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1

Triage, monitoring, and treatment of mass casualty events involving chemical, biological, radiological, or nuclear agents  

PubMed Central

In a mass casualty situation due to chemical, biological, radiological, or nuclear (CBRN) event, triage is absolutely required for categorizing the casualties in accordance with medical care priorities. Dealing with a CBRN event always starts at the local level. Even before the detection and analysis of agents can be undertaken, zoning, triage, decontamination, and treatment should be initiated promptly. While applying the triage system, the available medical resources and maximal utilization of medical assets should be taken into consideration by experienced triage officers who are most familiar with the natural course of the injury presented and have detailed information on medical assets. There are several triage systems that can be applied to CBRN casualties. With no one standardized system globally or nationally available, it is important for deploying a triage and decontamination system which is easy to follow and flexible to the available medical resources, casualty number, and severity of injury. PMID:21829319

Ramesh, Aruna C.; Kumar, S.

2010-01-01

2

SCHEDULING IMPATIENT JOBS IN A CLEARING SYSTEM WITH INSIGHTS ON PATIENT TRIAGE IN MASS CASUALTY  

E-print Network

SCHEDULING IMPATIENT JOBS IN A CLEARING SYSTEM WITH INSIGHTS ON PATIENT TRIAGE IN MASS CASUALTY consider a single-server clearing system in which jobs may abandon the system if they are not taken into service within their "lifetime." In this system, jobs are characterized by their lifetime and service time

Ziya, Serhan

3

Terrorism, trauma, and mass casualty triage: how might we solve the latest mind-body problem?  

PubMed

The global war on terrorism has led to increased concern about the ability of the U.S. healthcare system to respond to casualties from a chemical, biological, or radiological agent attack. Relatively little attention, however, has focused on the potential, in the immediate aftermath of such an attack, for large numbers of casualties presenting to triage points with acute health anxiety and idiopathic physical symptoms. This sort of "mass idiopathic illness" is not a certain outcome of chemical, biological, or radiological attack. However, in the event that this phenomenon occurs, it could result in surges in demand for medical evaluations that may disrupt triage systems and endanger lives. Conversely, if continuous primary care is not available for such patients after initial triage, many may suffer with unrecognized physical and emotional injuries and illness. This report is the result of an expert planning initiative seeking to facilitate triage protocols that will address the possibility of mass idiopathic illness and bolster healthcare system surge capacity. The report reviews key triage assumptions and gaps in knowledge and offers a four-stage triage model for further discussion and research. Optimal triage approaches offer flexibility and should be based on empirical studies, critical incident modeling, lessons from simulation exercises, and case studies. In addition to staging, the proposed triage and longitudinal care model relies on early recognition of symptoms, development of a registry, and use of non-physician care management to facilitate later longitudinal followup and collaboration between primary care and psychiatry for the significant minority of patients who develop persistent idiopathic symptoms associated with reduced functional status. PMID:17608601

Engel, Charles C; Locke, Steven; Reissman, Dori B; DeMartino, Robert; Kutz, Ilan; McDonald, Michael; Barsky, Arthur J

2007-06-01

4

Clinical review: Mass casualty triage – pandemic influenza and critical care  

PubMed Central

Worst case scenarios for pandemic influenza planning in the US involve over 700,000 patients requiring mechanical ventilation. UK planning predicts a 231% occupancy of current level 3 (intensive care unit) bed capacity. Critical care planners need to recognise that mortality is likely to be high and the risk to healthcare workers significant. Contingency planning should, therefore, be multi-faceted, involving a robust health command structure, the facility to expand critical care provision in terms of space, equipment and staff and cohorting of affected patients in the early stages. It should also be recognised that despite this expansion of critical care, demand will exceed supply and a process for triage needs to be developed that is valid, reproducible, transparent and consistent with distributive justice. We advocate the development and validation of physiological scores for use as a triage tool, coupled with candid public discussion of the process. PMID:17490495

Challen, Kirsty; Bentley, Andrew; Bright, John; Walter, Darren

2007-01-01

5

Orthopaedic triage during natural disasters and mass casualties: do scoring systems matter?  

PubMed

Mass casualty events, either natural disasters or man-made, are associated with extremities injuries. The treating surgeon often faces a challenging decision: can the affected extremity be saved or amputated? The following article will present the author's view on the subject of triage and the use of scoring systems in the decision-making process whether to salvage or amputate an affected extremity. The author will analyse the existing scoring systems and emphasise significance of the regional factors: geographical, cultural and level of health care, as factors playing roles in this process. PMID:23827955

Wolfson, Nikolaj

2013-08-01

6

Triage during mass gatherings.  

PubMed

Triage is a complex process and is one means for determining which patients most need access to limited resources. Triage has been studied extensively, particularly in relation to triage in overcrowded emergency departments, where individuals presenting for treatment often are competing for the available stretchers. Research also has been done in relation to the use of prehospital and field triage during mass-casualty incidents and disasters. In contrast, scant research has been done to develop and test an effective triage approach for use in mass-gathering and mass-participation events, although there is a growing body of knowledge regarding the health needs of persons attending large events. Existing triage and acuity scoring systems are suboptimal for this unique population, as these events can involve high patient presentation rates (PPR) and, occasionally, critically ill patients. Mass-gathering events are dangerous; a higher incidence of injury occurs than would be expected from general population statistics. The need for an effective triage and acuity scoring system for use during mass gatherings is clear, as these events not only create multiple patient encounters, but also have the potential to become mass-casualty incidents. Furthermore, triage during a large-scale disaster or mass-casualty incident requires that multiple, local agencies work together, necessitating a common language for triage and acuity scoring. In reviewing existing literature with regard to triage systems that might be employed for this population, it is noted that existing systems are biased toward traumatic injuries, usually ignoring mitigating factors such as alcohol and drug use and environmental exposures. Moreover, there is a substantial amount of over-triage that occurs with existing prehospital triage systems, which may lead to misallocation of limited resources. This manuscript presents a review of the available literature and proposes a triage system for use during mass gatherings that also may be used in the setting of mass-casualty incidents or disaster responses. PMID:23026028

Turris, Sheila A; Lund, Adam

2012-12-01

7

Mass casualty modelling: a spatial tool to support triage decision making  

PubMed Central

Background During a mass casualty incident, evacuation of patients to the appropriate health care facility is critical to survival. Despite this, no existing system provides the evidence required to make informed evacuation decisions from the scene of the incident. To mitigate this absence and enable more informed decision making, a web based spatial decision support system (SDSS) was developed. This system supports decision making by providing data regarding hospital proximity, capacity, and treatment specializations to decision makers at the scene of the incident. Methods This web-based SDSS utilizes pre-calculated driving times to estimate the actual driving time to each hospital within the inclusive trauma system of the large metropolitan region within which it is situated. In calculating and displaying its results, the model incorporates both road network and hospital data (e.g. capacity, treatment specialties, etc.), and produces results in a matter of seconds, as is required in a MCI situation. In addition, its application interface allows the user to map the incident location and assists in the execution of triage decisions. Results Upon running the model, driving time from the MCI location to the surrounding hospitals is quickly displayed alongside information regarding hospital capacity and capability, thereby assisting the user in the decision-making process. Conclusions The use of SDSS in the prioritization of MCI evacuation decision making is potentially valuable in cases of mass casualty. The key to this model is the utilization of pre-calculated driving times from each hospital in the region to each point on the road network. The incorporation of real-time traffic and hospital capacity data would further improve this model. PMID:21663636

