Science.gov

Sample records for emergent realist evaluation

  1. Realist evaluation: an immanent critique.

    PubMed

    Porter, Sam

    2015-10-01

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

  2. Faculty Development for Educators: A Realist Evaluation

    ERIC Educational Resources Information Center

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

    2015-01-01

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

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

    PubMed Central

    Ponge, Jean-François

    2005-01-01

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

  4. Remembering and Celebrating a Realistic Evaluation Visionary

    ERIC Educational Resources Information Center

    Patton, Michael Quinn

    2013-01-01

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

  5. Remembering and Celebrating a Realistic Evaluation Visionary

    ERIC Educational Resources Information Center

    Patton, Michael Quinn

    2013-01-01

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

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

    PubMed Central

    2010-01-01

    Background Realist evaluation offers an interesting approach to evaluation of interventions in complex settings, but has been little applied in health care. We report on a realist case study of a well performing hospital in Ghana and show how such a realist evaluation design can help to overcome the limited external validity of a traditional case study. Methods We developed a realist evaluation framework for hypothesis formulation, data collection, data analysis and synthesis of the findings. Focusing on the role of human resource management in hospital performance, we formulated our hypothesis around the high commitment management concept. Mixed methods were used in data collection, including individual and group interviews, observations and document reviews. Results We found that the human resource management approach (the actual intervention) included induction of new staff, training and personal development, good communication and information sharing, and decentralised decision-making. We identified 3 additional practices: ensuring optimal physical working conditions, access to top managers and managers' involvement on the work floor. Teamwork, recognition and trust emerged as key elements of the organisational climate. Interviewees reported high levels of organisational commitment. The analysis unearthed perceived organisational support and reciprocity as underlying mechanisms that link the management practices with commitment. Methodologically, we found that realist evaluation can be fruitfully used to develop detailed case studies that analyse how management interventions work and in which conditions. Analysing the links between intervention, mechanism and outcome increases the explaining power, while identification of essential context elements improves the usefulness of the findings for decision-makers in other settings (external validity). We also identified a number of practical difficulties and priorities for further methodological development. Conclusion This case suggests that a well-balanced HRM bundle can stimulate organisational commitment of health workers. Such practices can be implemented even with narrow decision spaces. Realist evaluation provides an appropriate approach to increase the usefulness of case studies to managers and policymakers. PMID:20100330

  7. Considerations for realistic ECCS evaluation methodology for LWRs

    SciTech Connect

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

    1985-01-01

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

  8. Employment advice in primary care: a realistic evaluation.

    PubMed

    Pittam, Gail; Boyce, Melanie; Secker, Jenny; Lockett, Helen; Samele, Chiara

    2010-11-01

    Every organisation in the UK is affected by mental distress and ill-health in the workforce. The first point of contact for most people with common mental health problems, such as mild to moderate anxiety or depression, is their general practitioner. The location of specialist employment advisers in GP surgeries is therefore a logical attempt to address the issue of people falling out of the workplace, through the provision of early intervention and combined vocational and psychological treatment packages. In 2007 the Richmond Fellowship, a national mental health charity, received a grant to provide four employment advisers to work with GP surgeries in Eastern England. The aim was to help people with mental health problems gain work (Regain clients) or retain their current employment (Retain clients). In this study a realistic evaluation framework was applied to address the question of what works, for whom and in which contexts through interviews with key stakeholders including 22 clients of the project, five primary health care staff and the four employment advisers. The interventions that Retain clients found most helpful were careers guidance (including psychological profiling) and developing strategies to negotiate and communicate with employers. These appeared to help individuals to take control, broaden their horizons and move forward. In many cases this was supported by assistance in helping clients think through whether they wanted to consider a career change. For Regain clients the most important interventions were help with interview skills, CV writing and assertiveness training. Employment outcomes were considerably higher for the Retain clients than for the Regain clients. The study indicates that it could be more effective for Retain and Regain services to be delivered through different care pathways to avoid diluting the services offered and consequently reducing their effectiveness. PMID:20500226

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

    ERIC Educational Resources Information Center

    Burgoyne, John G.

    2010-01-01

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

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

    NASA Astrophysics Data System (ADS)

    Wogram, Klaus

    2003-10-01

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

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

    PubMed Central

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

    2015-01-01

    Introduction Realist evaluation is an increasingly popular methodology in health services research. For realist evaluations (RE) this project aims to: develop quality and reporting standards and training materials; build capacity for undertaking and critically evaluating them; produce resources and training materials for lay participants, and those seeking to involve them. Methods To achieve our aims, we will: (1) Establish management and governance infrastructure; (2) Recruit an interdisciplinary Delphi panel of 35 participants with diverse relevant experience of RE; (3) Summarise current literature and expert opinion on best practice in RE; (4) Run an online Delphi panel to generate and refine items for quality and reporting standards; (5) Capture ‘real world’ experiences and challenges of RE—for example, by providing ongoing support to realist evaluations, hosting the RAMESES JISCmail list on realist research, and feeding problems and insights from these into the deliberations of the Delphi panel; (6) Produce quality and reporting standards; (7) Collate examples of the learning and training needs of researchers, students, reviewers and lay members in relation to RE; (8) Develop, deliver and evaluate training materials for RE and deliver training workshops; and (9) Develop and evaluate information and resources for patients and other lay participants in RE (eg, draft template information sheets and model consent forms) and; (10) Disseminate training materials and other resources. Planned outputs: (1) Quality and reporting standards and training materials for RE. (2) Methodological support for RE. (3) Increase in capacity to support and evaluate RE. (4) Accessible, plain-English resources for patients and the public participating in RE. Discussion The realist evaluation is a relatively new approach to evaluation and its overall place in the is not yet fully established. As with all primary research approaches, guidance on quality assurance and uniform reporting is an important step towards improving quality and consistency. PMID:26238395

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

    ERIC Educational Resources Information Center

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

    2011-01-01

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

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

    PubMed

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

    2016-03-01

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

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

    ERIC Educational Resources Information Center

    Jackson, Suzanne F.; Kolla, Gillian

    2012-01-01

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

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

    PubMed Central

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

    2009-01-01

    Context: Large-scale, whole-systems interventions in health care require imaginative approaches to evaluation that go beyond assessing progress against predefined goals and milestones. This project evaluated a major change effort in inner London, funded by a charitable donation of approximately $21 million, which spanned four large health care organizations, covered three services (stroke, kidney, and sexual health), and sought to “modernize” these services with a view to making health care more efficient, effective, and patient centered. Methods: This organizational case study draws on the principles of realist evaluation, a largely qualitative approach that is centrally concerned with testing and refining program theories by exploring the complex and dynamic interaction among context, mechanism, and outcome. This approach used multiple data sources and methods in a pragmatic and reflexive manner to build a picture of the case and follow its fortunes over the three-year study period. The methods included ethnographic observation, semistructured interviews, and scrutiny of documents and other contemporaneous materials. As well as providing ongoing formative feedback to the change teams in specific areas of activity, we undertook a more abstract, interpretive analysis, which explored the context-mechanism-outcome relationship using the guiding question “what works, for whom, under what circumstances?” Findings: In this example of large-scale service transformation, numerous projects and subprojects emerged, fed into one another, and evolved over time. Six broad mechanisms appeared to be driving the efforts of change agents: integrating services across providers, finding and using evidence, involving service users in the modernization effort, supporting self-care, developing the workforce, and extending the range of services. Within each of these mechanisms, different teams chose widely differing approaches and met with differing success. The realist analysis 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. PMID:19523123

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

    NASA Astrophysics Data System (ADS)

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

    2012-12-01

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

  17. Emergency Exercise Participation and Evaluation

    ERIC Educational Resources Information Center

    Smith, Julie; Black, Lynette; Williams, Linda

    2012-01-01

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

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

    PubMed Central

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

    2012-01-01

    Introduction There has been a lot of attention on the role of human resource management interventions to improve delivery of health services in low- and middle-income countries. However, studies on this subject are few due to limited research on implementation of programmes and methodological difficulties in conducting experimental studies on human resource interventions. The authors present the protocol of an evaluation of a district-level capacity-building intervention to identify the determinants of performance of health workers in managerial positions and to understand how changes (if any) are brought about. Methods and analysis The aim of this study is to understand how capacity building works. The authors will use realist evaluation to evaluate an intervention in Karnataka, India. The intervention is a capacity-building programme that seeks to improve management capacities of health managers at district and subdistrict levels through periodic classroom-based teaching and mentoring support at the workplace. The authors conducted interviews and reviewed literature on capacity building in health to draw out the programme theory of the intervention. Based on this, the authors formulated hypothetical pathways connecting the expected outcomes of the intervention (planning and supervision) to the inputs (contact classes and mentoring). The authors prepared a questionnaire to assess elements of the programme theory—organisational culture, self-efficacy and supervision. The authors shall conduct a survey among health managers as well as collect qualitative data through interviews with participants and non-participants selected purposively based on their planning and supervision performance. The authors will construct explanations in the form of context–mechanism–outcome configurations from the results. This will be iterative and the authors will use a realist evaluation framework to refine the explanatory theories that are based on the findings to explain and 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. PMID:22466036

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

    PubMed Central

    2014-01-01

    Background Interdisciplinary teamwork (ITW) is designed to promote the active participation of several disciplines in delivering comprehensive cancer care to patients. ITW provides mechanisms to support continuous communication among care providers, optimize professionals’ participation in clinical decision-making within and across disciplines, and foster care coordination along the cancer trajectory. However, ITW mechanisms are not activated optimally by all teams, resulting in a gap between desired outcomes of ITW and actual outcomes observed. The aim of the present study is to identify the conditions underlying outcome production by ITW in local oncology teams. Methods This retrospective multiple case study will draw upon realist evaluation principles to explore associations among context, mechanisms and outcomes (CMO). The cases are nine interdisciplinary cancer teams that participated in a previous study evaluating ITW outcomes. Qualitative data sources will be used to construct a picture of CMO associations in each case. For data collection, reflexive focus groups will be held to capture patients’ and professionals’ perspectives on ITW, using the guiding question, ‘What works, for whom, and under what circumstances?’ Intra-case analysis will be used to trace associations between context, ITW mechanisms, and patient outcomes. Inter-case analysis will be used to compare the different cases’ CMO associations for a better understanding of the phenomenon under study. Discussion This multiple case study will use realist evaluation principles to draw lessons about how certain contexts are more or less likely to produce particular outcomes. The results will make it possible to target more specifically the actions required to optimize structures and to activate the best mechanisms to meet the needs of cancer patients. This project could also contribute significantly to the development of improved research methods for conducting realist evaluations of 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. PMID:24938443

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

    PubMed

    Fehr, M

    2014-09-01

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

  1. Online Assessment, Measurement and Evaluation: Emerging Practices

    ERIC Educational Resources Information Center

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

    2006-01-01

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

  2. [PEEC (psychiatric evaluation in emergency care)].

    PubMed

    Higashioka, Hiroaki; Miyake, Yasufumi

    2016-02-01

    Psychiatric evaluation in emergency care (PEEC) course was developed by a surveillance committee of clinical care for suicide attempt patients of the Japanese Society of Emergency Medicine (JSEM). This course is applicable to patients with a variety of psychiatric state not only the suicide attempt person. The goals of the course are standardization of evaluation and the initial management of psychiatric symptoms in emergency care. And it is a course with an emphasis on interprofessional collaboration. It is expected that PEEC course is to bridge the emergency care and psychiatric care in each region. PMID:26915260

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

    PubMed

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

    2015-10-01

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

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

    NASA Astrophysics Data System (ADS)

    Hess, P.; Lomonosov, A. M.

    2013-09-01

    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.

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

    PubMed Central

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

    2012-01-01

    Background Despite evidence showing that adolescent-friendly health services (AFSs) increase young people's access to these services, health systems across the world are failing to integrate this approach. In Latin America, policies aimed at strengthening AFS abound. However, such services are offered only in a limited number of sites, and providers’ attitudes and respect for confidentiality have not been addressed to a sufficient extent. Methods The aim of this study was to explore the mechanisms that triggered the transformation of an ‘ordinary’ health care facility into an AFS in Ecuador. For this purpose, a realist evaluation approach was used in order to analyse three well-functioning AFSs. Information was gathered at the national level and from each of the settings including: (i) statistical information and unpublished reports; (ii) in-depth interviews and focus group discussions with policy makers, health care providers, users and adolescents participating in youth organisations and (iii) observations at the health care facilities. Thematic analysis was carried out, driven by the realist evaluation approach, namely exploring the connections between mechanisms, contexts and outcomes. Results The results highlighted that the development of the AFSs was mediated by four mechanisms: grounded self-confidence in trying new things, legitimacy, a transformative process and an integral approach to adolescents. Along this process, contextual factors at the national and institutional levels were further explored. Conclusion The Ministry of Health of Ecuador, based on the New Guidelines for Comprehensive Care of Adolescent Health, has started the scaling up of AFSs. Our research points towards the need to recognise and incorporate these mechanisms as part of the implementation strategy from the very beginning of the process. Although contextually limited to Ecuador, many mechanisms and good practices in these AFS may be relevant to the Latin American setting and elsewhere. PMID:22855646

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

    PubMed Central

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

    2013-01-01

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

  7. Evaluation of Emergency Medicine Residents by Nurses.

    ERIC Educational Resources Information Center

    Tintinalli, Judith E.

    1989-01-01

    Emergency medicine residents at William Beaumont Hospital are evaluated quarterly by the nursing staff. The nurses discuss each resident and reach consensus on each evaluation item and copies are given to each resident. Although the residents' attitudes have not been favorable, overall their behavioral interactions have improved markedly.…

  8. Toxicological evaluation of realistic emission source aerosols (TERESA): introduction and overview.

    PubMed

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

    2011-08-01

    Determining the health impacts of sources and components of fine particulate matter (PM(2.5)) is an important scientific goal. PM(2.5) is a complex mixture of inorganic and organic constituents that are likely to differ in their potential to cause adverse health outcomes. The Toxicological Evaluation of Realistic Emissions of Source Aerosols (TERESA) study focused on two PM sources--coal-fired power plants and mobile sources--and sought to investigate the toxicological effects of exposure to emissions from these sources. The set of papers published here document the power plant experiments. TERESA attempted to delineate health effects of primary particles, secondary (aged) particles, and mixtures of these with common atmospheric constituents. TERESA involved withdrawal of emissions from the stacks of three coal-fired power plants in the United States. The emissions were aged and atmospherically transformed in a mobile laboratory simulating downwind power plant plume processing. Toxicological evaluations were carried out in laboratory rats exposed to different emission scenarios with extensive exposure characterization. The approach employed in TERESA was ambitious and innovative. Technical challenges included the development of stack sampling technology that prevented condensation of water vapor from the power plant exhaust during sampling and transfer, while minimizing losses of primary particles; development and optimization of a photochemical chamber to provide an aged aerosol for animal exposures; development and evaluation of a denuder system to remove excess gaseous components; and development of a mobile toxicology laboratory. This paper provides an overview of the conceptual framework, design, and methods employed in the study. PMID:21639692

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

    PubMed Central

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

    2013-01-01

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

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

    PubMed Central

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

    2016-01-01

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

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

    NASA Astrophysics Data System (ADS)

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

    2013-03-01

    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.

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

    PubMed Central

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

    2013-01-01

    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. PMID:21913822

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

    PubMed Central

    Patsios, Demi; Carpenter, John

    2010-01-01

    Background Joint training for interagency working is carried out by Local Safeguarding Children Boards in England to promote effective local working to safeguard and promote the welfare of children. Purpose This paper reports on the findings of the outputs and outcomes of interagency training to safeguard children in eight Local Safeguarding Children Boards. Methods A review of Local Safeguarding Children Board documentation, observations of Local Safeguarding Children Board training sub-group meetings and a series of interviews with training key stakeholders in each Local Safeguarding Children Board were used to assess how partner agencies in the Local Safeguarding Children Boards carried out their statutory responsibilities to organise interagency training. ‘Realistic Evaluation’ was used to evaluate the mechanisms by which a central government mandate produced particular inter-agency training outputs (number of courses, training days) and joint working outcomes (effective partnerships), within particular Local Safeguarding Children Board contexts. Results The ‘mandated partnership’ imposed on Local Safeguarding Children Boards by central government left little choice but for partner agencies to work together to deliver joint training, which in turn affected the dynamics of working partnerships across the various sites. The effectiveness of the training sub group determined the success of the organisation and delivery of training for joint working. Despite having a central mandate, Local Safeguarding Children Boards had heterogeneous funding and training arrangements. These resulted in significant variations in the outputs in terms of the number of courses per ‘children in need’ in the locality and in the cost per course. Conclusions Interagency training which takes account of the context of the Local Safeguarding Children Board is more likely to produce better trained staff, effective partnership working, and lead to better integrated safeguarding children services. PMID:21290000

  14. Toxicological evaluation of realistic emission source aerosols (TERESA)-power plant studies: assessment of cellular responses.

    PubMed

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

    2011-08-01

    The Toxicological Evaluation of Realistic Emission Source Aerosols (TERESA) project assessed primary and secondary particulate by simulating the chemical reactions that a plume from a source might undergo during atmospheric transport and added other atmospheric constituents that might interact with it. Three coal-fired power plants with different coal and different emission controls were used. Male Sprague-Dawley rats were exposed for 6 h to either filtered air or aged aerosol from the power plant. Four exposure scenarios were studied: primary particles (P); primary + secondary (oxidized) particles (PO); primary + secondary (oxidized) particles + SOA (POS); and primary + secondary (oxidized) particles neutralized + SOA (PONS). Exposure concentrations varied by scenario to a maximum concentration of 257.1 ± 10.0 μg/m(3). Twenty-four hours after exposure, pulmonary cellular responses were assessed by bronchoalveolar lavage (BAL), complete blood count (CBC), and histopathology. Exposure to the PONS and POS scenarios produced significant increases in BAL total cells and macrophage numbers at two plants. The PONS and P scenarios were associated with significant increases in BAL neutrophils and the presence of occasional neutrophils and increased macrophages in the airways and alveoli of exposed animals. Univariate analyses and random forest analyses showed that increases in total cell count and macrophage cell count were significantly associated with neutralized sulfate and several correlated measurements. Increases in neutrophils in BAL were associated with zinc. There were no significant differences in CBC parameters or blood vessel wall thickness by histopathology. The association between neutrophils increases and zinc raises the possibility that metals play a role in this response. PMID:21466245

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

    ERIC Educational Resources Information Center

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

    2008-01-01

    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

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

    ERIC Educational Resources Information Center

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

    2008-01-01

    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…

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

    PubMed Central

    2013-01-01

    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. PMID:23799944

  18. A critical realist approach to understanding and evaluating heart health programmes.

    PubMed

    Clark, Alexander M; MacIntyre, Paul D; Cruickshank, Justin

    2007-10-01

    Secondary prevention programmes for Coronary Heart Disease (CHD) aim to reduce cardiovascular risks and promote health in people with heart disease. Though programmes have been associated with health improvements in study populations, access to programmes remains low, and quality and effectiveness is highly variable. Current guidelines propose significant modifications to programmes, but existing research provides little insight into why programme effectiveness varies so much. Drawing on a critical realist approach, this article argues that current research has been based on an impoverished ontology, which has elements of positivism, does not explore the social determinants of health or the effects on outcomes of salient contextual factors, and thereby fails to account for programme variations. Alternative constructivist approaches are also weak and lacking in clinical credibility. An alternative critical realist approach is proposed that draws on the merits of subjectivist and objectivist approaches but also reflects the complex interplay between individual, programme-related, socio-cultural and organizational factors that influence health outcomes in open systems. This approach embraces measurement of objective effectiveness but also examines the mechanisms, organizational and contextual-related factors causing these outcomes. Finally, a practical example of how a critical realist approach can guide research into secondary prevention programmes is provided. PMID:17855471

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

    NASA Technical Reports Server (NTRS)

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

    2014-01-01

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

  20. Multi-user system for training and evaluation of environmental emergency management response -- MUSTER

    SciTech Connect

    Andersen, V.; Andersen, H.B.

    1995-12-31

    The efficiency with which complex, large-scale organizations respond to emergencies and critical situations depends crucially on the coordination of actions and communication among decision makers. However, decision makers have typically few opportunities to train distributed crisis management under artificial, yet realistic conditions; and at the same time, real emergencies occur fortunately so relatively infrequently that few decision makers have a chance of establishing a useful real-life experience of crisis management. There is therefore a need for having available realistic and flexible multi-user training environments in which coordinated response to crises or emergencies may be trained. At the same time, a flexible training environment supporting tactical training of coordinated emergency response can be used as a platform on the basis of which not only emergency response capability can be evaluated but also different procedures and practices and even control systems may be assessed before they are put into real use. In order to identify requirements to, develop specifications of and finally produce a prototype of a flexible training and evaluation environment, a two-year project, MUSTER: Multi-User System for Training and Evaluation of Environmental Emergency Response, was started in 1993 and is now approaching its completion by mid-95.

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

    PubMed Central

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

    2014-01-01

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

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

    PubMed Central

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

    2015-01-01

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

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

    SciTech Connect

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

    2010-11-15

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

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

    PubMed

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

    2011-07-01

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

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

    NASA Astrophysics Data System (ADS)

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

    2015-08-01

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

  6. Emergency building temperature restrictions. Final evaluation

    SciTech Connect

    1980-11-01

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

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

    NASA Astrophysics Data System (ADS)

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

    2014-12-01

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

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

    ERIC Educational Resources Information Center

    Hunt, Kim Steven; Sridharan, Sanjeev

    2010-01-01

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

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

    ERIC Educational Resources Information Center

    Hunt, Kim Steven; Sridharan, Sanjeev

    2010-01-01

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

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

    SciTech Connect

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

    2010-11-15

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

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

    PubMed Central

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

    2010-01-01

    Purpose: This work presents an improved algorithm for the generation of 3D breast software phantoms and its evaluation for mammography. Methods: The improved methodology has evolved from a previously presented 3D noncompressed breast modeling method used for the creation of breast models of different size, shape, and composition. The breast phantom is composed of breast surface, duct system and terminal ductal lobular units, Cooper’s ligaments, lymphatic and blood vessel systems, pectoral muscle, skin, 3D mammographic background texture, and breast abnormalities. The key improvement is the development of a new algorithm for 3D mammographic texture generation. Simulated images of the enhanced 3D breast model without lesions were produced by simulating mammographic image acquisition and were evaluated subjectively and quantitatively. For evaluation purposes, a database with regions of interest taken from simulated and real mammograms was created. Four experienced radiologists participated in a visual subjective evaluation trial, as they judged the quality of the simulated mammograms, using the new algorithm compared to mammograms, obtained with the old modeling approach. In addition, extensive quantitative evaluation included power spectral analysis and calculation of fractal dimension, skewness, and kurtosis of simulated and real mammograms from the database. Results: The results from the subjective evaluation strongly suggest that the new methodology for mammographic breast texture creates improved breast models compared to the old approach. Calculated parameters on simulated images such as β exponent deducted from the power law spectral analysis and fractal dimension are similar to those calculated on real mammograms. The results for the kurtosis and skewness are also in good coincidence with those calculated from clinical images. Comparison with similar calculations published in the literature showed good agreement in the majority of cases. Conclusions: The improved methodology generated breast models with increased realism compared to the older model as shown in evaluations of simulated images by experienced radiologists. It is anticipated that the realism will be further improved using an advanced image simulator so that simulated images may be used in feasibility studies in mammography. PMID:21158272

  12. Emergency department evaluation of child abuse.

    PubMed

    Leetch, Aaron N; Woolridge, Dale

    2013-08-01

    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

  13. A Realistic Evaluation of Two Training Programs on Implementing Skin-to-Skin as a Standard of Care

    PubMed Central

    Brimdyr, Kajsa; Widström, Ann-Marie; Cadwell, Karin; Svensson, Kristin; Turner-Maffei, Cynthia

    2012-01-01

    The authors used realistic evaluation to examine the real-world effectiveness of two 5-day training techniques on sustained optimal skin-to-skin practices that support Step 4 of the revised Baby-Friendly Hospital Initiative (BFHI). The authors found that education alone was insufficient to effect sustainable practice change. Exposure to the 5-day immersion model (Practice, Reflection, Education and training, Combined with Ethnography for Sustainable Success, or PRECESS) alone or combined with education was an effective strategy to change and sustain the standard of care for skin-to-skin practice (p < 0.00001). The intended outcome of sustained practice change toward implementation of skin-to-skin care through immersion or a combined approach shows promise and should be repeated in other localities. PMID:23730126

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

    NASA Astrophysics Data System (ADS)

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

    2014-06-01

    The European COoperation in Science and Technology (COST) Action ES1205 on the transfer of Engineered Nano materials from wastewater Treatment and stormwatEr to Rivers (ENTER) aims to create and to maintain a trans European network among scientists. This perspective article delivers a brief overview on the status quo at the beginning of the project by addressing the following aspects on engineered nano materials (ENMs) in the urban systems: i) ENMs that need to be considered on a European level; ii) uncertainties on production-volume estimations; iii) fate of selected ENMs during waste water transport and treatment; iv) analytical strategies for ENM analysis; v) ecotoxicity of ENMs, and vi) 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.

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

    NASA Technical Reports Server (NTRS)

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

    2000-01-01

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

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

    PubMed Central

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

    2014-01-01

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

  17. Challenges in integrating nondestructive evaluation and finite-element methods for realistic structural analysis

    NASA Astrophysics Data System (ADS)

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

    2000-05-01

    Capabilities and expertise related to the development of links between nondestructive evaluation (NDE) and finite element analysis (FEA) at Glenn Research Center (GRC) are demonstrated. Current tools to analyze data produced by computed tomography (CT) scans are exercised to help assess the damage state in high temperature structural composite materials. A utility translator was written to convert velocity (an image processing software) STL data file to a suitable CAD-FEA type file. Finite element analyses are carried out with MARC, a commercial nonlinear finite element code, and the analytical results are discussed. Modeling was established by building MSC/Patran (a pre and post processing finite element package) generated model and comparing it to a model generated by Velocity2 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.

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

    NASA Technical Reports Server (NTRS)

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

    2003-01-01

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

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

    PubMed Central

    2011-01-01

    Background The English National Health Service has made a major investment in nine partnerships between higher education institutions and local health services called Collaborations for Leadership in Applied Health Research and Care (CLAHRC). They have been funded to increase capacity and capability to produce and implement research through sustained interactions between academics and health services. CLAHRCs provide a natural 'test bed' for exploring questions about research implementation within a partnership model of delivery. This protocol describes an externally funded evaluation that focuses on implementation mechanisms and processes within three CLAHRCs. It seeks to uncover what works, for whom, how, and in what circumstances. Design and methods This study is a longitudinal three-phase, multi-method realistic evaluation, which deliberately aims to explore the boundaries around knowledge use in context. The evaluation funder wishes to see it conducted for the process of learning, not for judging performance. The study is underpinned by a conceptual framework that combines the Promoting Action on Research Implementation in Health Services and Knowledge to Action frameworks to reflect the complexities of implementation. Three participating CLARHCS will provide in-depth comparative case studies of research implementation using multiple data collection methods including interviews, observation, documents, and publicly available data to test and refine hypotheses over four rounds of data collection. We will test the wider applicability of emerging findings with a wider community using an interpretative forum. Discussion The idea that collaboration between academics and services might lead to more applicable health research that is actually used in practice is theoretically and intuitively appealing; however the evidence for it is limited. Our evaluation is designed to capture the processes and impacts of collaborative approaches for implementing research, and 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. PMID:21771329

  20. [Cooperation between emergency and forensic medicine - retrospective evaluation of pre-hospital emergency measures].

    PubMed

    Buschmann, Claas T; Kleber, Christian; Tsokos, Michael; Püschel, Klaus; Hess, Thorsten; Kerner, Thoralf; Stuhr, Markus

    2015-06-01

    Emergency medical research is subject to special conditions. Emergency patients e.g. are generally considered to be non-capable of giving consent. This results in sparse emergency medical data when compared to clinical observation studies under controlled conditions. After emergency medical treatment, deceased patients are not rarely subject to forensic investigation. The cooperation between emergency and forensic medicine has not only emergency medical training potential in individual cases, but also scientific innovation potential especially with respect to the retrospective evaluation of pre-hospital emergency measures. Such partnerships (like in Berlin at the Charité - Universitätsmedizin Berlin between the Institute of Legal Medicine and the Center for Musculoskeletal Surgery or in Hamburg between the Institute for Legal Medicine at the University Hospital and the Municipal Fire Brigade with the Emergency Medical Service) are yet exceptional in Germany. PMID:26147409

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

    SciTech Connect

    Annette Rohr

    2006-03-01

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

  2. Bedside pediatric emergency evaluation through ultrasonography.

    PubMed

    Dietrich, Ann M; Coley, Brian D

    2008-11-01

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

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

    PubMed Central

    2010-01-01

    Background There is a growing consensus that linear approaches to improving the performance of health workers and health care organisations may only obtain short-term results. An alternative approach premised on the principle of human resource management described as a form of 'High commitment management', builds upon a bundles of balanced practices. This has been shown to contribute to better organisational performance. This paper illustrates an intervention and outcome of high commitment management (HiCom) at an urban hospital in Ghana. Few studies have shown how HiCom management might contribute to better performance of health services and in particular of hospitals in low and middle-income settings. Methods A realist case study design was used to analyse how specific management practices might contribute to improving the performance of an urban district hospital in Ho, Volta Region, in Ghana. Mixed methods were used to collect data, including document review, in-depth interviews, group discussions, observations and a review of routine health information. Results At Ho Municipal Hospital, the management team dealt with the crisis engulfing the ailing urban district hospital by building an alliance between hospital staff to generate a sense of ownership with a focus around participative problem analysis. The creation of an alliance led to improving staff morale and attitude, and contributed also to improvements in the infrastructure and equipment. This in turn had a positive impact on the revenue generating capacity of the hospital. The quick turn around in the state of this hospital showed that change was indeed possible, a factor that greatly motivated the staff. In a second step, the management team initiated the development of a strategic plan for the hospital to maintain the dynamics of change. This was undertaken through participative methods and sustained earlier staff involvement, empowerment and feelings of reciprocity. We found that these factors acted as the core mechanisms underlying the changes taking place at Ho Municipal Hospital. Conclusions This study shows how a hospital management team in Ghana succeeded in resuscitating an ailing hospital. Their high commitment management approach led to the active involvement and empowerment of staff. It also showed how a realist evaluation approach such as this, could be used in the research of the management of health care organisations to explain how management interventions may or may not work. PMID:21184678

  4. PET and MRI based treatment planning systems: a methodology for a realistic evaluation of the dose and fluence distributions in BNCT and in GdNCT

    NASA Astrophysics Data System (ADS)

    Cerullo, N.; Daquino, G. G.; Bufalino, D.

    2006-05-01

    The article focuses on the methodology for a realistic evaluation of the dose and fluence distributions in Neutron Capture Therapy (NCT), based on the Treatment Planning System (TPS) that takes into account the real macroscopic distribution of the neutron capturer. The neutron capturers considered in the present study are 10B and 157Gd, used in BNCT and GdNCT respectively.

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

    PubMed Central

    2014-01-01

    Background Mid-level health workers (MLHWs) form the front-line of service delivery in many low- and middle-income countries. Supervision is a critical institutional intervention linking their work to the health system, and it consists of activities intended to support health workers’ motivation and enable them to perform. However its impact depends not only on the frequency of these activities but also how they are carried out and received. This study aims to deepen understanding of the mechanisms through which supervision activities support the performance of auxiliary nurses, a cadre of MLHWs, in rural Guatemala. Methods A multiple case study was conducted to examine the operation of supervision of five health posts using a realist evaluation approach. A program theory was formulated describing local understanding of how supervision activities are intended to work. Data was collected through interviews and document review to test the theory. Analysis focused on comparison of activities, outcomes, mechanisms and the influence of context across cases, leading to revision of the program theory. Results The supervisor’s orientation was identified as the main mechanism contributing to variation observed in activities and their outcomes. Managerial control was the dominant orientation, reflecting the influence of standardized performance criteria and institutional culture. Humanized support was present in one case where the auxiliary nurse was motivated by the sense that the full scope of her work was valued. This orientation reflected the supervisor’s integration of her professional identity as a nurse. Conclusions The nature of the support health workers received was shaped by supervisors’ orientation, and in this study, nursing principles were central to humanized support. Efforts to strengthen the support that supervision provides to MLHWs should promote professional ethos as a means of developing shared performance goals and orient supervisors to a more holistic view of the health worker and their work. PMID:24602196

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

    PubMed

    Wedmore, Ian; Young, Scott; Franklin, Jill

    2015-05-01

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

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

    PubMed Central

    2014-01-01

    Background Evidence indicates that post − stroke rehabilitation improves function, independence and quality of life. A key aspect of rehabilitation is the provision of appropriate information and feedback to the learner. Advances in information and communications technology (ICT) have allowed for the development of various systems to complement stroke rehabilitation that could be used in the home setting. These systems may increase the provision of rehabilitation a stroke survivor receives and carries out, as well as providing a learning platform that facilitates long-term self-managed rehabilitation and behaviour change. This paper describes the application of an innovative evaluative methodology to explore the utilisation of feedback for post-stroke upper-limb rehabilitation in the home. Methods Using the principles of realistic evaluation, this study aimed to test and refine intervention theories by exploring the complex interactions of contexts, mechanisms and outcomes that arise from technology deployment in the home. Methods included focus groups followed by multi-method case studies (n = 5) before, during and after the use of computer-based equipment. Data were analysed in relation to the context-mechanism-outcome hypotheses case by case. This was followed by a synthesis of the findings to answer the question, ‘what works for whom and in what circumstances and respects?’ Results Data analysis reveals that to achieve desired outcomes through the use of ICT, key elements of computer feedback, such as accuracy, measurability, rewarding feedback, adaptability, and knowledge of results feedback, are required to trigger the theory-driven mechanisms underpinning the intervention. In addition, the pre-existing context and the personal and environmental contexts, such as previous experience of service delivery, personal goals, trust in the technology, and social circumstances may also enable or constrain the underpinning theory-driven mechanisms. 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. PMID:24903401

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

    PubMed Central

    2014-01-01

    Background Robotic surgery offers many potential benefits for patients. While an increasing number of healthcare providers are purchasing surgical robots, there are reports that the technology is failing to be introduced into routine practice. Additionally, in robotic surgery, the surgeon is physically separated from the patient and the rest of the team, with the potential to negatively impact teamwork in the operating theatre. The aim of this study is to ascertain: how and under what circumstances robotic surgery is effectively introduced into routine practice; and how and under what circumstances robotic surgery impacts teamwork, communication and decision making, and subsequent patient outcomes. Methods and design We will undertake a process evaluation alongside a randomised controlled trial comparing laparoscopic and robotic surgery for the curative treatment of rectal cancer. Realist evaluation provides an overall framework for the study. The study will be in three phases. In Phase I, grey literature will be reviewed to identify stakeholders’ theories concerning how robotic surgery becomes embedded into surgical practice and its impacts. These theories will be refined and added to through interviews conducted across English hospitals that are using robotic surgery for rectal cancer resection with staff at different levels of the organisation, along with a review of documentation associated with the introduction of robotic surgery. In Phase II, a multi-site case study will be conducted across four English hospitals to test and refine the candidate theories. Data will be collected using multiple methods: the structured observation tool OTAS (Observational Teamwork Assessment for Surgery); video recordings of operations; ethnographic observation; and interviews. In Phase III, interviews will be conducted at the four case sites with staff representing a range of surgical disciplines, to assess the extent to which the results of Phase II are generalisable and to 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. PMID:24885669

  9. Evaluation of semidecentralized emergency drinking water treatment.

    PubMed

    Eloidin, Ocane; Dorea, Caetano C

    2015-01-01

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

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

    PubMed Central

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

    2016-01-01

    Introduction Suboptimal retention in care and poor treatment adherence are key challenges to antiretroviral therapy (ART) in sub-Saharan Africa. Community-based approaches to HIV service delivery are recommended to improve patient retention in care and ART adherence. The implementation of the adherence clubs in the Western Cape province of South Africa was with variable success in terms of implementation and outcomes. The need for operational guidelines for its implementation has been identified. Therefore, understanding the contexts and mechanisms for successful implementation of the adherence clubs is crucial to inform the roll-out to the rest of South Africa. The protocol outlines an evaluation of adherence club intervention in selected primary healthcare facilities in the metropolitan area of the Western Cape Province, using the realist approach. Methods and analysis In the first phase, an exploratory study design will be used. Document review and key informant interviews will be used to elicit the programme theory. In phase two, a multiple case study design will be used to describe the adherence clubs in five contrastive sites. Semistructured interviews will be conducted with purposively selected programme implementers and members of the clubs to assess the context and mechanisms of the adherence clubs. For the programme's primary outcomes, a longitudinal retrospective cohort analysis will be conducted using routine patient data. Data analysis will involve classifying emerging themes using the context-mechanism-outcome (CMO) configuration, and refining the primary CMO configurations to conjectured CMO configurations. Finally, we will compare the conjectured CMO configurations from the cases with the initial programme theory. The final CMOs obtained will be translated into middle range theories. Ethics and dissemination The study will be conducted according to the principles of the declaration of Helsinki (1964). Ethics clearance was obtained from the University of the Western Cape. Dissemination will be done through publications and curation. PMID:27044575

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

    SciTech Connect

    Annette C. Rohr; Petros Koutrakis; John Godleski

    2011-03-31

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

  12. Project REALISTIC: Evaluation and Modification of REAding, LIStening, and ArithmeTIC Needs in Military Jobs Having Civilian Counterparts.

    ERIC Educational Resources Information Center

    Sticht, Thomas G.; And Others

    The papers in this collection present a description of, and the results of, research in Work Unit REALISTIC. In addition to the first paper which is an overview, the three papers are: "Psychometric Determination of Relationships Among Literacy Skills and Job Proficiency,""Reading Ability, Readability, and Readership: Identifying Job-Related…

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

    PubMed

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

    2014-10-01

    The interest on outdoor photocatalytic materials is growing in the last years. Nevertheless, most of the experimental devices designed for the assessment of their performance operate at controlled laboratory conditions, i.e., pollutant concentration, temperature, UV irradiation, and water vapor contents, far from those of real outdoor environments. The aim of the present study was the design and development of an experimental device for the continuous test of photocatalytic outdoor materials under sun irradiation using real outdoor air as feed, with the concomitant fluctuation of pollutant concentration, temperature, and water vapor content. A three-port measurement system based on two UV-transparent chambers was designed and built. A test chamber contained the photoactive element and a reference chamber to place the substrate without the photoactive element were employed. The third sampling point, placed outdoors, allowed the characterization of the surrounding air, which feeds the test chambers. Temperature, relative humidity (RH), and UV-A irradiance were monitored at each sampling point with specific sensors. NO x concentration was measured by a chemiluminescence NO x analyzer. Three automatic valves allowed the consecutive analysis of the concentration at the three points at fixed time intervals. The reliability of the analytical system was demonstrated by comparing the NO x concentration data with those obtained at the nearest weather station to the experimental device location. The use of a chamber-based reaction system leads to an attenuation of NO x and atmospheric parameter profiles, but maintaining the general trends. The air characterization results showed the wide operating window under which the photoactive materials should work outdoors, depending on the traffic intensity and the season, which are reproduced inside the test chambers. The designed system allows the measurement of the photoactivity of outdoor materials or the comparison of several samples at the same time. The suitability of the system for the evaluation of the DeNO x properties of construction elements at realistic outdoor conditions was demonstrated. The designed experimental device can be used 24/7 for testing materials under real fluctuations of NO x concentration, temperature, UV irradiation, and relative humidity and the presence of other outdoor air pollutants such as VOCs, SO x , or NH3. The chamber-based design allows comparing a photocatalytic material with respect to a reference substrate without the photoactive phase, or even the comparison of several outdoor elements at the same time. PMID:24652575

  14. Evaluation: Emergence, Mode of Inquiry, Theory and Practice

    ERIC Educational Resources Information Center

    Kenny, Aidan

    2007-01-01

    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

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

    PubMed Central

    Serrano, Emilio; Poveda, Geovanny; Garijo, Mercedes

    2014-01-01

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

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

    SciTech Connect

    Annette Rohr

    2004-12-02

    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.

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

    ERIC Educational Resources Information Center

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

    2005-01-01

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

  18. Evaluation of an online discussion forum for emergency practitioners.

    PubMed

    Curran, Janet A; Abidi, Syed Sibte Raza

    2007-12-01

    Knowledge is a critical element in the delivery of quality healthcare. In a busy emergency department (ED) clinicians attempting clinically relevant discussion with their peers face multiple interruptions and a lack of sustained meaningful interactions. Information and communication technologies such as online discussion forums enable practitioners to share practice knowledge at times that fit into their daily workflow. We conducted an experiment in which we provided emergency clinicians with access to an asynchronous discussion forum as a medium to support development of an online social network for information exchange. The outcomes were evaluated using a social network perspective to better understand the knowledge seeking and sharing behaviors among rural and urban emergency practitioners participating in the online discussion forum. The online discussion forum created an opportunity for emergency practitioners from multiple ED sites to engage in dialogue around topics that were relevant to their practice learning needs. PMID:18029403

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

    NASA Technical Reports Server (NTRS)

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

    1996-01-01

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

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

    Technology Transfer Automated Retrieval System (TEKTRAN)

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

  1. Emergency Medical Technician Performance Evaluation. NCHSR Research Report Series.

    ERIC Educational Resources Information Center

    Frazier, William H.; Cannon, Joseph F.

