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1

Emergent properties from organisms to ecosystems: towards a realistic approach  

PubMed Central

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.

Ponge, Jean-Francois

2005-01-01

2

A realistic evaluation: the case of protocol-based care  

PubMed Central

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 understanding how context influences evidence-based practice. The strengths and limitations of the approach are considered, including how to operationalise it and some of the challenges. This approach provided a useful interpretive framework with which to make sense of the multiple factors that were simultaneously at play and being observed through various data sources, and for developing explanatory theory about using standardised care approaches in practice.

2010-01-01

3

Remembering and Celebrating a Realistic Evaluation Visionary  

ERIC Educational Resources Information Center

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…

Patton, Michael Quinn

2013-01-01

4

Middletown 2010 -- A Realistic Interactive Emergency Simulation and Response System for the US Army.  

National Technical Information Service (NTIS)

The need to plan and calculate the effects of major emergencies, including terrorists' attacks, has become critical in the U.S. Army. To ensure optimal military readiness, there is an urgent need to realistically simulate these events. Development of a re...

H. Gundersen

2006-01-01

5

Time-scale invariance as an emergent property in a perceptron with realistic, noisy neurons  

PubMed Central

In most species, interval timing is time-scale invariant: errors in time estimation scale up linearly with the estimated duration. In mammals, time-scale invariance is ubiquitous over behavioral, lesion, and pharmacological manipulations. For example, dopaminergic drugs induce an immediate, whereas cholinergic drugs induce a gradual, scalar change in timing. Behavioral theories posit that time-scale invariance derives from particular computations, rules, or coding schemes. In contrast, we discuss a simple neural circuit, the perceptron, whose output neurons fire in a clockwise fashion (interval timing) based on the pattern of coincidental activation of its input neurons. We show numerically that time-scale invariance emerges spontaneously in a perceptron with realistic neurons, in the presence of noise. Under the assumption that dopaminergic drugs modulate the firing of input neurons, and that cholinergic drugs modulate the memory representation of the criterion time, we show that a perceptron with realistic neurons reproduces the pharmacological clock and memory patterns, and their time-scale invariance, in the presence of noise. These results suggest that rather than being a signature of higher-order cognitive processes or specific computations related to timing, time-scale invariance may spontaneously emerge in a massively-connected brain from the intrinsic noise of neurons and circuits, thus providing the simplest explanation for the ubiquity of scale invariance of interval timing.

Buhusi, Catalin V.; Oprisan, Sorinel A.

2013-01-01

6

Time-scale invariance as an emergent property in a perceptron with realistic, noisy neurons.  

PubMed

In most species, interval timing is time-scale invariant: errors in time estimation scale up linearly with the estimated duration. In mammals, time-scale invariance is ubiquitous over behavioral, lesion, and pharmacological manipulations. For example, dopaminergic drugs induce an immediate, whereas cholinergic drugs induce a gradual, scalar change in timing. Behavioral theories posit that time-scale invariance derives from particular computations, rules, or coding schemes. In contrast, we discuss a simple neural circuit, the perceptron, whose output neurons fire in a clockwise fashion based on the pattern of coincidental activation of its input neurons. We show numerically that time-scale invariance emerges spontaneously in a perceptron with realistic neurons, in the presence of noise. Under the assumption that dopaminergic drugs modulate the firing of input neurons, and that cholinergic drugs modulate the memory representation of the criterion time, we show that a perceptron with realistic neurons reproduces the pharmacological clock and memory patterns, and their time-scale invariance, in the presence of noise. These results suggest that rather than being a signature of higher order cognitive processes or specific computations related to timing, time-scale invariance may spontaneously emerge in a massively connected brain from the intrinsic noise of neurons and circuits, thus providing the simplest explanation for the ubiquity of scale invariance of interval timing. PMID:23518297

Buhusi, Catalin V; Oprisan, Sorinel A

2013-05-01

7

Realist Activity Theory for Digital Library Evaluation: Conceptual Framework and Case Study  

Microsoft Academic Search

A critical yet largely unexamined facet of digital library design anduse is how library content is assembled and vetted, which in turn hasprofound implications for ongoing digital library usefulness and usability.This article presents a social realist evaluation framework for anactivity theoretic case study of the Flora of North America digitallibrary. Social realist evaluation is a relatively new evaluationparadigm, positing that

Mark A. Spasser

2002-01-01

8

Emergency nurse residency program evaluation.  

PubMed

The purpose of this mixed method descriptive study was to perform a program evaluation on an emergency nurse residency program. The study identified leaders' goals, objectives, and outcomes and the nurse residents' perceptions of the program, including whether they felt prepared to make the transition into their new role. The program evaluation revealed that the nurse residents felt confident, secure, and prepared to function as well-rounded emergency nurses after completing the emergency nurse residency program, in congruence with leaders' objectives. PMID:24060658

Johnson, Anitra; Salisbury, Helen; Johannsson, Mark; Barajas, Kenny

2013-01-01

9

Realistic assessment of the physican-staffed emergency services in Germany  

Microsoft Academic Search

In Germany the emergency medical services, which include dispatching emergency physicians to the scene, are considered to be among the best in the world. However, the hospitals admitting these patients still report shortcomings in prehospital care. The quality of an emergency medical service depends on both formal qualification and experience in managing such emergencies. Therefore, we determined how frequently emergency

A. Gries; W. Zink; M. Bernhard; M. Messelken; T. Schlechtriemen

2006-01-01

10

Compendium of ECCS (Emergency Core Cooling Systems) research for realistic LOCA (loss-of-coolant accidents) analysis: Final report  

SciTech Connect

In the United States, Emergency Core Cooling Systems (ECCS) are required for light water reactors (LWRs) to provide cooling of the reactor core in the event of a break or leak in the reactor piping or an inadvertent opening of a valve. These accidents are called loss-of-coolant accidents (LOCA), and they range from small leaks up to a postulated full break of the largest pipe in the reactor cooling system. Federal government regulations provide that LOCA analysis be performed to show that the ECCS will maintain fuel rod cladding temperatures, cladding oxidation, and hydrogen production within certain limits. The NRC and others have completed a large body of research which investigated fuel rod behavior and LOCA/ECCS performance. It is now possible to make a realistic estimate of the ECCS performance during a LOCA and to quantify the uncertainty of this calculation. The purpose of this report is to summarize this research and to serve as a general reference for the extensive research effort that has been performed. The report: (1) summarizes the understanding of LOCA phenomena in 1974; (2) reviews experimental and analytical programs developed to address the phenomena; (3) describes the best-estimate computer codes developed by the NRC; (4) discusses the salient technical aspects of the physical phenomena and our current understanding of them; (5) discusses probabilistic risk assessment results and perspectives, and (6) evaluates the impact of research results on the ECCS regulations. 736 refs., 412 figs., 66 tabs.

Not Available

1988-12-01

11

Emergency Medical Technician Performance Evaluation.  

National Technical Information Service (NTIS)

An evaluation was conducted of the diagnostic accuracy and treatment appropriateness of emergency medical technicians (EMTs) in caring for 4,455 consecutive patients during a four and one-half month period. Data on EMT diagnosis and treatment and physicia...

J. F. Cannon W. H. Frazier

1978-01-01

12

Realistic nurse-led policy implementation, optimization and evaluation: novel methodological exemplar.  

PubMed

AIM: To report the first large-scale realistic nurse-led implementation, optimization and evaluation of a complex children's continuing-care policy. BACKGROUND: Health policies are increasingly complex, involve multiple Government departments and frequently fail to translate into better patient outcomes. Realist methods have not yet been adapted for policy implementation. DESIGN: Research methodology - Evaluation using theory-based realist methods for policy implementation. METHODS: An expert group developed the policy and supporting tools. Implementation and evaluation design integrated diffusion of innovation theory with multiple case study and adapted realist principles. Practitioners in 12 English sites worked with Consultant Nurse implementers to manipulate the programme theory and logic of new decision-support tools and care pathway to optimize local implementation. Methods included key-stakeholder interviews, developing practical diffusion of innovation processes using key-opinion leaders and active facilitation strategies and a mini-community of practice. New and existing processes and outcomes were compared for 137 children during 2007-2008. RESULTS: Realist principles were successfully adapted to a shorter policy implementation and evaluation time frame. Important new implementation success factors included facilitated implementation that enabled 'real-time' manipulation of programme logic and local context to best-fit evolving theories of what worked; using local experiential opinion to change supporting tools to more realistically align with local context and what worked; and having sufficient existing local infrastructure to support implementation. Ten mechanisms explained implementation success and differences in outcomes between new and existing processes. CONCLUSIONS: Realistic policy implementation methods have advantages over top-down approaches, especially where clinical expertise is low and unlikely to diffuse innovations 'naturally' without facilitated implementation and local optimization. PMID:23713840

Noyes, Jane; Lewis, Mary; Bennett, Virginia; Widdas, David; Brombley, Karen

2013-05-28

13

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

PubMed Central

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 of the fortunes of different subprojects identified aspects of context and mechanism that accounted for observed outcomes (both intended and unintended). Conclusions: This study was one of the first applications of realist evaluation to a large-scale change effort in health care. Even when an ambitious change program shifts from its original goals and meets unforeseen challenges (indeed, precisely because the program morphs and adapts over time), realist evaluation can draw useful lessons about how particular preconditions make particular outcomes more likely, even though it cannot produce predictive guidance or a simple recipe for success. Noting recent calls by others for the greater use of realist evaluation in health care, this article considers some of the challenges and limitations of this method in the light of this experience and suggests that its use will require some fundamental changes in the worldview of some health services researchers.

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

2009-01-01

14

A Realistic Empirical Evaluation of the Costs and Benefits of UML in Software Maintenance  

Microsoft Academic Search

The Unified Modeling Language (UML) is the de facto standard for object-oriented software analysis and design modeling. However, few empirical studies exist which investigate the costs and evaluate the benefits of using UML in realistic contexts. Such studies are needed so that the software industry can make informed decisions regarding the extent to which they should adopt UML in their

Wojciech James Dzidek; Erik Arisholm; Lionel C. Briand

2008-01-01

15

Creating Realistic Laboratory Settings: Comparative Studies of Three Think-Aloud Usability Evaluations of a Mobile System  

Microsoft Academic Search

This paper addresses the issue of creating a realistic laboratory setting when evaluating the usability of mobile systems. Three laboratory-based think-aloud evaluations of the same mobile system were designed and conducted for the purpose of comparing the impact of different approaches to creating realistic laboratory environments on the results subsequently produced. The three evaluations spanned the use of test subjects

Mikael B. Skov; Jesper Kjeldskov

2003-01-01

16

Online Assessment, Measurement and Evaluation: Emerging Practices  

ERIC Educational Resources Information Center

"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

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

2006-01-01

17

Transforming the patient care environment with Lean Six Sigma and realistic evaluation.  

PubMed

Lean Six Sigma (LSS) is a structured methodology for transforming processes, but it does not fully consider the complex social interactions that cause processes to form in hospital organizations. By combining LSS implementations with the concept of Realistic Evaluation, a methodology that promotes change by assessing and considering the individual characteristics of an organization's social environment, successful and sustainable process improvement is more likely. PMID:19522345

Black, Jason

2009-01-01

18

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

PubMed Central

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 validate an improved theory on ‘what works for whom and under what conditions’. Discussion The scope for applying realist evaluation to study human resource management interventions in health are discussed.

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

2012-01-01

19

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

PubMed Central

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 complex healthcare interventions. To our knowledge, this study is the first to use CMO associations to improved empirical and theoretical understanding of interdisciplinary teamwork in oncology, and its results could foster more effective implementation in clinical practice.

2014-01-01

20

Multi-Layer Realistic Voice Capacity Evaluation in LTE Rel. 9 and Performance Comparison with PMR and GSM  

Microsoft Academic Search

This paper proposes a multi-layer realistic voice capacity evaluation method for long term evolution (LTE) Release 9 downlink transmission, from a private mobile radio (PMR) perspective. The obtained voice spectral efficiency is also compared with existent PMR networks and global system for mobile communications (GSM). The realistic system model considers both transmission protocols overhead, including internet protocol (IP) and robust

Alina Alexandra Florea; Laurent Martinod; Philippe Mege; Hang Nguyen

2012-01-01

21

Noncontact, Nondestructive Evaluation of Realistic Cracks with Surface Acoustic Waves by Scanning Excitation and Detection Lasers  

NASA Astrophysics Data System (ADS)

Nondestructive evaluation of surface-breaking cracks with a scanning laser source, a scanning laser probe, or a scanning laser pump-probe setup is discussed. Multimode scattering of laser-excited surface acoustic wave pulses by artificial slots, realistic fatigue, or impulsive cracks is considered. This includes measuring the size of cracks in the micrometer-to-millimeter range by optical recording of the complete displacement or velocity field around the crack. Results obtained with a scanning pump-probe setup for a partially closed microcrack, generated by an elastic shock pulse in silica, are compared with those achieved with a scanning source or scanning probe for machined open notches. Crack size analysis based on the frequency spectrum of the reflected Rayleigh wave and the time lag of the transmitted Rayleigh wave is discussed. Signal enhancement effects observed in the displacement and velocity field near the crack are studied.

Hess, P.; Lomonosov, A. M.

2013-09-01

22

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

PubMed Central

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 elsewhere.

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

2012-01-01

23

Toxicological evaluation of realistic emission source aerosols (TERESA): summary and conclusions  

PubMed Central

The toxicological evaluation of realistic emissions of source aerosols (TERESA) study seeks to delineate health effects of aerosols formed from emissions of particulate matter sources. This series of papers reports the findings of experiments using coal-fired power plants as the source of emissions and this paper summarizes the findings and knowledge acquired from these studies. Emissions were drawn directly from the stacks of three coal-fired power plants in the US, and photochemically aged in a mobile laboratory to simulate downwind power plant plume processing. The power plants used different sources of coal and had different emission controls. Exposure scenarios included primary particles, secondary particles and mixtures of these with common atmospheric constituents (?-pinene and ammonia). Extensive exposure characterization was carried out, and toxicological outcomes were evaluated in Sprague-Dawley rats exposed to different emission scenarios. Breathing pattern, pulmonary inflammatory responses, in vivo pulmonary and cardiac chemiluminescence and cardiac response in a model of acute myocardial infarction were assessed. The results showed no response or relatively mild responses to the inhaled aerosols studied; complex scenarios which included oxidized emissions and ?-pinene to simulate biogenic secondary organic aerosol tended to induce more statistically significant responses than scenarios of oxidized and non-oxidized emissions alone. Relating adverse effects to specific components did not consistently identify a toxic constituent. These findings are consistent with most of the previously published studies using pure compounds to model secondary power plant emissions, but importantly add substantial complexity and thus have considerable merit in defining toxicological responses.

Godleski, John J.; Rohr, Annette C.; Coull, Brent A.; Kang, Choong-Min; Diaz, Edgar A.; Koutrakis, Petros

2013-01-01

24

Radiation Emergencies: Evaluation, Management, and Transplantation  

Microsoft Academic Search

Radiation or marrow toxic emergencies can lead to severe pancytopenia along with other multiorgan injury. Experience in managing severe myelosuppression suggests that hematology, oncology and transplantation physicians should participate in preparedness planning for such events. Evaluation and management of marrow injured patients requires their expertise. Understanding of the biology of radiation injury, clinical dosimetry to estimate exposure and defined elements

Daniel Weisdorf; Jane Apperley; Patrick Courmelon; Norbert-Claude Gorin; John Wingard; Nelson Chao

2007-01-01

25

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

PubMed Central

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.

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

2013-01-01

26

Evaluation of the no-disparity realistic image from a sense of presence and low fatigue  

NASA Astrophysics Data System (ADS)

We evaluated an observer's fatigue and a sense of presence, in observing the no-disparity realistic image (NDR image) [1-3]. NDR image is consisted of two images (right and left image). Right image is created by shifting all pixels in left image same amount. Consequently, there are no disparities in all area of NDR image. NDR image which is reconfigured the contents that contain image with large disparity might have a possibility that it suppress an observer's fatigue and let him feel high presence. Subjects observed three condition's videos (stereoscopic, NDR and 2D). Subjects observed two videos in each condition. Each video was 30 minutes. There were scenes with large disparity (more than 5 degrees) in videos. Subjects responded SSQ (Simulator Sickness Questionnaire), VAS (Visual Analogue Scale) for fatigue and questionnaire on realism and were measured CFF (Critical Frequency Fusion), accommodation tremor, stereoscopic vision test, ocular position measurement and eye sight test. Results showed that NDR image let observer feel high presence and an observer's fatigue was low. NDR image is effective, even if contents which contain large disparity are converted into NDR image.

Nate, H.; Natsui, N.; Hayashi, N.; Ishikawa, K.; Hatada, T.; Ichihara, Y.; Miyake, N.; Ushio, Y.

2013-03-01

27

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

Microsoft Academic Search

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

Annette C. Rohr; Petros Koutrakis; John Godleski

2011-01-01

28

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

PubMed

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

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

2010-06-01

29

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

PubMed Central

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 documents an important first step in the effort to introduce the ethical framework A4R into district planning processes. This study supports the idea that a greater involvement and accountability among local actors through the A4R process may increase the legitimacy and fairness of priority-setting decisions. Support from researchers in providing a broader and more detailed analysis of health system elements, and the socio-cultural context, could lead to better prediction of the effects of the innovation and pinpoint stakeholders' concerns, thereby illuminating areas that require special attention to promote sustainability.

2011-01-01

30

Combining Campbell Standards and the Realist Evaluation Approach: The Best of Two Worlds?  

ERIC Educational Resources Information Center

This article presents an approach to systematic reviews that combines the Campbell Collaboration Crime and Justice standards and the realist notion of contexts-mechanisms-outcomes (CMO) configurations. Both approaches have their advantages and drawbacks, and the authors will make a case for combining both approaches to profit from their advantages…

van der Knaap, Leontien M.; Leeuw, Frans L.; Bogaerts, Stefan; Nijssen, Laura T. J.

2008-01-01

31

Exclusion of context knowledge in the development of prehospital guidelines: results produced by realistic evaluation  

PubMed Central

Background Prehospital work is accomplished using guidelines and protocols, but there is evidence suggesting that compliance with guidelines is sometimes low in the prehospital setting. The reason for the poor compliance is not known. The objective of this study was to describe how guidelines and protocols are used in the prehospital context. Methods This was a single-case study with realistic evaluation as a methodological framework. The study took place in an ambulance organization in Sweden. The data collection was divided into four phases, where phase one consisted of a literature screening and selection of a theoretical framework. In phase two, semi-structured interviews with the ambulance organization's stakeholders, responsible for the development and implementation of guidelines, were performed. The third phase, observations, comprised 30 participants from both a rural and an urban ambulance station. In the last phase, two focus group interviews were performed. A template analysis style of documents, interviews and observation protocols was used. Results The development of guidelines took place using an informal consensus approach, where no party from the end users was represented. The development process resulted in guidelines with an insufficiently adapted format for the prehospital context. At local level, there was a conscious implementation strategy with lectures and manikin simulation. The physical format of the guidelines was the main obstacle to explicit use. Due to the format, the ambulance personnel feel they have to learn the content of the guidelines by heart. Explicit use of the guidelines in the assessment of patients was uncommon. Many ambulance personnel developed homemade guidelines in both electronic and paper format. The ambulance personnel in the study generally took a positive view of working with guidelines and protocols and they regarded them as indispensable in prehospital care, but an improved format was requested by both representatives of the organization and the ambulance personnel. Conclusions The personnel take a positive view of the use of guidelines and protocols in prehospital work. The main obstacle to the use of guidelines and protocols in this organization is the format, due to the exclusion of context knowledge in the development process.

2013-01-01

32

Evaluation of an Emerging Research Center: Lessons Learned  

PubMed Central

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 M?noa 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 celebration of successes, as well as early identification of problems and rapid response.

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

2012-01-01

33

Emergency building temperature restrictions. Final evaluation  

SciTech Connect

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.

None

1980-11-01

34

Realistic Solar Convection Simulations  

Microsoft Academic Search

We report on realistic simulations of solar surface convection that are essentially parameter-free, but include detailed physics in the equation of state and radiative energy exchange. The simulation results are compared quantitatively with observations. Excellent agreement is obtained for the distribution of the emergent continuum intensity, the profiles of weak photospheric lines, the p-mode frequencies, the asymmetrical shape of the

Robert F. Stein; Åke Nordlund

2000-01-01

35

Realistic Expectations: Constructing a Mission-Based Evaluation Model for Community Corrections Programs  

Microsoft Academic Search

Correctional practitioners have long argued that evaluators focus too heavily on recidivism measures and thus understate the value of their programs. The author asserts that the impact of community corrections programs can be more comprehensively evaluated when evaluation plans include measures that assess whether program goals, objectives, and overall mission were met. Therefore, the intent of this article is to

Crystal A. Garcia

2004-01-01

36

Emergency department evaluation of child abuse.  

PubMed

Child abuse presents commonly to emergency departments. Emergency providers are confronted with medical, social, and legal dilemmas with each case. A solid understanding of the definitions and risk factors of victims and perpetrators aids in identifying abuse cases. Forensic examination should be performed only after the child is medically stable. Emergency providers are mandatory reporters of a reasonable suspicion of abuse. The role of the emergency provider is to identify abuse, facilitate a thorough investigation, treat medical needs, protect the patient, provide an unbiased medical consultation to law enforcement, and to provide an ethical testimony if called to court. PMID:23915607

Leetch, Aaron N; Woolridge, Dale

2013-08-01

37

A Realistic Neural Mass Model of the Cortex with Laminar-Specific Connections and Synaptic Plasticity - Evaluation with Auditory Habituation  

PubMed Central

In this work we propose a biologically realistic local cortical circuit model (LCCM), based on neural masses, that incorporates important aspects of the functional organization of the brain that have not been covered by previous models: (1) activity dependent plasticity of excitatory synaptic couplings via depleting and recycling of neurotransmitters and (2) realistic inter-laminar dynamics via laminar-specific distribution of and connections between neural populations. The potential of the LCCM was demonstrated by accounting for the process of auditory habituation. The model parameters were specified using Bayesian inference. It was found that: (1) besides the major serial excitatory information pathway (layer 4 to layer 2/3 to layer 5/6), there exists a parallel “short-cut” pathway (layer 4 to layer 5/6), (2) the excitatory signal flow from the pyramidal cells to the inhibitory interneurons seems to be more intra-laminar while, in contrast, the inhibitory signal flow from inhibitory interneurons to the pyramidal cells seems to be both intra- and inter-laminar, and (3) the habituation rates of the connections are unsymmetrical: forward connections (from layer 4 to layer 2/3) are more strongly habituated than backward connections (from Layer 5/6 to layer 4). Our evaluation demonstrates that the novel features of the LCCM are of crucial importance for mechanistic explanations of brain function. The incorporation of these features into a mass model makes them applicable to modeling based on macroscopic data (like EEG or MEG), which are usually available in human experiments. Our LCCM is therefore a valuable building block for future realistic models of human cognitive function.

Wang, Peng; Knosche, Thomas R.

2013-01-01

38

Relevance of joint action toxicity evaluations in setting realistic environmental safe limits of heavy metals  

Microsoft Academic Search

The evaluation of types of toxicological interactions existing between heavy metals, which are prominent in effluents of some industrial establishments in Lagos State, Nigeria and the Lagos lagoon sediment was carried out against benthic animals, Tympanotonus fuscatus, Clibanarius africanus and Sesarma huzardi of the Lagos lagoon. In order to determine the type of interactions existing between the metals, acute toxicity

Adebayo Akeem Otitoloju

2003-01-01

39

Evaluation of Emergency Medicine Community Educational Program  

PubMed Central

Out-of-hospital emergencies occur frequently, and laypersons are often the first to respond to these events. As an outreach to our local communities, we developed “Basic Emergency Interventions Everyone Should Know,” a three-hour program addressing cardiopulmonary resuscitation and automated external defibrillator use, heart attack and stroke recognition and intervention, choking and bleeding interventions and infant and child safety. Each session lasted 45 minutes and was facilitated by volunteers from the emergency department staff. A self-administered 13-item questionnaire was completed by each participant before and after the program. A total of 183 participants completed the training and questionnaires. Average score pre-training was nine while the average score post-training was 12 out of a possible 13 (P< .0001). At the conclusion of the program 97% of participants felt the training was very valuable and 100% would recommend the program to other members of their community.

Garcia, Estevan Adan; Likourezos, Antonios; Ramsay, Carl; Hoffman, Sherry; Niles, Christopher; Pearl-Davis, Michelle; Podolsky, Seth; Davidson, Steven J.

2010-01-01

40

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

PubMed Central

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.

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

2014-01-01

41

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

NASA Technical Reports Server (NTRS)

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.

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

2000-01-01

42

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

Microsoft Academic Search

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

Chung-Hsin Lu; Jen-Hsin Teng; Yung-Muh Yang; Bor-Jing Chang

2010-01-01

43

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

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 therefore should contribute to the evidence base about an increasingly popular (e.g., Mode two, integrated knowledge transfer, interactive research), but poorly understood approach to knowledge translation. Additionally we hope to develop approaches for evaluating implementation processes and impacts particularly with respect to integrated stakeholder involvement.

2011-01-01

44

Monte Carlo evaluation of water equivalency of some plastic materials for realistic electron IORT beams  

NASA Astrophysics Data System (ADS)

The water equivalency of some commercially available water substitute materials for high energy electron beams dosimetry (PMMA, polystyrene and solid water WT1) has been investigated in this work for electron beams generated by the IORT linear accelerator NOVAC 7. The beams were simulated by the BEAMnrc/EGSnrc Monte Carlo code, while the dose distributions in water and plastic phantoms were calculated using DOSXYZnrc. The stopping power ratios were evaluated using SPRRZnrc user code. The results obtained for the depth-and fluence-scaling factors have been compared with the values recommended by the TRS-398 IAEA code of practice for absorbed dose determination in external beam radiotherapy. Due to the significant differences observed (sometimes more than 1%) and to the dependence of the scaling factors on the beam quality we can conclude that every time when plastic phantoms are used in electron IORT dosimetry, a theoretical or experimental investigation of the water equivalency of the water substitute materials must be done.

Oprea, M.; Mihailescu, D.; Borcia, C.

2012-12-01

45

Development and evaluation of realistic microbioassays in freely suspended droplets on a chip  

PubMed Central

A novel technique for biomolecular detection in microliter droplets floating on the surface of high density oil is presented. Each droplet was captured and manipulated dielectrophoretically and was used as a site for a microscopic bioassay based on agglutination of antibody-conjugated particles. The results were read out by the pattern of unagglomerated gold nanoparticles collected on the droplet surface. Two formats of bioassays, namely gold only agglutination and gold and latex agglutination, were investigated experimentally by varying analyte concentration, particle size and concentration, number of antigen binding sites per particle, time for incubation, and rate of particle collection on the droplet surface. The microbioassays performance was also evaluated with ricin antibodies and compared to the ricin assays in field use. It is estimated that the droplet based assays require 100× smaller sample volume and are ten times more sensitive, though they require longer times to complete. The experiments were interpreted by modeling the kinetics of particle agglutination and mass transfer processes inside the droplets. The incubation time and antigen concentration values calculated by the model correlate well with the experimental results. The results could allow for development of efficient immunoassays on a chip requiring even smaller sample volumes.

Rastogi, Vinayak; Velev, Orlin D.

2007-01-01

46

Notes on the Implementation of Non-Parametric Statistics within the Westinghouse Realistic Large Break LOCA Evaluation Model (ASTRUM)  

SciTech Connect

In recent years, non-parametric or order statistics methods have been widely used to assess the impact of the uncertainties within Best-Estimate LOCA evaluation models. The bounding of the uncertainties is achieved with a direct Monte Carlo sampling of the uncertainty attributes, with the minimum trial number selected to 'stabilize' the estimation of the critical output values (peak cladding temperature (PCT), local maximum oxidation (LMO), and core-wide oxidation (CWO A non-parametric order statistics uncertainty analysis was recently implemented within the Westinghouse Realistic Large Break LOCA evaluation model, also referred to as 'Automated Statistical Treatment of Uncertainty Method' (ASTRUM). The implementation or interpretation of order statistics in safety analysis is not fully consistent within the industry. This has led to an extensive public debate among regulators and researchers which can be found in the open literature. The USNRC-approved Westinghouse method follows a rigorous implementation of the order statistics theory, which leads to the execution of 124 simulations within a Large Break LOCA analysis. This is a solid approach which guarantees that a bounding value (at 95% probability) of the 95{sup th} percentile for each of the three 10 CFR 50.46 ECCS design acceptance criteria (PCT, LMO and CWO) is obtained. The objective of this paper is to provide additional insights on the ASTRUM statistical approach, with a more in-depth analysis of pros and cons of the order statistics and of the Westinghouse approach in the implementation of this statistical methodology. (authors)

Frepoli, Cesare; Oriani, Luca [Westinghouse Electric Company, Pittsburgh, PA-15230-0350 (United States)

2006-07-01

47

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

SciTech Connect

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 scenarios utilizing secondary particles (oxidized emissions) ranged from 70-256 {micro}g/m{sup 3}, and some of the atmospheres contained high acidity levels (up to 49 {micro}g/m{sup 3} equivalent of sulfuric acid). However, caution must be used in generalizing these results to other power plants utilizing different coal types and with different plant configurations, as the emissions may vary based on these factors.

Annette Rohr

2006-03-01

48

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

SciTech Connect

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 (BAL) fluid cytology and biochemistry; (3) blood cytology; (4) in vivo oxidative stress in heart and lung tissue; and (5) heart and lung histopathology. In addition, at one plant, cardiac arrhythmias and heart rate variability (HRV) were evaluated in a rat model of myocardial infarction. Statistical analyses included analyses of variance (ANOVA) to determine differences between exposed and control animals in response to different scenario/plant combinations; univariate analyses to link individual scenario components to responses; and multivariate analyses (Random Forest analyses) to evaluate component effects in a multipollutant setting. Results from the power plant studies indicated some biological responses to some plant/scenario combinations. A number of significant breathing pattern changes were observed; however, significant clinical changes such as specific irritant effects were not readily apparent, and effects tended to be isolated changes in certain respiratory parameters. Some individual exposure scenario components appeared to be more strongly and consistently related to respiratory parameter changes; however, the specific scenario investigated remained a better predictor of response than individual components of that scenario. Bronchoalveolar lavage indicated some changes in cellularity of BAL fluid in response to the POS and PONS scenarios; these responses were considered toxicologically mild in magnitude. No changes in blood cytology were observed at any plant or scenario. Lung oxidative stress was increased with the POS scenario at one plant, and cardiac oxidative stress was increased with the PONS scenario also at one plant, suggesting limited oxidative stress in response to power plant emissions with added atmospheric constituents. There were some mild histological findings in lung tissue in response to the P and PONS scenarios. Finally, the MI model experiments indicated that premature ventricular beat frequency was increased at the plant studied, while no changes in heart rate, HRV, or electrocardiographic intervals were observed. Overall, the

Annette C. Rohr; Petros Koutrakis; John Godleski

2011-03-31

49

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

PubMed Central

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.

Serrano, Emilio; Poveda, Geovanny; Garijo, Mercedes

2014-01-01

50

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

PubMed

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

Serrano, Emilio; Poveda, Geovanny; Garijo, Mercedes

2014-01-01

51

Evaluation: Emergence, Mode of Inquiry, Theory and Practice  

ERIC Educational Resources Information Center

The aim of this article is to present the reader with an accessible and practical account of evaluation as a mode of inquiry within the broad domain of social science. The starting point is the presentation of a general outline of the main milestones relating to the emergence of evaluation as a mode of inquiry and some of the prominent advocates…

Kenny, Aidan

2007-01-01

52

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

PubMed Central

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 holistic view of the health worker and their work.

2014-01-01

53

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

ERIC Educational Resources Information Center

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…

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

2005-01-01

54

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

PubMed Central

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. Conclusions Findings suggest that the theory-driven mechanisms underpinning the utilisation of feedback from computer-based technology for home-based upper-limb post-stroke rehabilitation are dependent on key elements of computer feedback and the personal and environmental context. The identification of these elements may therefore inform the development of technology; therapy education and the subsequent adoption of technology and a self-management paradigm; long-term self-managed rehabilitation; and importantly, improvements in the physical and psychosocial aspects of recovery.

2014-01-01

55

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

PubMed Central

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 refine the resulting theories to reflect the experience of a broader range of surgical disciplines. The study will provide (i) guidance to healthcare organisations on factors likely to facilitate successful implementation and integration of robotic surgery, and (ii) guidance on how to ensure effective communication and teamwork when undertaking robotic surgery.

2014-01-01

56

Evaluation of the Emergency Response Dose Assessment System(ERDAS)  

NASA Technical Reports Server (NTRS)

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.

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

1996-01-01

57

United States Coast Guard Emergency Underwater Escape Rebreather Evaluation.  

National Technical Information Service (NTIS)

The United States Coast Guard (USCG) Emergency Underwater Escape Rebreather (UER) was evaluated at the Navy Experimental Diving Unit. Physiologic testing in the dry laboratory, monitoring breath-to-breath O2 and CO2 levels, delineated the factors used in ...

C. G. Gray E. O. Thalmann R. Syklawer

1981-01-01

58

Emergency Medical Technician Performance Evaluation. NCHSR Research Report Series.  

ERIC Educational Resources Information Center

An evaluation was conducted of the diagnostic accuracy and treatment appropriateness of emergency medical technicians (EMTs) in caring for 4,455 consecutive patients during a four-and-one-half month period. Data on EMT diagnosis and treatment and physician diagnosis were collected, and EMT data validated by observers. There were fifty-eight…

Frazier, William H.; Cannon, Joseph F.

59

Evaluation of a Medical Emergency Team one year after implementation  

Microsoft Academic Search

Aim: To evaluate the activity and impact of a Medical Emergency Team (MET) one year after implementation. Setting and population: A 700-bed District General Hospital (DGH) in Southeast England with approximately 53,500 adult admissions per annum. The population studied included all adult admissions receiving intervention by the MET during a 12-month period between 1 October 2000 and 30 September 2001.

Gary Kenward; Nicolas Castle; Timothy Hodgetts; Loua Shaikh

2004-01-01

60

Evaluating Emergency Medicine Faculty at End-of-Shift  

PubMed Central

Introduction Faculty often evaluate learners in the emergency department (ED) at the end of each shift. In contrast, learners usually evaluate faculty only at the end of a rotation. In December 2007 Southern Illinois University School of Medicine changed its evaluation process, requiring ED trainees to complete end-of-shift evaluations of faculty. Objective Determine the feasibility and acceptance of end-of-shift evaluations for emergency medicine faculty. Methods We conducted this one-year observational study at two hospitals with 120,000 combined annual ED visits. Trainees (residents and students) anonymously completed seven-item shift evaluations and placed them in a locked box. Trainees and faculty completed a survey about the new process. Results During the study, trainees were assigned 699 shifts, and 633 end-of-shift evaluations were collected for a completion rate of 91%. The median number of ratings per faculty was 31, and the median number of comments was 11 for each faculty. The survey was completed by 16/22 (73%) faculty and 41/69 (59%) trainees. A majority of faculty (86%) and trainees (76%) felt comfortable being evaluated at end-of-shift. No trainees felt it was a time burden. Conclusion Evaluating faculty following an ED shift is feasible. End-of-shift faculty evaluations are accepted by trainees and faculty.