2011-01-01

8

A Wireless First Responder Handheld Device for Rapid Triage, Patient Assessment and Documentation during Mass Casualty Incidents  

PubMed Central

Medical care at mass casualty incidents and disasters requires rapid patient triage and assessment, acute care and disposition often in the setting of overwhelming numbers of victims, limited time, and little resources. Current systems rely on a paper triage tag on which rescuers and medical providers mark the patient’s triage status and record limited information on injuries and treatments administered in the field. In this manuscript, we describe the design, development and deployment of a wireless handheld device with an electronic medical record (EMR) for use by rescuers responding to mass casualty incidents (MCIs) and disasters. The components of this device, the WIISARD First Responder (WFR), includes a personal digital assistant (PDA) with 802.11 wireless transmission capabilities, microprocessor and non-volatile memory, and a unique EMR software that replicates the rapidity and ease of use of the standard paper triage tag. WFR also expands its functionality by recording real-time medical data electronically for simultaneous access by rescuers, mid-level providers and incident commanders on and off the disaster site. WFR is a part of the Wireless Information System for Medical Response in Disasters (WIISARD) architecture. PMID:17238377

Killeen, James P.; Chan, Theodore C.; Buono, Colleen; Griswold, William G.; Lenert, Leslie A.

2006-01-01

9

Triage performance of Swedish physicians using the ATLS algorithm in a simulated mass casualty incident: a prospective cross-sectional survey  

PubMed Central

Background In a mass casualty situation, medical personnel must rapidly assess and prioritize patients for treatment and transport. Triage is an important tool for medical management in disaster situations. Lack of common international and Swedish triage guidelines could lead to confusion. Attending the Advanced Trauma Life Support (ATLS) provider course is becoming compulsory in the northern part of Europe. The aim of the ATLS guidelines is provision of effective management of single critically injured patients, not mass casualties incidents. However, the use of the ABCDE algorithms from ATLS, has been proposed to be valuable, even in a disaster environment. The objective for this study was to determine whether the mnemonic ABCDE as instructed in the ATLS provider course, affects the ability of Swedish physician’s to correctly triage patients in a simulated mass casualty incident. Methods The study group included 169 ATLS provider students from 10 courses and course sites in Sweden; 153 students filled in an anonymous test just before the course and just after the course. The tests contained 3 questions based on overall priority. The assignment was to triage 15 hypothetical patients who had been involved in a bus crash. Triage was performed according to the ABCDE algorithm. In the triage, the ATLS students used a colour-coded algorithm with red for priority 1, yellow for priority 2, green for priority 3 and black for dead. The students were instructed to identify and prioritize 3 of the most critically injured patients, who should be the first to leave the scene. The same test was used before and after the course. Results The triage section of the test was completed by 142 of the 169 participants both before and after the course. The results indicate that there was no significant difference in triage knowledge among Swedish physicians who attended the ATLS provider course. The results also showed that Swedish physicians have little experience of real mass casualty incidents and exercises. Conclusion The mnemonic ABCDE doesn’t significantly affect the ability of triage among Swedish physicians. Actions to increase Swedish physicians’ knowledge of triage, within the ATLS context or separately, are warranted. PMID:24355021

2013-01-01

10

A next generation electronic triage to aid mass casualty emergency medical response.  

PubMed

For years, emergency medical response communities have relied upon paper triage tags, clipboards of notes, and voice communications to share information during medical emergencies. This workflow, however, has proven labor intensive, time consuming, and prone to human error [1]. In collaboration with three EMS groups in the Washington, DC Metropolitan area, we have developed a next generation triage system to improve the effectiveness of emergency response. This system includes: 1) electronic triage tags, 2) wearable vital sign sensors, 3) base stations laptops to monitor and manage patients, 4) pervasive tracking software to locate patients at all stages of the disaster response process, and 5) PDAs to support documentation and communication. Our system has evolved through three iterations of rapid-development, field-studies, usability reviews, and focus-group interview. This paper summarizes engineering considerations for technologies that must operate under constraints of medical emergencies. It is our hope that the lessons reported in this paper will help technologists in developing future emergency response systems. PMID:17959436

Gao, Tia; White, D

2006-01-01

11

Creating order from chaos: part I: triage, initial care, and tactical considerations in mass casualty and disaster response.  

PubMed

How do we train for the entire spectrum of potential emergency and crisis scenarios? Will we suddenly face large numbers of combat casualties, an earthquake, a plane crash, an industrial explosion, or a terrorist bombing? The daily routine can suddenly be complicated by large numbers of patients, exceeding the ability to treat in a routine fashion. Disaster events can result in patients with penetrating wounds, burns, blast injuries, chemical contamination, or all of these at once. Some events may disrupt infrastructure or result in loss of essential equipment or key personnel. The chaos of a catastrophic event impedes decision-making and effective treatment of patients. Disasters require a paradigm shift from the application of unlimited resources for the greatest good of each individual patient to the allocation of care, with limited resources, for the greatest good for the greatest number of patients. Training and preparation are essential to remain effective during crises and major catastrophic events. Disaster triage and crisis management represent a tactical art that incorporates clinical skills, didactic information, communication ability, leadership, and decision-making. Planning, rehearsing, and exercising various scenarios encourage the flexibility, adaptability, and innovation required in disaster settings. These skills can bring order to the chaos of overwhelming disaster events. PMID:17436764

Baker, Michael S

2007-03-01

12

Game-based mass casualty burn training.  

PubMed

An interactive, video game-based training module, Burn Center, was developed to simulate the real-life emergency events of a mass casualty disaster scenario, involving in 40 victims.The game contains two components - triage and resuscitation. The goal of the triage game is to correctly stabilize, sort, tag and transport burn victims during a mass casualty event at a busy theme park. After complete the triage component, the player will then take on the role of a burn care provider, balancing the clinical needs of multiple burn patients through a 36-hour resuscitation period, using familiar computer-simulated hospital devices. Once complete, players of Burn Center will come away with applicable skills and knowledge of burn care, for both field triage and initial resuscitation of the burn patients. PMID:19377134

Kurenov, Sergei N; Cance, William W; Noel, Ben; Mozingo, David W

2009-01-01

13

The "RTR" medical response system for nuclear and radiological mass-casualty incidents: a functional TRiage-TReatment-TRansport medical response model.  