    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…

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

    SciTech Connect

    Annette Rohr

    2004-02-29

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

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

    PubMed Central

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

    2015-01-01

    Introduction The recruitment of community health volunteers to support the delivery of health programmes is a well-established approach in many countries, particularly where health services are not readily available. However, studies on management of volunteers are scarce and current research on human resource management of volunteers faces methodological challenges. This paper presents the protocol of a realist evaluation that aims at identifying the factors influencing the performance of community health volunteers involved in the delivery of a Red Cross immunisation programme in Kampala (Uganda) with a specific focus on motivation. Methods and analysis The realist evaluation cycle structures the protocol. To develop the theoretical basis for the evaluation, the authors conducted interviews and reviewed the literature on community health volunteers’ performance, management and organisational behaviour. This led to the formulation of the initial programme theory, which links the intervention inputs (capacity-building strategies) to the expected outcomes (positive work behaviour) with mechanisms that point in the direction of drivers of motivation. The contextual elements include components such as organisational culture, resource availability, etc. A case study design will be adopted. We define a case as a Red Cross branch, run by a programme manager, and will select two cases at the district level in Kampala. Mixed methods will be used in data collection, including individual interviews of volunteers, participant observation and document review. The thematic analysis will be based on the initial programme theory and will seek for context-mechanism-outcome configurations. Findings from the two cases will be compared. Discussion We discuss the scope for applying realist evaluation and the methodological challenges we encountered in developing this protocol. Ethics and dissemination The study was approved by the Ethical Committee at Rennes University Hospital, France. Results will be published in scientific journals, and communicated to respondents and relevant institutions. PMID:25631314

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

    SciTech Connect

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

    2010-10-15

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

  5. Statistical Evaluation of Feasibility of Emergency Micro-Grid

    NASA Astrophysics Data System (ADS)

    Kondo, Yusuke; Kato, Takeyoshi; Suzuoki, Yasuo; Funabashi, Toshihisa

    When the target capacity of PV systems toward 2030 is realized, most of newly constructed houses may have a PV system. In such the situation, PV systems can contribute to electricity supply in the emergency situation as well as ordinary situation. This paper focuses on an emergency microgrid consisting of residential PV systems and battery system for the electricity supply to a load center during urban disaster or massive blackout. Considering a typical urban residential area of 500m×500m and a typical irradiation pattern, we calculated the available electricity from PV systems and the required capacity of battery for compensating for the shortage of electricity from PV systems. If the weather condition is fine, the total electricity supply from PV systems would be much larger than the restricted electricity demand during urban disaster, resulting in the battery recharged with the surplus electricity from PV systems. Therefore, if we install the battery system capable for electricity supply during one night, the emergency microgrid can meet the electricity demand during the most combinations of continuous three days in a year. Then, assuming that the emergency microgrid is formed in each 500m×500m area or 1km×1km area, we statistically evaluated the feasibility of emergency microgrid in Aichi prefecture. The result shows that if we can install the battery with the total capacity of 1500 MWh, the emergency microgrid can be applied in many residential areas for some million people those who may have black-out after the strong earthquake which may happen in Tokai area.

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

    PubMed Central

    2014-01-01

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

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

    PubMed Central

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

    2015-01-01

    We developed a realistic simulation dataset for simultaneous respiratory and cardiac (R&C) gated SPECT/CT using the 4D NURBS-based Cardiac-Torso (NCAT) Phantom and Monte Carlo simulation methods, and evaluated it for a sample application study. The 4D NCAT phantom included realistic respiratory motion and beating heart motion based on respiratory gated CT and cardiac tagged MRI data of normal human subjects. To model the respiratory motion, a set of 24 separate 3D NCAT phantoms excluding the heart was generated over a respiratory cycle. The beating heart motion was modelled separately with 48 frames per cardiac cycle for each of the 24 respiratory phases. The resultant set of 24×48 3D NCAT phantoms provides a realistic model of a normal human subject at different phases of combined R&C motions. An almost noise-free SPECT projection dataset for each of the 1,152 3D NCAT phantoms was generated using Monte Carlo simulation techniques and the radioactivity uptake distribution of 99mTc sestamibi in different organs. By grouping and summing the separate projection datasets, separate or simultaneous R&C gated acquired data with different gating schemes could be simulated. In the initial evaluation, we combined the projection datasets into no gating, 6 respiratory-gates only, 8 cardiac-gates only, and combined 6 respiratory-gates & 8 cardiac-gates projection datasets. Each dataset was reconstructed using 3D OS-EM without and with attenuation correction using the averaged and respiratory-gated attenuation maps, and the resulting reconstructed images were compared. These results were used to demonstrate the effects of R&C motions and the reduction of image artifact due to R&C motions by gating and attenuation corrections. We concluded that the realistic 4D NCAT phantom and Monte Carlo simulated SPECT projection datasets with R&C motions are powerful tools in the study of the effects of R&C motions, as well as in the development of R&C gating schemes and motion correction methods for improved SPECT/CT imaging. PMID:25612263

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

    NASA Astrophysics Data System (ADS)

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

    2015-02-01

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

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

    PubMed

    Lee, Taek-Soo; Tsui, Benjamin M W

    2015-02-21

    We developed a realistic simulation dataset for simultaneous respiratory and cardiac (R&C) gated SPECT/CT using the 4D NURBS-based Cardiac-Torso (NCAT) Phantom and Monte Carlo simulation methods, and evaluated it for a sample application study. The 4D NCAT phantom included realistic respiratory motion and beating heart motion based on respiratory gated CT and cardiac tagged MRI data of normal human subjects. To model the respiratory motion, a set of 24 separate 3D NCAT phantoms excluding the heart was generated over a respiratory cycle. The beating heart motion was modeled separately with 48 frames per cardiac cycle for each of the 24 respiratory phases. The resultant set of 24  ×  48 3D NCAT phantoms provides a realistic model of a normal human subject at different phases of combined R&C motions. An almost noise-free SPECT projection dataset for each of the 1152 3D NCAT phantoms was generated using Monte Carlo simulation techniques and the radioactivity uptake distribution of (99m)Tc sestamibi in different organs. By grouping and summing the separate projection datasets, separate or simultaneous R&C gated acquired data with different gating schemes could be simulated. In the initial evaluation, we combined the projection datasets into ungated, 6 respiratory-gates only, 8 cardiac-gates only, and combined 6 respiratory-gates & 8 cardiac-gates projection datasets. Each dataset was reconstructed using 3D OS-EM without and with attenuation correction using the averaged and respiratory-gated attenuation maps, and the resulting reconstructed images were compared. These results were used to demonstrate the effects of R&C motions and the reduction of image artifact due to R&C motions by gating and attenuation corrections. We concluded that the realistic 4D NCAT phantom and Monte Carlo simulated SPECT projection datasets with R&C motions are powerful tools in the study of the effects of R&C motions, as well as in the development of R&C gating schemes and motion correction methods for improved SPECT/CT imaging. PMID:25612263

  10. Emergency Oxygen System Evaluation for Exploration PLSS Applications

    NASA Technical Reports Server (NTRS)

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

    2006-01-01

    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.

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

    PubMed Central

    Wang, Peng; Knösche, Thomas R.

    2013-01-01

    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. PMID:24205009

  12. Emergency department evaluation and treatment of the shoulder and humerus.

    PubMed

    Bonz, James; Tinloy, Bradford

    2015-05-01

    Shoulder injuries are among the most common musculoskeletal complaints seen in US emergency departments (EDs). ED evaluation of the shoulder must account for the broad range of potential fracture patterns seen in the clavicle, scapula, and humerus. Acromioclavicular dislocation is often encountered in the ED and treatment varies by severity. Dislocation of the shoulder is frequently seen, and the ED physician must be skilled in several reduction techniques to optimize a successful reduction. An understanding of when orthopedic consultation is appropriate and when patients can be dispositioned with timely follow-up are integral to complete patient recovery. PMID:25892723

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

    PubMed Central

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

    2013-01-01

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

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

    PubMed Central

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

    2015-01-01

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

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

    NASA Astrophysics Data System (ADS)

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

    2015-05-01

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

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

    SciTech Connect

    Annette Rohr

    2005-03-31

    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.

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

    PubMed

    Grose, J; Richardson, J

    2016-06-01

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

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

    PubMed

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

    2015-06-01

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

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

    SciTech Connect

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

    2003-01-01

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

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

    SciTech Connect

    Kevin L Young; Alan M Snyder

    2007-11-01

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

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

    PubMed Central

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

    2009-01-01

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

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

    SciTech Connect

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

    2009-02-15

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

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

    PubMed

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

    2009-02-01

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

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

    NASA Astrophysics Data System (ADS)

    Newby, G. B.; Morton, D.

    2008-12-01

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

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

    NASA Astrophysics Data System (ADS)

    Merugula, Laura

    As civilization's collective knowledge grows, we are met with the realization that human-induced physical and biological transformations influenced by exogenous psychosocial and economic factors affect virtually every ecosystem on the planet. Despite improvements in energy generation and efficiencies, demand of material goods and energy services increases with no sign of a slowing pace. Sustainable development requires a multi-prong approach that involves reshaping demand, consumer education, sustainability-oriented policy, and supply chain management that does not serve the expansionist mentality. Thus, decision support tools are needed that inform developers, consumers, and policy-makers for short-term and long-term planning. These tools should incorporate uncertainty through quantitative methods as well as qualitatively informing the nature of the model as imperfect but necessary and adequate. A case study is presented of the manufacture and deployment of utility-scale wind turbines evaluated for a proposed change in blade manufacturing. It provides the first life cycle assessment (LCA) evaluating impact of carbon nanofibers, an emerging material, proposed for integration to wind power generation systems as blade reinforcement. Few LCAs of nanoproducts are available in scientific literature due to research and development (R&D) for applications that continues to outpace R&D for environmental, health, and safety (EHS) and life cycle impacts. LCAs of emerging technologies are crucial for informing developers of potential impacts, especially where market growth is swift and dissipative. A second case study is presented that evaluates consumer choice between disposable and reusable beverage cups. While there are a few studies that attempt to make the comparison using LCA, none adequately address uncertainty, nor are they representative for the typical American consumer. By disaggregating U.S. power generation into 26 subregional grid production mixes and evaluating the comparison with respect to a representative range of efficiencies in dishwasher units, a realistic comparison was made. A statistical approach was devised to process the available output by combining a Z-score test with the Cox method for confidence intervals. Despite the common use of LCA software with Monte Carlo analysis, this approach to compare distributions has not been discovered in LCA-related literature and offers a straightforward method for extending analysis under conditions of positive skew approximated by a lognormal distribution, which is common in LCA parameters. The two case studies provide product developer and consumer guidance, respectively. They furthermore may be used to inform policy in both direct and nuanced manners. The encouragement of product reuse is facilitated for individuals and organizations providing food-service facilities. Caution in efforts to increase power generation capacity with renewable energy not coupled with reduction of demand is implied.

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

    PubMed

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

    2015-12-01

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

  7. Realistic collective nuclear Hamiltonian

    SciTech Connect

    Dufour, M.; Zuker, A.P.

    1996-10-01

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

  8. Improving emergency department flow through Rapid Medical Evaluation unit

    PubMed Central

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

    2015-01-01

    The Toronto Western Hospital is an academic hospital in Toronto, Canada, with an annual Emergency Department (ED) volume of 64,000 patients. Despite increases in patient volumes of almost six percent per annum over the last decade, there have been no commensurate increases in resources, infrastructure, and staffing. This has led to substantial increase in patient wait times, most specifically for those patients with lower acuity presentations. Despite requiring only minimal care, these patients contribute disproportionately to ED congestion, which can adversely impact resource utilization and quality of care for all patients. We undertook a retrospective evaluation of a quality improvement initiative aimed at improving wait times experienced by patients with lower acuity presentations. A rapid improvement event was organized by frontline workers to rapidly overhaul processes of care, leading to the creation of the Rapid Medical Evaluation (RME) unit – a new pathway of care for patients with lower acuity presentations. The RME unit was designed by re-purposing existing resources and re-assigning one physician and one nurse towards the specific care of these patients. We evaluated the performance of the RME unit through measurement of physician initial assessment (PIA) times and total length of stay (LOS) times for multiple groups of patients assigned to various ED care pathways, during three periods lasting three months each. Weekly measurements of mean and 90th percentile of PIA and LOS times showed special cause variation in all targeted patient groups. Of note, the patients seen in the RME unit saw their median PIA and LOS times decrease from 98min to 70min and from 165min to 130min, respectively, from baseline. Despite ever-growing numbers of patient visits, wait times for all patients with lower acuity presentations remained low, and wait times of patients with higher acuity presentations assigned to other ED care pathways were not adversely affected. By specifically re-purposing a fraction of existing staff, resources, and infrastructure for patients with lower acuity presentations, we were able to streamline their care and decrease wait times in the ED. These results were achieved through the incremental improvements afforded by rapidly cycling through PDSA cycles, with strong frontline staff involvement and continuously eliciting feedback for improvement. We believe the model to be replicable in other academic medical centres. PMID:26734447

  9. Realistic and Schematic Visuals.

    ERIC Educational Resources Information Center

    Heuvelman, Ard

    1996-01-01

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

  10. Advanced Topics in Emergency Medicine: Curriculum Development and Initial Evaluation

    PubMed Central

    Kman, Nicholas E; Bernard, Aaron W; Martin, Daniel R; Bahner, David; Gorgas, Diane; Nagel, Rollin; Khandelwal, Sorabh

    2011-01-01

    Background Emergency medicine (EM) is a young specialty and only recently has a recommended medical student curriculum been developed. Currently, many schools do not require students to complete a mandatory clerkship in EM, and if one is required, it is typically an overview of the specialty. Objectives We developed a 10-month longitudinal elective to teach subject matter and skills in EM to fourth-year medical students interested in the specialty. Our goal was producing EM residents with the knowledge and skills to excel at the onset of their residency. We hoped to prove that students participating in this rigorous 10-month longitudinal EM elective would feel well prepared for residency. Methods We studied the program with an end-of-the-year, Internet-based, comprehensive course evaluation completed by each participant of the first 2 years of the course. Graduates rated each of the course components by using a 5-point Likert format from “strongly disagree” to “strongly agree,” either in terms of whether the component was beneficial to them or whether the course expectations were appropriate, or their perceptions related to the course. Results Graduates of this elective have reported feeling well prepared to start residency. The resident-led teaching shifts, Advanced Pediatric Life Support certification, Grand Rounds presentations, Advanced Cardiovascular Life Support proficiency testing, and ultrasound component, were found to be beneficial by all students. Conclusions Our faculty believes that participating students will be better prepared for an EM residency than those students just completing a 1-month clerkship. Our data, although limited, lead us to believe that a longitudinal, immersion-type experience assists fourth-year medical students in preparation for residency. PMID:22224157

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

    PubMed Central

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

    2008-01-01

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

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

    PubMed Central

    2014-01-01

    Background Although there is widespread agreement that strong district manager decision-making improves health systems, understanding about how the design and implementation of capacity-strengthening interventions work is limited. The Ghana Health Service has adopted the Leadership Development Programme (LDP) as one intervention to support the development of management and leadership within district teams. This paper seeks to address how and why the LDP ‘works’ when it is introduced into a district health system in Ghana, and whether or not it supports systems thinking in district teams. Methods We undertook a realist evaluation to investigate the outcomes, contexts, and mechanisms of the intervention. Building on two working hypotheses developed from our earlier work, we developed an explanatory case study of one rural district in the Greater Accra Region of Ghana. Data collection included participant observation, document review, and semi-structured interviews with district managers prior to, during, and after the intervention. Working backwards from an in-depth analysis of the context and observed short- and medium-term outcomes, we drew a causal loop diagram to explain interactions between contexts, outcomes, and mechanisms. Results The LDP was a valuable experience for district managers and teams were able to attain short-term outcomes because the novel approach supported teamwork, initiative-building, and improved prioritisation. However, the LDP was not institutionalised in district teams and did not lead to increased systems thinking. This was related to the context of high uncertainty within the district, and hierarchical authority of the system, which triggered the LDP’s underlying goal of organisational control. Conclusions Consideration of organisational context is important when trying to sustain complex interventions, as it seems to influence the gap between short- and medium-term outcomes. More explicit focus on systems thinking principles that enable district managers to better cope with their contexts may strengthen the institutionalisation of the LDP in the future. PMID:24935521

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

    PubMed Central

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

    2014-01-01

    Introduction Little is understood about the role of quality improvement in enabling health organisations to survive and thrive in the contemporary context of financial and economic challenges. We will draw on the theoretical foundations of the ‘Resource Based View of the Firm’ (RBV) to develop insights into why health organisations engage in improvement work, how impacts are conceptualised, and ‘what works’ in delivering these impacts. Specifically, RBV theorises that the mix and use of resources across different organisations may explain differences in performance. Whether improvement work influences these resources is unclear. Methods and analysis Case study research will be conducted across health organisations participating in four approaches to improvement, including: a national improvement programme; a multiorganisational partnership around implementation; an organisational strategy for quality improvement; and a coproduction project designed to enhance the experience of a clinical service from the perspective of patients. Data will comprise in-depth interviews with key informants, observation of key events and documents; analysed within and then across cases. Adopting a realist perspective, the core tenets of RBV will be evaluated as a programme theory, focusing on the interplay between organisational conditions and behavioural or resource responses that are reported through engagement in improvement. Ethics and dissemination The study has been approved by Bangor University Ethics Committee. The investigation will not judge the relative merits of different approaches to healthcare quality improvement. Rather, we will develop unique insights into the organisational consequences, and dependencies of quality improvement, providing an opportunity to add to the explanatory potential of RBV in this and other contexts. In addition to scientific and lay reports of the study findings, research outputs will include a framework for constructing the economic impacts of quality improvement and practical guidance for health service managers that maximises the impacts of investment in quality improvement. PMID:25082421

  14. 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...

  15. Realistic Solar Surface Convection Simulations

    NASA Technical Reports Server (NTRS)

    Stein, Robert F.; Nordlund, Ake

    2000-01-01

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

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

    PubMed

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

    2016-04-25

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

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

    PubMed Central

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

    2016-01-01

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

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

    ERIC Educational Resources Information Center

    Butvilofsky, Sandra Adriana; Sparrow, Wendy Lynn

    2012-01-01

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

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

    ERIC Educational Resources Information Center

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

    2015-01-01

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

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

    PubMed

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

    2015-05-01

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

  1. Evaluation of the need for emergency heat exchangers for long term emergency cooling of the Advanced Neutron Source Reactor

    SciTech Connect

    Khayat, M.I.; Anderson, J.L.; Battle, R.E.; March-Leuba, J.

    1994-05-01

    This report summarizes the work performed to evaluate the heat transferred to the light water pools from the primary piping system for the Advanced Neutron Source reactor (ANSR) conceptual design. It has been determined that the ANSR primary piping system will remove sufficient heat from the primary coolant system to the pools for certain design basis event accidents without the emergency heat exchangers if the design parameters, such as pool volumes and pipe sizes (length and surface area), are selected appropriately. Based on this analysis, the emergency heat exchangers might be removed, and their function can be performed by the primary piping passing through the light water pools described in the conceptual design report. This study also shows that connecting the pipe chase pool and the heat exchanger pools improve performance for ANSR emergency heat removal.

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

    PubMed Central

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

    2007-01-01

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

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

    PubMed Central

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

    2013-01-01

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

  4. Evaluation of two commercially available portal monitors for emergency response.

    PubMed

    Kramer, Gary H; Capello, Kevin; Hauck, Barry M

    2007-02-01

    The Human Monitoring Laboratory has compared two types (the P3 and the MiniSentry) of portal monitors that can be field deployed in response to an emergency. They can be used to screen persons for internal or external radioactive contamination by fission activation products (neither unit is capable of detecting alpha or beta radiation, and the amount of material required to alarm the monitors is unacceptably high for low energy x rays or gamma rays) following an incident involving the release of radioactive material (accidental or intentional). It was found that the P3 benefits from simplicity but requires slightly more activity to alarm than the MiniSentry, although for emergency response, the amount of activity that can be detected is far below a level where significant health effects will occur. The MiniSentry was found to have more capability than the P3, but these benefits also bring their own disadvantages. It was also found that the MiniSentry would be difficult to deploy in an outdoor setting whereas the P3 is well designed for a field setting. Despite the differences found, the HML has concluded that both have a distinct place in emergency monitoring. In the future, the HML plans to have both instruments ready for field deployment. PMID:17228189

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

    PubMed Central

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

    2009-01-01

    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. PMID:19261948

  6. Emergent Evaluation and Educational Reforms in Latin America

    ERIC Educational Resources Information Center

    Martinic, Sergio

    2012-01-01

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

  7. Integrative Evaluation: An Emerging Role for Classroom Studies of CAL.

    ERIC Educational Resources Information Center

    Draper, Stephen W.; And Others

    1996-01-01

    Reviews evaluations of CAL (computer-assisted learning) in use at the University of Glasgow (Scotland). Topics include methods used; prior knowledge; learning motivation; attitude measures; confidence logs; knowledge quizzes; study habits; Hawthorne effects; formative, summative, illuminative, and integrative evaluation; quality assurance

  8. Evaluating Unscheduled Readmission to Emergency Department in the Early Period

    PubMed Central

    Hocagil, Abdullah Cüneyt; Bildik, Fikret; Kılıçaslan, İsa; Hocagil, Hilal; Karabulut, Hasan; Keleş, Ayfer; Demircan, Ahmet

    2016-01-01

    Background: The readmission in the early period (RAEP) is defined as the admission of a patient to emergency department (ED) for the second time within 72 hours after discharge from the ED. Aims: The aim of this study was to determine the disease, patient, doctor, and system related causes of RAEP. Study Design: Descriptive study. Methods: This study is a two-stage study that was conducted at Department of Emergency, Gazi University Faculty of Medicine. The causes of RAEP were defined as disease, patient, doctor, and system related causes. Results: A total of 46,800 adult patients admitted to ED during the study period and 779 (1.66%) patients required RAEP. After the exclusion criteria, 429 of these patients were included the study. The most common reasons for RAEP were renal colic in 46 (10.7%) patients. It was detected that 60.4% of the causes of RAEP were related to disease, 20.0% were related to the doctor, 12.1% were related to the patient, and 7.5% were related to the hospital management system. Conclusion: This study revealed that there are patient-, doctor-, and system-related preventable reasons for RAEP and the patients requiring RAEP constitute the high risk group. PMID:26966621

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

    ERIC Educational Resources Information Center

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

    2015-01-01

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

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

    ERIC Educational Resources Information Center

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

    2015-01-01

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

  11. Evaluating the Emergency Notification Systems of the NASA White Sands Test

    NASA Technical Reports Server (NTRS)

    Chavez, Alfred Paul

    2004-01-01

    The problem was that the NASA Fire and Emergency Services did not know if the current emergency notification systems on the NASA White Sands Test Facility were appropriate for alerting the employees of an emergency. The purpose of this Applied Research Project was to determine if the current emergency notification systems of the White Sands Test Facility are appropriate for alerting the employees of an emergency. This was a descriptive research project. The research questions were: 1) What are similar facilities using to alert the employees of an emergency?; 2) Are the current emergency notification systems suitable for the community hazards on the NASA White Sands Test Facility?; 3) What is the NASA Fire and Emergency Services currently using to measure the effectiveness of the emergency notification systems?; and 4) What are the current training methods used to train personnel to the emergency notification systems at the NASA White Sands Test Facility? The procedures involved were to research other established facilities, research published material from credible sources, survey the facility to determine the facility perception of the emergency notification systems, and evaluate the operating elements of the established emergency notification systems for the facility. The results were that the current systems are suitable for the type of hazards the facility may endure. The emergency notification systems are tested frequently to ensure effectiveness in the event of an emergency. Personnel are trained and participate in a yearly drill to make certain personnel are educated on the established systems. The recommendations based on the results were to operationally improve the existing systems by developing and implementing one system that can overall notify the facility of a hazard. Existing procedures and training should also be improved to ensure that all personnel are educated on what to do when the emergency notification systems are activated.

  12. 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...

  13. An evaluation of the emerging vaccines against influenza in children

    PubMed Central

    2013-01-01

    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. PMID:24564565

  14. Use of field experimental studies to evaluate emergency response models

    SciTech Connect

    Gudiksen, P.H.; Lange, R.; Rodriguez, D.J.; Nasstrom, J.S.

    1985-07-16

    The three-dimensional diagnostic wind field model (MATHEW) and the particle-in-cell atmospheric transport and diffusion model (ADPIC) are used by the Atmospheric Release Advisory Capability to estimate the environmental consequences of accidental releases of radioactivity into the atmosphere. These models have undergone extensive evaluations against field experiments conducted in a variety of environmental settings ranging from relatively flat to very complex terrain areas. Simulations of tracer experiments conducted in a complex mountain valley setting revealed that 35 to 50% of the comparisons between calculated and measured tracer concentrations were within a factor of 5. This may be compared with a factor of 2 for 50% of the comparisons for relatively flat terrain. This degradation of results in complex terrain is due to a variety of factors such as the limited representativeness of measurements in complex terrain, the limited spatial resolution afforded by the models, and the turbulence parameterization based on sigma/sub theta/ measurements to evaluate the eddy diffusivities. Measurements of sigma/sub theta/ in complex terrain exceed those measured over flat terrain by a factor of 2 to 3 leading to eddy diffusivities that are unrealistically high. The results of model evaluations are very sensitive to the quality and the representativeness of the meteorological data. This is particularly true for measurements near the source. The capability of the models to simulate the dispersion of an instantaneously produced cloud of particulates was illustrated to be generally within a factor of 2 over flat terrain. 19 refs., 16 figs.

  15. Analysis and evaluation of emergency response using project management and simulation techniques

    SciTech Connect

    Alleman, K.; Steiner, S.H.

    1995-12-31

    This article describes how emergency response capabilities can be analyzed and evaluated using project management and simulation techniques. This evaluation approach is contrasted with traditional exercise-based evaluation strategies. Project and simulation models of response tasks are shown to be valuable tools for analyzing response times and variability in response times. Project models are relatively easy to develop and provide revealing information on the interactions of the various players in the emergency response system, but they are limited because they are based on point estimation. The development of simulation models is somewhat more involved, but because the models use probability distributions rather than point estimates, they yield a more accurate representation of the potential behavior of the emergency response system. These ideas and techniques were developed through application in the US Army Chemical Stockpile Emergency Preparedness Program (CSEPP).

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

    PubMed

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

    2015-01-01

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

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

    PubMed Central

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

    2015-01-01

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

  18. A realistic interstellar explorer

    NASA Astrophysics Data System (ADS)

    McNutt, R.

    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 firstorder 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. This work was supported under Task 7600-039 from the NASA Institute for Advanced Concepts (NIAC) under NASA Contract NAS5-98051.

  19. A realistic interstellar explorer

    NASA Astrophysics Data System (ADS)

    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

    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.

  20. Evaluation of patients' mask use after the implementation of cough etiquette in the emergency department.

    PubMed

    Longtin, Yves; Akakpo, Christophe; Rutschmann, Olivier T; Pittet, Didier; Sax, Hugo

    2009-09-01

    We developed a patient-based survey to evaluate the impact of a respiratory hygiene and cough etiquette implementation strategy on infection control practices in the emergency department. The frequency of self-reported mask use by coughing patients was low (27%) and often inconsistent. The frequency of use was highest among patients who presented with myalgia (odds ratio, 14.7; P = .02) and among patients who visited the emergency department during January (odds ratio, 4.1; P = .04). PMID:19622049

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

    PubMed Central

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

    1993-01-01

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

  2. Evaluating the effectiveness of a multifaceted, multilevel continuous quality improvement program in primary health care: developing a realist theory of change

    PubMed Central

    2013-01-01

    Background Variation in effectiveness of continuous quality improvement (CQI) interventions between services is commonly reported, but with little explanation of how contextual and other factors may interact to produce this variation. Therefore, there is scant information available on which policy makers can draw to inform effective implementation in different settings. In this paper, we explore how patterns of change in delivery of services may have been achieved in a diverse range of health centers participating in a wide-scale program to achieve improvements in quality of care for Indigenous Australians. Methods We elicited key informants interpretations of factors explaining patterns of change in delivery of guideline-scheduled services over three or more years of a wide-scale CQI project, and inductively analyzed these interpretations to propose fine-grained realist hypotheses about what works for whom and in what circumstances. Data were derived from annual clinical audits from 36 health centers operating in diverse settings, quarterly project monitoring reports, and workshops with 12 key informants who had key roles in project implementation. We abstracted potential context-mechanism-outcome configurations from the data, and based on these, identified potential program-strengthening strategies. Results Several context-specific, mechanism-based explanations for effectiveness of this CQI project were identified. These were collective valuing of clinical data for improvement purposes; collective efficacy; and organizational change towards a population health orientation. Health centers with strong central management of CQI, and those in which CQI efforts were more dependent on local health center initiative and were adapted to resonate with local priorities were both favorable contexts for collective valuing of clinical data. Where health centers had prior positive experiences of collaboration, effects appeared to be achieved at least partly through the mechanism of collective efficacy. Strong community linkages, staff ability to identify with patients, and staff having the skills and support to take broad ranging action, were favorable contexts for the mechanism of increased population health orientation. Conclusions Our study provides evidence to support strategies for program strengthening described in the literature, and extends the understanding of mechanisms through which strategies may be effective in achieving particular outcomes in different contexts. PMID:24098940

  3. RAMESES publication standards: realist syntheses

    PubMed Central

    2013-01-01

    Background There is growing interest in realist synthesis as an alternative systematic review method. This approach offers the potential to expand the knowledge base in policy-relevant areas - for example, by explaining the success, failure or mixed fortunes of complex interventions. No previous publication standards exist for reporting realist syntheses. This standard was developed as part of the RAMESES (Realist And MEta-narrative Evidence Syntheses: Evolving Standards) project. The project's aim is to produce preliminary publication standards for realist systematic reviews. Methods We (a) collated and summarized existing literature on the principles of good practice in realist syntheses; (b) considered the extent to which these principles had been followed by published syntheses, thereby identifying how rigor may be lost and how existing methods could be improved; (c) used a three-round online Delphi method with an interdisciplinary panel of national and international experts in evidence synthesis, realist research, policy and/or publishing to produce and iteratively refine a draft set of methodological steps and publication standards; (d) provided real-time support to ongoing realist syntheses and the open-access RAMESES online discussion list so as to capture problems and questions as they arose; and (e) synthesized expert input, evidence syntheses and real-time problem analysis into a definitive set of standards. Results We identified 35 published realist syntheses, provided real-time support to 9 on-going syntheses and captured questions raised in the RAMESES discussion list. Through analysis and discussion within the project team, we summarized the published literature and common questions and challenges into briefing materials for the Delphi panel, comprising 37 members. Within three rounds this panel had reached consensus on 19 key publication standards, with an overall response rate of 91%. Conclusion This project used multiple sources to develop and 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 PMID:23360677

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

    EPA Science Inventory

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

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

    ERIC Educational Resources Information Center

    Henwood, Tim; Bartlett, Helen; Carroll, Matthew

    2011-01-01

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

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

    EPA Science Inventory

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

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

    PubMed

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

    2006-01-01

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

  8. RECIST Applied to Realistic Tumor Models

    PubMed Central

    Levine, Zachary H.; Galloway, Benjamin R.; Peskin, Adele P.

    2011-01-01

    RECIST (Response Evaluation Criteria in Solid Tumors) is a linear measure intended to predict tumor size in medical computed tomography (CT). In this work, using purely geometrical considerations, we estimate how well RECIST can predict the volume of randomly-oriented tumor models, each composed of the union of ellipsoids. The principal conclusion is that RECIST is likely to work less well for realistic tumors than for ellipsoids.

  9. Realistic Radio Communications in Pilot Simulator Training

    NASA Technical Reports Server (NTRS)

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

    2000-01-01

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

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

    PubMed Central

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

    2015-01-01

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

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

    SciTech Connect

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

    1995-07-01

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

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

    PubMed Central

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

    2015-01-01

    Background Health care professionals, especially those working in primary health-care services, can play a key role in preventing and responding to intimate partner violence. However, there are huge variations in the way health care professionals and primary health care teams respond to intimate partner violence. In this study we tested a previously developed programme theory on 15 primary health care center teams located in four different Spanish regions: Murcia, C Valenciana, Castilla-León and Cantabria. The aim was to identify the key combinations of contextual factors and mechanisms that trigger a good primary health care center team response to intimate partner violence. Methods A multiple case-study design was used. Qualitative and quantitative information was collected from each of the 15 centers (cases). In order to handle the large amount of information without losing familiarity with each case, qualitative comparative analysis was undertaken. Conditions (context and mechanisms) and outcomes, were identified and assessed for each of the 15 cases, and solution formulae were calculated using qualitative comparative analysis software. Results The emerging programme theory highlighted the importance of the combination of each team’s self-efficacy, perceived preparation and women-centredness in generating a good team response to intimate partner violence. The use of the protocol and accumulated experience in primary health care were the most relevant contextual/intervention conditions to trigger a good response. However in order to achieve this, they must be combined with other conditions, such as an enabling team climate, having a champion social worker and having staff with training in intimate partner violence. Conclusions Interventions to improve primary health care teams’ response to intimate partner violence should focus on strengthening team’s self-efficacy, perceived preparation and the implementation of a woman-centred approach. The use of the protocol combined with a large working experience in primary health care, and other factors such as training, a good team climate, and having a champion social worker on the team, also played a key role. Measures to sustain such interventions and promote these contextual factors should be encouraged. PMID:26270816

  13. Evaluation and management of pediatric hypertensive crises: hypertensive urgency and hypertensive emergencies

    PubMed Central

    Patel, Nirali H; Romero, Sarah K; Kaelber, David C

    2012-01-01

    Hypertension (HTN) in the pediatric population is estimated to have a world-wide prevalence of 2%–5%. As with adults, pediatric patients with HTN can present with hypertensive crises include hypertensive urgency and hypertensive emergencies. However, pediatric blood pressure problems have a greater chance of being from secondary causes of HTN, as opposed to primary HTN, than in adults. Thorough evaluation of a child with a hypertensive emergency includes accurate blood pressure readings, complete and focused symptom history, and appropriate past medical, surgical, and family history. Physical exam should include height, weight, four-limb blood pressures, a general overall examination and especially detailed cardiovascular and neurological examinations, including fundoscopic examination. Initial work-up should typically include electrocardiography, chest X-ray, serum chemistries, complete blood count, and urinalysis. Initial management of hypertensive emergencies generally includes the use of intravenous or oral antihypertensive medications, as well as appropriate, typically outpatient, follow-up. Emergency department goals for hypertensive crises are to (1) safely lower blood pressure, and (2) treat/minimize acute end organ damage, while (3) identifying underlying etiology. Intravenous antihypertensive medications are the treatment modality of choice for hypertensive emergencies with the goal of reducing systolic blood pressure by 25% of the original value over an 8-hour period.

  14. [Evaluation of emergency hospital services in the state of Rio de Janeiro].

    PubMed

    O'Dwyer, Gisele; da Matta, Isabela Escórcio Augusto; Pepe, Vera Lucia Edais

    2008-01-01

    This study aimed at the evaluation of urgency/emergency hospital units and recorded the relations of emergency units with users, other hospital services and the healthcare network and approached the size of the teams, the relations among the professionals, their qualification and income. It further describes the infrastructure of these services including basic organizational aspects. The aspect care was one component in this broader object. It is a descriptive study applying a questionnaire to the heads of the emergency services of a sample of 30 hospitals.The statements suggest the overcrowding of emergency services (in 80% of hospitals) deteriorating the work and care conditions to be due to the inefficiency of primary care and the healthcare network. The deficit of human resources was found larger than the lack of technology. The precarious employment relations were considered a factor hampering the qualification and retention of professionals. The most favorably evaluated items were: relationship with service heads, trust and expectations with regard to the service. The worst items were: wages, team size and labor medicine. The nvestment in human resources is indispensable. There is a need for public policies that articulate more efficient interventions given that those in force are defining the configuration of territories with their hierarchized and solidary networks. PMID:18813664

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

    NASA Astrophysics Data System (ADS)

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

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

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

    ERIC Educational Resources Information Center

    Lopez, M. Elena, Ed.

    2002-01-01

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

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

    ERIC Educational Resources Information Center

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

    2001-01-01

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

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

    NASA Astrophysics Data System (ADS)

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

    2012-04-01

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

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

    PubMed Central

    2014-01-01

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

  20. The Potential and Challenges of Critical Realist Ethnography

    ERIC Educational Resources Information Center

    Barron, Ian

    2013-01-01

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

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

    PubMed

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

    2016-03-01

    This research focuses on developing an improved and robust measurement for emergency department (ED) performance and a criterion standard for global use via kinetic analysis.Based on kinetic approach, the input-throughput-output conceptual model of ED crowding is compared to the procedure of enzyme catalysis. All in average, the retented patients in EDs are defined as substrate ((Equation is included in full-text article.)), whereas the patients who depart the EDs as product ((Equation is included in full-text article.)). Therefore, the average ED departure velocity ((Equation is included in full-text article.)) can be presented as (Equation is included in full-text article.)divided by a given time (t) of the ED length of stay (LOS). The (Equation is included in full-text article.)and (Equation is included in full-text article.)plots are depicted hourly for the kinetic analysis. The long-term stability of the kinetic parameters is ascertained by the method of coefficient of variation (CV). The participants collected for this study are from the EDs of Changhua Christian Medical Center and the five branched hospitals, all located in Taiwan.Based on the (Equation is included in full-text article.)plot analysis, the results clearly show 2 curves, an upper and a lower curve. The timeline of the lower curve includes approximately the total ED busy hours, and thus it can be used for the subsequent kinetic analysis. In order to explore the adequate kinetic parameters for ED performance, the try-and-error process was followed in this study. As a result, the (Equation is included in full-text article.)plots adapted from the lower curves show the best linear regression of (Equation is included in full-text article.)on (Equation is included in full-text article.)with a good coefficient of determination (R). The Pan-Wen constant (PW), which is the slope of the liner regression line, and the ED medical personnel unit turnover number (EDMPU TON) were deduced from the kinetic meanings of (Equation is included in full-text article.)plots.In this research, the 2 kinetic parameters, PW and EDMPU TON were applied for the ED performance evaluations. An innovative relationship between the ED retented patients and the ED departure velocity is verified as PW; whereas, a feasible kinetic parameter, the EDMPU TON explicates the teamwork efficiency of the ED providers. Moreover, the EDMPU TON may not only be a reliable universal criterion standard for the ED performance, but also a valuable reference for both ED providers and payers. PMID:26986107

  2. Evaluation of a kit for rapid detection of group A streptococci in a pediatric emergency department.

    PubMed

    Mackenzie, A M; Li, M M; Chan, F T

    1988-05-15

    We evaluated a kit for the rapid detection of group A streptococci from throat swabs (Culturette Brand 10-Minute Group A Strep ID, Marion Scientific, Division of Marion Laboratories, Inc., Kansas City, Missouri) in the laboratory and in a busy pediatric emergency department. The sensitivity of the kit in the laboratory was 80% for all specimens and 94% for specimens with more than 10 colony-forming units of group A streptococci; the specificity was 99%. After initial training, emergency department pediatricians and nurses achieved sensitivities of 72% and 69% respectively. The specificity achieved by the pediatricians was 76% initially but 96% after further training. Untrained residents achieved a sensitivity of 58%. We conclude that this kit is potentially useful in the hands of adequately trained personnel, but without training the accuracy of the results is unacceptable. We recommend that the kit be used by designated staff trained and monitored by laboratory personnel. PMID:3284627

  3. Development of a Simulation Scenario and Evaluation Checklist for Patients With Asthma in Emergency Care.

    PubMed

    Lee, Jung Jae; Jeong, Hyeon-Cheol; Kang, Kyung-Ah; Kim, Ye-Jean; Lee, Myung-Nam

    2015-12-01

    Care for patients with asthma requires prompt and effective decision-making abilities. Many nursing students report a lack of preparedness and competence with respect to their ability to perform nursing duties. Simulation-based learning has been developed as a potential solution to this problem. Moreover, the simulation scenario with an evaluation checklist offers a reliable evaluation strategy for the education and training of clinical decision-making skills among nursing students. The simulation scenario and evaluation checklist developed in this study offer a means to improve patient safety during asthma care in the emergency care unit, as well as to improve nursing students' problem-solving competencies and communication with patients with asthma. PMID:26509408

  4. 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

    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

    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 μg/m3; total sulfate = 172.5 μg/m3; acidic sulfate = 132.5 μg/m3; organic carbon = 50.9 μg/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. PMID:21401387

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

    PubMed Central

    2014-01-01

    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. PMID:25055987

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

    ERIC Educational Resources Information Center

    Korat, Ofra; Haglili, Sharon

    2007-01-01

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

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

    PubMed

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

    2015-01-01

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

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

    PubMed Central

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

    2015-01-01

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

  9. Evaluating the management of anaphylaxis in US emergency departments: Guidelines vs. practice

    PubMed Central

    Russell, W. Scott; Farrar, Judith Rosen; Nowak, Richard; Hays, Daniel P.; Schmitz, Natalie; Wood, Joseph; Miller, Judi

    2013-01-01

    BACKGROUND: Anaphylaxis is characterized by acute episodes of potentially life-threatening symptoms that are often treated in the emergency setting. Current guidelines recommend: 1) quick diagnosis using standard criteria; 2) first-line treatment with epinephrine; and 3) discharge with a prescription for an epinephrine auto-injector, written instructions regarding long-term management, and a referral (preferably, allergy) for follow-up. However, studies suggest low concordance with guideline recommendations by emergency medicine (EM) providers. The study aimed to evaluate how emergency departments (EDs) in the United States (US) manage anaphylaxis in relation to guideline recommendations. METHODS: This was an online anonymous survey of a random sample of EM health providers in US EDs. RESULTS: Data analysis included 207 EM providers. For respondent EDs, approximately 9% reported using agreed-upon clinical criteria to diagnose anaphylaxis; 42% reported administering epinephrine in the ED for most anaphylaxis episodes; and <50% provided patients with a prescription for an epinephrine auto-injector and/or an allergist referral on discharge. Most provided some written materials, and follow-up with a primary care clinician was recommended. CONCLUSIONS: This is the first cross-sectional survey to provide “real-world” data showing that practice in US EDs is discordant with current guideline recommendations for the diagnosis, treatment, and follow-up of patients with anaphylaxis. The primary gaps are low (or no) utilization of standard criteria for defining anaphylaxis and inconsistent use of epinephrine. Prospective research is recommended. PMID:25215101

  10. Scott Emergency Escape Breathing Device evaluation for use by aircraft cabin crew and passengers.

    PubMed

    Martin, N A; Popplow, J R

    1987-08-01

    The Scott Emergency Escape Breathing Device (EEBD) was evaluated for use in Canadian Forces (CF) transport/passenger aircraft in providing smoke protection during emergencies and in preventing hypoxia during cabin decompression at high altitude. Five human subjects wearing the EEBD were subjected to decompression from 2,438 m (8,000 ft) to 9,753 m (32,000 ft) in approximately 15 s followed by a free fall to 7,010 m (23,000 ft) in a challenge gas atmosphere of 5,000 ppm of carbon monoxide (CO), where they performed moderate exercise (80 W output) on a bicycle ergometer. Very little in-leakage of CO was observed when the neck seal was maintained. Hood atmosphere was measured at 97% oxygen at 7,010 m, which resulted in an arterial oxygen saturation (SaO2) of 97%. Temperature in the hood rose to as high as 45.5 degrees C but the subjects were able to function normally. The EEBD is effective in providing noncockpit aircraft crew with smoke protection, adequate vision, and hypoxia prevention for at least 15 min in the event of a fire, smoke, or decompression emergencies at altitudes up to 7,010 m following a brief exposure to 9,753 m. PMID:3632533

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

    ERIC Educational Resources Information Center

    Zantal-Wiener, Kathy; Horwood, Thomas J.