Kovach, Regina A.; Griffen, David L.; Francis, Mark L.

2010-01-01

61

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

NASA Astrophysics Data System (ADS)

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.

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

2010-06-01

62

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

SciTech Connect

This report documents progress made on the subject project during the period of March 1, 2004 through August 31, 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 (henceforth referred to as Plant 0, and located in the Upper Midwest), followed by the performance and analysis of similar field experiments at two additional coal-fired power plants (Plants 1 and 2) utilizing different coal types and with different plant configurations. Significant progress was made on the Project during this reporting period, with field work being initiated at Plant 0. Initial testing of the stack sampling system and reaction apparatus revealed that primary particle concentrations were lower than expected in the emissions entering the mobile chemical laboratory. Initial animal exposures to primary emissions were carried out (Scenario 1) to ensure successful implementation of all study methodologies and toxicological assessments. Results indicated no significant toxicological effects in response to primary emissions exposures. Exposures were then carried out to diluted, oxidized, neutralized emissions with the addition of secondary organic aerosol (Scenario 5), both during the day and also at night when primary particle concentrations in the sampled stack emissions tended to be 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.

Annette Rohr

2004-12-02

63

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

SciTech Connect

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 through variations in reaction conditions. Because of the critical role played by this component in ensuring the overall success of the project, more time was required to develop and optimize the system, and the one-chamber simulation system outlined in the original Scope of Work for the Agreement was modified to comprise a more realistic dual chamber system. We are confident that the additional time required to optimize these methodologies will result in a significant improvement in the study. We fully expect that results for tasks covered under the Agreement, and a complete discussion of their relevance and value, will be included in the next semiannual progress report.

Annette Rohr

2004-02-29

64

Emergency Oxygen System Evaluation for Exploration PLSS Applications  

NASA Technical Reports Server (NTRS)

The Portable Life Support System (PLSS) emergency oxygen system is being reexamined for the next generation of suits. These suits will be used for transit to Low Earth Orbit, the Moon and to Mars as well as on the surface of the Moon and Mars. Currently, the plan is that there will be two different sets of suits, but there is a strong desire for commonality between them for construction purposes. The main purpose of this paper is to evaluate what the emergency PLSS requirements are and how they might best be implemented. Options under consideration are enlarging the tanks on the PLSS, finding an alternate method of storage/delivery, or providing additional O2 from an external source. The system that shows the most promise is the cryogenic oxygen system with a composite dewar which uses a buddy system to split the necessary oxygen between two astronauts.

Heather, Paul; Vonau, Walt, Jr.; Conger, Bruce

2006-01-01

65

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

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.

2014-01-01

66

Emergency exercise methodology  

SciTech Connect

Competence for proper response to hazardous materials emergencies is enhanced and effectively measured by exercises which test plans and procedures and validate training. Emergency exercises are most effective when realistic criteria is used and a sequence of events is followed. The scenario is developed from pre-determined exercise objectives based on hazard analyses, actual plans and procedures. The scenario should address findings from previous exercises and actual emergencies. Exercise rules establish the extent of play and address contingencies during the exercise. All exercise personnel are assigned roles as players, controllers or evaluators. These participants should receive specialized training in advance. A methodology for writing an emergency exercise plan will be detailed.

Klimczak, C.A.

1993-03-01

67

Emergency exercise methodology  

SciTech Connect

Competence for proper response to hazardous materials emergencies is enhanced and effectively measured by exercises which test plans and procedures and validate training. Emergency exercises are most effective when realistic criteria is used and a sequence of events is followed. The scenario is developed from pre-determined exercise objectives based on hazard analyses, actual plans and procedures. The scenario should address findings from previous exercises and actual emergencies. Exercise rules establish the extent of play and address contingencies during the exercise. All exercise personnel are assigned roles as players, controllers or evaluators. These participants should receive specialized training in advance. A methodology for writing an emergency exercise plan will be detailed.

Klimczak, C.A.

1993-01-01

68

Evaluation of chest pain in the emergency department.  

PubMed

The evaluation of chest pain in the emergency setting should be systematic, risk based, and goal driven. An effective program must be able to evaluate all patients with equal thoroughness under the assumption that any patient with chest pain could potentially be having an MI. The initial evaluation is based on the history, a focused physical examination, and the ECG. This information is sufficient to categorize patients into groups at high, moderate, and low risk. Table 14 is a template for a comprehensive chest-pain evaluation program. Patients at high risk need rapid initiation of appropriate therapy: thrombolytics or primary angioplasty for the patients with MIs or aspirin/heparin for the patients with unstable angina. Patients at moderate risk need to have an acute coronary syndrome ruled in or out expediently and additional comorbidities addressed before discharge. Patients at low risk also need to be evaluated, and once the likelihood of an unstable acute coronary syndrome is eliminated, they can be discharged with further evaluation performed as outpatients. Subsequent evaluation should attempt to assign a definitive diagnosis while also addressing issues specific to risk reduction, such as cholesterol lowering and smoking cessation. It is well documented that 4% to 5% of patients with MIs are inadvertently missed during the initial evaluation. This number is surprisingly consistent among many studies using various protocols and suggests that an initial evaluation limited to the history, physical examination, and ECG will fail to identify the small number of these patients who otherwise appear at low risk. The solution is to improve the sensitivity of the evaluation process to identify these patients. It appears that more than simple observation is required, and at the present time, no simple laboratory test can meet this need. However, success has been reported with a number of strategies including emergency imaging with either radionuclides such as sestamibi or echocardiography. Early provocative testing, either stress or pharmaceutic, may also be effective. The added value of these tests is only in their use as part of a systematic protocol for the evaluation of all patients with acute chest pain. The initial evaluation of the patient with chest pain should always consider cardiac ischemia as the cause, even in those with more atypical symptoms in whom a cardiac origin is considered less likely. The explicit goals for the evaluation of acute chest pain should be to reduce the time to treat MIs and to reduce the inadvertent discharge of patients with occult acute coronary syndromes. All physicians should become familiar with appropriate risk stratification of patients with acute chest pain. Systematic strategies must be in place to assure rapid and consistent identification of all patients and the expedient initiation of treatment for those patients with acute coronary syndromes. These strategies should include additional methods of identifying acute coronary syndromes in patients initially appearing as at moderate or low risk to assure that no unstable patients are discharged. All patients should be followed up closely until the cardiovascular evaluation is completed and, when possible, a definitive diagnosis is determined. Finally, this must be done efficiently, cost-effectively, and in a manner that will result in an overall improvement in patient care. PMID:9107535

Jesse, R L; Kontos, M C

1997-04-01

69

Noninvasive Evaluation of Portal Hypertension: Emerging Tools and Techniques  

PubMed Central

Portal hypertension is the main cause of complications in patients with cirrhosis. However, evaluating the development and progression of portal hypertension represents a challenge for clinicians. There has been considerable focus on the potential role of noninvasive markers of portal hypertension that could be used to stratify patients with respect to the stage of portal hypertension and to monitor disease progression or treatment response in a longitudinal manner without having to undertake repeated invasive assessment. The pathogenesis of portal hypertension is increasingly understood and emerging knowledge of the vascular processes that underpin portal hypertension has paved the way for exploring novel biomarkers of vascular injury, angiogenesis, and endothelial dysfunction. In this paper we focus on the pathogenesis of portal hypertension and potential non-invasive biomarkers with particular emphasis on serum analytes.

Snowdon, V. K.; Guha, N.; Fallowfield, J. A.

2012-01-01

70

Blood Cultures in the Emergency Department Evaluation of Childhood Pneumonia  

PubMed Central

Background Blood cultures are frequently obtained in the emergency department (ED) evaluation of children with community-acquired pneumonia (CAP). Objectives To determine the prevalence of bacteremia in children presenting to the ED with CAP, identify subgroups at increased risk for bacteremia, and quantify the impact of positive blood cultures on management. Methods This case-control study was nested within a cohort of children followed at 35 pediatric practices. Patients from this cohort who were ?18 years of age, evaluated in the ED in 2006–2007, and diagnosed with CAP were eligible. Cases were those with bacteremia. Controls included those with negative blood cultures and those without blood cultures performed. Results 877 (9.6%) of 9,099 children with CAP were evaluated in the ED. The mean age was 3.6 years; 53% were male. Blood cultures were obtained in 291 children (33.2%). Overall, the prevalence of bacteremia was 2.1% (95% confidence interval [CI]: 0.8%–4.4%). Bacteremia occurred in 2.6% (95% CI: 1.0%–5.6%) with an infiltrate on chest radiograph and in 13.0% (95% CI: 2.8%–33.6%) with complicated pneumonia. Streptococcus pneumoniae accounted for 4 of the 6 cases of bacteremia. Blood culture results altered management in 5 of the 6 bacteremic patients; 1 had an appropriate broadening and 4 had an appropriate narrowing of coverage. The contamination rate was 1.0% (95% CI: 0.2%–3.0%). Conclusion Children presenting to the ED for evaluation of CAP are at low risk for bacteremia. Although positive blood cultures frequently altered clinical management, the overall impact was small given the low prevalence of bacteremia.

Shah, Samir S.; Dugan, Maria H.; Bell, Louis M.; Grundmeier, Robert W.; Florin, Todd A.; Hines, Elizabeth M.; Metlay, Joshua P.

2010-01-01

71

Methods for Review and Evaluation of Emergency Procedure Guidelines Volume I: Methodologies.  

National Technical Information Service (NTIS)

Systematic methods for reviewing and evaluating improved emergency procedure guidelines are presented. The deficiencies of existing 'event-oriented' emergency procedures are discussed and the industry efforts to produce improved guidelines in the aftermat...

J. L. von Herrmann

1983-01-01

72

A controlled evaluation of comprehensive geriatric assessment in the emergency department: the 'Emergency Frailty Unit'  

PubMed Central

Background: the ageing demographic means that increasing numbers of older people will be attending emergency departments (EDs). Little previous research has focused on the needs of older people in ED and there have been no evaluations of comprehensive geriatric assessment (CGA) embedded within the ED setting. Methods: a pre-post cohort study of the impact of embedding CGA within a large ED in the East Midlands, UK. The primary outcome was admission avoidance from the ED, with readmissions, length of stay and bed-day use as secondary outcomes. Results: attendances to ED increased in older people over the study period, whereas the ED conversion rate fell from 69.6 to 61.2% in people aged 85+, and readmission rates in this group fell from 26.0% at 90 days to 19.9%. In-patient bed-day use increased slightly, as did the mean length of stay. Discussion: it is possible to embed CGA within EDs, which is associated with improvements in operational outcomes.

Conroy, Simon Paul; Ansari, Kharwar; Williams, Mark; Laithwaite, Emily; Teasdale, Ben; Dawson, Jeremey; Mason, Suzanne; Banerjee, Jay

2014-01-01

73

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

SciTech Connect

This report documents progress made on the subject project during the period of September 1, 2004 through February 28, 2005. 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 performance and analysis of field experiments at the first TERESA plant, located in the Upper Midwest and henceforth referred to as Plant 0, and at two additional coal-fired power plants (Plants 1 and 2) utilizing different coal types and with different plant configurations. During this reporting period, all fieldwork at Plant 0 was completed. Stack sampling was conducted in October to determine if there were significant differences between the in-stack PM concentrations and the diluted concentrations used for the animal exposures. Results indicated no significant differences and therefore confidence that the revised stack sampling methodology described in the previous semiannual report is appropriate for use in the Project. Animal exposures to three atmospheric scenarios were carried out. From October 4-7, we conducted exposures to oxidized emissions with the addition of secondary organic aerosol (SOA). Later in October, exposures to the most complex scenario (oxidized, neutralized emissions plus SOA) were repeated to ensure comparability with the results of the June/July exposures where a different stack sampling setup was employed. In November, exposures to oxidized 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 the fieldwork at Plant 1, including toxicological findings and interpretation.

Annette Rohr

2005-03-31

74

Performance Evaluation of Emerging High Performance Computing Technologies using WRF  

NASA Astrophysics Data System (ADS)

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 generations of GPUs lack a sufficient balance of computational resources to replace the general-purpose microprocessor found in most traditional supercomputer architectures. ARSC has also worked with the Cell Broadband Engine in a small Playstation3 cluster, as well as a 24-processor system based on IBM's QS22 blades. The QS22 system, called Quasar, features the PowerXCell 8i processor found in the RoadRunner system, along with an InfiniBand network and high performance storage. Quasar overcomes the limitations of the small memory and relatively slow network of the PS3 systems. The presentation will include system-level benchmarks on Quasar, as well as evaluation of the WRF test cases. Another technology evaluation focused on Sun's UltraSPARC T2+ processor, which ARSC evaluated in a two-way system. Each T2+ provides eight processor cores, each of which provides eight threads, for a total of 128 threads in a single system. WRF scalability was good up to the number of cores, but multiple threads per core did not scale as well. Throughout the discussion, practical findings from ARSC will be summarized. While multicore general-purpose microprocessors are anticipated to remain important for large computers running earth and space science applications, the role of other potentially disruptive technologies is less certain. Limitations of current and future technologies will be discussed. class="ab'>

Newby, G. B.; Morton, D.

2008-12-01

75

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

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 relative error in the residence time estimates taken over the phantom population. The mean errors in the residence time estimates over all the organs were <9.9% (pure QSPECT), <13.2% (pure QPLanar), <7.2% (hybrid QPlanar/QSPECT), <19.2% (hybrid CPlanar/QSPECT), and 7%-159% (pure CPlanar). The standard deviations of the errors for all the organs over all the phantoms were <9.9%, <11.9%, <10.8%, <22.0%, and <107.9% for the same methods, respectively. The processing methods differed both in terms of their average accuracy and the variation of the accuracy over the population of phantoms, thus demonstrating the importance of using a phantom population in evaluating quantitative imaging methods. Hybrid CPlanar/QSPECT provided improved accuracy compared to pure CPlanar and required the addition of only a single SPECT acquisition. The QPlanar or hybrid QPlanar/QSPECT methods had mean errors and standard deviations of errors that approached those of pure QSPECT while providing simplified image acquisition protocols, and thus may be more clinically practical.

He Bin; Du Yong; Segars, W. Paul; Wahl, Richard L.; Sgouros, George; Jacene, Heather; Frey, Eric C. [Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, Maryland 21287-0859 (United States)

2009-02-15

76

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

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 relative error in the residence time estimates taken over the phantom population. The mean errors in the residence time estimates over all the organs were < 9.9% (pure QSPECT), < 13.2% (pure QPLanar), < 7.2% (hybrid QPlanar/QSPECT), < 19.2% (hybrid CPlanar/QSPECT), and 7%-159% (pure CPlanar). The standard deviations of the errors for all the organs over all the phantoms were < 9.9%, < 11.9%, < 10.8%, < 22.0%, and < 107.9% for the same methods, respectively. The processing methods differed both in terms of their average accuracy and the variation of the accuracy over the population of phantoms, thus demonstrating the importance of using a phantom population in evaluating quantitative imaging methods. Hybrid CPlanar/QSPECT provided improved accuracy compared to pure CPlanar and required the addition of only a single SPECT acquisition. The QPlanar or hybrid QPlanar/QSPECT methods had mean errors and standard deviations of errors that approached those of pure QSPECT while providing simplified image acquisition protocols, and thus may be more clinically practical. PMID:19292001

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

2009-02-01

77

Technical Evaluation Report, Emergency Diesel Generator Technical Specifications Study Results.  

National Technical Information Service (NTIS)

The purpose of this report is to review technical specifications for emergency diesel generators in the context of new information developed in the Nuclear Plant Aging Research Program and the application of current NRC regulatory concepts and knowledge. ...

K. R. Hoopingarner

1991-01-01

78

An evaluation of emerging vaccines for childhood meningococcal disease  

Microsoft Academic Search

Background  Meningococcal meningitis is a major cause of disease worldwide, with frequent epidemics particularly affecting an area of\\u000a sub-Saharan Africa known as the “meningitis belt”. Neisseria meningitidis group A (MenA) is responsible for major epidemics in Africa. Recently W-135 has emerged as an important pathogen. Currently,\\u000a the strategy for control of such outbreaks is emergency use of meningococcal (MC) polysaccharide vaccines,

Debajeet Choudhuri; Tanvir Huda; Evropi Theodoratou; Harish Nair; Lina Zgaga; Rachel Falconer; Ivana Luksic; Hope L Johnson; Jian Shayne F Zhang; Shams El Arifeen; Christopher B Nelson; Ray Borrow; Harry Campbell; Igor Rudan

2011-01-01

79

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...

80

Realistic Animation of Liquids  

Microsoft Academic Search

We present a comprehensive methodology for realistically animating liquid phenomena. Our ap- proach unifies existing computer graphics techniques for simulating fluids and extends them by incorporating more complex behavior. It is based on the Navier-Stokes equations which couple momentum and mass conservation to completely describe fluid motion. Our starting point is an environment containing an arbitrary distribution of fluid, and

Nick Foster; Dimitris N. Metaxas

1996-01-01

81

Evaluation and management of bradydysrhythmias in the emergency department.  

PubMed

Bradydysrhythmias represent a collection of cardiac conduction abnormalities that span the spectrum of emergency presentations, from relatively benign conditions to conditions that represent serious, life-threatening emergencies. This review presents the electrocardiographic findings seen in common bradydysrhythmias and emphasizes prompt recognition of these patterns. Underlying etiologies that may accompany these conduction abnormalities are discussed, including bradydysrhythmias that are reflex mediated (including trauma induced) and those with metabolic, environmental, infectious, and toxicologic causes. Evidence regarding the management of bradydysrhythmias in the emergency department is limited; however, there are data to guide the approach to the unstable bradycardic patient. When decreased end-organ perfusion is present, the use of atropine, beta agonists, and transcutaneous or transvenous pacing may be required. PMID:24044868

Deal, Nathan

2013-09-01

82

Realistic Solar Surface Convection Simulations  

NASA Technical Reports Server (NTRS)

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.

Stein, Robert F.; Nordlund, Ake

2000-01-01

83

Realistic Simulation of Internet  

Microsoft Academic Search

The Internet is a complex collection of various nodes which run independently. The hardware and software of nodes are quite\\u000a diverse and these elements make the complexity of the Internet. It is difficult to model these behaviors, so we proposed and\\u000a implemented StarBED, a large-scale testbed using general PCs and switches. Thus we created an environment for experiment using\\u000a realistic

Toshiyuki Miyachi; Junya Nakata; Razvan Beuran; Ken-ichi Chinen; Kenji Masui; Satoshi Uda; Yasuo Tan; Yoichi Shinoda

84

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

PubMed Central

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 enable district managers to better cope with their contexts may strengthen the institutionalisation of the LDP in the future.

2014-01-01

85

Simulation of realistic retinoscopic measurement  

NASA Astrophysics Data System (ADS)

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.

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

2007-03-01

86

The evaluation and management of acute poisoning emergencies.  

PubMed

Emergency physicians will regularly be called upon to care for poisoned patients. The purpose of this article is to review the general approach to the poisoned patient. Specific signs and symptoms will be identified that may clue the clinician into a specific toxin class as a diagnosis. Necessary testing in poisonings will be highlighted. This article will also introduce the basics of gastrointestinal decontamination and antidotes against select poisons. PMID:18043563

Lawrence, D T; Bechtel, L; Walsh, J P; Holstege, C D

2007-10-01

87

Evaluation of potassium iodide prophylaxis knowledge and nuclear emergency preparedness: New Jersey 2005.  

PubMed

The Nuclear Regulatory Commission requires states to consider including potassium iodide as a protective measure in the unlikely event of a major release of radioactivity from a nuclear power plant. We evaluated emergency preparedness knowledge, including proper potassium iodide use, among the general public and emergency responders located around New Jersey's nuclear power plants. We found that knowledge about responder chain of command, evacuation routes, and some aspects of potassium iodide usage was incomplete among the general public and emergency responders. PMID:17413064

Blando, James; Robertson, Corwin; Pearl, Katina; Dixon, Carline; Valcin, Martin; Bresnitz, Eddy

2007-04-01

88

Constructing Effectiveness: The Emergence of the Evaluation Research Industry  

Microsoft Academic Search

Evaluation research is today an enormous industry, populated by a limited number of large firms and countless smaller ones. In this chapter, we explore the origins and evolution of this industry and the broader program evaluation profession by looking back at the period of the LBJ presidency when evaluation grew as a response to the enlargement of government and the

Peter Frumkin; Kimberly Francis

89

Forecasting Emergency Department Crowding: A Prospective, Real-time Evaluation  

PubMed Central

Objective Emergency department crowding threatens quality and access to health care, and a method of accurately forecasting near-future crowding should enable novel ways to alleviate the problem. The authors sought to implement and validate the previously developed ForecastED discrete event simulation for real-time forecasting of emergency department crowding. Design and Measurements The authors conducted a prospective observational study during a three-month period (5/1/07–8/1/07) in the adult emergency department of a tertiary care medical center. The authors connected the forecasting tool to existing information systems to obtain real-time forecasts of operational data, updated every 10 minutes. The outcome measures included the emergency department waiting count, waiting time, occupancy level, length of stay, boarding count, boarding time, and ambulance diversion; each forecast 2, 4, 6, and 8 hours into the future. Results The authors obtained crowding forecasts at 13,239 10-minute intervals, out of 13,248 possible (99.9%). The R2 values for predicting operational data 8 hours into the future, with 95% confidence intervals, were 0.27 (0.26, 0.29) for waiting count, 0.11 (0.10, 0.12) for waiting time, 0.57 (0.55, 0.58) for occupancy level, 0.69 (0.68, 0.70) for length of stay, 0.61 (0.59, 0.62) for boarding count, and 0.53 (0.51, 0.54) for boarding time. The area under the receiver operating characteristic curve for predicting ambulance diversion 8 hours into the future, with 95% confidence intervals, was 0.85 (0.84, 0.86). Conclusions The ForecastED tool provides accurate forecasts of several input, throughput, and output measures of crowding up to 8 hours into the future. The real-time deployment of the system should be feasible at other emergency departments that have six patient-level variables available through information systems.

Hoot, Nathan R.; LeBlanc, Larry J.; Jones, Ian; Levin, Scott R.; Zhou, Chuan; Gadd, Cynthia S.; Aronsky, Dominik

2009-01-01

90

Evaluation Research of Emergency Logistics System Based on Set Pair Analysis Model  

Microsoft Academic Search

Each year, there are kinds of new diseases or natural disasters that break out around the world. And, the emergency logistics system plays an important role in the process of fighting against these diseases and natural disasters. How to evaluate and optimize the emergency logistics system in contingencies is becoming the hot researching topic. This article establishes the set pair

Zhang Zhi-yong; Liu Cheng; Yang Lei

2009-01-01

91

Sexual Abuse Evaluations in the Emergency Department: Is the History Reliable?  

ERIC Educational Resources Information Center

Review of charts for 141 children who had undergone both a screening interview by an emergency department physician and an investigative interview for child sexual abuse evaluation found that perpetrator identification obtained during emergency department screening interviews usually agreed with information obtained at the subsequent investigative…

Gordon, Stacy; Jaudes, Paula K.

1996-01-01

92

TECHNICAL EVALUATION REPORT EMERGENCY DIESEL GENERATOR TECHNICAL SPECIFICATIONS STUDY RESULTS  

SciTech Connect

The purpose of this report is to review technical specifications for emergency diesel generators in the context of new information developed in the Nuclear Plant Aging Research Program and the application of current NRC regulatory concepts and knowledge. Aging and reliability relationships related to the standard technical specifications are reviewed and supported by data and published information to ensure that conservative and beneficial specifications are identified. Where technical specifications could adversely influence aging and reliability, the technical issues and reasonable alternatives are identified for consideration. This report documents and spans the technical progress from the published and approved regulatory documents to the current knowledge basis. This ensures that the technical bases for the technical specifications discussed are documented and relatively complete subject information is contained in one document. The Pacific Northwest Laboratory (PNL) has participated in the Nuclear Plant Aging Research (NPAR) Program directed by the Nuclear Regulatory Commission's (NRC) Office of Nuclear Regulatory Research, Division of Engineering. The NPAR study of emergency diesel generator aging was performed in two phases. In Phase I, plant operating experience, ~ata, expert opinion and statistical methods were used to produce a new data base related to aging, reliability, and operational readiness of nuclear service diesel generators. Phase II was chiefly concerned with aging mitigation measures.

Hoopingarner, K. R.

1991-03-01

93

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...

94

An evaluation of emerging vaccines for childhood meningococcal disease  

PubMed Central

Background Meningococcal meningitis is a major cause of disease worldwide, with frequent epidemics particularly affecting an area of sub-Saharan Africa known as the “meningitis belt”. Neisseria meningitidis group A (MenA) is responsible for major epidemics in Africa. Recently W-135 has emerged as an important pathogen. Currently, the strategy for control of such outbreaks is emergency use of meningococcal (MC) polysaccharide vaccines, but these have a limited ability to induce herd immunity and elicit an adequate immune response in infant and young children. In recent times initiatives have been taken to introduce meningococcal conjugate vaccine in these African countries. Currently there are two different types of MC conjugate vaccines at late stages of development covering serogroup A and W-135: a multivalent MC conjugate vaccine against serogroup A,C,Y and W-135; and a monovalent conjugate vaccine against serogroup A. We aimed to perform a structured assessment of these emerging meningococcal vaccines as a means of reducing global meningococal disease burden among children under 5 years of age. Methods We used a modified CHNRI methodology for setting priorities in health research investments. This was done in two stages. In the first stage we systematically reviewed the literature related to emerging MC vaccines relevant to 12 criteria of interest. In Stage II, we conducted an expert opinion exercise by inviting 20 experts (leading basic scientists, international public health researchers, international policy makers and representatives of pharmaceutical companies). They answered questions from CHNRI framework and their “collective optimism” towards each criterion was documented on a scale from 0 to 100%. Results For MenA conjugate vaccine the experts showed very high level of optimism (~ 90% or more) for 7 out of the 12 criteria. The experts felt that the likelihood of efficacy on meningitis was very high (~ 90%). Deliverability, acceptability to health workers, end users and the effect on equity were all seen as highly likely (~ 90%). In terms of the maximum potential impact on meningitis disease burden, the median potential effectiveness of the vaccines in reduction of overall meningitis mortality was estimated to be 20%; (interquartile range 20-40% and min. 8%, max 50 %). For the multivalent meningococcal vaccines the experts had similar optimism for most of the 12 CHNRI criteria with slightly lower optimism in answerability and low development cost criteria. The main concern was expressed over the cost of product, its affordability and cost of implementation. Conclusions With increasing recognition of the burden of meningococcal meningitis, especially during epidemics in Africa, it is vitally important that strategies are taken to reduce the morbidity and mortality attributable to this disease. Improved MC vaccines are a promising investment that could substantially contribute to reduction of child meningitis mortality world-wide.

2011-01-01

95

An evaluation of the emerging vaccines against influenza in children  

PubMed Central

Background Influenza is an under-appreciated cause of acute lower respiratory infections (ALRI) in children. It is estimated to cause approximately 20 million new episodes of ALRI in children annually, 97% of these occurring in developing countries. It is also estimated to result in 28000 to 112000 deaths annually in young children. Apart from hospitalisations and deaths, influenza has significant economic consequences. The current egg-based inactivated influenza vaccines have several limitations: annual vaccination, high production costs, and cannot respond adequately to meet the demand during pandemics. Methods We used a modified CHNRI methodology for setting priorities in health research investments. This was done in two stages. In Stage I, we systematically reviewed the literature related to emerging cross-protective vaccines against influenza relevant to several criteria of interest: answerability; cost of development, production and implementation; efficacy and effectiveness; deliverability, affordability and sustainability; maximum potential impact on disease burden reduction; acceptability to the end users and health workers; and effect on equity. In Stage II, we conducted an expert opinion exercise by inviting 20 experts (leading basic scientists, international public health researchers, international policy makers and representatives of pharmaceutical companies). They answered questions from the CHNRI framework and their “collective optimism” towards each criterion was documented on a scale from 0 to 100%. Results The experts expressed very high level of optimism for deliverability, impact on equity, and acceptability to health workers and end users. However, they expressed concerns over the criteria of answerability, low development cost, low product cost, low implementation cost, affordability and, to a lesser extent sustainability. In addition they felt that the vaccine would have higher efficacy and impact on disease burden reduction on overall influenza-associated disease rather than specifically influenza-associated pneumonia. Conclusion Although the landscape of emerging influenza vaccines shows several promising candidates, it is unlikely that the advancements in the newer vaccine technologies will be able to progress through to large scale production in the near future. The combined effects of continued investments in researching new vaccines and improvements of available vaccines will hopefully shorten the time needed to the development of an effective seasonal and pandemic influenza vaccine suitable for large scale production.

2013-01-01

96

Evaluating the effect of emergency department crowding on triage destination  

PubMed Central

Background Emergency Department (ED) crowding has been studied for the last 20 years, yet many questions remain about its impact on patient care. In this study, we aimed to determine if ED crowding influenced patient triage destination and intensity of investigation, as well as rates of unscheduled returns to the ED. We focused on patients presenting with chest pain or shortness of breath, triaged as high acuity, and who were subsequently discharged home. Methods This pilot study was a health records review of 500 patients presenting to two urban tertiary care EDs with chest pain or shortness of breath, triaged as high acuity and subsequently discharged home. Data extracted included triage time, date, treatment area, time to physician initial assessment, investigations ordered, disposition, and return ED visits within 14 days. We defined ED crowding as ED occupancy greater than 1.5. Data were analyzed using descriptive statistics and the ?2 and Fisher exact tests. Results Over half of the patients, 260/500 (52.0%) presented during conditions of ED crowding. More patients were triaged to the non-monitored area of the ED during ED crowding (65/260 (25.0%) vs. 39/240 (16.3%) when not crowded, P?=?0.02). During ED crowding, mean time to physician initial assessment was 132.0 minutes in the non-monitored area vs. 99.1 minutes in the monitored area, P <0.0001. When the ED was not crowded, mean time to physician initial assessment was 122.3 minutes in the non-monitored area vs. 67 minutes in the monitored area, P?=?0.0003. Patients did not return to the ED more often when triaged during ED crowding: 24/260 (9.3%) vs. 29/240 (12.1%) when ED was not crowded (P?=?0.31). Overall, when triaged to the non-monitored area of the ED, 44/396 (11.1%) patients returned, whereas in the monitored area 9/104 (8.7%) patients returned, P?=?0.46. Conclusions ED crowding conditions appeared to influence triage destination in our ED leading to longer wait times for high acuity patients. This did not appear to lead to higher rates of return ED visits amongst discharged patients in this cohort. Further research is needed to determine whether these delays lead to adverse patient outcomes.

2014-01-01

97

An evaluation of emerging vaccines for childhood pneumococcal pneumonia  

PubMed Central

Background Pneumonia is the leading cause of child mortality worldwide. Streptococcus pneumoniae (SP) or pneumococcus is estimated to cause 821,000 child deaths each year. It has over 90 serotypes, of which 7 to 13 serotypes are included in current formulations of pneumococcal conjugate vaccines that are efficacious in young children. To further reduce the burden from SP pneumonia, a vaccine is required that could protect children from a greater diversity of serotypes. Two different types of vaccines against pneumococcal pneumonia are currently at varying stages of development: a multivalent pneumococcal conjugate vaccine covering additional SP serotypes; and a conserved common pneumococcal protein antigen (PPA) vaccine offering protection for all serotypes. Methods We used a modified CHNRI methodology for setting priorities in health research investments. This was done in two stages. In Stage I, we systematically reviewed the literature related to emerging SP vaccines relevant to several criteria of interest: answerability; efficacy and effectiveness; cost of development, production and implementation; deliverability, affordability and sustainability; maximum potential for disease burden reduction; acceptability to the end users and health workers; and effect on equity. In Stage II, we conducted an expert opinion exercise by inviting 20 experts (leading basic scientists, international public health researchers, international policy makers and representatives of pharmaceutical companies). The policy makers and industry representatives accepted our invitation on the condition of anonymity, due to sensitive nature of their involvement in such exercises. They answered questions from CHNRI framework and their “collective optimism” towards each criterion was documented on a scale from 0 to 100%. Results The experts expressed very high level of optimism (over 80%) that low-cost polysaccharide conjugate SP vaccines would satisfy each of the 9 relevant CHNRI criteria. The median potential effectiveness of conjugate SP vaccines in reduction of overall childhood pneumonia mortality was predicted to be about 25% (interquartile range 20-38%, min. 15%, max 45%). For low cost, cross-protective common protein vaccines for SP the experts expressed concerns over answerability (72%) and the level of development costs (50%), while the scores for all other criteria were over 80%. The median potential effectiveness of common protein vaccines in reduction of overall childhood pneumonia mortality was predicted to be about 30% (interquartile range 26-40%, min. 20%, max 45%). Conclusions Improved SP vaccines are a very promising investment that could substantially contribute to reduction of child mortality world-wide.

2011-01-01

98

How to evaluate emerging technologies in cervical cancer screening?  

PubMed Central

Excellent recommendations exist for studying therapeutic and diagnostic questions. We observe that good guidelines on assessment of evidence for screening questions are currently lacking. Guidelines for diagnostic research (STARD), involving systematic application of the reference test (gold standard) to all subjects of large study populations, are not pertinent in situations of screening for disease that is currently not yet present. A five-step framework is proposed for assessing the potential use of a biomarker as a screening tool for cervical cancer: 1) correlation studies establishing a trend between the rate of biomarker expression and severity of neoplasia; 2) diagnostic studies in a clinical setting where all women are submitted to verification by the reference standard; 3) biobank-based studies with assessment in archived cytology samples of the biomarker in cervical cancer cases and controls; 4) prospective cohort studies with baseline assessment of the biomarker and monitoring of disease; 5) randomised intervention trials aiming to observe reduced incidence of cancer (or its surrogate, severe dysplasia) in the experimental arm at subsequent screening rounds. The 5-phases framework should guide researchers and test developers in planning assessment of new biomarkers and protect clinicians and stakeholders against premature claims for insufficiently evaluated products.

Arbyn, Marc; Ronco, Guglielmo; Cuzick, Jack; Wentzensen, Nicolas; Castle, Philip E.

2009-01-01

99

Life cycle evaluation of emerging lignocellulosic ethanol conversion technologies.  