PubMed

Developing a mass-casualty medical response to the detonation of an improvised nuclear device (IND) or large radiological dispersal device (RDD) requires unique advanced planning due to the potential magnitude of the event, lack of warning, and radiation hazards. In order for medical care and resources to be collocated and matched to the requirements, a [US] Federal interagency medical response-planning group has developed a conceptual approach for responding to such nuclear and radiological incidents. The "RTR" system (comprising Radiation-specific TRiage, TReatment, TRansport sites) is designed to support medical care following a nuclear incident. Its purpose is to characterize, organize, and efficiently deploy appropriate materiel and personnel assets as close as physically possible to various categories of victims while preserving the safety of responders. The RTR system is not a medical triage system for individual patients. After an incident is characterized and safe perimeters are established, RTR sites should be determined in real-time that are based on the extent of destruction, environmental factors, residual radiation, available infrastructure, and transportation routes. Such RTR sites are divided into three types depending on their physical/situational relationship to the incident. The RTR1 sites are near the epicenter with residual radiation and include victims with blast injuries and other major traumatic injuries including radiation exposure; RTR2 sites are situated in relationship to the plume with varying amounts of residual radiation present, with most victims being ambulatory; and RTR3 sites are collection and transport sites with minimal or no radiation present or exposure risk and a victim population with a potential variety of injuries or radiation exposures. Medical Care sites are predetermined sites at which definitive medical care is given to those in immediate need of care. They include local/regional hospitals, medical centers, other sites such as nursing homes and outpatient clinics, nationwide expert medical centers (such as cancer or burn centers), and possible alternate care facilities such as Federal Medical Stations. Assembly Centers for displaced or evacuating persons are predetermined and spontaneous sites safely outside of the perimeter of the incident, for use by those who need no immediate medical attention or only minor assistance. Decontamination requirements are important considerations for all RTR, Medical Care, and Assembly Center sites and transport vehicles. The US Department of Health and Human Services is working on a long-term project to generate a database for potential medical care sites and assembly centers so that information is immediately available should an incident occur. PMID:19618351

Hrdina, Chad M; Coleman, C Norman; Bogucki, Sandy; Bader, Judith L; Hayhurst, Robert E; Forsha, Joseph D; Marcozzi, David; Yeskey, Kevin; Knebel, Ann R

2009-01-01

14

Evaluation of a novel algorithm for primary mass casualty triage by paramedics in a physician manned EMS system: a dummy based trial  

PubMed Central

Background The Amberg-Schwandorf Algorithm for Primary Triage (ASAV) is a novel primary triage concept specifically for physician manned emergency medical services (EMS) systems. In this study, we determined the diagnostic reliability and the time requirements of ASAV triage. Methods Seven hundred eighty triage runs performed by 76 trained EMS providers of varying professional qualification were included into the study. Patients were simulated using human dummies with written vital signs sheets. Triage results were compared to a standard solution, which was developed in a modified Delphi procedure. Test performance parameters (e.g. sensitivity, specificity, likelihood ratios (LR), under-triage, and over-triage) were calculated. Time measurements comprised the complete triage and tagging process and included the time span for walking to the subsequent patient. Results were compared to those published for mSTaRT. Additionally, a subgroup analysis was performed for employment status (career/volunteer), team qualification, and previous triage training. Results For red patients, ASAV sensitivity was 87%, specificity 91%, positive LR 9.7, negative LR 0.139, over-triage 6%, and under-triage 10%. There were no significant differences related to mSTaRT. Per patient, ASAV triage required a mean of 35.4 sec (75th percentile 46 sec, 90th percentile 58 sec). Volunteers needed slightly more time to perform triage than EMS professionals. Previous mSTaRT training of the provider reduced under-triage significantly. There were significant differences in time requirements for triage depending on the expected triage category. Conclusions The ASAV is a specific concept for primary triage in physician governed EMS systems. It may detect red patients reliably. The test performance criteria are comparable to that of mSTaRT, whereas ASAV triage might be accomplished slightly faster. From the data, there was no evidence for a clinically significant reliability difference between typical staffing of mobile intensive care units, patient transport ambulances, or disaster response volunteers. Up to now, there is no clinical validation of either triage concept. Therefore, reality based evaluation studies are needed. PMID:25214310

2014-01-01

15

Managing mass casualties and decontamination.  

PubMed

Careful planning and regular exercising of capabilities is the key to implementing an effective response following the release of hazardous materials, although ad hoc changes may be inevitable. Critical actions which require immediate implementation at an incident are evacuation, followed by disrobing (removal of clothes) and decontamination. The latter can be achieved through bespoke response facilities or various interim methods which may utilise water or readily available (dry, absorbent) materials. Following transfer to a safe holding area, each casualty's personal details should be recorded to facilitate a health surveillance programme, should it become apparent that the original contaminant has chronic health effects. PMID:24684820

Chilcott, Robert P

2014-11-01

16

Advanced technology development for remote triage applications in bleeding combat casualties.  

PubMed

Combat developers within the Army have envisioned development of a "wear-and-forget" physiological status monitor (PSM) that will enhance far forward capabilities for assessment of Warrior readiness for battle, as well as for remote triage, diagnosis and decision-making once Soldiers are injured. This paper will review recent work testing remote triage system prototypes in both the laboratory and during field exercises. Current PSM prototypes measure the electrocardiogram and respiration, but we have shown that information derived from these measurements alone will not be suited for specific, accurate triage of combat injuries. Because of this, we have suggested that development of a capability to provide a metric of circulating blood volume status is required for remote triage. Recently, volume status has been successfully modeled using low-level physiological signals obtained from wearable devices as input to machine-learning algorithms; these algorithms are already able to discriminate between a state of physical activity (common in combat) and that of central hypovolemia, and thus show promise for use in wearable remote triage devices. PMID:21607908

Ryan, Kathy L; Rickards, Caroline A; Hinojosa-Laborde, Carmen; Gerhardt, Robert T; Cain, Jeffrey; Convertino, Victor A

2011-01-01

17

Mobile DIORAMA-II: Infrastructure less information collection system for mass casualty incidents.  

PubMed

In this paper we introduce DIORAMA-II system that provides real time information collection in mass casualty incidents. Using a mobile platform that includes active RFID tags and readers as well as Smartphones, the system can determine the location of victims and responders. The system provides user friendly multi dimensional user interfaces as well as collaboration tools between the responders and the incident commander. We conducted two simulated mass casualty incidents with 50 victims each and professional responders. DIORAMA-II significantly reduces the evacuation time by up to 43% when compared to paper based triage systems. All responders that participated in all trials were very satisfied. They felt in control of the incident and mentioned that the system significantly reduced their stress level during the incident. They all mentioned that they would use the system in an actual incident. PMID:25570543

Ganz, Aura; Schafer, James M; Zhuorui Yang; Jun Yi; Lord, Graydon; Ciottone, Gregory

2014-08-01

18

Autonomous mobile platform for enhanced situational awareness in Mass Casualty Incidents.  

