmental toxification of the soil-food web by metal exposure from anthropogenic sources in most of the developing industrialized world. The present study was conducted to analyze concentrations of Cd, Cr, Cu, Mn, Ni, Pb, and Zn in soil and vegetables in the urban-periurban areas influenced by emerging industry. Vegetables and their corresponding soil samples were collected and analyzed for heavy metals contents from six random sites. According to the results, the potential health risks from metals to the local communities were assessed by following the methodology described by the US-EPA. In general, the total non-carcinogenic risks were shown to be less than the limits set by the US-EPA. However, the potential risk of developing carcinogenicity in humans over a lifetime of exposure could be increased through the dietary intake of Cd, Cr and Ni. In some cases, Pb was also marginally higher than the safe level. It was concluded that some effective remedial approaches should be adopted to mitigate the risks of Cd, Cr, Ni and Pb in the study area because these metal levels have exceeded the safe limits for human health. However, new studies on gastrointestinal bioaccessibility in human are required to heighten our understanding about metals exposure and health risk assessment. PMID:26891360

  9. The Emerging Roles of Coronary Computed Tomographic Angiography: Acute Chest Pain Evaluation and Screening for Asymptomatic Individuals

    PubMed Central

    Chien, Ning; Wang, Tzung-Dau; Chang, Yeun-Chung; Lin, Po-Chih; Tseng, Yao-Hui; Lee, Yee-Fan; Ko, Wei-Chun; Lee, Bai-Chin; Lee, Wen-Jeng

    2016-01-01

    Coronary computed tomographic angiography (CCTA) has been widely available since 2004. After that, the diagnostic accuracy of CCTA has been extensively validated with invasive coronary angiography for detection of coronary arterial stenosis. In this paper, we reviewed the updated evidence of the role of CCTA in both scenarios including acute chest pain and screening in asymptomatic adults. Several large-scale studies have been conducted to evaluate the diagnostic value of CCTA in the context of acute chest pain patients. CCTA could play a role in delivering more efficient care. For risk stratification of asymptomatic patients using CCTA, latest studies have revealed incremental benefits. Future studies evaluating the totality of plaque characteristics may be useful for determining the role of noncalcified plaque for risk stratification in asymptomatic individuals. PMID:27122947

  10. Evaluation of syndromic algorithms for detecting patients with potentially transmissible infectious diseases based on computerised emergency-department data

    PubMed Central

    2013-01-01

    Background The objective of this study was to ascertain the performance of syndromic algorithms for the early detection of patients in healthcare facilities who have potentially transmissible infectious diseases, using computerised emergency department (ED) data. Methods A retrospective cohort in an 810-bed University of Lyon hospital in France was analysed. Adults who were admitted to the ED and hospitalised between June 1, 2007, and March 31, 2010 were included (N=10895). Different algorithms were built to detect patients with infectious respiratory, cutaneous or gastrointestinal syndromes. The performance parameters of these algorithms were assessed with regard to the capacity of our infection-control team to investigate the detected cases. Results For respiratory syndromes, the sensitivity of the detection algorithms was 82.70%, and the specificity was 82.37%. For cutaneous syndromes, the sensitivity of the detection algorithms was 78.08%, and the specificity was 95.93%. For gastrointestinal syndromes, the sensitivity of the detection algorithms was 79.41%, and the specificity was 81.97%. Conclusions This assessment permitted us to detect patients with potentially transmissible infectious diseases, while striking a reasonable balance between true positives and false positives, for both respiratory and cutaneous syndromes. The algorithms for gastrointestinal syndromes were not specific enough for routine use, because they generated a large number of false positives relative to the number of infected patients. Detection of patients with potentially transmissible infectious diseases will enable us to take precautions to prevent transmission as soon as these patients come in contact with healthcare facilities. PMID:24004720

  11. The emerging role of endoscopic ultrasound-guided core biopsy for the evaluation of solid pancreatic masses.

    PubMed

    Bhutani, M; Koduru, P; Lanke, G; Bruno, M; Maitra, A; Giovannini, M

    2015-06-01

    Pancreatic ductal adenocarcinoma is a lethal cancer with a 5-year survival rate of less than 5%. Surgical resection is the only curative treatment but only 20% are eligible for resection at the time of diagnosis. Early detection of cancer is of paramount importance in the management. Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is the preferred modality for obtaining tissue diagnosis of pancreatic masses. However, the diagnostic accuracy of EUS-FNA may be limited by several factors like availability of onsite cytopathology, adequacy of tissue core for histology, location of the mass, presence of underlying chronic pancreatitis, and experience of the endoscopist. Modern oncology is focusing on personalizing treatment based on tissue analysis of genetic aberrations and molecular biomarkers which are now available. Core tissue also aids in the diagnosis of disease entities like lymphoma, metastatic tumors, neuroendocrine tumors and autoimmune pancreatitis whose diagnosis rely on preserved tissue architecture and immunohistochemistry. Making accurate diagnosis of solid pancreatic masses is critical to avoid unnecessary resections in patients with benign lesions like focal lesions of chronic pancreatitis and autoimmune pancreatitis which mimic cancer. To overcome the limitations of FNA and to obtain adequate core tissue, a Tru-Cut biopsy needle was developed which met with variable success due to stiffness, cumbersome operation and technical failure using it in the duodenum/pancreatic head. More recently fine needle biopsy needles, with reverse bevel technology have become available in different sizes (19, 22, 25-gauge). The aim of this article was to review the emerging role of core biopsy needles in acquiring tissue in solid pancreatic masses and discuss its potential role in personalized medicine. PMID:25675155

  12. A Realistic Experimental Design and Statistical Analysis Project

    ERIC Educational Resources Information Center

    Muske, Kenneth R.; Myers, John A.

    2007-01-01

    A realistic applied chemical engineering experimental design and statistical analysis project is documented in this article. This project has been implemented as part of the professional development and applied statistics courses at Villanova University over the past five years. The novel aspects of this project are that the students are given a…

  13. Determination of quantum-noise parameters of realistic cavities

    NASA Astrophysics Data System (ADS)

    Semenov, A. A.; Vogel, W.; Khanbekyan, M.; Welsch, D.-G.

    2007-01-01

    A procedure is developed which allows one to measure all the parameters occurring in a complete model [A. A. Semenov , Phys. Rev. A 74, 033803 (2006)] of realistic leaky cavities with unwanted noise. The method is based on the reflection of properly chosen test pulses by the cavity.

  14. International Management: Creating a More Realistic Global Planning Environment.

    ERIC Educational Resources Information Center

    Waldron, Darryl G.