PubMed

Lignocellulosic ethanol holds promise for addressing climate change and energy security issues associated with personal transportation through lowering the fuel mixes' carbon intensity and petroleum demand. We compare the technological features and life cycle environmental impacts of near- and mid-term ethanol bioconversion technologies in the United States. Key uncertainties in the major processes: pre-treatment, hydrolysis, and fermentation are evaluated. The potential to reduce fossil energy use and greenhouse gas (GHG) emissions varies among bioconversion processes, although all options studied are considerably more attractive than gasoline. Anticipated future performance is found to be considerably more attractive than that published in the literature as being achieved to date. Electricity co-product credits are important in characterizing the GHG impacts of different ethanol production pathways; however, in the absence of near-term liquid transportation fuel alternatives to gasoline, optimizing ethanol facilities to produce ethanol (as opposed to co-products) is important for reducing the carbon intensity of the road transportation sector and for energy security. PMID:19762231

Spatari, Sabrina; Bagley, David M; MacLean, Heather L

2010-01-01

100

Are You Teaching Office Education Realistically?  

ERIC Educational Resources Information Center

Using office simulation in a practice/procedures class better prepares students to deal with actual working situations. To facilitate the office simulation, one must consider available equipment, provide interesting programs, be aware of student needs, provide realistic evaluation, and be an enthusiastic and flexible teacher. (JOW)

Neal, Dorothy A.

1982-01-01

101

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

PubMed Central

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.

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

1993-01-01

102

A realistic interstellar explorer  

NASA Astrophysics Data System (ADS)

For more than 20 years, an "Interstellar Precursor Mission" has been discussed as a high-priority mission for multiple scientific objectives. The chief difficulty with actually carrying out such a mission is the need for reaching significant penetration into the interstellar medium (˜1000 Astronomical Units (AU)) within the working lifetime of the initiators (<50 years). While there has been much speculation on various aspects of such a mission, we have systematically considered all of the components required, using realistic extrapolations of current and near-current technology. To provide a first-order cut at many of the engineering realities associated with such a mission, we consider a probe that can be launched with available vehicles and infrastructure. To implement the mission, we have revisited an old idea: the probe and a perihelion carrier are launched initially to Jupiter as a combined package and then fall to the Sun where a large propulsive maneuver propels the package on a high-energy, ballistic escape trajectory from the solar system. Outbound in deep space, the two separate, and the probe takes data with its onboard instruments and autonomously downlinks the data to Earth at regular intervals. The implementation requires a low-mass, highly-integrated spacecraft. Engineering issues separate into (1) the systems constraints imposed on the perihelion package by the combination of the propulsion system, carrying the needed propellant into perihelion, and the associated thermal and mechanical constraints, and (2) the requirements of power, autonomous operations, and data downlink from the probe itself. System trades define the minimum mass and power required for such a probe. We find that many of the requirements for a low-mass probe that operates autonomously for this mission are common for either this propulsion concept or more advanced low-thrust concepts, e.g., solar sails and ion propulsion. We describe an implementation, including science instrumentation and measurement goals, structure and thermal system, communications, avionics, propulsion, guidance and control, power, and architecture that could make such a mission into reality. We also describe some of the technology thrusts and developments that are required in order to begin such a mission in the next twenty-five years.

McNutt, R. L.; Andrews, G. B.; Gold, R. E.; Bokulic, R. S.; Boone, B. G.; Haley, D. R.; McAdams, J. V.; Williams, B. D.; Boyle, M. P.; Starstrom, G.; Riggin, J.; Lester, D.; Lyman, R.; Ewing, M.; Krishnan, R.; Read, D.; Naes, L.; McPherson, M.; Deters, R.

2004-01-01

103

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

ERIC Educational Resources Information Center

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…

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

2003-01-01

104

Sexual abuse evaluations in the emergency department: Is the history reliable?  

Microsoft Academic Search

The authors assessed agreement on perpetrator identification obtained at two interviews of child victims of sexual abuse. We reviewed charts for 141 children who had undergone both a screening interview by an emergency department physician and an investigative interview by an interdisciplinary team specializing in child sexual abuse evaluation. For 107 (76%) cases, information was consistent; for instance, identification occurred

Paula K. Jaudes

1996-01-01

105

Integrating realistic job previews and realistic living conditions previews : Realistic recruitment for internationally mobile knowledge workers  

Microsoft Academic Search

Purpose – The purpose of this paper is to explore the use of realistic job previews (RJPs) and realistic living conditions previews (RLCPs) during the recruitment of a group of internationally mobile knowledge workers who elect to go overseas independently rather than as part of an overseas assignment. It also aims to explore individual perceptions of the value of RJPs

Julia Richardson; Ken McBey; Steve McKenna

2008-01-01

106

Telemental health evaluations enhance access and efficiency in a critical access hospital emergency department.  

PubMed

Abstract Introduction: Mentally ill patients in crisis presenting to critical access hospital emergency rooms often face exorbitant wait times to be evaluated by a trained mental health provider. Patients may be discharged from the hospital before receiving an evaluation or boarded in a hospital bed for observation, reducing quality and increasing costs. This study examined the effectiveness of an emergency telemental health evaluation service implemented in a rural hospital emergency room. Materials and Methods: Retrospective data collection was implemented to consider patients presenting to the emergency room for 212 days prior to telemedicine interventions and for 184 days after. The study compared measures of time to treatment, length of stay (regardless of inpatient or outpatient status), and door-to-consult time. Results: There were 24 patients seen before telemedicine was implemented and 38 seen using telemedicine. All patients had a mental health evaluation ordered by a physician and completed by a mental health specialist. Significant reductions in all three time measures were observed. Mean and median times to consult were reduced from 16.2?h (standard deviation=13.2?h) and 14.2?h, respectively, to 5.4?h (standard deviation=6.4?h) and 2.6?h. Similar reductions in length of stay and door-to-consult times were observed. By t tests, use of telemedicine was associated with a statistically significant reduction in all three outcome measures. Conclusions: Telemedicine appears to be an effective intervention for mentally ill patients by providing more timely access to mental health evaluations in rural hospital emergency departments. PMID:24811858

Southard, Erik P; Neufeld, Jonathan D; Laws, Stephanie

2014-07-01

107

TOPAZ0 4.0 — A new version of a computer program for evaluation of deconvoluted and realistic observables at LEP 1 and LEP 2  

NASA Astrophysics Data System (ADS)

The program TOPAZ0 was developed for computing a variety of physical observables which are related to the e +e - annihilation into fermion pairs and to the large angle Bhabha scattering around the Z resonance. Among them the Z parameters or pseudo-observables, the deconvoluted cross sections and those dressed with QED radiation, and finally the forward—backward asymmetries. The calculations are performed both for a completely inclusive experimental setup and for a realistic one, i.e. a setup with cuts on the acollinearity angle, on the energy of the outgoing fermions or on their invariant mass and angular acceptance. The new version, 4.0, includes several innovative features. First of all, the most important new capabilities since previous versions are electroweak, QCD and QED correction factors that are relevant at the Z resonance in the light of the present experimental accuracy. Among them, the effect of the next-to-leading O(? 2m 2l) corrections, the radiative corrections to the hadronic decay of the Z, providing complete corrections of O(?? s) to ?( Z ? qq¯) with q = u, d, s, c, and b, and leading O(? 3) QED corrections. Secondly, the program has been upgraded to cover two-fermion final states at LEP 2 energies, where some of the assumptions made for earlier versions are no longer valid. In particular, to this aim all the electroweak radiative corrections relevant far from the Z peak have been added for s-channel processes, e.g. purely weak boxes, next-to-leading O(? 2) and leading O(? 3) QED corrections.

Montagna, Guido; Nicrosini, Oreste; Piccinini, Fulvio; Passerino, Giampiero

1999-03-01

108

RAMESES publication standards: realist syntheses  

PubMed Central

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 draw together evidence and expertise in realist synthesis. For each item we have included an explanation for why it is important and guidance on how it might be reported. Realist synthesis is a relatively new method for evidence synthesis and as experience and methodological developments occur, we anticipate that these standards will evolve to reflect further methodological developments. We hope that these standards will act as a resource that will contribute to improving the reporting of realist syntheses. To encourage dissemination of the RAMESES publication standards, this article is co-published in the Journal of Advanced Nursing and is freely accessible on Wiley Online Library (http://www.wileyonlinelibrary.com/journal/jan). Please see related article http://www.biomedcentral.com/1741-7015/11/20 and http://www.biomedcentral.com/1741-7015/11/22

2013-01-01

109

Control Technology: 1992 Update of U.S. EPA's Superfund Innovative Technology Evaluation (SITE) Emerging Technology Program.  

National Technical Information Service (NTIS)

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 ...

N. M. Lewis N. P. Barkley T. Williams

1992-01-01

110

The Evaluation Exchange: Emerging Strategies in Evaluating Child and Family Services, 1997.  

ERIC Educational Resources Information Center

This document is comprised of the 1997 issues of a quarterly 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 evaluation methodology and includes articles on the following topics: (1) mixing evaluation

Evaluation Exchange: Emerging Strategies in Evaluating Child and Family Services, 1997

1997-01-01

111

Spatially Realistic Population Model for Informing Forest Management Decisions.  

National Technical Information Service (NTIS)

A spatially realistic population model (SRPM) was developed to evaluate the relative effects of different habitat management strategies on the spotted owl subpopulation of the Olympic Peninsula. SPRMs address a fundamental problem commonly confronted by w...

G. F. Wilhere N. H. Schumaker S. P. Horton

2000-01-01

112

Chapter 5. Realistic Computer Models  

NASA Astrophysics Data System (ADS)

Many real-world applications involve storing and processing large amounts of data. These data sets need to be either stored over the memory hierarchy of one computer or distributed and processed over many parallel computing devices or both. In fact, in many such applications, choosing a realistic computation model proves to be a critical factor in obtaining practically acceptable solutions. In this chapter, we focus on realistic computation models that capture the running time of algorithms involving large data sets on modern computers better than the traditional RAM (and its parallel counterpart PRAM) model.

Ajwani, Deepak; Meyerhenke, Henning

113

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

ERIC Educational Resources Information Center

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…

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

2001-01-01

114

The Potential and Challenges of Critical Realist Ethnography  

ERIC Educational Resources Information Center

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…

Barron, Ian

2013-01-01

115

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

SciTech Connect

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.

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

2009-08-05

116

Evaluating adverse drug event reporting in administrative data from emergency departments: a validation study  

PubMed Central

Background Adverse drug events are a frequent cause of emergency department presentations. Administrative data could be used to identify patients presenting with adverse drug events for post-market surveillance, and to conduct research in patient safety and in drug safety and effectiveness. However, such data sources have not been evaluated for their completeness with regard to adverse drug event reporting. Our objective was to determine the proportion of adverse drug events to outpatient medications diagnosed at the point-of-care in emergency departments that were documented in administrative data. Methods We linked the records of patients enrolled in a prospective observational cohort study on adverse drug events conducted in two Canadian tertiary care emergency departments to their administrative data. We compared the number of adverse drug events diagnosed and recorded at the point-of-care in the prospective study with the number of adverse drug events recorded in the administrative data. Results Among 1574 emergency department visits, 221 were identified as adverse drug event-related in the prospective database. We found 15 adverse drug events documented in administrative records with ICD-10 codes clearly indicating an adverse drug event, indicating a sensitivity of 6.8% (95% CI 4.0–11.2%) of this code set. When the ICD-10 code categories were broadened to include codes indicating a very likely, likely or possible adverse event to a medication, 62 of 221 events were identifiable in administrative data, corresponding to a sensitivity of 28.1% (95% CI 22.3-34.6%). Conclusions Adverse drug events to outpatient medications were underreported in emergency department administrative data compared to the number of adverse drug events diagnosed and recorded at the point-of-care.

2013-01-01

117

Simulated evaluation of two triage scales in an emergency department in Israel.  

PubMed

At the time of this study, the Sheba Medical Center Emergency Department (ED) in Israel had no formal triage system in place. To evaluate the interobserver reliability of two triage scales among nurses in our ED, the time-based Australasian Triage Scale (ATS) and the resource-based Emergency Severity Index (ESI), 10 nurses participated in a workshop on ATS and ESI. They then independently assessed 100 simulated triage scenarios taken from actual ED patients, and completed a survey. Intraclass correlation coefficients were calculated. The intraclass correlation coefficient for ATS was 0.64 (95% confidence interval: 0.57, 0.71), whereas for ESI, it was 0.52 (95% confidence interval: 0.45, 0.61). The nurses felt that ESI was slightly easier to use. Using conventional interpretations, the agreement for ATS is considered substantial, whereas that for ESI is considered moderate. Conversely, the nurses found the ESI somewhat easier to use. PMID:24165355

Alpert, Evan A; Lipsky, Ari M; Hertz, Dvora; Rieck, Jonathon; Or, Jacob

2013-12-01

118

Realistic modeling for facial animation  

Microsoft Academic Search

A major unsolved problem in computer graphics is the construc- tion and animation of realistic human facial models. Traditionally, facial models have been built painstakingly by manual digitization and animated by ad hoc parametrically controlled facial mesh defor- mations or kinematic approximation of muscle actions. Fortunately, animators are now able to digitize facial geometries through the use of scanning range

Yuencheng Lee; Demetri Terzopoulos; Keith Walters

1995-01-01

119

Realistic Fire Simulation: A Survey  

Microsoft Academic Search

Abstract-As fire is one of the basic elements of nature, realistic fire simulation plays a significant role in fire control, film special effects, military emulation, and virtual reality. Fire simulation has been being an eternal theme in the field of computer graphics, because of the anisotropic shape and complex physical mechanism of the fire. This paper presents a survey on

Zhaohui Wu; Zhong Zhou; Wei Wu

2011-01-01

120

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)

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.

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

2012-04-01

121

Early economic evaluation of emerging health technologies: protocol of a systematic review  

PubMed Central

Background The concept of early health technology assessment, discussed well over a decade, has now been collaboratively implemented by industry, government, and academia to select and expedite the development of emerging technologies that may address the needs of patients and health systems. Early economic evaluation is essential to assess the value of emerging technologies, but empirical data to inform the current practice of early evaluation is limited. We propose a systematic review of early economic evaluation studies in order to better understand the current practice. Methods/design This protocol describes a systematic review of economic evaluation studies of regulated health technologies in which the evaluation is conducted prior to regulatory approval and when the technology effectiveness is not well established. Included studies must report an economic evaluation, defined as the comparative analysis of alternatives with respect to their associated costs and health consequences, and must evaluate some regulated health technology such as pharmaceuticals, biologics, high-risk medical devices, or biomarkers. We will conduct the literature search on multiple databases, including MEDLINE, EMBASE, the Centre for Reviews and Dissemination Databases, and EconLit. Additional citations will be identified via scanning reference lists and author searching. We suspect that many early economic evaluation studies are unpublished, especially those conducted for internal use only. Additionally, we use a chain-referral sampling approach to identify authors of unpublished studies who work in technology discovery and development, starting out with our contact lists and authors who published relevant studies. Citation screening and full-text review will be conducted by pairs of reviewers. Abstracted data will include those related to the decision context and decision problem of the early evaluation, evaluation methods (e.g., data sources, methods, and assumptions used to identify, measure, and value the likely effectiveness and the costs and consequences of the new technology, handling of uncertainty), and whether the study results adequately address the main study question or objective. Data will be summarized overall and stratified by publication status. Discussion This study is timely to inform early economic evaluation practice, given the international trend in early health technology assessment initiatives.

2014-01-01

122

The Evaluation Exchange: Emerging Strategies in Evaluating Child and Family Services, 2000.  

ERIC Educational Resources Information Center

This document is comprised of the single 2000 issue 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 issue focuses on after-school programs and includes the following articles: (1) "Building the After School Field"; (2)…

Goodyear, Leslie, Ed.; Horsch, Karen, Ed.

2000-01-01

123

True-to-Life? Realistic Fiction.  

ERIC Educational Resources Information Center

Suggests that modern realistic fiction for young readers is intensely moralistic and directive at the spoken and unspoken behest of the adults who write, select, and buy that literature. Discusses moral tales, early realistic fiction, modern realistic fiction, and choosing realistic fiction. (RS)

Jordan, Anne Devereaux

1995-01-01

124

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

NASA Technical Reports Server (NTRS)

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.

Carden, H. D.

1981-01-01

125

Evaluation of Technologies for Identifying Acute Cardiac Ischemia in Emergency Departments. Evidence Report/Technology Assessment Number 26.  

National Technical Information Service (NTIS)

This report evaluates the accuracy of technologies for diagnosing acute cardiac ischemia (ACI) in Emergency Departments and their clinical impact when used in ED setting. The diagnostic technologies examined include the following: electocardiography (preh...

J. Lau

2001-01-01

126

Detailed evaluation of patients admitted to emergency department with a tick bite complaint.  

PubMed

BACKGROUND AND OBJECTIVE. A tick bite has been an emergency of increased importance in recent years since it can cause a progressive, fatal disease such as Crimean-Congo hemorrhagic fever (CCHF). This issue should be considered by physicians working not only in endemic areas but also in the entire world, taking into account immigration, overseas trips, etc. In our study, we aimed to increase the awareness of the issue by evaluating the emergency department admissions of tick bite complaints in an endemic area. MATERIAL AND METHODS. In total, 251 patients who had been admitted to the emergency department with a complaint of a tick bite within 10 months were included into the study. The data were obtained by collecting main complaints, demographic characteristics, cell counts on admission, and biochemical tests as well as CCHF findings in the RT-PCR test. The patients were divided into 2 groups according to the results of real-time polymerase chain reaction (PCR+ and PCR-). RESULTS. All the patients complained of tick bites. As for the additional complaints, 46% of the overall study population had fatigue and 36% experienced fever. Fever was the most common complaint in the PCR+ group (39%). The platelet and white blood cell counts were significantly lower and the AST level was significantly higher in the PCR+ group than the PCR- group (P<0.01). CONCLUSIONS. In CCHF, where an early diagnosis is very important in reducing mortality, and the symptoms such as a tick bite, fever, and fatigue should be taken seriously by emergency medicine physicians. Leukopenia and thrombocytopenia and higher levels of enzymes in the liver function tests should be taken into account. PMID:24509147

Ba?ol, Nur?ah; Duygu, Fazilet; Ayan, Murat

2013-01-01

127

Analysis of the Evaluative Components on the Standard Letter of Recommendation (SLOR) in Emergency Medicine  

PubMed Central

Introduction The standard letter of recommendation in emergency medicine (SLOR) was developed to standardize the evaluation of applicants, improve inter-rater reliability, and discourage grade inflation. The primary objective of this study was to describe the distribution of categorical variables on the SLOR in order to characterize scoring tendencies of writers. Methods We performed a retrospective review of all SLORs written on behalf of applicants to the three Emergency Medicine residency programs in the University of Arizona Health Network (i.e. the University Campus program, the South Campus program and the Emergency Medicine/Pediatrics combined program) in 2012. All “Qualifications for Emergency Medicine” and “Global Assessment” variables were analyzed. Results 1457 SLORs were reviewed, representing 26.7% of the total number of Electronic Residency Application Service applicants for the academic year. Letter writers were most likely to use the highest/most desirable category on “Qualifications for EM” variables (50.7%) and to use the second highest category on “Global Assessments” (43.8%). For 4-point scale variables, 91% of all responses were in one of the top two ratings. For 3-point scale variables, 94.6% were in one of the top two ratings. Overall, the lowest/least desirable ratings were used less than 2% of the time. Conclusions SLOR letter writers do not use the full spectrum of categories for each variable proportionately. Despite the attempt to discourage grade inflation, nearly all variable responses on the SLOR are in the top two categories. Writers use the lowest categories less than 2% of the time. Program Directors should consider tendencies of SLOR writers when reviewing SLORs of potential applicants to their programs.

Grall, Kristi H.; Hiller, Katherine M.; Stoneking, Lisa R.

2014-01-01

128

Realistic models of paracrystalline silicon  

SciTech Connect

We present a procedure for the preparation of physically realistic models of paracrystalline silicon based on a modification of the bond-switching method of Wooten, Winer, and Weaire. The models contain randomly oriented c-Si grains embedded in a disordered matrix. Our technique creates interfaces between the crystalline and disordered phases of Si with an extremely low concentration of coordination defects. The resulting models possess structural and vibrational properties comparable with those of good continuous random network models of amorphous silicon and display realistic optical properties, correctly reproducing the electronic band gap of amorphous silicon. The largest of our models also shows the best agreement of any atomistic model structure that we tested with fluctuation microscopy experiments, indicating that this model has a degree of medium-range order closest to that of the real material.

Nakhmanson, S. M.; Voyles, P. M.; Mousseau, Normand; Barkema, G. T.; Drabold, D. A.

2001-06-15

129

Diagnostic Patterns in the Evaluation of Patients Presenting with Syncope at the Emergency or Outpatient Department  

PubMed Central

Purpose Patterns of syncope evaluation vary widely among physicians and hospitals. The aim of this study was to assess current diagnostic patterns and medical costs in the evaluation of patients presenting with syncope at the emergency department (ED) or the outpatient department (OPD) of a referral hospital. Materials and Methods This study included 171 consecutive patients with syncope, who visited the ED or OPD between January 2009 and July 2009. Results The ED group had fewer episodes of syncope [2 (1-2) vs. 2 (1-5), p=0.014] and fewer prodromal symptoms (81.5% vs. 93.3%, p=0.018) than the OPD group. Diagnostic tests were more frequently performed in the ED group than in the OPD group (6.2±1.7 vs. 5.3±2.0; p=0.012). In addition, tests with low diagnostic yields were more frequently used in the ED group than in the OPD group. The total cost of syncope evaluation per patient was higher in the ED group than in the OPD group [823000 (440000-1408000) won vs. 420000 (186000-766000) won, p<0.001]. Conclusion There were some differences in the clinical characteristics of patients and diagnostic patterns in the evaluation of syncope between the ED and the OPD groups. Therefore, a selective diagnostic approach according to the presentation site is needed to improve diagnostic yields and to reduce the time and costs of evaluation of syncope.

Kang, Gu Hyun; Oh, Ju Hyeon; On, Young Keun; Jo, Ik Joon; Kim, Su Jin; Bae, Su-Jin; Shin, Tae Gun

2012-01-01

130

Penile emergencies.  

PubMed

The penis is a very sensitive organ and even minor injury or discomfort may cause a patient to seek emergency evaluation. Emergency practitioners must be most concerned with the entities that, if left untreated, can result in ischemia and necrosis of the penis, namely ischemic priapism, paraphimosis, and entrapment injury. Any penile trauma should be considered an emergency until proven otherwise. This article discusses emergent penile complaints in adults, with emphasis on the most serious and common conditions. PMID:21782070

Dubin, Jeffrey; Davis, Jonathan E

2011-08-01

131

Electrocardiographic and Respiratory Responses to Coal-Fired Power Plant Emissions in a Rat Model of Acute Myocardial Infarction: Results from the Toxicological Evaluation of Realistic Emissions of Source Aerosols (TERESA) Study  

PubMed Central

Background Ambient particulate matter (PM) derived from coal-fired power plants may have important cardiovascular effects, but existing toxicological studies are inadequate for understanding these effects. The Toxicological Evaluation of Realistic Emissions of Source Aerosols (TERESA) study aims to evaluate the toxicity of primary and secondary PM derived from coal-fired power plants. As part of this effort, we evaluated in susceptible animals the effect of stack emissions on cardiac electrophysiology and respiratory function under exposure conditions intended to simulate an aged plume with unneutralized acidity and secondary organic aerosols (POS exposure scenario). Methods Rats with acute myocardial infarction were exposed to either stack emissions (n=15) or filtered air (n=14) for 5 hours at a single power plant. Respiration and electrocardiograms were continuously monitored via telemetry and heart rate, heart rate variability (HRV), premature ventricular beat (PVB) frequency, electrocardiographic intervals, and respiratory intervals and volumes were evaluated. Similar experiments at another power plant were attempted but were unsuccessful. Results POS exposure (fine particle mass = 219.1 ?g/m3; total sulfate = 172.5 ?g/m3; acidic sulfate = 132.5 ?g/m3; organic carbon = 50.9 ?g/m3) was associated with increased PVB frequency and decreased respiratory expiratory time and end-inspiratory pause, but not with changes in heart rate, HRV, or electrocardiographic intervals. Results from a second power plant were uninterpretable. Conclusions Short-term exposure to primary and unneutralized secondary particulate matter formed from aged emissions from a coal-fired power plant, as simulated by the POS scenario, may be associated with increased risk of ventricular arrhythmias in susceptible animals.

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

2013-01-01

132

Electromagnetic Scattering from Realistic Targets  

NASA Technical Reports Server (NTRS)

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.

Lee, Shung- Wu; Jin, Jian-Ming

1997-01-01

133

Evaluation of Clinical Reasoning in Basic Emergencies Using a Script Concordance Test  

PubMed Central

Objectives To develop and assess the reliability of a script concordance test (SCT) to evaluate pharmacy students' clinical reasoning when facing basic emergency situations. Design A first aid course was designed that consisted of 8 weekly instructional sessions (4 on internal medicine, including life threatening situations; 2 on pediatrics; and 2 on trauma) in which the instructor presented case studies in a small-group format. In the first and final sessions of the course, a practice SCT was administered to familiarize students with the test format. Assessment A 66-question SCT examination was administered to the 68 third-year pharmacy students enrolled in the first aid course. The students' mean score was 68.5% ± 9.8% and panel members' mean score was 86.5% ± 4.2%. Twenty students were selected randomly to complete a course survey and 85% indicated they were satisfied with using the SCT. Conclusions A first aid SCT was found to be both a practical and reliable testing instrument for assessing the clinical reasoning of pharmacy students in basic emergency situations.

Charlin, Bernard; Vanpee, Dominique

2010-01-01

134

Study designs and evaluation models for emergency department public health research.  

PubMed

Abstract 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

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

2009-11-01

135

Evaluation of unpredictable critical conditions of patients treated in the observation unit of the Emergency Department.  

PubMed

We evaluated unpredictable critical conditions of patients treated in the Emergency Department (ED) observation unit, who were transferred into the emergency resuscitation room from January 1 through June 30, 2001. A total of 175 patients were observed for the following critical conditions: dyspnea (51 patients; 29.14%), hypotension (28; 16.00%), chest pain (18; 10.29%), dysrhythmia (15; 8.57%), hematemesis (15; 8.57%), altered mental status (12; 6.85%), shock (10; 5.71%), coma (8; 4.57%), apnea (5; 2.86%), hematochezia (3; 1.72%), seizure (3; 1.72%), and others (7; 4.00%). The 27 patients who had cardiopulmonary resuscitation (CPR), endotracheal tube intubation, or cardioversion/defibrillation in the ED suffered an in-ED mortality of 25.9% (7) and an in-hospital mortality of 59.2% (16). The remaining 148 patients who received appropriate treatment, except for the above, had a lower in-hospital mortality (20.28%, 30 patients) (p < 0.05). We should limit the number of patients in the observation unit to avoid overloading, and classify patients according to their clinical conditions. We should determine whether or not they have definite diagnoses or are waiting for hospital admission while receiving simple treatments. The observation unit must be provided with well-trained staff and suitable physical facilities with support services, and rapid specialty consultations must be available. PMID:15261350

Chang, Yun-Te; Chen, Chih-Chung; Chang, Chao-Yu; Kuo, Yau-Chang

2004-08-01

136

Comparison of Arterial and Venous Blood Gas Values in the Initial Emergency Department Evaluation of Patients With Diabetic Ketoacidosis  

Microsoft Academic Search

Study objective: To determine whether venous blood gas values can replace arterial gas values in the initial emergency department evaluation of patients with suspected diabetic ketoacidosis. Methods: This prospective comparison was performed in an adult university teaching hospital ED. Samples for arterial and venous blood gas analysis were obtained during initial ED evaluations. The venous gas samples were collected with

Mark A Brandenburg; Daniel J Dire

1998-01-01

137

A novel emergency department based prevention intervention program for people living with HIV: evaluation of early experiences  

Microsoft Academic Search

BACKGROUND: HIV prevention is increasingly focused on people living with HIV (PLWH) and the role of healthcare settings in prevention. Emergency Departments (EDs) frequently care for PLWH, but do not typically endorse a prevention mission. We conducted a pilot exploratory evaluation of the first reported ED program to address the prevention needs of PLWH. METHODS: This retrospective observational cohort evaluation

Michael S Lyons; Dana L Raab; Christopher J Lindsell; Alexander T Trott; Carl J Fichtenbaum

2007-01-01

138

[Evaluation of urgent and emergency services in the hospital referral system in Northeast Brazil].  

PubMed

This article evaluates the degree of implementation of ten urgent and emergency hospital services comprising the macro and micro-regional referral system in Pernambuco State, Northeast Brazil. The study analyzes criteria related to structure (physical and organizational, and material and human resources) and process (routine and referral/counter-referral activities), classifying the hospitals as satisfactory, acceptable, and deficient. The majority of the hospitals were classified as deficient, including all the micro-regional units and one macro-regional referral unit. Macro-regional units show better performance in the work process, while implementation of the structural dimension is better in the micro-regional hospitals. The results highlight the priority of upgrading these hospitals by strengthening decentralized human resources and technology policies, oriented towards the improvement of work processes in keeping with the State's regional contexts. PMID:21229210

Dubeux, Luciana Santos; Freese, Eduardo; Reis, Yluska Almeida Coelho dos

2010-08-01

139

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

PubMed

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

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

2004-03-01

140

Flight Simulator Evaluation of Enhanced Propulsion Control Modes for Emergency Operation  

NASA Technical Reports Server (NTRS)

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.

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

2012-01-01

141

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

PubMed

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

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

142

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

PubMed Central

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.

2014-01-01

143

Realistic modeling of neurons and networks: towards brain simulation  

PubMed Central

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.

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

144

Realistic modeling of neurons and networks: towards brain simulation.  

PubMed

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

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

2013-01-01

145

Use of a 90-minute protocol to evaluate patients presenting to the emergency department with chest pain: a case study.  

PubMed

Frustration with emergency department wait times may contribute to patient delays in seeking care for subsequent episodes of chest pain and lower patient satisfaction ratings. In response to patient feedback and the dissemination of new knowledge, the existing emergency chest pain protocol was updated to include point-of-care laboratory testing and evaluation at baseline and 90 minutes. A case study was utilized to illustrate implementation of this protocol in the management of a patient presenting to the emergency department with chest pain. PMID:24895948

Bunch, Azalea Marie; Carithers, Cathrin; Leasure, A Renee

2014-01-01

146

Evaluating the Use of a Low-Cost Unmanned Aerial Vehicle Platform in Acquiring Digital Imagery for Emergency Response  

Microsoft Academic Search

This research project evaluates the utilization of a low-cost Unmanned Aerial Vehicle (UAV) digital imaging platform developed\\u000a in Manitoba, Canada for emergency response situations. Such a platform allows for the timely acquisition of high resolution\\u000a imagery during emergency situations by personnel with relatively limited UAV flight training.\\u000a \\u000a Although military use of UAVs has been around since the First World War,

G. Lewis

147

Prototyping iPhone apps: realistic experiences on the device  

Microsoft Academic Search

In this paper we evaluate Touch Application Prototype - a tool for designers to quickly create interactive and realistic prototypes of Apple® iPhone® apps and test them on the device. We define 5 requirements such as Speed, Practicality and Realism, and evaluate the tool during the development of a mobile work tool. Users intuitively use their inherent knowledge about touch

Anders P. Jørgensen; Matthijs Collard; Christian Koch

2010-01-01

148

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

SciTech Connect

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.

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

1985-01-01

149

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

NASA Astrophysics Data System (ADS)

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.

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

1993-09-01

150

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

NASA Technical Reports Server (NTRS)

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 Crewmembers to more speedily and accurately respond to medical situations on the ISS.

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

2003-01-01

151

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

NASA Technical Reports Server (NTRS)

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 completion and/or navigation, in particular the execution of the Surgeon call sequence. Debrief comments were used to analyze unclear procedural steps and to discern any discrepancies between the procedure and generally accepted BME actions. The sequence followed by BME participants differed considerably from the sequence intended by the procedure. Common deviations included the call sequence used to contact Surgeon, the content of BME and crew interaction and the gathering of pertinent console resources. Differing perceptions of task priority and imprecise language seem to have caused multiple deviations from the procedure s intended sequence. The study generated 40 recommendations for the procedure, of which 34 are being implemented. These recommendations address improving the clarity of the instructions, identifying training considerations, expediting Surgeon contact, improving cues for anticipated flight control team communication and identifying missing console tools.

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

2006-01-01

152

Pediatric gastroenteritis in the emergency department: practice evaluation in Belgium, France, The Netherlands and Switzerland  

PubMed Central

Background Based on European recommendations of ESPGHAN/ESPID from 2008, first line therapy for dehydration caused by acute gastroenteritis (AGE) is oral rehydration solution (ORS). In case of oral route failure, nasogastric tube enteral rehydration is as efficient as intra-venous rehydration and seems to lead to fewer adverse events. The primary objective was to describe rehydration strategies used in cases of AGE in pediatric emergency departments (PEDs) in Belgium, France, The Netherlands, and Switzerland. Methods An electronic survey describing a scenario in which a toddler had moderate dehydration caused by AGE was sent to physicians working in pediatric emergency departments. Analytical data were analyzed with descriptive statistics and Kruskal –Wallis Rank test. Results We analyzed 68 responses, distributed as follows: Belgium N?=?10, France N?=?37, The Netherlands N?=?7, and Switzerland N?=?14. Oral rehydration with ORS was the first line of treatment for 90% of the respondents. In case of first line treatment failure, intravenous rehydration was preferred by 95% of respondents from France, whereas nasogastric route was more likely to be used by those from Belgium (80%), The Netherlands (100%) and Switzerland (86%). Serum electrolyte measurements were more frequently prescribed in France (92%) and Belgium (80%) than in The Netherlands (43%) and Switzerland (29%). Racecadotril was more frequently used in France, and ondansetron was more frequently used in Switzerland. No respondent suggested routine use of antibiotics. Conclusion We found variations in practices in terms of invasiveness and testing. Our study supports the need for further evaluation and implementation strategies of ESPGHAN/ESPID guidelines. We plan to extend the study throughout Europe with support of the Young ESPID Group.

2014-01-01

153

The emergence of ocean biogeochemical provinces: A quantitative assessment and a diagnostic for model evaluation  

NASA Astrophysics Data System (ADS)

The concept of ocean biogeochemical provinces is based on the observation that large ocean regions are characterized by coherent physical forcing and environmental conditions, which are eventually representative of macroscale ocean ecosystems. Biogeochemical models of the global ocean focus on simulating the coupling between prevalent physical conditions and the biogeochemical processes with the assumption that biological properties respond coherently to physics and therefore should produce such provinces as an emergent property. In this paper, we quantitatively assess the emergence of a reference set of predefined biogeochemical provinces in the available global data sets and propose a province-based approach to the evaluation of one of the most comprehensive models of ocean biogeochemistry. Multivariate statistical tools were applied to model and observation data, verifying the existence, distinctiveness and reliability of the predefined provinces and quantifying the correlation of model results with observations at the global scale. The analysis of similarity between provinces shows that they are statistically separable in data and model output and therefore can be used as reliable metrics. The analyses indicate that provinces can be more easily distinguished in terms of their environmental features rather than using chlorophyll concentration. The characterization of provinces by means of chlorophyll values shows a significant overlap in both the Sea-viewing Wide Field-of-view Sensor (SeaWiFS) data and the model. It is likely this is related to the choice of province boundaries based on coarse-resolution mapped data, which are not necessarily the same as those derivable from high-resolution satellite data. We also demonstrated through cluster analysis that the long-term time series data collected at Joint Global Ocean Flux Study (JGOFS) stations are representative of environmental conditions of the respective province and can thus be used to evaluate model results extracted from that province. The method shows promise for helping to overcome problems with model verification due to under sampling of most ocean biogeochemical variables but also gives indications that unsupervised clustering may be required when more spatially resolved data and models are available.