PubMed

To enhance the efficiency of the search and rescue process of a Mass Casualty Incident, we introduce a low cost autonomous mobile platform. The mobile platform motion is controlled by an Android Smartphone mounted on a robot. The pictures and video captured by the Smartphone camera can significantly enhance the situational awareness of the incident commander leading to a more efficient search and rescue process. Moreover, the active RFID readers mounted on the mobile platform can improve the localization accuracy of victims in the disaster site in areas where the paramedics are not present, reducing the triage and evacuation time. PMID:25570104

Dongyi Yang; Schafer, James; Sili Wang; Ganz, Aura

2014-08-01

19

Assessment of Biodosimetry Methods for a Mass-Casualty Radiological Incident: Medical Response and Management Considerations  

PubMed Central

Following a mass-casualty nuclear disaster, effective medical triage has the potential to save tens of thousands of lives. In order to best use the available scarce resources, there is an urgent need for biodosimetry tools to determine an individual’s radiation dose. Initial triage for radiation exposure will include location during the incident, symptoms, and physical examination. Stepwise triage will include point of care assessment of less than or greater than 2 Gy, followed by secondary assessment, possibly with high throughput screening, to further define an individual’s dose. Given the multisystem nature of radiation injury, it is unlikely that any single biodosimetry assay can be used as a stand-alone tool to meet the surge in capacity with the timeliness and accuracy needed. As part of the national preparedness and planning for a nuclear or radiological incident, we reviewed the primary literature to determine the capabilities and limitations of a number of biodosimetry assays currently available or under development for use in the initial and secondary triage of patients. Understanding the requirements from a response standpoint and the capability and logistics for the various assays will help inform future biodosimetry technology development and acquisition. Factors considered include: type of sample required, dose detection limit, time interval when the assay is feasible biologically, time for sample preparation and analysis, ease of use, logistical requirements, potential throughput, point-of-care capability, and the ability to support patient diagnosis and treatment within a therapeutically relevant time point. PMID:24162058

Sullivan, Julie M.; Prasanna, Pataje G. S.; Grace, Marcy B.; Wathen, Lynne; Wallace, Rodney L.; Koerner, John F.; Coleman, C. Norman

2013-01-01

20

Medical management of toxicological mass casualty events.  

PubMed

The relative accessibility to various chemical agents, including chemical warfare agents and toxic industrial compounds, places a toxicological mass casualty event, including chemical terrorism, among the major threats to homeland security. TMCE represents a medical and logistic challenge with potential hazardous exposure of first-response teams. In addition, TMCE poses substantial psychological and economic impact. We have created a simple response algorithm that provides practical guidelines for participating forces in TMCE. Emphasis is placed on the role of first responders, highlighting the importance of early recognition of the event as a TMCE, informing the command and control centers, and application of appropriate self-protection. The medical identification of the toxidrome is of utmost importance as it may dictate radically different approaches and life-saving modalities. Our proposed emergency management of TMCE values the "Scoop & Run" approach orchestrated by an organized evacuation plan rather than on-site decontamination. Finally, continuous preparedness of health systems - exemplified by periodic CBRN (Chemical, Biological, Radio-Nuclear) medical training of both first responders and hospital staff, mandatory placement of antidotal auto-injectors in all ambulances and CBRN emergency kits in the emergency departments - would considerably improve the emergency medical response to TMCE. PMID:19070282

Markel, Gal; Krivoy, Amir; Rotman, Eran; Schein, Ophir; Shrot, Shai; Brosh-Nissimov, Tal; Dushnitsky, Tsvika; Eisenkraft, Arik

2008-11-01

21

Premature chromosome condensation (PCC) assay for dose assessment in mass casualty accidents.  

PubMed

The study was undertaken to establish a dose calibration curve for a practical PCC ring assay and to apply it in a simulated mass casualty accident. The PCC assay was validated against the conventional dicentric assay. A linear relationship was established for PCC rings after (60)Co gamma irradiation with doses up to 20 Gy. In the simulated accident experiment, 62 blood samples were analyzed with both the PCC ring assay and the conventional dicentric assay, applying a triage approach. Samples received various uniform and non-uniform (10-40% partial-body) irradiations up to doses of 13 Gy. The results indicated that both assays yielded good dose estimates for the whole-body exposure scenario, although in the lower-dose range (0-6 Gy) dicentric scoring resulted in more accurate whole-body estimates, whereas PCC rings were better in the high-dose range (>6 Gy). Neither assay was successful in identifying partial-body exposures, most likely due to the low numbers of cells scored in the triage mode. In conclusion, the study confirmed that the PCC ring assay is suitable for use as a biodosimeter after whole-body exposure to high doses of radiation. However, there are limitations for its use in the triage of people exposed to high, partial-body doses. PMID:20041761

Lindholm, Carita; Stricklin, Daniela; Jaworska, Alicja; Koivistoinen, Armi; Paile, Wendla; Arvidsson, Eva; Deperas-Standylo, Joanna; Wojcik, Andrzej

2010-01-01

22

Portable ultrasonography in mass casualty incidents: The CAVEAT examination  

PubMed Central

Ultrasonography used by practicing clinicians has been shown to be of utility in the evaluation of time-sensitive and critical illnesses in a range of environments, including pre-hospital triage, emergency department, and critical care settings. The increasing availability of light-weight, robust, user-friendly, and low-cost portable ultrasound equipment is particularly suited for use in the physically and temporally challenging environment of a multiple casualty incident (MCI). Currently established ultrasound applications used to identify potentially lethal thoracic or abdominal conditions offer a base upon which rapid, focused protocols using hand-carried emergency ultrasonography could be developed. Following a detailed review of the current use of portable ultrasonography in military and civilian MCI settings, we propose a protocol for sonographic evaluation of the chest, abdomen, vena cava, and extremities for acute triage. The protocol is two-tiered, based on the urgency and technical difficulty of the sonographic examination. In addition to utilization of well-established bedside abdominal and thoracic sonography applications, this protocol incorporates extremity assessment for long-bone fractures. Studies of the proposed protocol will need to be conducted to determine its utility in simulated and actual MCI settings. PMID:22474622

Stawicki, Stanislaw Peter; Howard, James M; Pryor, John P; Bahner, David P; Whitmill, Melissa L; Dean, Anthony J

2010-01-01

23

MASCAL: RFID Tracking of Patients, Staff and Equipment to Enhance Hospital Response to Mass Casualty Events  

PubMed Central

Most medical facilities practice managing the large numbers of seriously injured patients expected during catastrophic events. As the demands on the healthcare team increase, however, the challenges faced by managers escalate, workflow bottlenecks develop and system capacity decreases. This paper describes MASCAL, an integrated software–hardware system designed to enhance management of resources at a hospital during a mass casualty situation. MASCAL uses active 802.11b asset tags to track patients, equipment and staff during the response to a disaster. The system integrates tag position information with data from personnel databases, medical information systems, registration applications and the US Navy’s TACMEDCS triage application in a custom visual disaster management environment. MASCAL includes interfaces for a hospital command center, local area managers (emergency room, operating suites, radiology, etc.) and registration personnel. MASCAL is an operational system undergoing functional evaluation at the Naval Medical Center, San Diego, CA. PMID:16779042

Fry, Emory A.; Lenert, Leslie A.

2005-01-01

24

Emergency response to mass casualty incidents in Lebanon.  