    2000-01-01

    Discusses the need for realistic global planning environments in international business education, introducing a strategic planning model that has teams interacting with teams to strategically analyze a selected multinational company. This dynamic process must result in a single integrated written analysis that specifies an optimal strategy for…

  15. Highly realistic, immersive training for navy corpsmen: preliminary results.

    PubMed

    Booth-Kewley, Stephanie; McWhorter, Stephanie K

    2014-12-01

    Highly realistic, immersive training has been developed for Navy corpsmen based on the success of the Infantry Immersion Trainer. This new training is built around scenarios that are designed to depict real-life, operational situations. Each scenario used in the training includes sights, sounds, smells, and distractions to simulate realistic and challenging combat situations. The primary objective of this study was to assess corpsmen participants' satisfaction with highly realistic training. The study sample consisted of 434 male Navy service members attending Field Medical Training Battalion-West, Camp Pendleton, California. Corpsmen participants completed surveys after receiving the training. Participants expressed high levels of satisfaction with the training overall and with several specific elements of the training. The element of the training that the corpsmen rated the highest was the use of live actors. The vast majority of the participants reported that the training had increased their overall confidence about being successful corpsmen and had strengthened their confidence in their ability to provide care under pressure. Additional research should extend highly realistic training to other military medical provider populations. PMID:25469964

  16. Eliciting Mathematical Thinking of Students through Realistic Mathematics Education

    ERIC Educational Resources Information Center

    Anwar, Lathifu; Budayasa, I Ketut; Amin, Siti M.; de Haan, Dede

    2012-01-01

    This paper focuses on an implementation a sequence of instructional activities about addition of fractions that has been developed and implemented in grade four of primary school in Surabaya, Indonesia. The theory of Realistic Mathematics Education (RME) has been applied in the sequence, which aims to assist low attaining learners in supporting…

  17. Synthesis Of Realistic Animations Of A Person Speaking

    NASA Technical Reports Server (NTRS)

    Scott, Kenneth C.; Kagels, David S.; Watson, Stephen H.; Rom, Hillel S.; Lorre, Jean J.; Wright, John R.; Duxbury, Elizabeth D.

    1995-01-01

    Actors computer program implements automated process that synthesizes realistic animations of person speaking. Produces "newscaster" type video sequences. Uses images of person and, therefore, not limited to cartoons and cartoonlike movies. Potential applications also include use of process for automatically producing on-the-fly animations for human/computer interfaces and for reducing bandwidth needed to transmit video telephone signals.

  18. Developing Skills: Realistic Work Environments in Further Education. FEDA Reports.

    ERIC Educational Resources Information Center

    Armstrong, Paul; Hughes, Maria

    To establish the prevalence and perceived value of realistic work environments (RWEs) in colleges and their use as learning resources, all further education (FE) sector colleges in Great Britain were surveyed in the summer of 1998. Of 175 colleges that responded to 2 questionnaires for senior college managers and RWE managers, 127 had at least 1…

  19. A SPATIALLY REALISTIC MODEL FOR INFORMING FOREST MANAGEMENT DECISIONS

    EPA Science Inventory

    Spatially realistic population models (SRPMs) address a fundamental
    problem commonly confronted by wildlife managers - predicting the
    effects of landscape-scale habitat management on an animal population.
    SRPMs typically consist of three submodels: (1) a habitat submodel...

  20. Realistic glottal motion and airflow rate during human breathing.

    PubMed

    Scheinherr, Adam; Bailly, Lucie; Boiron, Olivier; Lagier, Aude; Legou, Thierry; Pichelin, Marine; Caillibotte, Georges; Giovanni, Antoine

    2015-09-01

    The glottal geometry is a key factor in the aerosol delivery efficiency for treatment of lung diseases. However, while glottal vibrations were extensively studied during human phonation, the realistic glottal motion during breathing is poorly understood. Therefore, most current studies assume an idealized steady glottis in the context of respiratory dynamics, and thus neglect the flow unsteadiness related to this motion. This is particularly important to assess the aerosol transport mechanisms in upper airways. This article presents a clinical study conducted on 20 volunteers, to examine the realistic glottal motion during several breathing tasks. Nasofibroscopy was used to investigate the glottal geometrical variations simultaneously with accurate airflow rate measurements. In total, 144 breathing sequences of 30s were recorded. Regarding the whole database, two cases of glottal time-variations were found: "static" or "dynamic" ones. Typically, the peak value of glottal area during slow breathing narrowed from 217 ± 54 mm(2) (mean ± STD) during inspiration, to 178 ± 35 mm(2) during expiration. Considering flow unsteadiness, it is shown that the harmonic approximation of the airflow rate underevaluates the inertial effects as compared to realistic patterns, especially at the onset of the breathing cycle. These measurements provide input data to conduct realistic numerical simulations of laryngeal airflow and particle deposition. PMID:26159687

  1. Two-Capacitor Problem: A More Realistic View.

    ERIC Educational Resources Information Center

    Powell, R. A.

    1979-01-01

    Discusses the two-capacitor problem by considering the self-inductance of the circuit used and by determining how well the usual series RC circuit approximates the two-capacitor problem when realistic values of L, C, and R are chosen. (GA)

  2. Critical Realist Review: Exploring the Real, beyond the Empirical

    ERIC Educational Resources Information Center

    Edgley, Alison; Stickley, Theodore; Timmons, Stephen; Meal, Andy

    2016-01-01

    This article defines the "critical realist review", a literature-based methodological approach to critical analysis of health care studies (or any discipline charged with social interventions) that is robust, insightful and essential for the complexities of twenty-first century evidence-based health and social care. We argue that this…

  3. The Instructional Effectiveness of Integrating Abstract and Realistic Visualization.

    ERIC Educational Resources Information Center

    Joseph, John H.

    This study examined the question of whether the integration of abstract and realistic visualization can improve the effectiveness of visualized instruction. Two methods of integrating visualizations were investigated. The first method used hybrid illustrations, i.e., a real color photograph into which a line drawing segment has been inserted. This…

  4. Magical Realist Pathways into and under the Psychotherapeutic Imaginary

    ERIC Educational Resources Information Center

    Speedy, Jane

    2011-01-01

    My experience of people's life stories from my work as a narrative therapist consistently destabilised distinctions between imagined/magical and real experiences. I came to realise that the day-to-day magical realist juxtapositions I came upon were encounters with people's daily lives, as lived, that have remained unacknowledged within the…

  5. Emerging technologies

    SciTech Connect

    Lu, Shin-yee

    1993-03-01

    The mission of the Emerging Technologies thrust area at Lawrence Livermore National Laboratory is to help individuals establish technology areas that have national and commercial impact, and are outside the scope of the existing thrust areas. We continue to encourage innovative ideas that bring quality results to existing programs. We also take as our mission the encouragement of investment in new technology areas that are important to the economic competitiveness of this nation. In fiscal year 1992, we have focused on nine projects, summarized in this report: (1) Tire, Accident, Handling, and Roadway Safety; (2) EXTRANSYT: An Expert System for Advanced Traffic Management; (3) Odin: A High-Power, Underwater, Acoustic Transmitter for Surveillance Applications; (4) Passive Seismic Reservoir Monitoring: Signal Processing Innovations; (5) Paste Extrudable Explosive Aft Charge for Multi-Stage Munitions; (6) A Continuum Model for Reinforced Concrete at High Pressures and Strain Rates: Interim Report; (7) Benchmarking of the Criticality Evaluation Code COG; (8) Fast Algorithm for Large-Scale Consensus DNA Sequence Assembly; and (9) Using Electrical Heating to Enhance the Extraction of Volatile Organic Compounds from Soil.