Vichi, Marcello; Allen, J. Icarus; Masina, Simona; Hardman-Mountford, Nicholas J.

2011-06-01

154

Prospective Comparison of Live Evaluation and Video Review in the Evaluation of Operator Performance in a Pediatric Emergency Airway Simulation  

PubMed Central

Introduction Real-time assessment of operator performance during procedural simulation is a common practice that requires undivided attention by 1 or more reviewers, potentially over many repetitions of the same case. Objective To determine whether reviewers display better interrater agreement of procedural competency when observing recorded, rather than live, performance; and to develop an assessment tool for pediatric rapid sequence intubation (pRSI). Methods A framework of a previously established Objective Structured Assessment of Technical Skills (OSATS) tool was modified for pRSI. Emergency medicine residents (postgraduate year 1–4) were prospectively enrolled in a pRSI simulation scenario and evaluated by 2 live raters using the modified tool. Sessions were videotaped and reviewed by the same raters at least 4 months later. Raters were blinded to their initial rating. Interrater agreement was determined by using the Krippendorff generalized concordance method. Results Overall interrater agreement for live review was 0.75 (95% confidence interval [CI], 0.72–0.78) and for video was 0.79 (95% CI, 0.73–0.82). Live review was significantly superior to video review in only 1 of the OSATS domains (Preparation) and was equivalent in the other domains. Intrarater agreement between the live and video evaluation was very good, greater than 0.75 for all raters, with a mean of 0.81 (95% CI, 0.76–0.85). Conclusion The modified OSATS assessment tool demonstrated some evidence of validity in discriminating among levels of resident experience and high interreviewer reliability. With this tool, intrareviewer reliability was high between live and 4-months' delayed video review of the simulated procedure, which supports feasibility of delayed video review in resident assessment.

House, Joseph B.; Dooley-Hash, Suzanne; Kowalenko, Terry; Sikavitsas, Athina; Seeyave, Desiree M.; Younger, John G.; Hamstra, Stanley J.; Nypaver, Michele M.

2012-01-01

155

Standards for clinical evaluation and documentation by the emergency medicine provider  

Microsoft Academic Search

Pediatric emergency medicine is full of challenges. When a pediatric patient has a poor outcome after treatment in an emergency\\u000a department (ED), a malpractice lawsuit is likely to result. Pediatric emergency medicine (PEM) physicians might sometimes\\u000a alter their medical care and practice “defensive medicine” in hopes of avoiding a malpractice lawsuit. Radiographs and other\\u000a diagnostic studies might be ordered without

Steven M. Selbst

2008-01-01

156

Evaluation of an emergency department triage screening tool for suspected severe sepsis and septic shock.  

PubMed

Early identification of septic patients is important to prevent delays in appropriate management. To improve detection of septic patients presenting to the emergency department (ED), we implemented a triage screening tool. Our study sought to determine the effect of this tool on time to antibiotics in patients with suspected severe sepsis or septic shock presenting to the ED. This was a retrospective chart review examining the time interval to antibiotics pre- and postimplementation of the triage tool. Multiple linear regression analyses were conducted to evaluate the effect of the triage tool on time to antibiotics while controlling for the effect of level of triage. We identified 185 patients with severe sepsis or septic shock in the pretriage tool group and 170 patients in the posttriage tool group. The mean time (in minutes) to antibiotics (±SD) in the pre- and postcohorts was 283 (±213) and 207 (±150), respectively. The multivariable analysis showed that the mean time to antibiotics decreased by 21% (95% CI 6-36%, p < .0074) comparing pre- versus posttriage tool implementation. The use of a sepsis triage screening tool significantly decreased the time to antibiotics in patients presenting to the ED with suspected severe sepsis or septic shock. PMID:24372995

Patocka, Catherine; Turner, Joel; Xue, Xiaoqing; Segal, Eli

2014-01-01

157

Trauma emergency unit: long-term evaluation of a quality assurance programme  

PubMed Central

OBJECTIVE: Long-term evaluation of a quality assurance programme (after an assessment in 1993). DESIGN: Review of medical records. SETTING: Emergency area of an orthopaedic, trauma, and plastic surgery unit in a French teaching hospital (Besancon). SUBJECTS: 1187 consecutive ambulatory patients' records, from July 1995. MAIN MEASURES: Occurrence of near adverse events (at risk events causing situations which could lead to the occurrence of an adverse event). RESULTS: 71 near adverse events were identified (5.9% of the ambulatory visits). There was a significant decrease in the rate of near adverse events between 1993 (9.9% (2056 ambulatory visits, 204 near adverse events)), and 1995 (5.9% (1187 ambulatory visits, 71 near adverse events)), and significant change in the proportion of each category of adverse event (decrease in departures from prevention protocols). CONCLUSIONS: Despite their limitations, the effectiveness and efficiency of quality assurance programmes seem to be real and valuable. Maintaining quality improvement requires conditions which include some of the basic principles of total quality management (leadership, participatory management, openness, continuous feed back). The organisation of this unit as a specialised trauma centre was also a determining factor in the feasibility of a quality assurance programme (specialisation and small size, high activity volume, management of the complete care process). Quality assurance is an important initial step towards quality improvement, that should precede consideration of a total quality management programme.

Gagneux, E.; Lombrail, P.; Vichard, P.

1998-01-01

158

The Emerging Role of HE4 in the Evaluation of Advanced Epithelial Ovarian and Endometrial Carcinomas  

PubMed Central

HE4 (human epididymis protein 4) is overexpressed in both ovarian and endometrial cancers. Levels of the shed HE4 protein are elevated in sera from ovarian and endometrial cancer patients. HE4 is less frequently elevated than cancer antigen 125 (CA 125) in benign gynecological conditions and is found in a fraction of endometrial and ovarian cancers that lack CA 125 expression. Consequently, HE4 has emerged as an important biomarker that complements CA 125 in discriminating between benign and malignant pelvic masses, monitoring response to treatment, and detecting recurrences of both ovarian and endometrial cancer. The risk of ovarian malignancy algorithm (ROMA) incorporates CA 125, HE4 and menopausal status to distinguish benign from malignant adnexal masses and has been approved by the US Food and Drug Administration to aid in referring patients who are likely to have ovarian cancer to specially trained gynecologic oncologists for surgery. HE4 also promises to augment the sensitivity of CA_125 for detecting early-stage ovarian cancer. In this review, we discuss the discovery and biological significance of HE4 and evaluate available evidence regarding the utility of HE4 as a biomarker for ovarian and endometrial cancer.

Simmons, Archana R.; Baggerly, Keith; Bast, Robert C.

2014-01-01

159

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

PubMed Central

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.

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

2013-01-01

160

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). ...

161

EVALUATION OF DEMONSTRATED AND EMERGING TECHNOLOGIES FOR THE TREATMENT AND CLEAN-UP OF CONTAMINATED LAND AND GROUNDWATER  

EPA Science Inventory

This article provides an overview of the Phase III Pilot Study on the Evaluation of Demonstrated and Emerging Technologies for Treatment and Clean Up of Contaminated Land and Groundwater. It also contains the key conclusions of the Pilot Study and recommendations for further act...

162

An Economic Evaluation of Use of a Payer-Based Electronic Health Record within an Emergency Department  

Microsoft Academic Search

Background: Although use of electronic health records (EHR) is being advocated by many in the public and private sectors, a limited number of analyses evaluating the economic impact associated with using EHR have been performed. The hypothesis of this analysis was that the implementation of an EHR within an emergency department (ED) would result in decreased healthcare costs. Methods: We

Vincent J. Willey; Gregory W. Daniel

163

Content, Conciousness, and Colleagues: Emerging Themes from a Program Evaluation of Graduate Student Progress toward Multidisciplinary Science.  

ERIC Educational Resources Information Center

Multidisciplinary education attempts to produce individuals with new capacities to address the problems of an increasingly interconnected world. Although these programs are often exciting, descriptions of optimal design and measures of success are few. Emerging evaluation results from one multidisciplinary graduate training program provide…

Kusmierek, Kristin N.; Piontek, Mary

164

Realistic 3D Human Facial Animation  

Microsoft Academic Search

Construction and animation of realistic human facial models is an important research field in computer graphics. How to simulate the motions of human faces on 3D facial models in real-time to generate realistic facial expressions is still a challenge. In this paper, a technique to simulate the human facial animation realistically in real-time is presented. First of all, the 3D

ZHANG Qing-Shan; CHEN Guo-Liang

2003-01-01

165

Evaluation of a low-cost permanent emergency lighting system based on high-efficiency LEDs  

Microsoft Academic Search

Nowadays, Permanent Emergency Lighting Systems (PELSs) are widely used in many applications, including emergency exit indication and lighting in critical or strategic points. Limitation in operation hours in classical lamps (10 000-20 000 h for fluorescent lamps) implies short lamp replacement times and, therefore, high maintenance costs. This paper shows an alternative solution based on high-efficiency LEDs. The long operation

M. Rico-Secades; A. J. Calleja; J. Ribas; E. L. Corominas; J. M. Alonso; J. Cardesin; J. Garcia-Garcia

2005-01-01

166

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

ERIC Educational Resources Information Center

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.…

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

2010-01-01

167

Impact of emergency oral rabies vaccination of foxes in northeastern Italy, 28 December 2009-20 January 2010: preliminary evaluation.  

PubMed

Fox rabies re-emerged in northeastern Italy in 2008, in an area bordering Slovenia. In 2009, the infection spread westward to Veneto region and in 2010 to the provinces of Trento and Bolzano. Aerial emergency oral fox vaccination was implemented in the winter 2009-10. Since this vaccination was performed at altitudes below the freezing level, a statistical analysis was conducted to evaluate its impact. Of the foxes sampled following the vaccination campaign, 77% showed a rabies antibody titre of >or=0.5 IU/ml. PMID:20650054

Capello, K; Mulatti, P; Comin, A; Gagliazzo, L; Guberti, V; Citterio, C; De Benedictis, P; Lorenzetto, M; Costanzi, C; Vio, P; Zambotto, P; Ferri, G; Mutinelli, F; Bonfanti, L; Marangon, S

2010-01-01

168

Evaluation of an off-the-shelf mobile telemedicine model in emergency department wound assessment and management.  

PubMed

We examined the agreement between a videoconference-based evaluation and a bedside evaluation in the management of acute traumatic wounds in an emergency department. Adult and paediatric patients with acute wounds of various severities to the face, trunk and/or extremities presenting to the emergency department within 24 hours of injury were enrolled. Research assistants transmitted video images of the wound to an emergency physician using a laptop computer. The physician completed a standard wound assessment form before conducting a bedside evaluation and then completing a second assessment form. The primary outcome measure was wound length and depth. We also assessed management decision-making. A total of 173 wounds were evaluated. The correlation coefficient between video and bedside assessments was 0.96 for wound length. The mean difference between the lengths was 0.02 cm (SD 0.91). Management of the wound would have been the same in 94% of cases. The agreement on wound characteristics and wound management ranged from 84-100%. The highest correlation was 0.92 in suture material used and the lowest correlation was 0.64 in wound type. The ability of video images to distinguish between a minor and non-minor wound, and predicting the need for hospital management, had high degrees of sensitivity and specificity. The study showed that wound characteristics and management decisions appear to correlate well between video and bedside evaluations. PMID:23470449

Van Dillen, Christine; Silvestri, Salvatore; Haney, Marisa; Ralls, George; Zuver, Christian; Freeman, Dave; Diaz, Lissa; Papa, Linda

2013-02-01

169

Realistic control of network dynamics.  

PubMed

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 behaviour or fail. Here we show that it is possible to exploit the same principle to control network behaviour. 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 signalling network of human cancer. PMID:23803966

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

2013-01-01

170

Keynote address: United Kingdom experiences of evaluating performance and quality in emergency medicine.  

PubMed

Demand for emergency care is rising throughout the western world and represents a major public health problem. Increased reliance on professionalized health care by the public means that strategies need to be developed to manage the demand safely and in a way that is achievable and acceptable to both consumers of emergency care, but also to service providers. In the United Kingdom, strategies have previously been aimed at managing demand better and included introducing new emergency services for patients to access, extending the skills within the existing workforce, and more recently, introducing time targets for emergency departments (EDs). This article will review the effect of these strategies on demand for care and discuss the successes and failures with reference to future plans for tackling this increasingly difficult problem in health care. PMID:22168184

Mason, Suzanne

2011-12-01

171

Evaluation of Emergency-Locator-Transmitter Performance in Real and Simulated Crash Tests.  

National Technical Information Service (NTIS)

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 pro...

H. D. Carden

1981-01-01

172

Emerging Technology Program (ETP) of the U.S. EPA's Superfund Innovative Technology Evaluation (SITE) Program,  

National Technical Information Service (NTIS)

The Emerging Technology Program offers a mechanism for performing joint technology development between the private sector and the U.S. Environmental Protection Agency (EPA) with the goal of shortening the time period from 'proof of concept' to actual tech...

M. I. Black

1988-01-01

173

Response surface model predictions of emergence and response to pain in the recovery room: an evaluation of patients emerging from an isoflurane and fentanyl anesthetic  

PubMed Central

Introduction Sevoflurane - remifentanil interaction models that predict responsiveness and response to painful stimuli have been evaluated in patients undergoing elective surgery. Preliminary evaluations of model predictions were found to be consistent with observations in patients anesthetized with sevoflurane, remifentanil and fentanyl. The present study explored the feasibility of adapting the predictions of sevoflurane-remifentanil interaction models to an isoflurane-fentanyl anesthetic. We hypothesized that model predictions adapted for isoflurane and fentanyl are consistent with observed patient responses and are similar to the predictions observed in our prior work with sevoflurane-remifentanil/fentanyl anesthetics. Methods Twenty-five patients scheduled for elective surgery received a fentanyl-isoflurane anesthetic. Model predictions of unresponsiveness were recorded at emergence and predictions of a response to noxious stimulus were recorded when patients first required analgesics in the recovery room. Model predictions were compared to observations with graphical and temporal analyses. Results were also compared to our prior predictions following a sevoflurane-remifentanil/fentanyl anesthetic. Results While patients were anesthetized, model predictions indicated a high likelihood that patients would be unresponsive (? 99%). Following termination of the anesthetic, model predictions of responsiveness well described the actual fraction of patients observed to be responsive during emergence. Half of the patients awoke within 2 minutes of the 50% model predicted probability of unresponsiveness; 70% awoke within 4 minutes. Similarly, predictions of a response to a noxious stimulus were consistent with the number of patients who required fentanyl in the recovery room. Model predictions following an isoflurane-fentanyl anesthetic were similar to model predictions following a sevoflurane-remifentanil/fentanyl anesthetic. Discussion Results confirmed our study hypothesis; model predictions for unresponsiveness and no response to painful stimuli, adapted to isoflurane-fentanyl, were consistent with observations. These results were similar to our prior study comparing model predictions and patient observations following a sevoflurane-remifentanil/fentanyl anesthetic.

Syroid, Noah D.; Johnson, Ken B.; Pace, Nathan L.; Westenskow, Dwayne R.; Tyler, Diane; Bruhschwein, Frederike; Albert, Robert W.; Roalstad, Shelly; Costy-Bennett, Samuel; Egan, Talmage D.

2009-01-01

174

Realistic BGP traffic for test labs  

Microsoft Academic Search

This paper examines the possibility of generating realistic routing tables of arbitrary size along with realistic BGP updates of arbitrary frequencies via an automated tool deployable in a small-scale test lab. Such a tool provides the necessary foundations to study such questions as: the limits of BGP scalability, the reasons behind routing instability, and the extent to which routing instability

Olaf Maennel; Anja Feldmann

2002-01-01

175

Research Paper: Forecasting Emergency Department Crowding: A Prospective, Real-time Evaluation  

Microsoft Academic Search

ObjectiveEmergency department crowding threatens quality and access to health care, and a method of accurately forecasting near-future crowding should enable novel ways to alleviate the problem. The authors sought to implement and validate the previously developed ForecastED discrete event simulation for real-time forecasting of emergency department crowding.Design and MeasurementsThe authors conducted a prospective observational study during a three-month period (5\\/1\\/07–8\\/1\\/07)

Nathan R. Hoot; Larry J. LeBlanc; Ian Jones; Scott R. Levin; Chuan Zhou; Cynthia S. Gadd; Dominik Aronsky

2009-01-01

176

Evaluation and Treatment of Sickle Cell Pain in the Emergency Department: Paths to a Better Future  

PubMed Central

Pain is the hallmark of sickle cell disease in children and adolescents. Many children seek relief from their pain in the emergency department. These visits have historically been characterized by undertreatment, bias and distrust. Through compassionate care, aggressive pain management, and the development of clinical pathways or care guidelines, better analgesia and a better experience can be assured for the child with sickle cell disease in need of emergency care.

Zempsky, William T.

2010-01-01

177

Evaluating western corn rootworm (Coleoptera: Chrysomelidae) emergence and root damage in a seed mix refuge.  

PubMed

Resistance management is essential for maintaining the efficacy and long-term durability of transgenic corn engineered to control western corn rootworm (Diabrotica virgifera virgifera Le Conte). Theoretically, a refuge can be provided by growing susceptible (refuge) plants in either a separate section of the field adjacent to resistant (transgenic) plants, or as a seed mixture. We examined the effects of varying the structure of a 10 and 20% refuge between currently approved structured refuges (block or strip plantings), as well as deploying the refuge within a seed mix, on adult emergence timing and magnitude, root damage and yield. Our 2-yr field study used naturally occurring western corn rootworm populations and included seven treatments: 10 and 20% block refuge, 10 and 20% strip refuge, 10 and 20% seed mix refuge, and 100% refuge. Beetles emerging from refuge corn emerged more synchronously with those emerging from transgenic (Bacillus thuringiensis [Berliner] Bt-RW) corn in seed mix refuges when compared with block refuges. The proportion of beetles emerging from refuge plants was significantly greater in a block and strip refuge structure than in a seed mix refuge. More beetles emerged from Bt-RW corn plants when they were grown as part of a seed mix. We discuss the potential benefits and drawbacks of a seed mix refuge structure in light of these findings. PMID:20214380

Murphy, A F; Ginzel, M D; Krupke, C H

2010-02-01

178

The 4-D descent trajectory generation techniques under realistic operating conditions  

NASA Technical Reports Server (NTRS)

NASA-Langley has been conducting and sponsoring research in airborne energy management for a number of years. During the course of this research, two fundamental techniques for the generation of 4D (fixed time) descent trajectories have emerged as viable candidates for advanced flight management systems. The first technique utilizes speed schedules of constant Mach number transitioning to constant calibrated airspeed chosen empirically to produce minimum fuel usage. The second technique computes cost optimized speed schedules of variable airspeed developed through application of optimal control theory. Both techniques have been found to produce reasonable and flyable descent trajectories. The formulation of the algorithms for each technique is evaluated and their suitability for operations in realistic conditions is discussed. Operational factors considered include: airplace speed, thrust, and altitude rate constaints; wind, temperature, and pressure variations; Air Traffic Control altitude, speed, and time constaints; and pilot interface and guidance considerations. Time flexibility, fuel usage, and airborne computational requirements were the primary performance measures.

Williams, David H.; Knox, Charles E.

1990-01-01

179

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

PubMed

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 strongest antimutagenicity and peroxidase activity in all the fractions of the Sec extracts. PMID:11527563

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

2001-11-01

180

Strategies to evaluate synchronous carcinomas of the colon and rectum in patients that present for emergent surgery.  

PubMed

It is not always possible to evaluate patients that present acutely with carcinoma of the colon and rectum for synchronous lesions. Patients that require emergent surgery necessitate urgent and efficient operation. Patients with lower gastrointestinal bleeding, perforation, or obstruction represent a challenging subset of patients with colorectal cancer. An organized approach to these patients in the effort not to overlook a synchronous carcinoma is important. The present paper provides an evidenced-based approach to this special situation. PMID:23476758

Agnew, Jennifer L; Abbadessa, Benjamin; Leitman, I Michael

2013-01-01

181

Thallium myocardial scanning in the emergency department evaluation of chest pain  

SciTech Connect

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.

Mace, S.E.

1989-05-01

182

Role-playing for more realistic technical skills training.  

PubMed

Clinical skills are an important and necessary part of clinical competence. Simulation plays an important role in many fields of medical education. Although role-playing is common in communication training, there are no reports about the use of student role-plays in the training of technical clinical skills. This article describes an educational intervention with analysis of pre- and post-intervention self-selected student survey evaluations. After one term of skills training, a thorough evaluation showed that the skills-lab training did not seem very realistic nor was it very demanding for trainees. To create a more realistic training situation and to enhance students' involvement, case studies and role-plays with defined roles for students (i.e. intern, senior consultant) were introduced into half of the sessions. Results of the evaluation in the second term showed that sessions with role-playing were rated significantly higher than sessions without role-playing. PMID:16019330

Nikendei, C; Zeuch, A; Dieckmann, P; Roth, C; Schäfer, S; Völkl, M; Schellberg, D; Herzog, W; Jünger, J

2005-03-01

183

Emergency department mental health triage consultancy service: an evaluation of the first year of the service.  

PubMed

This article presents the findings of a review of the first year of a night emergency department (ED) mental health triage and consultancy service. During the first 12 months of operation of the service, data on key performance indicators were entered into an emergency mental health triage and consultancy database. Data were also obtained from pre- and post-satisfaction surveys completed by ED staff and from self-appraisal statements generated by the five mental health nurses who undertook the position during the review period. The findings show the ED mental health triage and consultancy service positively impacted on the functioning of the emergency department. This was evidenced by staff' perceptions regarding the value of the service and through shorter "seen by times", a reduction in the number of patients with psychiatric/psychosocial problems who left the department without being seen, and the effective management of patients presenting with psychiatric/psychosocial problems, particularly those presenting with deliberate self-harm. The review provided evidence regarding the value of the emergency mental health triage and consultancy service and highlighted the advanced practice role undertaken by mental health nurses in this position. PMID:14700570

McDonough, Stuart; Wynaden, Dianne; Finn, Michael; McGowan, Sunita; Chapman, Rose; Hood, Sean

2004-01-01

184

Auerbach Final Report on an Evaluation of the Emergency Loan Program.  

National Technical Information Service (NTIS)

The emergency loan program (ELP) is a low-income loan program based on the 1966 amendments to the Economic Opportunity Act, to demonstrate that lending to the poor would work and could be effective as part of an overall attack on underlying causes of pove...

1970-01-01

185

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

ERIC Educational Resources Information Center

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…

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

2013-01-01

186

EVALUATION OF NEW AND EMERGING TECHNOLOGIES IN THE METAL FINISHING INDUSTRY  

EPA Science Inventory

A research program was completed to identify new and emerging waste management technologies in the metal finishing industry. A limited field sampling and analytical program was pursued to define performance at full scale operating facilities for the following technologies: (1) bu...

187

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

ERIC Educational Resources Information Center

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…

Colarossi, Lisa; Billowitz, Marissa; Breitbart, Vicki

2010-01-01

188

Evaluating the impact of emerging streaming media applications on TCP\\/IP performance  

Microsoft Academic Search

Emerging streaming media applications in the Internet primarily use UDP transport. The difficulty with supporting this type of traffic on the Internet is that they not only generate large volumes of traffic, but they are also not as responsive to network congestion as TCP-based applications. As a result, streaming media UDP traffic can cause two major problems in the Internet:

Duke P. Hong; C. Albuquerque; C. Oliveira; T. Suda

2001-01-01

189

Scalable Emergency Response System for Oceangoing Assets Report on Brainstorming Concept Evaluations.  

National Technical Information Service (NTIS)

The scalable emergency system is intended to cover the full scale of possible at-sea incidents from the routine to the rare; from the detection and decontamination of a single piece of equipment before it is loaded on a vessel, to the response, rescue, co...

E. J. Dougherty

2007-01-01

190

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

ERIC Educational Resources Information Center

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…

Deuber, Dagmar; Leung, Glenda-Alicia

2013-01-01

191

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

ERIC Educational Resources Information Center

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,…

Githens, William H.; Zalinski, James

192

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

PubMed

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 (?-hCG) level below a discriminatory threshold? (2) In patients who have an indeterminate transvaginal ultrasound, what is the diagnostic utility of ?-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

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

2012-09-01

193

Synthesizing realistic environments in an anechoic chamber  

Microsoft Academic Search

We present an experimental setup in anechoic chamber that synthesizes realistic frequency selective fading properties. Antennas for S-band mobile TV applications are tested in that synthesized environment.

L. Rudant; C. Delaveaud; M. AbouElAnouar

2009-01-01

194

Toward a Direct Realist Account of Observation.  

ERIC Educational Resources Information Center

Criticizes the account of observation given by Alan Chalmers in "What Is This Thing Called Science?" and provides an alternative based on direct realist approaches to perception. Contains 15 references. (Author/WRM)

Sievers, K. H.

1999-01-01

195

Wisconsin Emergency Department Utilization Study.  

National Technical Information Service (NTIS)

Data are presented from an emergency department utilization study initiated by the Wisconsin Emergency Medical Services Program to evaluate demands placed on the emergency medical service system in the State. The following characteristics of emergency dep...

E. Agisim M. Woll D. Giovannini

1973-01-01

196

Looking at terrorism through left realist lenses  

Microsoft Academic Search

While terrorism has moved into the spotlight of criminological study, including critical criminology, it has yet to be thoroughly\\u000a explored from a left realist perspective. Left realism addresses four aspects of crime: causes of offending, impact on the\\u000a victims, and both official and public responses to crime. A left realist approach to terrorism would argue that similar to\\u000a those who

Jennifer C. Gibbs

2010-01-01

197

The emergency medicine approach to the evaluation and treatment of pulmonary embolism.  

PubMed

Each year in the United States, up to 900,000 individuals will suffer from acute pulmonary embolism, resulting in an estimated 200,000 to 300,000 hospital admissions. Despite decades of research on the topic, the diagnosis remains elusive in many situations and the fatality rate remains significant. This issue presents a review of the current evidence guiding the emergency medicine approach to the diagnosis and treatment of pulmonary embolism. Key to this approach is the concept of risk stratification: using factors from the history and physical examination, plus ancillary tests, to guide clinical decision making. The pathophysiology of pulmonary embolism and decision-support tools are reviewed, and emergency department management strategies are described. PMID:23218203

Church, Amy; Tichauer, Matthew

2012-12-01

198

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

NASA Technical Reports Server (NTRS)

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.

Carden, H. D.

1981-01-01

199

Traumatic Brain Injuries Evaluated in U.S. Emergency Departments, 1992-1994  

Microsoft Academic Search

Objective: To describe the incidence and patient characteristics of traumatic brain injuries (TBIs) treated in U.S. emergency departments (EDs). Methods: A secondary analysis was performed on data from the National Hospital Ambulatory Medical Care Survey administered from 1992 to 1994. An ED visit was determined to represent a case of TBI if the case record contained ICD-9-CM codes of 800.0-

Thomas E. Jager; Harold B. Weiss; Jeffrey H. Coben; Paul E. Pepe

2000-01-01

200

Adult Sexual Assault Evaluations at Rhode Island Emergency Departments, 1995–2001  

Microsoft Academic Search

The objectives of this study were to estimate the incidence and identify the temporal patterns of visits to Rhode Island emergency\\u000a departments (EDs) by adults who were sexually assaulted. Visits to all Rhode Island EDs from January 1995–June 2001 by adults\\u000a who were sexually assaulted were identified using International Classification of Disease, Ninth Revision, Clinical Modification\\u000a (ICD-9) codes. Medical records

Roland C. Merchant; Tse Chiang Lau; Tao Liu; Kenneth H. Mayer; Bruce M. Becker

2009-01-01

201

Performance evaluation of laboratory scale up-flow constructed wetlands with different designs and emergent plants  

Microsoft Academic Search

The objective of present study was to assess the simultaneous removal of organic pollutants and nutrients by five laboratory scale up-flow constructed wetlands (UFCWs). Aerobic and anaerobic regions were well developed at the upper and lower beds, respectively, in the UFCW reactors with supplementary aeration. The emergent plants employed were Phragmites australis and Manchurian wild rice. The COD, T–N, T–P,

Soon-An Ong; Katsuhiro Uchiyama; Daisuke Inadama; Yuji Ishida; Kazuaki Yamagiwa

2010-01-01

202

Evaluating the use of computerised clinical guidelines in the accident and emergency department  

Microsoft Academic Search

Objectives—To investigate the pattern and frequency of use of computerised clinical guidelines (CCG) in an accident and emergency department.Methods—A software program was written to record information on a central database each time the CCG were used. Data were collected prospectively for a six month period. Users were blind to the study. The date, time of use and guidelines consulted were

H D M Poncia; G D R Bryant; J Ryan

2000-01-01

203

Randomized, Placebo-Controlled Evaluation of Prochlorperazine Versus Metoclopramide for Emergency Department Treatment of Migraine Headache  

Microsoft Academic Search

Study objective: To determine the comparative efficacy of IV metoclopramide and prochlorperazine for the initial emergency department treatment of migraine headache.Design: Prospective, randomized, double-blind, placebo-controlled trial. Setting: Military community hospital ED with an annual census of 75,000. Participants: Seventy consenting adults from a convenience sample of patients presenting with migraine headache similar to that experienced in at least one prior

Marco Coppola; Donald M Yealy; Robert A Leibold

1995-01-01

204

Methodology for evaluation of insulation-debris effects. Containment emergency sump performance-unresolved safety issue A-43  

SciTech Connect

The postulated failure of high energy piping within a light water reactor containment has raised safety questions related to the generation of insulation debris, the migration of such debris to the containment emergency sump screens and the potential for severe screen blockages. High, or total, screen blockages could result in impairment of the long term RHR recirculation systems. Debris considerations are an integral part of the unresolved Safety Issue A-43, Containment Emergency Sump Performance. This report develops calculational methods and debris transport models which can be used for estimating the quantities of debris that might be generated by a LOCA, the transport of such debris, methods for estimating screen blockages and attendant pressure losses. Five operating plants were analyzed using this debris evaluation methodology. These calculations show the dependency on plant containment layout, sump location and design, and types and quantities of insulation employed. 9 figures, 6 tables.

Wysocki, J.; Kolbe, R.

1982-09-01

205

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

SciTech Connect

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.

NONE

1993-10-28

206

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

SciTech Connect

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.

Rodriguez, D.; Walker, H. [Lawrence Livermore National Lab., CA (United States); Klepikova, N.; Kostrikov, A. [Inst. of Experimental Meteorology, Obninsk (Russian Federation)

1993-05-14

207

Emergency Victim Care. A Training Manual for Emergency Medical Technicians. Module 2. Equipment, Safe Driving Practices, Legal Aspects, Controlling the Situation, Action Evaluation Conference. Revised.  

ERIC Educational Resources Information Center

This student manual, the second in a set of 14 modules, is designed to train emergency medical technicians (EMTs) in Ohio. The module contains five sections that cover the following course content: ambulance equipment, safe driving practices for emergency vehicle drivers, legal aspects of the EMT's job, how to maintain control at an accident scene…

Ohio State Dept. of Education, Columbus. Div. of Vocational Education.

208

An Evaluation of Technologies for Identifying Acute Cardiac Ischemia in the Emergency Department: A Report from a National Heart Attack Alert Program Working Group  

Microsoft Academic Search

[Selker HP, Zalenski RJ, Antman EM, Aufderheide TP, Bernard SA, Bonow RO, Gibler WB, Hagen MD, Johnson P, Lau J, McNutt RA, Ornato J, Schwartz JS, Scott JD, Tunick PA, Weaver WD: An evaluation of technologies for identifying acute cardiac ischemia in the emergency department: A report from a National Heart Attack Alert Program Working Group. Ann Emerg Med January

Harry P Selker; Robert J Zalenski; Elliott M Antman; Tom P Aufderheide; Sheilah Ann Bernard; Robert O Bonow; W. Brian Gibler; Michael D Hagen; Paula Johnson; Joseph Lau; Robert A McNutt; Joseph Ornato; J. Sanford Schwartz; Jane D Scott; Paul A Tunick; W. Douglas Weaver

1997-01-01

209

An Evaluation of Technologies for Identifying Acute Cardiac Ischemia in the Emergency Department: Executive Summary of a National Heart Attack Alert Program Working Group Report  

Microsoft Academic Search

[Selker HP, Zalenski RJ, Antman EM, Aufderheide TP, Bernard SA, Bonow RO, Gibler WB, Hagen MD, Johnson P, Lau J, McNutt RA, Ornato J, Schwartz JS, Scott JD, Tunick PA, Weaver WD: An evaluation of technologies for identifying acute cardiac ischemia in the emergency department: Executive Summary of a National Heart Attack Alert Program Working Group report. Ann Emerg Med

Harry P Selker; Robert J Zalenski; Elliott M Antman; Tom P Aufderheide; Sheilah Ann Bernard; Robert O Bonow; W. Brian Gibler; Michael D Hagen; Paula Johnson; Joseph Lau; Robert A McNutt; Joseph Ornato; J. Sanford Schwartz; Jane D Scott; Paul A Tunick; W. Douglas Weaver

1997-01-01

210

Using DEMs to evaluate morphological change around an emergent vegetation patch over repeated hydrographs  

NASA Astrophysics Data System (ADS)

Flume experiments tested a sand-gravel sediment mixture and two model emergent vegetation patches of varying stem density to explore changes in bed morphology around a patch when subjected to a series of repeated hydrographs. The wake area downstream of emergent vegetation patches is typically considered a region of sediment accumulation. However, the extent to which mixed size sediment transports and deposits around emergent vegetation patches remains poorly defined. This uncertainty is heightened by changes in bed morphology over large temporal scales and unsteady flow conditions. In these experiments unsteady flow hydrographs were discretized with 17 four-minute constant flow intervals with magnitudes modeled to fit the asymmetrical shape of the NRCS dimensionless unit hydrograph. Hydrographs were applied to a channel of mixed gravel and sand sediment in which a patch of emergent vegetation was fixed. The same hydrograph was repeated in each experiment and between hydrographs, a 2-hour baseflow was run to simulate lower flow periods and provide a flow history to the channel. Suspended and bedload sediment transport rates were measured during every flow interval of each hydrograph. After each hydrograph a detailed digital elevation model (DEM) was created to map the bed morphology and allow for DEM differencing. A unit bed adjustment parameter, ?b, is introduced to quantify the amount of reach-averaged channel change and monitor morphological stability over the scales of multiple hydrographs. Flow and sediment conditions were repeated for patches with sparse and dense stem densities. Results indicated that the total sediment yield over each hydrograph was reduced for both the sparse and dense model patches relative to unvegetated channel conditions. In the case of the sparse patch, the channel reached a dynamically stable state in one fewer hydrograph than when there was no patch present. A characteristic morphology developed downstream of the patch, with a mound of sediment accumulation forming within 10 patch diameters and significant ripple formation beyond this point farther downstream. The channel bed adjusted in a similar fashion for the dense patch, though the sediment mound was locally higher just downstream of the patch, not as extensive laterally, and dune formation was somewhat delayed and not as regular as for the sparse patch. More erosion was observed adjacent to the dense patch than for the sparse, consistent with flow acceleration due to increased channel blockage. Overall, the dense patch appeared to introduce more variability in the channel bed morphology, reflected by a larger range and standard deviation of bed elevations for the series of DEMs.