    2010-01-01

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

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

    ERIC Educational Resources Information Center

    Zantal-Wiener, Kathy; Horwood, Thomas J.

    2010-01-01

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

  13. An evaluation of treatment results of emergency versus elective surgery in colorectal cancer patients

    PubMed Central

    Bayar, Bahattin; Yılmaz, Kerim Bora; Akıncı, Melih; Şahin, Alpaslan; Kulaçoğlu, Hakan

    2016-01-01

    Objective: Colorectal cancer is still one of the most common causes of cancer related deaths in the world despite improvements in diagnosis and treatment modalities, and application of community-based screening methods. Symptoms of colorectal cancer are non-specific and usually manifest following local progression. A number of patients with advanced stage colorectal cancer present to emergency departments with obstruction as the first sign of disease without any previous symptoms. This presentation is an indication for emergency surgery that has a high rate of morbidity and mortality. In this study, we aimed to determine the factors associated with early diagnosis and survival by comparing postoperative results of colorectal cancer patients who underwent surgery under emergency or elective situation. Material and Methods: Files of colorectal patients treated between 2009–2013 were retrospectively analyzed. Data on patient age, gender, operation type, intraoperative results, length of hospital stay, co-morbidities, postoperative complications and pathological results were evaluated and compared. Results: There was no statistical difference between groups in terms of age, gender, and pathology results (p>0.05). The difference between groups in terms of postoperative length of hospital stay, presence of co-morbid diseases, pathological stage, and postoperative complications was statistically significant (p<0.05). Length of hospital stay, advanced stage on admission, complications such as surgical site infection, evisceration, and anastomosis leakage rates were higher in patients in the emergency surgery group. Conclusion: Risk groups should be determined in order to diagnose colorectal cancer patients at an early stage while they are still asymptomatic, and this information should be incorporated into effective screening programs. This approach will be beneficial to treatment outcomes, complication rates, length of hospital stay, and survival and treatment results.

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

    PubMed Central

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

    2014-01-01

    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. PMID:25035747

  15. Nuclear matter with realistic hamiltonians

    SciTech Connect

    Lagaris, I.

    1981-01-01

    In this thesis we first review some of the theoretical methods designed to handle the nuclear matter many-body problem. The emphasis is put on the variational theory developed by Pandharipande and Wiringa. This method treats the so called v/sub 6/ model, in which the two-nucleon interaction is assumed to have only central, spin, isospin and tensor components, and there are no many nucleon interactions. A realistic v/sub 14/ model of the two-nucleon interaction is obtained by fitting the available two-body data in S, P, D and F waves. This interaction has terms that are linear and quadratic in spin orbit and quadratic in the relative orbital angular momentum. The variational theory is extended to treat this realistic interaction model and nuclear matter properties are calculated with it neglecting many-nucleon interactions. The results of these calculations show that the empirically known properties of nucelar matter, such as its ground state energy, equilibrium density and compressibility, cannot be explained by this nuclear hamiltonian that incorporates only two-body interactions. Results obtained with other realistic two-nucleon interactions also fail to reproduce the empirical nuclear matter properties. Hence we postulate a form for a three-nucleon interaction (TNI), inspired from the meson theory of nuclear interactions. Instead of attempting to develop a variational theory to treat TNI microscopically in nuclear matter, we parametrize the effect of TNI on the energy of nuclear matter with three parameters. These are varied to obtain the empirical energy, density and compressibility of nuclear matter. The results of our calculations show that the TNI contribution on the energy is much smaller than that of the two-body v/sub 14/ interaction, as expected, and thus it may be reasonable to neglect four and more nucleon interactions in the nuclear hamiltonian.

  16. Electromagnetic Scattering from Realistic Targets

    NASA Technical Reports Server (NTRS)

    Lee, Shung- Wu; Jin, Jian-Ming

    1997-01-01

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

  17. Emergency department preparedness for the evaluation and treatment of victims of biological or chemical terrorist attack.

    PubMed

    Greenberg, Michael I; Jurgens, Sherri M; Gracely, Ed J

    2002-04-01

    This study evaluated the preparedness of Emergency Departments (EDs) in the greater Philadelphia area to evaluate and treat victims of a terrorist biological or chemical agent release. All hospitals with EDs in the survey target area were included. A survey instrument consisting of 38 questions was mailed to the physician director of each ED. Fifty-four of 62 directors returned usable surveys. This represented an overall response rate of 88.5%. Deficiencies in preparedness were identified involving physician training and education, antidote stocking, written policies, interagency agreements, and decontamination facilities. The overall level of preparedness for hospital EDs responding to this survey was low based on a set of predetermined, implicit criteria. Comprehensive plans should be developed and implemented to remedy the identified deficiencies. PMID:11932091

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

    PubMed

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

    2016-01-01

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

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

    PubMed

    Lin, Wei-Ching; Lin, Chien-Heng

    2016-06-01

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

  20. Standardized Approaches to Syncope Evaluation for Reducing Hospital Admissions and Costs in Overcrowded Emergency Departments

    PubMed Central

    Shin, Tae Gun; Jo, Ik Joon; Sim, Min Seob; Park, Seung-Jung

    2013-01-01

    Purpose The evaluation of syncope is often disorganized and ineffective. The objective of this study was to examine whether implementation of a standardized emergency department (ED) protocol improves the quality of syncope evaluation. Materials and Methods This study was a prospective, non-randomized study conducted at a 1900-bed, tertiary teaching hospital in South Korea. We compared two specific periods, including a 12-month observation period (control group, January-December 2009) and a 10-month intervention period after the implementation of standardized approaches, comprising risk stratification, hospital order sets and establishment of a syncope observational unit (intervention group, March-December 2010). Primary end points were hospital admission rates and medical costs related to syncope evaluation. Results A total of 244 patients were enrolled in this study (116 patients in the control group and 128 patients in the intervention group). The admission rate decreased by 8.3% in the intervention group (adjusted odds ratio 0.31, 95% confidence interval 0.13-0.70, p=0.005). There was a cost reduction of about 30% during the intervention period [369000 Korean won (KRW), interquartile range (IQR) 240000-602000 KRW], compared with the control period (542000 KRW, IQR 316000-1185000 KRW). The length of stay in the ED was also reduced in the intervention group (median: 4.6 hours vs. 3.4 hours). Conclusion Standardized approaches to syncope evaluation reduced hospital admissions, medical costs and length of stay in the overcrowded emergency department of a tertiary teaching hospital in South Korea. PMID:23918559

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

    SciTech Connect

    Not Available

    1993-11-01

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

  2. Simulating realistic enough patient records.

    PubMed

    Cunningham, James; Ainsworth, John

    2015-01-01

    Information systems for storing, managing and manipulating electronic medical records must place an emphasis on maintaining the privacy and security of those records. Though the design, development and testing of such systems also requires the use of data, the developers of these systems, rarely also their final end users, are unlikely to have ethical or governance approval to use real data. Alternative test data is commonly either randomly produced or taken from carefully anonymised subsets of records. In both cases there are potential shortcomings that can impact on the quality of the product being developed. We have addressed these shortcomings with a tool and methodology for efficiently simulating large amounts of realistic enough electronic patient records which can underpin the development of data-centric electronic healthcare systems. PMID:25991097

  3. Realistic Ground Motion Scenarios: Methodological Approach

    SciTech Connect

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

    2008-07-08

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

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

    PubMed Central

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

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

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

    PubMed Central

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

    2011-01-01

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

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

    PubMed

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

    2015-01-01

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

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

    NASA Technical Reports Server (NTRS)

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

    1999-01-01

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

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

    PubMed Central

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

    2015-01-01

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

  9. Focused versus screening CT scans for evaluation of nontraumatic abdominal pain in the emergency department

    PubMed Central

    Thurston, Kristy; Magge, Suma; Fuller, Robert; Voytovich, Anthony; Lee, Jessica; Kozol, Robert

    2010-01-01

    Objective To evaluate the utility of computed tomography (CT) scans in patients with abdominal pain in the emergency department. We compared focused scans (having a single diagnosis in mind) and screening scans (having no diagnosis or more than one diagnosis in mind) with the hypothesis that focused scans will reveal pathology more often than screening scans. Treatment plans and patient outcomes were also compared between the two populations. Methods This is a prospective study in which 100 patients who presented to an academic medical center with abdominal pain and underwent an abdominal CT were enrolled in the study. A chart review was later completed to gather ultimate outcome data for each of the enrolled subjects. Results Of the 61 patients having a focused CT, pathology was identified on 63.9% of the scans, which did not differ significantly from the 65.4% of scans that revealed pathology in the screening group. In the focused group, anticipated admissions were reduced, but the reduction was not significant. The screening group did show a significant difference, with eight fewer patients being admitted than initially planned. The total number of patients deemed to require admission was significantly reduced by 15% following all CT scans. Conclusion While there was no difference between the focused and screening groups in the rate of identifying pathology, there was a significant decline in number of patients requiring admission to the hospital in the “screening” CT group (when comparing emergency physicians’ pre- and post-CT treatment plans).

  10. Preclinical biosafety evaluation of cell-based therapies: emerging global paradigms.

    PubMed

    Basu, Joydeep; Assaf, Basel T; Bertram, Timothy A; Rao, Mahendra

    2015-01-01

    Cell-based therapies have the potential to treat a diversity of disease conditions, many representing significant and long-standing unmet medical needs. Certain properties of cell-based therapies, such as differentiation potential and proliferative potential, present safety concerns uniquely distinct from those of small molecule drugs and other macromolecule biologics. These cellular products carry risks associated with localized host tissue response, long-term persistence, ectopic tissue formation, differentiation to undesirable cell and tissue types, uncontrollable biodistribution, tumorigenicity, and immunogenicity. Such risks are generally evaluated in preclinical animal model studies as part of a comprehensive safety program prior to administration in humans. However, safety assessment for these products can be challenging because of inconsistent approaches to product characterization, inadequately defined product parameters that anticipate adverse events, and the lack of standardized approaches in evaluating in vivo host responses. In this symposium, we introduced cell-based therapies as an emerging product class to the Society of Toxicologic Pathology (STP) and highlighted key challenges for consideration during product biosafety evaluation. PMID:25476796

  11. Evaluation of a sequential structured educational curriculum for emergency medical technicians in airway management

    PubMed Central

    Parida, Satyen; Mishra, Sandeep Kumar; Badhe, Ashok Shankar

    2014-01-01

    Background and Aims: Emergency medical technician (EMT) training programs for certification vary greatly from course to course, but it is necessary that each course at least meets local and national requirements. It is reasonable to expect that EMTs’ performance should improve after a structured educational curriculum. We hypothesized that EMTs’ performance in airway management would improve after a sequential structured educational curriculum involving airway, followed by cardiopulmonary resuscitation (CPR) modules, beyond what is achieved after only the airway module. Materials and Methods: To evaluate this, 76 EMTs were assigned to a 2-week airway module with a structured curriculum. This was followed by the 2-week CPR module, and the EMTs were tested before (preCPR test) and after (postCPR test) the CPR modules for improvement in their airway skills. EMTs also completed a questionnaire to evaluate the curriculum. Results: PostCPR test mean scores were higher than those of the preCPR test (P < 0.05) except for the bag valve mask domain. EMTs evaluated the curriculum and gave a score of 3.7/5 for perceived achievement of goals of the syllabus for improving their airway skills. Conclusion: Thus, a sequential, structured curriculum in airway management followed by CPR, improves EMTs’ performance levels above what they achieved after only the airway module, except for bag valve mask ventilation. PMID:25425773

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

    PubMed Central

    Baumbach, Joan; Cieslak, Paul R.

    2015-01-01

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

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

    PubMed Central

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

    2007-01-01

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

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

    PubMed

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

    2007-03-01

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

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

    NASA Technical Reports Server (NTRS)

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

    2012-01-01

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

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

    PubMed

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

    2009-01-01

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

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

    PubMed

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

    2015-09-01

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

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

    PubMed Central

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

    2015-01-01

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

  19. [Training before departure of volunteers during nutritional emergencies. From inception to evaluation].

    PubMed

    Grellety-Bosviel, Y; Beauquesne, I

    1996-01-01

    Predeparture training is rarely undertaken within emergency nongovernmental organizations. Although field-training is considered as the only real school, the technical requirements are increasingly more constraining. To cope with this problem, the technical officers of Action contre la faim planned a predeparture training project based on self-instruction of any volunteer leaving for a nutritional emergency mission. The project began in 1994. Six self-instruction sessions were produced to enable volunteers to learn. To improve the quality of work, this framework encouraged creativity, constant research and motivation. The training supervisor accompanied the volunteers and put them in simulated situations where various tools were made available to them. A series of measures have been used to improve this basic training: 1) a training contract meant to make the volunteer responsible for his training; 2) better programming to ensure adequate relay from one volunteer to the next; 3) an apprentice report covering the first 15 days of the volunteer's integration into the field, thereby providing important feed-back to the supervisor; 4) an evaluation of the monthly report and an interview-grid used to follow the volunteer in the short and medium-term; 5) and an evaluation form completed by the volunteer which enables the updating of sessions and simulated situations. This initiative has made us aware of the importance of following the volunteers at all stages: this can increase the volunteer's efficiency and their fidelity to the non-governmental organization. Currently, the main objective is to gain the support of qualified technical coordinators who will be the most important factor in continuous training. PMID:8764453

  20. Emergent Expertise?

    ERIC Educational Resources Information Center

    McGivern, Patrick

    2014-01-01

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

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

    PubMed

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

    2014-01-01

    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

  2. An Online Tool for Nurse Triage to Evaluate Risk for Acute Coronary Syndrome at Emergency Department

    PubMed Central

    Sittichanbuncha, Yuwares; Sanpha-asa, Patchaya; Keeratikasikorn, Chaiyapon; Aekphachaisawat, Noppadol

    2015-01-01

    Background. To differentiate acute coronary syndrome (ACS) from other causes in patients presenting with chest pain at the emergency department (ED) is crucial and can be performed by the nurse triage. We evaluated the effectiveness of the ED nurse triage for ACS of the tertiary care hospital. Methods. We retrospectively enrolled consecutive patients who were identified as ACS at risk patients by the ED nurse triage. Patients were categorized as ACS and non-ACS group by the final diagnosis. Multivariate logistic analysis was used to predict factors associated with ACS. An online model predictive of ACS for the ED nurse triage was constructed. Results. There were 175 patients who met the study criteria. Of those, 28 patients (16.0%) were diagnosed with ACS. Patients with diabetes, patients with previous history of CAD, and those who had at least one character of ACS chest pain were independently associated with having ACS by multivariate logistic regression. The adjusted odds ratios (95% confidence interval) were 4.220 (1.445, 12.327), 3.333 (1.040, 10.684), and 12.539 (3.876, 40.567), respectively. Conclusions. The effectiveness of the ED nurse triage for ACS was 16%. The online tool is available for the ED triage nurse to evaluate risk of ACS in individuals. PMID:25922767

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

    NASA Astrophysics Data System (ADS)

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

    1993-09-01

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

  4. Fluorodeoxyglucose positron emission tomography: emerging roles in the evaluation of putative Alzheimer's disease-modifying treatments.

    PubMed

    Reiman, Eric M

    2011-12-01

    Alzheimer's disease (AD) is associated with characteristic and progressive reductions in flourodeoxyglucose positron emission tomography (FDG PET) measurements of the regional cerebral metabolic rate for glucose. These reductions begin years before the onset of symptoms, are correlated with clinical severity, and may help predict an affected patient's clinical course and neuropathological diagnosis. Like several other AD biomarkers, FDG PET has the potential to accelerate the evaluation of AD-modifying treatments, particularly in the earliest clinical and preclinical stages. This article considers FDG PET's role in the detection and tracking of AD, its emerging roles in the evaluation of disease-slowing treatments, some of the issues involved in the acquisition, analysis, and interpretation of FDG PET data, and the evidence needed to help qualify FDG PET and other biomarkers for use in the accelerated approval of AD-slowing treatments. It recommends scientific strategies and public policies to further establish the role of FDG PET and other AD biomarkers in therapeutic trials and find demonstrably effective disease-modifying and presymptomatic AD treatments as quickly as possible. PMID:21983241

  5. Evaluation of field triage decision scheme educational resources: audience research with emergency medical service personnel.

    PubMed

    Sarmiento, Kelly; Eckstein, Daniel; Zambon, Allison

    2013-03-01

    In an effort to encourage appropriate field triage procedures, the Centers for Disease Control and Prevention (CDC), in collaboration with the National Highway Traffic Safety Administration and the American College of Surgeons-Committee on Trauma, convened the National Expert Panel on Field Triage to update the Field Triage Decision Scheme: The National Trauma Triage Protocol (Decision Scheme). In support of the Decision Scheme, CDC developed educational resources for emergency medical service (EMS) professionals, one of CDC's first efforts to develop and broadly disseminate educational information for the EMS community. CDC wanted to systematically collect information from the EMS community on what worked and what did not with respect to these educational materials and which materials were of most use. An evaluation was conducted to obtain feedback from EMS professionals about the Decision Scheme and use of Decision Scheme educational materials. The evaluation included a survey and a series of focus groups. Findings indicate that a segment of the Decision Scheme's intended audience is using the materials and learning from them, and they have had a positive influence on their triage practices. However, many of the individuals who participated in this research are not using the Decision Scheme and indicated that the materials have not affected their triage practices. Findings presented in this article can be used to inform development and distribution of additional Decision Scheme educational resources to ensure they reach a greater proportion of EMS professionals and to inform other education and dissemination efforts with the EMS community. PMID:22773617

  6. Realistic models of biological motion

    NASA Astrophysics Data System (ADS)

    Derényi, Imre; Vicsek, Tamás

    The origin of biological motion can be traced back to the function of molecular motor proteins. Cytoplasmic dynein and kinesin transport organelles within our cells moving along a polymeric filament, the microtubule. The motion of the myosin molecules along the actin filaments is responsible for the contraction of our muscles. Recent experiments have been able to reveal some important features of the motion of individual motor proteins, and a new statistical physical description - often referred to as “thermal ratchets” - has been developed for the description of motion of these molecules. In this approach, the motors are considered as Brownian particles moving along one-dimensional periodic structures due to the effect of nonequilibrium fluctuations. Assuming specific types of interaction between the particles the models can be made more realistic. We have been able to give analytic solutions for our model of kinesin with elastically coupled Brownian heads and for the motion of the myosin filament where the motors are connected through a rigid backbone. Our theoretical predictions are in a very good agreement with the various experimental results. In addition, we have considered the effects arising as a result of interaction among a large number of molecular motors, leading to a number of novel cooperative transport phenomena.

  7. Towards a realistic echographic simulator.

    PubMed

    d'Aulignac, D; Laugier, C; Troccaz, J; Vieira, S

    2006-02-01

    Echography is a useful tool to diagnose a thrombosis; however, since it is difficult to learn to perform this procedure, the objective of this work is to create a simulation to allow students to practice in a virtual environment. Firstly, a physical model of the thigh was constructed based on experimental data obtained using a force sensor mounted on a robotic arm. We present a spring damper model consisting of both linear and non-linear elements. The parameters of each of these elements are then fitted to the experimental data using an optimization technique. By employing an implicit integration to solve the dynamics of the system we obtain a stable physical simulation at over 100 Hz. Secondly, a haptic interface was added to interact with the simulation. Using a PHANToM force-feedback device may touch and deform the thigh in real-time. In order to allow a realistic sensation of the contact we employ a local modeling technique allowing to approximate the forces at much higher frequency using a multi-threaded architecture. Finally, we present the basis for a fast echographic image generation depending on the position and orientation of the virtual probe as well as the force applied to it. PMID:15919234

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

    PubMed Central

    2014-01-01

    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. PMID:24884619

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

    NASA Technical Reports Server (NTRS)

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

    2006-01-01

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

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

    SciTech Connect

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

    1990-10-01

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

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

    NASA Technical Reports Server (NTRS)

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

    2003-01-01

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

  12. Gravity waves in a realistic atmosphere.

    NASA Technical Reports Server (NTRS)

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

    1966-01-01

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

  13. Bosonic condensates in realistic supersymmetric GUT cosmic strings

    NASA Astrophysics Data System (ADS)

    Allys, Erwan

    2016-04-01

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

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

    PubMed Central

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

    2013-01-01

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

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

    PubMed

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

    2016-05-15

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

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

    PubMed Central

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

    2014-01-01

    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. PMID:23909069

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

    PubMed Central

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

    2016-01-01

    Emergency Departments (ED) are trying to alleviate crowding using various interventions. We assessed the effect of an alternative model of care, the Medical Team Evaluation (MTE) concept, encompassing team triage, quick registration, redesign of triage rooms and electronic medical records (EMR) on door-to-doctor (waiting) time and ED length of stay (LOS). We conducted an observational, before-and-after study at an urban academic tertiary care centre. On July 17th 2014, MTE was initiated from 9:00 a.m. to 10 p.m., 7 days a week. A registered triage nurse was teamed with an additional senior ED physician. Data of the 5-month pre-MTE and the 5-month MTE period were analysed. A matched comparison of waiting times and ED LOS of discharged and admitted patients pertaining to various Emergency Severity Index (ESI) triage categories was performed based on propensity scores. With MTE, the median waiting times improved from 41.2 (24.8–66.6) to 10.2 (5.7–18.1) minutes (min; P < 0.01). Though being beneficial for all strata, the improvement was somewhat greater for discharged, than for admitted patients. With a reduction from 54.3 (34.2–84.7) to 10.5 (5.9–18.4) min (P < 0.01), in terms of waiting times, MTE was most advantageous for ESI4 patients. The overall median ED LOS increased for about 15 min (P < 0.01), increasing from 3.4 (2.1–5.3) to 3.7 (2.3–5.6) hours. A significant increase was observed for all the strata, except for ESI5 patients. Their median ED LOS dropped by 73% from 1.2 (0.8–1.8) to 0.3 (0.2–0.5) hours (P < 0.01). In the same period the total orders for diagnostic radiology increased by 1,178 (11%) from 10,924 to 12,102 orders, with more imaging tests being ordered for ESI 2, 3 and 4 patients. Despite improved waiting times a decrease of ED LOS was only seen in ESI level 5 patients, whereas in all the other strata ED LOS increased. We speculate that this was brought about by the tendency of triage physicians to order more diagnostic radiology, anticipating that it may be better for the downstream physician to have more information rather than less. PMID:27104911

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

    ERIC Educational Resources Information Center

    RMC Research Corp., Arlington, VA.

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

  19. 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). ...

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

    ERIC Educational Resources Information Center

    Atwood, Nancy K.

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

  1. 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...

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

    EPA Science Inventory

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

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

    ERIC Educational Resources Information Center

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

    2010-01-01

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

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

    PubMed

    Robertson, C K

    1981-07-01

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

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

    PubMed

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

    2009-01-01

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

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

    PubMed

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

    2015-01-01

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

  7. Standards for clinical evaluation and documentation by the emergency medicine provider.

    PubMed

    Selbst, Steven M

    2008-11-01

    Pediatric emergency medicine is full of challenges. When a pediatric patient has a poor outcome after treatment in an emergency department (ED), a malpractice lawsuit is likely to result. Pediatric emergency medicine (PEM) physicians might sometimes alter their medical care and practice "defensive medicine" in hopes of avoiding a malpractice lawsuit. Radiographs and other diagnostic studies might be ordered without true indications to "completely rule out" a diagnosis. This can result in excess radiation for a child. On the other hand, failure to order the appropriate study or misinterpretation of a radiographic study by a radiologist or an emergency physician can result in a malpractice lawsuit. PEM physicians must work cooperatively with radiologists to improve the care for children in the ED. Together these specialists can decide on appropriate studies for children in the ED, keep radiation exposure to a minimum and ensure proper management based on these studies. PMID:18810419

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

    PubMed

    Wilson, Shauna B; Lonigan, Christopher J

    2010-01-01

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

  9. Evaluation of a discussion forum for knowledge sharing among emergency practitioners: a social network approach.

    PubMed

    Curran, Janet; Abidi, Syed Sibte Raza

    2006-01-01

    Peer to peer knowledge sharing is recognized as a key contributor to the development of expert practice for health care professionals. Emergency departments with access to extensive expertise, such as in urban hospital settings, present greater potential for rich collaborative learning opportunities as compared with rural settings where expertise is at times scarce. Collaborative technologies such as electronic discussion boards may assist in leveling the "knowledge" playing field and increase opportunities for the growth of a strong social network for emergency clinicians. A social network perspective is used to explore the effectiveness of a discussion forum to support knowledge sharing among emergency practitioners in rural and urban emergency departments in Nova Scotia. PMID:17108632

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

    EPA Science Inventory

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

  11. Evaluation of preparedness for medical emergencies at dental offices: A survey

    PubMed Central

    Kumarswami, Shweta; Tiwari, Anish; Parmar, Mayank; Shukla, Manisha; Bhatt, Amit; Patel, Mittal

    2015-01-01

    Background: The best way to handle an emergency is to be prepared in advance. The purpose of this study was to assess the availability of medical emergency drugs at dental offices and to determine the level of knowledge and preparedness of dentists to manage medical emergencies at their dental offices. Materials and Methods: A descriptive cross-sectional study was conducted from January to June 2014 with 250 dental graduates to determine their knowledge and ability in the management of medical emergencies and assess availability of emergency drugs and equipments in dental offices in the Ahmedabad and Udaipur areas of India. The questionnaire consisted of mainly objective questions, requiring a simple yes or no reply. Mann–Whitney test was used for the analysis. A 95% confidence level was used and a P value of less than or equal to 0.05 was considered statistically significant. Results: The results of our study showed that almost all the surveyed dentists (98%) enquired about medical history, but only 12% obtained filled health history proforma from patients regarding the above. Only 38.4% participants recorded the vital signs of patients before commencing any treatment. Also, 7.6% reported about having attended any workshops on emergency training or management programs. Emergency kits were available with only 24% participants and the available kits were assessed for the availability of emergency drugs. Also, 34% were confident about giving intramuscular injection and only 6.6% were sure about giving intravenous injections. The P value was found to be highly statistically significant. Conclusion: The results of our study reflect an alarming situation about the capability of dentists to deal with such conditions. PMID:25767767

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

    PubMed

    Borczuk, Pierre

    2013-07-01

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

  13. Evaluating the quality of the educational environment for medical interns in an emergency department using the DREEM inventory.

    PubMed

    Farahmand, Shervin; Bagheri-Hariri, Shahram; Moghanloo, Samaneh; Basir Ghafouri, Hamed; Saeedi, Morteza; Afzalimoghadam, Mohammad; Gao, Yun

    2014-01-01

    Moving toward establishing more student center educational environment to meet the ever-changing learning expectations in a challenging climate like emergency department for under graduates is an intimidating task. In our newly founded academic emergency department, every step toward scoring as a dynamic and modern educational environment for both undergraduates and postgraduates would be a great success. The last 18 months of undergraduate medical education in Iran is considered as an internship. Interns have two months mandatory emergency department rotation during that period. This study has design to evaluate the medical students' conception about the educational environment using the Dundee Ready Education Environment Measure (DREEM) questionnaire. 156 undergraduate interns during their two months emergency medicine rotation from October 2009 to March 2010 enrolled into a cross sectional observational study to anonymously fill up the DREEM questionnaire  on the last week of the course. The overall mean score of DREEM questionnaire was 134.79 out of 200 for the emergency department.  The mean scores are 135.37 in female (n=87) group and 131.56 in male (n=69) group.  There was not any significant difference between two genders (P>0.05). A score of 134.79 is compatible with the modern universities. Scores of 100 or less indicate serious problems and scores above 170 is compatible with ultimate student centered and modern educational environment. Such an achievement in the start of the new installed Emergency Medicine program is admirable, hence great effort must be put to pinpoint problems and fix them. DREEM questionnaire helped us moving toward a more student center environment in the emergency department. PMID:25149888

  14. Evaluation of an Asynchronous Physician Voice Mail Sign-out for Emergency Department Admissions

    PubMed Central

    Horwitz, Leora I.; Parwani, Vivek; Shah, Nidhi R.; Schuur, Jeremiah D.; Meredith, Thom; Jenq, Grace Y.; Kulkarni, Raghavendra G.

    2009-01-01

    Background Communication failures contribute to errors in the transfer of patients from the emergency department (ED) to inpatient medicine units. Oral (synchronous) communication has numerous benefits but is costly and time-consuming. Taped (asynchronous) communication may be more reliable and efficient, but lacks interaction. We evaluated a new asynchronous physician-physician sign-out compared to the traditional synchronous sign-out. Methods A voicemail-based, semi-structured sign-out for routine ED admissions to internal medicine was implemented in October, 2007 at an urban, academic medical center. Outcomes were obtained by pre- and post-intervention surveys of ED and IM housestaff, physician assistants and hospitalist attendings; and by examination of access logs and administrative data. Outcome measures included utilization; physician perceptions of ease, accuracy, content, interaction and errors; and rate of transfers to intensive care from the floor within 24 hours of ED admission. Results were analyzed both quantitatively, and qualitatively using standard qualitative analytic techniques. Results During September-October, 2008 (one year post-intervention), voicemails were recorded regarding 90.5% of medicine admissions; 69.7% of these were accessed at least once by admitting physicians. The median length of each sign-out was 2.6 minutes (IQR 1.9 to 3.5). We received 117/197 responses (59%) to the pre-intervention survey and 113/206 responses (55%) to the post-intervention survey. A total of 73/101 (72%) respondents reported dictated sign-out was easier than oral sign-out and 43/101 (43%) reported it was more accurate. However, 70/101 (69%) reported interaction among participants was worse. There was no change in the rate of ICU transfer within 24 hours of admission from the ED in April-June, 2007 (65/6,147; 1.1%) versus April-June 2008 (70/6,263; 1.1%); difference of 0%, 95% CI, −0.4% to 0.3%. The proportion of internists reporting at least one perceived adverse event relating to transfer from the ED decreased a non-significant 10% after the intervention (95% CI, −27% to 6%), from 44% pre-intervention (32/72) to 34% post-intervention (23/67). Conclusion Voicemail sign-out for ED-internal medicine communication was easier than oral sign-out without any change in early ICU transfers or the perception of major adverse events. However, interaction among participants was reduced. Voicemail sign-out may be an efficient means of improving sign-out communication for stable ED admissions. PMID:19282064

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

    SciTech Connect

    Mace, S.E.

    1989-05-01

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

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

    ERIC Educational Resources Information Center

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

    2013-01-01

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

  17. Identifying Preschool Children at Risk of Later Reading Difficulties: Evaluation of Two Emergent Literacy Screening Tools

    ERIC Educational Resources Information Center

    Wilson, Shauna B.; Lonigan, Christopher J.

    2010-01-01

    Emergent literacy skills are predictive of children's early reading success, and literacy achievement in early schooling declines more rapidly for children who are below-average readers. It is therefore important for teachers to identify accurately children at risk for later reading difficulty so children can be exposed to effective emergent…

  18. An evaluation of the effectiveness and acceptability of nurse practitioners in an adult emergency department.

    PubMed

    Wilson, Anne; Shifaza, Fathimath

    2008-04-01

    This study aimed to investigate the effectiveness of nurse practitioner services for minor injuries in an adult emergency department and to ascertain consumers' satisfaction with the care received. Nurse practitioner roles in Australia have been progressively developing since a pilot project in 1990 examined their feasibility. Currently, nurse practitioners in Australia practise in a variety of specialist areas including coronary care cardiology, adult and paediatric palliative care, emergency, diabetics, aged care and perinatal care. The reported study used a retrospective design that conducted case-note audits and explored patient satisfaction with after-care questionnaires. One hundred case notes of patients treated by the nurse practitioner were audited and 57 patients completed questionnaires exploring their satisfaction and perception of the care received. Analysis of the case-note data indicated that the majority of presenting complaints were minor injuries. Of these injuries, 96.3% of presentations triaged level 4 and 94.4% of those triaged level 5 were seen within the time frame recommended by the Australasian Triage Scale. Forty-six per cent of patients required X-rays and 2% required pathology tests during their emergency department stay. The majority of patients were satisfied with the treatment received from the nurse practitioner. Patients are satisfied with management of small injury presentations by nurse practitioners in the emergency department. Incidentally, it was noted that the flow of patients through the department was improved, resulting in medical resources concentrated to higher priority presentations. PMID:18315828

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

    ERIC Educational Resources Information Center

    Colarossi, Lisa; Billowitz, Marissa; Breitbart, Vicki

    2010-01-01

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

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

    ERIC Educational Resources Information Center

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

    2010-01-01

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

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

    ERIC Educational Resources Information Center

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

    2010-01-01

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

  2. An Assessment of an Oral Examination Format for Evaluating Clinical Competence in Emergency Medicine.

    ERIC Educational Resources Information Center

    Solomon, David J.; And Others

    1990-01-01

    In July 1989 the American Board of Emergency Medicine conducted a field test of the oral recertification examination process. Sixteen examiners and 25 examinees participated in the field test. The examination included 3 chart-stimulated recall and 3 simulated-patient encounter cases. (MLW)

  3. Blend Shape Interpolation and FACS for Realistic Avatar

    NASA Astrophysics Data System (ADS)

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

    2015-03-01

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

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

    PubMed

    Erdoğan, Haluk; Arslan, Hande

    2013-04-01

    Legionnaires' disease (LD) is a systemic infection caused by Legionella species especially colonized in the water systems. Hotels are common locations in which waterwork-associated sporadic or epidemic legionellosis can be detected. The aim of this study was to evaluate a small Legionella outbreak emerged in a recently opened 600-bed hotel in Alanya, a touristic county in Mediterranean part of Turkey. A 66 years old male patient who stayed in this hotel opened on May 15th, 2009, was admitted to our hospital on May 21st, 2009 with the complaints of high fever, headache and diarrhea lasting for three days. Since chest X-ray revealed non-homogenous density increase in left middle and inferior zone, the patient was diagnosed as atypical pneumoniae and LD was confirmed by positive urinary Legionella antigen test (Card test, BinaxNOW®Legionella Urinary Antigen Test; Alere Co, USA) result. Following the identification of the index case, the records of our hospital were reviewed and revealed another case being treated with the diagnosis of community acquired pneumonia who was also the guest of the same hotel. This patient was then diagnosed as LD by positive urinary antigen test. Since new cases were identified during the following days (May 22, 25 and 26) the Antalya County Health Department and hotel management were informed about a cluster of LD. In addition subsequent investigation for environmental surveillance and water sampling were conducted. The LD diagnosis and environmental inspections were performed according to the procedure described in the guideline from "Turkish Ministry of Health Travel-Associated Legionnaires' Disease Control Programme". Five definitive cases and one presumptive case of LD were identified during the outbreak period (May 20-26, 2009). All of the cases were successfully treated (intravenous ciprofloxacin or levofloxacin or clarithromycin), however one patient died due to sudden death during sleep after being discharged. Since sputum samples could not be obtained from the cases, the diagnosis were not confirmed by culture but by urinary antigen test. Besides high antibody titer in single serum sample was accepted as a diagnostic marker. Additionally 26 cases who accommodated in the same hotel and presented with high fever without pneumonia were treated in the outpatient clinics of our hospital. Urinary antigen test was performed in 11 of those patients to confirm the prediagnosis of pontiac fever, however all were found negative. Likewise convalescent phase sera for the confirmation of the diagnosis by seroconversion could not be obtained since they all were foreign tourists. Investigation of water sources of the hotel revealed that the municipal drinking water network had not been connected yet and the hotel supplied water from groundwater sources. The analysis of multiple samples from multiple sites of hotel's water system indicated that the water temperature was between 35-45°C and the iron level was beyond the acceptable limits (245 µg/L) recommended for drinking water in the regulation guides. These properties were considered as the factors that enhanced the growth and survival of Legionella species. Water samples were cultivated on BCYE-_ (Buffered Charcoal Yeast Extract a-Ketoglutarate) and GVPC (Glycine-Vancomycin-Polymyxin-Cycloheximide) agar plates and 11 out of a total 13 samples yielded Legionella spp. growth. All isolates were identified as L.pneumophila serogroup 1 by specific antisera. Legionella decontamination of hotel's water system was managed by implementation of hyperchlorination method as well as superheating (> 60°C) of water. The hotel was not closed during the outbreak and cultures of water samples obtained for one year later did not yield any Legionella spp. growth. This outbreak emphasized that hotel residents are at risk for acquiring LD in the presence of a colonized water system, even in a newly constructed building. In conclusion, effective control and decontamination programmes for the prevention of Legionella colonization should be applied even in new opening hotels. PMID:23621724

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

    PubMed

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

    2012-09-01

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

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

    PubMed Central

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

    2015-01-01

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

  7. Development of a realistic human airway model.

    PubMed

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

    2012-03-01

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

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

    PubMed Central

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

    2015-01-01

    Background Serious games involving virtual patients in medical education can provide a controlled setting within which players can learn in an engaging way, while avoiding the risks associated with real patients. Moreover, serious games align with medical students’ preferred learning styles. The Virtual Emergency TeleMedicine (VETM) game is a simulation-based game that was developed in collaboration with the mEducator Best Practice network in response to calls to integrate serious games in medical education and training. The VETM game makes use of data from an electrocardiogram to train practicing doctors, nurses, or medical students for problem-solving in real-life clinical scenarios through a telemedicine system and virtual patients. The study responds to two gaps: the limited number of games in emergency cardiology and the lack of evaluations by professionals. Objective The objective of this study is a quantitative, professional feedback-informed evaluation of one scenario of VETM, involving cardiovascular complications. The study has the following research question: “What are professionals’ perceptions of the potential of the Virtual Emergency Telemedicine game for training people involved in the assessment and management of emergency cases?” Methods The evaluation of the VETM game was conducted with 90 professional ambulance crew nursing personnel specializing in the assessment and management of emergency cases. After collaboratively trying out one VETM scenario, participants individually completed an evaluation of the game (36 questions on a 5-point Likert scale) and provided written and verbal comments. The instrument assessed six dimensions of the game: (1) user interface, (2) difficulty level, (3) feedback, (4) educational value, (5) user engagement, and (6) terminology. Data sources of the study were 90 questionnaires, including written comments from 51 participants, 24 interviews with 55 participants, and 379 log files of their interaction with the game. Results Overall, the results were positive in all dimensions of the game that were assessed as means ranged from 3.2 to 3.99 out of 5, with user engagement receiving the highest score (mean 3.99, SD 0.87). Users’ perceived difficulty level received the lowest score (mean 3.20, SD 0.65), a finding which agrees with the analysis of log files that showed a rather low success rate (20.6%). Even though professionals saw the educational value and usefulness of the tool for pre-hospital emergency training (mean 3.83, SD 1.05), they identified confusing features and provided input for improving them. Conclusions Overall, the results of the professional feedback-informed evaluation of the game provide a strong indication of its potential as an educational tool for emergency training. Professionals’ input will serve to improve the game. Further research will aim to validate VETM, in a randomized pre-test, post-test control group study to examine possible learning gains in participants’ problem-solving skills in treating a patient’s symptoms in an emergency situation. PMID:26084866

  9. Research on ultra-realistic communications

    NASA Astrophysics Data System (ADS)

    Enami, Kazumasa

    2009-05-01

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

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

    SciTech Connect

    1993-10-28

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

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

    SciTech Connect

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

    1993-05-14

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

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

    SciTech Connect

    Wysocki, J.; Kolbe, R.

    1982-09-01

    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.

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

    PubMed Central

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

    2016-01-01

    Objectives Service and stakeholder evaluation of an NHS-funded service providing out-ofhours (OOH) emergency repeat medications to patients self-presenting at community pharmacies. Setting Community pharmacies across the North East of England accredited to provide this service. Participants Patients self-presenting to community pharmacies during OOH periods with emergency repeat medication supply requests. Intervention Community pharmacists assessed each request for clinical appropriateness and when suitable provide an emergency repeat medication supply, with additional pharmaceutical advice and services if required. Primary outcomes Number of emergency repeat medication supplies, time of request, reason for access, medication(s), pharmaceutical advice and services provided. Secondary outcomes were community pharmacist and patient satisfaction. Results A total of 2485 patients were managed across 227 community pharmacies (15 December 2014 to 7 April 2015). Most patients presented on Saturdays, with increased activity over national holidays. Older age was associated with increased service use. Of the 3226 medications provided, 439 were classified as high risk. Patients found this service easy to access and were willing to access the community pharmacy in the future for medication-related issues. In the absence of this service, 50% of patients would have missed their medication(s) until they saw their doctor and a further 46% would have accessed an alternative service. The cost of National Health Service (NHS) service(s) for patients who would have accessed an alternative OOH service was estimated as 37 times that of the community pharmacy service provided. Community pharmacists were happy to provide this service despite increased consultation times and workload. Conclusions Community pharmacists were able to manage patients’ OOH requests for emergency repeat medication and patients were happy with the service provided. Since the service cost was favourable when compared with alternative OOH services, it would be a viable option to reduce the workload on the wider NHS. PMID:26787252

  14. Realistic animation of human figures using artificial neural networks.

    PubMed

    Taha, Z; Brown, R; Wright, D

    1996-12-01

    We describe a new approach to the animation of human figures which can produce realistic animation and based on artificial neural networks (ANN). A fully connected ANN is trained with inputs and outputs of key frames obtained from image analysis and key postures and parameters of standing, walking and running. A behaviour index is introduced as an input to the ANN. Each index is unique to each behaviour. Other inputs include speed, cycle history and subsystem index. The subsystem index refers to the different subsystem of the human figure e.g. the right leg is a subsystem referred to by an index. The outputs are the joints displacements. The ANN is trained using the back propagation method. The ANN was able to generate realistic animations of walking and running and could merge three different behaviours, standing, walking and running. The proposed method should enable design evaluations, human factors analysis, task simulation and motion understanding easier for non-animation experts. PMID:8953559

  15. Evaluation of attempted suicide in emergency departments in Sanliurfa province, southeastern Turkey

    PubMed Central

    Demir, Canan; Er, Glistan; Munir, Kerim M.