  6. Comparison of three electromagnetic NDE procedures using realistic feedwater heater mock-ups

    SciTech Connect

    Krzywosz, K.; Cagle, L. Jr. )

    1993-02-01

    Three electromagnetic NDE techniques are currently available to evaluate the tubing integrity of high-pressure feedwater heaters. They are remote-field eddy current, magnetically biased partial saturation eddy current, and flux leakage. To evaluate the performance of each technique, tubes containing filed-induced flaws were removed from retired bundles, characterized both destructively and nondestructively, and assembled into realistic mock-ups with tube support plates at their original locations. The assembled mockups were tested by vendors using three different inspection techniques. Each procedure was evaluated for its ability to detect and size field-induced flaws. Both flaw detection and NDE estimates were compared with known ground truth.' Based on the comparative test results, the most suitable inspection procedures evaluated to date for flaw detection and sizing were discerned. The evaluated high-pressure feedwater heater was made of SA 556-C2 carbon steel (CS) tubing.

  7. Optimizing Wind And Hydropower Generation Within Realistic Reservoir Operating Policy

    NASA Astrophysics Data System (ADS)

    Magee, T. M.; Clement, M. A.; Zagona, E. A.

    2012-12-01

    Previous studies have evaluated the benefits of utilizing the flexibility of hydropower systems to balance the variability and uncertainty of wind generation. However, previous hydropower and wind coordination studies have simplified non-power constraints on reservoir systems. For example, some studies have only included hydropower constraints on minimum and maximum storage volumes and minimum and maximum plant discharges. The methodology presented here utilizes the pre-emptive linear goal programming optimization solver in RiverWare to model hydropower operations with a set of prioritized policy constraints and objectives based on realistic policies that govern the operation of actual hydropower systems, including licensing constraints, environmental constraints, water management and power objectives. This approach accounts for the fact that not all policy constraints are of equal importance. For example target environmental flow levels may not be satisfied if it would require violating license minimum or maximum storages (pool elevations), but environmental flow constraints will be satisfied before optimizing power generation. Additionally, this work not only models the economic value of energy from the combined hydropower and wind system, it also captures the economic value of ancillary services provided by the hydropower resources. It is recognized that the increased variability and uncertainty inherent with increased wind penetration levels requires an increase in ancillary services. In regions with liberalized markets for ancillary services, a significant portion of hydropower revenue can result from providing ancillary services. Thus, ancillary services should be accounted for when determining the total value of a hydropower system integrated with wind generation. This research shows that the end value of integrated hydropower and wind generation is dependent on a number of factors that can vary by location. Wind factors include wind penetration level

  8. Evaluating the co-production of a near real time Earthquake Aftershock forecasting tool for humanitarian risk assessment and emergency planning

    NASA Astrophysics Data System (ADS)

    Quinn, Keira; Hope, Max; McCloskey, John; NicBhloscaidh, Mairead; Jimenez, Abigail; Dunlop, Paul

    2015-04-01

    Concern Worldwide and the University of Ulster Geophysics Research Group are engaged in a project to co-produce a suite of software and mapping tools to assess aftershock hazard in near real-time during the emergency response phase of earthquake disaster, and inform humanitarian emergency planning and response activities. This paper uses a social learning approach to evaluate this co-production process. Following Wenger (1999) we differentiate between the earthquake science and humanitarian communities of practice (CoP) along three dimensions: enterprise (the purpose of CoPs and the problems participants are working to address), repertoire (knowledge, skills, language), and identity (values and boundaries). We examine the effectiveness of learning between CoP, focusing on boundary work and objects, and various organisational structures and aspects of the wider political economy of learning that enable and hinder the co-production process. We conclude by identifying a number of ways to more effectively integrate earthquake science into humanitarian decision-making, policy development and programme design.

  9. The Implementation and Evaluation of the Emergency Response Dose Assessment System (ERDAS) at Cape Canaveral Air Station/Kennedy Space Center

    NASA Technical Reports Server (NTRS)

    Evans, Randolph J.; Tremback, Craig J.; Lyons, Walter A.

    1996-01-01

    The Emergency Response Dose Assessment System (ERDAS) is a system which combines the mesoscale meteorological prediction model RAMS with the diffusion models REEDM and HYPACT. Operators use a graphical user interface to run the models for emergency response and toxic hazard planning at CCAS/KCS. The Applied Meteorology Unit has been evaluating the ERDAS meteorological and diffusion models and obtained the following results: (1) RAMS adequately predicts the occurrence of the daily sea breeze during non-cloudy conditions for several cases. (2) RAMS shows a tendency to predict the sea breeze to occur slightly earlier and to move it further inland than observed. The sea breeze predictions could most likely be improved by better parameterizing the soil moisture and/or sea surface temperatures. (3) The HYPACT/REEDM/RAMS models accurately predict launch plume locations when RAMS winds are accurate and when the correct plume layer is modeled. (4) HYPACT does not adequately handle plume buoyancy for heated plumes since all plumes are presently treated as passive tracers. Enhancements should be incorporated into the ERDAS as it moves toward being a fully operational system and as computer workstations continue to increase in power and decrease in cost. These enhancements include the following: activate RAMS moisture physics; use finer RAMS grid resolution; add RAMS input parameters (e.g. soil moisture, radar, and/or satellite data); automate data quality control; implement four-dimensional data assimilation; modify HYPACT plume rise and deposition physics; and add cumulative dosage calculations in HYPACT.

  10. Human Performance in a Realistic Instrument-Control Task during Short-Term Microgravity

    PubMed Central

    Steinberg, Fabian; Kalicinski, Michael; Dalecki, Marc; Bock, Otmar

    2015-01-01

    Previous studies have documented the detrimental effects of microgravity on human sensorimotor skills. While that work dealt with simple, laboratory-type skills, we now evaluate the effects of microgravity on a complex, realistic instrument-control skill. Twelve participants controlled a simulated power plant during the short-term microgravity intervals of parabolic flight as well as during level flight. To this end they watched multiple displays, made strategic decisions and used multiple actuators to maximize their virtual earnings from the power plant. We quantified control efficiency as the participants’ net earnings (revenue minus expenses), motor performance as hand kinematics and dynamics, and stress as cortisol level, self-assessed mood and self-assessed workload. We found that compared to normal gravity, control efficiency substantially decreased in microgravity, hand velocity slowed down, and cortisol level and perceived physical strain increased, but other stress and motor scores didn’t change. Furthermore, control efficiency was not correlated with motor and stress scores. From this we conclude that realistic instrument control was degraded in short-term microgravity. This degradation can’t be explained by the motor and/or stress indicators under study, and microgravity affected motor performance differently in our complex, realistic skill than in the simple, laboratory-type skills of earlier studies. PMID:26083473

  11. Evaluation of the Impact of Implementing the Emergency Medical Services Traumatic Brain Injury Guidelines in Arizona: The Excellence in Prehospital Injury Care (EPIC) Study Methodology

    PubMed Central

    Spaite, Daniel W.; Bobrow, Bentley J.; Stolz, Uwe; Sherrill, Duane; Chikani, Vatsal; Barnhart, Bruce; Sotelo, Michael; Gaither, Joshua B.; Viscusi, Chad; Adelson, P. David; Denninghoff, Kurt R.