Waters, K. A.; Curran, J. C.

2013-12-01

211

Evaluation of emerging parallel optical link technology for high energy physics  

SciTech Connect

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.

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

2012-01-01

212

Development of a realistic human airway model.  

PubMed

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

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

2012-03-01

213

Process and Outcome Evaluation of an Emergency Department Intervention for Persons with Mental Health Concerns Using a Population Health Approach  

Microsoft Academic Search

Purpose:  To evaluate an emergency department’s use of a mental health triage and mental health crisis counsellor for persons presenting\\u000a with mental health concerns.\\u000a \\u000a \\u000a \\u000a Method:  Mixed method (qualitative and quantitative), multiple measures.\\u000a \\u000a \\u000a \\u000a Results:  Significant pre- and post-intervention reductions for wait time, security incidents and hospital admissions were found. Follow\\u000a ups with a community agency, medications and a psychiatrist increased post-intervention, while follow ups

Evelyn Vingilis; Kathleen Hartford; Kristine Diaz; Beth Mitchell; Raj Velamoor; Marnie Wedlake; Dawn White

2007-01-01

214

Evaluation of ambulance offload delay at a university hospital emergency department  

PubMed Central

Background Ambulance offload delay (AOD) has been recognized by the National Association of EMS Physicians (NAEMSP) as an important quality marker. AOD is the time between arrival of a patient by EMS and the time that the EMS crew has given report and moved the patient off of the EMS stretcher, allowing the EMS crew to begin the process of returning to service. The AOD represents a potential delay in patient care and a delay in the availability of an EMS crew and their ambulance for response to emergencies. This pilot study was designed to assess the AOD at a university hospital utilizing direct observation by trained research assistants. Findings A convenience sample of 483 patients was observed during a 12-month period. Data were analyzed to determine the AOD overall and for four groups of National Emergency Department Overcrowding Scale (NEDOCS) score ranges. The AOD ranged from 0 min to 157 min with a median of 11 min. When data were grouped by NEDOCS score, there was a statistically significant difference in median AOD between the groups (p < 0.001), indicating the relationship between ED crowding and AOD. Conclusion The median AOD was considered significant and raised concerns related to patient care and EMS system resource availability. The NEDOCS score had a positive correlation with AOD and should be further investigated as a potential marker for determining diversion status or for destination decision-making by EMS personnel.

2013-01-01

215

Evaluation of a new nonnvasive device in determining hemoglobin levels in emergency department patients.  

PubMed

Introduction: The Masimo Radical-7 Pulse CO-Oximeter is a medical device recently approved by the US Food and Drug Administration that performs noninvasive oximetry and estimated venous or arterial hemoglobin measurements. A portable, noninvasive device that rapidly measures hemoglobin concentration could be useful in both austere and modern hospital settings. The objective of this study is to determine the degree of variation between the device's estimated hemoglobin measurement and the actual venous hemoglobin concentration in undifferentiated emergency department (ED) patients. Methods: We conducted a prospective, observational, cross-sectional study of adult patients presenting to the ED. The subjects consisted of a convenience sample of adult ED patients who required a complete blood count as part of their care in the ED. A simultaneous probe hemoglobin was obtained and recorded. Results: Bias between probe and laboratory hemoglobin measurements was -0.5 (95% confidence interval, - 0.8 to -0.1) but this was not statistically significant from 0 (t 0.05,124 = 0.20, P > 0.5). The limits of agreement were -4.7 and 3.8, beyond the clinically relevant standard of equivalency of ± 1 g/dL. Conclusion: These data suggest that noninvasive hemoglobin determination is not sufficiently accurate for emergency department use. PMID:23687550

Knutson, Tristan; Della-Giustina, David; Tomich, Eric; Wills, Brandon; Luerssen, Emily; Reynolds, Penny

2013-05-01

216

Evaluation of a New Nonnvasive Device in Determining Hemoglobin Levels in Emergency Department Patients  

PubMed Central

Introduction: The Masimo Radical-7 Pulse CO-Oximeter is a medical device recently approved by the US Food and Drug Administration that performs noninvasive oximetry and estimated venous or arterial hemoglobin measurements. A portable, noninvasive device that rapidly measures hemoglobin concentration could be useful in both austere and modern hospital settings. The objective of this study is to determine the degree of variation between the device's estimated hemoglobin measurement and the actual venous hemoglobin concentration in undifferentiated emergency department (ED) patients. Methods: We conducted a prospective, observational, cross-sectional study of adult patients presenting to the ED. The subjects consisted of a convenience sample of adult ED patients who required a complete blood count as part of their care in the ED. A simultaneous probe hemoglobin was obtained and recorded. Results: Bias between probe and laboratory hemoglobin measurements was –0.5 (95% confidence interval, – 0.8 to –0.1) but this was not statistically significant from 0 (t0.05,124 = 0.20, P > 0.5). The limits of agreement were –4.7 and 3.8, beyond the clinically relevant standard of equivalency of ± 1 g/dL. Conclusion: These data suggest that noninvasive hemoglobin determination is not sufficiently accurate for emergency department use.

Knutson, Tristan; Della-Giustina, David; Tomich, Eric; Wills, Brandon; Luerssen, Emily; Reynolds, Penny

2013-01-01

217

"easyMine" - realistic and systematic mine detection simulation tooltion  

NASA Astrophysics Data System (ADS)

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.

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

2004-05-01

218

Evaluation of the precision of emergency department diagnoses in young children with fever.  

PubMed

OBJECTIVE. To characterize causes of fever in children presenting to a pediatric emergency department (ED). METHODS. One-year retrospective review of ED records. Inclusion criteria were 2 to 36 months of age with a documented temperature ? 39°C. Exclusion criteria were elopement, repeat visit, and underlying diagnosis with a predisposition to infection. Medical records were reviewed using a predefined, study-specific, data abstraction tool. Based on diagnosis and pathogen detection, visits were assigned to 3 groups, laboratory confirmed pathogen and focal or nonfocal diagnosis without confirmed pathogen. RESULTS. A total of 1091 visits met inclusion criteria. Fourteen percent had a pathogen detected, 56% had a focal diagnosis without a confirmed pathogen, and 30% had a nonfocal diagnosis without confirmed pathogen. CONCLUSIONS. In a cohort of febrile children 2 to 36 months of age, only 14% had a confirmed pathogen. New rapid viral diagnostic techniques may provide an opportunity to improve diagnostic certainty in young children presenting with fever. PMID:21868591

Colvin, Joshua M; Jaffe, David M; Muenzer, Jared T

2012-01-01

219

Nine-year evaluation of emergency department personnel exposure to ionizing radiation  

SciTech Connect

Emergency department personnel experience potential occupational hazards from exposure to ionizing radiation (x-rays). To assess this risk, ionizing radiation exposure was analyzed during a nine-year period for 128 ED personnel. The group consisted of 21 physicians, 92 nurses, and 15 ancillary personnel. Exposure was measured for both penetrating and nonpenetrating radiation using standard film dosimeter badges. Film badge use compliance was 66.7% for physicians, 86.2% for nurses, and 86.7% for ancillary personnel. Penetrating radiation exposure averaged 0.12 mrem/month for physicians, 0.70 mrem/month for nurses, and 0 mrem/month for ancillary personnel, all less than the average natural background exposure. We concluded that if standard radiation precautions are taken, the occupational risk from ionizing radiation exposure to personnel in the ED is minimal, and that routine monitoring of radiation exposure of ED personnel is unnecessary.

Grazer, R.E.; Meislin, H.W.; Westerman, B.R.; Criss, E.A.

1987-03-01

220

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

SciTech Connect

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.

Duberstein, Corey A.; Downs, Janelle L.

2008-11-06

221

Evaluation of emerging parallel optical link technology for high energy physics  

NASA Astrophysics Data System (ADS)

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. This work was supported by the U.S. Department of Energy, operated by Fermi Research Alliance, LLC under contract No. DE-AC02-07CH11359 with the United States Department of Energy.

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

2012-01-01

222

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)

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.

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

1996-01-01

223

Perioperative evaluation of cardiac surgical risk: particularities in the emergency surgery - from the guidelines to the clinical practice  

PubMed Central

Rationale: Cardiac risk in patients undergoing surgery depends on many factors from the patient's cardiovascular history to the surgical procedure itself, with its particularities, the type of anesthesia, fluid exchanges and the supervision of the patient. Therefore, this risk must be carefully considered and it determines the endorsement of perioperative measures with important medical implications. Objective: Perioperative cardiac risk evaluation guidelines were published since 2010 and they represent a highly important assessmnet tool. Emergency surgery requires an adaptation of the guidelines to the actual medical situations in extreme conditions. Methods, Results, Discussion: Analyzing the way the perioperative evaluation itself is conducted is an extremely important tool. Quantifying the clinical application of the guidelines, one can monitor real parameters and find solutions for improving medical care. The current study was conducted on a representative sample of 8326 patients, respecting the recommendation strategies for calculating the surgical risk adapted for the emergency surgery setting. The dominant conclusion is the need to develop a standardized form, summarized for quick and objective assessment of perioperative cardiac risk score. Only a complex medical team could calculate this score while the decisional team leader for the surgical patient remains the surgeon.

Andronescu, AM; Nechita, AC; Ittu, G; Delcea, C; Dumitrescu, G; Vintila, MM

2013-01-01

224

On a realistic interpretation of quantum mechanics  

Microsoft Academic Search

The best mathematical arguments against a realistic interpretation of quantum mechanics - that gives definite but partially unknown values to all observables - are analysed and shown to be based on reasoning that is not compelling. This opens the door for an interpretation that, while respecting the indeterministic nature of quantum mechanics, allows to speak of definite values for all

Arnold Neumaier

1999-01-01

225

Is resilience engineering realist or constructivist?  

Microsoft Academic Search

This exploratory paper questions whether resilience engineering is a realist or constructivist approach of safety. After a presentation of two positions: critical realism and radical constructivism, the authors explain how the frameworks provided by these two positions were used in different researches, answering different questions that arose during the work. For one, critical realism offered an answer to the problem

Jean Christophe Le Coze; Kenneth Pettersen

226

Artificial Animals in Realistic Virtual Worlds  

Microsoft Academic Search

This paper describes a virtual marine ecosystem inhab- ited by realistic artificial life that emulates the appearan ce, movement, and behavior of real fishes. Each artificial fish is an autonomous agent in a simulated physical world. It has (i) a three-dimensional body with internal muscle ac- tuators and functional fins, which deforms and locomotes in accordance with biomechanic and hydrodynamic

Demetri Terzopoulos

1996-01-01

227

Realistic audio in immersive video conferencing  

Microsoft Academic Search

With increasing computation power, network bandwidth, and improvements in display and capture technologies, fully immersive conferencing and tele-immersion is becoming ever closer to reality. Outside of video, one of the key components needed is high quality spatialized audio. This paper presents an implementation of a relatively low complexity, simple solution which allows realistic audio spatialization of arbitrary positions in a

Sanjeev Mehrotra; Wei-ge Chen; Zhengyou Zhang; Philip A. Chou

2011-01-01

228

Realistic modeling and rendering of plant ecosystems  

Microsoft Academic Search

Modeling and rendering of natural scenes with thousands of plants poses a number of problems. The terrain must be modeled and plants must be distributed throughout it in a realistic manner, reflecting the interactions of plants with each other and with their environment. Geometric models of individual plants, consistent with their po- sitions within the ecosystem, must be synthesized to

Oliver Deussen; Pat Hanrahan; Bernd Lintermann; Radomír M?ch; Matt Pharr; Przemyslaw Prusinkiewicz

1998-01-01

229

Diagnostic evaluation of the MRP-8/14 for the emergency assessment of chest pain  

PubMed Central

Elevated levels of myeloid-related protein (MRP)-8/14 (S100A8/A9) are associated with first cardiovascular events in healthy individuals and worse prognosis in patients with acute coronary syndrome (ACS). The diagnostic utility of MRP-8/14 in patients presenting to the emergency room with symptoms concerning for ACS is uncertain. MRP-8/14 was measured in serial serum and plasma samples in a single center prospective cohort-study of patients presenting to the emergency room with non-traumatic chest pain concerning for ACS. Final diagnosis was adjudicated by an endpoint committee. Of patients with baseline MRP-8/14 results (n = 411), the median concentration in serum was 1.57 ?g/ml (25th, 75th: 0.87, 2.68) and in plasma was 0.41 ?g/ml (<0.4, 1.15) with only moderate correlation between serum and plasma (? = 0.40). A final diagnosis of MI was made in 106 (26%). Peak serum MRP-8/14 was higher in patients presenting with MI (p <0.001). However, the overall diagnostic performance of MRP-8/14 was poor: sensitivity 28% (95% CI 20–38), specificity 82% (78–86), positive predictive value 36% (26–47), and negative predictive value 77% (72–81). The area under the ROC curve for diagnosis of MI with MRP-8/14 was 0.55 (95% CI 0.51–0.60) compared with 0.95 for cTnI. The diagnostic performance was not improved in early-presenters, patients with negative initial cTnI, or using later MRP-8/14 samples. Patients presenting with MI had elevated levels of serum MRP-8/14 compared to patients with non-cardiac chest pain. However, overall diagnostic performance of MRP-8/14 was poor and neither plasma nor serum MRP-8/14 offered diagnostic utility comparable to cardiac troponin.

Vora, Amit N.; Ruff, Christian T.; Jarolim, Petr; Murphy, Sabina; Croce, Kevin; Sabatine, Marc S.; Simon, Daniel I.; Morrow, David A.

2014-01-01

230

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

USGS Publications Warehouse

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 deeper water habitat of S. acutus. The Landsat 7 dataset (7 images) predicted biomass slightly better than the WV-2 dataset (6 images) (R2 = 0.56, %RMSE = 20.9%, compared to R2 = 0.45, RMSE = 21.5%). The Hyperion dataset (one image) was least successful in predicting biomass (R2 = 0.27, %RMSE = 33.5%). Shortwave infrared bands on 30 m-resolution Hyperion and Landsat 7 sensors aided biomass estimation; however managers need to weigh tradeoffs between cost, additional spectral information, and high spatial resolution that will identify variability in small, fragmented marshes common to the Sacramento–San Joaquin River Delta and elsewhere in the Western U.S.

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

2014-01-01

231

Imaging-Based Tumor Treatment Response Evaluation: Review of Conventional, New, and Emerging Concepts  

PubMed Central

Tumor response may be assessed readily by the use of Response Evaluation Criteria in Solid Tumor version 1.1. However, the criteria mainly depend on tumor size changes. These criteria do not reflect other morphologic (tumor necrosis, hemorrhage, and cavitation), functional, or metabolic changes that may occur with targeted chemotherapy or even with conventional chemotherapy. The state-of-the-art multidetector CT is still playing an important role, by showing high-quality, high-resolution images that are appropriate enough to measure tumor size and its changes. Additional imaging biomarker devices such as dual energy CT, positron emission tomography, MRI including diffusion-weighted MRI shall be more frequently used for tumor response evaluation, because they provide detailed anatomic, and functional or metabolic change information during tumor treatment, particularly during targeted chemotherapy. This review elucidates morphologic and functional or metabolic approaches, and new concepts in the evaluation of tumor response in the era of personalized medicine (targeted chemotherapy).

Kang, Hee; Lee, Kyung Soo; Kim, Jae-Hun

2012-01-01

232

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

PubMed Central

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.

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

2013-01-01

233

Evaluation of release consistent software distributed shared memory on emerging network technology  

Microsoft Academic Search

We evaluate the effect of processor speed, network characteristics, and software overhead on the performance of release-consistent software distributed shared memory. We examine five different protocols for implementing release consistency: eager update, eager invalidate, lazy update, lazy invalidate, and a new protocol called lazy hybrid. This lazy hybrid protocol combines the benefits of both lazy update and lazy invalidate.Our simulations

Sandhya Dwarkadas; Peter J. Keleher; Alan L. Cox; Willy Zwaenepoel

1993-01-01

234

Evaluation Report of the Title VII Emergency School Aid Act Program of the Springfield Public Schools.  

ERIC Educational Resources Information Center

Three discrete programs were evaluated by comparing students' pretest-posttest results, and by surveying teachers, principals, and parents for their perceptions of the programs and recommendations for improvement. Over 500 students, referred to student relations specialists because of personal or social problems, showed statistically significant…

Ferrara, Barbara E.; Redemer, Merrill

235

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

PubMed

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

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

2011-01-01

236

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 ...

237

Near-realistic mobile exergames with wireless wearable sensors.  

PubMed

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

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

2014-03-01

238

The quest for physically realistic streamflow forecasting models  

NASA Astrophysics Data System (ADS)

The current generation of time stepping hydrological models used by operational forecasting agencies are process-weak, where model parameters are often assigned unrealistic values to compensate for model structural weaknesses. These time stepping simulation models are therefore subject to the same stationarity predicament that plagues statistical streamflow forecasting systems. Consequently, the operational forecasting community has similar research priorities to the science community, that is, to develop physically realistic hydrological models. This paper describes development of a new modeling framework to improve the representation of hydrological processes within operational streamflow forecasting models. The framework recognizes that the majority of process-based models use the same set of physics - most models use Darcy's Law to represent the flow of water through the soil matrix and Fourier's Law for thermodynamics. The new modeling framework uses numerically robust solutions of the hydrology and thermodynamic governing equations as the structural core, and incorporates multiple options to represent the impact of different modeling decisions, including different methods to represent spatial variability and different parameterizations of surface fluxes and shallow groundwater. Use of multivariate research data to evaluate these different modeling options reveals that the new modeling framework can provide realistic simulations of both point-scale measurements of hydrologic states and fluxes as well as realistic simulations of streamflow in headwater catchments, with minimal calibration. Moreover, the availability of multiple modeling options improves representation of model uncertainty.

Restrepo, Pedro; Wood, Andy; Clark, Martyn

2013-04-01

239

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

PubMed Central

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.

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

2013-01-01

240

Thruster Options for Microspacecraft: A Review and Evaluation of Existing Hardware and Emerging Technologies  

Microsoft Academic Search

State-of-the-art thruster technologies are reviewed and evaluated in view of potential microspacecraft applications. Microspacecraft are defined in this study as spacecraft with masses between 1 and 20 kg. Based on this review of existing technologies, future development needs for micropropulsion systems are defined and advanced new micropropulsion concepts especially designed with microspacecraft applications in mind are introduced. Of the state-of-

Juergen Mueller

241

Comparative analysis of the effectiveness of three immunization strategies in controlling disease outbreaks in realistic social networks.  

PubMed

The high incidence of emerging infectious diseases has highlighted the importance of effective immunization strategies, especially the stochastic algorithms based on local available network information. Present stochastic strategies are mainly evaluated based on classical network models, such as scale-free networks and small-world networks, and thus are insufficient. Three frequently referred stochastic immunization strategies-acquaintance immunization, community-bridge immunization, and ring vaccination-were analyzed in this work. The optimal immunization ratios for acquaintance immunization and community-bridge immunization strategies were investigated, and the effectiveness of these three strategies in controlling the spreading of epidemics were analyzed based on realistic social contact networks. The results show all the strategies have decreased the coverage of the epidemics compared to baseline scenario (no control measures). However the effectiveness of acquaintance immunization and community-bridge immunization are very limited, with acquaintance immunization slightly outperforming community-bridge immunization. Ring vaccination significantly outperforms acquaintance immunization and community-bridge immunization, and the sensitivity analysis shows it could be applied to controlling the epidemics with a wide infectivity spectrum. The effectiveness of several classical stochastic immunization strategies was evaluated based on realistic contact networks for the first time in this study. These results could have important significance for epidemic control research and practice. PMID:24787718

Xu, Zhijing; Zu, Zhenghu; Zheng, Tao; Zhang, Wendou; Xu, Qing; Liu, Jinjie

2014-01-01

242

Comparative Analysis of the Effectiveness of Three Immunization Strategies in Controlling Disease Outbreaks in Realistic Social Networks  

PubMed Central

The high incidence of emerging infectious diseases has highlighted the importance of effective immunization strategies, especially the stochastic algorithms based on local available network information. Present stochastic strategies are mainly evaluated based on classical network models, such as scale-free networks and small-world networks, and thus are insufficient. Three frequently referred stochastic immunization strategies—acquaintance immunization, community-bridge immunization, and ring vaccination—were analyzed in this work. The optimal immunization ratios for acquaintance immunization and community-bridge immunization strategies were investigated, and the effectiveness of these three strategies in controlling the spreading of epidemics were analyzed based on realistic social contact networks. The results show all the strategies have decreased the coverage of the epidemics compared to baseline scenario (no control measures). However the effectiveness of acquaintance immunization and community-bridge immunization are very limited, with acquaintance immunization slightly outperforming community-bridge immunization. Ring vaccination significantly outperforms acquaintance immunization and community-bridge immunization, and the sensitivity analysis shows it could be applied to controlling the epidemics with a wide infectivity spectrum. The effectiveness of several classical stochastic immunization strategies was evaluated based on realistic contact networks for the first time in this study. These results could have important significance for epidemic control research and practice.

Xu, Zhijing; Zu, Zhenghu; Zheng, Tao; Zhang, Wendou; Xu, Qing; Liu, Jinjie

2014-01-01

243

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

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…

O'Reilly, Daniel J.

2011-01-01

244

Out-of-hours emergency dental services--evaluation of the first year of a pilot project in Fife.  

PubMed

The Scottish Executive Health Department approved funding in 2001 for Fife NHS Board to pilot an integrated model of out-of-hours dental services based upon a dental nurse-led triage system during the evenings, weekends and some public holidays. After one year of the pilot project the activity was evaluated by analysing the triage database. Nearly 4,000 calls were received--Fridays and Saturdays were the most popular days to telephone which resulted in nearly half of all callers being referred to an emergency weekend clinic. Thirty-nine percent of callers received advice only or were advised to contact their own dentist during working hours. A further 12% who were not registered with a dentist (n=479) were offered a next-day appointment with a dentist in their area--around half of these callers subsequently attended for an appointment. Only two out of every 100 callers were deemed to require emergency out-of-hours attention and were referred to oral surgery staff in a local hospital. PMID:15731793

Topping, G V A

2005-02-26

245

Evaluation and improvement of doctor-patient communication competence for emergency neurosurgeons: a standardized family model  

PubMed Central

Disease treatments have been significantly influenced by the communications between patients, their families, and doctors the lack of which may lead to malpractice allegations and complaints. In particular, inadequate communication may delay diagnosis and treatment. Therefore, for doctors communication and interpersonal skills, are as important as clinical skills and medical knowledge. In this study we intended to develop two detailed communication content checklists and a modified interpersonal skills inventory, aiming to evaluate their integrity in the midst of communication skills assessments, to provide feedback for some participants, and to observe their communication competence in both aspects

Wu, Xi; Wang, Zhinong; Hong, Bo; Shen, Shengjuan; Guo, Yan; Huang, Qinghai; Liu, Jianmin

2014-01-01

246

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

SciTech Connect

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.

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

2009-04-01

247

Nonsymmetrized Hyperspherical Harmonics with Realistic Potentials  

NASA Astrophysics Data System (ADS)

The Schrödinger equation is solved for an A-nucleon system using an expansion of the wave function in nonsymmetrized hyperspherical harmonics. The present approach is based on a formalism developed by Gattobigio et al. (Phys. Rev. A 79:032513, 2009; Few-Body Syst. 45:127-131, 2009; Phys. Rev. C 83:024001, 2011). Spin and isospin degrees of freedom are included; this makes possible calculations with realistic NN potential models. The fermionic ground state is determined by introducing an additional potential term involving the Casimir operator such that the antisymmetric ground state becomes the lowest eigenstate of the A-body system. Results are discussed for 4He with the realistic AV18 NN potential and for 6Li with the semirealistic MTI/III NN potential.

Deflorian, Sergio; Barnea, Nir; Leidemann, Winfried; Orlandini, Giuseppina

2013-12-01

248

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

PubMed

'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

Bibila, S; Rabiee, F

2014-07-01

249

Fast, Realistic Lighting for Video Games  

Microsoft Academic Search

Global lighting effects produced by diffuse interreflections are typically simulated using global illumination methods such as radiosity or ray tracing. Although diffuse interreflections are crucial to produce realistic images, radiosity-like methods are rarely used in production rendering because of slow performance, robustness problems and difficulty-to-control. We present a novel technology that produces natural-looking lighting effects in a much faster way

Andrei Iones; Anton Krupkin; Mateu Sbert; Sergey Zhukov

2003-01-01

250

Use of computed tomography in the emergency room to evaluate blunt cerebrovascular injury.  

PubMed

BCVI remains a potentially devastating consequence of blunt-force trauma. However, over the past decades significant advances have been made in understanding the pathophysiology, risk factors, and natural history of BCVI. Given the initial asymptomatic period, there is time to diagnose and treat these lesions before the onset of neurologic insult. This early recognition and intervention greatly improves morbidity and mortality directly associated with BCVI. Screening criteria have been identified and reviewed. All patients at risk of BCVI, based on mechanism of injury and risk factors, should be rapidly evaluated for possible injury. It is the authors' current belief that even the newest generation of CT scanners has not been proved to reliably diagnose BCVI. Until further work is done to advance the technology of CTA and prove its equivalence to DSA, there exists too much potential neurologic morbidity and mortality for one to rely on CTA alone (Table 2). Given the variable, and often low, reported sensitivities of CTA, the cost analysis done by Kaye and colleagues [23] would also recommend initial DSA as being cost-effective in avoiding the long-term devastating sequelae of stroke. At the time of writing the authors recommend that CTA be included in an algorithm to evaluate BCVI, but the current data are too disparate with widely variable reported sensitivities, and the risk of missed injury and stroke too severe, to rely on CTA as the definitive diagnostic or screening test for BCVI. Rather, abnormal CTA findings should be added to the traditional screening criteria to identify patients at risk of BCVI; these patients should be evaluated with DSA for definitive screening. Adding abnormal CTA findings to the traditionally described BCVI screening criteria widens the criteria substantially, allowing identification of almost all of the elusive 20% of patients traditionally not identified with basic screening criteria. In addition, given the high specificity of CTA and the decreased morbidity of BCVI with rapid institution of treatment, the authors recommend beginning a low-dose heparin drip (if there are no contraindications to anticoagulation) based on CTA findings while awaiting the confirmatory DSA. Despite advances in CTA technology in recent years, DSA currently remains the gold standard for the diagnosis of BCVI. All patients with standard risk factors for BCVI, or abnormal findings on CTA, should undergo DSA as the screening test of choice for BCVI. PMID:22873041

Parks, Nancy A; Croce, Martin A

2012-01-01

251

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

PubMed

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

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

252

Evaluation of remifentanil sevoflurane response surface models in patients emerging from anesthesia: Model improvement using effect-site sevoflurane concentrations  

PubMed Central

Introduction We previously reported models that characterized the synergistic interaction between remifentanil and sevoflurane in blunting responses to verbal and painful stimuli. This preliminary study evaluated the ability of these models to predict a return of responsiveness (ROR) during emergence from anesthesia and a response to tibial pressure when patients required analgesics in the recovery room. We hypothesized that model predictions would be consistent with observed responses. We also hypothesized that under non steady state conditions, accounting for the lag time between effect site (Ce) and end tidal (ET) sevoflurane concentrations would improve predictions. Methods Twenty patients received a sevoflurane, remifentanil, and fentanyl anesthetic. Two model predictions of responsiveness were recorded at emergence: an ET based and a Ce based prediction. Similarly two predictions of a response to noxious stimuli were recorded when patients first required analgesics in the recovery room. Model predictions were compared to observations with graphical and temporal analyses. Results While patients were anesthetized, model predictions indicated a high likelihood that patients would be unresponsive (? 99%). However, following termination of the anesthetic, models exhibited a wide range of predictions at emergence (1% to 97%). Although wide, the Ce based predictions of responsiveness were better distributed over a percentage ranking of observations than the ET based predictions. For the ET based model, 45% of the patients awoke within 2 minutes of the 50% model predicted probability of unresponsiveness; 65% awoke within 4 minutes. For the Ce based model, 45% of the patients awoke within 1 minute of the 50% model predicted probability of unresponsiveness; 85% awoke within 3.2 minutes. Predictions of a response to a painful stimulus in the recovery room were similar for the Ce and ET based models. Discussion Results confirmed in part our study hypothesis; accounting for the lag time between Ce and ET sevoflurane concentrations improved model predictions of responsiveness but had no effect on predicting a response to a noxious stimulus in the recovery room. These models may be useful in predicting events of clinical interest but large scale evaluations with numerous patients are needed to better characterize model performance.

Johnson, Ken B.; Syroid, Noah D.; Gupta, Dhanesh K.; Manyam, Sandeep C.; Pace, Nathan L.; LaPierre, Cris D.; Egan, Talmage D.; White, Julia L.; Tyler, Diane; Westenskow, Dwayne R.

2009-01-01

253

Dynamic apeerture in damping rings with realistic wigglers  

SciTech Connect

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.

Cai, Yunhai; /SLAC

2005-05-04

254

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

PubMed

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

Isaacson, Stuart H; Skettini, Julia

2014-01-01

255

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

PubMed Central

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.

Isaacson, Stuart H; Skettini, Julia

2014-01-01

256

Realistic inflation models and primordial gravity waves  

NASA Astrophysics Data System (ADS)

We investigate both supersymmetric and non-supersymmetric realistic models of inflation. In non-supersymmetric models, inflation is successfully realized by employing both Coleman Weinberg and Higgs potentials in GUTs such as SU(5) and SO(10). The quantum smearing of tree level predictions is discussed in the Higgs inflation. These quantum corrections can arise from the inflaton couplings to other particles such as GUT scalars. As a result of including these corrections, a reduction in the tensor-to-scalar ratio r, a canonical measure of gravity waves produced during inflation, is observed. In a simple phi4 chaotic model, we reconsider a non-minimal (xi > 0) gravitationalcoupling of inflaton ? arising from the interaction xi R phi2, where R is the Ricci scalar. In estimating bounds on various inflationaryparameters we also include quantum corrections. We emphasize that while working with high precision observations such as the current Planck satellite experiment we cannot ignore these radiative and gravitational corrections in analyzing the predictions of various inflationary models. In supersymmetric hybrid inflation with minimal Kahler potential, the soft SUSY breaking terms are shown to play an important role in realizing inflation consistent with the latest WMAP data. The SUSY hybrid models which we consider here predict exceedingly small values of r. However, to obtain observable gravity waves the non-minimal Kahler potential turns out to be a necessary ingredient. A realistic model of flipped SU(5) model, which benefits from the absence of topological defects, is considered in the standard SUSY hybrid inflation. We also present a discussion of shifted hybrid inflation in a realistic model of SUSY SU(5) GUT.

Rehman, Mansoor Ur

257

Inflation with realistic supersymmetric SO(10)  

SciTech Connect

We implement inflation within a realistic supersymmetric SO(10) model in which the doublet-triplet splitting is realized through the Dimopoulos-Wilczek mechanism, the MSSM {mu} problem is resolved, and Higgsino mediated dimension five nucleon decay is heavily suppressed. The cosmologically unwanted topological defects are inflated away, and from {delta}T/T, the B-L breaking scale is estimated to be of order 10{sup 16}-10{sup 17} GeV. Including supergravity corrections, the scalar spectral index n{sub s}=0.99{+-}0.01, with vertical bar dn{sub s}/dlnk vertical bar < or approx. 10{sup -3}.

Kyae, Bumseok [School of Physics, Korea Institute for Advanced Study, 207-43, Cheongnyangni-Dong, Dongdaemun-Gu, Seoul 130-722 (Korea, Republic of); Shafi, Qaisar [Bartol Research Institute, University of Delaware, Newark, Delaware 19716 (United States)

2005-09-15

258

Quantum states prepared by realistic entanglement swapping  

SciTech Connect

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.

Scherer, Artur; Howard, Regina B.; Sanders, Barry C.; Tittel, Wolfgang [Institute for Quantum Information Science, University of Calgary, Alberta, T2N 1N4 (Canada)

2009-12-15

259

Implementing successful intimate partner violence screening programs in health care settings: Evidence generated from a realist-informed systematic review  

Microsoft Academic Search

We undertook a synthesis of existing studies to re-evaluate the evidence on program mechanisms of intimate partner violence (IPV) universal screening and disclosure within a health care context by addressing how, for whom, and in what circumstances these programs work. Our review is informed by a realist review approach, which focuses on program mechanisms. Systematic, realist reviews can help reveal

Patricia O’Campo; Maritt Kirst; Charoula Tsamis; Catharine Chambers; Farah Ahmad

2011-01-01

260

Realistic Mobility Modeling for Vehicular Ad Hoc Networks  

NASA Astrophysics Data System (ADS)

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.

Akay, Hilal; Tugcu, Tuna

2009-08-01

261

Comparative evaluation of differential laser-induced perturbation spectroscopy as a technique to discriminate emerging skin pathology  

NASA Astrophysics Data System (ADS)

Fluorescence spectroscopy has been widely investigated as a technique for identifying pathological tissue; however, unrelated subject-to-subject variations in spectra complicate data analysis and interpretation. We describe and evaluate a new biosensing technique, differential laser-induced perturbation spectroscopy (DLIPS), based on deep ultraviolet (UV) photochemical perturbation in combination with difference spectroscopy. This technique combines sequential fluorescence probing (pre- and post-perturbation) with sub-ablative UV perturbation and difference spectroscopy to provide a new spectral dimension, facilitating two improvements over fluorescence spectroscopy. First, the differential technique eliminates significant variations in absolute fluorescence response within subject populations. Second, UV perturbations alter the extracellular matrix (ECM), directly coupling the DLIPS response to the biological structure. Improved biosensing with DLIPS is demonstrated in vivo in a murine model of chemically induced skin lesion development. Component loading analysis of the data indicates that the DLIPS technique couples to structural proteins in the ECM. Analysis of variance shows that DLIPS has a significant response to emerging pathology as opposed to other population differences. An optimal likelihood ratio classifier for the DLIPS dataset shows that this technique holds promise for improved diagnosis of epithelial pathology. Results further indicate that DLIPS may improve diagnosis of tissue by augmenting fluorescence spectra (i.e. orthogonal sensing).