    2013-01-01

    Aim Attempted suicide is one of the most important public health problems among preventable causes of mortality in the general population. Identifying risk factors for the prevention of suicide is a major public health goal. The aim of this study was to determine the annual rate of attempted suicide, related risk factors, and interventions, among referrals to emergency departments in the Sanliurfa province of southeastern Turkey. Subjects and methods Data were obtained from all emergency departments in the province based on the Suicide Attempt Registry standardized records for the calendar year 2010. Sociodemographic characteristics, aetiology, psychiatric history, psychiatric consultations, and interventions were examined. The groups were analysed with the chi-square test; the significance level was set at p<0.05. Results The annual rate of suicide attempts was 55.39 in 100,000 for the calendar year 2010. The rate was 3.47 times higher among women than men, and in particular 4.15 times higher for the 1524 year age group among women than in men with the highest incidence of suicide attempts. The majority of cases were referred in April and May. Medication or toxic agent ingestions comprised 90.3 % of cases. The main reason for attempts was family problems or domestic violence among women, and economic hardships among men, and rates of physical and mental problems were similar for both sexes. Only 8.8 % of cases were subsequently referred for psychiatric consultation. Among cases with a prior suicide attempt history, 44.6 % had a reported psychiatric disorder. Conclusion The results of this investigation show that strengthening of surveillance and emergency healthcare systems, enhancement of mental health literacy, and inter-sector collaboration for development of community empowerment programmes are of vital importance for prevention of attempted suicide. The low rate of psychiatric referrals for subsequent intervention represented a major gap in urgent mental health services in the region. PMID:25067888

  16. Evaluation and management of traumatic knee injuries in the emergency department.

    PubMed

    Knutson, Tristan; Bothwell, Jason; Durbin, Ricky

    2015-05-01

    Posttraumatic knee pain is a common presentation in the emergency department (ED). The use of clinical decision rules can rule out reliably fractures of the knee and reduce the unnecessary cost and radiation exposure associated with plain radiographs. If ligamentous or meniscal injury to the knee is suspected, the ED physician should arrange for expedited follow- up with the patient's primary care physician or an orthopedic specialist for consideration of an MRI and further management. Patients presenting after high-energy mechanisms are at risk for occult fracture and vascular injuries. ED providers must consider these injuries in the proper clinical setting. PMID:25892726

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

    SciTech Connect

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

    2012-01-01

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

  18. 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

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

    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…

  19. 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

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

    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

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

    PubMed Central

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

    2015-01-01

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

  1. Making a Literature Methods Course "Realistic."

    ERIC Educational Resources Information Center

    Lewis, William J.

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

  2. Satellite Maps Deliver More Realistic Gaming

    NASA Technical Reports Server (NTRS)

    2013-01-01

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

  3. Spatial Visualization by Realistic 3D Views

    ERIC Educational Resources Information Center

    Yue, Jianping

    2008-01-01

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

  4. Realistic Planning for the Day Care Consumer.

    ERIC Educational Resources Information Center

    Emlen, Arthur C.

    This paper questions public attitudes of disparagement toward child care that is privately arranged in neighborhood homes, and cites research to show that the widespread non-use of organized facilities is based on realistic alternative patterns of day care behavior. Some determinants of day care use are discussed, and an understanding of

  5. Improving Intuition Skills with Realistic Mathematics Education

    ERIC Educational Resources Information Center

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

    2014-01-01

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

  6. Spatial Visualization by Realistic 3D Views

    ERIC Educational Resources Information Center

    Yue, Jianping

    2008-01-01

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

  7. 75 FR 22817 - Emerging Infectious Diseases: Evaluation to Implementation for Transfusion and Transplantation...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-04-30

    ... for Transfusion and Transplantation Safety and Quantitative Risk Assessment: Blood Safety and... workshop) and ``Quantitative Risk Assessment: Blood Safety and Availability'' (QRA public workshop... should contact Rhonda Dawson, Center for Biologics Evaluation and Research (HFM-302), Food and...

  8. 77 FR 50546 - Agency Information Collection: Emergency Submission for OMB Review (CEPACT (Center for Evaluation...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-08-21

    ... of PACT) Demographic Questionnaire and Patient Focus Group); Comment Request AGENCY: Veterans Health... Evaluation of PACT) Demographic Questionnaire, VA Form 10-0534 and Patient Focus Group. OMB Control...

  9. (177)Lu: DDEP Evaluation of the decay scheme for an emerging radiopharmaceutical.

    PubMed

    Kellett, M A

    2016-03-01

    A new decay scheme evaluation using the DDEP methodology for (177)Lu is presented. Recently measured half-life measurements have been incorporated, as well as newly available γ-ray emission probabilities. For the first time, a thorough investigation has been made of the γ-ray multipolarities. The complete data tables and detailed evaluator comments are available through the DDEP website. PMID:26671793

  10. Evaluation of a commercial software package's ability to calibrate an in vivo counter for emergency response.

    PubMed

    Kramer, Gary H; Capello, Kevin; DiNardo, Anthony; Hauck, Barry

    2012-08-01

    A commercial detector calibration package has been assessed for its use to calibrate the Human Monitoring Laboratory's Portable Whole Body Counter that is used for emergency response. The advantage of such a calibration software is that calibrations can be derived very quickly once the model has been designed. The commercial package's predictions were compared to experimental point source data and to predictions from Monte Carlo simulations. It was found that the software adequately predicted the counting efficiencies of a point source geometry to values derived from Monte Carlo simulations and experimental work. Both the standing and seated counting geometries agreed sufficiently well that the commercial package could be used in the field. PMID:22739971

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

    SciTech Connect

    Duberstein, Corey A.; Downs, Janelle L.

    2008-11-06

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

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

    PubMed

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

    2016-06-01

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

  13. Evaluating Current Patterns of Assessment for Self-Harm in Emergency Departments, A Multicenter Study

    PubMed Central

    Caterino, Jeffrey M.; Sullivan, Ashley F.; Betz, Marian E.; Espinola, Janice A.; Miller, Ivan; Camargo, Carlos A.; Boudreaux, Edwin D.

    2013-01-01

    Objectives To describe self-harm assessment practices in U.S. emergency departments (EDs) and to identify predictors of being assessed. Methods This was a prospective observational cohort study of adults presenting to eight U.S. EDs. A convenience sample of adults presenting to the EDs during covered research shifts was entered into a study log. Self-harm assessment was defined as ED documentation of suicide attempt, suicidal ideation, or non-suicidal self-injury thoughts, behaviors, or both. Institution characteristics were compared relative to percentage assessed. To identify predictive patient characteristics, multivariable generalized linear models were created controlling for weekend presentation, time of presentation, age, sex, and race and ethnicity. Results Among 94,354 charts, self-harm assessment ranged from 3.5% to 31%, except for one outlying site at 95%. Overall, 26% were assessed (11% excluding the outlying site). Current self-harm was present in 2.7% of charts. Sites with specific self-harm assessment policies had higher assessment rates. In the complete model, adjusted risk ratios (aRR) for assessment included age ≥ 65 years (0.56, 95% CI = 0.35 to 0.92) and male sex (1.17, 95% CI = 1.10 to 1.26). There was an interaction between these variables in the smaller model (excluding outlying site), with males <65 years of age being more likely to be assessed (aRR 1.14, 95% CI = 1.02 to 1.37). Conclusions Emergency department assessment of self-harm was highly variable among institutions. Presence of specific assessment policies was associated with higher assessment rates. Assessment varied based upon patient characteristics. The identification of self-harm in 2.7% of ED patients indicates that a substantial proportion of current risk of self-harm may go unidentified, particularly in certain patient groups. PMID:24033624

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

    NASA Technical Reports Server (NTRS)

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

    1996-01-01

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

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

    PubMed

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

    2014-03-01

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

  16. An anatomically realistic temperature phantom for radiofrequency heating measurements

    PubMed Central

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

    2014-01-01

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

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

    PubMed Central

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

    2012-01-01

    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). PMID:22778559

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

    ERIC Educational Resources Information Center

    Ferrara, Barbara E.; Redemer, Merrill

    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…

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

    ERIC Educational Resources Information Center

    Rowold, Milam C.; And Others

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

  20. Evaluating applicants to a new emergency medicine residency program: subjective assessment of applicant characteristics

    PubMed Central

    Groke, Steven F.; Strate, Laura; Knapp, Stuart; Dawson, Matt; Stroud, Susan; Hartsell, Stephen; Davis, Virgil

    2010-01-01

    Background Because of the Accreditation Council for Graduate Medical Education (ACGME) and the Residency Review Committee (RRC) approval timelines, new residency programs cannot use Electronic Residency Application Service (ERAS) during their first year of applicants. Aim We sought to identify differences between program directors’ subjective ratings of applicants from an emergency medicine (EM) residency program’s first year (in which ERAS was not used) to their ratings of applicants the following year in which ERAS was used. Method The University of Utah Emergency Medicine Residency Program received approval from the ACGME in 2004. Applicants for the entering class of 2005 (year 1) did not use ERAS, submitting a separate application, while those applying for the following year (year 2) used ERAS. Residency program directors rated applicants using subjective components of their applications, assigning scores on scales from 0–10 or 0–5 (10 or 5 = highest score) for select components of the application. We retrospectively reviewed and compared these ratings between the 2 years of applicants. Results A total of 130 and 458 prospective residents applied during year 1 and year 2, respectively. Applicants were similar in average scores for research (1.65 vs. 1.81, scale 0–5, p = 0.329) and volunteer work (5.31 vs. 5.56, scale 0–10, p = 0.357). Year 1 applicants received higher scores for their personal statement (3.21 vs. 2.22, scale 0–5, p < 0.001), letters of recommendation (7.0 vs. 5.94, scale 0–10, p < 0.001), dean’s letter (3.5 vs. 2.7, scale 1–5, p < 0.001), and in their potential contribution to class characteristics (4.64 vs. 3.34, scale 0–10, p < 0.001). Conclusion While the number of applicants increased, the use of ERAS in a new residency program did not improve the overall subjective ratings of residency applicants. Year 1 applicants received higher scores for the written components of their applications and in their potential contributions to class characteristics. PMID:21373291

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

    USGS Publications Warehouse

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

    2014-01-01

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

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

    PubMed Central

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

    2015-01-01

    Introduction Clinicians and residency programs are increasing their use of social media (SM) websites for educational and promotional uses, yet little is known about the use of these sites by residents and faculty. The objective of the study is to assess patterns of SM use for personal and professional purposes among emergency medicine (EM) residents and faculty. Methods In this multi-site study, an 18-question survey was sent by e-mail to the residents and faculty in 14 EM programs and to the Council of Emergency Medicine Residency Directors (CORD) listserv via the online tool SurveyMonkey™. We compiled descriptive statistics, including assessment with the chi-square test or Fisher’s exact test. StatsDirect software (v 2.8.0, StatsDirect, Cheshire, UK) was used for all analyses. Results We received 1,314 responses: 63% of respondents were male, 40% were <30 years of age, 39% were between the ages 31 and 40, and 21% were older than 40. The study group consisted of 772 residents and 542 faculty members (15% were program directors, 21% were assistant or associate PDs, 45% were core faculty, and 19% held other faculty positions. Forty-four percent of respondents completed residency more than 10 years ago. Residents used SM markedly more than faculty for social interactions with family and friends (83% vs 65% [p<0.0001]), entertainment (61% vs 47% [p<0.0001]), and videos (42% vs 23% [p=0.0006]). Residents used Facebook™ and YouTube™ more often than faculty (86% vs 67% [p<0.001]; 53% vs 46% [p=0.01]), whereas residents used Twitter™ (19% vs 26% [p=0.005]) and LinkedIn™ (15% vs 32% [p<0.0001]) less than faculty. Overall, residents used SM sites more than faculty, notably in daily use (30% vs 24% [p<0.001]). For professional use, residents were most interested in its use for open positions/hiring (30% vs 18% [p<0.0001]) and videos (33% vs 26% [p=0.005]) and less interested than faculty with award postings (22% vs 33% [p<0.0001]) or publications (30% vs 38% [p=0.0007]). Conclusion EM residents and faculty have different patterns and interests in the personal and professional uses of social media. Awareness of these utilization patterns could benefit future educational endeavors. PMID:26587096

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

    PubMed Central

    Gomez, Carles; Oller, Joaquim; Paradells, Josep

    2012-01-01

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

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

    PubMed

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

    2013-01-01

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

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

    PubMed Central

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

    2016-01-01

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

  6. Realistic molecular model of kerogen's nanostructure

    NASA Astrophysics Data System (ADS)

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

    2016-05-01

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

  7. The Challenge of Realistic TPV System Modeling

    NASA Astrophysics Data System (ADS)

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

    2003-01-01

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

  8. Spectral tunability of realistic plasmonic nanoantennas

    SciTech Connect

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

    2014-09-01

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

  9. Realistic molecular model of kerogen's nanostructure.

    PubMed

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

    2016-05-01

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

  10. Spatially realistic theory of metapopulation ecology.

    PubMed

    Hanski, I

    2001-09-01

    Much of spatial ecology since the late 1960s has been dominated by two theories, the dynamic theory of island biogeography and the classical metapopulation theory. The latter theory largely replaced the former one in the 1980s, especially in conservation applications. It is only recently that ecologists have fully realized that a relatively simple general theory can be readily constructed that makes some of the simplifying assumptions of the two earlier theories unnecessary. The spatially realistic metapopulation theory thereby provides a more unified framework for spatial ecology than the island theory or the classical metapopulation theory. This article describes the application of the spatially realistic metapopulation theory to real metapopulations living in highly fragmented landscapes. I discuss the principal messages for population ecology and conservation biology, and I also place this theory into a broader context of other approaches to spatial ecology. PMID:11688412

  11. Imaging acute complications in cancer patients: what should be evaluated in the emergency setting?

    PubMed Central

    2014-01-01

    Increased incidence world-wide of cancer and increased survival has also resulted in physicians seeing more complications in patients with cancer. In many cases, complications are the first manifestations of the disease. They may be insidious and develop over a period of months, or acute and manifest within minutes to days. Imaging examinations play an essential role in evaluating cancer and its complications. Plain radiography and ultrasonography (US) are generally performed initially in an urgent situation due to their wide availability, low cost, and minimal or no radiation exposure. However, depending on a patient’s symptoms, evaluation with cross-sectional imaging methods such as computed tomography (CT) and magnetic resonance imaging (MRI) is often necessary. In this review article, we discuss some of the most important acute noninfectious oncological complications for which imaging methods play an essential role in diagnosis. PMID:25609051

  12. PLATO Simulator: Realistic simulations of expected observations

    NASA Astrophysics Data System (ADS)

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

    2015-06-01

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

  13. Effective vaccination strategies for realistic social networks

    NASA Astrophysics Data System (ADS)

    Miller, Joel C.; Hyman, James M.

    2007-12-01

    We consider the effectiveness of targeted vaccination at preventing the spread of infectious disease in a realistic social network. We compare vaccination strategies based on no information (random vaccination) to complete information (PageRank) about the network. The most effective strategy we find is to vaccinate those people with the most unvaccinated contacts. However, this strategy requires considerable information and computational effort which may not be practical. The next best strategies vaccinate people with many contacts who in turn have few contacts.

  14. Dynamical Symmetries Reflected in Realistic Interactions

    SciTech Connect

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

    2007-04-06

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

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

    PubMed Central

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

    2013-01-01

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

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

    PubMed Central

    Morris, J; Vine, K; Grimmer, K

    2015-01-01

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

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

    PubMed

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

    2016-06-01

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

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

    PubMed Central

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

    2014-01-01

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

  19. Adult sexual assault evaluations at Rhode Island emergency departments, 1995-2001.

    PubMed

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

    2009-01-01

    The objectives of this study were to estimate the incidence and identify the temporal patterns of visits to Rhode Island emergency departments (EDs) by adults who were sexually assaulted. Visits to all Rhode Island EDs from January 1995-June 2001 by adults who were sexually assaulted were identified using International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9) codes. Medical records of these visits were reviewed. Frequency distributions of the assault characteristics and patient demographics were generated. Incidence rates (IRs) of ED visits after sexual assault were estimated using 2000 US Census data. Analyses of the temporal patterns of the ED visits after sexual assault were conducted. Of the 823 ED visits, 796 (96.7%) were by females and 27 (3.3%) were by males. The median age for females was 25 years (range, 18-96 years) and was 28 years (range, 18-87 years) for males. Among the female patients, 76.6% sustained a vaginal/anal assault. Among the male patients, 59.3% sustained an anal assault. The average annual IR of ED visits after sexual assault was 30.3/100,000/year for females and 1.2/100,000/year for males, which is a 25-fold greater incidence of these visits for females than males. ED visits after adult sexual assault were more frequent during warmer months and around 5 P.M. There was a gradual 43% increase in the IRs of ED visits after sexual assault over the 6.5-year period. These findings should help direct EDs to maximize supportive services when they are needed most often. PMID:18797994

  20. Dynamic apeerture in damping rings with realistic wigglers

    SciTech Connect

    Cai, Yunhai; /SLAC

    2005-05-04

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

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

    PubMed Central

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

    2014-01-01

    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 PMID:25018623

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

    SciTech Connect

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

    2009-04-01

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

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

    PubMed

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

    2016-07-01

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

  4. The consumer quality index (CQ-index) in an accident and emergency department: development and first evaluation

    PubMed Central

    2012-01-01

    Background Assessment of patients’ views are essential to provide a patient-centred health service and to evaluating quality of care. As no standardized and validated system for measuring patients’ experiences in accident and emergency departments existed, we have developed the Consumer Quality index for the accident and emergency department (CQI A&E). Methods Qualitative research has been undertaken to determine the content validity of the CQI A&E. In order to assess psychometric characteristics an 84-item questionnaire was sent to 653 patients who had attended a large A&E in the Netherlands. Also, fifty importance questions were added to determine relevance of the questions and for future calculations of improvement scores. Exploratory factor analysis was applied to detect the domains of the questionnaire. Results Survey data of 304 (47%) patients were used for the analysis. The first exploratory factor analysis resulted in three domains based on 13 items: ‘Attitude of the healthcare professionals’, ‘Environment and impression of the A&E’ and ‘Respect for and explanation to the patient’. The first two had an acceptable internal consistency. The second analysis, included 24 items grouped into 5 domains: ‘Attitude of the healthcare professionals’, ‘Information and explanation’, ‘Environment of the A&E’,’Leaving the A&E’ and ‘General information and rapidity of care’. All factors were internal consistent. According to the patients, the three most important aspects in healthcare performance in the A&E were: trust in the competence of the healthcare professionals, hygiene in the A&E and patients’ health care expectations. In general, the highest improvement scores concerned patient information. Conclusions The Consumer Quality index for the accident and emergency department measures patients’ experiences of A&E healthcare performance. Preliminary psychometric characteristics are sufficient to justify further research into reliability and validity. PMID:22929061

  5. Lung Emergencies

    MedlinePlus

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

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

    PubMed Central

    Liu, Wendi; Tang, Sanyi; Xiao, Yanni

    2015-01-01

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

  7. Technical and economic evaluation of emerging biomass pyrolysis processes for gasoline production

    NASA Astrophysics Data System (ADS)

    Wan, Edward I.; Fraser, Malcolm D.; Kwarteng, Isaac K.

    1987-11-01

    The technical and economic results are given of a recent evaluation of two advanced biomass-to-gasoline processes: a fast pyrolysis process in which wood pyrolyzate is upgraded via two-stage hydrotreating, and a flash ablative pyrolysis process in which pyrolyzate vapors are upgraded via deoxygenation over zeolite catalysts. The results indicate that gasoline can be produced from a 1000-tpd future biomass conversion plant via Georgia Tech's fast pyrolysis for about $0.86 to $1.07 per gallon of product at a potential yield of 91.6 gallons per ton (dry), and via SERI flash pyrolysis for about $0.94 to $1.13 per gallon at a yield of 65.5 gallons per ton (dry).

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

    PubMed

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

    2013-11-01

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

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

    PubMed Central

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

    2012-01-01

    Context An evidence base that addresses issues of complexity and context is urgently needed for large-system transformation (LST) and health care reform. Fundamental conceptual and methodological challenges also must be addressed. The Saskatchewan Ministry of Health in Canada requested a six-month synthesis project to guide four major policy development and strategy initiatives focused on patient- and family-centered care, primary health care renewal, quality improvement, and surgical wait lists. The aims of the review were to analyze examples of successful and less successful transformation initiatives, to synthesize knowledge of the underlying mechanisms, to clarify the role of government, and to outline options for evaluation. Methods We used realist review, whose working assumption is that a particular intervention triggers particular mechanisms of change. Mechanisms may be more or less effective in producing their intended outcomes, depending on their interaction with various contextual factors. We explain the variations in outcome as the interplay between context and mechanisms. We nested this analytic approach in a macro framing of complex adaptive systems (CAS). Findings Our rapid realist review identified five “simple rules” of LST that were likely to enhance the success of the target initiatives: (1) blend designated leadership with distributed leadership; (2) establish feedback loops; (3) attend to history; (4) engage physicians; and (5) include patients and families. These principles play out differently in different contexts affecting human behavior (and thereby contributing to change) through a wide range of different mechanisms. Conclusions Realist review methodology can be applied in combination with a complex system lens on published literature to produce a knowledge synthesis that informs a prospective change effort in large-system transformation. A collaborative process engaging both research producers and research users contributes to local applications of universal principles and mid-range theories, as well as to a more robust knowledge base for applied research. We conclude with suggestions for the future development of synthesis and evaluation methods. PMID:22985277

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

    PubMed

    Bibila, S; Rabiee, F

    2014-07-01

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

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

    PubMed Central

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

    2015-01-01

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

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

    ERIC Educational Resources Information Center

    O'Reilly, Daniel J.

    2011-01-01

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

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

    ERIC Educational Resources Information Center

    O'Reilly, Daniel J.

    2011-01-01

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

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

    PubMed

    Yasui, Shojiro

    2015-01-01

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

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

    PubMed Central

    2014-01-01

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

  16. Techniques of emergency ventilation: a model to evaluate tidal volume, airway pressure, and gastric insufflation.

    PubMed

    Johannigman, J A; Branson, R D; Davis, K; Hurst, J M

    1991-01-01

    We designed a model to evaluate the effectiveness of various noninvasive methods of ventilation. The upper airway was simulated with the head of a Resusci-Annie which was attached to a test lung. The esophagus and stomach were simulated with a Penrose drain connected to a rolling seal spirometer via a PEEP valve. Fifteen paramedic volunteers ventilated the model utilizing mouth-to-mouth, mouth-to-mask, bag-valve-mask, or portable field ventilator (Impact or HARV). Recording of tidal volume, gastric volume, and proximal and distal airway pressure was completed at three different levels of compliance. At normal compliance, all methods except the HARV met or exceeded American Heart Association standards. As compliance decreased, tidal volume fell and gastric insufflation increased. At a compliance of 0.02 L/cm H2O all methods failed to meet AHA standards and gastric insufflation volume equalled delivered tidal volumes for mouth-to-mouth and mouth-to-mask techniques. Mouth-to-mouth and mouth-to-mask techniques generated the largest tidal volumes but also created the largest volume of gastric insufflation. The Impact ventilator provided an acceptable tidal volume with minimal gastric insufflation. Our results suggest that mouth-to-mask ventilation with supplemental oxygen enrichment is the most efficient technique for non-invasive airway management. PMID:1986139

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

    PubMed

    Isaacson, Stuart H; Skettini, Julia

    2014-01-01

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

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

    PubMed

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

    2015-08-01

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

  19. Anderson localization for chemically realistic systems

    NASA Astrophysics Data System (ADS)

    Terletska, Hanna

    2015-03-01

    Disorder which is ubiquitous for most materials can strongly effect their properties. It may change their electronic structures or even cause their localization, known as Anderson localization. Although, substantial progress has been achieved in the description of the Anderson localization, a proper mean-field theory of this phenomenon for more realistic systems remains elusive. Commonly used theoretical methods such as the coherent potential approximation and its cluster extensions fail to describe the Anderson transition, as the average density of states (DOS) employed in such theories is not critical at the transition. However, near the transition, due to the spatial confinement of carriers, the local DOS becomes highly skewed with a log-normal distribution, for which the most probable and the typical values differ noticeably from the average value. Dobrosavljevic et.al., incorporated such ideas in their typical medium theory (TMT), and showed that the typical (not average) DOS is critical at the transition. While the TMT is able to capture the localized states, as a local single site theory it still has several drawbacks. For the disorder Anderson model in three dimension it underestimates the critical disorder strength, and fails to capture the re-entrance behavior of the mobility edge. We have recently developed a cluster extension of the TMT, which addresses these drawbacks by systematically incorporating non-local corrections. This approach converges quickly with cluster size and allows us to incorporate the effect of interactions and realistic electronic structure. As the first steps towards realistic material modeling, we extended our TMDCA formalisms to systems with the off diagonal disorder and multiple bands structures. We also applied our TMDCA scheme to systems with both disorder and interactions and found that correlations effects tend to stabilize the metallic behavior even in two dimensions. This work was supported by DOE SciDAC Grant No. DE-FC02-10ER25916 and BES CMCSN Grant No. DE-AC02-98CH10886.

  20. A realistic renormalizable supersymmetric E₆ model

    SciTech Connect

    Bajc, Borut; Susič, Vasja

    2014-01-01

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

  1. Quantum states prepared by realistic entanglement swapping

    SciTech Connect

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

    2009-12-15

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

  2. Adiabatic Hyperspherical Analysis of Realistic Nuclear Potentials

    NASA Astrophysics Data System (ADS)

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

    2015-12-01

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

  3. A realistic renormalizable supersymmetric E6 model

    NASA Astrophysics Data System (ADS)

    Bajc, Borut; Susič, Vasja

    2014-06-01

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

  4. Realistic DMFT calculations for nickelate superlattices

    NASA Astrophysics Data System (ADS)

    Han, M. J.; Wang, Xin; Marianetti, Chris A.; Millis, Andrew J.

    2011-03-01

    We present phase diagram, photo-emission and RIXS (resonant inelastic X-ray scattering) spectra, orbital polarization, and Fermi surface plots for LaNiO3/LaXO3 superlattice (X=Al, Ga,...) obtained from DMFT (dynamical mean-field theory) calculation based on a realistic multi-band tight-binding model derived from DFT (density functional theory) calculations and in particular including oxygen orbitals. Our results indicate that heterostructuring is unlikely to produce one band model physics and point toward a new view of metal-insulator transition of this system. This work is supported by ARO via grant No. W911NF0910345-56032PH.

  5. Any realistic model of a physical system must be computationally realistic

    NASA Astrophysics Data System (ADS)

    Bolotin, A.

    2015-01-01

    It is argued that any possible definition of a realistic physics theory - i.e., a mathematical model representing the real world - cannot be considered comprehensive unless it is supplemented with requirement of being computationally realistic. That is, the mathematical structure of a realistic model of a physical system must allow the collection of all the system's physical quantities to compute all possible measurement outcomes on some computational device not only in an unambiguous way but also in a reasonable amount of time. In the paper, it is shown that a deterministic quantum model of a microscopic system evolving in isolation should be regarded as realistic since the NP-hard problem of finding the exact solution to the Schrödinger equation for an arbitrary physical system can be surely solved in a reasonable amount of time in the case, in which the system has just a small number of degrees of freedom. In contrast to this, the deterministic quantum model of a truly macroscopic object ought to be considered as non-realistic since in a world of limited computational resources the intractable problem possessing that enormous amount of degrees of freedom would be the same as mere unsolvable.

  6. Organization, execution and evaluation of the 2014 Academic Emergency Medicine consensus conference on Gender-Specific Research in Emergency Care - an executive summary.

    PubMed

    Safdar, Basmah; Greenberg, Marna R

    2014-12-01

    With the goal of reducing inequalities in patient care, the 2014 Academic Emergency Medicine (AEM) consensus conference, "Gender-Specific Research in Emergency Care: Investigate, Understand, and Translate How Gender Affects Patient Outcomes," convened a diverse group of researchers, clinicians, health care providers, patients, and representatives of federal agencies and policy-makers in Dallas, Texas, in May 2014. The executive and steering committees identified seven clinical domains as key to gender-specific emergency care: cardiovascular, neurological, trauma/injury, substance abuse, pain, mental health, and diagnostic imaging. The main aims of the conference were to: 1) summarize and consolidate current data related to sex- and gender-specific research for acute care and identify critical gender-related gaps in knowledge to inform an EM research agenda; 2) create a consensus-driven research agenda that advances sex- and gender-specific research in the prevention, diagnosis, and management of acute diseases and identify strategies to investigate them; and 3) build a multinational interdisciplinary consortium to disseminate and study the sex and gender medicine of acute conditions. Over a 2-year period, this collaborative network of stakeholders identified key areas where sex- and gender-specific research is most likely to improve clinical care and ultimately patient outcomes. The iterative consensus process culminated in a daylong conference on May 13, 2014, with a total of 133 registrants, with the majority being between ages 31 and 50 years (57%), females (71%), and whites (79%). Content experts led the consensus-building workshops at the conference and used the nominal group technique to consolidate consensus recommendations for priority research. In addition, panel sessions addressed funding mechanisms for gender-specific research as well as gender-specific regulatory challenges to product development and approval. This special issue of AEM reports the results of the 2014 consensus conference as well as related original research with the goal of bringing high-quality equitable care to male and female emergency patients. PMID:25420469

  7. Barotropic stability of realistic stratospheric jets

    NASA Technical Reports Server (NTRS)

    Manney, Gloria L.; Nathan, Terrence R.; Stanford, John L.

    1988-01-01

    The stability of realistic jets is examined in a linearized barotropic model on a sphere. Approximately non-dispersive modes associated with a region of negative basic state absolute vorticity gradient on the poleward side of the jet are examined in detail. As in previous studies, broader jets and those which peak at higher latitudes produce poleward modes that are less dispersive. Jet profiles derived from observational data at 10, 5, and 2 mb for three Southern Hemisphere winter months are used in the model, and the results are compared with quasi-nondispersive features (QNDF) which have been observed in satellite data in the Southern Hemisphere winter stratosphere. Characteristics of the barotropically unstable modes compare remarkably well with those of the observed modes. The barotropic model results for a month in which these features are not observed indicate the presence of equatorward modes at wavenumbers 3 and 4 which grow considerably faster than the quasi-nondispersive poleward modes. The appearance of westward moving modes in the summer hemisphere during June and in analytical profiles with a realistic global structure is also noted.

  8. TMS modeling toolbox for realistic simulation.

    PubMed

    Cho, Young Sun; Suh, Hyun Sang; Lee, Won Hee; Kim, Tae-Seong

    2010-01-01

    Transcranial magnetic stimulation (TMS) is a technique for brain stimulation using rapidly changing magnetic fields generated by coils. It has been established as an effective stimulation technique to treat patients suffering from damaged brain functions. Although TMS is known to be painless and noninvasive, it can also be harmful to the brain by incorrect focusing and excessive stimulation which might result in seizure. Therefore there is ongoing research effort to elucidate and better understand the effect and mechanism of TMS. Lately Boundary element method (BEM) and Finite element method (FEM) have been used to simulate the electromagnetic phenomenon of TMS. However, there is a lack of general tools to generate the models of TMS due to some difficulties in realistic modeling of the human head and TMS coils. In this study, we have developed a toolbox through which one can generate high-resolution FE TMS models. The toolbox allows creating FE models of the head with isotropic and anisotropic electrical conductivities in five different tissues of the head and the coils in 3D. The generated TMS model is importable to FE software packages such as ANSYS for further and efficient electromagnetic analysis. We present a set of demonstrative results of realistic simulation of TMS with our toolbox. PMID:21095745

  9. Syncope: Assessment of risk and an approach to evaluation in the emergency department and urgent care clinic☆

    PubMed Central

    Akdemir, Baris; Krishnan, Balaji; Senturk, Tunay; Benditt, David G.

    2015-01-01

    Syncope is among the most frequent forms of transient loss of consciousness (TLOC), and is characterized by a relatively brief and self-limited loss of consciousness that by definition is triggered by transient cerebral hypoperfusion. Most often, syncope is caused by a temporary drop of systemic arterial pressure below that required to maintain cerebral function, but brief enough not to cause permanent structural brain injury. Currently, approximately one-third of syncope/collapse patients seen in the emergency department (ED) or urgent care clinic are admitted to hospital for evaluation. The primary objective of developing syncope/TLOC risk stratification schemes is to provide guidance regarding the immediate prognostic risk of syncope patients presenting to the ED or clinic; thereafter, based on that risk assessment physicians may be better equipped to determine which patients can be safely evaluated as outpatients, and which require hospital care. In general, the need for hospitalization is determined by several key issues: i) the patient's immediate (usually considered 1 week to 1 month) mortality risk and risk for physical injury (e.g., falls risk), ii) the patient's ability to care for him/herself, and iii) whether certain treatments inherently require in-hospital initiation (e.g., pacemaker implantation). However, at present no single risk assessment protocol appears to be satisfactory for universal application, and development of a consensus recommendation is an essential next step. PMID:26937094

  10. Realistic Mobility Modeling for Vehicular Ad Hoc Networks

    NASA Astrophysics Data System (ADS)

    Akay, Hilal; Tugcu, Tuna

    2009-08-01

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

  11. Evaluating legacy contaminants and emerging chemicals in marine environments using adverse outcome pathways and biological effects-directed analysis.

    PubMed

    Hutchinson, Thomas H; Lyons, Brett P; Thain, John E; Law, Robin J

    2013-09-30

    Natural and synthetic chemicals are essential to our daily lives, food supplies, health care, industries and safe sanitation. At the same time protecting marine ecosystems and seafood resources from the adverse effects of chemical contaminants remains an important issue. Since the 1970s, monitoring of persistent, bioaccumulative and toxic (PBT) chemicals using analytical chemistry has provided important spatial and temporal trend data in three important contexts; relating to human health protection from seafood contamination, addressing threats to marine top predators and finally providing essential evidence to better protect the biodiversity of commercial and non-commercial marine species. A number of regional conventions have led to controls on certain PBT chemicals over several years (termed 'legacy contaminants'; e.g. cadmium, lindane, polycyclic aromatic hydrocarbons [PAHs] and polychlorinated biphenyls [PCBs]). Analytical chemistry plays a key role in evaluating to what extent such regulatory steps have been effective in leading to reduced emissions of these legacy contaminants into marine environments. In parallel, the application of biomarkers (e.g. DNA adducts, CYP1A-EROD, vitellogenin) and bioassays integrated with analytical chemistry has strengthened the evidence base to support an ecosystem approach to manage marine pollution problems. In recent years, however,the increased sensitivity of analytical chemistry, toxicity alerts and wider environmental awareness has led to a focus on emerging chemical contaminants (defined as chemicals that have been detected in the environment, but which are currently not included in regulatory monitoring programmes and whose fate and biological impacts are poorly understood). It is also known that natural chemicals (e.g. algal biotoxins) may also pose a threat to marine species and seafood quality. Hence complex mixtures of legacy contaminants, emerging chemicals and natural biotoxins in marine ecosystems represent important scientific, economic and health challenges. In order to meet these challenges and pursue cost-effective scientific approaches that can provide evidence necessary to support policy needs (e.g. the European Marine Strategy Framework Directive), it is widely recognised that there is a need to (i) provide marine exposure assessments for priority contaminants using a range of validated models, passive samplers and biomarkers; (ii) integrate chemical monitoring data with biological effects data across spatial and temporal scales (including quality controls); and (iii) strengthen the evidence base to understand the relationship between exposure to complex chemical mixtures, biological and ecological impacts through integrated approaches and molecular data (e.g. genomics, proteomics and metabolomics). Additionally, we support the widely held view that (iv) that rather than increasing the analytical chemistry monitoring of large number of emerging contaminants, it will be important to target analytical chemistry towards key groups of chemicals of concern using effects-directed analysis. It is also important to evaluate to what extent existing biomarkers and bioassays can address various classes of emerging chemicals using the adverse outcome pathway (AOP) approach now being developed by the Organization for Economic Cooperation and Development (OECD) with respect to human toxicology and ecotoxicology. PMID:23820191

  12. Evaluation of Publicly Financed and Privately Delivered Model of Emergency Referral Services for Maternal and Child Health Care in India

    PubMed Central

    Prinja, Shankar; Bahuguna, Pankaj; Lakshmi, P. V. M.; Mokashi, Tushar; Aggarwal, Arun Kumar; Kaur, Manmeet; Reddy, K. Rahul; Kumar, Rajesh

    2014-01-01

    Background Emergency referral services (ERS) are being strengthened in India to improve access for institutional delivery. We evaluated a publicly financed and privately delivered model of ERS in Punjab state, India, to assess its extent and pattern of utilization, impact on institutional delivery, quality and unit cost. Methods Data for almost 0.4 million calls received from April 2012 to March 2013 was analysed to assess the extent and pattern of utilization. Segmented linear regression was used to analyse month-wise data on number of institutional deliveries in public sector health facilities from 2008 to 2013. We inspected ambulances in 2 districts against the Basic Life Support (BLS) standards. Timeliness of ERS was assessed for determining quality. Finally, we computed economic cost of implementing ERS from a health system perspective. Results On an average, an ambulance transported 3–4 patients per day. Poor and those farther away from the health facility had a higher likelihood of using the ambulance. Although the ERS had an abrupt positive effect on increasing the institutional deliveries in the unadjusted model, there was no effect on institutional delivery after adjustment for autocorrelation. Cost of operating the ambulance service was INR 1361 (USD 22.7) per patient transported or INR 21 (USD 0.35) per km travelled. Conclusion Emergency referral services in Punjab did not result in a significant change in public sector institutional deliveries. This could be due to high baseline coverage of institutional delivery and low barriers to physical access. Choice of interventions for reduction in Maternal Mortality Ratio (MMR) should be context-specific to have high value for resources spent. The ERS in Punjab needs improvement in terms of quality and reduction of cost to health system. PMID:25360798

  13. Toward more realistic drug–target interaction predictions

    PubMed Central

    Pahikkala, Tapio; Airola, Antti; Pietilä, Sami; Shakyawar, Sushil; Szwajda, Agnieszka; Tang, Jing

    2015-01-01

    A number of supervised machine learning models have recently been introduced for the prediction of drug–target interactions based on chemical structure and genomic sequence information. Although these models could offer improved means for many network pharmacology applications, such as repositioning of drugs for new therapeutic uses, the prediction models are often being constructed and evaluated under overly simplified settings that do not reflect the real-life problem in practical applications. Using quantitative drug–target bioactivity assays for kinase inhibitors, as well as a popular benchmarking data set of binary drug–target interactions for enzyme, ion channel, nuclear receptor and G protein-coupled receptor targets, we illustrate here the effects of four factors that may lead to dramatic differences in the prediction results: (i) problem formulation (standard binary classification or more realistic regression formulation), (ii) evaluation data set (drug and target families in the application use case), (iii) evaluation procedure (simple or nested cross-validation) and (iv) experimental setting (whether training and test sets share common drugs and targets, only drugs or targets or neither). Each of these factors should be taken into consideration to avoid reporting overoptimistic drug–target interaction prediction results. We also suggest guidelines on how to make the supervised drug–target interaction prediction studies more realistic in terms of such model formulations and evaluation setups that better address the inherent complexity of the prediction task in the practical applications, as well as novel benchmarking data sets that capture the continuous nature of the drug–target interactions for kinase inhibitors. PMID:24723570

  14. 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 ...

  15. Standardized Patients Provide Realistic and Worthwhile Experiences for Athletic Training Students

    ERIC Educational Resources Information Center

    Walker, Stacy E.; Weidner, Thomas G.

    2010-01-01

    Context: Standardized patients are more prominently used to both teach and evaluate students' clinical skills and abilities. Objective: To investigate whether athletic training students perceived an encounter with a standardized patient (SP) as realistic and worthwhile and to determine their perceived comfort in future lower extremity evaluations

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

    ERIC Educational Resources Information Center

    Drake, Jennifer E.; Winner, Ellen

    2010-01-01

    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…

  17. Modeling and Analysis of Realistic Fire Scenarios in Spacecraft

    NASA Technical Reports Server (NTRS)

    Brooker, J. E.; Dietrich, D. L.; Gokoglu, S. A.; Urban, D. L.; Ruff, G. A.

    2015-01-01

    An accidental fire inside a spacecraft is an unlikely, but very real emergency situation that can easily have dire consequences. While much has been learned over the past 25+ years of dedicated research on flame behavior in microgravity, a quantitative understanding of the initiation, spread, detection and extinguishment of a realistic fire aboard a spacecraft is lacking. Virtually all combustion experiments in microgravity have been small-scale, by necessity (hardware limitations in ground-based facilities and safety concerns in space-based facilities). Large-scale, realistic fire experiments are unlikely for the foreseeable future (unlike in terrestrial situations). Therefore, NASA will have to rely on scale modeling, extrapolation of small-scale experiments and detailed numerical modeling to provide the data necessary for vehicle and safety system design. This paper presents the results of parallel efforts to better model the initiation, spread, detection and extinguishment of fires aboard spacecraft. The first is a detailed numerical model using the freely available Fire Dynamics Simulator (FDS). FDS is a CFD code that numerically solves a large eddy simulation form of the Navier-Stokes equations. FDS provides a detailed treatment of the smoke and energy transport from a fire. The simulations provide a wealth of information, but are computationally intensive and not suitable for parametric studies where the detailed treatment of the mass and energy transport are unnecessary. The second path extends a model previously documented at ICES meetings that attempted to predict maximum survivable fires aboard space-craft. This one-dimensional model implies the heat and mass transfer as well as toxic species production from a fire. These simplifications result in a code that is faster and more suitable for parametric studies (having already been used to help in the hatch design of the Multi-Purpose Crew Vehicle, MPCV).

  18. Helioseismology of a Realistic Magnetoconvective Sunspot Simulation

    NASA Technical Reports Server (NTRS)

    Braun, D. C.; Birch, A. C.; Rempel, M.; Duvall, T. L., Jr.