PubMed

The emergency response to mass casualty incidents in Lebanon lacks uniformity. Three recent large-scale incidents have challenged the existing emergency response process and have raised the need to improve and develop incident management for better resilience in times of crisis. We describe some simple emergency management principles that are currently applied in the United States. These principles can be easily adopted by Lebanon and other developing countries to standardize and improve their emergency response systems using existing infrastructure. PMID:24229530

El Sayed, Mazen J

2013-08-01

25

Mass Casualties and Health Care Following the Release of Toxic Chemicals or Radioactive Material—Contribution of Modern Biotechnology  

PubMed Central

Catastrophic chemical or radiological events can cause thousands of casualties. Such disasters require triage procedures to identify the development of health consequences requiring medical intervention. Our objective is to analyze recent advancements in biotechnology for triage in mass emergency situations. In addition to identifying persons “at risk” of developing health problems, these technologies can aid in securing the unaffected or “worried well”. We also highlight the need for public/private partnerships to engage in some of the underpinning sciences, such as patho-physiological mechanisms of chemical and radiological hazards, and for the necessary investment in the development of rapid assessment tools through identification of biochemical, molecular, and genetic biomarkers to predict health effects. For chemical agents, biomarkers of neurotoxicity, lung damage, and clinical and epidemiological databases are needed to assess acute and chronic effects of exposures. For radiological exposures, development of rapid, sensitive biomarkers using advanced biotechnologies are needed to sort exposed persons at risk of life-threatening effects from persons with long-term risk or no risk. The final implementation of rapid and portable diagnostics tools suitable for emergency care providers to guide triage and medical countermeasures use will need public support, since commercial incentives are lacking. PMID:22408587

Göransson Nyberg, Ann; Stricklin, Daniela; Sellström, Åke

2011-01-01

26

Challenges of the management of mass casualty: lessons learned from the Jos crisis of 2001  

PubMed Central

Background Jos has witnessed a series of civil crises which have generated mass casualties that the Jos University Teaching Hospital has had to respond to from time to time. We review the challenges that we encountered in the management of the victims of the 2001 crisis. Methodology We reviewed the findings of our debriefing sessions following the sectarian crisis of September 2001 and identified the challenges and obstacles experienced during these periods. Results Communication was a major challenge, both within and outside the hospital. In the field, there was poor field triage and no prehospital care. Transportation and evacuation was hazardous, for both injured patients and medical personnel. This was worsened by the imposition of a curfew on the city and its environs. In the hospital, supplies such as fluids, emergency drugs, sterile dressings and instruments, splints, and other consumables, blood and food were soon exhausted. Record keeping was erratic. Staff began to show signs of physical and mental exhaustion as well as features of anxiety and stress. Tensions rose between different religious groups in the hospital and an attempt was made by rioters to attack the hospital. Patients suffered poor subsequent care following resuscitation and/or surgery and there was neglect of patients on admission prior to the crisis as well as non trauma medical emergencies. Conclusion Mass casualties from disasters that disrupt organized societal mechanisms for days can pose significant challenges to the best of institutional disaster response plans. In the situation that we experienced, our disaster plan was impractical initially because it failed to factor in such a prolongation of both crisis and response. We recommend that institutional disaster response plans should incorporate provisions for the challenges we have enumerated and factor in peculiarities that would emanate from the need for a prolonged response. PMID:24164778

2013-01-01

27

Pediatric and neonatal interfacility transport medicine after mass casualty incidents.  

PubMed

Pediatric and neonatal interfacility transport medicine is a relatively young but a rapidly evolving specialty. Transport teams are essential for the safe interfacility movement of critically ill patients. A mass casualty incident (MCI) can present major challenges for a critical care transport team. This article will examine the capabilities and limitations of pediatric and neonatal critical care transport teams. The predicaments brought about by Hurricane Katrina that hindered the evacuation of pediatric and neonatal patients out of ravaged hospitals are also reviewed. From these experiences, recommendations to improve the efficiency and efficacy of interfacility transport of pediatric patients will be presented. PMID:19667853

Lowe, Calvin G

2009-08-01

28

Sample Tracking in an Automated Cytogenetic Biodosimetry Laboratory for Radiation Mass Casualties  

PubMed Central

Chromosome aberration-based dicentric assay is expected to be used after mass casualty life-threatening radiation exposures to assess radiation dose to individuals. This will require processing of a large number of samples for individual dose assessment and clinical triage to aid treatment decisions. We have established an automated, high-throughput, cytogenetic biodosimetry laboratory to process a large number of samples for conducting the dicentric assay using peripheral blood from exposed individuals according to internationally accepted laboratory protocols (i.e., within days following radiation exposures). The components of an automated cytogenetic biodosimetry laboratory include blood collection kits for sample shipment, a cell viability analyzer, a robotic liquid handler, an automated metaphase harvester, a metaphase spreader, high-throughput slide stainer and coverslipper, a high-throughput metaphase finder, multiple satellite chromosome-aberration analysis systems, and a computerized sample tracking system. Laboratory automation using commercially available, off-the-shelf technologies, customized technology integration, and implementation of a laboratory information management system (LIMS) for cytogenetic analysis will significantly increase throughput. This paper focuses on our efforts to eliminate data transcription errors, increase efficiency, and maintain samples’ positive chain-of-custody by sample tracking during sample processing and data analysis. This sample tracking system represents a “beta” version, which can be modeled elsewhere in a cytogenetic biodosimetry laboratory, and includes a customized LIMS with a central server, personal computer workstations, barcode printers, fixed station and wireless hand-held devices to scan barcodes at various critical steps, and data transmission over a private intra-laboratory computer network. Our studies will improve diagnostic biodosimetry response, aid confirmation of clinical triage, and medical management of radiation exposed individuals. PMID:18037985

Martin, P.R.; Berdychevski, R.E.; Subramanian, U.; Blakely, W.F.; Prasanna, P.G.S.

2007-01-01

29

Mass casualty following unprecedented tornadic events in the Southeast: natural disaster outcomes at a Level I trauma center.  