Kozikowski, Raymond T.; Smith, Sarah E.; Lee, Jennifer A.; Castleman, William L.; Sorg, Brian S.; Hahn, David W.

2012-06-01

262

Impact evaluation of green-grey infrastructure interaction on built-space integrity: an emerging perspective to urban ecosystem service.  

PubMed

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

Tiwary, Abhishek; Kumar, Prashant

2014-07-15

263

Optimizing performance of hybrid FSO/RF networks in realistic dynamic scenarios  

NASA Astrophysics Data System (ADS)

Hybrid Free Space Optical (FSO) and Radio Frequency (RF) networks promise highly available wireless broadband connectivity and quality of service (QoS), particularly suitable for emerging network applications involving extremely high data rate transmissions such as high quality video-on-demand and real-time surveillance. FSO links are prone to atmospheric obscuration (fog, clouds, snow, etc) and are difficult to align over long distances due the use of narrow laser beams and the effect of atmospheric turbulence. These problems can be mitigated by using adjunct directional RF links, which provide backup connectivity. In this paper, methodologies for modeling and simulation of hybrid FSO/RF networks are described. Individual link propagation models are derived using scattering theory, as well as experimental measurements. MATLAB is used to generate realistic atmospheric obscuration scenarios, including moving cloud layers at different altitudes. These scenarios are then imported into a network simulator (OPNET) to emulate mobile hybrid FSO/RF networks. This framework allows accurate analysis of the effects of node mobility, atmospheric obscuration and traffic demands on network performance, and precise evaluation of topology reconfiguration algorithms as they react to dynamic changes in the network. Results show how topology reconfiguration algorithms, together with enhancements to TCP/IP protocols which reduce the network response time, enable the network to rapidly detect and act upon link state changes in highly dynamic environments, ensuring optimized network performance and availability.

Llorca, Jaime; Desai, Aniket; Baskaran, Eswaran; Milner, Stuart; Davis, Christopher

2005-08-01

264

Evaluation of emergency department performance - a systematic review on recommended performance and quality-in-care measures  

PubMed Central

Background Evaluation of emergency department (ED) performance remains a difficult task due to the lack of consensus on performance measures that reflects high quality, efficiency, and sustainability. Aim To describe, map, and critically evaluate which performance measures that the published literature regard as being most relevant in assessing overall ED performance. Methods Following the PRISMA guidelines, a systematic literature review of review articles reporting accentuated ED performance measures was conducted in the databases of PubMed, Cochrane Library, and Web of Science. Study eligibility criteria includes: 1) the main purpose was to discuss, analyse, or promote performance measures best reflecting ED performance, 2) the article was a review article, and 3) the article reported macro-level performance measures, thus reflecting an overall departmental performance level. Results A number of articles addresses this study’s objective (n?=?14 of 46 unique hits). Time intervals and patient-related measures were dominant in the identified performance measures in review articles from US, UK, Sweden and Canada. Length of stay (LOS), time between patient arrival to initial clinical assessment, and time between patient arrivals to admission were highlighted by the majority of articles. Concurrently, “patients left without being seen” (LWBS), unplanned re-attendance within a maximum of 72 hours, mortality/morbidity, and number of unintended incidents were the most highlighted performance measures that related directly to the patient. Performance measures related to employees were only stated in two of the 14 included articles. Conclusions A total of 55 ED performance measures were identified. ED time intervals were the most recommended performance measures followed by patient centeredness and safety performance measures. ED employee related performance measures were rarely mentioned in the investigated literature. The study’s results allow for advancement towards improved performance measurement and standardised assessment across EDs.

2013-01-01

265

Overuse of Computed Tomography Pulmonary Angiography in the Evaluation of Patients with Suspected Pulmonary Embolism in the Emergency Department  

PubMed Central

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.

Crichlow, Amanda; Cuker, Adam; Mills, Angela M.

2012-01-01

266

Randomized controlled trial to evaluate screening and brief intervention for drug-using multiethnic emergency and trauma department patients.  

PubMed

BACKGROUND: Screening and brief intervention (SBI) is a comprehensive, integrated public health approach to identify and deliver a spectrum of early detection and intervention services for substance use in general medical care settings. Although the SBI approach has shown promise for alcohol use, relatively little is known about its effectiveness for illicit drug use. We are evaluating the SBI approach for drug use using a rigorous randomized controlled trial. The purpose of the report is to describe the overall trial and its programmatic and methodological strengths with a focus on health educator (HE) selection and training. In addition, the baseline characteristics of the recently enrolled multiethnic cohort are described.Methods/design: A randomized two-group repeated measures design is being used in which drug-related outcomes of an intervention group will be compared with those of an attention-placebo control group. Selection of bicultural paraprofessional HEs---their training in research concepts, comorbid mental health issues, special treatment of marijuana use, and nonscripted enhanced motivational interviewing as well as their ongoing monitoring and evaluation---are among the features described. The HEs enrolled, consented, and conducted an intervention among 700 illicit drug users in two large hospital emergency departments/trauma units. To be eligible, a participant needed to be an adult (age >=18 years), an English or Spanish speaker, awake and able to give consent, and reachable by telephone to schedule a six-month follow-up interview. DISCUSSION: A comprehensive HE training protocol combined with rigorous, ongoing process measurement resulted in skill mastery in many areas and a successful participant recruitment period. Strengths and limitations of the study protocol are discussed as well as the characteristics of those recruited. This trial will be among the first to provide information about the effectiveness of SBI for illicit drug use. Outcome analysis has not yet been completed, but demonstrated programming and design successes have implications for future research and service delivery.Trial registration: NCT01683227. PMID:23566363

Eisenberg, Kimberly; Woodruff, Susan I

2013-04-01

267

Children Gifted in Drawing: Precocious Realists vs. Autism Spectrum Disorder  

ERIC Educational Resources Information Center

Individuals differ in their ability to draw realistically and these differences can be seen in early childhood, prior to any formal instruction. Some children, considered precocious realists, are able to draw far more realistically than their peers, even if they have never received formal instruction. In this article, the authors describe some of…

Drake, Jennifer E.; Winner, Ellen

2010-01-01

268

The potential of the EMINENT tool in the screening and evaluation of emerging technologies for CO2 reduction related to buildings  

Microsoft Academic Search

The EC supported project EMINENT has resulted in a tool for evaluating the potential impact of emerging energy technologies. It consists of an integrated resource manager, a demand manager, an Early Stage Technology Manager, and an Analysis tool. The various tools are linked to a number of complex and comprehensive databases. It is a web flexible based tool. This paper

Simon Perry; Igor Bulatov

269

Evaluation of the KMS 48 Replacement Full Face Mask with the Emergency Breathing System for Use with MK 16 MOD 1 Underwater Breathing Apparatus.  

National Technical Information Service (NTIS)

Navy Experimental Diving Unit (NEDU) was tasked by references (1) and (2) to test and evaluate the MK 16 MOD 1 underwater breathing apparatus (UBA) for use as an emergency breathing system (EBS) in conjunction with the KMS 48 full face mask (FFM). Testing...

C. S. Hedricks S. J. Stanek

2002-01-01

270

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...

271

Health-related quality of life for pediatric emergency department febrile illnesses: an Evaluation of the Pediatric Quality of Life Inventory™ 4.0 generic core scales  

Microsoft Academic Search

OBJECTIVE: We sought to assess the validity and short-term responsiveness of the Pediatric Quality of Life Inventory™ 4.0 Generic Core Scales (PedsQL™) for febrile illnesses evaluated in the pediatric emergency department (ED). DESIGN: Prospective cohort study of children 2–18 years discharged after ED evaluation for fever (? 38°C). Self-administered, parent-report of health-related quality of life (HRQOL) was assessed using the

Rakesh D Mistry; Molly W Stevens; Marc H Gorelick

2009-01-01

272

UAV based distributed ATR under realistic simulated environmental effects  

NASA Astrophysics Data System (ADS)

Over the past several years, the military has grown increasingly reliant upon the use of unattended aerial vehicles (UAVs) for surveillance missions. There is an increasing trend towards fielding swarms of UAVs operating as large-scale sensor networks in the air. Such systems tend to be used primarily for the purpose of acquiring sensory data with the goal of automatic detection, identification, and tracking objects of interest. These trends have been paralleled by advances in both distributed detection, image/signal processing and data fusion techniques. Furthermore, swarmed UAV systems must operate under severe constraints on environmental conditions and sensor limitations. In this work, we investigate the effects of environmental conditions on target detection and recognition performance in a UAV network. We assume that each UAV is equipped with an optical camera, and use a realistic computer simulation to generate synthetic images. The detection algorithm relies on Haar-based features while the automatic target recognition (ATR) algorithm relies on Bessel K features. The performance of both algorithms is evaluated using simulated images that closely mimic data acquired in a UAV network under realistic environmental conditions. We design several fusion techniques and analyze both the case of a single observation and the case of multiple observations of the same target.

Chen, Xiaohan; Gong, Shanshan; Schmid, Natalia A.; Valenti, Matthew C.

2007-04-01

273

Effect of realistic vegetation variability on seasonal forecasts  

NASA Astrophysics Data System (ADS)

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.

Catalano, Franco; Alessandri, Andrea; De Felice, Matteo; Doblas-Reyes, Francisco J.

2014-05-01

274

Realistic synthetic observations from radiative transfer models  

NASA Astrophysics Data System (ADS)

When modeling young stars and star-forming regions throughout the Galaxy, it is important to correctly treat the limitations of the data such as finite resolution and sensitivity. In order to study these effects, and to make radiative transfer models directly comparable to real observations, we have developed a Python package that allows post-processing the output of the 3-d Monte Carlo Radiative Transfer code HYPERION (Robitaille 2011 A&A 536, A79, see poster 2S001). With this package, realistic synthetic observations can be generated, modeling the effects of convolution with arbitrary PSFs, transmission curves, finite pixel resolution, noise and reddening. Pipelines can be written to compute synthetic observations that simulate observatories such as the Spitzer Space Telescope or the Herschel Space Observatory. In this poster we describe the package and present examples of such synthetic observations.

Koepferl, Christine; Robitaille, Thomas

2013-07-01

275

Realistic page-turning of electronic books  

NASA Astrophysics Data System (ADS)

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.

Fan, Chaoran; Li, Haisheng; Bai, Yannan

2014-01-01

276

Efficient, physiologically realistic lung airflow simulations.  

PubMed

One of the key challenges for computational fluid dynamics (CFD) simulations of human lung airflow is the sheer size and complexity of the complete, multiscale geometry of the bronchopulmonary tree. Since 3-D CFD simulations of the full airway tree are currently intractable, researchers have proposed reduced geometry models in which multiple airway paths are truncated downstream of the first few generations. This paper investigates a recently proposed method for closing the CFD model by application of physiologically correct boundary conditions at truncated outlets. A realistic, reduced geometry model of the lung airway based on CT data has been constructed up to generation 18, including extrathoracic, bronchi, and bronchiole regions. Results indicate that the new method yields reasonable results for pressure drop through the airway, at a small fraction of the cost of fully resolved simulations. PMID:21768041

Walters, D Keith; Burgreen, Greg W; Lavallee, David M; Thompson, David S; Hester, Robert L

2011-10-01

277

Demonstrating a Realistic IP Mission Prototype  

NASA Technical Reports Server (NTRS)

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.

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

278

Evaluation of a Continuous Indicator for Syndromic Surveillance through Simulation. Application to Vector Borne Disease Emergence Detection in Cattle Using Milk Yield  

PubMed Central

Two vector borne diseases, caused by the Bluetongue and Schmallenberg viruses respectively, have emerged in the European ruminant populations since 2006. Several diseases are transmitted by the same vectors and could emerge in the future. Syndromic surveillance, which consists in the routine monitoring of indicators for the detection of adverse health events, may allow an early detection. Milk yield is routinely measured in a large proportion of dairy herds and could be incorporated as an indicator in a surveillance system. However, few studies have evaluated continuous indicators for syndromic surveillance. The aim of this study was to develop a framework for the quantification of both disease characteristics and model predictive abilities that are important for a continuous indicator to be sensitive, timely and specific for the detection of a vector-borne disease emergence. Emergences with a range of spread characteristics and effects on milk production were simulated. Milk yields collected monthly in 48 713 French dairy herds were used to simulate 576 disease emergence scenarios. First, the effect of disease characteristics on the sensitivity and timeliness of detection were assessed: Spatio-temporal clusters of low milk production were detected with a scan statistic using the difference between observed and simulated milk yields as input. In a second step, the system specificity was evaluated by running the scan statistic on the difference between observed and predicted milk yields, in the absence of simulated emergence. The timeliness of detection depended mostly on how easily the disease spread between and within herds. The time and location of the emergence or adding random noise to the simulated effects had a limited impact on the timeliness of detection. The main limitation of the system was the low specificity i.e. the high number of clusters detected from the difference between observed and predicted productions, in the absence of disease.

Madouasse, Aurelien; Marceau, Alexis; Lehebel, Anne; Brouwer-Middelesch, Henriette; van Schaik, Gerdien; Van der Stede, Yves; Fourichon, Christine

2013-01-01

279

Emergency contraception  

MedlinePLUS

Morning-after pill; Postcoital contraception; Birth control - emergency; Plan B ... prevents pregnancy in the same way as regular birth control pills. TYPES OF EMERGENCY CONTRACEPTION Two emergency contraceptive ...

280

Emergency Contraception  

MedlinePLUS

... emergency contraceptive pills. If you are pregnant, have breast cancer, or have had blood clots, you should not use emergency contraceptive pills. Talk with your doctor about whether emergency ...

281

Pediatric emergencies: thoracic emergencies  

Microsoft Academic Search

.   Emergencies always require rapid diagnosis and an urgent or semi-urgent medical, interventional, or surgical action. In most\\u000a cases radiology plays an essential role in making an accurate diagnosis. Reviewing the causes of acute respiratory pathology\\u000a in the different pediatric age groups, we thought it would be interesting to divide the pathologies into two main parts: one\\u000a part concerning pathologies

L. Breysem; S. Loyen; A. Boets; M. Proesmans; K. De Boeck; M.-H. Smet

2002-01-01

282

Worker Responses to Realistic Evacuation Training.  

National Technical Information Service (NTIS)

This paper discusses the data collected during an emergency evacuation training exercise at an underground mine in the United States. This focus of this paper is on the human reaction to smoke and the use of personal protective equipment. Specific issues ...

C. Vaught L. Mallett K. Kowalski M. Brnich

2005-01-01

283

Are bogs reservoirs for emerging disease vectors? Evaluation of culicoides populations in the Hautes Fagnes Nature Reserve (Belgium).  

PubMed

Several species of Culicoides (Diptera: Ceratopogonidae) biting midges serve as biological vectors for the bluetongue virus (BTV) and the recently described Schmallenberg virus (SBV) in northern Europe. Since their recent emergence in this part of the continent, these diseases have caused considerable economic losses to the sheep and cattle industries. Much data is now available that describe the distribution, population dynamics, and feeding habits of these insects. However, little is known regarding the presence of Culicoides in unusual habitats such as peaty marshes, nor their potential vector capacity. This study evaluated Culicoides biting midges present in the bogs of a Belgian nature reserve compared to those residing at a nearby cattle farm. Culicoides were trapped in 2011 at four different sites (broadleaved and coniferous forested areas, open environments, and at a scientific station) located in the Hautes Fagnes Nature Reserve (Belgium). An additional light trap was operated on a nearby cattle farm. Very high numbers of biting midges were captured in the marshy area and most of them (70 to 95%) were Culicoides impunctatus, a potential vector of BTV and other pathogens. In addition, fewer numbers of C. obsoletus/C. scoticus species, C. chiopterus, and C. dewulfi were observed in the bogs compared to the farm. The wet environment and oligotrophic nature of the soil were probably responsible for these changes in the respective populations. A total of 297,808 Culicoides midges belonging to 27 species were identified during this study and 3 of these species (C. sphagnumensis, C. clintoni and C. comosioculatus) were described in Belgium for the first time. PMID:23799137

Zimmer, Jean-Yves; Smeets, François; Simonon, Grégory; Fagot, Jean; Haubruge, Eric; Francis, Frédéric; Losson, Bertrand

2013-01-01

284

Are Bogs Reservoirs for Emerging Disease Vectors? Evaluation of Culicoides Populations in the Hautes Fagnes Nature Reserve (Belgium)  

PubMed Central

Several species of Culicoides (Diptera: Ceratopogonidae) biting midges serve as biological vectors for the bluetongue virus (BTV) and the recently described Schmallenberg virus (SBV) in northern Europe. Since their recent emergence in this part of the continent, these diseases have caused considerable economic losses to the sheep and cattle industries. Much data is now available that describe the distribution, population dynamics, and feeding habits of these insects. However, little is known regarding the presence of Culicoides in unusual habitats such as peaty marshes, nor their potential vector capacity. This study evaluated Culicoides biting midges present in the bogs of a Belgian nature reserve compared to those residing at a nearby cattle farm. Culicoides were trapped in 2011 at four different sites (broadleaved and coniferous forested areas, open environments, and at a scientific station) located in the Hautes Fagnes Nature Reserve (Belgium). An additional light trap was operated on a nearby cattle farm. Very high numbers of biting midges were captured in the marshy area and most of them (70 to 95%) were Culicoides impunctatus, a potential vector of BTV and other pathogens. In addition, fewer numbers of C. obsoletus/C. scoticus species, C. chiopterus, and C. dewulfi were observed in the bogs compared to the farm. The wet environment and oligotrophic nature of the soil were probably responsible for these changes in the respective populations. A total of 297,808 Culicoides midges belonging to 27 species were identified during this study and 3 of these species (C. sphagnumensis, C. clintoni and C. comosioculatus) were described in Belgium for the first time.

Zimmer, Jean-Yves; Smeets, Francois; Simonon, Gregory; Fagot, Jean; Haubruge, Eric; Francis, Frederic; Losson, Bertrand

2013-01-01

285

Noninvasive continuous versus intermittent arterial pressure monitoring: evaluation of the vascular unloading technique (CNAP device) in the emergency department  

PubMed Central

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 allows immediate recognition of clinically relevant hypotensive episodes, which are missed or only belatedly recognized with intermittent AP measurement.

2014-01-01

286

Evaluating the New York City Emergency Department Syndromic Surveillance for Monitoring Influenza Activity during the 2009-10 Influenza Season  

PubMed Central

Objective: To use laboratory data to assess the specificity of syndromes used by the New York City emergency department (ED) syndromic surveillance system to monitor influenza activity. Design: For the period from October 1, 2009 through March 31, 2010, we examined the correlation between citywide ED syndrome assignment and laboratory-confirmed influenza and respiratory syncytial virus (RSV). In addition, ED syndromic data from five select NYC hospitals were matched at the patient and visit level to corresponding laboratory reports of influenza and RSV. The matched dataset was used to evaluate syndrome assignment by disease and to calculate the sensitivity and specificity of the influenza-like illness (ILI) syndrome. Results: Citywide ED visits for ILI correlated well with influenza laboratory diagnoses (R=0.92). From October 1, 2009, through March 31, 2010, there were 264,532 ED visits at the five select hospitals, from which the NYC Department of Health and Mental Hygiene (DOHMH) received confirmatory laboratory reports of 655 unique cases of influenza and 1348 cases of RSV. The ED visit of most (56%) influenza cases had been categorized in the fever/flu syndrome; only 15% were labeled ILI. Compared to other influenza-related syndromes, ILI had the lowest sensitivity (15%) but the highest specificity (90%) for laboratory-confirmed influenza. Sensitivity and specificity varied by age group and influenza activity level. Conclusions: The ILI syndrome in the NYC ED syndromic surveillance system served as a specific but not sensitive indicator for influenza during the 2009-2010 influenza season. Despite its limited sensitivity, the ILI syndrome can be more informative for tracking influenza trends than the fever/flu or respiratory syndromes because it is less likely to capture cases of other respiratory viruses. However, ED ILI among specific age groups should be interpreted alongside laboratory surveillance data. ILI remains a valuable tool for monitoring influenza activity and trends as it facilitates comparisons nationally and across jurisdictions and is easily communicated to the public.

Westheimer, Emily; Paladini, Marc; Balter, Sharon; Weiss, Don; Fine, Anne; Nguyen, Trang Quyen

2012-01-01

287

WIPER: An Emergency Response System  

Microsoft Academic Search

This paper describes the WIPER system, a proof of concept prototype, and progress made on its development to date. WIPER is intended to provide emergency response managers with an integrated system that detects possible emergencies from cellular communication data, attempts to predict the development of emergency situations, and provides tools for evaluating possible courses of action in dealing with emergency

Alec Pawling; Tim Schoenharl; Ping Yan; Greg Madey

288

Fractured shale reservoirs: Towards a realistic model  

SciTech Connect

Fractured shale reservoirs are fundamentally unconventional, which is to say that their behavior is qualitatively different from reservoirs characterized by intergranular pore space. Attempts to analyze fractured shale reservoirs are essentially misleading. Reliance on such models can have only negative results for fractured shale oil and gas exploration and development. A realistic model of fractured shale reservoirs begins with the history of the shale as a hydrocarbon source rock. Minimum levels of both kerogen concentration and thermal maturity are required for effective hydrocarbon generation. Hydrocarbon generation results in overpressuring of the shale. At some critical level of repressuring, the shale fractures in the ambient stress field. This primary natural fracture system is fundamental to the future behavior of the fractured shale gas reservoir. The fractures facilitate primary migration of oil and gas out of the shale and into the basin. In this process, all connate water is expelled, leaving the fractured shale oil-wet and saturated with oil and gas. What fluids are eventually produced from the fractured shale depends on the consequent structural and geochemical history. As long as the shale remains hot, oil production may be obtained. (e.g. Bakken Shale, Green River Shale). If the shale is significantly cooled, mainly gas will be produced (e.g. Antrim Shale, Ohio Shale, New Albany Shale). Where secondary natural fracture systems are developed and connect the shale to aquifers or to surface recharge, the fractured shale will also produce water (e.g. Antrim Shale, Indiana New Albany Shale).

Hamilton-Smith, T. [Applied Earth Science, Lexington, KY (United States)

1996-09-01

289

Comparing Realistic Subthalamic Nucleus Neuron Models  

NASA Astrophysics Data System (ADS)

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.

Njap, Felix; Claussen, Jens C.; Moser, Andreas; Hofmann, Ulrich G.

2011-06-01

290

Body Tides of a Realistic Earth  

NASA Astrophysics Data System (ADS)

A precise modelling of the Earth tides is necessary to correct the space gravimetry observations, from satellites such as GRACE and GOCE. It is also useful to correct ground measurements, and even more important for superconducting gravimeters, which have a 10 nGal precision. The Earth response (deformation and gravity) to tides or atmospheric load is generally computed assuming radial symmetry in stratified Earth models, at the hydrostatic equilibrium. Our study aims at providing a new Earth tide model, which accounts for the whole complexity of a more realistic Earth. Our model is based on a dynamically consistent equilibrium state which includes lateral variations in density and rheological parameters (shear and bulk moduli), and interface topographies. We use a finite element method and we solve numerically the gravito-elasticity equations. The deviation from the hydrostatic equilibrium has been taken into account as a first order perturbation. The equations are written in the Fourier domain, in order to allow degree one translational and rotational modes of the Earth. We investigate the impact on Earth tidal response of an equilibrium state different from hydrostatic and of the topography of the interfaces, for a simple model of lateral variation: a spherical anomaly in the mantle, which can represent plumes and superplumes. At the M2 frequency (semi-diurnal), we estimate the order of magnitude of the perturbation as a function of the radius and physical parameters of the anomaly.

Metivier, L.; Greff-Lefftz, M.; Diament, M.

2005-12-01

291

Determination of Realistic Fire Scenarios in Spacecraft  

NASA Technical Reports Server (NTRS)

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.

Dietrich, Daniel L.; Ruff, Gary A.; Urban, David

2013-01-01

292

Realistic cosmological scenario with nonminimal kinetic coupling  

NASA Astrophysics Data System (ADS)

We investigate cosmological scenarios in the theory of gravity with the scalar field possessing a nonminimal kinetic coupling to the curvature. It is shown that the kinetic coupling provides an essentially new inflationary mechanism. Namely, at early cosmological times the domination of coupling terms in the field equations guarantees the quasi-de Sitter behavior of the scale factor: a(t)?eH?t with H?=1/9?, where ??10-74sec2 is the coupling parameter. The primary inflationary epoch driven by nonminimal kinetic coupling comes to the end at tf?10-35sec. Later on, the matter terms are dominating, and the Universe enters into the matter-dominated epoch which lasts approximately 0.5H0-1˜0.5×1018sec. Then, the cosmological term comes into play, and the Universe enters into the secondary inflationary epoch with a(t)?eH?t, where H?=?/3. Thus, the cosmological model with nonminimal kinetic coupling represents the realistic cosmological scenario which successfully describes basic cosmological epochs and provides the natural mechanism of epoch change without any fine-tuned potential.

Sushkov, Sergey V.

2012-06-01

293

Quantifying introgression risk with realistic population genetics  

PubMed Central

Introgression is the permanent incorporation of genes from the genome of one population into another. This can have severe consequences, such as extinction of endemic species, or the spread of transgenes. Quantification of the risk of introgression is an important component of genetically modified crop regulation. Most theoretical introgression studies aimed at such quantification disregard one or more of the most important factors concerning introgression: realistic genetical mechanisms, repeated invasions and stochasticity. In addition, the use of linkage as a risk mitigation strategy has not been studied properly yet with genetic introgression models. Current genetic introgression studies fail to take repeated invasions and demographic stochasticity into account properly, and use incorrect measures of introgression risk that can be manipulated by arbitrary choices. In this study, we present proper methods for risk quantification that overcome these difficulties. We generalize a probabilistic risk measure, the so-called hazard rate of introgression, for application to introgression models with complex genetics and small natural population sizes. We illustrate the method by studying the effects of linkage and recombination on transgene introgression risk at different population sizes.

Ghosh, Atiyo; Meirmans, Patrick G.; Haccou, Patsy

2012-01-01

294

Emergency Department Presentation  

Microsoft Academic Search

\\u000a Patients with acute coronary syndrome (ACS) may present to the emergency department (ED) via emergency medical services or\\u000a self-transport. When they present via emergency medical services, a diagnostic-quality prehospital 12-lead EKG may enhance\\u000a the sensitivity and specificity of ACS diagnosis and shorten time to treatment. The ED evaluation of the patient at risk for\\u000a ACS includes a thorough history and

Jeffrey A. Holmes; Sean Collins

295

A realistic molecular model of cement hydrates.  

PubMed

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/cm(3)) 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

Pellenq, Roland J-M; Kushima, Akihiro; Shahsavari, Rouzbeh; Van Vliet, Krystyn J; Buehler, Markus J; Yip, Sidney; Ulm, Franz-Josef

2009-09-22

296

Economic Outcome of Cardiac CT-Based Evaluation and Standard of Care for Suspected Acute Coronary Syndrome In the Emergency Department: A Decision Analytic Model  

PubMed Central

Rationale and Objectives Cardiac computed tomography (CCT) in the Emergency Department may be cost saving for suspected acute coronary syndrome (ACS), but economic outcome data are limited. The objective of this study was to compare the cost of CCT-based evaluation versus standard of care (SOC) using the results of a clinical trial. Materials and Methods We developed a decision analytic cost-minimization model to compare CCT-based and SOC evaluation costs to obtain a correct diagnosis. Model inputs, including Medicare-adjusted patient costs, were primarily obtained from a cohort study of 102 patients at low to intermediate risk for ACS who underwent an Emergency Department SOC clinical evaluation and a 64 channel CCT. SOC costs included stress testing in 77% of patients. Data from published literature completed the model inputs and expanded data ranges for sensitivity analyses. Results Modeled mean patient costs for CCT-based evaluation were $750 (24%) lower than the SOC ($2,384 and $3,134, respectively). Sensitivity analyses indicated that CCT was less expensive over a wide range of estimates and was only more expensive with a CCT specificity below 67%. Probabilistic sensitivity analysis suggested that CCT-based evaluation had a 98.9% probability of being less expensive compared to SOC. Conclusion Using a decision analytic model, CCT-based evaluation resulted in overall lower cost than the SOC for possible ACS patients over a wide range of cost and outcome assumptions, including CT-related complications and downstream costs.

Branch, Kelley R.; Bresnahan, Brian W.; Veenstra, David L.; Shuman, William P.; Weintraub, William S.; Busey, Janet M.; Elliott, Daniel J.; Mitsumori, Lee; Strote, Jared; Jobe, Kathleen; Dubinsky, Ted; Caldwell, James

2011-01-01

297

Abnormal Lipoprotein(a) Levels Predict Coronary Artery Calcification in Southeast Asians but Not in Caucasians: Use of Noninvasive Imaging for Evaluation of an Emerging Risk Factor  

Microsoft Academic Search

Subclinical atherosclerosis can be quantified by coronary artery calcium (CAC) scoring. Due to its high specificity for atherosclerosis,\\u000a CAC is an excellent phenotypic tool for the evaluation of emerging risk markers. Lipoprotein(a) [Lp(a)] is atherogenic due\\u000a to the presence of apoB and may be thrombogenic through its apo(a) component. Lp(a) has been linked to cardiovascular events\\u000a in Caucasians; however, its

Abhinav Sharma; Manoefris Kasim; Parag H. Joshi; Zhen Qian; Eric Krivitsky; Kamran Akram; Sarah Rinehart; Gustavo Vazquez; Joseph Miller; Mohammad Saifur Rohman; Szilard Voros

298

Optimising care in a Swiss University Emergency Department by implementing a multicentre trauma register (TARN): report on evaluation, costs and benefits of trauma registries  

Microsoft Academic Search

BackgroundDiagnostic and therapeutic approaches to trauma patients are, depending on experience, equipment and different therapeutic doctrines, subject to wide variations. The ability to compare trauma centres using a standardised trauma register helps to reveal unresolved systemic issues and simplifies the quality management in an Emergency Department (ED).MethodsThis study describes the selection, implementation and initial evaluation process of an international trauma

Maximilian J Hartel; Nicole Jordi; Dimitrios-Stergios Evangelopoulos; Rebecca Hasler; Kathrin Dopke; Heinz Zimmermann; Aristomenis K Exadaktylos

2010-01-01

299

A low-cost realistic testbed for mobile ad hoc networks  

Microsoft Academic Search

Theoretical frameworks and simulation environments are proven to be very useful in evaluating conventional wired settings. However, due to the inclusion of various deficiency parameters which naturally exist in wireless channels modelling the communication behaviour in MANETs become much more complex. To overcome these major problems and create a realistic test platform for MANET research, we propose the use of

Y. O. Yazir; K. Jahanbakhsh; S. Ganti; G. C. Shoja; Y. Coady

2009-01-01

300

Emergence of Anisotropy in Flock Simulations and Its Computational Analysis  

NASA Astrophysics Data System (ADS)

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 ?-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 ?-value might enable us to judge whether an optimal flock simulation seems to be realistic or not.

Makiguchi, Motohiro; Inoue, Jun-Ichi

301

Emergence of Anisotropy in Flock Simulations and Its Computational Analysis  

NASA Astrophysics Data System (ADS)

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 that this structure of anisotropy also emerges in an artificial flock simulation, namely, Boid simulation by Reynolds [C.W. Reynolds, Flocks, Herds, and Schools: A Distributed Behavioral Model, Computer Graphics, 21, pp. 25-34 (1987)]. To quantify the anisotropy, we evaluate a useful statistics, that is to say, the so-called ?-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 the flock is moving. Our results concerning the emergence of the anisotropy through the ?-value might enable us to judge whether an optimal flock simulation seems to be realistic or not.

Makiguchi, Motohiro; Inoue, Jun-Ichi

2010-03-01

302

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

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.

Slonecker, E. Terrence; Fisher, Gary B.

2011-01-01

303

The Mathematics Component of the Minneapolis Schools' 1973-74 Emergency School Aid Act Project. An Evaluation.  

ERIC Educational Resources Information Center

The Emergency School Aid Act (ESAA) Math Component was designed to improve mastery of math basic skills among the lowest achieving math students in 8 desegregating public junior high schools, junior-high-level grades in 6 nonpublic schools, and the ninth grade in one public high school. The Math Component consisted of 25 teacher aides, a part-time…

Higgins, Paul S.

304

Pediatric Emergency Department Suicidal Patients: Two-Site Evaluation of Suicide Ideators, Single Attempters, and Repeat Attempters  

ERIC Educational Resources Information Center

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…

Asarnow, Joan Rosenbaum; Baraff, Larry J.; Berk, Michele; Grob, Charles; Devich-Navarro, Mona; Suddath, Robert; Piacentini, John; Tang, Lingqi

2008-01-01

305

Building Leadership Capacity: An Evaluation of the University of Cape Town's Emerging Student Leaders Programme  

ERIC Educational Resources Information Center

Universities worldwide are becoming increasingly interested in the importance of emerging co-curricula that focus on developing graduate attributes beyond specific academic disciplines. This is being influenced by industry demands for graduates with behavioural and cognitive skills aligned to the work they will do in their early careers. This…

Mukoza, Stella Kyobula; Goodman, Suki

2013-01-01

306

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

Microsoft Academic Search

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

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

1993-01-01

307

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

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

Shi, Shenggang; Cao, Jingcan; Feng, Li; Liang, Wenyan; Zhang, Liqiu

2014-07-15

308

Diabetic Emergencies  

MedlinePLUS

... blurb should go here Social Media ACEP in Social Media Campaigns Campaigns Read Patient Stories Health News About Emergencies Childhood / Student Emergencies Diseases & Infections Disaster Preparedness Elderly Safety Holiday & Seasonal Injury Prevention Travel & Motor Vehicle ...

309

Whites' opposition to busing: Symbolic racism or realistic group conflict?  

Microsoft Academic Search

The theory of symbolic racism contends that White individuals' opposition to busing springs from a basic underlying prejudiced or intolerant attitudinal predisposition toward Blacks, not self-interest or realistic group conflict motives. The present research argues that realistic group conflict motives do help explain Whites' opposition to busing. Two major criticisms of the symbolic racism approach are made: (a) that the

Lawrence Bobo

1983-01-01

310

Pairwise comparisons of means under realistic nonnormality, unequal variances, outliers and equal sample sizes  

Microsoft Academic Search

A Monte Carlo simulation evaluated six pairwise multiple comparison procedures for controlling Type I error rates, any-pair power, and all-pairs power. Realistic conditions of nonnormality were based on a previous survey, and the effects of outliers were investigated. Variance ratios varied from 1:1 to 8:1. Evaluated procedures included Tukey's honestly significant difference (HSD) preceded by an F-test, the Hayter–Fisher, the

Philip H. Ramsey; Kyrstle Barrera; Pri Hachimine-Semprebom; Chang-Chia Liu

2011-01-01

311

Towards realistic representation of hydrological processes in integrated WRF-urban modeling system  

NASA Astrophysics Data System (ADS)

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 deepens our insight into the dynamics of urban land surface processes and its impact on the regional hydroclimate through land-atmosphere interactions.