    2012-01-01

    We compare helioseismic travel-time shifts measured from a realistic magnetoconvective sunspot simulation using both helioseismic holography and time-distance helioseismology, and measured from real sunspots observed with the Helioseismic and Magnetic Imager instrument on board the Solar Dynamics Observatory and the Michelson Doppler Imager instrument on board the Solar and Heliospheric Observatory. We find remarkable similarities in the travel-time shifts measured between the methodologies applied and between the simulated and real sunspots. Forward modeling of the travel-time shifts using either Born or ray approximation kernels and the sound-speed perturbations present in the simulation indicates major disagreements with the measured travel-time shifts. These findings do not substantially change with the application of a correction for the reduction of wave amplitudes in the simulated and real sunspots. Overall, our findings demonstrate the need for new methods for inferring the subsurface structure of sunspots through helioseismic inversions.

  19. Probabilistic infrasound propagation using realistic atmospheric perturbations

    NASA Astrophysics Data System (ADS)

    Smets, P. S. M.; Evers, L. G.; Näsholm, S. P.; Gibbons, S. J.

    2015-08-01

    This study demonstrates probabilistic infrasound propagation modeling using realistic perturbations. The ensembles of perturbed analyses, provided by the European Centre for Medium-Range Weather Forecasts (ECMWF), include error variances of both model and assimilated observations. Ensemble spread profiles indicate a yearly mean effective sound speed variation of up to 8 ms-1 in the stratosphere, exceeding occasionally 25 ms-1 for a single ensemble set. It is shown that errors in point estimates of effective sound speed are dominated by variations in wind strength and direction. One year of large mining explosions in the Aitik mine, northern Sweden, observed at infrasound array IS37 in northern Norway are simulated using 3-D ray tracing. Probabilistic propagation modeling using the ensembles demonstrates that small-scale fluctuations are not always necessary to improve the match between predictions and observations.

  20. HELIOSEISMOLOGY OF A REALISTIC MAGNETOCONVECTIVE SUNSPOT SIMULATION

    SciTech Connect

    Braun, D. C.; Birch, A. C.; Rempel, M.; Duvall, T. L. Jr. E-mail: aaronb@cora.nwra.com E-mail: Thomas.L.Duvall@nasa.gov

    2012-01-01

    We compare helioseismic travel-time shifts measured from a realistic magnetoconvective sunspot simulation using both helioseismic holography and time-distance helioseismology, and measured from real sunspots observed with the Helioseismic and Magnetic Imager instrument on board the Solar Dynamics Observatory and the Michelson Doppler Imager instrument on board the Solar and Heliospheric Observatory. We find remarkable similarities in the travel-time shifts measured between the methodologies applied and between the simulated and real sunspots. Forward modeling of the travel-time shifts using either Born or ray approximation kernels and the sound-speed perturbations present in the simulation indicates major disagreements with the measured travel-time shifts. These findings do not substantially change with the application of a correction for the reduction of wave amplitudes in the simulated and real sunspots. Overall, our findings demonstrate the need for new methods for inferring the subsurface structure of sunspots through helioseismic inversions.

  1. Realistic page-turning of electronic books

    NASA Astrophysics Data System (ADS)

    Fan, Chaoran; Li, Haisheng; Bai, Yannan

    2014-01-01

    The booming electronic books (e-books), as an extension to the paper book, are popular with readers. Recently, many efforts are put into the realistic page-turning simulation o f e-book to improve its reading experience. This paper presents a new 3D page-turning simulation approach, which employs piecewise time-dependent cylindrical surfaces to describe the turning page and constructs smooth transition method between time-dependent cylinders. The page-turning animation is produced by sequentially mapping the turning page into the cylinders with different radii and positions. Compared to the previous approaches, our method is able to imitate various effects efficiently and obtains more natural animation of turning page.

  2. Simulating realistic predator signatures in quantitative fatty acid signature analysis

    USGS Publications Warehouse

    Bromaghin, Jeffrey F.

    2015-01-01

    Diet estimation is an important field within quantitative ecology, providing critical insights into many aspects of ecology and community dynamics. Quantitative fatty acid signature analysis (QFASA) is a prominent method of diet estimation, particularly for marine mammal and bird species. Investigators using QFASA commonly use computer simulation to evaluate statistical characteristics of diet estimators for the populations they study. Similar computer simulations have been used to explore and compare the performance of different variations of the original QFASA diet estimator. In both cases, computer simulations involve bootstrap sampling prey signature data to construct pseudo-predator signatures with known properties. However, bootstrap sample sizes have been selected arbitrarily and pseudo-predator signatures therefore may not have realistic properties. I develop an algorithm to objectively establish bootstrap sample sizes that generates pseudo-predator signatures with realistic properties, thereby enhancing the utility of computer simulation for assessing QFASA estimator performance. The algorithm also appears to be computationally efficient, resulting in bootstrap sample sizes that are smaller than those commonly used. I illustrate the algorithm with an example using data from Chukchi Sea polar bears (Ursus maritimus) and their marine mammal prey. The concepts underlying the approach may have value in other areas of quantitative ecology in which bootstrap samples are post-processed prior to their use.

  3. UAV based distributed ATR under realistic simulated environmental effects

    NASA Astrophysics Data System (ADS)

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

    2007-04-01

    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.

  4. Electron percolation in realistic models of carbon nanotube networks

    NASA Astrophysics Data System (ADS)

    Simoneau, Louis-Philippe; Villeneuve, Jérémie; Rochefort, Alain

    2015-09-01

    The influence of penetrable and curved carbon nanotubes (CNT) on the charge percolation in three-dimensional disordered CNT networks have been studied with Monte-Carlo simulations. By considering carbon nanotubes as solid objects but where the overlap between their electron cloud can be controlled, we observed that the structural characteristics of networks containing lower aspect ratio CNT are highly sensitive to the degree of penetration between crossed nanotubes. Following our efficient strategy to displace CNT to different positions to create more realistic statistical models, we conclude that the connectivity between objects increases with the hard-core/soft-shell radii ratio. In contrast, the presence of curved CNT in the random networks leads to an increasing percolation threshold and to a decreasing electrical conductivity at saturation. The waviness of CNT decreases the effective distance between the nanotube extremities, hence reducing their connectivity and degrading their electrical properties. We present the results of our simulation in terms of thickness of the CNT network from which simple structural parameters such as the volume fraction or the carbon nanotube density can be accurately evaluated with our more realistic models.

  5. Demonstrating a Realistic IP Mission Prototype

    NASA Technical Reports Server (NTRS)

    Rash, James; Ferrer, Arturo B.; Goodman, Nancy; Ghazi-Tehrani, Samira; Polk, Joe; Johnson, Lorin; Menke, Greg; Miller, Bill; Criscuolo, Ed; Hogie, Keith

    2003-01-01

    Flight software and hardware and realistic space communications environments were elements of recent demonstrations of the Internet Protocol (IP) mission concept in the lab. The Operating Missions as Nodes on the Internet (OMNI) Project and the Flight Software Branch at NASA/GSFC collaborated to build the prototype of a representative space mission that employed unmodified off-the-shelf Internet protocols and technologies for end-to-end communications between the spacecraft/instruments and the ground system/users. The realistic elements used in the prototype included an RF communications link simulator and components of the TRIANA mission flight software and ground support system. A web-enabled camera connected to the spacecraft computer via an Ethernet LAN represented an on-board instrument creating image data. In addition to the protocols at the link layer (HDLC), transport layer (UDP, TCP), and network (IP) layer, a reliable file delivery protocol (MDP) at the application layer enabled reliable data delivery both to and from the spacecraft. The standard Network Time Protocol (NTP) performed on-board clock synchronization with a ground time standard. The demonstrations of the prototype mission illustrated some of the advantages of using Internet standards and technologies for space missions, but also helped identify issues that must be addressed. These issues include applicability to embedded real-time systems on flight-qualified hardware, range of applicability of TCP, and liability for and maintenance of commercial off-the-shelf (COTS) products. The NASA Earth Science Technology Office (ESTO) funded the collaboration to build and demonstrate the prototype IP mission.

  6. Compact entanglement distillery using realistic quantum memories

    NASA Astrophysics Data System (ADS)

    Chakhmakhchyan, Levon; Guérin, Stéphane; Nunn, Joshua; Datta, Animesh

    2013-10-01

    We adopt the beam-splitter model for losses to analyze the performance of a recent compact continuous-variable entanglement distillation protocol [A. Datta , Phys. Rev. Lett.PRLTAO0031-900710.1103/PhysRevLett.108.060502 108, 060502 (2012)] implemented using realistic quantum memories. We show that the decoherence undergone by a two-mode squeezed state while stored in a quantum memory can strongly modify the results of the preparatory step of the protocol. We find that the well-known method for locally increasing entanglement, phonon subtraction, may not result in entanglement gain when losses are taken into account. Thus, we investigate the critical number mc of phonon subtraction attempts from the matter modes of the quantum memory. If the initial state is not de-Gaussified within mc attempts, the protocol should be restarted to obtain any entanglement increase. Moreover, the condition mc>1 implies an additional constraint on the subtraction beam-splitter interaction transmissivity, viz., it should be about 50% for a wide range of protocol parameters. Additionally, we consider the average entanglement rate, which takes into account both the unavoidable probabilistic nature of the protocol and its possible failure as a result of a large number of unsuccessful subtraction attempts. We find that a higher value of the average entanglement can be achieved by increasing the subtraction beam-splitter interaction transmissivity. We conclude that the compact distillation protocol with the practical constraints coming from realistic quantum memories allows a feasible experimental realization within existing technologies.

  7. Two Realistic Beagle Models for Dose Assessment.

    PubMed

    Stabin, Michael G; Kost, Susan D; Segars, William P; Guilmette, Raymond A

    2015-09-01

    Previously, the authors developed a series of eight realistic digital mouse and rat whole body phantoms based on NURBS technology to facilitate internal and external dose calculations in various species of rodents. In this paper, two body phantoms of adult beagles are described based on voxel images converted to NURBS models. Specific absorbed fractions for activity in 24 organs are presented in these models. CT images were acquired of an adult male and female beagle. The images were segmented, and the organs and structures were modeled using NURBS surfaces and polygon meshes. Each model was voxelized at a resolution of 0.75 × 0.75 × 2 mm. The voxel versions were implemented in GEANT4 radiation transport codes to calculate specific absorbed fractions (SAFs) using internal photon and electron sources. Photon and electron SAFs were then calculated for relevant organs in both models. The SAFs for photons and electrons were compatible with results observed by others. Absorbed fractions for electrons for organ self-irradiation were significantly less than 1.0 at energies above 0.5 MeV, as expected for many of these small-sized organs, and measurable cross irradiation was observed for many organ pairs for high-energy electrons (as would be emitted by nuclides like 32P, 90Y, or 188Re). The SAFs were used with standardized decay data to develop dose factors (DFs) for radiation dose calculations using the RADAR Method. These two new realistic models of male and female beagle dogs will be useful in radiation dosimetry calculations for external or internal simulated sources. PMID:26222214

  8. A fully adaptive multiresolution algorithm for atrial arrhythmia simulation on anatomically realistic unstructured meshes.

    PubMed

    Cristoforetti, Alessandro; Mase, Michela; Ravelli, Flavia

    2013-09-01

    Biophysically detailed and anatomically realistic atrial models are emerging as a valuable tool in the study of atrial arrhythmias, nevertheless clinical use of these models would be favored by a reduction of computational times. This paper introduces a novel adaptive mesh algorithm, based on multiresolution representation (MR), for the efficient integration of cardiac ordinary differential equation (ODE)-partial differential equation (PDE) systems on unstructured triangle meshes. The algorithm applies a dynamically adapted node-centered finite volume method (FVM) scheme for integration of diffusion. The method accuracy and efficiency were evaluated by simulating propagation scenarios of increasing complexity levels (pacing, stable spirals, atrial fibrillation) on tomography-derived three-dimensional monolayer atrial models, based on a monodomain reaction-diffusion formulation coupled with the Courtemanche atrial ionic model. All simulated propagation patterns were accurately reproduced with substantially reduced computational times (10%-30% of the full-resolution simulation time). The proposed algorithm, combining the MR computational efficiency with the geometrical flexibility of unstructured meshes, may favor the development of patient-specific multiscale models of atrial arrhythmias and their application in the clinical setting. PMID:23674407

  9. Emergence delirium.

    PubMed

    Munk, Louise; Andersen, Lars Peter Holst; Ggenur, Ismail

    2013-11-01

    Emergence delirium (ED) is a well-known phenomenon in the postoperative period. However, the literature concerning this clinical problem is limited. This review evaluates the literature with respect to epidemiology and risk factors. Treatment strategies are discussed. The review concludes that there is a need for guidelines concerning diagnosis and treatment of ED. Risk factors should be investigated further in the clinical setting in the future. PMID:24312995

  10. Parallel Quality Assessment of Emergency Departments by European Foundation for Quality Management Model and Iranian National Program for Hospital Evaluation

    PubMed Central

    IMANI NASAB, Mohammad Hasan; MOHAGHEGH, Bahram; KHALESI, Nader; JAAFARIPOOYAN, Ebrahim

    2013-01-01

    Background European Foundation for Quality Management (EFQM) model is a widely used quality management system (QMS) worldwide, including Iran. Current study aims to verify the quality assessment results of Iranian National Program for Hospital Evaluation (INPHE) based on those of EFQM. Methods: This cross-sectional study was conducted in 2012 on a sample of emergency departments (EDs) affiliated with Tehran University of Medical Sciences (TUMS), Iran. The standard questionnaire of EFQM (V-2010) was used to gather appropriate data. The results were compared with those of INPHE. MS Excel was used to classify and display the findings. Results: The average assessment score of the EDs based on the INPHE and EFQM model were largely different (i.e. 86.4% and 31%, respectively). In addition, the variation range among five EDs’ scores according to each model was also considerable (22% for EFQM against 7% of INPHE), especially in the EDs with and without prior record of applying QMSs. Conclusion: The INPHE’s assessment results were not confirmed by EFQM model. Moreover, the higher variation range among EDs’ scores using EFQM model could allude to its more differentiation power in assessing the performance comparing with INPHE. Therefore, a need for improvement in the latter drawing on other QMSs’ (such as EFQM) strengths, given the results emanated from its comparison with EFQM seems indispensable. PMID:23967429

  11. Use of the SONET Score to Evaluate High Volume Emergency Department Overcrowding: A Prospective Derivation and Validation Study

    PubMed Central

    Wang, Hao; Robinson, Richard D.; Garrett, John S.; Bunch, Kellie; Huggins, Charles A.; Watson, Katherine; Daniels, Joni; Banks, Brett; D'Etienne, James P.; Zenarosa, Nestor R.

    2015-01-01

    Background. The accuracy and utility of current Emergency Department (ED) crowding estimation tools remain uncertain in EDs with high annual volumes. We aimed at deriving a more accurate tool to evaluate overcrowding in a high volume ED setting and determine the association between ED overcrowding and patient care outcomes. Methods. A novel scoring tool (SONET: Severely overcrowded-Overcrowded-Not overcrowded Estimation Tool) was developed and validated in two EDs with both annual volumes exceeding 100,000. Patient care outcomes including the number of left without being seen (LWBS) patients, average length of ED stay, ED 72-hour returns, and mortality were compared under the different crowding statuses. Results. The total number of ED patients, the number of mechanically ventilated patients, and patient acuity levels were independent risk factors affecting ED overcrowding. SONET was derived and found to better differentiate severely overcrowded, overcrowded, and not overcrowded statuses with similar results validated externally. In addition, SONET scores correlated with increased length of ED stay, number of LWBS patients, and ED 72-hour returns. Conclusions. SONET might be a better fit to determine high volume ED overcrowding. ED overcrowding negatively impacts patient care operations and often produces poor patient perceptions of standardized care delivery. PMID:26167302

  12. The Use of Facial CT for the Evaluation of a Suspected Simple Dentoalveolar Abscess in the Emergency Department

    PubMed Central

    Shuaib, Waqas; Hashmi, Mariyam; Vijayasarathi, Arvind; Arunkumar, Jay; Tiwana, Sabeen; Khosa, Faisal

    2015-01-01

    Introduction Facial computed tomography (CT) is often performed in the emergency department as a part of the diagnostic workup for patients presenting with the signs and symptoms of dentoalveolar abscess (DA). This investigation evaluated the diagnostic yield of the facial CT and its effects on management change in patients suspected of DA. Furthermore, we assessed secondary consequences of routine facial CT use in this population by using turn-around time (TAT), cost, and radiation exposure as the key parameters. Material and Methods We retrospectively reviewed records of suspected DA patients over a 5-year period, from June 2008 to June 2013. TAT was calculated for patients from the time the examination was ordered by the emergency department physician, to the time the report was finalized by the attending radiologist. Effective radiation dose for facial CT was calculated by multiplying dose length product by the standard conversion coefficient K (K = 0.0021 mSv/mGy x cm). CT cost was included for reference but was not analyzed extensively due to the lack of standardization of costs across the various institutions. Results Our investigation consisted of 117 patients; 75 males of average age 41 (±12) years and 42 females of average age 44 (±17) years. Out of the total 117 patients that underwent CT for the suspicion of a simple DA, only a single individual (0.85%) underwent a management change. Mean TAT of facial CT was 110 (±63) minutes, and a median TAT was 87 (±71) minutes. Average effective radiation dose for a facial CT was 2.4 (±0.4) mSv. Approximate estimated cost of a contrast enhanced facial CT was $253 and non-contrast facial CT was $209. Conclusion Our study shows that routine use of facial CT has a very limited diagnostic value in the workup of simple DA and rarely results in management change. The overall impact on patient management is miniscule in the context of prolonged TAT, radiation exposure, and adding to the rising medical costs. PMID:25487236

  13. Evaluating and Measuring the Return on Investment of an Emergency Center Health Care Professional Picture Archiving and Communication Systems Training Program

    ERIC Educational Resources Information Center

    Roelandt, James P.

    2012-01-01

    Picture archiving and communication system (PACS) workflow directly affects the quality of emergency patient care through radiology exam turn-around times and the speed of delivery of diagnostic radiology results. This study was a mixed methods training and performance improvement study that evaluated the effectiveness and value of a hospital…

  14. 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...

  15. Evaluation of seed coating formulations of Trichoderma harzianum on cucumber seeds against pre- and post-emergence damping-off caused by Pythium ultimum

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Seed coating formulations of Trichoderma harzianum were evaluated on cucumber seeds to control pre- and post-emergence damping-off caused by Pythium ultimum in greenhouse studies. Results showed that coating formulation H reduced the disease incidence significantly, and had the potential for commer...

  16. Evaluating and Measuring the Return on Investment of an Emergency Center Health Care Professional Picture Archiving and Communication Systems Training Program

    ERIC Educational Resources Information Center

    Roelandt, James P.

    2012-01-01

    Picture archiving and communication system (PACS) workflow directly affects the quality of emergency patient care through radiology exam turn-around times and the speed of delivery of diagnostic radiology results. This study was a mixed methods training and performance improvement study that evaluated the effectiveness and value of a hospital

  17. Evaluation of natural language processing from emergency department computerized medical records for intra-hospital syndromic surveillance

    PubMed Central

    2011-01-01

    Background The identification of patients who pose an epidemic hazard when they are admitted to a health facility plays a role in preventing the risk of hospital acquired infection. An automated clinical decision support system to detect suspected cases, based on the principle of syndromic surveillance, is being developed at the University of Lyon's Hôpital de la Croix-Rousse. This tool will analyse structured data and narrative reports from computerized emergency department (ED) medical records. The first step consists of developing an application (UrgIndex) which automatically extracts and encodes information found in narrative reports. The purpose of the present article is to describe and evaluate this natural language processing system. Methods Narrative reports have to be pre-processed before utilizing the French-language medical multi-terminology indexer (ECMT) for standardized encoding. UrgIndex identifies and excludes syntagmas containing a negation and replaces non-standard terms (abbreviations, acronyms, spelling errors...). Then, the phrases are sent to the ECMT through an Internet connection. The indexer's reply, based on Extensible Markup Language, returns codes and literals corresponding to the concepts found in phrases. UrgIndex filters codes corresponding to suspected infections. Recall is defined as the number of relevant processed medical concepts divided by the number of concepts evaluated (coded manually by the medical epidemiologist). Precision is defined as the number of relevant processed concepts divided by the number of concepts proposed by UrgIndex. Recall and precision were assessed for respiratory and cutaneous syndromes. Results Evaluation of 1,674 processed medical concepts contained in 100 ED medical records (50 for respiratory syndromes and 50 for cutaneous syndromes) showed an overall recall of 85.8% (95% CI: 84.1-87.3). Recall varied from 84.5% for respiratory syndromes to 87.0% for cutaneous syndromes. The most frequent cause of lack of processing was non-recognition of the term by UrgIndex (9.7%). Overall precision was 79.1% (95% CI: 77.3-80.8). It varied from 81.4% for respiratory syndromes to 77.0% for cutaneous syndromes. Conclusions This study demonstrates the feasibility of and interest in developing an automated method for extracting and encoding medical concepts from ED narrative reports, the first step required for the detection of potentially infectious patients at epidemic risk. PMID:21798029

  18. Breast imaging after dark: patient outcomes following evaluation for breast abscess in the emergency department after hours.

    PubMed

    Bosma, Melissa S; Morden, Kasey L; Klein, Katherine A; Neal, Colleen H; Knoepp, Ursula S; Patterson, Stephanie K

    2016-02-01

    In our study, we sought to report the management, clinical outcomes, and follow-up rates of patients who presented for evaluation of breast abscess in the Emergency Department (ED) after hours. A retrospective search of ultrasound reports at our institution identified all patients from January 1, 2009 to June 30, 2013 who were scanned in the ED after hours to evaluate for breast abscess. Patient demographics, clinical information, imaging findings, follow-up rates, and outcomes were reviewed. One hundred eighty-five patients were included in the study. Forty-four percent (86/185) of the patients were diagnosed with abscess based on ultrasound findings in the ED. Twenty-seven percent (23/86) were recently post-operative, and 12 % (10/86) were postpartum/breastfeeding. Mastitis was the diagnosis in the remaining 54 % (99/185). Only 1/86 cases were associated with breast cancer. Seventy-seven percent (66/86) of patients were treated with an invasive procedure; 39 % (26/66) had surgical evacuation, 30 % (20/66) image-guided drainage, 23 % (15/66) bedside or clinic incision and drainage, and 8 % (5/66) palpation-guided fine needle aspiration (FNA). Seventy-seven percent (143/185) of patients had clinical and/or imaging follow-up. Forty-four percent (63/143) had long-term follow-up (≥3 months). Almost 50 % of the patients who presented to the ED for evaluation of abscess were diagnosed with abscess while the remaining patients were diagnosed with mastitis. Appropriate clinical and/or imaging follow-up occurred in 77 %. Long-term follow-up (≥3 months) occurred more frequently in patients older than 30 years of age. Appropriate follow-up does not occur in approximately one fourth of cases, suggesting that additional clinician and patient education is warranted. PMID:26433916

  19. Development and Evaluation of Senior High School Courses on Emerging Technology: A Case Study of a Course on Virtual Reality

    ERIC Educational Resources Information Center

    Chen, Chi-Tung

    2012-01-01

    In Taiwan, the National Science Council has implemented the High Scope Program (HSP) since 2006. The purpose of this study was to analyze the development and effectiveness of senior high school HSP courses on emerging technology. This study used a course on virtual reality as an example, to investigate the influence of emerging technology courses…

  20. Differentiability of correlations in realistic quantum mechanics

    NASA Astrophysics Data System (ADS)

    Cabrera, Alejandro; de Faria, Edson; Pujals, Enrique; Tresser, Charles

    2015-09-01

    We prove a version of Bell's theorem in which the locality assumption is weakened. We start by assuming theoretical quantum mechanics and weak forms of relativistic causality and of realism (essentially the fact that observable values are well defined independently of whether or not they are measured). Under these hypotheses, we show that only one of the correlation functions that can be formulated in the framework of the usual Bell theorem is unknown. We prove that this unknown function must be differentiable at certain angular configuration points that include the origin. We also prove that, if this correlation is assumed to be twice differentiable at the origin, then we arrive at a version of Bell's theorem. On the one hand, we are showing that any realistic theory of quantum mechanics which incorporates the kinematic aspects of relativity must lead to this type of rough correlation function that is once but not twice differentiable. On the other hand, this study brings us a single degree of differentiability away from a relativistic von Neumann no hidden variables theorem.

  1. Fractured shale reservoirs: Towards a realistic model

    SciTech Connect

    Hamilton-Smith, T.

    1996-09-01

    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).

  2. Comparing Realistic Subthalamic Nucleus Neuron Models

    NASA Astrophysics Data System (ADS)

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

    2011-06-01

    The mechanism of action of clinically effective electrical high frequency stimulation is still under debate. However, recent evidence points at the specific activation of GABA-ergic ion channels. Using a computational approach, we analyze temporal properties of the spike trains emitted by biologically realistic neurons of the subthalamic nucleus (STN) as a function of GABA-ergic synaptic input conductances. Our contribution is based on a model proposed by Rubin and Terman and exhibits a wide variety of different firing patterns, silent, low spiking, moderate spiking and intense spiking activity. We observed that most of the cells in our network turn to silent mode when we increase the GABAA input conductance above the threshold of 3.75 mS/cm2. On the other hand, insignificant changes in firing activity are observed when the input conductance is low or close to zero. We thus reproduce Rubin's model with vanishing synaptic conductances. To quantitatively compare spike trains from the original model with the modified model at different conductance levels, we apply four different (dis)similarity measures between them. We observe that Mahalanobis distance, Victor-Purpura metric, and Interspike Interval distribution are sensitive to different firing regimes, whereas Mutual Information seems undiscriminative for these functional changes.

  3. Alveolar mechanics using realistic acinar models

    NASA Astrophysics Data System (ADS)

    Kumar, Haribalan; Lin, Ching-Long; Tawhai, Merryn H.; Hoffman, Eric A.

    2009-11-01

    Accurate modeling of the mechanics in terminal airspaces of the lung is desirable for study of particle transport and pathology. The flow in the acinar region is traditionally studied by employing prescribed boundary conditions to represent rhythmic breathing and volumetric expansion. Conventional models utilize simplified spherical or polygonal units to represent the alveolar duct and sac. Accurate prediction of flow and transport characteristics may require geometries reconstructed from CT-based images and serve to understand the importance of physiologically realistic representation of the acinus. In this effort, we present a stabilized finite element framework, supplemented with appropriate boundary conditions at the alveolar mouth and septal borders for simulation of the alveolar mechanics and the resulting airflow. Results of material advection based on Lagrangian tracking are presented to complete the study of transport and compare the results with simplified acinar models. The current formulation provides improved understanding and realization of a dynamic framework for parenchymal mechanics with incorporation of alveolar pressure and traction stresses.

  4. Differentiability of correlations in realistic quantum mechanics

    SciTech Connect

    Cabrera, Alejandro; Faria, Edson de; Pujals, Enrique; Tresser, Charles

    2015-09-15

    We prove a version of Bell’s theorem in which the locality assumption is weakened. We start by assuming theoretical quantum mechanics and weak forms of relativistic causality and of realism (essentially the fact that observable values are well defined independently of whether or not they are measured). Under these hypotheses, we show that only one of the correlation functions that can be formulated in the framework of the usual Bell theorem is unknown. We prove that this unknown function must be differentiable at certain angular configuration points that include the origin. We also prove that, if this correlation is assumed to be twice differentiable at the origin, then we arrive at a version of Bell’s theorem. On the one hand, we are showing that any realistic theory of quantum mechanics which incorporates the kinematic aspects of relativity must lead to this type of rough correlation function that is once but not twice differentiable. On the other hand, this study brings us a single degree of differentiability away from a relativistic von Neumann no hidden variables theorem.

  5. Real-time realistic skin translucency.

    PubMed

    Jimenez, Jorge; Whelan, David; Sundstedt, Veronica; Gutierrez, Diego

    2010-01-01

    Diffusion theory allows the production of realistic skin renderings. The dipole and multipole models allow for solving challenging diffusion-theory equations efficiently. By using texture-space diffusion, a Gaussian-based approximation, and programmable graphics hardware, developers can create real-time, photorealistic skin renderings. Performing this diffusion in screen space offers advantages that make diffusion approximation practical in scenarios such as games, where having the best possible performance is crucial. However, unlike the texture-space counterpart, the screen-space approach can't simulate transmittance of light through thin geometry; it yields unrealistic results in those cases. A new transmittance algorithm turns the screen-space approach into an efficient global solution, capable of simulating both reflectance and transmittance of light through a multilayered skin model. The transmittance calculations are derived from physical equations, which are implemented through simple texture access. The method performs in real time, requiring no additional memory usage and only minimal additional processing power and memory bandwidth. Despite its simplicity, this practical model manages to reproduce the look of images rendered with other techniques (both offline and real time) such as photon mapping or diffusion approximation. PMID:20650726

  6. Determination of Realistic Fire Scenarios in Spacecraft

    NASA Technical Reports Server (NTRS)

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

    2013-01-01

    This paper expands on previous work that examined how large a fire a crew member could successfully survive and extinguish in the confines of a spacecraft. The hazards to the crew and equipment during an accidental fire include excessive pressure rise resulting in a catastrophic rupture of the vehicle skin, excessive temperatures that burn or incapacitate the crew (due to hyperthermia), carbon dioxide build-up or accumulation of other combustion products (e.g. carbon monoxide). The previous work introduced a simplified model that treated the fire primarily as a source of heat and combustion products and sink for oxygen prescribed (input to the model) based on terrestrial standards. The model further treated the spacecraft as a closed system with no capability to vent to the vacuum of space. The model in the present work extends this analysis to more realistically treat the pressure relief system(s) of the spacecraft, include more combustion products (e.g. HF) in the analysis and attempt to predict the fire spread and limiting fire size (based on knowledge of terrestrial fires and the known characteristics of microgravity fires) rather than prescribe them in the analysis. Including the characteristics of vehicle pressure relief systems has a dramatic mitigating effect by eliminating vehicle overpressure for all but very large fires and reducing average gas-phase temperatures.

  7. What makes Health Demand-Side Financing Schemes Work in Low-and Middle-Income Countries? A Realist Review

    PubMed Central

    Gopalan, Saji S.; Das, Ashis; Mutasa, Ronald

    2014-01-01

    This realist review explored causal pathways of the possible consumer effects of health sector demand-side financial (DSF) incentives, their contextual factors and mechanisms in low-and-middle-income countries. We searched six electronic data bases and identified 659 abstracts with different evaluation designs. Based on methodological rigor and content relevance, only 24 studies published up to April 2013 were selected for the final review. A conceptual framework consisting of various program theories on potential context-mechanism-outcome (C-M-O) configuration of DSF initiative was designed, tested and adapted during the review. Synthesized results were presented as a C-M-O configuration for each of the consumer –side effect. DSF was effective to improve health seeking behaviour considerably and health status to some extent. The causal pathway of DSF’s functioning and effectiveness was not linear. Key demand-side contextual factors which affected DSF’s consumer-side effects were background characteristics of the beneficiaries including their socio-cultural beliefs, motivations, and level of health awareness. At the supply-side, service availability status and provider incentives were contextual determinants. The mechanisms which enabled the interaction of contextual influence were consumer and provider accountability and consumer trust on providers. In order to enhance DSF programs’ effectiveness, their design and implementation should carefully consider the potential contextual elements that may influence the causal pathways. Significance for public health This article focuses on a rare topic i.e. Realist Review, which is an emerging concept to explore causal factors behind every intervention that make it effective or ineffective. This manuscript is a first attempt on a Realist Review of health sector demand-side financing (DSF) in a number of low-and middle-income countries. DSF is a widely employed health promotion strategy in many countries to improve health seeking behaviour. However, the existing evidence explores only its effectiveness and not the determinants of its effectiveness. It is also essential to understand the causal pathways of DSF’s effectiveness, i.e. what are the factors affecting its effectiveness. This Realist Review attempts to explore the causal pathways of effectiveness of many prominent DSF initiatives in the world. The study findings have policy implications and will be widely referred to in future. PMID:25553311

  8. What makes Health Demand-Side Financing Schemes Work in Low-and Middle-Income Countries? A Realist Review.

    PubMed

    Gopalan, Saji S; Das, Ashis; Mutasa, Ronald

    2014-12-01

    This realist review explored causal pathways of the possible consumer effects of health sector demand-side financial (DSF) incentives, their contextual factors and mechanisms in low-and-middle-income countries. We searched six electronic data bases and identified 659 abstracts with different evaluation designs. Based on methodological rigor and content relevance, only 24 studies published up to April 2013 were selected for the final review. A conceptual framework consisting of various program theories on potential context-mechanism-outcome (C-M-O) configuration of DSF initiative was designed, tested and adapted during the review. Synthesized results were presented as a C-M-O configuration for each of the consumer -side effect. DSF was effective to improve health seeking behaviour considerably and health status to some extent. The causal pathway of DSF's functioning and effectiveness was not linear. Key demand-side contextual factors which affected DSF's consumer-side effects were background characteristics of the beneficiaries including their socio-cultural beliefs, motivations, and level of health awareness. At the supply-side, service availability status and provider incentives were contextual determinants. The mechanisms which enabled the interaction of contextual influence were consumer and provider accountability and consumer trust on providers. In order to enhance DSF programs' effectiveness, their design and implementation should carefully consider the potential contextual elements that may influence the causal pathways. Significance for public healthThis article focuses on a rare topic i.e. Realist Review, which is an emerging concept to explore causal factors behind every intervention that make it effective or ineffective. This manuscript is a first attempt on a Realist Review of health sector demand-side financing (DSF) in a number of low-and middle-income countries. DSF is a widely employed health promotion strategy in many countries to improve health seeking behaviour. However, the existing evidence explores only its effectiveness and not the determinants of its effectiveness. It is also essential to understand the causal pathways of DSF's effectiveness, i.e. what are the factors affecting its effectiveness. This Realist Review attempts to explore the causal pathways of effectiveness of many prominent DSF initiatives in the world. The study findings have policy implications and will be widely referred to in future. PMID:25553311

  9. Evaluation of Risk for Late Language Emergence after In Utero Antiretroviral Drug Exposure in HIV-exposed Uninfected Infants

    PubMed Central

    Rice, Mabel L.; Zeldow, Bret; Siberry, George K.; Purswani, Murli; Malee, Kathleen; Hoffman, Howard J.; Frederick, Toni; Buchanan, Ashley; Sirois, Patricia A.; Allison, Susannah M.; Williams, Paige L

    2013-01-01

    Background Combination antiretroviral (cARV) regimens are recommended for pregnant women with HIV to prevent perinatal HIV transmission. Safety is a concern for infants who were HIV-exposed but uninfected (HEU), particularly for neurodevelopmental problems, such as language delays. Methods We studied late language emergence (LLE) in HEU children enrolled in a US-based prospective cohort study. LLE was defined as a caregiver-reported score ≤ 10th percentile in any of 4 domains of the MacArthur-Bates Communicative Development Inventory for one-year-olds and as ≥1 standard deviation below age-specific norms for the Ages and Stages Questionnaire for two-year-olds. Logistic regression models were used to evaluate associations of in utero cARV exposure with LLE, adjusting for infant, maternal, and environmental characteristics. Results 1,129 language assessments were conducted among 792 one- and two-year-olds (50% male, 62% black, and 37% Hispanic). Overall, 86% had in utero exposure to cARV and 83% to protease inhibitors. LLE was identified in 26% of one-year-olds and 23% of two-year-olds, with higher rates among boys. In adjusted models, LLE was not associated with maternal cARV or ARV drug classes in either age group. Among cARV-exposed one-year-olds, increased odds of LLE was observed for those exposed to atazanavir (aOR=1.83, 95% CI=1.10-3.04), particularly after the first trimester (aOR=3.56, p=0.001), compared to atazanavir-unexposed infants. No associations of individual ARV drugs with LLE were observed among two-year-olds. Conclusions In utero cARV exposure showed little association with LLE, except for a higher risk of language delay observed in one-year-old infants with atazanavir exposure. PMID:24067563

  10. Evaluating the Quality of Cardiopulmonary Resuscitation in the Emergency Department by Real-Time Video Recording System

    PubMed Central

    Min, Hongye; Li, Hong; Wang, Huiqi; Zhuang, Yugang; Chen, Yuanzhuo; Gao, Chengjin; Peng, Hu

    2015-01-01

    Objectives To compare cardiopulmonary resuscitation (CPR) quality between manual CPR and miniaturized chest compressor (MCC) CPR. To improve CPR quality through evaluating the quality of our clinical work of resuscitation by real-time video recording system. Methods The study was a retrospective observational study of adult patients who experienced CPR at the emergency department of Shanghai Tenth People’s Hospital from March 2013 to August 2014. All the performance of CPR were checked back by the record of “digital real-time video recording system”. Average chest compression rate, actual chest compression rate, the percentage of hands-off period, time lag from patient arrival to chest compression, time lag from patient arrival to manual ventilation, time lag from patient arrival to first IV establish were compared. Causes of chest compression hands-off time were also studied. Results 112 cases of resuscitation attempts were obtained. Average chest compression rate was over 100 compression per minute (cpm) in the majority of cases. However, indicators such as percentage of hands-off periods, time lag from patient arrival to the first manual ventilation and time lag from patient arrival to the first IV establish seemed to be worse in the manual CPR group compared to MCC CPR group. The saving of operators change time seemed to counteract the time spent on MCC equipment. Indicators such as percentage of hands-off periods, time lag between patient arrival to the first chest compression, time lag between patient arrival to the first manual ventilation and time lag from patient arrival to the first IV establish may influence the survival. Conclusion Our CPR quality remained to be improved. MCC may have a potentially positive role in CPR. PMID:26431420

  11. Evaluation of the Bladder Stimulation Technique to Collect Midstream Urine in Infants in a Pediatric Emergency Department

    PubMed Central

    Tran, Antoine; Demonchy, Diane; Caci, Hervé; Desmontils, Jonathan; Montaudie-Dumas, Isabelle; Bensaïd, Ronny; Haas, Hervé; Berard, Etienne

    2016-01-01

    Objective Midstream clean-catch urine is an accepted method to diagnose urinary tract infection but is impracticable in infants before potty training. We tested the bladder stimulation technique to obtain a clean-catch urine sample in infants. Materials and methods We included 142 infants under walking age who required a urine sample in a cross- sectional study carried out during a 3-months period, from September to November 2014, in the emergency department of the University Children’s Hospital of Nice (France). A technique based on bladder stimulation and lumbar stimulation maneuvers, with at least two attempts, was tested by four trained physicians. The success rate and time to obtain urine sample within 3 minutes were evaluated. Discomfort (EVENDOL score ≥4/15) was measured. We estimated the risk factors in the failure of the technique. Chi-square test or Fisher’s exact test were used to compare frequencies. T-test and Wilcoxon test were used to compare quantitative data according to the normality of the distribution. Risk factors for failure of the technique were evaluated using a multivariate logistic regression model. Results We obtained midstream clean-catch urine in 55.6% of infants with a median time of 52.0 s (10.0; 110.0). The success rate decreased with age from 88.9% (newborn) to 28.6% (>1 y) (p = 0.0001) and with weight, from 85.7% (<4kg) to 28.6% (>10kg) (p = 0.0004). The success rate was 60.8% for infants without discomfort (p<0.0001). Heavy weight and discomfort were associated with failure, with adjusted ORs of 1.47 [1.04–2.31] and 6.65 [2.85–15.54], respectively. Conclusion Bladder stimulation seems to be efficient in obtaining midstream urine with a moderate success rate in our study sample. This could be an alternative technique for infants before potty training but further randomized multicenter studies are needed to validate this procedure. PMID:27031953

  12. A realistic molecular model of cement hydrates

    PubMed Central

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

    2009-01-01

    Despite decades of studies of calcium-silicate-hydrate (C-S-H), the structurally complex binder phase of concrete, the interplay between chemical composition and density remains essentially unexplored. Together these characteristics of C-S-H define and modulate the physical and mechanical properties of this “liquid stone” gel phase. With the recent determination of the calcium/silicon (C/S = 1.7) ratio and the density of the C-S-H particle (2.6 g/cm3) by neutron scattering measurements, there is new urgency to the challenge of explaining these essential properties. Here we propose a molecular model of C-S-H based on a bottom-up atomistic simulation approach that considers only the chemical specificity of the system as the overriding constraint. By allowing for short silica chains distributed as monomers, dimers, and pentamers, this C-S-H archetype of a molecular description of interacting CaO, SiO2, and H2O units provides not only realistic values of the C/S ratio and the density computed by grand canonical Monte Carlo simulation of water adsorption at 300 K. The model, with a chemical composition of (CaO)1.65(SiO2)(H2O)1.75, also predicts other essential structural features and fundamental physical properties amenable to experimental validation, which suggest that the C-S-H gel structure includes both glass-like short-range order and crystalline features of the mineral tobermorite. Additionally, we probe the mechanical stiffness, strength, and hydrolytic shear response of our molecular model, as compared to experimentally measured properties of C-S-H. The latter results illustrate the prospect of treating cement on equal footing with metals and ceramics in the current application of mechanism-based models and multiscale simulations to study inelastic deformation and cracking. PMID:19805265

  13. Measurable realistic image-based 3D mapping

    NASA Astrophysics Data System (ADS)

    Liu, W.; Wang, J.; Wang, J. J.; Ding, W.; Almagbile, A.

    2011-12-01

    Maps with 3D visual models are becoming a remarkable feature of 3D map services. High-resolution image data is obtained for the construction of 3D visualized models.The3D map not only provides the capabilities of 3D measurements and knowledge mining, but also provides the virtual experienceof places of interest, such as demonstrated in the Google Earth. Applications of 3D maps are expanding into the areas of architecture, property management, and urban environment monitoring. However, the reconstruction of high quality 3D models is time consuming, and requires robust hardware and powerful software to handle the enormous amount of data. This is especially for automatic implementation of 3D models and the representation of complicated surfacesthat still need improvements with in the visualisation techniques. The shortcoming of 3D model-based maps is the limitation of detailed coverage since a user can only view and measure objects that are already modelled in the virtual environment. This paper proposes and demonstrates a 3D map concept that is realistic and image-based, that enables geometric measurements and geo-location services. Additionally, image-based 3D maps provide more detailed information of the real world than 3D model-based maps. The image-based 3D maps use geo-referenced stereo images or panoramic images. The geometric relationships between objects in the images can be resolved from the geometric model of stereo images. The panoramic function makes 3D maps more interactive with users but also creates an interesting immersive circumstance. Actually, unmeasurable image-based 3D maps already exist, such as Google street view, but only provide virtual experiences in terms of photos. The topographic and terrain attributes, such as shapes and heights though are omitted. This paper also discusses the potential for using a low cost land Mobile Mapping System (MMS) to implement realistic image 3D mapping, and evaluates the positioning accuracy that a measureable realistic image-based (MRI) system can produce. The major contribution here is the implementation of measurable images on 3D maps to obtain various measurements from real scenes.