    2014-01-01

    Traumatic brain injury (TBI) exacts a great toll on society. Fortunately, there is growing evidence that the management of TBI in the early minutes after injury may significantly reduce morbidity and mortality. In response, evidence-based prehospital and in-hospital TBI treatment guidelines have been established by authoritative bodies. However, no large studies have yet evaluated the effectiveness of implementing these guidelines in the prehospital setting. This article describes the background, design, implementation, emergency medical services (EMS) treatment protocols, and statistical analysis of a prospective, controlled (before/after), statewide study designed to evaluate the effect of implementing the EMS TBI guidelines—the Excellence in Prehospital Injury Care (EPIC) study (NIH/NINDS R01NS071049, “EPIC”; and 3R01NS071049-S1, “EPIC4Kids”). The specific aim of the study is to test the hypothesis that statewide implementation of the international adult and pediatric EMS TBI guidelines will significantly reduce mortality and improve nonmortality outcomes in patients with moderate or severe TBI. Furthermore, it will specifically evaluate the effect of guideline implementation on outcomes in the subgroup of patients who are intubated in the field. Over the course of the entire study (~9 years), it is estimated that approximately 25,000 patients will be enrolled. PMID:25112451

  12. Physical-chemical properties and evaluative fate modelling of 'emerging' and 'novel' brominated and organophosphorus flame retardants in the indoor and outdoor environment.

    PubMed

    Liagkouridis, Ioannis; Cousins, Anna Palm; Cousins, Ian T

    2015-08-15

    Several groups of flame retardants (FRs) have entered the market in recent years as replacements for polybrominated diphenyl ethers (PBDEs), but little is known about their physical-chemical properties or their environmental transport and fate. Here we make best estimates of the physical-chemical properties and undertake evaluative modelling assessments (indoors and outdoors) for 35 so-called 'novel' and 'emerging' brominated flame retardants (BFRs) and 22 organophosphorus flame retardants (OPFRs). A QSPR (Quantitative Structure-Property Relationship) based technique is used to reduce uncertainty in physical-chemical properties and to aid property selection for modelling, but it is evident that more, high quality property data are required for improving future assessments. Evaluative modelling results show that many of the alternative FRs, mainly alternative BFRs and some of the halogenated OPFRs, behave similarly to the PBDEs both indoors and outdoors. These alternative FRs exhibit high overall persistence (Pov), long-range transport potential (LRTP) and POP-like behaviour and on that basis cannot be regarded as suitable replacements to PBDEs. A group of low molecular weight alternative BFRs and non-halogenated OPFRs show a potentially better environmental performance based on Pov and LRTP metrics. Results must be interpreted with caution though since there are significant uncertainties and limited data to allow for thorough model evaluation. Additional environmental parameters such as toxicity and bioaccumulative potential as well as functionality issues should be considered in an industrial substitution strategy. PMID:25933174

  13. Geomorphic Classification and Evaluation of Channel Width and Emergent Sandbar Habitat Relations on the Lower Platte River, Nebraska

    USGS Publications Warehouse

    Elliott, Caroline M.

    2011-01-01

    width and high channel sinuosities at larger scales. The segment from Salt Creek to the Missouri River has narrow valleys and generally low channel sinuosity. Tern and plover nest sites from 2006 through 2009 in the multi-scale multivariate classification indicated relative nesting selection of cluster 2 reaches among the four-cluster classification and reaches containing clusters 2, 3, and 6 from the seven-cluster classification. These classes, with the exception of cluster 6 are common downstream from the Elkhorn River. Trends in total channel width indicated that reaches dominated by dark vegetation (islands) are the widest on the Lower Platte River. Reaches with high percentages of dry sand and dry sand plus light vegetation were the narrowest reaches. This suggests that narrow channel reaches have sufficient transport capacity to maintain sandbars under recent (2006) flow regimes and are likely to be most amenable to maintaining tern and plover habitat in the Lower Platte River. Further investigations into the dynamics of emergent sandbar habitat and the effects of bank stabilization on in-channel habitats will require the collection and analysis of new data, particularly detailed elevation information and an assessment of existing bank stabilization structures.

  14. Contextual Emergence

    NASA Astrophysics Data System (ADS)

    Atmanspacher, Harald

    The concept of contextual emergence has been proposed as a nonreductive, yet well-defined relation between different levels of description of physical and other systems. It yields a formally sound and empirically applicable procedure to translate between descriptive levels in an overall consistent fashion. This will be discussed for the contextual emergence of mental states from a neural level of description.

  15. Application of ICA to realistically simulated 1H-MRS data

    PubMed Central

    Kalyanam, Ravi; Boutte, David; Hutchison, Kent E; Calhoun, Vince D

    2015-01-01

    Introduction 1H-MRS signals from brain tissues capture information on in vivo brain metabolism and neuronal biomarkers. This study aims to advance the use of independent component analysis (ICA) for spectroscopy data by objectively comparing the performance of ICA and LCModel in analyzing realistic data that mimics many of the known properties of in vivo data. Methods This work identifies key features of in vivo 1H-MRS signals and presents methods to simulate realistic data, using a basis set of 12 metabolites typically found in the human brain. The realistic simulations provide a much needed ground truth to evaluate performances of various MRS analysis methods. ICA is applied to collectively analyze multiple realistic spectra and independent components identified with our generative model to obtain ICA estimates. These same data are also analyzed using LCModel and the comparisons between the ground-truth and the analysis estimates are presented. The study also investigates the potential impact of modeling inaccuracies by incorporating two sets of model resonances in simulations. Results The simulated fid signals incorporating line broadening, noise, and residual water signal closely resemble the in vivo signals. Simulation analyses show that the resolution performances of both LCModel and ICA are not consistent across metabolites and that while ICA resolution can be improved for certain resonances, ICA is as effective as, or better than, LCModel in resolving most model resonances. Conclusion The results show that ICA can be an effective tool in comparing multiple spectra and complements existing approaches for providing quantified estimates. PMID:26221570