Yang, Jiachuan; Wang, Zhi-hua; Chen, Fei; Miao, Shiguang; Tewari, Mukul; Georgescu, Matei

2014-05-01

312

Experimental evaluation of foot-and-mouth disease vaccines for emergency use in ruminants and pigs: a review  

PubMed Central

Changes to foot-and-mouth disease (FMD) control policies since 2001 mean that emergency vaccination must be considered more readily as a control measure in the future. Since field application of vaccine for emergency use has only rarely been applied, the effectiveness of single dose administration, as a control measure in an outbreak situation, is poorly understood. In this review we consider all the available experimental data from studies utilizing either experimental or readily available, commercially produced vaccines, in order to assess their likely effectiveness as an additional means of controlling FMD transmission and spread in an emergency. Overall it is concluded that such vaccines offer an additional and valuable means of FMD control for both ruminants and pigs. They are able to reduce clinical disease, sub-clinical infection and excretion and onward transmission of virus. However, to be most effective, vaccination should be rapidly applied to give maximum opportunity for immunity to develop. We also identify areas for future research and emphasize the importance of vaccine efficacy studies in providing data for models that can help to predict the efficacy of differing FMD control strategies.

Cox, Sarah J.; Barnett, Paul V.

2009-01-01

313

Developing the protocol for the evaluation of the health foundation's 'engaging with quality initiative' - an emergent approach  

PubMed Central

In 2004 a UK charity, The Health Foundation, established the 'Engaging with Quality Initiative' to explore and evaluate the benefits of engaging clinicians in quality improvement in healthcare. Eight projects run by professional bodies or specialist societies were commissioned in various areas of acute care. A developmental approach to the initiative was adopted, accompanied by a two level evaluation: eight project self-evaluations and a related external evaluation. This paper describes how the protocol for the external evaluation was developed. The challenges faced included large variation between and within the projects (in approach, scope and context, and in understanding of quality improvement), the need to support the project teams in their self-evaluations while retaining a necessary objectivity, and the difficulty of evaluating the moving target created by the developmental approach adopted in the initiative. An initial period to develop the evaluation protocol proved invaluable in helping us to explore these issues.

Soper, Bryony; Buxton, Martin; Hanney, Stephen; Oortwijn, Wija; Scoggins, Amanda; Steel, Nick; Ling, Tom

2008-01-01

314

Emergency medicine physicians' and pediatricians' use of computed tomography in the evaluation of pediatric patients with abdominal pain without trauma in a community hospital.  

PubMed

There is a paucity of data regarding emergency department (ED) provider type and computed tomography (CT) scan use in the evaluation of pediatric patients with abdominal pain without trauma. The purpose of this retrospective single community hospital study was to determine if there was a difference in CT use between emergency medicine physicians (EMPs) and pediatricians (PEDs) in all patients younger than 18 years with abdominal pain without trauma who presented to the ED during the study period. The study included 165 patients. EMPs saw 83 patients and used CT in 31 compared with PEDs who saw 82 patients and used CT in 12 (P = .002). EMPs used CT significantly more frequently than PEDs in the designated sample. Economic pressures may cause changes in ED provider type in community and rural hospitals and this study shows that ED provider type may affect medical decision making, including CT use. PMID:24391124

Grim, Paul Francis

2014-05-01

315

Fitness Testing with a Realistic Purpose  

ERIC Educational Resources Information Center

Five objectives that might be attained through fitness testing are: (1) evaluation of program effect on participant fitness; (2) participant motivation to improve fitness; (3) identification of low-fit individuals; (4) dissemination of information regarding fitness; and (5) identification of potential athletes.

Pate, Russell, R.

1978-01-01

316

42 CFR 460.100 - Emergency care.  

Code of Federal Regulations, 2013 CFR

...Are needed to evaluate or stabilize an emergency medical condition. (c) An emergency medical condition means a condition manifesting...physician views as medically necessary after an emergency medical condition has been stabilized. They...

2013-10-01

317

Realistic Broadcasting Using Multi-modal Immersive Media  

Microsoft Academic Search

\\u000a Realistic broadcasting is considered as a next generation broadcasting system supporting user-friendly interactions. In this\\u000a paper, we define multi-modal immersive media and introduce technologies for a realistic broadcasting system, which are developed\\u000a at Realistic Broadcasting Research Center (RBRC) in Korea. In order to generate three-dimensional (3-D) scenes, we acquire\\u000a immersive media using a depth-based camera or multi-view cameras. After converting

Sung-yeol Kim; Seung-uk Yoon; Yo-sung Ho

2005-01-01

318

Emergency telepsychiatry.  

PubMed

Telepsychiatry can be used in two kinds of psychiatric emergencies: one-time clinical events and public health situations associated with mass disaster. Emergency telepsychiatry delivered by videoconferencing has the potential to improve patient care in many settings. Although experience is limited, it has been found to be safe and effective, as well as satisfactory to both emergency department staff and the psychiatric patients treated. The development of comprehensive and standardized guidelines is necessary. There has been little use of acute telemedicine in disaster situations to date. However, telemedicine is becoming part of routine emergency medical response planning in many jurisdictions. Emergency telepsychiatry has the potential to reduce emergency department overcrowding, provide much needed care in rural areas and improve access to psychiatric care in the event of a natural or man-made disaster. PMID:18776070

Yellowlees, Peter; Burke, Michelle M; Marks, Shayna L; Hilty, Donald M; Shore, Jay H

2008-01-01

319

Relativistic description of finite nuclei based on realistic NN interactions  

SciTech Connect

A set of relativistic mean-field models is constructed, which includes the Hartree and Hartree-Fock (HF) approximations accounting for the exchange of isoscalar and isovector mesons as well as the pion. Density-dependent coupling functions are determined to reproduce the components of the nucleon self-energy at the Fermi surface, obtained within the Dirac-Brueckner-HF (DBHF) approach by using a realistic nucleon-nucleon interaction. It is investigated to which extent the various mean-field models can reproduce the DBHF results for the momentum dependence of the self-energies and the total energy of infinite matter. Also, the mean-field models are used to evaluate the bulk properties of spherical closed-shell nuclei. We find that the HF model, which allows for the exchange of {sigma}, {omega}, {rho}, and {delta} mesons and pions, yields the best reproduction of the DBHF results in infinite matter and also provides a good description of the properties of finite nuclei without any adjustment of parameters.

Dalen, E. N. E. van; Muether, H. [Institut fuer Theoretische Physik, Universitaet Tuebingen, Auf der Morgenstelle 14, D-72076 Tuebingen (Germany)

2011-08-15

320

In-house CAD training: a realistic approach  

SciTech Connect

The need for industry to retrain its engineering personnel to use a CAD system can be demanding, as well as frustrating. In fact, the larger and more diverse the organization, the more demanding these requirements may be. It should be noted that in preparing for CAD implementation, the training needs and requirements are often underestimated. Additionally, most engineering organizations implementing CAD do not have personnel experienced in developing training programs or in teaching manipulative skills. This text describes the evolution of the in-house CADAM basic training program at Martin Marietta Energy Systems, Inc. Rather than emphasize the theoretical aspects of designing such a program, the paper will concentrate on the practical, more realistic aspects of program development. The paper should serve as a guide to others desiring to develop a similar program. This paper first presents a brief look at factors concerning retraining the experienced engineering employee. Then, the actual planning, organization, structuring, implementation, and evaluation of the training program, as well as possible future directions are presented. Finally, the paper offers advice to those planning similar in-house CAD training programs.

Whitus, T.

1986-04-10

321

Unsteady transonic algorithm improvements for realistic aircraft applications  

NASA Technical Reports Server (NTRS)

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.

Batina, John T.

1987-01-01

322

Neurotoxic emergencies.  

PubMed

Neurotoxic emergencies are depicted by severe disruption of critical central or peripheral nervous system functions caused by xenobiotics with rapid mechanisms of action. This article reviews 4 categories of neurotoxic emergency: drug-induced and toxin-induced seizures, acute depressed mental status, acute excited mental status, and peripheral neurotoxic agents. Selected xenobiotics, representing the frontiers of neurotoxic emergencies, are discussed in detail based on the major neurotransmitters involved. PMID:21803209

Barry, J Dave; Wills, Brandon K

2011-08-01

323

Evaluation, modification and validation of a set of asthma illustrations in children with chronic asthma in the emergency department  

PubMed Central

OBJECTIVES: To test, modify and validate a set of illustrations depicting different levels of asthma control and common asthma triggers in pediatric patients (and/or their parents) with chronic asthma who presented to the emergency department at the Children’s Hospital of Eastern Ontario, Ottawa, Ontario. METHODS: Semistructured interviews using guessability and translucency questionnaires tested the comprehensibility of 15 illustrations depicting different levels of asthma control and common asthma triggers in children 10 to 17 years of age, and parents of children one to nine years of age who presented to the emergency department. Illustrations with an overall guessability score <80% and/or translucency median score <6, were reviewed by the study team and modified by the study’s graphic designer. Modifications were made based on key concepts identified by study participants. RESULTS: A total of 80 patients were interviewed. Seven of the original 15 illustrations (47%) required modifications to obtain the prespecified guessability and translucency goals. CONCLUSION: The authors successfully developed, modified and validated a set of 15 illustrations representing different levels of asthma control and common asthma triggers. PRACTICE IMPLICATIONS: These illustrations will be incorporated into a child-friendly asthma action plan that enables the child to be involved in his or her asthma self-management care.

Tulloch, Joanie; Vaillancourt, Regis; Irwin, Danica; Pascuet, Elena

2012-01-01

324

Simulating realistic genomic data with rare variants  

PubMed Central

Increasing evidence suggests that rare and generally deleterious genetic variants might have strong impact on disease risks of not only Mendelian disease, but also many common diseases. However, identifying such rare variants remains to be challenging, and novel statistical methods and bioinformatic software must be developed. Hence, we have to extensively evaluate various methods under reasonable genetic models. While there are abundant genomic data, they are not most helpful for the evaluation of the methods because the disease mechanism is unknown. Thus, it is imperative that we simulate genomic data that mimic the real data containing rare variants and that enable us to impose a known disease penetrance model. Although resampling simulation methods have shown their advantages in computational efficiency and in preserving important properties such as linkage disequilibrium (LD) and allele frequency, they still have limitations as we demonstrated. We propose an algorithm that combines a regression-based imputation with resampling to simulate genetic data with both rare and common variants. Logistic regression model was employed to fit the relationship between a rare variant and its nearby common variants in the 1000 Genomes Project data and then applied to the real data to fill in one rare variant at a time using the fitted logistic model based on common variants. Individuals then were simulated using the real data with imputed rare variants. We compared our method with existing simulators and demonstrated that our method performed well in retaining the real sample properties, such as LD and minor allele frequency, qualitatively.

Xu, Yaji; Wu, Yinghua; Song, Chi; Zhang, Heping

2012-01-01

325

Emerging technologies  

SciTech Connect

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.

Lu, Shin-yee

1993-03-01

326

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

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

Lee, Lung-Sheng; Wei, Yen-Shun; Wang, Li-Yun

2013-01-01

327

Student Work Experience: A Realistic Approach to Merchandising Education.  

ERIC Educational Resources Information Center

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)

Horridge, Patricia; And Others

1980-01-01

328

Superrotation in a Venus GCM with Realistic Radiative Forcing  

NASA Astrophysics Data System (ADS)

This presentation will discuss the Ashima Research Venus GCM with an integrated radiation scheme that simulates realistic solar and infrared fluxes. We will show simulations using this GCM that develop superrotation and SS-AS circulation.

Lee, C.; Richardson, M. I.; Newman, C. E.; Lian, Y.

2012-06-01

329

Evaluation of a biologically-based filtration water reclamation plant for removing emerging contaminants: a pilot plant study.  

PubMed

The effect of hydraulic retention time (HRT), solar radiation and seasonality on the removal efficiency of 18 emerging contaminants has been studied in a biological filtration pilot plant based on Daphnia sp. The pilot plant consisted of a homogenization tank and two lines, A and B, each with four 1 m(3) tanks. One of these lines was directly exposed to sunlight whereas the other line was covered. Our results suggest that biodegradation and photodegradation are the most important removal pathways, whereas sorption makes a minor contribution. The removal efficiency ranged from no detectable removal to more than 90%. The kinetics of the degradation process was fit to a first order kinetic, with half-lives from 0.6 to 42 days, depending on the particular compound. However, a scaling effect comes into play as the pilot plant was found to be more efficient than a similar full-scale polishing pond. PMID:22153292

Matamoros, Víctor; Sala, Lluís; Salvadó, Victòria

2012-01-01

330

Middletown 2010-A Realistic Interactive Emergency Simulation and Response System for the U.S. Army.  

National Technical Information Service (NTIS)

A prototype has been developed to handle positioned based photos videos voice and environmental data. This prototype forms the basis for the following solutions. Middletown can provide an advanced simulation solution to provide better training. It can be ...

H. Gundersen

2008-01-01

331

The Effect of Emergency Medical Systems on Prehospital Cardiovascular Care: An Evaluation of Studies and an Inventory of Data Bases.  

National Technical Information Service (NTIS)

This report begins with a summary of the clinical rationale for prehospital coronary care and a review of the history of the prehospital coronary care system. The report then leads into the evaluation of the generic methodological problems of prehospital ...

1979-01-01

332

Humanitarian Emergencies  

Microsoft Academic Search

Countries or regions affected by humanitarian emergencies remain challenging situations for the provision of health and nutrition services in developing countries. Major advances in recent decades have been made regarding our knowledge of the main causes of morbidity and mortality in humanitarian emergencies, the availability of standardized guidance protocols and indicators, and the development of new products, especially for severely

Reinhard Kaiser; Paul B. Spiegel

333

A time-responsive tool for informing policy making: rapid realist review  

PubMed Central

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 designed to engage knowledge users and review stakeholders to define the research questions, and to streamline the review process. In addition, results are presented with a focus on context-specific explanations for what works within a particular set of parameters rather than producing explanations that are potentially transferrable across contexts and populations. For policy makers faced with making difficult decisions in short time frames for which there is sufficient (if limited) published/research and practice-based evidence available, RRR provides a practical, outcomes-focused knowledge synthesis method.

2013-01-01

334

Comparative Evaluation of Stroke Triage Algorithms for Emergency Medical Dispatchers (MeDS): Prospective Cohort Study Protocol  

PubMed Central

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 with 80% power, we will enroll a total of 370 subjects in this trial. Discussion A three week pilot study was performed which demonstrated the feasibility of implementation of the study protocol.

2011-01-01

335

Emergent Patterns of Mate Choice in Human Populations  

Microsoft Academic Search

Abstract: We present a model of human mate choice that shows how realisticpopulation-level patterns of assortative mating can self-organizeand emerge from the behavior of individuals using simple mate searchrules. In particular, we model plausible psychological mechanisms formate search and choice in a realistic social ecology. Through individualinteractions, patterns emerge that match those observed in typical humansocieties, particularly in terms of

Jorge Simão; Peter M. Todd

2003-01-01

336

Choosing profile double-sampling designs for survival estimation with application to President's Emergency Plan for AIDS Relief evaluation.  

PubMed

Most studies that follow subjects over time are challenged by having some subjects who dropout. Double sampling is a design that selects and devotes resources to intensively pursue and find a subset of these dropouts, then uses data obtained from these to adjust naïve estimates, which are potentially biased by the dropout. Existing methods to estimate survival from double sampling assume a random sample. In limited-resource settings, however, generating accurate estimates using a minimum of resources is important. We propose using double-sampling designs that oversample certain profiles of dropouts as more efficient alternatives to random designs. First, we develop a framework to estimate the survival function under these profile double-sampling designs. We then derive the precision of these designs as a function of the rule for selecting different profiles, in order to identify more efficient designs. We illustrate using data from the United States President's Emergency Plan for AIDS Relief-funded HIV care and treatment program in western Kenya. Our results show why and how more efficient designs should oversample patients with shorter dropout times. Further, our work suggests generalizable practice for more efficient double-sampling designs, which can help maximize efficiency in resource-limited settings. Copyright © 2014 John Wiley & Sons, Ltd. PMID:24408038

An, Ming-Wen; Frangakis, Constantine E; Yiannoutsos, Constantin T

2014-05-30

337

An analysis of Chemical Stockpile Emergency Preparedness Program exercise results. Volume 2: Preliminary evaluation and analysis of CSEPP exercise database  

SciTech Connect

This study investigated the quality and usefulness of the information in the Chemical Stockpile Emergency Preparedness Program (CSEPP) exercise database. It incorporates the results of two separate analytical efforts. The first effort investigated the process of assigning standardized codes to issues identified in CSEPP exercise reports. A small group of issues was coded independently by each of several individuals, and the results of the individual codings were compared. Considerable differences were found among the individuals` codings. The second effort consisted of a statistical multivariate analysis, to investigate whether exercise issues are evenly distributed among exercise tabs, sites, and objectives. It was found that certain tabs, sites, and objectives were disproportionately associated with problem areas in exercises. In some cases, these problem areas have persisted over time, but in other cases they have undergone significant shifts over the time span of the investigation. The study concludes that the database can be a useful resource for analyzing problem areas and setting priorities for CSEPP program resources. However, some further analyses should be performed in order to more fully explore the data and increase confidence in the results.

Wernette, D.; Lerner, K.

1998-06-01

338

Life cycle assessment of two emerging sewage sludge-to-energy systems: evaluating energy and greenhouse gas emissions implications.  

PubMed

A "cradle-to-grave" life cycle assessment was conducted to examine the energy and greenhouse gas (GHG) emission footprints of two emerging sludge-to-energy systems. One system employs a combination of anaerobic digestion (AD) and fast pyrolysis for bioenergy conversion, while the other excludes AD. Each system was divided into five process phases: plant construction, sludge pretreatment, sludge-to-bioenergy conversion, bioenergy utilizations and biochar management. Both systems achieved energy and GHG emission benefits, and the AD-involving system performed better than the AD-excluding system (5.30 vs. 0.63 GJ/t sludge in net energy gain and 0.63 vs. 0.47 t CO(2)eq/t sludge in emission credit for base case). Detailed contribution and sensitivity analyses were conducted to identify how and to what degree the different life-cycle phases are responsible for the energy and emission impacts. The energy and emission performances were significantly affected by variations in bioenergy production, energy requirement for sludge drying and end use of bioenergy. PMID:23131626

Cao, Yucheng; Paw?owski, Artur

2013-01-01

339

Usefulness of Automated Serial 12Lead ECG Monitoring During the Initial Emergency Department Evaluation of Patients With Chest Pain  

Microsoft Academic Search

Study objective: To determine whether the use of automated serial 12-lead ECG monitoring (SECG) is more sensitive and specific than the initial 12-lead ECG in the detection of injury and ischemia in patients with acute coronary syndromes (ACS) during the initial ED evaluation of patients with chest pain. Methods: A prospective observational study was performed in 1,000 patients with chest

Francis M Fesmire; Robert F Percy; Jim B Bardoner; David R Wharton; Frank B Calhoun

1998-01-01

340

Thermal-Hydraulic Evaluation Study of the Effectiveness of Emergency Core Cooling System for Light Water Reactors.  

National Technical Information Service (NTIS)

In order to evaluate the core cooling capability of the emergeny core cooling system, which is a safety guard system of light water reactors for a loss-of-coolant accident, a variety of large scale test were performed. Through the results, many phenomena ...

M. Sobajima

1985-01-01

341

Serious Gaming for Behavioural Assessment and Research in Case of Emergency. An Evaluation of Experiments in Virtual Reality  

Microsoft Academic Search

Human behaviour in fires is mainly studied by incident evaluations and real-life experiments, such as unannounced evacuation drills. The possibilities of virtual reality for studying human behaviour in fires are so far hardly adopted by researchers. Nevertheless, the application of a behavioural assessment and research tool (BART) in virtual reality is expected to be a valuable supplement on the existing

Margrethe Kobes; Nancy Oberijé; Karin Groenewegen; Ter Morsche

342

Climate change impacts on irrigated maize in Mediterranean climates: Evaluation of double cropping as an emerging adaptation alternative  

Microsoft Academic Search

Because its relevance for the sustenance and livelihood of human systems, the assessment of the impacts that future climatic conditions may have on agricultural productivity becomes a key piece of information for agricultural scientists and policy makers.Several authors have performed assessments of the impacts of climate change on agricultural productivity evaluating alternatives for adaptation that are closely related to current

Francisco J. Meza; Daniel Silva; Hernán Vigil

2008-01-01

343

Emergency Contraception  

MedlinePLUS

... provider after using emergency contraception pills? • Can I get pregnant later in my menstrual cycle after I have ... pregnancy if you are already pregnant. Can I get pregnant later in my menstrual cycle after I have ...

344

Chemical Emergencies  

MedlinePLUS

... the case of a terrorist attack with a chemical weapon. Some hazardous chemicals have been developed by military ... there are no guarantees of safety during a chemical emergency, you can take actions to protect yourself. You ...

345

Critical evaluation of justifications for the transfusion of red blood cells: the reality of a government emergency hospital  

PubMed Central

Background Blood products and derivatives are indispensable resources in medical therapies. However, it is important to note that the number of donations is far from ideal. Despite constant campaign efforts, a deficit of 1 million units is expected by 2030. Objectives To determine the adequacy of the indications for red blood cell transfusion in an emergency hospital in Alagoas. Methods This was a cross-sectional observational study conducted at the Alagoas Blood Center. Of a total of 2936 red blood cell transfusion requests in 2009, 334 were randomized and compared with transfusion parameters described in the literature (primary variable). After analysis, the transfusion requests were categorized as adequate, inadequate or inconclusive. This last group included all red blood cell transfusion requests with insufficient clinical information, rendering their classification as adequate or inadequate impossible. The secondary variable involved the reasons for red blood cell transfusion. A 95% confidence interval was used in the statistical analysis. Results Forty-seven (14.07%) requests were adequate and 30 (8.98%) were inadequate. Most of the requests were classified as inconclusive (76.94%). The main indications for transfusion were upper gastrointestinal bleeding (26.95%), anemia (46.71%), hypovolemia/hypovolemic shock (10.78%) and sepsis/septic shock (3.29%). Conclusion It was not possible to reach a conclusion on the adequacy of the indication for transfusion in most of the cases. Therefore, it is important to adopt a transfusion protocol, rigorously analyze blood bank requests, to provide awareness campaigns on the rational use of blood and to implement strategies to use blood products more effectively.

de Souza, Diego Agra; Silva, Felipe Gama e; Costa, Paulo Jose Medeiros de Souza

2013-01-01

346

Using polychromatic X-radiography to examine realistic imitation firearms.  

PubMed

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

Austin, J C; Day, C R; Kearon, A T; Valussi, S; Haycock, P W

2008-10-25

347

Evaluation of the modified MEDS, MEWS score and Charlson comorbidity index in patients with community acquired sepsis in the emergency department.  

PubMed

Sepsis is one of the most important causes of morbidity and mortality in patients presenting to the emergency department. SIRS criteria that define sepsis are not specific and do not reflect the severity of infection. We aimed to evaluate the ability of the modified mortality in emergency department sepsis (MEDS) score, the modified early warning score (MEWS) and the Charlson comorbidity index (CCI) to predict prognosis in patients who are diagnosed in sepsis. We prospectively investigated the value of the CCI, MEWS and modified MEDS Score in the prediction of 28-day mortality in patients presenting to the emergency department who were diagnosed with sepsis. 230 patients were enrolled in the study. In these patients, the 5-day mortality was 17 % (n = 40) and the 28-day mortality was 32.2 % (n = 74). A significant difference was found between surviving patients and those who died in terms of their modified MEDS, MEWS and Charlson scores for both 5-day mortality (p < 0.001, p = 0.013 and p = 0.006, respectively) and 28-day mortality (p < 0.001, p = 0.008 and p < 0.001, respectively). The area under the curve (AUC) for the modified MEDS score in terms of 28-day mortality was 0.77. The MEDS score had a greater prognostic value compared to the MEWS and CCI scores. The performance of modified MEDS score was better than that of other scoring systems, in our study. Therefore, we believe that the modified MEDS score can be reliably used for the prediction of mortality in sepsis. PMID:23250543

Ç?ld?r, Ergün; Bulut, Mehtap; Akal?n, Halis; Kocaba?, Egemen; Ocako?lu, Gökhan; Ayd?n, ?ule Akköse

2013-04-01

348

Emerging methods for evaluating the effectiveness of intramuscular interferon beta-1a for relapsing-remitting multiple sclerosis.  

PubMed

Newer outcome-based assessment methods have been developed that complement and improve upon the ability of historical clinical and magnetic resonance imaging (MRI) outcome measures to measure multiple sclerosis (MS) disease activity, patient functionality, treatment efficacy, and the risk of MS disease progression. These newer MS outcome assessments include instruments to evaluate cognitive function and patient quality of life; enhanced measures of disability, such as the Multiple Sclerosis Functional Composite instrument; and newer MRI measures of MS disease activity and neuronal changes, such as permanent T? hypointensities and central nervous system atrophy. When utilized in conjunction with standard MS outcome measures, these newer MS outcomes provide a more comprehensive picture of disease status and course and hold promise as tools for use in the development and testing of future MS therapies. The well-established first-line MS therapy intramuscular interferon beta-1a, which has been evaluated using a broad range of assessment methods, was used as a reference MS disease-modifying therapy to provide specific examples of studies utilizing newer evaluation methods. Utilization of evolving disease and assessment measures for patients with MS should improve MS patient diagnosis, treatment decisions, and monitoring of therapy. PMID:23383728

Foley, John F; Barnes, Christopher J; Nair, Kavita V

2013-01-01

349

Speaker Verification in Realistic Noisy Environment in Forensic Science  

NASA Astrophysics Data System (ADS)

In forensic voice telephony speaker verification, we may be requested to identify a speaker in a very noisy environment, unlike the conditions in general research. In a noisy environment, we process speech first by clarifying it. However, the previous study of speaker verification from clarified speech did not yield satisfactory results. In this study, we experimented on speaker verification with clarification of speech in a noisy environment, and we examined the relationship between improving acoustic quality and speaker verification results. Moreover, experiments with realistic noise such as a crime prevention alarm and power supply noise was conducted, and speaker verification accuracy in a realistic environment was examined. We confirmed the validity of speaker verification with clarification of speech in a realistic noisy environment.

Kamada, Toshiaki; Minematsu, Nobuaki; Osanai, Takashi; Makinae, Hisanori; Tanimoto, Masumi

350

The effects of realistic pancake solenoids on particle transport  

SciTech Connect

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.

Gu, X.; Okamura, M.; Pikin, A.; Fischer, W.; Luo, Y.

2011-02-01

351

Homogeneous nucleation of methane hydrates: unrealistic under realistic conditions.  

PubMed

Methane hydrates are ice-like inclusion compounds with importance to the oil and natural gas industry, global climate change, and gas transportation and storage. The molecular mechanism by which these compounds form under conditions relevant to industry and nature remains mysterious. To understand the mechanism of methane hydrate nucleation from supersaturated aqueous solutions, we performed simulations at controlled and realistic supersaturation. We found that critical nuclei are extremely large and that homogeneous nucleation rates are extremely low. Our findings suggest that nucleation of methane hydrates under these realistic conditions cannot occur by a homogeneous mechanism. PMID:23148735

Knott, Brandon C; Molinero, Valeria; Doherty, Michael F; Peters, Baron

2012-12-01

352

Emerging Viruses  

NSDL National Science Digital Library

Emerging viruses are those "whose incidence in humans has increased in the past 2 decades or threatens to increase in the near future." This week's Topic in Depth focuses on sites related to viruses, particularly those that are considered "emerging."The first site (1) is an essay by Alison Jacobson of the University of Capetown that discusses some emerging and potentially emerging viruses, along with factors that contribute to the threat. From a US government interagency working group, the second report (2) focuses on the responses to infectious disease outbreaks, including drugs, vaccines, and government response. A World Health Organization site (3) highlights recent reports of infectious disease, archived by date and by disease. This ThinkQuest site (4) gives a basic introduction to viruses and how they cause infections. An online virology tutorial (5) by Ed Rybicki of the University of Cape Town serves as a lesson on the basics of virology for a more advanced student. The next two sites focus on the specifics of selected viruses. From the Institute for Molecular Virology (6) comes a resource on Marburg and Ebola viruses, and from the National Biological Information Infrastructure (7) is a site on West Nile Virus. The last resource (8) is a scholarly journal from the Centers for Disease Control that presents some of the latest scientific research on emerging diseases.

Lee, Amy.

2002-01-01

353

Experimental evaluation of the reproductive quality of Africanized queen bees (Apis mellifera) on the basis of body weight at emergence.  

PubMed

There has been much speculation about which phenotypic traits serve as reliable indicators of productivity in queen honeybees (Apis mellifera). To investigate the predictive value of queen body weight on colony development and quality, we compared colonies in which queens weighed less than 180 mg to those in which queens weighed more than 200 mg. Both groups contained naturally mated and instrumentally inseminated queens. Colonies were evaluated on the basis of performance quality, growth rate, and queen longevity. We found that queen body weight was significantly correlated with fecundity and colony quality. Heavy queens exhibited the most favorable performance and colony quality. In contrast, naturally mated, with the opposite trend being obtained for light-weight queens. We found no statistically significant difference between instrumentally inseminated queens and naturally mated queens. Our results support the use of queen body weight as a reliable visual (physiological) indicator of potential colony productivity in honey bees to enhance genetic lines in genetic improvement programs. PMID:24301910

De Souza, D A; Bezzera-Laure, M A F; Francoy, T M; Gonçalves, L S

2013-01-01

354

Emerging phleboviruses?  

PubMed Central

The Bunyavidae family is the largest grouping of RNA viruses and arguably the most diverse. Bunyaviruses have a truly global distribution and can infect vertebrates, invertebrates and plants. The majority of bunyaviruses are vectored by arthropods and thus have the remarkable capability to replicate in hosts of disparate phylogeny. The family has provided many examples of emerging viruses including Sin Nombre and related viruses responsible for hantavirus cardiopulmonary syndrome in the Americas, first identified in 1993, and Schmallenberg virus which emerged in Europe in 2011, causing foetal malformations in ruminants. In addition, some well-known bunyaviruses like Rift Valley fever and Crimean-Congo haemorrhagic fever viruses continue to emerge in new geographical locations. In this short review we focus on newly identified viruses associated with severe haemorrhagic disease in humans in China and the US.

Elliott, Richard M; Brennan, Benjamin

2014-01-01

355

Emerging phleboviruses.  

PubMed

The Bunyavidae family is the largest grouping of RNA viruses and arguably the most diverse. Bunyaviruses have a truly global distribution and can infect vertebrates, invertebrates and plants. The majority of bunyaviruses are vectored by arthropods and thus have the remarkable capability to replicate in hosts of disparate phylogeny. The family has provided many examples of emerging viruses including Sin Nombre and related viruses responsible for hantavirus cardiopulmonary syndrome in the Americas, first identified in 1993, and Schmallenberg virus which emerged in Europe in 2011, causing foetal malformations in ruminants. In addition, some well-known bunyaviruses like Rift Valley fever and Crimean-Congo haemorrhagic fever viruses continue to emerge in new geographical locations. In this short review we focus on newly identified viruses associated with severe haemorrhagic disease in humans in China and the US. PMID:24607799

Elliott, Richard M; Brennan, Benjamin

2014-04-01

356

Full-vector analysisof a realistic photonic crystal fiber  

Microsoft Academic Search

We analyze the guiding problem in a realistic photonic crystal fiber using a novel full-vector modal technique, a biorthogonal modal method based on the nonselfadjoint character of the electromagnetic propagation in a fiber. Dispersion curves of guided modes for different fiber structural parameters are calculated along with the 2D transverse intensity distribution of the fundamental mode. Our results match those

A. Ferrando; E. Silvestre; J. J. Miret; P. Andrés; M. V. Andrés

1999-01-01

357

Towards Realistic Soft Tissue Modeling in Medical Simulation  

Microsoft Academic Search

Most of today's medical simulation systems are based on geometric representations of anatomical structures that take no account of their physical nature. Representing physical phenomena and, more specifically the realistic modeling of soft tissue will not only improve current medical simulation systems but will considerably enlarge the set of applications and the credibility of medical simulation, from neurosurgery planning to

Hervé Delingette

2000-01-01

358

Synthesis Of Realistic Animations Of A Person Speaking  

NASA Technical Reports Server (NTRS)

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.

Scott, Kenneth C.; Kagels, David S.; Watson, Stephen H.; Rom, Hillel S.; Lorre, Jean J.; Wright, John R.; Duxbury, Elizabeth D.

1995-01-01

359

Installing a Realistic Job Preview: Ten Tough Choices.  

ERIC Educational Resources Information Center

Raises 10 issues concerning initiation, development, and implementation of realistic job previews (RJPs), framing issues as tough choices that must be made. Makes recommendations for each of 10 choices on basis of previous RJP research, relevant theory, and personal experience. (Author/NB)

Wanous, John P.

1989-01-01

360

VanetMobiSim: generating realistic mobility patterns for VANETs  

Microsoft Academic Search

In this paper, we present and describe VanetMobiSim, a generator of realistic vehicular movement traces for telecommunication networks simulators. VanetMobiSim mobility description is validated by illustrating how the interaction between featured macro- and micro-mobility is able to reproduce typical phenomena of vehicular traffic.

Jérôme Härri; Fethi Filali; Christian Bonnet; Marco Fiore

2006-01-01

361

Inquiring into the Real: A Realist Phenomenological Approach  

ERIC Educational Resources Information Center

The need for postpositivist or antipositivist methods in the social sciences, including library and information science, is well documented. A promising alternative synthesizes critical realism and phenomenology. This method embraces ontological reality in all things, including human and social action. The ontology underlying the realist

Budd, John M.; Hill, Heather; Shannon, Brooke

2010-01-01

362

Sample-Based Synthesis of Photo-Realistic Talking Heads  

Microsoft Academic Search

This paper describes a system that generates photo- realistic video animations of talking heads. First the system derives head models from existing video footage using image recognition techniques. It locates, extracts and labels facial parts such as mouth, eyes, and eyebrows into a compact library. Then, using these face models and a text-to-speech synthesizer, it synthesizes new video sequences of

Eric Cosatto; Hans Peter Graf

1998-01-01

363

Formulation of a Realistic Windshield and Headlight Dirt Film.  

National Technical Information Service (NTIS)

In an effort to obtain a realistic mixture which could be used as a test condition to qualify headlamp and windshield washers and wipers, a mixture (dirt film) based on a formulation provided in 'Composition and Removal of Automobile Windshield Films', pu...

1973-01-01

364

LEARNING AND THOUGHT PROCESSES IN REALISTIC MATHEMATICS INSTRUCTION  

Microsoft Academic Search

This article deals with the various different approaches to mathematics and the influence that these approaches have had on the teaching of this subject. In addition to the three generally known schools of mathematics instruction - the mechanistic, the structuralistic and the empirical - the article focuses on the realistic school, which has brought about far-reaching changes in mathematics instruction.