PubMed

On April 27, 2011, an EF4 (enhanced Fujita scale) tornado struck a 48-mile path across northwest Georgia and southeast Tennessee. Traumatic injuries sustained during this tornado and others in one of the largest tornado outbreaks in history presented to the regional Level I trauma center, Erlanger Health System, in Chattanooga, TN. Patients were triaged per mass casualty protocols through an incident command center and triage officer. Medical staffing was increased to anticipate a large patient load. Records of patients admitted as a result of tornado-related injury were retrospectively reviewed and characterized by the injury patterns, demographics, procedures performed, length of stay, and complications. One hundred four adult patients were treated in the emergency department; of these, 28 (27%) patients required admission to the trauma service. Of those admitted, 16 (57%) were male with an age range of 21 to 87 years old and an average length of stay of 10.9 ± 11.8 days. Eleven (39%) patients required intensive care unit admissions. The most common injuries seen were those of soft tissue, bony fractures, and the chest. Interventions included tube thoracostomies, exploratory laparotomies, orthopedic fixations, soft tissue reconstructions, and craniotomy. All 28 patients admitted survived to discharge. Nineteen (68%) patients were discharged home, six (21%) went to a rehabilitation hospital, and three (11%) were transferred to skilled nursing facilities. Emergency preparedness and organization are key elements in effectively treating victims of natural disasters. Those victims who survive the initial tornadic event and present to a Level I trauma center have low mortality. Like in our experience, triage protocols need to be implemented to quickly and effectively manage mass injuries. PMID:22748536

Hartmann, Elizabeth H; Creel, Nathan; Lepard, Jacob; Maxwell, Robert A

2012-07-01

30

THE ROLE OF FORWARD MEDICAL SUPPORT IN HANDLING MASSES OF CASUALTIES IN ACTIVE NUCLEAR WARFARE  

Microsoft Academic Search

Some facts and opinions are presented relative to the operational ; problem of handling situations wherein masses of casualties occur on the nuclear ; battlefield. To visualize this problem, a situation is assumed in which a battle ; group is inactivated by a nuclear weapon and initially a maximum number of living ; casualties would result. A hypothetical situation is

Sheedy

1962-01-01

31

Mass Casualty Incident Response and Aeromedical Evacuation in Antarctica  

PubMed Central

Antarctica is one of the most remote regions on Earth. Mass casualty incident (MCI) responses in Antarctica are prone to complications from multiple environmental and operational challenges. This review of the current status of MCI risks and response strategies for Antarctica focuses on aeromedical evacuation, a critical component of many possible MCI scenarios. Extreme cold and weather, a lack of medical resources and a multitude of disparate international bases all exert unique demands on MCI response planning. Increasing cruise ship traffic is also escalating the risk of MCI occurrence. To be successful, MCI response must be well coordinated and undertaken by trained rescuers, especially in the setting of Antarctica. Helicopter rescue or aeromedical evacuation of victims to off-continent facilities may be necessary. Currently, military forces have the greatest capacity for mass air evacuation. Specific risks that are likely to occur include structure collapses, vehicle incapacitations, vehicle crashes and fires. All of these events pose concomitant risks of hypothermia among both victims and rescuers. Antarctica’s unique environment requires flexible yet robust MCI response planning among the many entities in operation on the continent. PMID:21691470

Mills, Christopher N.; Mills, Gregory H.

2011-01-01

32

An Intelligent 802.11 Triage Tag For Medical Response to Disasters  

PubMed Central

When medical care is initiated at a mass casualty event, the first activity is the triage of victims, which is the grouping by victims severity of injury. Paper triage tags are often used to mark victims’ triage status and to record information on injuries and treatments administered in the field. In this paper we describe the design and development of an“Intelligent Triage Tag” (ITT), an electronic device to coordinate patient field care. ITTs combine the basic functionality of a paper triage tag with sensors, nonvolatile memory, a microprocessor and 802.11 wireless transmission capabilities. ITTs not only display victims' triage status but also signal alerts, and mark patients for transport or immediate medical attention. ITTs record medical data for later access offsite and help organize care by relaying information on the location of the victims during field treatment. ITTs are a part of the Wireless Information System for Medical Response in Disasters (WIISARD) architecture. PMID:16779078

Lenert, Leslie A.; Palmer, Douglas A.; Chan, Theodore C; Rao, Ramesh

2005-01-01

33

Triaging multiple victims in an avalanche setting: the Avalanche Survival Optimizing Rescue Triage algorithmic approach.  

PubMed

As winter backcountry activity increases, so does exposure to avalanche danger. A complicated situation arises when multiple victims are caught in an avalanche and where medical and other rescue demands overwhelm resources in the field. These mass casualty incidents carry a high risk of morbidity and mortality, and there is no recommended approach to patient care specific to this setting other than basic first aid principles. The literature is limited with regard to triaging systems applicable to avalanche incidents. In conjunction with the development of an electronic avalanche rescue training module by the Canadian Avalanche Association, we have designed the Avalanche Survival Optimizing Rescue Triage algorithm to address the triaging of multiple avalanche victims to optimize survival and disposition decisions. PMID:20591351

Bogle, Lee B; Boyd, Jeff J; McLaughlin, Kyle A

2010-03-01

34

K-plan for patient repatriation after mass casualty events abroad.  

PubMed

In addition to requests for individual aeromedical evacuation (AE), medical assistance companies also may respond to mass casualty incidents abroad. The purpose of this report was to evaluate the effectiveness of our primary casualty plan, based on experience involving a January 2010 bus crash in southern Egypt. The main evaluative criterion was time elapsed from the initial call until the return of victims to their home country. Three critically injured patients underwent an initial AE to Cairo for advanced trauma care. After stabilization, they arrived back in their home country 42 hours after the initial call. The remaining group of patients arrived 27 hours later, or a total of 69 hours after the first call. These findings suggest that the "K-Plan" standardized operating process may be effective for rapid and appropriate repatriation of numerous victims. Some specific issues, such as efficiently locating a large-capacity charter aircraft, require further improvement. PMID:22386102

Duchateau, François-Xavier; Verner, Laurent

2012-01-01

35

Design and development of a mobile-based system for supporting emergency triage decision making.  

PubMed

Emergency care for mass casualty incidents is a sophisticated multi-participant process. To manage this process effectively, many information systems have been proposed. However, their performance in improving the efficiency and accuracy of patient triage is not satisfactory. This paper is concerned with the development of a mobile-based system for supporting emergency triage in the emergency care process for mass casualty incidents. This system collects the patient's emergency data throughout the whole emergency care process through a mobile application and data transfer mechanism. Using a Cox proportional hazard model, the system has the capacity to present the survival curve to the triage officer, helping him/her to make triage and transportation decisions. This system offers an alternative injury assessment tool based on the vital signs data of the injury patient. With the help of this system, the triage officer can more directly and comprehensively learn about each patient's situation and deterioration without additional operations at the incident site. PMID:24898115

Tian, Yu; Zhou, Tian-Shu; Wang, Yu; Zhang, Mao; Li, Jing-Song

2014-06-01

36

[The influence of the pre-hospital application of non-invasive measurements of carboxyhemoglobin in the practice of emergency medical services in multiple and mass casualty incidents (MCI)--a case report].  