  14. Probabilistic sequence alignments: realistic models with efficient algorithms.

    PubMed

    Yeramian, Edouard; Debonneuil, Edouard

    2007-02-16

    Alignment algorithms usually rely on simplified models of gaps for computational efficiency. Based on correspondences between alignments and structural models for nucleic acids, and using methods from statistical mechanics, we show that alignments with realistic laws for gaps can be computed with fast algorithms. Improved performances of probabilistic alignments with realistic models of gaps are illustrated. By contrast with optimization-based alignments, such improvements with realistic laws are not observed. General perspectives for biological and physical modelings are mentioned. PMID:17359063

  15. Can routinely recorded reproductive events be used as indicators of disease emergence in dairy cattle? An evaluation of 5 indicators during the emergence of bluetongue virus in France in 2007 and 2008.

    PubMed

    Marceau, Alexis; Madouasse, Aurlien; Lehbel, Anne; van Schaik, Gerdien; Veldhuis, Anouk; Van der Stede, Yves; Fourichon, Christine

    2014-10-01

    In response to increasing risks of emerging infectious diseases, syndromic surveillance can be a suitable approach to detect outbreaks of such diseases across a large territory in an early phase. To implement a syndromic surveillance system, the primary challenge is to find appropriate health-related data. The objective of this study was to evaluate whether routinely collected dates of reproductive events in dairy cattle could be used to build indicators of health anomalies for syndromic surveillance. The evaluation was performed on data collected in France between 2003 and 2009. First, a set of 5 indicators was proposed to assess several types of reproductive disorders. For each indicator, the demographic coverage over the total number of cattle at risk was analyzed in time and space. Second, the ability to detect an emerging disease in an early phase was retrospectively evaluated during epidemics of bluetongue serotypes 1 and 8 (BTV-1, BTV-8) in France in 2007 and 2008. Reproductive indicators were analyzed weekly during these epidemics for each indicator in each infected French district (16 in 2007 and 50 in 2008 out of 94 districts). The indicators were able to detect the BTV epidemics despite their low demographic coverage on a weekly basis relatively to total number of cattle (median=1.21%; range=0-11.7%). Four indicators related to abortions, late embryonic death, and short gestations were abnormally elevated during both BTV epidemics. Median times to abnormal elevations in these indicators were 20 to 71 d after the first notification of clinical signs of BTV by veterinarians. These results demonstrate that reproduction data can be used as indicators of disease emergences, whereas in the specific case of these BTV epidemics, detection via these indicators was later than clinical detection by veterinarians. The emergence of bluetongue in 2007 in France was associated with gestations that were a few days shorter than expected. A short gestation indicator underwent high elevations relative to prior random fluctuations and was the earliest (out of the 4 indicators) to show abnormal elevations, making it possible to detect this emergence. PMID:25087027

  16. Standardized Patients Provide Realistic and Worthwhile Experiences for Athletic Training Students

    ERIC Educational Resources Information Center

    Walker, Stacy E.; Weidner, Thomas G.

    2010-01-01

    Context: Standardized patients are more prominently used to both teach and evaluate students' clinical skills and abilities. Objective: To investigate whether athletic training students perceived an encounter with a standardized patient (SP) as realistic and worthwhile and to determine their perceived comfort in future lower extremity evaluations…

  17. Emergency supply of prescription-only medicines to patients by community pharmacists: a mixed methods evaluation incorporating patient, pharmacist and GP perspectives

    PubMed Central

    Morecroft, Charles W; Mackridge, Adam J; Stokes, Elizabeth C; Gray, Nicola J; Wilson, Sarah E; Ashcroft, Darren M; Mensah, Noah; Pickup, Graham B

    2015-01-01

    Objective To evaluate and inform emergency supply of prescription-only medicines by community pharmacists (CPs), including how the service could form an integral component of established healthcare provision to maximise adherence. Design Mixed methods. 4 phases: prospective audit of emergency supply requests for prescribed medicines (October–November 2012 and April 2013); interviews with CPs (February–April 2013); follow-up interviews with patients (April–May 2013); interactive feedback sessions with general practice teams (October–November 2013). Setting 22 community pharmacies and 6 general practices in Northwest England. Participants 27 CPs with experience of dealing with requests for emergency supplies; 25 patients who received an emergency supply of a prescribed medicine; 58 staff at 6 general practices. Results Clinical audit in 22 pharmacies over two 4-week periods reported that 526 medicines were requested by 450 patients. Requests peaked over a bank holiday and around weekends. A significant number of supplies were made during practice opening hours. Most requests were for older patients and for medicines used in long-term conditions. Difficulty in renewing repeat medication (forgetting to order, or prescription delays) was the major reason for requests. The majority of medicines were ‘loaned’ in advance of a National Health Service (NHS) prescription. Interviews with CPs and patients indicated that continuous supply had a positive impact on medicines adherence, removing the need to access urgent care. General practice staff were surprised and concerned by the extent of emergency supply episodes. Conclusions CPs regularly provide emergency supplies to patients who run out of their repeat medication, including during practice opening hours. This may aid adherence. There is currently no feedback loop, however, to general practice. Patient care and interprofessional communication may be better served by the introduction of a formally structured and funded NHS emergency supply service from community pharmacies, with ongoing optimisation of repeat prescribing. PMID:26163029

  18. Evaluation of a stand-alone computer-aided detection system for acute intra-cranial hemorrhage in emergency environments

    NASA Astrophysics Data System (ADS)

    Fernandez, James; Deshpande, Ruchi; Wang, Ximing; Liu, Brent; Brazaitis, Michael; Munter, Fletcher; Liu, Margaret

    2011-03-01

    Acute intra-cranial hemorrhage (AIH) may result from traumatic brain injury (TBI). Successful management of AIH depends heavily on the speed and accuracy of diagnosis. Timely diagnosis in emergency environments in both civilian and military settings is difficult primarily due to severe time restraints and lack of resources. Often, diagnosis is performed by emergency physicians rather than trained radiologists. As a result, added support in the form of computer-aided detection (CAD) would greatly enhance the decision-making process and help in providing faster and more accurate diagnosis of AIH. This paper discusses the implementation of a CAD system in an emergency environment, and its efficacy in aiding in the detection of AIH.

  19. All Health Care is Not Local: An Evaluation of the Distribution of Emergency Department Care Delivered in Indiana

    PubMed Central

    Finnell, John T.; Overhage, J. Marc; Grannis, Shaun

    2011-01-01

    The Emergency Department (ED) delivers a major portion of health care often with incomplete knowledge about the patient. As such, EDs are particularly likely to benefit from a health information exchange (HIE). The Indiana Public Health Emergency Surveillance System (PHESS) sends real-time registration information for emergency department encounters. Over the three-year study period, we found 2.8 million patients generated 7.4 million ED visits. The average number of visits was 2.6 visits/patient (range 1385). We found more than 40% of ED visits during the study period were for patients having data at multiple institutions. When examining the network density, we found nearly all EDs share patients with more than 80 other EDs. Our results help clarify future health care policy decisions regarding optimal NHIN architecture and discount the notion that all healthcare is local. PMID:22195094

  20. Oligonucleotides as antivirals: dream or realistic perspective?

    PubMed

    Van Aerschot, Arthur

    2006-09-01

    Many reports have been published on antiviral activity of synthetic oligonucleotides, targeted to act either by a true antisense effect or via non-sequence specific interactions. This short review will try to evaluate the current status of the field by focusing on the effects as reported for inhibition of either HSV-1, HCMV or HIV-1. Following an introduction with a historical background and a brief discussion on the different types of constructs and mechanisms of action, the therapeutic potential of antisense oligonucleotides as antivirals, as well as possible pitfalls upon their evaluation will be discussed. PMID:16621039

  1. Diabetic Emergencies

    MedlinePlus

    ... Emergency Care or Urgent Care? When To Call 911 What To Do In A Medical Emergency Childhood ... If the person is unconscious or unresponsive, call 911 or your local emergency number immediately. If an ...

  2. Chemical Emergency

    MedlinePlus

    ... listen to a local Emergency Alert System (EAS) station for emergency instructions from county or state officials. ... and your family. Listen to your emergency broadcast stations on radio and TV. Use your phone only ...

  3. Fitness Testing with a Realistic Purpose

    ERIC Educational Resources Information Center

    Pate, Russell, R.

    1978-01-01

    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.

  4. Graphic products used in the evaluation of traditional and emerging remote sensing technologies for the detection of fugitive contamination at selected superfund hazardous waste sites

    USGS Publications Warehouse

    Slonecker, E. Terrence; Fisher, Gary B.

    2011-01-01

    This report presents the overhead imagery and field sampling results used to prepare U.S. Geological Survey Open-File Report 2011-1050, 'Evaluation of Traditional and Emerging Remote Sensing Technologies for the Detection of Fugitive Contamination at Selected Superfund Hazardous Waste Sites'. These graphic products were used in the evaluation of remote sensing technology in postclosure monitoring of hazardous waste sites and represent an ongoing research effort. Soil sampling results presented here were accomplished with field portable x-ray fluoresence (XRF) technology and are used as screening tools only representing the current conditions of metals and other contaminants at selected Superfund hazardous waste sites.

  5. Who initiates emergency commitments?

    PubMed

    Christy, Annette; Handelsman, Jessica B; Hanson, Ardis; Ochshorn, Ezra

    2010-04-01

    Florida's Mental Health Act was amended in 2005 and 2006 to include licensed mental health counselors and licensed marriage and family therapists, respectively, to the list of professionals authorized to initiate emergency commitments. The present study evaluates the volume of involuntary emergency commitments by type of initiator for a 5 year period. The results indicate that allowing licensed mental health counselors and licensed marriage and family therapist to initiate emergency commitments has not been related to increased numbers of emergency commitments or a higher proportion of emergency commitments being initiated by mental health professionals. Potential policy and fiscal implications, as well as future directions for research, are discussed. PMID:19597746

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

    ERIC Educational Resources Information Center

    Mukoza, Stella Kyobula; Goodman, Suki

    2013-01-01

    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…

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

    ERIC Educational Resources Information Center

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

    2008-01-01

    The study examines ideators, single attempters, and repeats attempters of suicide to clarify optimal strategies for emergency department management and risk assessment to help them in reducing youth suicide and suicide attempts. Depression was found to be a strong predictor of suicide/suicide attempts along with substance use, externalizing

  8. Understanding Sources of Contaminants of Emerging Concern: An Evaluation of Land Use with Occurrence of Aquatic Contaminants

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The occurrence of pharmaceuticals, antibiotics, hormones, and other contaminants of emerging concern (CEC) in surface waters, nationally and internationally, raises questions of their source, fate, and potential ecological and human health effects. A number of CECs have been shown to disrupt the nor...

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

    ERIC Educational Resources Information Center

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

    2008-01-01

    The study examines ideators, single attempters, and repeats attempters of suicide to clarify optimal strategies for emergency department management and risk assessment to help them in reducing youth suicide and suicide attempts. Depression was found to be a strong predictor of suicide/suicide attempts along with substance use, externalizing…

  10. A novel two-stage evaluation system based on a Group-G1 approach to identify appropriate emergency treatment technology schemes in sudden water source pollution accidents.

    PubMed

    Qu, Jianhua; Meng, Xianlin; Hu, Qi; You, Hong

    2016-02-01

    Sudden water source pollution resulting from hazardous materials has gradually become a major threat to the safety of the urban water supply. Over the past years, various treatment techniques have been proposed for the removal of the pollutants to minimize the threat of such pollutions. Given the diversity of techniques available, the current challenge is how to scientifically select the most desirable alternative for different threat degrees. Therefore, a novel two-stage evaluation system was developed based on a circulation-correction improved Group-G1 method to determine the optimal emergency treatment technology scheme, considering the areas of contaminant elimination in both drinking water sources and water treatment plants. In stage 1, the threat degree caused by the pollution was predicted using a threat evaluation index system and was subdivided into four levels. Then, a technique evaluation index system containing four sets of criteria weights was constructed in stage 2 to obtain the optimum treatment schemes corresponding to the different threat levels. The applicability of the established evaluation system was tested by a practical cadmium-contaminated accident that occurred in 2012. The results show this system capable of facilitating scientific analysis in the evaluation and selection of emergency treatment technologies for drinking water source security. PMID:26449677

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

    NASA Astrophysics Data System (ADS)

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

    2014-05-01

    To meet the demand of the ever-increasing urbanized global population, substantial conversion of natural landscapes to urban terrains is expected in the next few decades. The landscape modification will emerge as the source of many adverse effects that challenge the environmental sustainability of cities under changing climatic patterns. To address these adverse effects and to develop corresponding adaptation/mitigation strategies, physically-based single layer urban canopy model (SLUCM) has been developed and implemented into the Weather Research and Forecasting (WRF) platform. However, due to the lack of realistic representation of urban hydrological processes, simulation of urban climatology by current coupled WRF/SLUCM is inevitably inadequate. Aiming at improving the accuracy of simulations, in this study we implement physically-based parameterization of urban hydrological processes into the model, including (1) anthropogenic latent heat, (2) urban irrigation, (3) evaporation over water-holding engineered pavements, (4) urban oasis effect, and (5) green roof. In addition, we use an advanced Monte Carlo approach to quantify the sensitivity of urban hydrological modeling to parameter uncertainties. Evaluated against field observations at four major metropolitan areas, results show that the enhanced model is significantly improved in accurately predicting turbulent fluxes arising from built surfaces, especially the latent heat flux. Case studies show that green roof is capable of reducing urban surface temperature and sensible heat flux effectively, and modifying local and regional hydroclimate. Meanwhile, it is efficient in decreasing energy loading of buildings, not only cooling demand in summers but also heating demand in winters, through the combined evaporative cooling and insulation effect. Effectiveness of green roof is found to be limited by availability of water resources and highly sensitive to surface roughness heights. The enhanced WRF/SLUCM model deepens our insight into the dynamics of urban land surface processes and its impact on the regional hydroclimate through land-atmosphere interactions.

  12. Construction of a technique plan repository and evaluation system based on AHP group decision-making for emergency treatment and disposal in chemical pollution accidents.

    PubMed

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

    2014-07-15

    The environmental pollution resulting from chemical accidents has caused increasingly serious concerns. Therefore, it is very important to be able to determine in advance the appropriate emergency treatment and disposal technology for different types of chemical accidents. However, the formulation of an emergency plan for chemical pollution accidents is considerably difficult due to the substantial uncertainty and complexity of such accidents. This paper explains how the event tree method was used to create 54 different scenarios for chemical pollution accidents, based on the polluted medium, dangerous characteristics and properties of chemicals involved. For each type of chemical accident, feasible emergency treatment and disposal technology schemes were established, considering the areas of pollution source control, pollutant non-proliferation, contaminant elimination and waste disposal. Meanwhile, in order to obtain the optimum emergency disposal technology schemes as soon as the chemical pollution accident occurs from the plan repository, the technique evaluation index system was developed based on group decision-improved analytical hierarchy process (AHP), and has been tested by using a sudden aniline pollution accident that occurred in a river in December 2012. PMID:24887122

  13. Validation of a dose warping algorithm using clinically realistic scenarios

    PubMed Central

    Dehghani, H; Green, S; Webster, G J

    2015-01-01

    Objective: Dose warping following deformable image registration (DIR) has been proposed for interfractional dose accumulation. Robust evaluation workflows are vital to clinically implement such procedures. This study demonstrates such a workflow and quantifies the accuracy of a commercial DIR algorithm for this purpose under clinically realistic scenarios. Methods: 12 head and neck (H&N) patient data sets were used for this retrospective study. For each case, four clinically relevant anatomical changes have been manually generated. Dose distributions were then calculated on each artificially deformed image and warped back to the original anatomy following DIR by a commercial algorithm. Spatial registration was evaluated by quantitative comparison of the original and warped structure sets, using conformity index and mean distance to conformity (MDC) metrics. Dosimetric evaluation was performed by quantitative comparison of the dose–volume histograms generated for the calculated and warped dose distributions, which should be identical for the ideal “perfect” registration of mass-conserving deformations. Results: Spatial registration of the artificially deformed image back to the planning CT was accurate (MDC range of 1–2 voxels or 1.2–2.4 mm). Dosimetric discrepancies introduced by the DIR were low (0.02 ± 0.03 Gy per fraction in clinically relevant dose metrics) with no statistically significant difference found (Wilcoxon test, 0.6 ≥ p ≥ 0.2). Conclusion: The reliability of CT-to-CT DIR-based dose warping and image registration was demonstrated for a commercial algorithm with H&N patient data. Advances in knowledge: This study demonstrates a workflow for validation of dose warping following DIR that could assist physicists and physicians in quantifying the uncertainties associated with dose accumulation in clinical scenarios. PMID:25791569

  14. Realistic training for effective crew performance

    NASA Technical Reports Server (NTRS)

    Foushee, H. C.

    1985-01-01

    Evaluation of incident and accident statistics reveals that most problems occur not because of a lack of proficiency in pilot training, but because of the inability to coordinate skills into effective courses of action. Line-Oriented Flight Training (LOFT) and Cockpit Resource Management (CRM) programs provide training which will develop both individual crew member skills, as well as those associated with effective group function. A study conducted by NASA at the request of the U.S. Congress supports the argument for training that enhances crew performance in addition to providing individual technical skills, and is described in detail.

  15. Role of point of care - ST2, Galectin-3 and adrenomedullin in the evaluation and treatment of emergency patients

    PubMed Central

    Siler-Fisher, Angela; Tucci, Veronica; Kalra, Sarathi; Galwankar, Sagar C; Khose, Swapnil D; Sanjeevani, S; Goel, Ashish; Peacock, Frank W

    2014-01-01

    There have been many technological advances improving the work up and treatment of patients in the emergency department (ED). Point of care testing (POCT) is becoming more common, especially in the time compressed clinically high-pressured environment of the emergency department. In present times, emphasis of POCT has spurred search of novel biomarkers which promise earlier and more specific detection of disease. This article reviews the role of ST2, Galectin-3 and Adrenomedullin in the acute care setting addressing the screening, diagnostic, and prognostic role of each marker for stratification of patients. Use of these markers has shown a strong correlation with early identification and efficient management in the ED. PMID:25337491

  16. Role of point of care - ST2, Galectin-3 and adrenomedullin in the evaluation and treatment of emergency patients.

    PubMed

    Siler-Fisher, Angela; Tucci, Veronica; Kalra, Sarathi; Galwankar, Sagar C; Khose, Swapnil D; Sanjeevani, S; Goel, Ashish; Peacock, Frank W

    2014-07-01

    There have been many technological advances improving the work up and treatment of patients in the emergency department (ED). Point of care testing (POCT) is becoming more common, especially in the time compressed clinically high-pressured environment of the emergency department. In present times, emphasis of POCT has spurred search of novel biomarkers which promise earlier and more specific detection of disease. This article reviews the role of ST2, Galectin-3 and Adrenomedullin in the acute care setting addressing the screening, diagnostic, and prognostic role of each marker for stratification of patients. Use of these markers has shown a strong correlation with early identification and efficient management in the ED. PMID:25337491

  17. Effects of realistic tensor force on nuclear structure

    SciTech Connect

    Nakada, H.

    2012-10-20

    First-order tensor-force effects on nuclear structure are investigated in the self-consistent mean-field and RPA calculations with the M3Y-type semi-realistic interactions, which contain the realistic tensor force. The tensor force plays a key role in Z- or N-dependence of the shell structure, and in transitions involving spin degrees-of-freedom. It is demonstrated that the semi-realistic interactions successfully describe the N-dependence of the shell structure in the proton-magic nuclei (e.g. Ca and Sn), and the magnetic transitions (e.g. M1 transition in {sup 208}Pb).

  18. Use of new adjuvants in an emergency vaccine against foot-and-mouth disease virus: evaluation of conferred immunity.

    PubMed

    Quattrocchi, V; Bianco, V; Fondevila, N; Pappalardo, S; Sadir, A; Zamorano, P

    2004-01-01

    The ability of an emergency adjuvanted FMDV vaccine to elicit early protective immune response in mice was examined. We studied the efficacy of several adjuvants to induce such protection. The aqueous IMS1313 plus inactivated FMDV induce a higher protective immune response than the vaccine with inactivated virus alone at seven days post vaccination (dpv). Mice vaccinated with this formula showed higher lymphoproliferative index values and higher IL-2, IL-4 and IFNgamma levels than the controls. PMID:15742663

  19. Linear perspective limitations on virtual reality and realistic displays

    NASA Astrophysics Data System (ADS)

    Temme, Leonard A.

    2007-04-01

    The visual images of the natural world, with their immediate intuitive appeal, seem like the logical gold standard for evaluating displays. After all, since photorealistic displays look so increasingly like the real world, what could be better? Part of the shortcoming of this intuitive appeal for displays is its naivete. Realism itself is full of potential illusions that we do not notice because, most of the time, realism is good enough for our everyday tasks. But when confronted with tasks that go beyond those for which our visual system has evolved, we may be blindsided. If we survive, blind to our erroneous perceptions and oblivious to our good fortune at having survived, we will not be any wiser next time. Realist displays depend on linear perspective (LP), the mathematical mapping of three dimensions onto two. Despite the fact that LP is a seductively elegant system that predicts results with defined mathematical procedures, artists do not stick to the procedures, not because they are math-phobic but because LP procedures, if followed explicitly, produce ugly, limited, and distorted images. If artists bother with formal LP procedures at all, they invariably temper the renderings by eye. The present paper discusses LP assumptions, limitations, and distortions. It provides examples of kluges to cover some of these LP shortcomings. It is important to consider the limitations of LP so that we do not let either naive assumptions or the seductive power of LP guide our thinking or expectations unrealistically as we consider its possible uses in advanced visual displays.

  20. Unsteady transonic algorithm improvements for realistic aircraft applications

    NASA Technical Reports Server (NTRS)

    Batina, John T.

    1987-01-01

    Improvements to a time-accurate approximate factorization (AF) algorithm were implemented for steady and unsteady transonic analysis of realistic aircraft configurations. These algorithm improvements were made to the CAP-TSD (Computational Aeroelasticity Program - Transonic Small Disturbance) code developed at the Langley Research Center. The code permits the aeroelastic analysis of complete aircraft in the flutter critical transonic speed range. The AF algorithm of the CAP-TSD code solves the unsteady transonic small-disturbance equation. The algorithm improvements include: an Engquist-Osher (E-O) type-dependent switch to more accurately and efficiently treat regions of supersonic flow; extension of the E-O switch for second-order spatial accuracy in these regions; nonreflecting far field boundary conditions for more accurate unsteady applications; and several modifications which accelerate convergence to steady-state. Calculations are presented for several configurations including the General Dynamics one-ninth scale F-16C aircraft model to evaluate the algorithm modifications. The modifications have significantly improved the stability of the AF algorithm and hence the reliability of the CAP-TSD code in general.

  1. A Chimeric Virus-Mouse Model System for Evaluating the Function and Inhibition of Papain-Like Proteases of Emerging Coronaviruses

    PubMed Central

    Deng, Xufang; Agnihothram, Sudhakar; Mielech, Anna M.; Nichols, Daniel B.; Wilson, Michael W.; StJohn, Sarah E.; Larsen, Scott D.; Mesecar, Andrew D.; Lenschow, Deborah J.; Baric, Ralph S.

    2014-01-01

    ABSTRACT To combat emerging coronaviruses, developing safe and efficient platforms to evaluate viral protease activities and the efficacy of protease inhibitors is a high priority. Here, we exploit a biosafety level 2 (BSL-2) chimeric Sindbis virus system to evaluate protease activities and the efficacy of inhibitors directed against the papain-like protease (PLpro) of severe acute respiratory syndrome coronavirus (SARS-CoV), a biosafety level 3 (BSL-3) pathogen. We engineered Sindbis virus to coexpress PLpro and a substrate, murine interferon-stimulated gene 15 (ISG15), and found that PLpro mediates removal of ISG15 (deISGylation) from cellular proteins. Mutation of the catalytic cysteine residue of PLpro or addition of a PLpro inhibitor blocked deISGylation in virus-infected cells. Thus, deISGylation is a marker of PLpro activity. Infection of alpha/beta interferon receptor knockout (IFNAR−/−) mice with these chimeric viruses revealed that PLpro deISGylation activity removed ISG15-mediated protection during viral infection. Importantly, administration of a PLpro inhibitor protected these mice from lethal infection, demonstrating the efficacy of a coronavirus protease inhibitor in a mouse model. However, this PLpro inhibitor was not sufficient to protect the mice from lethal infection with SARS-CoV MA15, suggesting that further optimization of the delivery and stability of PLpro inhibitors is needed. We extended the chimeric-virus platform to evaluate the papain-like protease/deISGylating activity of Middle East respiratory syndrome coronavirus (MERS-CoV) to provide a small-animal model to evaluate PLpro inhibitors of this recently emerged pathogen. This platform has the potential to be universally adaptable to other viral and cellular enzymes that have deISGylating activities. IMPORTANCE Evaluating viral protease inhibitors in a small-animal model is a critical step in the path toward antiviral drug development. We modified a biosafety level 2 chimeric virus system to facilitate evaluation of inhibitors directed against highly pathogenic coronaviruses. We used this system to demonstrate the in vivo efficacy of an inhibitor of the papain-like protease of severe acute respiratory syndrome coronavirus. Furthermore, we demonstrate that the chimeric-virus system can be adapted to study the proteases of emerging human pathogens, such as Middle East respiratory syndrome coronavirus. This system provides an important tool to rapidly assess the efficacy of protease inhibitors targeting existing and emerging human pathogens, as well as other enzymes capable of removing ISG15 from cellular proteins. PMID:25100850

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

    PubMed

    Cox, Sarah J; Barnett, Paul V

    2009-01-01

    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. PMID:19040829

  3. Emergence of Anisotropy in Flock Simulations and Its Computational Analysis

    NASA Astrophysics Data System (ADS)

    Makiguchi, Motohiro; Inoue, Jun-Ichi

    In real flocks, it was revealed that the angular density of nearest neighbors shows a strong anisotropic structure of individuals by very recent extensive field studies [Ballerini et al, Proceedings of the National Academy of Sciences USA, 105, pp. 1232-1237 (2008)]. In this paper, we show this structure of anisotropy also emerges in an artificial flock simulation, namely, Boid simulation. To quantify the anisotropy, we evaluate a useful statistics, that is to say, the so-called γ-value which is defined as an inner product between the vector in the direction of the lowest angular density of flocks and the vector in the direction of moving of the flock. Our results concerning the emergence of the anisotropy through the γ-value might enable us to judge whether an optimal flock simulation seems to be realistic or not.

  4. A critical evaluation of whether recombination in virus-resistant transgenic plants will lead to the emergence of novel viral diseases.

    PubMed

    Tepfer, Mark; Jacquemond, Mireille; García-Arenal, Fernando

    2015-08-01

    In the evaluation of the potential impacts of first-generation genetically modified (GM) crops, one of the most complex issues has been whether the expression of viral sequences would lead to the emergence of novel viruses, which could occur through recombination between transgene mRNA and that of an infecting non-target virus. Here, we examine this issue, focusing on Cucumber mosaic virus (CMV), which is a particularly pertinent choice, as it is both a major plant pathogen and also the virus with which this question has been studied in the most detail. Using recent results on recombination in CMV, we employ a novel framework giving particular prominence to the formulation of the risk hypothesis and to hypothesis testing via examination of the potential pathway to harm. This allows us to conclude with greater certainty that the likelihood of this potential harm, the emergence of novel viruses, is low. PMID:25982848

  5. An evaluation of the professional, social and demographic profile and quality of life of physicians working at the Prehospital Emergency Medical System (SAMU) in Brazil

    PubMed Central

    Tallo, Fernando Sabia; de Campos Vieira Abib, Simone; Baitello, André Luciano; Lopes, Renato Delascio

    2014-01-01

    OBJECTIVE: To describe the profile of physicians working at the Prehospital Emergency Medical System (SAMU) in Brazil and to evaluate their quality of life. METHODS: Both a semi-structured questionnaire with 57 questions and the SF-36 questionnaire were sent to research departments within SAMU in the Brazilian state capitals, the Federal District and inland towns in Brazil. RESULTS: Of a total of 902 physicians, including 644 (71.4%) males, 533 (59.1%) were between 30 and 45 years of age and 562 (62.4%) worked in a state capital. Regarding education level, 45.1% had graduated less than five years before and only 43% were specialists recognized by the Brazilian Medical Association. Regarding training, 95% did not report any specific training for their work at SAMU. The main weaknesses identified were psychiatric care and surgical emergencies in 57.2 and 42.9% of cases, respectively; traumatic pediatric emergencies, 48.9%; and medical emergencies, 42.9%. As for procedure-related skills, the physicians reported difficulties in pediatric advanced support (62.4%), airway surgical access (45.6%), pericardiocentesis (64.4%) and thoracentesis (29.9%). Difficulties in using an artificial ventilator (43.3%) and in transcutaneous pacing (42.2%) were also reported. Higher percentages of young physicians, aged 25-30 years (26.7 vs 19.0%; p<0.01), worked exclusively in prehospital care (18.0 vs 7.7%; p<0.001), with workloads >48 h per week (12.8 vs 8.6%; p<0.001), and were non-specialists with the shortest length of service (<1 year) at SAMU (30.1 vs 18.2%; p<0.001) who were hired without having to pass public service exams* (i.e., for a temporary job) (61.8 vs 46.2%; p<0.001). Regarding quality of life, the pain domain yielded the worst result among physicians at SAMU. CONCLUSIONS: The doctors in this sample were young and within a few years of graduation, and they had no specific training in prehospital emergencies. Deficiencies were mostly found in pediatrics and psychiatry, with specific deficiencies in the handling of essential equipment and in the skills necessary to adequately attend to prehospital emergencies. A disrespectful labor scenario was also found; the evaluation of quality of life showed a notable presence of pain on the SF-36 among physicians at SAMU and especially among doctors who had worked for a longer length of time at SAMU. PMID:25318091

  6. Student Work Experience: A Realistic Approach to Merchandising Education.

    ERIC Educational Resources Information Center

    Horridge, Patricia; And Others

    1980-01-01

    Relevant and realistic experiences are needed to prepare the student for a future career. Addresses the results of a survey of colleges and universities in the United States in regard to their student work experience (SWE) in fashion merchandising. (Author)

  7. Realistic shell model study of nuclei around 132 Sn

    NASA Astrophysics Data System (ADS)

    Gargano, A.

    2003-04-01

    We have performed shell model calculations for 134Te, 130,134Sn, and 132,134Sb using a realistic effective interaction derived from the CD-Bonn nucleon-nucleon potential. The calculated results are compared with the available experimental data. The main aim of this study was to put to a comprehensive test our realistic effective interaction in the A = 132 region. A very good agreement is obtained for all the five nuclei considered.

  8. Characterization and Monitoring Data for Evaluating Constructed Emergent Sandbar Habitat in the Missouri River Mainstem 2004-2009

    SciTech Connect

    Duberstein, Corey A.

    2011-04-01

    The U.S. Army Corps of Engineers (Corps) provides the primary operational management of the Missouri River Main Stem Reservoir System. Management of the Missouri River has generally reduced peak river flows that form and maintain emergent sandbar habitat. Emergent sandbars provide non-vegetated nesting habitat for the endangered interior least tern (Sternula antillarum athalassos) and the threatened Northern Great Plains piping plover (Charadrius melodus). Since 2000, piping plover nesting habitat within the Gavins Point Reach, Garrison Reach, Lake Oahe, and Lake Sakakawea has fledged the majority of piping plovers produced along the Missouri River system. Habitats within Lewis and Clark Lake have also recently become important plover production areas. Mechanical construction of emergent sandbar habitat (ESH) within some of these reaches within the Missouri River began in 2004. Through 2009, 11 sandbar complexes had been constructed (10 in Gavins Point Reach, 1 in Lewis and Clarke Lake) totaling about 543 ac of piping plover and interior least tern nesting habitat. ESH Construction has resulted in a net gain of tern and plover nesting habitat. Both terns and plovers successfully nest and fledge young on constructed sandbars, and constructed habitats were preferred over natural habitats. Natural processes may limit the viability of constructed sandbars as nesting habitat. Continued research is needed to identify if changes in constructed sandbar engineering and management increase the length of time constructed habitats effectively function as nesting habitat. However, the transfer of information from researchers to planners through technical research reports may not be timely enough to effectively foster the feedback mechanisms of an adaptive management strategy.

  9. Evaluation of Off-Hour Emergency Care in Acute Ischemic Stroke: Results from the China National Stroke Registry

    PubMed Central

    Wang, Guifen; Liu, Gaifen; Zhang, Runhua; Ji, Ruijun; Gao, Baoqin; Wang, Yilong; Pan, Yuesong; Li, Zixiao; Wang, Yongjun

    2015-01-01

    Background and Purpose The quality of after-hour emergency care of patients with acute ischemic stroke is debatable. We therefore, sought to analyze the performance measures, quality of care and clinical outcomes in these patients admitted during off-hours. Methods Our study included 4493 patients from a selected cohort of patients admitted to the hospitals with ischemic stroke in the China National Stroke Registry (CNSR) from September 2007 to August 2008. On-hour presentation was defined as arrival at the emergency department from the scene between 8AM and 5PM from Monday through Friday. Off-hours included the remainder of the on-hours and statutory holidays. The association between off-hour presentation and outcome was analyzed using multivariate logistic-regression models. Results Off-hour presentation was identified in 2672 (59.5%) patients with ischemic stroke. Comparison of patients admitted during off-hours with those admitted during on-hours revealed an unadjusted odds ratio of in-hospital mortality of 1.38 (95% confidence interval, 1.041.85), which declined to 1.34 (95% confidence interval, 0.931.93) after adjusting for patient characteristics (especially, pre-hospital delay). No difference in 30-day mortality, total death or dependence at three, six and 12 months between two groups was observed. No association between off-hour admission and quality of care was found. Conclusions In the CNSR database, compared with on-hour patients, off-hour patients with acute ischemic stroke admitted to the emergency departments from scene manifested a higher incidence of in-hospital mortality. However, the difference in incidence and quality of care between the groups disappeared after adjusting for pre-hospital delay and other variables. PMID:26379280

  10. Prehospital Evaluation of Effusion, Pneumothorax, and Standstill (PEEPS): Point-of-care Ultrasound in Emergency Medical Services

    PubMed Central

    Bhat, Sundeep R.; Johnson, David A.; Pierog, Jessica E.; Zaia, Brita E.; Williams, Sarah R.; Gharahbaghian, Laleh

    2015-01-01

    Introduction In the United States, there are limited studies regarding use of prehospital ultrasound (US) by emergency medical service (EMS) providers. Field diagnosis of life-threatening conditions using US could be of great utility. This study assesses the ability of EMS providers and students to accurately interpret heart and lung US images. Methods We tested certified emergency medical technicians (EMT-B) and paramedics (EMT-P) as well as EMT-B and EMT-P students enrolled in prehospital training programs within two California counties. Participants completed a pre-test of sonographic imaging of normal findings and three pathologic findings: pericardial effusion, pneumothorax, and cardiac standstill. A focused one-hour lecture on emergency US imaging followed. Post-tests were given to all EMS providers immediately following the lecture and to a subgroup one week later. Results We enrolled 57 prehospital providers (19 EMT-B students, 16 EMT-P students, 18 certified EMT-B, and 4 certified EMT-P). The mean pre-test score was 65.2%±12.7% with mean immediate post-test score of 91.1%±7.9% (95% CI [22%–30%], p<0.001). Scores significantly improved for all three pathologic findings. Nineteen subjects took the one-week post-test. Their mean score remained significantly higher: pre-test 65.8%±10.7%; immediate post-test 90.5%±7.0% (95% CI [19%–31%], p<0.001), one-week post-test 93.1%±8.3% (95% CI [21%–34%], p<0.001). Conclusion Using a small sample of EMS providers and students, this study shows the potential feasibility for educating prehospital providers to accurately identify images of pericardial effusion, pneumothorax, and cardiac standstill after a focused lecture. PMID:26265961

  11. Quantitative and Qualitative Evaluation of Bio-Aerosols in Surgery Rooms and Emergency Department of an Educational Hospital

    PubMed Central

    Mirzaei, Ramazan; Shahriary, Esmat; Qureshi, Mazhar Iqbal; Rakhshkhorshid, Ataollah; Khammary, Abdolali; Mohammadi, Mahdi

    2014-01-01

    Background: Bio-aerosols are a potential hazard in hospitals and are mostly produced by hospital staff, patients and visitors. Bio-aerosols are solid or liquid particles pending in the air and they consist of aerosols accompanying micro-organisms or organic compounds of micro-organisms such as endotoxin, metabolite, toxin and other parts of organism. Those are a potential hazard in hospitals and are mostly produced by hospital staff, patients and visitors. Objectives: This study aimed to determine the types and amount of bacterial contamination in operating rooms and emergency department of an educational hospital in Zahedan, South-East of Iran. Materials and Methods: In this study, 72 samples were collected from three operating rooms and three rooms in the emergency department of an educational hospital during 2012. On the first day of every month, a sample was taken from each room during the morning shift; active sampling was done on plates consisting of blood agar and brain-heart infusion agar (BHI) for 10 minutes in the axis of a one-story Anderson impactor (flow rate 28.1 litter per minutes) and SIBATA air pump SIP 32-L and samples were then placed in a 35°C Incubator. Bacterial colonies were counted; warm coloring and differential tests were done and the data were analyzed using Mann-Whitney U and Kruskal-Wallis tests. Results: Seventeen types of bacteria were detected including Staphylococcus, Micrococcus, Viridians, Pneumococcus, Escherichia coli, Streptococcus, Bacillus cereus, B. subtilis, Klebsiella, Pseudomonas, Diphtheroid, Citrobacter and Enterobacter. Quantitative bacterial results showed that the number of observed bacteria in the emergency department with an average of 103.88 ± 33.84 cfu/m³ was more than that of the surgery rooms with an average of 63.32 ± 32.94 cfu/m³. Furthermore, the highest average number of all counted colonies (106 ± 28.45 cfu/m³) was determined in autumn. In all samples, S. aureus and Micrococcus were the most detected bacteria. Conclusions: The World Health Organization (WHO) has suggested relatively relaxed limits of 100 cfu/m3 for bacteria and 50 cfu/m3 for fungi in the hospital air. Therefore, quantitative and qualitative outcomes of this study demonstrate that contamination level and bacterial variety in surgery rooms and emergency departments is high and effective measures must be taken to control the possible health risks. PMID:25632321

  12. Evaluation/disposition of observations no. 6-17, 6-18, and 6-22 from site electrical assessment report, 300 area powerhouse and emergency sys.

    SciTech Connect

    Ahola, E.L.

    1996-09-30

    Disposition of Observations 6-17, 6-18, 6-22 of Site Electrical Assessment Report. Application of generator differential protection, and synchro-check relay rewiring for generators of building 3621-D. In 1990, the WHC Site Electrical Task Group issued a Site Electrical Assessment Report, ``300 Area Powerhouse and Emergency System.`` This report included numerous findings and observations relating to observed deficiencies or opportunities for improvement in maintenance of the inspected electrical systems. The purpose of this letter report is to provide an evaluation and proposed disposition of Observations No. 6-1 7, 6-1 8, and 6-22 of the Site Electrical Assessment Report.

  13. The visualizable, the representable and the inconceivable: realist and non-realist mathematical models in physics and beyond.

    PubMed

    Plotnitsky, Arkady

    2016-01-13

    The project of this article is twofold. First, it aims to offer a new perspective on, and a new argument concerning, realist and non-realist mathematical models, and differences and affinities between them, using physics as a paradigmatic field of mathematical modelling in science. Most of the article is devoted to this topic. Second, the article aims to explore the implications of this argument for mathematical modelling in other fields, in particular in cognitive psychology and economics. PMID:26621990

  14. Chemical Emergencies

    MedlinePlus

    Chemical Emergencies Under certain conditions, chemicals which are normally safe can be poisonous or harmful to your health. A major chemical emergency is an accident that releases a hazardous amount ...

  15. Radiation Emergencies

    MedlinePlus

    ... day from sources such as sunlight. A radiation emergency would involve larger amounts of radiation and could ... are no guarantees of safety during a radiation emergency, you can take actions to protect yourself. You ...

  16. Heat emergencies

    MedlinePlus

    Heat emergencies or illnesses are caused by exposure to extreme heat and sun. Heat illnesses can be prevented by ... to regulate the temperature, and make a heat emergency more likely: Drinking alcohol before or during exposure ...

  17. Emergency Checklist

    MedlinePlus

    ... Prevention Week National Prescription Drug Take-Back Day Emergency Checklist If someone may have been poisoned, call ... may save you from a visit to the emergency room. Below is a checklist to help you ...

  18. Ear emergencies

    MedlinePlus

    Ear emergencies include objects in the ear canal and ruptured eardrums. ... Depending on the type of ear emergency, follow the steps below. OBJECT IN THE EAR Calm and reassure the person. If the object is sticking out and easy to ...

  19. Eye emergencies

    MedlinePlus

    Eye emergencies include cuts, scratches, objects in the eye, burns , chemical exposure, and blunt injuries to the eye or ... Eye emergencies include any of the following: Trauma A black eye is usually caused by direct trauma to the ...

  20. Evaluation of knowledge and behavior of workers in Prince Mohammed International Airport in Western Saudi Arabia regarding public health emergency measures applied during Hajj season 2014

    PubMed Central

    Gosadi, Ibrahim M.; Al-Hazmi, Ali M.; Fadl, Amin A.; Alharbi, Khalid H.; Swarelzahab, Mazin M.