  16. Effects of Defining Realistic Compositions of the Ocular Melanoma on Proton Therapy

    PubMed Central

    Keshazare, Sh; Masoudi, S F; S Rasouli, F

    2014-01-01

    Background: Recent studies in eye plaque brachytherapy have shown a considerable difference between the dosimetric results using water phantom and a model of human eye containing realistic materials. In spite of this fact, there is a lack of simulation studies based on such a model in proton therapy literatures. In the presented work, the effect of utilizing an eye model with ocular media on proton therapy is investigated using the MCNPX Monte Carlo Code. Methods: Two different eye models are proposed to study the effect of defining realistic materials on dose deposition due to utilizing pencil beam scanning (PBS) method for proton therapy of ocular melanoma. The first model is filled with water, and the second one contains the realistic materials of tumor and vitreous. Spread out Bragg peaks (SOBP) are created to cover a typical tumor volume. Moreover, isodose curves are figured in order to evaluate planar variations of absorbed dose in two models. Results: The results show that the maximum delivered dose in ocular media is approximately 12-32% more than in water phantom. Also it is found that using the optimized weighted beams in water phantom leads to disturbance of uniformity of SOBP in ocular media. Conclusion: Similar to the results reported in eye brachytherapy published papers, considering the ocular media in simulation studies leads to a more realistic assessment of sufficiency of the designed proton beam in tissue. This effect is of special importance in creating SOBP, as well as in delivered dose in the tumor boundaries in proton pencil beam scanning method. PMID:25599060

  17. Particles and gaseous emissions from realistic operation of residential wood pellet heating systems

    NASA Astrophysics Data System (ADS)

    Win, Kaung Myat; Persson, Tomas; Bales, Chris

    2012-11-01

    Gaseous and particulate emissions from six residential wood pellet heating systems are determined at a realistic six day operation sequence. The study aims to investigate the total emissions from a realistic operation of the heating systems including start-up and stop phases. Five combined solar and pellet heating systems and one reference boiler without solar system with an integrated DHW preparation was tested in a laboratory at realistic operation conditions. The investigated emissions comprised carbon monoxide (CO), nitrogen oxide (NO), total organic carbon (TOC) and particulate matter (PM2.5). In this study, the emissions are presented as accumulated total emissions from the whole six days period and the emissions from start-up and stop phases are also presented separately to evaluate the influence of the emissions from these phases on the total emissions. Emission factors of the measured systems from the six day period are between 192 and 547 mg MJ-1 for the CO emissions, between 61 and 95 mg MJ-1 for the NO, between 6 and 45 mg MJ-1 for the TOC, between 31 and 116 mg MJ-1 for the particulate matter and between 2.1 × 1013 and 4 × 1013 for the number of particles. The emissions from the start-up and stop phases are significantly high for the CO (63-95 %) and the TOC (48-93 %). NO and particles emissions are shown to dominate during stationary operation. However, 30-40 % of the particle emissions arise from the start and stop periods. It is also shown that the average emissions of CO, TOC and particles under the realistic annual conditions were higher than the limit values of two eco labels.

  18. Evaluation of performance reference compounds (PRCs) to monitor emerging polar contaminants by polar organic chemical integrative samplers (POCIS) in rivers.

    PubMed

    Carpinteiro, Inmaculada; Schopfer, Adrien; Estoppey, Nicolas; Fong, Camille; Grandjean, Dominique; de Alencastro, Luiz F

    2016-02-01

    In this work, a method combining polar organic chemical integrative samplers (POCIS) and ultraperformance liquid chromatography coupled with tandem mass spectrometry (UPLC-MS/MS) was assessed for the determination of two corrosion inhibitors (benzotriazole and methylbenzotriazole), seven pesticides (atrazine, diuron, isoproturon, linuron, metolachlor, penconazole, terbuthylazine), and four pharmaceuticals (carbamazepine, diclofenac, metformin, sulfamethoxazole) in river water. As a first step, two POCIS sorbents, hydrophilic-lipophilic balance (HLB) and Strata X-CW, were compared. The comparison of the uptake profiles of the studied compounds showed that the HLB sorbent provides better uptake (higher sampled amount and better linearity) than Strata X-CW except for the basic compound metformin. Since the sampling rate (R s) of POCIS depends on environmental factors, seven compounds were evaluated as potential performance reference compounds (PRCs) through kinetic experiments. Deisopropylatrazine-d5 (DIA-d5) and, as far as we know, for the first time 4-methylbenzotriazole-d3 showed suitable desorption. The efficiency of both compounds to correct for the effect of water velocity was shown using a channel system in which POCIS were exposed to 2 and 50 cm s(-1). Finally, POCIS were deployed upstream and downstream of agricultural wine-growing and tree-growing areas in the Lienne River and the Uvrier Canal (Switzerland). The impact of the studied areas on both streams could be demonstrated. PMID:26637214

  19. Pediatric Respiratory Emergencies.

    PubMed

    Richards, Amber M

    2016-02-01

    Respiratory emergencies are 1 of the most common reasons parents seek evaluation for the their children in the emergency department (ED) each year, and respiratory failure is the most common cause of cardiopulmonary arrest in pediatric patients. Whereas many respiratory illnesses are mild and self-limiting, others are life threatening and require prompt diagnosis and management. Therefore, it is imperative that emergency clinicians be able to promptly recognize and manage these illnesses. This article reviews ED diagnosis and management of foreign body aspiration, asthma exacerbation, epiglottitis, bronchiolitis, community-acquired pneumonia, and pertussis. PMID:26614243

  20. Realistic Covariance Prediction for the Earth Science Constellation

    NASA Technical Reports Server (NTRS)

    Duncan, Matthew; Long, Anne

    2006-01-01

    Routine satellite operations for the Earth Science Constellation (ESC) include collision risk assessment between members of the constellation and other orbiting space objects. One component of the risk assessment process is computing the collision probability between two space objects. The collision probability is computed using Monte Carlo techniques as well as by numerically integrating relative state probability density functions. Each algorithm takes as inputs state vector and state vector uncertainty information for both objects. The state vector uncertainty information is expressed in terms of a covariance matrix. The collision probability computation is only as good as the inputs. Therefore, to obtain a collision calculation that is a useful decision-making metric, realistic covariance matrices must be used as inputs to the calculation. This paper describes the process used by the NASA/Goddard Space Flight Center's Earth Science Mission Operations Project to generate realistic covariance predictions for three of the Earth Science Constellation satellites: Aqua, Aura and Terra.

  1. Realistic Covariance Prediction For the Earth Science Constellations

    NASA Technical Reports Server (NTRS)

    Duncan, Matthew; Long, Anne

    2006-01-01

    Routine satellite operations for the Earth Science Constellations (ESC) include collision risk assessment between members of the constellations and other orbiting space objects. One component of the risk assessment process is computing the collision probability between two space objects. The collision probability is computed via Monte Carlo techniques as well as numerically integrating relative probability density functions. Each algorithm takes as inputs state vector and state vector uncertainty information for both objects. The state vector uncertainty information is expressed in terms of a covariance matrix. The collision probability computation is only as good as the inputs. Therefore, to obtain a collision calculation that is a useful decision-making metric, realistic covariance matrices must be used as inputs to the calculation. This paper describes the process used by NASA Goddard's Earth Science Mission Operations Project to generate realistic covariance predictions for three of the ESC satellites: Aqua, Aura, and Terra

  2. Realistic fetus skin color processing for ultrasound volume rendering

    NASA Astrophysics Data System (ADS)

    Kim, Yun-Tae; Kim, Kyuhong; Park, Sung-Chan; Kang, Jooyoung; Kim, Jung-Ho

    2014-01-01

    This paper proposes realistic fetus skin color processing using a 2D color map and a tone mapping function (TMF) for ultrasound volume rendering. The contributions of this paper are a 2D color map generated through a gamut model of skin color and a TMF that depends on the lighting position. First, the gamut model of fetus skin color is calculated by color distribution of baby images. The 2D color map is created using a gamut model for tone mapping of ray casting. For the translucent effect, a 2D color map in which lightness is inverted is generated. Second, to enhance the contrast of rendered images, the luminance, color, and tone curve TMF parameters are changed using 2D Gaussian function that depends on the lighting position. The experimental results demonstrate that the proposed method achieves better realistic skin color reproduction than the conventional method.