PubMed

In 2013 a fire broke out in the Nursing Home (NH) in the Henryszew village 5 km away from the district hospital in Zyrardów. At the time of the incident 52 residents and 16 staff members were present in the building. Due to a large number of casualties, the occurrence was classified as a potentially mass casualty incident (MCI). Troops of the State Fire Brigade, Paramedic Rescue Squads, choppers of the Helicopter Emergency Medical Service, the Police, and the NH staff took part in the rescue operation. The priority was given to the evacuation of the NH residents carried out by the NH staff and firefighters, extinguishing the fire, as well as to primary and secondary survey triage. Due to the pre-accident health state of the victims, the latter posed a considerable difficulty. A decisive role was played by the need to conduct non-invasive measurements of carboxyhemoglobin in all the casualties, which then made it possible to adequately diagnose the patients and implement proper procedures. The rescue operation was correctly followed although it proved to be a serious logistical and technical undertaking for the participating emergency services. The residents were not found to be suffering from carbon monoxide poisoning, therefore 46 of the residents safely returned to the building. The fact that all the Paramedic Rescue Squads were equipped with medical triage sets and were able to conduct non-invasive measurements of carboxyhemoglobin made it possible to introduce effective procedures in the cases of suspected carbon monoxide poisoning and abandon costly and complicated organisational procedures when they proved to be unnecessary. PMID:25090858

Ga?azkowski, Robert; Wejnarski, Arkadiusz; Baumberg, Ignacy; ?wie?ewski, Stanis?aw; Timler, Dariusz

2014-01-01

37

Clinical guidelines for responding to chemical, biological, radiological, nuclear and trauma/burn mass casualty incidents: Quick reference guides for emergency department staff.  

PubMed

The word 'DISASTER' may be used as a mnemonic for listing the critical elements of emergency response. The National Disaster Life Support Education Foundation's (NDLSEC) DISASTER paradigm emphasises out-of-hospital emergency response and includes the following elements: (1) detect; (2) incident command system; (3) security and safety; (4) assessment; (5) support; (6) triage and treatment; (7) evacuate; and (8) recovery. This paper describes how the DISASTER paradigm was used to create a series of clinical guidelines to assist the preparedness effort of hospitals for mitigating chemical, biological, radiological, nuclear incidents or explosive devices resulting in trauma/burn mass casualty incidents (MCIs) and their initial response to these events. Descriptive information was obtained from observations and records associated with this project. The information contributed by a group of subject matter experts in disaster medicine, at the Yale New Haven Health System Center for Emergency Preparedness and Disaster Response was used to author the clinical guidelines. Akin to the paradigm developed by the NDLSEC for conducting on-scene activities, the clinical guidelines use the letters in the word 'disaster' as a mnemonic for recalling the main elements required for mitigating MCIs in the hospital emergency department. PMID:25416374

Albanese, Joseph; Burich, David; Smith, Deborah; Hayes, Lynn; Paturas, James; Tomassoni, Anthony

2014-01-01

38

Mass-casualty Response to the Kiss Nightclub in Santa Maria, Brazil.  

PubMed

On January 27, 2013, a fire at the Kiss Nightclub in Santa Maria, Brazil led to a mass-casualty incident affecting hundreds of college students. A total of 234 people died on scene, 145 were hospitalized, and another 623 people received treatment throughout the first week following the incident.1 Eight of the hospitalized people later died.1 The Military Police were the first on scene, followed by the state fire department, and then the municipal Mobile Prehospital Assistance (SAMU) ambulances. The number of victims was not communicated clearly to the various units arriving on scene, leading to insufficient rescue personnel and equipment. Incident command was established on scene, but the rescuers and police were still unable to control the chaos of multiple bystanders attempting to assist in the rescue efforts. The Municipal Sports Center (CDM) was designated as the location for dead bodies, where victim identification and communication with families occurred, as well as forensic evaluation, which determined the primary cause of death to be asphyxia. A command center was established at the Hospital de Caridade Astrogildo de Azevedo (HCAA) in Santa Maria to direct where patients should be admitted, recruit staff, and procure additional supplies, as needed. The victims suffered primarily from smoke inhalation and many required endotracheal intubation and mechanical ventilation. There was a shortage of ventilators; therefore, some had to be borrowed from local hospitals, neighboring cities, and distant areas in the state. A total of 54 patients1 were transferred to hospitals in the capital city of Porto Alegre (Brazil). The main issues with the response to the fire were scene control and communication. Areas for improvement were identified, namely the establishment of a disaster-response plan, as well as regularly scheduled training in disaster preparedness/response. These activities are the first steps to improving mass-casualty responses. Dal Ponte ST , Dornelles CFD , Arquilla B , Bloem C , Roblin P . Mass-casualty response to the Kiss Nightclub in Santa Maria, Brazil. Prehosp Disaster Med. 2015;30(1):1-4 . PMID:25544145

Dal Ponte, Silvana T; Dornelles, Carlos F D; Arquilla, Bonnie; Bloem, Christina; Roblin, Patricia

2015-02-01

39

Oral and Enteral Resuscitation of Burn Shock The Historical Record and Implications for Mass Casualty Care  

PubMed Central

In the aftermath of a mass disaster, standard care methods for treatment of burn injury will often not be available for all victims. A method of fluid resuscitation for burns that has largely been forgotten by contemporary burn experts is enteral resuscitation. We identified 12 studies with over 700 patients treated with enteral resuscitation, defined as drinking or gastric infusion of salt solutions, from the literature. These studies suggest that enteral resuscitation can be an effective treatment for burn shock under conditions in which the standard IV therapy is unavailable or delayed, such as in mass disasters and combat casualties. Enteral resuscitation of burn shock was effective in patients with moderate (10–40% TBSA) and in some patients with more severe injuries. The data suggests that some hypovolemic burn and trauma patients can be treated exclusively with enteral resuscitation, and others might benefit from enteral resuscitation as an initial alternative and a supplement to IV therapy. A complication of enteral resuscitation was vomiting, which occurred less in children and much less when therapy was initiated within the first postburn hour. Enteral resuscitation is contra-indicated when the patient is in “peripheral circulatory collapse”. The optimal enteral solution and regimen has not yet been defined, nor has its efficacy been tested against modern IV resuscitation. The oldest studies used glucose-free solutions of buffered isotonic and hypotonic saline. Studies that are more recent show benefit of adding glucose to electrolyte solutions similar to those used in the treatment of cholera. If IV therapy for mass casualty care is delayed due to logistical constraints, enteral resuscitation should be considered. PMID:20827301

Kramer, George C.; Michell, Michael W.; Oliveira, Hermes; Brown, Tim La H.; Herndon, David; Baker, R. David; Muller, Michael

2010-01-01

40

Cyanide antidotes for mass casualties: water-soluble salts of the dithiane (sulfanegen) from 3-mercaptopyruvate for intramuscular administration.  

PubMed

Current cyanide antidotes are administered by IV infusion, which is suboptimal for mass casualties. Therefore, in a cyanide disaster, intramuscular (IM) injectable antidotes would be more appropriate. We report the discovery of the highly water-soluble sulfanegen triethanolamine as a promising lead for development as an IM injectable cyanide antidote. PMID:23301495

Patterson, Steven E; Monteil, Alexandre R; Cohen, Jonathan F; Crankshaw, Daune L; Vince, Robert; Nagasawa, Herbert T

2013-02-14

41

Cyanide Antidotes for Mass Casualties: Water-Soluble Salts of the Dithiane (Sulfanegen) from 3-Mercaptopyruvate for Intramuscular Administration  

PubMed Central

Current cyanide antidotes are administered by IV infusion which is suboptimal for mass casualties. Therefore, in a cyanide disaster intramuscular (IM) injectable antidotes would be more appropriate. We report the discovery of the highly water-soluble sulfanegen triethanolamine as a promising lead for development as an IM injectable cyanide antidote. PMID:23301495

Patterson, Steven E.; Monteil, Alexandre R.; Cohen, Jonathan F.; Crankshaw, Daune L.; Vince, Robert; Nagasawa, Herbert T.