    2015-01-01

    Objectives: To evaluate the knowledge and behavior of workers at a Saudi airport regarding public health emergency measures applied during Hajj season. Methods: This study is a cross-sectional study conducted at the Prince Mohammed International Airport in Al-Madinah Al-Munawwarah, Saudi Arabia between August and September 2014. Data were collected by semi-structured questionnaires during personal interviews. Non-random purposive sampling was conducted to target workers at higher risk of acquiring infection from travellers. Results: One hundred and eighty-six participants were recruited of whom 92.5% were males. The study participants were workers in 8 different sectors. Twenty-six percent of the participants were health workers. Non-health workers were more likely to be concerned on acquiring infection while working at the airport compared with health workers (p=0.023). The most commonly feared disease was Ebola viral disease (EBV) among 30% of health workers, and 47% of non-health workers. Approximately 47% of non-health workers reported no knowledge of the procedures implemented during public health emergencies. The proportion of participants who received public health related training among non-health workers was significantly lower compared with health workers (p<0.00001). Conclusion: More emphasis should be given to educating airport workers on the potential health threats at the airport. Specific guidelines for public health emergencies at the airport should be established and communicated with airport sectors. PMID:25828283

  1. Boundary conditions towards realistic simulation of jet engine noise

    NASA Astrophysics Data System (ADS)

    Dhamankar, Nitin S.

    Strict noise regulations at major airports and increasing environmental concerns have made prediction and attenuation of jet noise an active research topic. Large eddy simulation coupled with computational aeroacoustics has the potential to be a significant research tool for this problem. With the emergence of petascale computer clusters, it is now computationally feasible to include the nozzle geometry in jet noise simulations. In high Reynolds number experiments on jet noise, the turbulent boundary layer on the inner surface of the nozzle separates into a turbulent free shear layer. Inclusion of a nozzle with turbulent inlet conditions is necessary to simulate this phenomenon realistically. This will allow a reasonable comparison of numerically computed noise levels with the experimental results. Two viscous wall boundary conditions are implemented for modeling the nozzle walls. A characteristic-based approach is compared with a computationally cheaper, extrapolation-based formulation. In viscous flow over a circular cylinder under two different regimes, excellent agreement is observed between the results of the two approaches. The results agree reasonably well with reference experimental and numerical results. Both the boundary conditions are thus found to be appropriate, the extrapolation-based formulation having an edge with its low cost. This is followed with the crucial step of generation of a turbulent boundary layer inside the nozzle. A digital filter-based turbulent inflow condition, extended in a new way to non-uniform curvilinear grids is implemented to achieve this. A zero pressure gradient flat plate turbulent boundary layer is simulated at a high Reynolds number to show that the method is capable of producing sustained turbulence. The length of the adjustment region necessary for synthetic inlet turbulence to recover from modeling errors is estimated. A low Reynolds number jet simulation including a round nozzle geometry is performed and the method is found to be successful in producing a turbulent shear layer. Imposition of larger turbulent integral length scales at the inlet is found to be effective in achieving a quicker recovery of turbulent fluctuations at low Reynolds numbers.

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

    PubMed Central

    2013-01-01

    Background A realist synthesis attempts to provide policy makers with a transferable theory that suggests a certain program is more or less likely to work in certain respects, for particular subjects, in specific kinds of situations. Yet realist reviews can require considerable and sustained investment over time, which does not always suit the time-sensitive demands of many policy decisions. ‘Rapid Realist Review’ methodology (RRR) has been developed as a tool for applying a realist approach to a knowledge synthesis process in order to produce a product that is useful to policy makers in responding to time-sensitive and/or emerging issues, while preserving the core elements of realist methodology. Methods Using examples from completed RRRs, we describe key features of the RRR methodology, the resources required, and the strengths and limitations of the process. All aspects of an RRR are guided by both a local reference group, and a group of content experts. Involvement of knowledge users and external experts ensures both the usability of the review products, as well as their links to current practice. Results RRRs have proven useful in providing evidence for and making explicit what is known on a given topic, as well as articulating where knowledge gaps may exist. From the RRRs completed to date, findings broadly adhere to four (often overlapping) classifications: guiding rules for policy-making; knowledge quantification (i.e., the amount of literature available that identifies context, mechanisms, and outcomes for a given topic); understanding tensions/paradoxes in the evidence base; and, reinforcing or refuting beliefs and decisions taken. Conclusions ‘Traditional’ realist reviews and RRRs have some key differences, which allow policy makers to apply each type of methodology strategically to maximize its utility within a particular local constellation of history, goals, resources, politics and environment. In particular, the RRR methodology is explicitly 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. PMID:24007206

  3. An Evaluation of a Natural Language Processing Tool for Identifying and Encoding Allergy Information in Emergency Department Clinical Notes

    PubMed Central

    Goss, Foster R.; Plasek, Joseph M.; Lau, Jason J.; Seger, Diane L.; Chang, Frank Y.; Zhou, Li

    2014-01-01

    Emergency department (ED) visits due to allergic reactions are common. Allergy information is often recorded in free-text provider notes; however, this domain has not yet been widely studied by the natural language processing (NLP) community. We developed an allergy module built on the MTERMS NLP system to identify and encode food, drug, and environmental allergies and allergic reactions. The module included updates to our lexicon using standard terminologies, and novel disambiguation algorithms. We developed an annotation schema and annotated 400 ED notes that served as a gold standard for comparison to MTERMS output. MTERMS achieved an F-measure of 87.6% for the detection of allergen names and no known allergies, 90% for identifying true reactions in each allergy statement where true allergens were also identified, and 69% for linking reactions to their allergen. These preliminary results demonstrate the feasibility using NLP to extract and encode allergy information from clinical notes. PMID:25954363

  4. Clinical evaluation of the Emergency Medical Services (EMS) ambulance dispatch-based syndromic surveillance system, New York City.

    PubMed

    Greenko, Jane; Mostashari, Farzad; Fine, Annie; Layton, Marci

    2003-06-01

    Since 1998, the New York City Department of Health has used New York City Emergency Medical Services (EMS) ambulance dispatch data to monitor for a communitywide rise in influenzalike illness (ILI) as an early detection system for bioterrorism. A clinical validation study was conducted during peak influenza season at six New York City emergency departments (EDs) to compare patients with ILI brought in by ambulance with other patients to examine potential biases associated with ambulance dispatch-based surveillance. We also examined the utility of 4 EMS call types (selected from 52) for case detection of ILI. Clinical ILI was defined as fever (temperature higher than 100 degrees F) on history or exam, along with either cough or sore throat. Of the 2,294 ED visits reviewed, 522 patients (23%) met the case definition for ILI, 64 (12%) of whom arrived by ambulance. Patients with ILI brought in by ambulance were older, complained of more severe symptoms, and were more likely to undergo diagnostic testing, be diagnosed with pneumonia, and be admitted to the hospital than patients who arrived by other means. The median duration of symptoms prior to presenting to the ED, however, was the same for both groups (48 hours). The selected call types had a sensitivity of 58% for clinical ILI, and a predictive value positive of 22%. Individuals with symptoms consistent with the prodrome of inhalational anthrax were likely to utilize the EMS system and usually did so early in the course of illness. While EMS-based surveillance is more sensitive for severe illness and for illness affecting older individuals, there is not necessarily a loss of timeliness associated with EMS-based (versus ED-based) surveillance. PMID:12791779

  5. Searching for the mechanisms of change: a protocol for a realist review of batterer treatment programmes

    PubMed Central

    Cheff, Rebecca; Finn, Debbie; Davloor, Whitney; O'Campo, Patricia

    2016-01-01

    Introduction Conflicting results reported by evaluations of typical batterer intervention programmes leave many judicial officials and policymakers uncertain about the best way to respond to domestic violence, and whether to recommend and fund these programmes. Traditional evaluations and systematic reviews tend to focus predominantly on whether the programmes ‘worked’ (eg, reduced recidivism) often at the exclusion of understanding for whom they may or may not have worked, under what circumstances, and why. Methods and analysis We are undertaking a realist review of the batterer treatment programme literature with the aim of addressing this gap. Keeping with the goals of realist review, our primary aims are to identify the theory that underlies these programmes, highlight the mechanisms that trigger changes in participant behaviour and finally explain why these programmes help some individuals reduce their use of violence and under what conditions they are effective or not effective. We begin by describing the process of perpetrator treatment, and by proposing an initial theoretical model of behaviour change that will be tested by our review. We then describe the criteria for inclusion of an evaluation into the review, the search strategy we will use to identify the studies, and the plan for data extraction and analysis. Ethics and dissemination The results of this review will be written up using the RAMESES Guidelines for Realist Synthesis, and disseminated through peer-reviewed publications aimed at the practitioner community as well as presented at community forums, and at violence against women conferences. Ethics approval was not needed. PMID:27053268

  6. Higher Education Institutional and Program Evaluations in Taiwan and the Emerging Roles of Higher Education Evaluation and Accreditation Council of Taiwan (HEEACT)

    ERIC Educational Resources Information Center

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

    2013-01-01

    Post-secondary education institutions in Taiwan are divided into two tracks, general higher education (HE) and technological and vocational education (TVE). The evaluation of all universities/colleges is mandated by the University Act. Higher education institutions receive mandated institutional evaluation every six years and program evaluation…

  7. Foreword: In situ gas surface interactions: approaching realistic conditions

    NASA Astrophysics Data System (ADS)

    Lundgren, Edvin; Over, Herbert

    2008-03-01

    This special issue is devoted to the application of in situ surface-sensitive techniques in the elucidation of catalysed reactions at (model) catalyst surfaces. Both reaction intermediates and the nature of the catalytically active phase are the targets of these investigations. In situ surface science techniques are also used to study the interaction of water with surfaces under realistic conditions. Since 80% of all technical chemicals are manufactured by utilizing (heterogeneous) catalysis, scientific understanding and technological development of catalysis are of central practical importance in modern society [1]. Heterogeneously catalysed reactions take place at the gas/solid interface. Therefore one of the major topics in surface chemistry and physics is closely related to heterogeneous catalysis, with the aim of developing novel catalysts and to improve catalysts' performances on the basis of atomic scale based knowledge. Despite the economical and environmental rewards—if such a goal is achieved—and despite 40 years of intensive research, practical catalysis is still safely in a black box: the reactivity and selectivity of a catalyst are commercially still optimized on a trial and error basis, applying the high throughput screening approach. The reason for this discrepancy between ambition and reality lies in the inherent complexity of the catalytic system, consisting of the working catalyst and the interaction of the catalyst with the reactant mixture. Practical (solid) catalysts consist of metal or oxide nanoparticles which are dispersed and stabilized on a support and which may be promoted by means of additives. These particles catalyse a reaction in pressures as high as 100 bar. Practical catalysis is in general considered to be far too complex for gaining atomic-scale understanding of the mechanism of the catalysed reaction of an industrial catalyst during its operation. Therefore it has been necessary to introduce idealization and simplification of both the catalyst and the reaction conditions. For structural simplicity, single crystals of transition metals or oxides are typically used to mimic the catalyst's active surface. To avoid interfering 'dirt' effects, ultrapure reactants are introduced in ultrahigh vacuum (pressures better than 10-8 mbar) chamber systems. In order to gain an atomic-scale understanding of the reaction process, electron-based spectroscopic techniques, such as photoemission spectroscopy, LEED, etc, are applied, which need high vacuum environments due to the limited mean free path of the electrons. Simple model reactions, such as the CO oxidation reaction, have been chosen for trying to understand the microscopic reaction mechanism under these conditions. In this way, important, fundamental information on adsorption sites, dissociation processes and reaction pathways has been obtained over the past 40 years [2]. Nevertheless, the large differences between these simple UHV model systems and more real-world non-single-crystal surfaces exposed to high pressures often prevent extrapolation of this atomic-scale knowledge to more realistic situations: a materials and pressure gap (cf figure 1) is introduced [3]. figure 1 Figure 1. Model catalysis and practical catalysis are separated by two gaps, i.e. the pressure gap and the materials gap. The pressure gap is introduced by well-defined reaction and preparation conditions in model catalysis when ultrahigh vacuum (UHV) conditions are used, while typical pressures in practical catalysis are as high as several 100 bar. The materials gap is introduced by the low structural complexity of the model catalyst. Typically, practical catalysts in heterogeneous catalysis are supported oxides or nanoparticles. It is evident that the pressure gap is established by the use of ultrahigh vacuum (UHV) conditions to maintain well-defined reaction conditions. It is also clear that the materials gap is caused by oversimplifying the model catalyst as having single-crystal surfaces, by neglecting defects, by the simultaneous presence of various orientations on the catalyst's particle, and by communication between the various facets and by having support-particle interaction. However, there is a third and extremely important issue which is devoted to the interaction of the catalyst with the reactant gas phase at elevated pressure and elevated temperatures [4, 5]. Under such conditions, the catalyst can easily undergo a chemical transformation into a surface compound, and the shape of a catalytic nanoparticle may change substantially. For instance, under typical reaction conditions for the oxidation of CO and other molecules the transition metal (TM) catalyst may be oxidized, while under more reducing reaction conditions the TM oxide surface formed may decompose to form metallic TM particles. Therefore, the interaction of the reactant gas mixture and the catalyst surface may have a dramatic influence on the catalytic properties of catalysts under reaction conditions. Consequently the application of in situ techniques is mandatory to identify the catalytically active state of the catalyst. At the moment, the nature of the active catalyst cannot be theoretically predicted without experimental input, or easily envisaged through studies at low temperatures under UHV conditions. In recent years, a substantial effort has been directed to overcoming these obstacles in model catalysis [6]. At present, the technical development is rapid, and it is expected that a number of groups and laboratories (in particular emerging synchrotron ones) will actively promote the building of in situ instruments based on existing design as well as the invention of novel experimental in situ techniques. This special issue presents a collection of studies illustrating these efforts. The ultimate goal of these efforts is to allow transfer of the knowledge gained by model catalysis to practical catalysis. The first six studies in this issue [7-12] concentrate on the effect on single-crystal surfaces using realistic gas pressures. These studies show that although the pressure in itself has a significant influence on the surface, the temperature of the sample governs compound formation which completely transforms the properties of the surface. The examples presented here of changing catalyst surfaces are the formation of surface oxides under reaction conditions and the formation of subsurface species in oxidation and hydrogenation reactions. The next two papers [13, 14] increase the complexity of the system studied by focusing on nanoparticles on model substrate oxides as these are exposed to high pressures and temperatures. One section in this special issue is devoted to theory [15-17]. For theoretical studies to be 'in situ' or to be 'under operando' means that these calculations include practical issues such as the interaction of the reacting gas mixture with the catalyst's surface over a wide pressure range, introducing quasi-thermal equilibrium between gas mixture and catalyst surface in terms of the chemical potential. This includes also the chemical stability of the catalyst particle under varying conditions of reaction, such as the chemical potential of oxygen. For instance, metal surfaces may oxidize under oxidizing reaction conditions, forming surface oxides. An extremely important issue which so far has not been discussed to much extent in the surface chemistry/physics literature, at least not under realistic conditions, is related to the interaction of water with various kinds of surfaces, including metal, oxide and biomaterial surfaces, at higher water pressures. These interaction systems are important not only to biology and electrochemistry in general, but also for heterogeneous catalysis, where water is a well-known poison of catalytic reactions. Two such studies are presented here [18, 19]. In this special issue we have tried to illustrate the importance of approaching realistic conditions in catalysis related surface science research. Our aim is to provide a solid backbone for those scientists entering the emerging and dynamic field of surface chemistry and physics. Acknowledgments This work was financially supported by the Swedish Research Council, Deutsche Forschungsgemeinschaft (DFG, SPP1091), and the European Commission under contract NMP3-CT-2003-505670 (NANO2). References [1] Ertl G, Knözinger H and Weitkamp J (ed) 1997 Handbook of Heterogeneous Catalysis (Weinheim: VCH) [2] Ertl G and Freund H-J 1999 Phys. Today 52 32 [3] Ertl G 1990 Angew. Chem. Int. Edn Engl. 29 1219 [4] Schlögl R and Abd Hamid S B 2004 Angew. Chem. Int. Edn Engl. 43 1628 [5] Somorjai G A 1996 Chem. Rev. 96 1223 [6] Stierle A and Moelenbrok A 2007 Novel in situ probes for nano catalysis MRS Bull. 32 [7] Ellinger C, Stierle A, Robinson I K, Nefedov A and Dosch H 2008 Atmospheric pressure oxidation of Pt(111) J. Phys.: Condens. Matter 20 184013 [8] Barbier A, Stierle A, Finocchi F and Jupille J 2008 Stability and stoichiometry of (polar) oxide surfaces for varying oxygen chemical potential J. Phys.: Condens. Matter 20 184014 [9] Weaver J F, Kan H H and Shumbera R B 2008 Growth and properties of high-concentration phases of atomic oxygen on platinum single-crystal surfaces J. Phys.: Condens. Matter 20 184015 [10] Vass E, Hävecker M, Zafeiratos S, Teschner D, Knop-Gericke A and Schlögl R 2008 The role of carbon species in heterogeneous catalytic processes: an in situ soft x-ray photoelectron spectroscopy study J. Phys.: Condens. Matter 20 184016 [11] Assman J, Narhkede V, Breuer N, Muhler M, Seitsonen A P, Knapp M, Crihan D, Farkas A, Mellau G and Over H 2008 Heterogeneous oxidation catalysis on ruthenium: bridging the pressure and materials gaps and beyond J. Phys.: Condens. Matter 20 184017 [12] Westerström R, Wang J G, Ackermann M D, Gustafson J, Resta A, Mikkelsen A, Andersen J N, Lundgren E, Balmes O, Torrelles X, Frenken J W M and Hammer B 2008 J. Phys.: Condens. Matter 20 184018 [13] Rupprechter G and Weilach C 2008 Spectroscopic studies of surface-gas interactions and catalyst restructuring at ambient pressure: mind the gap! J. Phys.: Condens. Matter 20 184019 [14] Evans M and Tromp M 2008 Interaction of small gas phase molecules with alumina supportedrhodium nanoparticles: an in situ spectroscopic study J. Phys.: Condens. Matter 20 184020 [15] Stampfl C, Soon A, Piccinin S, Shi H and Zhang H 2008 Bridging the temperature and pressure gaps: close-packed transition metal surfaces in an oxygen environment J. Phys.: Condens. Matter 21 184021 [16] Li W-X 2008 Oxidation of platinum surfaces and reaction with carbon monoxide J. Phys.: Condens. Matter 20 184022 [17] Seriani N and Mittendorfer F 2008 Platinum-group and noble metals under oxidizing conditions J. Phys.: Condens. Matter 20 184023 [18] Ketteler G, Ashby P, Mun B S, Ratera I, Bluhm H, Kasemo B and Salmeron M 2008 In situ photoelectron spectroscopy study of water absorption on model biomaterial surfaces J. Phys.: Condens. Matter 20 184024 [19] Yamamoto S, Bluhm H, Andersson K, Ketteler G, Ogasawara H, Salmeron M and Nilsson A 2008 In situ x-ray photoelectron spectroscopy studies of water on metals and oxides at ambient conditions J. Phys.: Condens. Matter 20 184025

  8. Description and validation of realistic and structured endourology training model

    PubMed Central

    Soria, Federico; Morcillo, Esther; Sanz, Juan Luis; Budia, Alberto; Serrano, Alvaro; Sanchez-Margallo, Francisco M

    2014-01-01

    Purpose: The aim of the present study was to validate a model of training, which combines the use of non-biological and ex vivo biological bench models, as well as the modelling of urological injuries for endourological treatment in a porcine animal model. Material and Methods: A total of 40 participants took part in this study. The duration of the activity was 16 hours. The model of training was divided into 3 levels: level I, concerning the acquisition of basic theoretical knowledge; level II, involving practice with the bench models and level III, concerning practice in the porcine animal model. First, trainees practiced with animals without using a model of injured (ureteroscopy, management of guide wires and catheters under fluoroscopic control) and later practiced in lithiasic animal model. During the activity, an evaluation of the face and content validity was conducted, as well as constructive validation provided by the trainees versus experts. Evolution of the variables during the course within each group was analysed using the Student’s t test for paired samples, while comparisons between groups, were performed using the Student’s t test for unpaired samples. Results: The assessments of face and content validity were satisfactory. The constructive validation, “within one trainee” shows that were statistical significant differences between the first time the trainees performed the tasks in the animal model and the last time, mainly in the knowledge of procedure and Holmium laser lithotripsy cathegories. At the beginning of level III, there are also statistical significant differences between trainee’s scores and the expert’s scores.Conclusions: This realistic Endourology training model allows the acquisition of knowledge and technical and non-technical skills as evidenced by the face, content and constructive validity. Structured use of bench models (biological and non biological) and animal model simulators increase the endourological basic skills. PMID:25374928

  9. Error Reduction and Performance Improvement in the Emergency Department through Formal Teamwork Training: Evaluation Results of the MedTeams Project

    PubMed Central

    Morey, John C; Simon, Robert; Jay, Gregory D; Wears, Robert L; Salisbury, Mary; Dukes, Kimberly A; Berns, Scott D

    2002-01-01

    Objective To evaluate the effectiveness of training and institutionalizing teamwork behaviors, drawn from aviation crew resource management (CRM) programs, on emergency department (ED) staff organized into caregiver teams. Study Setting Nine teaching and community hospital EDs. Study Design A prospective multicenter evaluation using a quasi-experimental, untreated control group design with one pretest and two posttests of the Emergency Team Coordination CourseTM (ETCC). The experimental group, comprised of 684 physicians, nurses, and technicians, received the ETCC and implemented formal teamwork structures and processes. Assessments occurred prior to training, and at intervals of four and eight months after training. Three outcome constructs were evaluated: team behavior, ED performance, and attitudes and opinions. Trained observers rated ED staff team behaviors and made observations of clinical errors, a measure of ED performance. Staff and patients in the EDs completed surveys measuring attitudes and opinions. Data Collection Hospital EDs were the units of analysis for the seven outcome measures. Prior to aggregating data at the hospital level, scale properties of surveys and event-related observations were evaluated at the respondent or case level. Principal Findings A statistically significant improvement in quality of team behaviors was shown between the experimental and control groups following training (p = .012). Subjective workload was not affected by the intervention (p = .668). The clinical error rate significantly decreased from 30.9 percent to 4.4 percent in the experimental group (p = .039). In the experimental group, the ED staffs' attitudes toward teamwork increased (p = .047) and staff assessments of institutional support showed a significant increase (p = .040). Conclusion Our findings point to the effectiveness of formal teamwork training for improving team behaviors, reducing errors, and improving staff attitudes among the ETCC-trained hospitals. PMID:12546286

  10. Wetland Biomass Production: emergent aquatic management options and evaluations. A final subcontract report. [Includes a bibliography containing 686 references on Typha from biological abstracts

    SciTech Connect

    Pratt, D.C.; Dubbe, D.R.; Garver, E.G.; Linton, P.J.

    1984-07-01

    The high yield potential and attractive chemical composition of Typha make it a particularly viable energy crop. The Minnesota research effort has demonstrated that total annual biomass yields equivalent to 30 dry tonnes/ha (13 tons/acre) are possible in planted stands. This compares with yields of total plant material between 9 and 16 dry tonnes/ha (4 to 7 tons/acre) in a typical Minnesota corn field. At least 50% of the Typha plant is comprised of a belowground rhizome system containing 40% starch and sugar. This high level of easily fermentable carbohydrate makes rhizomes an attractive feedstock for alcohol production. The aboveground portion of the plant is largely cellulose, and although it is not easily fermentable, it can be gasified or burned. This report is organized in a manner that focuses on the evaluation of the management options task. Results from stand management research performed at the University of Minnesota during 1982 and 1983 are integrated with findings from an extensive survey of relevant emergent aquatic plant research and utilization. These results and findings are then arranged in sections dealing with key steps and issues that need to be dealt with in the development of a managed emergent aquatic bio-energy system. A brief section evaluating the current status of rhizome harvesting is also included along with an indexed bibliography of the biology, ecology, and utilization of Typha which was completed with support from this SERI subcontract. 686 references, 11 figures, 17 tables.

  11. Realistic Real-Time Outdoor Rendering in Augmented Reality

    PubMed Central

    Kolivand, Hoshang; Sunar, Mohd Shahrizal

    2014-01-01

    Realistic rendering techniques of outdoor Augmented Reality (AR) has been an attractive topic since the last two decades considering the sizeable amount of publications in computer graphics. Realistic virtual objects in outdoor rendering AR systems require sophisticated effects such as: shadows, daylight and interactions between sky colours and virtual as well as real objects. A few realistic rendering techniques have been designed to overcome this obstacle, most of which are related to non real-time rendering. However, the problem still remains, especially in outdoor rendering. This paper proposed a much newer, unique technique to achieve realistic real-time outdoor rendering, while taking into account the interaction between sky colours and objects in AR systems with respect to shadows in any specific location, date and time. This approach involves three main phases, which cover different outdoor AR rendering requirements. Firstly, sky colour was generated with respect to the position of the sun. Second step involves the shadow generation algorithm, Z-Partitioning: Gaussian and Fog Shadow Maps (Z-GaF Shadow Maps). Lastly, a technique to integrate sky colours and shadows through its effects on virtual objects in the AR system, is introduced. The experimental results reveal that the proposed technique has significantly improved the realism of real-time outdoor AR rendering, thus solving the problem of realistic AR systems. PMID:25268480

  12. Emergent Data-Driven Approaches to School Improvement: The Journey of Three Schools through Self-Evaluation

    ERIC Educational Resources Information Center

    Karagiorgi, Yiasemina; Nicolaidou, Maria; Yiasemis, Christos; Georghiades, Petros

    2015-01-01

    This article aims to illustrate a school self-evaluation project implemented in three Cyprus primary schools. The project adopted three theoretical assumptions, namely, an orientation towards school improvement, a participatory school-level approach allowing support from a critical friend and a focus on effective teaching. In line with a…

  13. Southern Schools: An Evaluation of the Effects of the Emergency School Assistance Program and of School Desegregation. Volume I.

    ERIC Educational Resources Information Center

    Crain, Robert L., Ed.

    This evaluation sampled 150 pairs of schools (50 pairs of high schools and 100 pairs of elementary schools) eligible for ESAP funds, randomly designating one school from each pair as a control school to receive no ESAP funds and using a flip of the coin to so designate. The first volume of the report comprises four chapters and seven appendices.…

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

    PubMed

    Cao, Yucheng; Pawłowski, Artur

    2013-01-01

    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

  15. The importance of evaluating metal exposure and predicting human health risks in urban-periurban environments influenced by emerging industry.

    PubMed

    Yousaf, Balal; Amina; Liu, Guijian; Wang, Ruwei; Imtiaz, Muhammad; Rizwan, Muhammad Shahid; Zia-Ur-Rehman, Muhammad; Qadir, Abdul; Si, Youbin

    2016-05-01

    The human population boom, urbanization and rapid industrialization have either directly or indirectly resulted in the serious environmental toxification of the soil-food web by metal exposure from anthropogenic sources in most of the developing industrialized world. The present study was conducted to analyze concentrations of Cd, Cr, Cu, Mn, Ni, Pb, and Zn in soil and vegetables in the urban-periurban areas influenced by emerging industry. Vegetables and their corresponding soil samples were collected and analyzed for heavy metals contents from six random sites. According to the results, the potential health risks from metals to the local communities were assessed by following the methodology described by the US-EPA. In general, the total non-carcinogenic risks were shown to be less than the limits set by the US-EPA. However, the potential risk of developing carcinogenicity in humans over a lifetime of exposure could be increased through the dietary intake of Cd, Cr and Ni. In some cases, Pb was also marginally higher than the safe level. It was concluded that some effective remedial approaches should be adopted to mitigate the risks of Cd, Cr, Ni and Pb in the study area because these metal levels have exceeded the safe limits for human health. However, new studies on gastrointestinal bioaccessibility in human are required to heighten our understanding about metals exposure and health risk assessment. PMID:26891360

  16. Speaker Verification in Realistic Noisy Environment in Forensic Science

    NASA Astrophysics Data System (ADS)

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

    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.

  17. The Emerging Roles of Coronary Computed Tomographic Angiography: Acute Chest Pain Evaluation and Screening for Asymptomatic Individuals

    PubMed Central

    Chien, Ning; Wang, Tzung-Dau; Chang, Yeun-Chung; Lin, Po-Chih; Tseng, Yao-Hui; Lee, Yee-Fan; Ko, Wei-Chun; Lee, Bai-Chin; Lee, Wen-Jeng

    2016-01-01

    Coronary computed tomographic angiography (CCTA) has been widely available since 2004. After that, the diagnostic accuracy of CCTA has been extensively validated with invasive coronary angiography for detection of coronary arterial stenosis. In this paper, we reviewed the updated evidence of the role of CCTA in both scenarios including acute chest pain and screening in asymptomatic adults. Several large-scale studies have been conducted to evaluate the diagnostic value of CCTA in the context of acute chest pain patients. CCTA could play a role in delivering more efficient care. For risk stratification of asymptomatic patients using CCTA, latest studies have revealed incremental benefits. Future studies evaluating the totality of plaque characteristics may be useful for determining the role of noncalcified plaque for risk stratification in asymptomatic individuals. PMID:27122947

  18. A generic framework to simulate realistic lung, liver and renal pathologies in CT imaging.

    PubMed

    Solomon, Justin; Samei, Ehsan

    2014-11-01

    Realistic three-dimensional (3D) mathematical models of subtle lesions are essential for many computed tomography (CT) studies focused on performance evaluation and optimization. In this paper, we develop a generic mathematical framework that describes the 3D size, shape, contrast, and contrast-profile characteristics of a lesion, as well as a method to create lesion models based on CT data of real lesions. Further, we implemented a technique to insert the lesion models into CT images in order to create hybrid CT datasets. This framework was used to create a library of realistic lesion models and corresponding hybrid CT images. The goodness of fit of the models was assessed using the coefficient of determination (R(2)) and the visual appearance of the hybrid images was assessed with an observer study using images of both real and simulated lesions and receiver operator characteristic (ROC) analysis. The average R(2) of the lesion models was 0.80, implying that the models provide a good fit to real lesion data. The area under the ROC curve was 0.55, implying that the observers could not readily distinguish between real and simulated lesions. Therefore, we conclude that the lesion-modeling framework presented in this paper can be used to create realistic lesion models and hybrid CT images. These models could be instrumental in performance evaluation and optimization of novel CT systems. PMID:25325156

  19. The effects of realistic pancake solenoids on particle transport

    SciTech Connect

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

    2011-02-01

    Solenoids are widely used to transport or focus particle beams. Usually, they are assumed as being ideal solenoids with a high axial-symmetry magnetic field. Using the Vector Field Opera program, we modeled asymmetrical solenoids with realistic geometry defects, caused by finite conductor and current jumpers. Their multipole magnetic components were analyzed with the Fourier fit method; we present some possible optimized methods for them. We also discuss the effects of 'realistic' solenoids on low energy particle transport. The finding in this paper may be applicable to some lower energy particle transport system design.

  20. The effects of realistic pancake solenoids on particle transport

    SciTech Connect

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

    2011-02-17

    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 Fields 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 findings in this paper may be applicable to the lower energy particle transport system design.

  1. A Distributed Radiator, Heavy Ion Target with Realistic Ion Beams

    NASA Astrophysics Data System (ADS)

    Callahan, Debra A.; Tabak, Max

    1997-11-01

    Recent efforts in heavy ion target design have centered around the distributed radiator design of Tabak(M. Tabak, Bull. Am. Phys. Soc., Vol 41, No 7, 1996.). The initial distributed radiator target assumed beams with a uniform radial density distribution aimed directly along the z axis. Chamber propagation simulations indicate that the beam distribution is more nearly Gaussian at best focus. In addition, more than two beams will be necessary to carry the required current; this means that the beams must be angled to allow space for the final focusing systems upstream. We will describe our modifications to the distributed radiator target to allow realistic beams and realistic beam angles.

  2. The effects of realistic pancake solenoids on particle transport

    NASA Astrophysics Data System (ADS)

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

    2011-05-01

    Solenoids are widely used to transport or focus particle beams. Usually, they are assumed as being ideal solenoids with a high axial-symmetry magnetic field. Using the Vector Fields 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 findings in this paper may be applicable to the lower energy particle transport system design.

  3. Homogeneous nucleation of methane hydrates: unrealistic under realistic conditions.

    PubMed

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

    2012-12-01

    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

  4. Continuous central venous oximetry and shock index in the emergency department: use in the evaluation of clinical shock.

    PubMed

    Rady, M Y; Rivers, E P; Martin, G B; Smithline, H; Appelton, T; Nowak, R M

    1992-11-01

    Initial therapy of shock in the emergency department (ED) emphasizes the normalization of physiologic variables such as heart rate (HR), mean arterial pressure (MAP), and central venous pressure (CVP) rather than restoration of adequate tissue oxygenation. After hemodynamic stabilization of MAP, CVP, and HR, the authors examined tissue oxygenation as indicated by continuous central venous oximetry (SCVO2), lactic acid concentration, and shock index (SI). Sixteen consecutive nonrandomized patients presenting to the ED of a large urban hospital in shock (MAP < 60 mm Hg, HR > 120 beats/min, and altered sensorium) were initially resuscitated with fluid, blood, inotropes, and/or vasoactive drug therapy to normalize MAP, CVP, and HR. In addition, SCVO2, arterial lactate concentration, and SI were measured after completion of resuscitation in the ED. Eight patients (group no. 1) had inadequate tissue oxygenation reflected by low SCVO2 (less than 65%). Four patients in group no. 1 had elevated arterial lactic acid concentration. All group no. 1 patients had an elevated SI (> 0.7) suggesting persistent impairment of left ventricular stroke work. Eight patients (group no. 2) had normal or elevated SCVO2 (> 65%). In group no. 2, arterial lactic acid concentration was elevated in six and SI in seven patients. Normalization of hemodynamic variables does not adequately reflect the optimal endpoint of initial therapy in shock in the ED. Most (94%) of these patients continue to have significant global ischemia and cardiac dysfunction as indicated by reduced SCVO2 and elevated lactic acid concentration and SI. Systemic tissue oxygenation should be monitored and optimized in the ED in these critically ill patients.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:1388378

  5. Evaluation of syndromic algorithms for detecting patients with potentially transmissible infectious diseases based on computerised emergency-department data

    PubMed Central

    2013-01-01

    Background The objective of this study was to ascertain the performance of syndromic algorithms for the early detection of patients in healthcare facilities who have potentially transmissible infectious diseases, using computerised emergency department (ED) data. Methods A retrospective cohort in an 810-bed University of Lyon hospital in France was analysed. Adults who were admitted to the ED and hospitalised between June 1, 2007, and March 31, 2010 were included (N=10895). Different algorithms were built to detect patients with infectious respiratory, cutaneous or gastrointestinal syndromes. The performance parameters of these algorithms were assessed with regard to the capacity of our infection-control team to investigate the detected cases. Results For respiratory syndromes, the sensitivity of the detection algorithms was 82.70%, and the specificity was 82.37%. For cutaneous syndromes, the sensitivity of the detection algorithms was 78.08%, and the specificity was 95.93%. For gastrointestinal syndromes, the sensitivity of the detection algorithms was 79.41%, and the specificity was 81.97%. Conclusions This assessment permitted us to detect patients with potentially transmissible infectious diseases, while striking a reasonable balance between true positives and false positives, for both respiratory and cutaneous syndromes. The algorithms for gastrointestinal syndromes were not specific enough for routine use, because they generated a large number of false positives relative to the number of infected patients. Detection of patients with potentially transmissible infectious diseases will enable us to take precautions to prevent transmission as soon as these patients come in contact with healthcare facilities. PMID:24004720

  6. The emerging role of endoscopic ultrasound-guided core biopsy for the evaluation of solid pancreatic masses.

    PubMed

    Bhutani, M; Koduru, P; Lanke, G; Bruno, M; Maitra, A; Giovannini, M

    2015-06-01

    Pancreatic ductal adenocarcinoma is a lethal cancer with a 5-year survival rate of less than 5%. Surgical resection is the only curative treatment but only 20% are eligible for resection at the time of diagnosis. Early detection of cancer is of paramount importance in the management. Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is the preferred modality for obtaining tissue diagnosis of pancreatic masses. However, the diagnostic accuracy of EUS-FNA may be limited by several factors like availability of onsite cytopathology, adequacy of tissue core for histology, location of the mass, presence of underlying chronic pancreatitis, and experience of the endoscopist. Modern oncology is focusing on personalizing treatment based on tissue analysis of genetic aberrations and molecular biomarkers which are now available. Core tissue also aids in the diagnosis of disease entities like lymphoma, metastatic tumors, neuroendocrine tumors and autoimmune pancreatitis whose diagnosis rely on preserved tissue architecture and immunohistochemistry. Making accurate diagnosis of solid pancreatic masses is critical to avoid unnecessary resections in patients with benign lesions like focal lesions of chronic pancreatitis and autoimmune pancreatitis which mimic cancer. To overcome the limitations of FNA and to obtain adequate core tissue, a Tru-Cut biopsy needle was developed which met with variable success due to stiffness, cumbersome operation and technical failure using it in the duodenum/pancreatic head. More recently fine needle biopsy needles, with reverse bevel technology have become available in different sizes (19, 22, 25-gauge). The aim of this article was to review the emerging role of core biopsy needles in acquiring tissue in solid pancreatic masses and discuss its potential role in personalized medicine. PMID:25675155

  7. Emerging technologies

    SciTech Connect

    Lu, Shin-yee

    1993-03-01

    The mission of the Emerging Technologies thrust area at Lawrence Livermore National Laboratory is to help individuals establish technology areas that have national and commercial impact, and are outside the scope of the existing thrust areas. We continue to encourage innovative ideas that bring quality results to existing programs. We also take as our mission the encouragement of investment in new technology areas that are important to the economic competitiveness of this nation. In fiscal year 1992, we have focused on nine projects, summarized in this report: (1) Tire, Accident, Handling, and Roadway Safety; (2) EXTRANSYT: An Expert System for Advanced Traffic Management; (3) Odin: A High-Power, Underwater, Acoustic Transmitter for Surveillance Applications; (4) Passive Seismic Reservoir Monitoring: Signal Processing Innovations; (5) Paste Extrudable Explosive Aft Charge for Multi-Stage Munitions; (6) A Continuum Model for Reinforced Concrete at High Pressures and Strain Rates: Interim Report; (7) Benchmarking of the Criticality Evaluation Code COG; (8) Fast Algorithm for Large-Scale Consensus DNA Sequence Assembly; and (9) Using Electrical Heating to Enhance the Extraction of Volatile Organic Compounds from Soil.

  8. Rehand: Realistic electric prosthetic hand created with a 3D printer.

    PubMed

    Yoshikawa, Masahiro; Sato, Ryo; Higashihara, Takanori; Ogasawara, Tsukasa; Kawashima, Noritaka

    2015-08-01

    Myoelectric prosthetic hands provide an appearance with five fingers and a grasping function to forearm amputees. However, they have problems in weight, appearance, and cost. This paper reports on the Rehand, a realistic electric prosthetic hand created with a 3D printer. It provides a realistic appearance that is same as the cosmetic prosthetic hand and a grasping function. A simple link mechanism with one linear actuator for grasping and 3D printed parts achieve low cost, light weight, and ease of maintenance. An operating system based on a distance sensor provides a natural operability equivalent to the myoelectric control system. A supporter socket allows them to wear the prosthetic hand easily. An evaluation using the Southampton Hand Assessment Procedure (SHAP) demonstrated that an amputee was able to operate various objects and do everyday activities with the Rehand. PMID:26736794

  9. Influenza: an emerging disease.

    PubMed Central

    Webster, R. G.

    1998-01-01

    Because all known influenza A subtypes exist in the aquatic bird reservoir, influenza is not an eradicable disease; prevention and control are the only realistic goals. If people, pigs, and aquatic birds are the principal variables associated with interspecies transfer of influenza virus and the emergence of new human pandemic strains, influenza surveillance in these species is indicated. Live-bird markets housing a wide variety of avian species together (chickens, ducks, geese, pigeon, turkeys, pheasants, guinea fowl), occasionally with pigs, for sale directly to the public provide outstanding conditions for genetic mixing and spreading of influenza viruses; therefore, these birds should be monitored for influenza viruses. Moreover, if pigs are the mixing vessel for influenza viruses, surveillance in this population may also provide an early warning system for humans. PMID:9716966

  10. A SPATIALLY REALISTIC MODEL FOR INFORMING FOREST MANAGEMENT DECISIONS

    EPA Science Inventory

    Spatially realistic population models (SRPMs) address a fundamental
    problem commonly confronted by wildlife managers - predicting the
    effects of landscape-scale habitat management on an animal population.
    SRPMs typically consist of three submodels: (1) a habitat submodel...

  11. The Instructional Effectiveness of Integrating Abstract and Realistic Visualization.

    ERIC Educational Resources Information Center

    Joseph, John H.

    This study examined the question of whether the integration of abstract and realistic visualization can improve the effectiveness of visualized instruction. Two methods of integrating visualizations were investigated. The first method used hybrid illustrations, i.e., a real color photograph into which a line drawing segment has been inserted. This…

  12. Critical Realist Review: Exploring the Real, beyond the Empirical

    ERIC Educational Resources Information Center

    Edgley, Alison; Stickley, Theodore; Timmons, Stephen; Meal, Andy

    2016-01-01

    This article defines the "critical realist review", a literature-based methodological approach to critical analysis of health care studies (or any discipline charged with social interventions) that is robust, insightful and essential for the complexities of twenty-first century evidence-based health and social care. We argue that this…

  13. Inquiring into the Real: A Realist Phenomenological Approach

    ERIC Educational Resources Information Center

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

    2010-01-01

    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

  14. Synthesis Of Realistic Animations Of A Person Speaking

    NASA Technical Reports Server (NTRS)

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

    1995-01-01

    Actors computer program implements automated process that synthesizes realistic animations of person speaking. Produces "newscaster" type video sequences. Uses images of person and, therefore, not limited to cartoons and cartoonlike movies. Potential applications also include use of process for automatically producing on-the-fly animations for human/computer interfaces and for reducing bandwidth needed to transmit video telephone signals.

  15. A Realistic Experimental Design and Statistical Analysis Project

    ERIC Educational Resources Information Center

    Muske, Kenneth R.; Myers, John A.

    2007-01-01

    A realistic applied chemical engineering experimental design and statistical analysis project is documented in this article. This project has been implemented as part of the professional development and applied statistics courses at Villanova University over the past five years. The novel aspects of this project are that the students are given a

  16. Two-Capacitor Problem: A More Realistic View.

    ERIC Educational Resources Information Center

    Powell, R. A.