  3. Automatic Perceptual Color Map Generation for Realistic Volume Visualization

    PubMed Central

    Silverstein, Jonathan C.; Parsad, Nigel M.; Tsirline, Victor

    2008-01-01

    Advances in computed tomography imaging technology and inexpensive high performance computer graphics hardware are making high-resolution, full color (24-bit) volume visualizations commonplace. However, many of the color maps used in volume rendering provide questionable value in knowledge representation and are non-perceptual thus biasing data analysis or even obscuring information. These drawbacks, coupled with our need for realistic anatomical volume rendering for teaching and surgical planning, has motivated us to explore the auto-generation of color maps that combine natural colorization with the perceptual discriminating capacity of grayscale. As evidenced by the examples shown that have been created by the algorithm described, the merging of perceptually accurate and realistically colorized virtual anatomy appears to insightfully interpret and impartially enhance volume rendered patient data. PMID:18430609

  4. An Argument Against the Realistic Interpretation of the Wave Function

    NASA Astrophysics Data System (ADS)

    Rovelli, Carlo

    2016-07-01

    Testable predictions of quantum mechanics are invariant under time reversal. But the evolution of the quantum state in time is not so, neither in the collapse nor in the no-collapse interpretations of the theory. This is a fact that challenges any realistic interpretation of the quantum state. On the other hand, this fact raises no difficulty if we interpret the quantum state as a mere calculation device, bookkeeping past real quantum events.

  5. Realistic localizer courses for aircraft instrument landing simulators

    NASA Technical Reports Server (NTRS)

    Murphy, T. A.

    1984-01-01

    The realistic instrument landing simulator (ILS) course structures for use in aircraft simulators are described. Software developed for data conversion and translation of ILS course structure measurements and calcomp plots of the courses provided are described. A method of implementing the ILS course structure data in existing aircraft simulators is outlined. A cockpit used in the lab to review the digitized ILS course structures is displayed.

  6. Evidence of Multistability in a Realistic Computer Simulation of Hippocampus Subfield CA1

    PubMed Central

    Siekmeier, Peter J.

    2009-01-01

    The manner in which hippocampus processes neural signals is thought to be central to the memory encoding process. A theoretically-oriented literature has suggested that this is carried out via “attractors” or distinctive spatio-temporal patterns of activity. However, these ideas have not been thoroughly investigated using computational models featuring both realistic single-cell physiology and detailed cell-to-cell connectivity. Here we present a 452 cell simulation based on Traub et al’s pyramidal cell [81] and interneuron [83] models, incorporating patterns of synaptic connectivity based on an extensive review of the neuroanatomic literature. When stimulated with a one second physiologically realistic input, our simulated tissue shows the ability to hold activity on-line for several seconds; furthermore, its spiking activity, as measured by frequency and interspike interval (ISI) distributions, resembles that of in vivo hippocampus. An interesting emergent property of the system is its tendency to transition from stable state to stable state, a behavior consistent with recent experimental findings [73]. Inspection of spike trains and simulated blockade of KAHP channels suggest that this is mediated by spike frequency adaptation. This finding, in conjunction with studies showing that apamin, a KAHP channel blocker, enhances the memory consolidation process in laboratory animals, suggests the formation of stable attractor states is central to the process by which memories are encoded. Ways that this methodology could shed light on the etiology of mental illness, such as schizophrenia, are discussed. PMID:19378385

  7. Realistic Modeling of Multi-Scale MHD Dynamics of the Solar Atmosphere

    NASA Technical Reports Server (NTRS)

    Kitiashvili, Irina; Mansour, Nagi N.; Wray, Alan; Couvidat, Sebastian; Yoon, Seokkwan; Kosovichev, Alexander

    2014-01-01

    Realistic 3D radiative MHD simulations open new perspectives for understanding the turbulent dynamics of the solar surface, its coupling to the atmosphere, and the physical mechanisms of generation and transport of non-thermal energy. Traditionally, plasma eruptions and wave phenomena in the solar atmosphere are modeled by prescribing artificial driving mechanisms using magnetic or gas pressure forces that might arise from magnetic field emergence or reconnection instabilities. In contrast, our 'ab initio' simulations provide a realistic description of solar dynamics naturally driven by solar energy flow. By simulating the upper convection zone and the solar atmosphere, we can investigate in detail the physical processes of turbulent magnetoconvection, generation and amplification of magnetic fields, excitation of MHD waves, and plasma eruptions. We present recent simulation results of the multi-scale dynamics of quiet-Sun regions, and energetic effects in the atmosphere and compare with observations. For the comparisons we calculate synthetic spectro-polarimetric data to model observational data of SDO, Hinode, and New Solar Telescope.

  8. Increasing Completion Rate of an M4 Emergency Medicine Student End-of-Shift Evaluation Using a Mobile Electronic Platform and Real-Time Completion

    PubMed Central

    Tews, Matthew C.; Treat, Robert W.; Nanes, Maxwell

    2016-01-01

    Introduction Medical students on an emergency medicine rotation are traditionally evaluated at the end of each shift with paper-based forms, and data are often missing due to forms not being turned in or completed. Because students’ grades depend on these evaluations, change was needed to increase form rate of return. We analyzed a new electronic evaluation form and modified completion process to determine if it would increase the completion rate without altering how faculty scored student performance. Methods During fall 2013, 29 faculty completed paper N=339 evaluations consisting of seven competencies for 33 students. In fall 2014, an electronic evaluation form with the same competencies was designed using an electronic platform and completed N=319 times by 27 faculty using 25 students’ electronic devices. Feedback checkboxes were added to facilitate collection of common comments. Data was analyzed with IBM® SPSS® 21.0 using multi-factor analysis of variance with the students’ global rating (GR) as an outcome. Inter-item reliability was determined with Cronbach alpha. Results There was a significantly higher completion rate (p=0.001) of 98% electronic vs. 69% paper forms, lower (p=0.001) missed GR rate (1% electronic. vs 12% paper), and higher mean scores (p=0.001) for the GR with the electronic (7.0±1.1) vs. paper (6.8±1.2) form. Feedback checkboxes were completed on every form. The inter-item reliability for electronic and paper forms was each alpha=0.95. Conclusion The use of a new electronic form and modified completion process for evaluating students at the end of shift demonstrated a higher faculty completion rate, a lower missed data rate, a higher global rating and consistent collection of common feedback. The use of the electronic form and the process for obtaining the information made our end-of-shift evaluation process for students more reliable and provided more accurate, up-to-date information for student feedback and when determining

  9. Low-Dose (10%) Computed Tomography May Be Inferior to Standard-Dose CT in the Evaluation of Acute Renal Colic in the Emergency Room Setting

    PubMed Central

    Han, Esther; Atalla, Christopher S.; Santucci, Richard A.; O'Neil, Brian; Wynberg, Jason B.