J. Nelissen; W. Tomic

2008-01-01

365

Magical Realist Pathways into and under the Psychotherapeutic Imaginary  

ERIC Educational Resources Information Center

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…

Speedy, Jane

2011-01-01

366

Binding energy of $\\\\Lambda$ hypernuclei from realistic YN interactions  

Microsoft Academic Search

s- and p-wave $\\\\Lambda$ single-particle enrgies are obtained for a variety of $\\\\Lambda$ hypernuclei from the relevant self-energy constructed within the framework of a perturbative many-body approach. Results are presented for present realistic hyperon-nucleon interactions such as J\\\\\\

I. Vidaña; A. Polls; A. Ramos; M. Hjorth-Jensen

1998-01-01

367

A realistic technicolor model from 150 TeV down  

Microsoft Academic Search

A realistic technicolor model is presented with the dynamics below 150 TeV treated explicitly. Electroweak symmetry is broken by the condensates of a ``minimal'' doublet of technifermions. The new feature of the model is that the third generation quarks are unified with the technifermions into multiplets of a walking gauge force down to a scale of 10 TeV. The remaining

Raman Sundrum

1993-01-01

368

Efcient Acquisition and Realistic Rendering of Car Paint  

Microsoft Academic Search

The outside appearance of cars is mostly dened through only two distinct materials ñ glass and car paint. While glass can rather easily be simulated by the simple physical laws of reection and refrac- tion, modeling car paint is more challenging. In this paper we present a framework for the ef- cient acquisition and realistic rendering of real- world car

Tongbo Chen; Michael Goesele; Ingo Wald; Hans-Peter Seidel

2005-01-01

369

A Realistic Power Consumption Model for Wireless Sensor Network Devices  

Microsoft Academic Search

A realistic power consumption model of wireless communication subsystems typically used in many sensor network node devices is presented. Simple power consumption models for major components are individually identified, and the effective transmission range of a sensor node is modeled by the output power of the transmitting power amplifier, sensitivity of the receiving low noise amplifier, and RF environment. Using

Qin Wang; Mark Hempstead; Woodward Yang

2006-01-01

370

Report of the workshop on realistic SSC lattices.  

National Technical Information Service (NTIS)

A workshop was held at the SSC Central Design Group from May 29 to June 4, 1985, on topics relating to the lattice of the SSC. The workshop marked a shift of emphasis from the investigation of simplified test lattices to the development of a realistic lat...

1985-01-01

371

Determination of quantum-noise parameters of realistic cavities  

NASA Astrophysics Data System (ADS)

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.

Semenov, A. A.; Vogel, W.; Khanbekyan, M.; Welsch, D.-G.

2007-01-01

372

International Management: Creating a More Realistic Global Planning Environment.  

ERIC Educational Resources Information Center

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…

Waldron, Darryl G.

2000-01-01

373

Emergent Curriculum.  

ERIC Educational Resources Information Center

Emergent curriculum in early childhood education refers to the process of using the spontaneity generated in the daily life of the children and adults in the program, along with teacher planning, to develop the curriculum. This book presents a story about a year in the life of a fictional child care center as a context for the discussion of…

Jones, Elizabeth; Nimmo, John

374

EMERGING ISSUES  

EPA Science Inventory

In order to better fulfill its mission under the Great Lakes Water Quality Agreement for the restoration and maintenance of the chemical, physical, and biological integrity of the Great Lakes Basin Ecosystem GLNPO has funded strategic or emerging issues of basin-wide importance: ...

375

Emergency cricothyrotomy.  

PubMed

The indications for the ruling for the Gulf Forces that emergency cricothyrotomy is to be performed where the airway is thought to be compromised are reviewed. The advantages of this procedure are outlined and some of the likely consequences regarding the incidence of complications and their management predicted. PMID:1761938

Milner, S M; Bennett, J D

1991-11-01

376

The role of myeloperoxidase (MPO) for prognostic evaluation in sensitive cardiac troponin I negative chest pain patients in the emergency department  

PubMed Central

Background: The diagnostic work-up of patients with acute chest pain in the emergency department (ED) is a challenging task. Serial troponin testing is required to rule-out acute myocardial infarction. Objective: To evaluate the value of myeloperoxidase (MPO) testing in sensitive cardiac troponin I (cTnI) negative patients with suspected acute coronary syndromes (ACS) in the routine setting of an ED. Methods: MPO was assessed in 432 consecutive patients presenting to the ED with ACS. In 266 patients, serial blood samples were available. After 6 weeks, major adverse cardiac events (MACE) were assessed. MPO and cTnI were measured in all available samples. For cTnI, a sensitive assay was used. Cut-off values were derived from an independent sample of 300 healthy volunteers. Results: Incidence of MACE in our population was 13%. MPO levels revealed sensitivity (Sens) of 82.1% and specificity (Spec) of 37.2% for MACE compared with 60.7% Sens and 61.4% Spec for sensitive cTnI. In serial sensitive cTnI negative patients (n=218), MACE incidence was 6.4%. MPO continued to demonstrate significant discriminatory power for the prognosis of MACE. Multivariate analyses confirmed these findings. Conclusion: MPO has an independent prognostic value overall and most notably in patients tested negative with a higher sensitive cardiac troponin I assay. MPO could be a promising biomarker for the initial evaluation of patients in chest pain units and is worth further investigation.

Shih, Jessie; Muller, Reinhold; Vollert, Jorn O; Muller, Christian; Danne, Oliver; Datwyler, Saul; Mockel, Martin

2013-01-01

377

Effective health care for older people resident in care homes: the optimal study protocol for realist review  

PubMed Central

Background Care homes in the UK rely on general practice for access to specialist medical and nursing care as well as referral to therapists and secondary care. Service delivery to care homes is highly variable in both quantity and quality. This variability is also evident in the commissioning and organisation of care home-specific services that range from the payment of incentives to general practitioners (GPs) to visit care homes, to the creation of care home specialist teams and outreach services run by geriatricians. No primary studies or systematic reviews have robustly evaluated the impact of these different approaches on organisation and resident-level outcomes. Our aim is to identify factors which may explain the perceived or demonstrated effectiveness of programmes to improve health-related outcomes in older people living in care homes. Methods/Design A realist review approach will be used to develop a theoretical understanding of what works when, why and in what circumstances. Elements of service models of interest include those that focus on assessment and management of residents’ health, those that use strategies to encourage closer working between visiting health care providers and care home staff, and those that address system-wide issues about access to assessment and treatment. These will include studies on continence, dignity, and speech and language assessment as well as interventions to promote person centred dementia care, improve strength and mobility, and nutrition. The impact of these interventions and their different mechanisms will be considered in relation to five key outcomes: residents’ medication use, use of out of hours’ services, hospital admissions (including use of Accident and Emergency) and length of hospital stay, costs and user satisfaction. An iterative three-stage approach will be undertaken that is stakeholder-driven and optimises the knowledge and networks of the research team. Discussion This realist review will explore why and for whom different approaches to providing health care to residents in care homes improves access to health care in the five areas of interest. It will inform commissioning decisions and be the basis for further research. This systematic review protocol is registered on the PROSPERO database reference number: CRD42014009112.

2014-01-01

378

Designing future dark energy space missions. I. Building realistic galaxy spectro-photometric catalogs and their first applications  

Microsoft Academic Search

Context: Future dark energy space missions such as JDEM and EUCLID are being designed to survey the galaxy population to trace the geometry of the universe and the growth of structure, which both depend on the cosmological model. To reach the goal of high precision cosmology they need to evaluate the capabilities of different instrument designs based on realistic mock

S. Jouvel; J.-P. Kneib; O. Ilbert; G. Bernstein; S. Arnouts; T. Dahlen; A. Ealet; B. Milliard; H. Aussel; P. Capak; A. Koekemoer; V. Le Brun; H. McCracken; M. Salvato; N. Scoville

2009-01-01

379

Designing Future Dark Energy Space Mission: I. Building Realistic Galaxy Spectro-Photometric Catalogs and their first applic ations  

Microsoft Academic Search

Context. Future dark energy space missions such as JDEM and EUCLID are being designed to survey the galaxy population to trace the geometry of the universe and the growth of structure, which both depend on the cosmological model. To reach the goal of high precision cosmology they need to evaluate the capabilities of different instrument designs based on realistic mock

S. Jouvel; J. P. Kneib; O. Ilbert; G. Bernstein; S. Arnouts; T. Dahlen; A. Ealet; B. Milliard; H. Aussel; P. Capak; H. McCracken; M. Salvato; N. Scoville

380

Optimizing Wind And Hydropower Generation Within Realistic Reservoir Operating Policy  

NASA Astrophysics Data System (ADS)

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, variability due to geographic distribution of wind resources, and forecast error. Electric power system factors include the mix of thermal generation resources, available transmission, demand patterns, and market structures. Hydropower factors include relative storage capacity, reservoir operating policies and hydrologic conditions. In addition, the wind, power system, and hydropower factors are often interrelated because stochastic weather patterns can simultaneously influence wind generation, power demand, and hydrologic inflows. One of the central findings is that the sensitivity of the model to changes cannot be performed one factor at a time because the impact of the factors is highly interdependent. For example, the net value of wind generation may be very sensitive to changes in transmission capacity under some hydrologic conditions, but not at all under others.

Magee, T. M.; Clement, M. A.; Zagona, E. A.

2012-12-01

381

[Psychiatric emergencies].  

PubMed

Psychiatric emergencies must not just be seen as catastrophies. They invariably represent the nadir of a development which has not been given enough attention while it arose. In contrast to a typical medical emergency situation the doctor is usually not particularly welcome by the disturbed psychiatric patient and his family. This may represent some hardship for the good doctor. When arriving at the scene of a psychiatric emergency, an accurate differential diagnosis will be of primary importance. Suicidality, disturbances of consciousness, states of excitement, dyskinesias and affective crises are the most frequent findings. In contrast to a somatic crisis where rapid intervention may be life-saving, it is advisable, to take your time and make sure you took everything into account, before making a decision. Sometimes the use of medication can dramatically change the scene from drama to dialogue. Basically, one has to determine if a hospitalization is necessary or not. Two primary concerns have to be looked into here: suicidal risk and dangerousness to others. It is good to be aware of those situations and diagnoses well known for their high suicidal potential. The question which - if any - compulsive measures have to be taken has to be answered and acted upon. Unpopular as they may be, they can resolve an extremely difficult situation within minutes. Unnecessary hesitation is not asked here for the sake of the patient as well as his family. The best way to deal with psychiatric emergencies is to avoid them. Looking out for signs and symptoms of a beginning psychotic development or suicidal ideation and acting upon it, for instance with medication and/or intensifying contacts with the patient are the primary means to prevent a crisis. Stopping medication, by patient or doctor, is one of the main reasons for psychiatric emergencies. After a psychiatric emergency has evolved, it pays out, to carefully analyse its development, the way it was handled and how it finally ended. Thus a crisis may, like the Chinese symbol for it with its double meaning, evolve to a chance for the patient. PMID:8999491

Laemmel, K

1996-12-10

382

Realistic spatial and temporal earthquake distributions in a modified Olami-Feder-Christensen model.  

PubMed

The Olami-Feder-Christensen model describes a limiting case of an elastic surface that slides on top of a substrate and is one of the simplest models that display some features observed in actual seismicity patterns. However, temporal and spatial correlations of real earthquakes are not correctly described by this model in its original form. I propose and study a modified version of the model, which includes a mechanism of structural relaxation. With this modification, realistic features of seismicity emerge, which are not obtained with the original version, mainly: aftershocks that cluster spatially around the slip surface of the main shock and follow the Omori law, and averaged frictional properties similar to those observed in rock friction, in particular the velocity-weakening effect. In addition, a Gutenberg-Richter law for the decaying of number of earthquakes with magnitude is obtained, with a decaying exponent within the range of experimentally observed values. Contrary to the original version of the model, a realistic value of the exponent appears without the necessity to fine tune any parameter. PMID:20481796

Jagla, E A

2010-04-01

383

Pediatric hypertensive emergencies.  

PubMed

Hypertensive emergency is a life-threatening condition that requires immediate evaluation and treatment. In children, severe hypertension can be caused by a variety of different underlying conditions. It usually presents with neurological involvement; however, signs and symptoms of injury to the kidneys, myocardium and eyes can also be present. Hospitalization for intravenous treatment with antihypertensive(s) and close monitoring in an intensive care setting are required for these patients. Few studies in children with hypertensive emergency have been done in the last several years. The findings and observations of these studies are discussed in this review. PMID:24908135

Baracco, Rossana; Mattoo, Tej K

2014-08-01

384

[Diabetes emergencies].  

PubMed

Diabetes-associated emergencies are frequent and include hyperglycemic states, such as diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) as well as hypoglycemia (hypoglycemic coma) and metabolic disturbances that are unrelated to pathological blood glucose aberrations (lactic acidosis). Knowledge of the respective risk situations, key signs and symptoms as well as early detection, special aspects of intensive care treatment and procedures for the prevention of these diabetes emergency cases is a must not only for the duty doctor in intensive care but also for diabetologists, internists and family doctors in the outpatient situation. The basic facts on these issues are presented in this continuing medical education (CME) article in a didactically clear form. PMID:24820043

Scherbaum, W A; Scherbaum, C R

2014-05-01

385

The effectiveness and cost-effectiveness of shared care: protocol for a realist review  

PubMed Central

Background Shared care (an enhanced information exchange over and above routine outpatient letters) is commonly used to improve care coordination and communication between a specialist and primary care services for people with long-term conditions. Evidence of the effectiveness and cost-effectiveness of shared care is mixed. Informed decision-making for targeting shared care requires a greater understanding of how it works, for whom it works, in what contexts and why. This protocol outlines how realist review methods can be used to synthesise evidence on shared care for long-term conditions. A further aim of the review is to explore economic evaluations of shared care. Economic evaluations are difficult to synthesise due to problems in accounting for contextual differences that impact on resource use and opportunity costs. Realist review methods have been suggested as a way to overcome some of these issues, so this review will also assess whether realist review methods are amenable to synthesising economic evidence. Methods/Design Database and web searching will be carried out in order to find relevant evidence to develop and test programme theories about how shared care works. The review will have two phases. Phase 1 will concentrate on the contextual conditions and mechanisms that influence how shared care works, in order to develop programme theories, which partially explain how it works. Phase 2 will focus on testing these programme theories. A Project Reference Group made up of health service professionals and people with actual experience of long-term conditions will be used to ground the study in real-life experience. Review findings will be disseminated through local and sub-national networks for integrated care and long-term conditions. Discussion This realist review will explore why and for whom shared care works, in order to support decision-makers working to improve the effectiveness of care for people outside hospital. The development of realist review methods to take into account cost and cost-effectiveness evidence is particularly innovative and challenging, and if successful will offer a new approach to synthesising economic evidence. This systematic review protocol is registered on the PROSPERO database (registration number: CRD42012002842).

2013-01-01

386

Biophysically Realistic Filament Bending Dynamics in Agent-Based Biological Simulation  

PubMed Central

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.

Alberts, Jonathan B.

2009-01-01

387

Neurobiologically realistic determinants of self-organized criticality in networks of spiking neurons.  

PubMed

Self-organized criticality refers to the spontaneous emergence of self-similar dynamics in complex systems poised between order and randomness. The presence of self-organized critical dynamics in the brain is theoretically appealing and is supported by recent neurophysiological studies. Despite this, the neurobiological determinants of these dynamics have not been previously sought. Here, we systematically examined the influence of such determinants in hierarchically modular networks of leaky integrate-and-fire neurons with spike-timing-dependent synaptic plasticity and axonal conduction delays. We characterized emergent dynamics in our networks by distributions of active neuronal ensemble modules (neuronal avalanches) and rigorously assessed these distributions for power-law scaling. We found that spike-timing-dependent synaptic plasticity enabled a rapid phase transition from random subcritical dynamics to ordered supercritical dynamics. Importantly, modular connectivity and low wiring cost broadened this transition, and enabled a regime indicative of self-organized criticality. The regime only occurred when modular connectivity, low wiring cost and synaptic plasticity were simultaneously present, and the regime was most evident when between-module connection density scaled as a power-law. The regime was robust to variations in other neurobiologically relevant parameters and favored systems with low external drive and strong internal interactions. Increases in system size and connectivity facilitated internal interactions, permitting reductions in external drive and facilitating convergence of postsynaptic-response magnitude and synaptic-plasticity learning rate parameter values towards neurobiologically realistic levels. We hence infer a novel association between self-organized critical neuronal dynamics and several neurobiologically realistic features of structural connectivity. The central role of these features in our model may reflect their importance for neuronal information processing. PMID:21673863

Rubinov, Mikail; Sporns, Olaf; Thivierge, Jean-Philippe; Breakspear, Michael

2011-06-01

388

Automatic Perceptual Color Map Generation for Realistic Volume Visualization  

PubMed Central

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.

Silverstein, Jonathan C.; Parsad, Nigel M.; Tsirline, Victor

2008-01-01

389

Dimits Shift in Realistic Gyrokinetic Plasma-Turbulence Simulations  

SciTech Connect

In simulations of turbulent plasma transport due to long wavelength (k{sub perpendicular}){rho}{sub i}{<=}1) electrostatic drift-type instabilities, we find a persistent nonlinear up-shift of the effective threshold. Next-generation tokamaks will likely benefit from the higher effective threshold for turbulent transport, and transport models should incorporate suitable corrections to linear thresholds. The gyrokinetic simulations reported here are more realistic than previous reports of a Dimits shift because they include nonadiabatic electron dynamics, strong collisional damping of zonal flows, and finite electron and ion collisionality together with realistic shaped magnetic geometry. Reversing previously reported results based on idealized adiabatic electrons, we find that increasing collisionality reduces the heat flux because collisionality reduces the nonadiabatic electron microinstability drive.

Mikkelsen, D. R.; Dorland, W. [Princeton Plasma Physics Laboratory, P.O. Box 451, Princeton, New Jersey 08543 (United States); University of Maryland, College Park, Maryland 20742 (United States)

2008-09-26

390

Realistic Covariance Prediction For the Earth Science Constellations  

NASA Technical Reports Server (NTRS)

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

Duncan, Matthew; Long, Anne

2006-01-01

391

Realistic Covariance Prediction for the Earth Science Constellation  

NASA Technical Reports Server (NTRS)

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.

Duncan, Matthew; Long, Anne

2006-01-01

392

Energy Emergency Districts: Concepts and Applications.  

National Technical Information Service (NTIS)

This final report describes the development and evaluation of models of the Energy Emergency District concept, and also explores potential applications of the concept for enhancing emergency management procedures. Part I provides summary descriptions of t...

R. B. Stewart

1985-01-01

393

A Real-Time Photo-Realistic Visual Flythrough  

Microsoft Academic Search

In this paper we present a comprehensive flythrough system whichgenerates photo-realistic images in true real-time. The high performanceis due to an innovative rendering algorithm based on a discreteray casting approach, accelerated by ray coherence and multiresolutiontraversal. The terrain as well as the 3D objects are represented bya textured mapped voxel-based model. The system is based on a puresoftware algorithm and

Eran Rich; Uri Lerner; Victor Shenkar

1996-01-01

394

Photo-Realistic Talking-Heads from Image Samples  

Microsoft Academic Search

This paper describes a system for creating aphoto-realistic model of the human head that can be animatedand lip-synched from phonetic transcripts of text. Combined witha state-of-the-art text-to-speech synthesizer (TTS), it generatesvideo animations of talking heads that closely resemble real people.To obtain a naturally looking head, we choose a "data-driven"approach. We record a talking person and apply image recognitionto extract automatically

Eric Cosatto; Hans Peter Graf

2000-01-01

395

Realistic modeling of chamber transport for heavy-ion fusion  

SciTech Connect

Transport of intense heavy-ion beams to an inertial-fusion target after final focus is simulated here using a realistic computer model. It is found that passing the beam through a rarefied plasma layer before it enters the fusion chamber can largely neutralize the beam space charge and lead to a usable focal spot for a range of ion species and input conditions.

Sharp, W.M.; Grote, D.P.; Callahan, D.A.; Tabak, M.; Henestroza, E.; Yu, S.S.; Peterson, P.F.; Welch, D.R.; Rose, D.V.

2003-05-01

396

Developments in realistic design for aperiodic Mo/Si multilayermirrors  

SciTech Connect

Aperiodic multilayers have been designed for various applications, using numeric algorithms and analytical solutions, for many years with varying levels of success. This work developed a more realistic model for simulating aperiodic Mo/Si multilayers to be used in these algorithms by including the formation of MoSi{sub 2}. Using a genetic computer code we were able to optimize a 45{sup o} multilayer for a large bandpass reflection multilayer that gave good agreement with the model.

Aquila, A.L.; Salmassi, F.; Dollar, F.; Liu, Y.; Gullikson, E.M.

2006-04-05

397

Behaviorly realistic simulations of stock market traders with a soul  

NASA Astrophysics Data System (ADS)

The price fluctuations of the stocks in the financial markets are the result of the individual operations by many individual investors. However for many decades the financial theory did not use directly this "microscopic representation" of the markets. The main difficulties preventing this approach were solved recently with the advent of modern computer technology: - massive detailed data on the individual market operations became available; - "microscopic simulations" of the stock markets in terms of their individual participating agents allow very realistic treatment of the problem. By taking advantage of the modern computer processing and simulation techniques, we are now able to confront real market data with the results of simulating "microscopic" realistic models of the markets. These models have the potential to include and study the effects on the market of any desired feature in the investors behavior: departures from rationality, herding effects, heterogeneous investor-specific trading strategies. We propose to use the comparison of computer simulations of microscopic models with the actual market data in order to validate and enhance the knowledge on the financial behavior of individuals. Moreover we hope to explain, understand (and may be predict and control) macroscopic market dynamical features (e.g., cycles of booms and crashes, investors wealth distribution, market returns probability distribution etc.) based on realistic models using this knowledge.

Solomon, Sorin

1999-09-01

398

Realistic colon simulation in CT colonography using mesh skinning  

NASA Astrophysics Data System (ADS)

Realistic colon simulations do not exist but would be valuable for CT colonography (CTC) CAD development and validation of new colon image processing algorithms. The human colon is a convoluted tubular structure and very hard to model physically and electronically. In this investigation, we propose a novel approach to generate realistic colon simulation using mesh skinning. The method proceeds as follows. First, a digital phantom of a cylindrical tube is modeled to simulate a straightened colon. Second, haustral folds and teniae coli are added to the cylindrical tube. Third, a centerline equipped with rotation-minimizing frames (RMF) and distention values is computed. Fourth, mesh skinning is applied to warp the tube around the centerline and generate realistic colon simulation. Lastly, colonic polyps in the shape of ellipsoids are also modeled. Results show that the simulated colon highly resembles the real colon. This is the first colon simulation that incorporates most colon characteristics in one model, including curved centerline, variable distention, haustral folds, teniae coli and colonic polyps.

Yao, Jianhua; Chowdhury, Ananda S.; Summers, Ronald M.

2010-03-01

399

Relating realist metatheory to issues of gender and mental health.  

PubMed

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

Bergin, M; Wells, John S G; Owen, Sara

2010-06-01

400

Exposure render: an interactive photo-realistic volume rendering framework.  

PubMed

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

Kroes, Thomas; Post, Frits H; Botha, Charl P

2012-01-01

401

Exposure Render: An Interactive Photo-Realistic Volume Rendering Framework  

PubMed Central

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.

Kroes, Thomas; Post, Frits H.; Botha, Charl P.

2012-01-01

402

Realistic terrain visualization based on 3D virtual world technology  

NASA Astrophysics Data System (ADS)

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.

Huang, Fengru; Lin, Hui; Chen, Bin; Xiao, Cai

2009-09-01

403

76 FR 71991 - Agency Information Collection Activities: Proposed Collection; Comment Request, Emergency...  

Federal Register 2010, 2011, 2012, 2013

...HOMELAND SECURITY Federal Emergency Management Agency [Docket ID FEMA-2011-0038...Collection; Comment Request, Emergency Management Institute Course Evaluation Form AGENCY: Federal Emergency Management Agency, DHS. ACTION:...

2011-11-21

404

Emergency Medical Services Program Standards.  

ERIC Educational Resources Information Center

This guide contains 45 program standards for the emergency medical services program conducted in technical institutes in Georgia. The standards are divided into 12 categories: foundations (philosophy, purpose, goals, program objectives, availability, evaluation); admissions (admission requirements, provisional admission requirements, recruitment,…

Georgia Univ., Athens. Dept. of Vocational Education.

405

Validity and reliability of an in-training evaluation report to measure the CanMEDS Roles in emergency medicine residents.  

PubMed

ABSTRACTBackground: There is a question of whether a single assessment tool can assess the key competencies of residents as mandated by the Royal College of Physicians and Surgeons of Canada CanMEDS roles framework.Objective:The objective of the present study was to investigate the reliability and validity of an emergency medicine (EM) in-training evaluation report (ITER).Method:ITER data from 2009 to 2011 were combined for residents across the 5 years of the EM residency training program. An exploratory factor analysis with varimax rotation was used to explore the construct validity of the ITER. A total of 172 ITERs were completed on residents across their first to fifth year of training.Results:A combined, 24-item ITER yielded a five-factor solution measuring the CanMEDs role Medical Expert/Scholar, Communicator/Collaborator, Professional, Health Advocate and Manager subscales. The factor solution accounted for 79% of the variance, and reliability coefficients (Cronbach alpha) ranged from ? ?=? 0.90 to 0.95 for each subscale and ? ?=? 0.97 overall. The combined, 24-item ITER used to assess residents' competencies in the EM residency program showed strong reliability and evidence of construct validity for assessment of the CanMEDS roles.Conclusion:Further research is needed to develop and test ITER items that will differentiate each CanMEDS role exclusively. PMID:23816236

Kassam, Aliya; Donnon, Tyrone; Rigby, Ian

2013-01-01

406

Validity and reliability of an in-training evaluation report to measure the CanMEDS roles in emergency medicine residents.  

PubMed

ABSTRACTBackground:There is a question of whether a single assessment tool can assess the key competencies of residents as mandated by the Royal College of Physicians and Surgeons of Canada CanMEDS roles framework.Objective:The objective of the present study was to investigate the reliability and validity of an emergency medicine (EM) in-training evaluation report (ITER).Method:ITER data from 2009 to 2011 were combined for residents across the 5 years of the EM residency training program. An exploratory factor analysis with varimax rotation was used to explore the construct validity of the ITER. A total of 172 ITERs were completed on residents across their first to fifth year of training.Results:A combined, 24-item ITER yielded a five-factor solution measuring the CanMEDs role Medical Expert/Scholar, Communicator/Collaborator, Professional, Health Advocate and Manager subscales. The factor solution accounted for 79% of the variance, and reliability coefficients (Cronbach alpha) ranged from ? ?=? 0.90 to 0.95 for each subscale and ? ?=? 0.97 overall. The combined, 24-item ITER used to assess residents' competencies in the EM residency program showed strong reliability and evidence of construct validity for assessment of the CanMEDS roles.Conclusion:Further research is needed to develop and test ITER items that will differentiate each CanMEDS role exclusively. PMID:24626119

Kassam, Aliya; Donnon, Tyrone; Rigby, Ian

2014-03-01

407

Abnormal lipoprotein(a) levels predict coronary artery calcification in Southeast Asians but not in Caucasians: use of noninvasive imaging for evaluation of an emerging risk factor.  

PubMed

Subclinical atherosclerosis can be quantified by coronary artery calcium (CAC) scoring. Due to its high specificity for atherosclerosis, CAC is an excellent phenotypic tool for the evaluation of emerging risk markers. Lipoprotein(a) [Lp(a)] is atherogenic due to the presence of apoB and may be thrombogenic through its apo(a) component. Lp(a) has been linked to cardiovascular events in Caucasians; however, its link to atherosclerosis in various ethnicities remains unclear. We evaluated the ability of Lp(a) mass to predict subclinical atherosclerosis in Southeast Asians and Caucasians, as measured by CAC. Traditional lipid measurements, Lp(a) measurements, and CAC by 64-slice multidetector computed tomography was performed in 103 consecutive patients in the USA and in 104 consecutive patients in Jakarta, Indonesia. Proportion of positive CAC and median CAC in Southeast Asians and in Caucasians was 61.5% and 63.1%, and 23.5 (interquartile range, 0-270) and 13 (interquartile range, 0-388), respectively. Significantly higher proportion of Southeast Asians had elevated Lp(a) levels, compared to Caucasians (51.0% vs. 29.2%; p?=?0.005). In Southeast Asians, Lp(a) remained an independent predictor of CAC with an odds ratio of 4.97 (95% confidence interval, 1.56-15.88; p?

Sharma, Abhinav; Kasim, Manoefris; Joshi, Parag H; Qian, Zhen; Krivitsky, Eric; Akram, Kamran; Rinehart, Sarah; Vazquez, Gustavo; Miller, Joseph; Rohman, Mohammad Saifur; Voros, Szilard

2011-08-01

408

Chernobyl nuclear accident hydrologic analysis and emergency evaluation of radionuclide distributions in the Dnieper River, Ukraine, during the 1993 summer flood  

SciTech Connect

This report describes joint activities of Program 7.1.F, ``Radionuclide Transport in Water and Soil Systems,`` of the USA/Commonwealth of Independent States (CIS) Joint Coordinating Committee of Civilian Nuclear Reactor Safety to study the hydrogeochemical behavior of radionuclides released to the Pripyat and Dnieper rivers from the Chernobyl Nuclear Power Plant in Ukraine. These joint activities included rapid evaluation of radionuclide distributions in the Pripyat and Dnieper river system and field data evaluation and modeling for the 1993 summer flood to assist the Ukrainian government in their emergency response during the flood. In July-August 1993, heavy rainfall over the Pripyat River Catchment in Belarus and Ukraine caused severe flooding, significantly raising {sup 90}Sr concentrations in the river. Near the Chernobyl area, the maximum {sup 90}Sr concentration in the Pripyat River reached 20--25 PCi/L in early August; near the Pripyat River mouth, the concentration rose to 35 pCi/L. The peak {sup 90}Sr concentration in the Kiev Reservoir (a major source of drinking water for Kiev) was 12 pCi/L. Based on these measured radionuclide levels, additional modeling results and the assumption of water purification in a water treatment station, {sup 90}Sr concentrations in Kiev`s drinking water were estimated to be less than 8 pCi/L. Unlike {sup 90}Sr, {sup 137}Cs concentrations in the Pripyat River during the flood did not rise significantly to the pre-flood levels. Estimated {sup 137}Cs concentrations for the Kiev drinking water were two orders of magnitude lower than the drinking water standard of 500 pCi/L for {sup 137}Cs.

Voitsekhovitch, O.V. [Ukrainian Hydrometeorological Inst., Kiev (Ukraine); Zheleznyak, M.J. [Ukrainian Academy of Sciences, Kiev (Ukraine). Cybernetics Center; Onishi, Y. [Pacific Northwest Lab., Richland, WA (United States)

1994-06-01

409

On the fully automatic construction of a realistic head model for EEG source localization.  

PubMed

Accurate multi-tissue segmentation of magnetic resonance (MR) images is an essential first step in the construction of a realistic finite element head conductivity model (FEHCM) for electroencephalography (EEG) source localization. All of the segmentation approaches proposed to date for this purpose require manual intervention or correction and are thus laborious, time-consuming, and subjective. In this paper we propose and evaluate a fully automatic method based on a hierarchical segmentation approach (HSA) incorporating Bayesian-based adaptive mean-shift segmentation (BAMS). An evaluation of HSA-BAMS, as well as two reference methods, in terms of both segmentation accuracy and the source localization accuracy of the resulting FEHCM is also presented. The evaluation was performed using (i) synthetic 2D multi-modal MRI head data and synthetic EEG (generated for a prescribed source), and (ii) real 3D T1-weighted MRI head data and real EEG data (with expert determined source localization). Expert manual segmentation served as segmentation ground truth. The results show that HSA-BAMS outperforms the two reference methods and that it can be used as a surrogate for manual segmentation for the construction of a realistic FEHCM for EEG source localization. PMID:24110441

Mahmood, Qaiser; Shirvany, Yazdan; Mehnert, Andrew; Chodorowski, Artur; Gellermann, Johanna; Edelvik, Fredrik; Hedstrom, Anders; Persson, Mikael

2013-01-01

410

Fatality Assessment and Control Evaluation (FACE) Report: Fire Fighter-Technician Suffers Cardiac Death 6 Hours after Responding to Several Emergency Calls.  

National Technical Information Service (NTIS)

On July 6, 2007, a 34-year old male, career, Fire Fighter-Technician responded to three emergency calls, performed a fire prevention inspection, and attended training during his shift. About six hours after his emergency response, the FF-Technician experi...

T. Baldwin T. R. Hales

2007-01-01

412

Low resolution brain electromagnetic tomography in a realistic geometry head model: a simulation study  

NASA Astrophysics Data System (ADS)

It is of importance to localize neural sources from scalp recorded EEG. Low resolution brain electromagnetic tomography (LORETA) has received considerable attention for localizing brain electrical sources. However, most such efforts have used spherical head models in representing the head volume conductor. Investigation of the performance of LORETA in a realistic geometry head model, as compared with the spherical model, will provide useful information guiding interpretation of data obtained by using the spherical head model. The performance of LORETA was evaluated by means of computer simulations. The boundary element method was used to solve the forward problem. A three-shell realistic geometry (RG) head model was constructed from MRI scans of a human subject. Dipole source configurations of a single dipole located at different regions of the brain with varying depth were used to assess the performance of LORETA in different regions of the brain. A three-sphere head model was also used to approximate the RG head model, and similar simulations performed, and results compared with the RG-LORETA with reference to the locations of the simulated sources. Multi-source localizations were discussed and examples given in the RG head model. Localization errors employing the spherical LORETA, with reference to the source locations within the realistic geometry head, were about 20-30 mm, for four brain regions evaluated: frontal, parietal, temporal and occipital regions. Localization errors employing the RG head model were about 10 mm over the same four brain regions. The present simulation results suggest that the use of the RG head model reduces the localization error of LORETA, and that the RG head model based LORETA is desirable if high localization accuracy is needed.

Ding, Lei; Lai, Yuan; He, Bin

2005-01-01

413

Computed Tomographic Coronary Artery Calcium Assessment for Evaluating Chest Pain in the Emergency Department: Long-term Outcome of a Prospective Blind Study  

PubMed Central

OBJECTIVE: To determine the long-term outcome of computed tomographic (CT) quantification of coronary artery calcium (CAC) used as a triage tool for patients presenting with chest pain to an emergency department (ED). PATIENTS AND METHODS: Patients (men aged 30-62 years and women aged 30-65 years) with chest pain and low-to-moderate probability of coronary artery disease underwent both conventional ED chest pain evaluation and CT CAC assessment prospectively. Patients' physicians were blinded to the CAC results. The results of the conventional evaluation were compared with CAC findings on CT, a