    1979-01-01

    Discusses the two-capacitor problem by considering the self-inductance of the circuit used and by determining how well the usual series RC circuit approximates the two-capacitor problem when realistic values of L, C, and R are chosen. (GA)

  17. International Management: Creating a More Realistic Global Planning Environment.

    ERIC Educational Resources Information Center

    Waldron, Darryl G.

    2000-01-01

    Discusses the need for realistic global planning environments in international business education, introducing a strategic planning model that has teams interacting with teams to strategically analyze a selected multinational company. This dynamic process must result in a single integrated written analysis that specifies an optimal strategy for…

  18. Engendering Anthropocentrism: Lessons from Children's Realistic Animal Stories.

    ERIC Educational Resources Information Center

    Johnson, Kathleen R.

    In children's realistic stories about animals a number of wholly and unambiguously anthropocentric assumptions are at work. For instance, in a study most of the books (81%) in one sampling of 50 stories involve a pet or the process of domesticating a wild animal. In most cases the primary animal character is a dog or horse. The predominance of…

  19. Developing Skills: Realistic Work Environments in Further Education. FEDA Reports.

    ERIC Educational Resources Information Center

    Armstrong, Paul; Hughes, Maria

    To establish the prevalence and perceived value of realistic work environments (RWEs) in colleges and their use as learning resources, all further education (FE) sector colleges in Great Britain were surveyed in the summer of 1998. Of 175 colleges that responded to 2 questionnaires for senior college managers and RWE managers, 127 had at least 1…

  20. Evaluating the co-production of a near real time Earthquake Aftershock forecasting tool for humanitarian risk assessment and emergency planning

    NASA Astrophysics Data System (ADS)

    Quinn, Keira; Hope, Max; McCloskey, John; NicBhloscaidh, Mairead; Jimenez, Abigail; Dunlop, Paul

    2015-04-01

    Concern Worldwide and the University of Ulster Geophysics Research Group are engaged in a project to co-produce a suite of software and mapping tools to assess aftershock hazard in near real-time during the emergency response phase of earthquake disaster, and inform humanitarian emergency planning and response activities. This paper uses a social learning approach to evaluate this co-production process. Following Wenger (1999) we differentiate between the earthquake science and humanitarian communities of practice (CoP) along three dimensions: enterprise (the purpose of CoPs and the problems participants are working to address), repertoire (knowledge, skills, language), and identity (values and boundaries). We examine the effectiveness of learning between CoP, focusing on boundary work and objects, and various organisational structures and aspects of the wider political economy of learning that enable and hinder the co-production process. We conclude by identifying a number of ways to more effectively integrate earthquake science into humanitarian decision-making, policy development and programme design.

  1. The Implementation and Evaluation of the Emergency Response Dose Assessment System (ERDAS) at Cape Canaveral Air Station/Kennedy Space Center

    NASA Technical Reports Server (NTRS)

    Evans, Randolph J.; Tremback, Craig J.; Lyons, Walter A.

    1996-01-01

    The Emergency Response Dose Assessment System (ERDAS) is a system which combines the mesoscale meteorological prediction model RAMS with the diffusion models REEDM and HYPACT. Operators use a graphical user interface to run the models for emergency response and toxic hazard planning at CCAS/KCS. The Applied Meteorology Unit has been evaluating the ERDAS meteorological and diffusion models and obtained the following results: (1) RAMS adequately predicts the occurrence of the daily sea breeze during non-cloudy conditions for several cases. (2) RAMS shows a tendency to predict the sea breeze to occur slightly earlier and to move it further inland than observed. The sea breeze predictions could most likely be improved by better parameterizing the soil moisture and/or sea surface temperatures. (3) The HYPACT/REEDM/RAMS models accurately predict launch plume locations when RAMS winds are accurate and when the correct plume layer is modeled. (4) HYPACT does not adequately handle plume buoyancy for heated plumes since all plumes are presently treated as passive tracers. Enhancements should be incorporated into the ERDAS as it moves toward being a fully operational system and as computer workstations continue to increase in power and decrease in cost. These enhancements include the following: activate RAMS moisture physics; use finer RAMS grid resolution; add RAMS input parameters (e.g. soil moisture, radar, and/or satellite data); automate data quality control; implement four-dimensional data assimilation; modify HYPACT plume rise and deposition physics; and add cumulative dosage calculations in HYPACT.

  2. Evaluation of the impact of implementing the emergency medical services traumatic brain injury guidelines in Arizona: the Excellence in Prehospital Injury Care (EPIC) study methodology.

    PubMed

    Spaite, Daniel W; Bobrow, Bentley J; Stolz, Uwe; Sherrill, Duane; Chikani, Vatsal; Barnhart, Bruce; Sotelo, Michael; Gaither, Joshua B; Viscusi, Chad; Adelson, P David; Denninghoff, Kurt R

    2014-07-01

    Traumatic brain injury (TBI) exacts a great toll on society. Fortunately, there is growing evidence that the management of TBI in the early minutes after injury may significantly reduce morbidity and mortality. In response, evidence-based prehospital and in-hospital TBI treatment guidelines have been established by authoritative bodies. However, no large studies have yet evaluated the effectiveness of implementing these guidelines in the prehospital setting. This article describes the background, design, implementation, emergency medical services (EMS) treatment protocols, and statistical analysis of a prospective, controlled (before/after), statewide study designed to evaluate the effect of implementing the EMS TBI guidelines-the Excellence in Prehospital Injury Care (EPIC) study (NIH/NINDS R01NS071049, "EPIC"; and 3R01NS071049-S1, "EPIC4Kids"). The specific aim of the study is to test the hypothesis that statewide implementation of the international adult and pediatric EMS TBI guidelines will significantly reduce mortality and improve nonmortality outcomes in patients with moderate or severe TBI. Furthermore, it will specifically evaluate the effect of guideline implementation on outcomes in the subgroup of patients who are intubated in the field. Over the course of the entire study (~9 years), it is estimated that approximately 25,000 patients will be enrolled. PMID:25112451

  3. Physical-chemical properties and evaluative fate modelling of 'emerging' and 'novel' brominated and organophosphorus flame retardants in the indoor and outdoor environment.

    PubMed

    Liagkouridis, Ioannis; Cousins, Anna Palm; Cousins, Ian T

    2015-08-15

    Several groups of flame retardants (FRs) have entered the market in recent years as replacements for polybrominated diphenyl ethers (PBDEs), but little is known about their physical-chemical properties or their environmental transport and fate. Here we make best estimates of the physical-chemical properties and undertake evaluative modelling assessments (indoors and outdoors) for 35 so-called 'novel' and 'emerging' brominated flame retardants (BFRs) and 22 organophosphorus flame retardants (OPFRs). A QSPR (Quantitative Structure-Property Relationship) based technique is used to reduce uncertainty in physical-chemical properties and to aid property selection for modelling, but it is evident that more, high quality property data are required for improving future assessments. Evaluative modelling results show that many of the alternative FRs, mainly alternative BFRs and some of the halogenated OPFRs, behave similarly to the PBDEs both indoors and outdoors. These alternative FRs exhibit high overall persistence (Pov), long-range transport potential (LRTP) and POP-like behaviour and on that basis cannot be regarded as suitable replacements to PBDEs. A group of low molecular weight alternative BFRs and non-halogenated OPFRs show a potentially better environmental performance based on Pov and LRTP metrics. Results must be interpreted with caution though since there are significant uncertainties and limited data to allow for thorough model evaluation. Additional environmental parameters such as toxicity and bioaccumulative potential as well as functionality issues should be considered in an industrial substitution strategy. PMID:25933174

  4. Evaluation of the Impact of Implementing the Emergency Medical Services Traumatic Brain Injury Guidelines in Arizona: The Excellence in Prehospital Injury Care (EPIC) Study Methodology

    PubMed Central

    Spaite, Daniel W.; Bobrow, Bentley J.; Stolz, Uwe; Sherrill, Duane; Chikani, Vatsal; Barnhart, Bruce; Sotelo, Michael; Gaither, Joshua B.; Viscusi, Chad; Adelson, P. David; Denninghoff, Kurt R.

    2014-01-01

    Traumatic brain injury (TBI) exacts a great toll on society. Fortunately, there is growing evidence that the management of TBI in the early minutes after injury may significantly reduce morbidity and mortality. In response, evidence-based prehospital and in-hospital TBI treatment guidelines have been established by authoritative bodies. However, no large studies have yet evaluated the effectiveness of implementing these guidelines in the prehospital setting. This article describes the background, design, implementation, emergency medical services (EMS) treatment protocols, and statistical analysis of a prospective, controlled (before/after), statewide study designed to evaluate the effect of implementing the EMS TBI guidelines—the Excellence in Prehospital Injury Care (EPIC) study (NIH/NINDS R01NS071049, “EPIC”; and 3R01NS071049-S1, “EPIC4Kids”). The specific aim of the study is to test the hypothesis that statewide implementation of the international adult and pediatric EMS TBI guidelines will significantly reduce mortality and improve nonmortality outcomes in patients with moderate or severe TBI. Furthermore, it will specifically evaluate the effect of guideline implementation on outcomes in the subgroup of patients who are intubated in the field. Over the course of the entire study (~9 years), it is estimated that approximately 25,000 patients will be enrolled. PMID:25112451

  5. Contextual Emergence

    NASA Astrophysics Data System (ADS)

    Atmanspacher, Harald

    The concept of contextual emergence has been proposed as a nonreductive, yet well-defined relation between different levels of description of physical and other systems. It yields a formally sound and empirically applicable procedure to translate between descriptive levels in an overall consistent fashion. This will be discussed for the contextual emergence of mental states from a neural level of description.

  6. Optimizing Wind And Hydropower Generation Within Realistic Reservoir Operating Policy

    NASA Astrophysics Data System (ADS)

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

    2012-12-01

    Previous studies have evaluated the benefits of utilizing the flexibility of hydropower systems to balance the variability and uncertainty of wind generation. However, previous hydropower and wind coordination studies have simplified non-power constraints on reservoir systems. For example, some studies have only included hydropower constraints on minimum and maximum storage volumes and minimum and maximum plant discharges. The methodology presented here utilizes the pre-emptive linear goal programming optimization solver in RiverWare to model hydropower operations with a set of prioritized policy constraints and objectives based on realistic policies that govern the operation of actual hydropower systems, including licensing constraints, environmental constraints, water management and power objectives. This approach accounts for the fact that not all policy constraints are of equal importance. For example target environmental flow levels may not be satisfied if it would require violating license minimum or maximum storages (pool elevations), but environmental flow constraints will be satisfied before optimizing power generation. Additionally, this work not only models the economic value of energy from the combined hydropower and wind system, it also captures the economic value of ancillary services provided by the hydropower resources. It is recognized that the increased variability and uncertainty inherent with increased wind penetration levels requires an increase in ancillary services. In regions with liberalized markets for ancillary services, a significant portion of hydropower revenue can result from providing ancillary services. Thus, ancillary services should be accounted for when determining the total value of a hydropower system integrated with wind generation. This research shows that the end value of integrated hydropower and wind generation is dependent on a number of factors that can vary by location. Wind factors include wind penetration level, 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.

  7. Evaluation of Physicians' and Nurses' Knowledge, Attitudes, and Compliance With Family Presence During Resuscitation in an Emergency Department Setting After an Educational Intervention.

    PubMed

    Ferrara, Gineen; Ramponi, Denise; Cline, Thomas W

    2016-01-01

    Family presence during resuscitation (FPDR) has been an ongoing topic of discussion in many hospital emergency departments throughout the United States. With the current emphasis promoting patient- and family-centered care, families are now exercising their right to be present at the bedside during resuscitation. With or without a policy, there is continued resistance to allow families to remain with their loved ones during resuscitation. The purpose of this study was to evaluate if an evidence-based educational intervention would increase physicians' and nurses' knowledge, attitudes, and compliance with allowing FPDR. This quasi-experimental study evaluated 30 attending physicians' and 65 registered nurses' knowledge of an existing family presence policy and their attitudes toward family presence post-educational intervention in an emergency department setting. Compliance of family presence was observed for 2 months pre- and post-educational intervention. Results show that most physicians and nurses either were not sure or were not aware that there was an existing written policy. The study demonstrated that nurses agree more than physicians that the option of FPDR is a patient/family right. The results also showed that the educational intervention had no effect on the physicians and nurses attitudes for FPDR, but it did change behaviors. Of the events involving professionals who were exposed to the educational intervention, family members were present 87.5% of the time. In contrast, only 23% of the events involving professionals who did not receive the educational intervention had families present. Ongoing staff education will heighten awareness to FPDR, make the staff more comfortable with families being present, and will presumably continue to increase invitations for FPDR. PMID:26817429

  8. Evaluation of pulsed Nd:YAG laser posterior hyaloidotomy as an emergency treatment for blinding premacular subhyaloid hemorrhage

    PubMed Central

    Hazem, Hazem A; Shazly, Tarek A

    2011-01-01

    Purpose: This study aimed to evaluate the benefits of Nd:YAG laser posterior hyaloidotomy as a method allowing rapid drainage of subhyaloid hemorrhage into the vitreous gel. Design: Nonrandomized, prospective, interventional, controlled case series. Methods: Nd:YAG laser posterior hyaloidotomy was performed in four eyes of three patients with premacular subhyaloid hemorrhage. The etiologies were bleeding tendency, proliferative diabetic retinopathy, and idiopathic. Four eyes of four patients with premacular subhyaloid hemorrhage were managed conservatively. The etiologies were proliferative diabetic retinopathy and Valsalva retinopathy. Results: A rapid resolution of subhyaloid hemorrhage with improvement of visual acuity was achieved in all patients treated with Nd:YAG laser posterior hyaloidotomy, without evidence of damage to the retina or choroid. With regard to the conservatively managed eyes, there was a tendency towards slow spontaneous absorption of hemorrhage during the follow-up period. Conclusion: Nd:YAG laser posterior hyaloidotomy was a safe and effective procedure for rapid resolution of premacular subhyaloid hemorrhage, allowing rapid restoration of visual acuity, visualization of the underlying retina, expedited access for macular photocoagulation and avoidance of vitrectomy.

  9. Evaluation of performance reference compounds (PRCs) to monitor emerging polar contaminants by polar organic chemical integrative samplers (POCIS) in rivers.

    PubMed

    Carpinteiro, Inmaculada; Schopfer, Adrien; Estoppey, Nicolas; Fong, Camille; Grandjean, Dominique; de Alencastro, Luiz F

    2016-02-01

    In this work, a method combining polar organic chemical integrative samplers (POCIS) and ultraperformance liquid chromatography coupled with tandem mass spectrometry (UPLC-MS/MS) was assessed for the determination of two corrosion inhibitors (benzotriazole and methylbenzotriazole), seven pesticides (atrazine, diuron, isoproturon, linuron, metolachlor, penconazole, terbuthylazine), and four pharmaceuticals (carbamazepine, diclofenac, metformin, sulfamethoxazole) in river water. As a first step, two POCIS sorbents, hydrophilic-lipophilic balance (HLB) and Strata X-CW, were compared. The comparison of the uptake profiles of the studied compounds showed that the HLB sorbent provides better uptake (higher sampled amount and better linearity) than Strata X-CW except for the basic compound metformin. Since the sampling rate (R s) of POCIS depends on environmental factors, seven compounds were evaluated as potential performance reference compounds (PRCs) through kinetic experiments. Deisopropylatrazine-d5 (DIA-d5) and, as far as we know, for the first time 4-methylbenzotriazole-d3 showed suitable desorption. The efficiency of both compounds to correct for the effect of water velocity was shown using a channel system in which POCIS were exposed to 2 and 50 cm s(-1). Finally, POCIS were deployed upstream and downstream of agricultural wine-growing and tree-growing areas in the Lienne River and the Uvrier Canal (Switzerland). The impact of the studied areas on both streams could be demonstrated. PMID:26637214

  10. Development and Process Evaluation of a Primary Care Internet-Based Intervention to Prevent Depression in Emerging Adults

    PubMed Central

    Van Voorhees, Benjamin W.; Ellis, Justin M.; Gollan, Jackie K.; Bell, Carl C.; Stuart, Scott S.; Fogel, Joshua; Corrigan, Patrick W.; Ford, Daniel E.

    2007-01-01

    Background: Primary care is a potential setting for implementation of depression prevention interventions using cognitive behavioral therapy (CBT) and interpersonal psychotherapy (IPT). The purpose of this study was to develop and conduct a process evaluation of a primary care/ Internet-based intervention that addresses key dissemination barriers in a community setting. Method: We used an interdisciplinary team of investigators in a multistep intervention development process among a sample of primary care patients (aged 18 to 24 years). The intervention included an initial primary care motivational interview to engage the participant, 11 Internet-based modules based on CBT (to counter pessimistic thinking) and IPT (to activate social networks and strengthen relationship skills), and a follow-up motivational interview in primary care to enhance behavior change. Each component of the intervention was rated with regard to dissemination barriers of (1) fidelity, (2) motivation, (3) dose, (4) perceived helpfulness (rated on a Likert scale), and (5) potential costs. The study was conducted from April through June of 2004. Results: Fidelity checklist and serial reviews were satisfactory (100% core concepts translated into intervention). Key motivations for participation included (1) risk reduction, (2) intervention effectiveness, (3) “resiliency,” and (4) altruism. In terms of dose, 13 of 14 participants engaged the Internet-based components, completing a mean of 7.2 modules (SD = 3.9). The 2 primary care interviews and the self-assessment and resiliency modules received the highest helpfulness ratings. The duration of the 2 motivational interviews was approximately 17–18 minutes, which is similar to a typical primary care visit. Conclusions: By using multidisciplinary teams and incorporating the opinions of potential users, complex preventive mental health interventions can be translated into primary care settings with adequate fidelity, motivation, dose, and perceived helpfulness, and at a reasonably low cost. PMID:17998953

  11. Evaluating validity of clinical criteria for requesting chest X-rays in trauma patients referred to emergency room

    PubMed Central

    Nejati, A; Khalaj, S; Azizkhani, Reza; Shahryarian, Shahriar; Kolahdouzan, Mohsen; Hossein, Montazer Seyyed

    2012-01-01

    Background: Our goal was to identify the clinical criteria for requesting the chest X-ray in patients with blunt trauma and whether its findings such as clinical signs with a high sensitivity could be used to codify the final criteria. Materials and Methods: 386 patients with multiple trauma or blunt chest trauma examined by a physician and the injury mechanism, vital signs, O2 saturation, auscultation findings, abrasions and ecchymosis, crepitation, tenderness on palpation, and pain on lateral compression were noted. The physician's clinical judgment on the necessity of a chest X-ray was also noted in a questionnaire. After taking the X-ray, a digital photo was taken and showed to a radiologist to report any significant chest injury. Data were collected and the positive and negative predictive values, sensitivity and specificity were estimated. Results: 350 males (90.9%) and 35 females (9.1%) with the mean age of 47.1 ± 15.5 years old were evaluated. Falling down (37.7%) was the major mechanism of injury and chest pain (48%) the first complaint of patients. In 87.3% of the chest X-rays, there was no abnormal finding. Among several pathological findings in the chest X-rays, hemothorax, and rib fracture (each with 3.4% prevalence) had a higher prevalence. Tenderness on palpation with clinical judgment had a higher sensitivity about 95% and higher specificity about 100% in crepitation detected. Conclusion: Results showed the combination of positive chest pain and tachypnea in the patients could identify a significant chest injury with 100% sensitivity. More studies on this issue are warranted. PMID:23210081

  12. Human Performance in a Realistic Instrument-Control Task during Short-Term Microgravity

    PubMed Central

    Steinberg, Fabian; Kalicinski, Michael; Dalecki, Marc; Bock, Otmar

    2015-01-01

    Previous studies have documented the detrimental effects of microgravity on human sensorimotor skills. While that work dealt with simple, laboratory-type skills, we now evaluate the effects of microgravity on a complex, realistic instrument-control skill. Twelve participants controlled a simulated power plant during the short-term microgravity intervals of parabolic flight as well as during level flight. To this end they watched multiple displays, made strategic decisions and used multiple actuators to maximize their virtual earnings from the power plant. We quantified control efficiency as the participants’ net earnings (revenue minus expenses), motor performance as hand kinematics and dynamics, and stress as cortisol level, self-assessed mood and self-assessed workload. We found that compared to normal gravity, control efficiency substantially decreased in microgravity, hand velocity slowed down, and cortisol level and perceived physical strain increased, but other stress and motor scores didn’t change. Furthermore, control efficiency was not correlated with motor and stress scores. From this we conclude that realistic instrument control was degraded in short-term microgravity. This degradation can’t be explained by the motor and/or stress indicators under study, and microgravity affected motor performance differently in our complex, realistic skill than in the simple, laboratory-type skills of earlier studies. PMID:26083473

  13. Effects of Defining Realistic Compositions of the Ocular Melanoma on Proton Therapy

    PubMed Central

    Keshazare, Sh; Masoudi, S F; S Rasouli, F

    2014-01-01

    Background: Recent studies in eye plaque brachytherapy have shown a considerable difference between the dosimetric results using water phantom and a model of human eye containing realistic materials. In spite of this fact, there is a lack of simulation studies based on such a model in proton therapy literatures. In the presented work, the effect of utilizing an eye model with ocular media on proton therapy is investigated using the MCNPX Monte Carlo Code. Methods: Two different eye models are proposed to study the effect of defining realistic materials on dose deposition due to utilizing pencil beam scanning (PBS) method for proton therapy of ocular melanoma. The first model is filled with water, and the second one contains the realistic materials of tumor and vitreous. Spread out Bragg peaks (SOBP) are created to cover a typical tumor volume. Moreover, isodose curves are figured in order to evaluate planar variations of absorbed dose in two models. Results: The results show that the maximum delivered dose in ocular media is approximately 12-32% more than in water phantom. Also it is found that using the optimized weighted beams in water phantom leads to disturbance of uniformity of SOBP in ocular media. Conclusion: Similar to the results reported in eye brachytherapy published papers, considering the ocular media in simulation studies leads to a more realistic assessment of sufficiency of the designed proton beam in tissue. This effect is of special importance in creating SOBP, as well as in delivered dose in the tumor boundaries in proton pencil beam scanning method. PMID:25599060

  14. Particles and gaseous emissions from realistic operation of residential wood pellet heating systems

    NASA Astrophysics Data System (ADS)

    Win, Kaung Myat; Persson, Tomas; Bales, Chris

    2012-11-01

    Gaseous and particulate emissions from six residential wood pellet heating systems are determined at a realistic six day operation sequence. The study aims to investigate the total emissions from a realistic operation of the heating systems including start-up and stop phases. Five combined solar and pellet heating systems and one reference boiler without solar system with an integrated DHW preparation was tested in a laboratory at realistic operation conditions. The investigated emissions comprised carbon monoxide (CO), nitrogen oxide (NO), total organic carbon (TOC) and particulate matter (PM2.5). In this study, the emissions are presented as accumulated total emissions from the whole six days period and the emissions from start-up and stop phases are also presented separately to evaluate the influence of the emissions from these phases on the total emissions. Emission factors of the measured systems from the six day period are between 192 and 547 mg MJ-1 for the CO emissions, between 61 and 95 mg MJ-1 for the NO, between 6 and 45 mg MJ-1 for the TOC, between 31 and 116 mg MJ-1 for the particulate matter and between 2.1 × 1013 and 4 × 1013 for the number of particles. The emissions from the start-up and stop phases are significantly high for the CO (63-95 %) and the TOC (48-93 %). NO and particles emissions are shown to dominate during stationary operation. However, 30-40 % of the particle emissions arise from the start and stop periods. It is also shown that the average emissions of CO, TOC and particles under the realistic annual conditions were higher than the limit values of two eco labels.

  15. Application of ICA to realistically simulated 1H-MRS data

    PubMed Central

    Kalyanam, Ravi; Boutte, David; Hutchison, Kent E; Calhoun, Vince D

    2015-01-01

    Introduction 1H-MRS signals from brain tissues capture information on in vivo brain metabolism and neuronal biomarkers. This study aims to advance the use of independent component analysis (ICA) for spectroscopy data by objectively comparing the performance of ICA and LCModel in analyzing realistic data that mimics many of the known properties of in vivo data. Methods This work identifies key features of in vivo 1H-MRS signals and presents methods to simulate realistic data, using a basis set of 12 metabolites typically found in the human brain. The realistic simulations provide a much needed ground truth to evaluate performances of various MRS analysis methods. ICA is applied to collectively analyze multiple realistic spectra and independent components identified with our generative model to obtain ICA estimates. These same data are also analyzed using LCModel and the comparisons between the ground-truth and the analysis estimates are presented. The study also investigates the potential impact of modeling inaccuracies by incorporating two sets of model resonances in simulations. Results The simulated fid signals incorporating line broadening, noise, and residual water signal closely resemble the in vivo signals. Simulation analyses show that the resolution performances of both LCModel and ICA are not consistent across metabolites and that while ICA resolution can be improved for certain resonances, ICA is as effective as, or better than, LCModel in resolving most model resonances. Conclusion The results show that ICA can be an effective tool in comparing multiple spectra and complements existing approaches for providing quantified estimates. PMID:26221570

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

    PubMed Central

    2013-01-01

    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). PMID:23402391

  17. 42 CFR 438.114 - Emergency and poststabilization services.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... Emergency and poststabilization services. (a) Definitions. As used in this section— Emergency medical...) Needed to evaluate or stabilize an emergency medical condition. Poststabilization care services means covered services, related to an emergency medical condition that are provided after an enrollee...

  18. 42 CFR 438.114 - Emergency and poststabilization services.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... Emergency and poststabilization services. (a) Definitions. As used in this section— Emergency medical...) Needed to evaluate or stabilize an emergency medical condition. Poststabilization care services means covered services, related to an emergency medical condition that are provided after an enrollee...

  19. 42 CFR 438.114 - Emergency and poststabilization services.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... Emergency and poststabilization services. (a) Definitions. As used in this section— Emergency medical...) Needed to evaluate or stabilize an emergency medical condition. Poststabilization care services means covered services, related to an emergency medical condition that are provided after an enrollee...

  20. 42 CFR 438.114 - Emergency and poststabilization services.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... Emergency and poststabilization services. (a) Definitions. As used in this section— Emergency medical...) Needed to evaluate or stabilize an emergency medical condition. Poststabilization care services means covered services, related to an emergency medical condition that are provided after an enrollee...

  1. Emergency contraception

    MedlinePlus

    Morning-after pill; Postcoital contraception; Birth control - emergency; Plan B ... Mosby; 2012:chap 92. Jensen JT, Mishell DR. Family planning: contraception, sterilization, and pregnancy termination. In: Lentz GM, ...

  2. Emergency Contraception

    MedlinePlus

    ... pills are currently available at drug stores or family planning clinics for anyone 17 or older without a ... plans cover the cost of emergency contraception and family planning clinics (such as Planned Parenthood) may charge much ...

  3. Evaluation of factors influencing knowledge and attitudes of mothers with preschool children regarding their adoption of preventive measures for home injuries referred to academic emergency centres, Tehran, Iran.

    PubMed

    Hatamabadi, Hamid Reza; Mahfoozpour, Soad; Alimohammadi, Hossein; Younesian, Somaye

    2014-01-01

    Excessive dependence of preschool children on their parents has led to a significant increase in the incidence of home injuries. Therefore, the present study aimed to evaluate factors influencing the knowledge and attitudes of mothers in this group regarding their adoption of preventive measures for home injuries. The subjects in this descriptive/analytical study consisted of all mothers of preschool children with home injuries, who had referred to the emergency department of Imam Hussein Hospital and Shohada-e-Haftome Tir Hospital in Tehran, Iran. After knowledge levels and attitudes of mothers were divided into two groups, multivariate logistic regression analysis and chi-squared test were used. Finally, 230 mothers, with a mean age of 29.4 ± 5.2 years, were evaluated, 75.0% of whom had good knowledge and 46.2% had positive attitudes. High school education, mothers' employment and mothers' absence from home for at least 8 hours a day were the factors predicting poor attitudes of mothers. There was a close correlation between mothers' knowledge and attitudes. The results of this study showed that mothers' high educational status, absence, occupation and the number of children in the family and history of accidents during the previous 3 weeks are important predicting factors. PMID:23886078

  4. Realistic Covariance Prediction for the Earth Science Constellation

    NASA Technical Reports Server (NTRS)

    Duncan, Matthew; Long, Anne

    2006-01-01

    Routine satellite operations for the Earth Science Constellation (ESC) include collision risk assessment between members of the constellation and other orbiting space objects. One component of the risk assessment process is computing the collision probability between two space objects. The collision probability is computed using Monte Carlo techniques as well as by numerically integrating relative state probability density functions. Each algorithm takes as inputs state vector and state vector uncertainty information for both objects. The state vector uncertainty information is expressed in terms of a covariance matrix. The collision probability computation is only as good as the inputs. Therefore, to obtain a collision calculation that is a useful decision-making metric, realistic covariance matrices must be used as inputs to the calculation. This paper describes the process used by the NASA/Goddard Space Flight Center's Earth Science Mission Operations Project to generate realistic covariance predictions for three of the Earth Science Constellation satellites: Aqua, Aura and Terra.

  5. Realistic Covariance Prediction For the Earth Science Constellations

    NASA Technical Reports Server (NTRS)

    Duncan, Matthew; Long, Anne

    2006-01-01

    Routine satellite operations for the Earth Science Constellations (ESC) include collision risk assessment between members of the constellations and other orbiting space objects. One component of the risk assessment process is computing the collision probability between two space objects. The collision probability is computed via Monte Carlo techniques as well as numerically integrating relative probability density functions. Each algorithm takes as inputs state vector and state vector uncertainty information for both objects. The state vector uncertainty information is expressed in terms of a covariance matrix. The collision probability computation is only as good as the inputs. Therefore, to obtain a collision calculation that is a useful decision-making metric, realistic covariance matrices must be used as inputs to the calculation. This paper describes the process used by NASA Goddard's Earth Science Mission Operations Project to generate realistic covariance predictions for three of the ESC satellites: Aqua, Aura, and Terra

  6. Realistic fetus skin color processing for ultrasound volume rendering

    NASA Astrophysics Data System (ADS)

    Kim, Yun-Tae; Kim, Kyuhong; Park, Sung-Chan; Kang, Jooyoung; Kim, Jung-Ho

    2014-01-01

    This paper proposes realistic fetus skin color processing using a 2D color map and a tone mapping function (TMF) for ultrasound volume rendering. The contributions of this paper are a 2D color map generated through a gamut model of skin color and a TMF that depends on the lighting position. First, the gamut model of fetus skin color is calculated by color distribution of baby images. The 2D color map is created using a gamut model for tone mapping of ray casting. For the translucent effect, a 2D color map in which lightness is inverted is generated. Second, to enhance the contrast of rendered images, the luminance, color, and tone curve TMF parameters are changed using 2D Gaussian function that depends on the lighting position. The experimental results demonstrate that the proposed method achieves better realistic skin color reproduction than the conventional method.

  7. Automatic Perceptual Color Map Generation for Realistic Volume Visualization

    PubMed Central

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

    2008-01-01

    Advances in computed tomography imaging technology and inexpensive high performance computer graphics hardware are making high-resolution, full color (24-bit) volume visualizations commonplace. However, many of the color maps used in volume rendering provide questionable value in knowledge representation and are non-perceptual thus biasing data analysis or even obscuring information. These drawbacks, coupled with our need for realistic anatomical volume rendering for teaching and surgical planning, has motivated us to explore the auto-generation of color maps that combine natural colorization with the perceptual discriminating capacity of grayscale. As evidenced by the examples shown that have been created by the algorithm described, the merging of perceptually accurate and realistically colorized virtual anatomy appears to insightfully interpret and impartially enhance volume rendered patient data. PMID:18430609

  8. Realistic Geometry and Global Implementations of the Gyrokinetic Summit Framework

    NASA Astrophysics Data System (ADS)

    Leboeuf, J. N.; Decyk, V. K.; Dimits, A.; Shumaker, D.

    2002-11-01

    The Summit Framework is a gyrokinetic particle-in-cell turbulence simulation environment that incorporates several algorithmic advances including the delta-f solution of the toroidal gyrokinetic Vlasov equation for the ion dynamics, field-aligned "quasi-ballooning" representation and a flux tube simulation domain. The Summit Framework, written in Fortran 90, provides a unified object-based environment for sharing common components in a massively parallel setting. Work is under way to include kinetic electron models and electromagnetic effects, realistic magnetic geometry using quasi-ballooning coordinates and global effects under one software environment. Progress towards realistic geometry and global implementations of the Summit Framework building from the PG3EQ code [Dimits et al., Phys. Rev. letts. 77, 71 (1996)] will be reported. Work on general geometry starts with the base code that is electrostatic with adiabatic electrons. Ways of covering more of the plasma minor radius within the quasi-ballooning representation are also being investigated.

  9. ImpastoR: a realistic surface display system.

    PubMed

    Ferwerda, James A

    2015-04-01

    In this paper we describe our efforts to create a surface display system that produces realistic representations of real-world surfaces. Our system, based on a desktop PC with GPU hardware, LCD display, light and position sensors, and custom graphics software, supports the photometrically accurate and visually realistic real-time simulation and display of surfaces with complex color, gloss, and textural properties in real-world lighting environments, and allows users to interact with and manipulate these virtual surfaces as naturally as if they were real ones. We explain the system design, illustrate its capabilities, describe experiments we conducted to validate its fidelity, and discuss potential applications in material appearance research and computer-aided appearance design. PMID:25449157

  10. Realistic shell-model calculations for neutron deficient Sn isotopes

    NASA Astrophysics Data System (ADS)

    Andreozzi, F.; Coraggio, L.; Covello, A.; Gargano, A.; Kuo, T. T. S.; Li, Z. B.; Porrino, A.

    1996-10-01

    We have performed shell-model calculations for 102,103,104,105Sn using two realistic effective interactions derived from the Bonn A and Paris nucleon-nucleon potentials, respectively. From the comparison of the calculated spectra of 104Sn and 105Sn with the experimental ones it turns out that the best agreement is obtained with the weaker tensor force potential (Bonn A). This agreement appears to be significantly better than for other nuclear regions, such as the sd shell, and thus encourages use of modern realistic potentials in shell-model calculations for medium- and heavy-mass nuclei. In addition, it supports confidence in our predictions of the spectra of the hitherto unknown isotopes 102Sn and 103Sn.

  11. Realistic Modeling of Multi-Scale MHD Dynamics of the Solar Atmosphere

    NASA Technical Reports Server (NTRS)

    Kitiashvili, Irina; Mansour, Nagi N.; Wray, Alan; Couvidat, Sebastian; Yoon, Seokkwan; Kosovichev, Alexander

    2014-01-01

    Realistic 3D radiative MHD simulations open new perspectives for understanding the turbulent dynamics of the solar surface, its coupling to the atmosphere, and the physical mechanisms of generation and transport of non-thermal energy. Traditionally, plasma eruptions and wave phenomena in the solar atmosphere are modeled by prescribing artificial driving mechanisms using magnetic or gas pressure forces that might arise from magnetic field emergence or reconnection instabilities. In contrast, our 'ab initio' simulations provide a realistic description of solar dynamics naturally driven by solar energy flow. By simulating the upper convection zone and the solar atmosphere, we can investigate in detail the physical processes of turbulent magnetoconvection, generation and amplification of magnetic fields, excitation of MHD waves, and plasma eruptions. We present recent simulation results of the multi-scale dynamics of quiet-Sun regions, and energetic effects in the atmosphere and compare with observations. For the comparisons we calculate synthetic spectro-polarimetric data to model observational data of SDO, Hinode, and New Solar Telescope.

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

    PubMed

    Jagla, E A

    2010-04-01

    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

  13. Developments in realistic design for aperiodic Mo/Si multilayermirrors

    SciTech Connect

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

    2006-04-05

    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.

  14. Simulation of human ischemic stroke in realistic 3D geometry

    NASA Astrophysics Data System (ADS)

    Dumont, Thierry; Duarte, Max; Descombes, Stéphane; Dronne, Marie-Aimée; Massot, Marc; Louvet, Violaine

    2013-06-01

    In silico research in medicine is thought to reduce the need for expensive clinical trials under the condition of reliable mathematical models and accurate and efficient numerical methods. In the present work, we tackle the numerical simulation of reaction-diffusion equations modeling human ischemic stroke. This problem induces peculiar difficulties like potentially large stiffness which stems from the broad spectrum of temporal scales in the nonlinear chemical source term as well as from the presence of steep spatial gradients in the reaction fronts, spatially very localized. Furthermore, simulations on realistic 3D geometries are mandatory in order to describe correctly this type of phenomenon. The main goal of this article is to obtain, for the first time, 3D simulations on realistic geometries and to show that the simulation results are consistent with those obtain in experimental studies or observed on MRI images in stroke patients. For this purpose, we introduce a new resolution strategy based mainly on time operator splitting that takes into account complex geometry coupled with a well-conceived parallelization strategy for shared memory architectures. We consider then a high order implicit time integration for the reaction and an explicit one for the diffusion term in order to build a time operator splitting scheme that exploits efficiently the special features of each problem. Thus, we aim at solving complete and realistic models including all time and space scales with conventional computing resources, that is on a reasonably powerful workstation. Consequently and as expected, 2D and also fully 3D numerical simulations of ischemic strokes for a realistic brain geometry, are conducted for the first time and shown to reproduce the dynamics observed on MRI images in stroke patients. Beyond this major step, in order to improve accuracy and computational efficiency of the simulations, we indicate how the present numerical strategy can be coupled with spatial adaptive multiresolution schemes. Preliminary results in the framework of simple geometries allow to assess the proposed strategy for further developments.

  15. Realistic localizer courses for aircraft instrument landing simulators

    NASA Technical Reports Server (NTRS)

    Murphy, T. A.

    1984-01-01

    The realistic instrument landing simulator (ILS) course structures for use in aircraft simulators are described. Software developed for data conversion and translation of ILS course structure measurements and calcomp plots of the courses provided are described. A method of implementing the ILS course structure data in existing aircraft simulators is outlined. A cockpit used in the lab to review the digitized ILS course structures is displayed.

  16. Predictive Evaluation

    ERIC Educational Resources Information Center

    Scriven, Michael

    2007-01-01

    Noting that there has been extensive discussion of the relation of evaluation to: (1) research; (2) explanations (a.k.a. theory-driven, logic model, or realistic evaluation); and (3) recommendations, the author introduces: (4) prediction. He advocates that unlike the first three concepts, prediction is necessarily part of most kinds of evaluation,…

  17. Behaviorly realistic simulations of stock market traders with a soul

    NASA Astrophysics Data System (ADS)

    Solomon, Sorin

    1999-09-01

    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.

  18. MRXCAT: Realistic numerical phantoms for cardiovascular magnetic resonance

    PubMed Central

    2014-01-01

    Background Computer simulations are important for validating novel image acquisition and reconstruction strategies. In cardiovascular magnetic resonance (CMR), numerical simulations need to combine anatomical information and the effects of cardiac and/or respiratory motion. To this end, a framework for realistic CMR simulations is proposed and its use for image reconstruction from undersampled data is demonstrated. Methods The extended Cardiac-Torso (XCAT) anatomical phantom framework with various motion options was used as a basis for the numerical phantoms. Different tissue, dynamic contrast and signal models, multiple receiver coils and noise are simulated. Arbitrary trajectories and undersampled acquisition can be selected. The utility of the framework is demonstrated for accelerated cine and first-pass myocardial perfusion imaging using k-t PCA and k-t SPARSE. Results MRXCAT phantoms allow for realistic simulation of CMR including optional cardiac and respiratory motion. Example reconstructions from simulated undersampled k-t parallel imaging demonstrate the feasibility of simulated acquisition and reconstruction using the presented framework. Myocardial blood flow assessment from simulated myocardial perfusion images highlights the suitability of MRXCAT for quantitative post-processing simulation. Conclusion The proposed MRXCAT phantom framework enables versatile and realistic simulations of CMR including breathhold and free-breathing acquisitions. PMID:25204441

  19. Exposure Render: An Interactive Photo-Realistic Volume Rendering Framework

    PubMed Central

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

    2012-01-01

    The field of volume visualization has undergone rapid development during the past years, both due to advances in suitable computing hardware and due to the increasing availability of large volume datasets. Recent work has focused on increasing the visual realism in Direct Volume Rendering (DVR) by integrating a number of visually plausible but often effect-specific rendering techniques, for instance modeling of light occlusion and depth of field. Besides yielding more attractive renderings, especially the more realistic lighting has a positive effect on perceptual tasks. Although these new rendering techniques yield impressive results, they exhibit limitations in terms of their exibility and their performance. Monte Carlo ray tracing (MCRT), coupled with physically based light transport, is the de-facto standard for synthesizing highly realistic images in the graphics domain, although usually not from volumetric data. Due to the stochastic sampling of MCRT algorithms, numerous effects can be achieved in a relatively straight-forward fashion. For this reason, we have developed a practical framework that applies MCRT techniques also to direct volume rendering (DVR). With this work, we demonstrate that a host of realistic effects, including physically based lighting, can be simulated in a generic and flexible fashion, leading to interactive DVR with improved realism. In the hope that this improved approach to DVR will see more use in practice, we have made available our framework under a permissive open source license. PMID:22768292

  20. I-Love relations for incompressible stars and realistic stars

    NASA Astrophysics Data System (ADS)

    Chan, T. K.; Chan, AtMa P. O.; Leung, P. T.

    2015-02-01

    In spite of the diversity in the equations of state of nuclear matter, the recently discovered I-Love-Q relations [Yagi and Yunes, Science 341, 365 (2013), 10.1126/science.1236462], which relate the moment of inertia, tidal Love number (deformability), and the spin-induced quadrupole moment of compact stars, hold for various kinds of realistic neutron stars and quark stars. While the physical origin of such universality is still a current issue, the observation that the I-Love-Q relations of incompressible stars can well approximate those of realistic compact stars hints at a new direction to approach the problem. In this paper, by establishing recursive post-Minkowskian expansion for the moment of inertia and the tidal deformability of incompressible stars, we analytically derive the I-Love relation for incompressible stars and show that the so-obtained formula can be used to accurately predict the behavior of realistic compact stars from the Newtonian limit to the maximum mass limit.