    2016-01-01

    Abstract Introduction: Noncontrast CT is the standard of care to evaluate nephrolithiasis. We evaluated the performance of low-dose CT (LDCT) scan for evaluation of renal colic in the emergency room (ER). Materials and Methods: Patients visiting the ER with suspected nephrolithiasis received a standard-dose CT (SDCT) and an LDCT. Two urologists read the LDCTs and later they read SDCTs. Stone information was recorded on a diagram of the renal system. Findings on SDCTs and LDCTs were correlated through side-by-side comparison of the diagrams. Later, the two urologists adjudicated all nonconcordance between SDCTs and LDCTs in an unblinded manner. Results: Twenty-seven patients were included. SDCTs revealed 27 stones in 18 patients. Mean stone size was 3.81 mm. LDCTs revealed 27 stones in 18 patients with a mean stone size of 4.7 mm (p = 0.23). Overall sensitivity and specificity of LDCTs were 70% and 39%, respectively. There were eight false-positive and eight false-negative stones. All the false-positive stones on LDCTs were placed in the ureter, in which all of the corresponding SDCTs were visible calcifications outside the ureter. Of the eight false-negative stones on LDCTs, seven were visible calcifications on the SDCTs and the eighth stone was 1 mm and was not visible. Conclusion: LDCT may not perform well in the evaluation of suspected nephrolithiasis in the acute setting. LDCT scan accurately demonstrates calcifications; however, accurate placement of calcifications in or out of the urinary tract may be diminished due to impaired resolution of soft tissue structures. PMID:26728321

  10. MRXCAT: Realistic numerical phantoms for cardiovascular magnetic resonance

    PubMed Central

    2014-01-01

    Background Computer simulations are important for validating novel image acquisition and reconstruction strategies. In cardiovascular magnetic resonance (CMR), numerical simulations need to combine anatomical information and the effects of cardiac and/or respiratory motion. To this end, a framework for realistic CMR simulations is proposed and its use for image reconstruction from undersampled data is demonstrated. Methods The extended Cardiac-Torso (XCAT) anatomical phantom framework with various motion options was used as a basis for the numerical phantoms. Different tissue, dynamic contrast and signal models, multiple receiver coils and noise are simulated. Arbitrary trajectories and undersampled acquisition can be selected. The utility of the framework is demonstrated for accelerated cine and first-pass myocardial perfusion imaging using k-t PCA and k-t SPARSE. Results MRXCAT phantoms allow for realistic simulation of CMR including optional cardiac and respiratory motion. Example reconstructions from simulated undersampled k-t parallel imaging demonstrate the feasibility of simulated acquisition and reconstruction using the presented framework. Myocardial blood flow assessment from simulated myocardial perfusion images highlights the suitability of MRXCAT for quantitative post-processing simulation. Conclusion The proposed MRXCAT phantom framework enables versatile and realistic simulations of CMR including breathhold and free-breathing acquisitions. PMID:25204441

  11. Relating realist metatheory to issues of gender and mental health.

    PubMed

    Bergin, M; Wells, John S G; Owen, Sara

    2010-06-01

    This paper seeks to advance the debate that considers critical realism as an alternative approach for understanding gender and mental health and its relatedness to mental health research and practice. The knowledge base of how 'sex' and 'gender' affect mental health and illness is expanding. However, the way we conceptualize gender is significant and challenging as quite often our ability to think about 'gender' as independent of 'sex' is not common. The influences and interplay of how sex (biological) and gender (social) affect mental health and illness requires consideration. Critical realism suggests a shared ontology and epistemology for the natural and social sciences. While much of the debate surrounding gender is guided within a constructivist discourse, an exploration of the concept 'gender' is reflected on and some key realist propositions are considered for mental health research and practice. This is achieved through the works of some key realist theorists. Critical realism offers potential for research and practice in relation to gender and mental health because it facilitates changes in our understanding, while simultaneously, not discarding that which is already known. In so doing, it allows the biological (sex) and social (gender) domains of knowledge for mental health and illness to coexist, without either being reduced to or defined by the other. Arguably, greater depth and explanations for gender and mental health issues are presented within a realist metatheory. PMID:20584241

  12. Depigmented Skin and Phantom Color Measurements for Realistic Prostheses

    PubMed Central

    Tanner, Paul; Leachman, Sancy; Boucher, Kenneth; Ozçelik, Tunçer Burak

    2013-01-01

    Purpose The purpose of this study was to test the hypothesis that regardless of human skin phototype, areas of depigmented skin, as seen in vitiligo, are optically indistinguishable among skin phototypes. The average of the depigmented skin measurements can be used to develop the base color of realistic prostheses. Methods and Materials Data from 20 of 32 recruited vitiligo study participants. Diffuse reflectance spectroscopy measurements were made from depigmented skin and adjacent pigmented skin, then compared to 66 pigmented polydimethylsiloxane phantoms to determine pigment concentrations in turbid media for making realistic facial prostheses. Results The Area Under spectral intensity Curve (AUC) was calculated for average spectroscopy measurements of pigmented sites in relation to skin phototype (p=0.0505) and depigmented skin in relation to skin phototype (p=0.59). No significant relationship exists between skin phototypes and depigmented skin spectroscopy measurements. The average of the depigmented skin measurements (AUC 19,129) was the closest match to phantom 6.4 (AUC 19,162) Conclusions Areas of depigmented skin are visibly indistinguishable per skin phototype, yet spectrometry shows that depigmented skin measurements varied and were unrelated to skin phototype. Possible sources of optical variation of depigmented skin include age, body site, blood flow, quantity/quality of collagen, and other chromophores. The average of all depigmented skin measurements can be used to derive the pigment composition and concentration for realistic facial prostheses. PMID:23750920

  13. Realistic terrain visualization based on 3D virtual world technology

    NASA Astrophysics Data System (ADS)

    Huang, Fengru; Lin, Hui; Chen, Bin; Xiao, Cai

    2010-11-01

    The rapid advances in information technologies, e.g., network, graphics processing, and virtual world, have provided challenges and opportunities for new capabilities in information systems, Internet applications, and virtual geographic environments, especially geographic visualization and collaboration. In order to achieve meaningful geographic capabilities, we need to explore and understand how these technologies can be used to construct virtual geographic environments to help to engage geographic research. The generation of three-dimensional (3D) terrain plays an important part in geographical visualization, computer simulation, and virtual geographic environment applications. The paper introduces concepts and technologies of virtual worlds and virtual geographic environments, explores integration of realistic terrain and other geographic objects and phenomena of natural geographic environment based on SL/OpenSim virtual world technologies. Realistic 3D terrain visualization is a foundation of construction of a mirror world or a sand box model of the earth landscape and geographic environment. The capabilities of interaction and collaboration on geographic information are discussed as well. Further virtual geographic applications can be developed based on the foundation work of realistic terrain visualization in virtual environments.

  14. Realistic terrain visualization based on 3D virtual world technology

    NASA Astrophysics Data System (ADS)

    Huang, Fengru; Lin, Hui; Chen, Bin; Xiao, Cai

    2009-09-01

    The rapid advances in information technologies, e.g., network, graphics processing, and virtual world, have provided challenges and opportunities for new capabilities in information systems, Internet applications, and virtual geographic environments, especially geographic visualization and collaboration. In order to achieve meaningful geographic capabilities, we need to explore and understand how these technologies can be used to construct virtual geographic environments to help to engage geographic research. The generation of three-dimensional (3D) terrain plays an important part in geographical visualization, computer simulation, and virtual geographic environment applications. The paper introduces concepts and technologies of virtual worlds and virtual geographic environments, explores integration of realistic terrain and other geographic objects and phenomena of natural geographic environment based on SL/OpenSim virtual world technologies. Realistic 3D terrain visualization is a foundation of construction of a mirror world or a sand box model of the earth landscape and geographic environment. The capabilities of interaction and collaboration on geographic information are discussed as well. Further virtual geographic applications can be developed based on the foundation work of realistic terrain visualization in virtual environments.

  15. Exposure Render: An Interactive Photo-Realistic Volume Rendering Framework

    PubMed Central

    Kroes, Thomas; Post, Frits H.; Botha, Charl P.

    2012-01-01

    The field of volume visualization has undergone rapid development during the past years, both due to advances in suitable computing hardware and due to the increasing availability of large volume datasets. Recent work has focused on increasing the visual realism in Direct Volume Rendering (DVR) by integrating a number of visually plausible but often effect-specific rendering techniques, for instance modeling of light occlusion and depth of field. Besides yielding more attractive renderings, especially the more realistic lighting has a positive effect on perceptual tasks. Although these new rendering techniques yield impressive results, they exhibit limitations in terms of their exibility and their performance. Monte Carlo ray tracing (MCRT), coupled with physically based light transport, is the de-facto standard for synthesizing highly realistic images in the graphics domain, although usually not from volumetric data. Due to the stochastic sampling of MCRT algorithms, numerous effects can be achieved in a relatively straight-forward fashion. For this reason, we have developed a practical framework that applies MCRT techniques also to direct volume rendering (DVR). With this work, we demonstrate that a host of realistic effects, including physically based lighting, can be simulated in a generic and flexible fashion, leading to interactive DVR with improved realism. In the hope that this improved approach to DVR will see more use in practice, we have made available our framework under a permissive open source license. PMID:22768292

  16. Urologic Emergencies.

    PubMed

    Ludvigson, Adam E; Beaule, Lisa T

    2016-06-01

    The diagnosis and management of urologic emergencies are incorporated into the basic training of all urology residents. In institutions without access to urologic services, it is usually left to the General Surgeon or Emergency Medicine physician to provide timely care. This article discusses diagnoses that are important to recognize and treatment that is practically meaningful for the non-Urologist to identify and treat. The non-Urology provider, after reading this article, will have a better understanding and a higher comfort level with treating patients with urologic emergencies. PMID:27261785

  17. Predictive Evaluation

    ERIC Educational Resources Information Center

    Scriven, Michael

    2007-01-01

    Noting that there has been extensive discussion of the relation of evaluation to: (1) research; (2) explanations (a.k.a. theory-driven, logic model, or realistic evaluation); and (3) recommendations, the author introduces: (4) prediction. He advocates that unlike the first three concepts, prediction is necessarily part of most kinds of evaluation,…

  18. Framework for single input single output nanonetwork-based realistic molecular communication.

    PubMed

    Abd El-Atty, Saied M; Gharsseldien, Zakaria M; Lizos, Konstantinos A

    2015-12-01

    Mobile ad hoc molecular nanonetwork (MAMNET) is a new paradigm for the realisation of future nanonetworks. In MAMNET, transmission of nanoscale information from nanomachine to infostation is based on collision and adhesion. In this study, the authors develop a realistic framework for encompassing the electronic structure of the neurotransmitter in the process of transmitting nanoscale information at a single input single output nanonetwork. Nanonetwork performance is evaluated in terms of average packet delay, throughput and incurred traffic rate. Numerical results demonstrate the influence of the neurotransmitter's electronic structure over the performance of nanonetworks. PMID:26647808

  19. Biophysically Realistic Filament Bending Dynamics in Agent-Based Biological Simulation

    PubMed Central

    Alberts, Jonathan B.

    2009-01-01

    An appealing tool for study of the complex biological behaviors that can emerge from networks of simple molecular interactions is an agent-based, computational simulation that explicitly tracks small-scale local interactions – following thousands to millions of states through time. For many critical cell processes (e.g. cytokinetic furrow specification, nuclear centration, cytokinesis), the flexible nature of cytoskeletal filaments is likely to be critical. Any computer model that hopes to explain the complex emergent behaviors in these processes therefore needs to encode filament flexibility in a realistic manner. Here I present a numerically convenient and biophysically realistic method for modeling cytoskeletal filament flexibility in silico. Each cytoskeletal filament is represented by a series of rigid segments linked end-to-end in series with a variable attachment point for the translational elastic element. This connection scheme allows an empirically tuning, for a wide range of segment sizes, viscosities, and time-steps, that endows any filament species with the experimentally observed (or theoretically expected) static force deflection, relaxation time-constant, and thermal writhing motions. I additionally employ a unique pair of elastic elements – one representing the axial and the other the bending rigidity– that formulate the restoring force in terms of single time-step constraint resolution. This method is highly local –adjacent rigid segments of a filament only interact with one another through constraint forces—and is thus well-suited to simulations in which arbitrary additional forces (e.g. those representing interactions of a filament with other bodies or cross-links / entanglements between filaments) may be present. Implementation in code is straightforward; Java source code is available at www.celldynamics.org. PMID:19283085

  20. Rheumatologic emergencies.

    PubMed

    Gutiérrez-González, Luis Arturo

    2015-12-01

    Rheumatological conditions can sometimes present as emergencies. These can occur due to the disease process or infection; contrary to what many people think, rheumatologic emergencies like a pain, rheumatic crisis, or attack gout do not compromise the patient's life. This article mentioned only true emergencies: catastrophic antiphospholipid syndrome (cAPS), kidney-lung syndrome, central nervous system (CNS) vasculitis, anti-Ro syndrome (neonatal lupus), and macrophage activation syndrome (MAS). The management of above emergencies includes critical care, immunosuppression when indicated, and use of a diagnostic flowchart as well as fast laboratory profile for making decisions. Anticoagulants have to be used in the management of antiphospholipid syndrome. A good understanding of these conditions is of paramount importance for proper management. PMID:26099604