2013-01-01

42

Use of a Computer-Mediated Delphi Process to Validate a Mass Casualty Conceptual Model  

PubMed Central

Since the original work on the Delphi technique, multiple versions have been developed and used in research and industry; however, very little empirical research has been conducted that evaluates the efficacy of using online computer, Internet, and e-mail applications to facilitate a Delphi method that can be used to validate theoretical models. The purpose of this research was to develop computer, Internet, and e-mail applications to facilitate a modified Delphi technique through which experts provide validation for a proposed conceptual model that describes the information needs for a mass-casualty continuum of care. Extant literature and existing theoretical models provided the basis for model development. Two rounds of the Delphi process were needed to satisfy the criteria for consensus and/or stability related to the constructs, relationships, and indicators in the model. The majority of experts rated the online processes favorably (mean of 6.1 on a seven-point scale). Using online Internet and computer applications to facilitate a modified Delphi process offers much promise for future research involving model building or validation. The online Delphi process provided an effective methodology for identifying and describing the complex series of events and contextual factors that influence the way we respond to disasters. PMID:21076283

CULLEY, JOAN M.

2012-01-01

43

Family support and victim identification in mass casualty terrorist attacks: an integrative approach.  

PubMed

Terrorist bombing attacks in Israel between 2000 and 2004 caused mass casualties. After each attack in the north of Israel, Rambam Medical Center, the largest hospital in the region, absorbs the majority of injured, especially the more severely injured and unidentified victims. Immediately with the media reports of a terrorist attack, tens of relatives come to the hospital, looking for missing family members. This paper describes an assistance unit for families of unidentified victims. It is staffed by the hospital's social work department, and its tasks are to identify the unidentified victims, help relatives find and be united with them, and assist other relatives in the identification of bodies of deceased family members. The process involves gathering information from relatives and cross-checking it with data and pictures from the hospitals' emergency and operating rooms; and providing crisis intervention and psychological first aid to victims' relatives. The family assistance unit works with several other professional units in the hospital and in the community, and always adjusts its operations to the features of each event. Clearer guidelines for dynamic training of social workers and research-based interventions to prevent compassion fatigue among the workers must be further developed. PMID:16107044

Gagin, Roni; Cohen, Miri; Peled-Avram, Maya

2005-01-01

44

Reporting for Duty During Mass Casualty Events: A Survey of Factors Influencing Emergency Medicine Physicians  

PubMed Central

Background Academic medical centers play a major role in disaster response, and residents frequently serve as key resources in these situations. Studies examining health care professionals' willingness to report for duty in mass casualty situations have varying response rates, and studies of emergency medicine (EM) residents' willingness to report for duty in disaster events and factors that affect these responses are lacking. Objective We sought to determine EM resident and faculty willingness to report for duty during 4 disaster scenarios (natural, explosive, nuclear, and communicable), to identify factors that affect willingness to work, and to assess opinions regarding disciplinary action for physicians unwilling to work in a disaster situation. Methods We surveyed residents and faculty at 7 US teaching institutions with accredited EM residency programs between April and November 2010. Results A total of 229 faculty and 259 residents responded (overall response rate, 75.4%). Willingness to report for duty ranged from 54.1% for faculty in a natural disaster to 94.2% for residents in a nonnuclear explosive disaster. The 3 most important factors influencing disaster response were concern for the safety of the family, belief in the physician's duty to provide care, and availability of protective equipment. Faculty and residents recommended minimal or no disciplinary action for individuals unwilling to work, except in the infectious disease scenario. Conclusions Most EM residents and faculty indicated they would report for duty. Residents and faculty responses were similar in all but 1 scenario. Disciplinary action for individuals unwilling to work generally was not recommended. PMID:24404305

Snipes, Carly; Miramonti, Charles; Chisholm, Carey; Chisholm, Robin

2013-01-01

45

National strategy for mass casualty situations and its effects on the hospital.  

PubMed

A mass-casualty situation (MCS) usually is short in duration and resolves itself. To minimize the risks to patients during MCS, planning is essential. This article summarizes the preparations needed at the hospital level, for a local MCS involving numerous trauma victims arriving to the Emergency Department at a short notice. Experiences and conclusions related to the implementation of the Israeli strategy in one hospital that combines the responsibilities of both the military and civilians are summarized. The Ministry of Health distributes the master MCS plan to each hospital where a local committee adapts it to the specific situation in a format of standing orders. After its approval by the Ministry of Health, an annual inspection is conducted to check the ability of the staff to manage a MCS. A full-scale drill is conducted every second year during which each site's readiness level and the continuity of the flow of care are tested. In building the strategy for treating trauma victims during a MCS, a few assumptions were taken into account. The goal of treatment in a MCS is to deliver an acceptable quality of care while preserving as many lives as is possible. In theory, the capacity of the hospital is its ability to manage a load of patients in the range of 20% of the hospital bed capacity. Planning and drilling are the ways to minimize deviations from the guidelines and to avoid management mistakes. Special attention should be paid to problems related to the initial phase of receiving the first message, outside communication, inside hospital communication, and staff recruitment. Other issues include: free access to the hospital; opening a public information center; and dealing with the media and very important persons (VIPs). A new method for creating the needed MCS plan in the hospital is suggested. It is based upon knowledge of management techniques that used multi-level documents, which are spread via Intranet between the different key figures. Using this method, it is possible to keep the strategy, the source documentation, and reasons for choosing it, as well as immediate release of checklists for each functions. This detailed, time consuming work is worthwhile in the long run, when the benefits of easy updating and better preparedness are apparent. PMID:12357558

Levi, Leon; Michaelson, Moshe; Admi, Hanna; Bregman, David; Bar-Nahor, Ronen

2002-01-01

46

Evolving need for alternative triage management in public health emergencies: a Hurricane Katrina case study.  

PubMed

In many countries, traditional medical planning for disasters developed largely in response to battlefield and multiple casualty incidents, generally involving corporal injuries. The mass evacuation of a metropolitan population in the aftermath of Hurricane Katrina evolved into life-and-death triage scenarios involving thousands of patients with nontraumatic illnesses and special medical needs. Although unprecedented in the United States, triage management needs for this disaster were similar to other large-scale public health emergencies, both natural and human-generated, that occurred globally in the past half-century. The need for alternative triage-management processes similar to the methodologies of other global mass public health emergencies is illustrated through the experience of disaster medical assistance teams in the first 3 days following Katrina's landfall. The immediate establishment of disaster-specific, consensus-based, public health emergency-related triage protocols-developed with ethical and legal expertise and a renewed focus on multidimensional, multifactorial matrix decision-making processes-is strongly recommended. PMID:18769266

Klein, Kelly R; Pepe, Paul E; Burkle, Frederick M; Nagel, Nanci E; Swienton, Raymond E

2008-09-01

47

Management of casualties from the bombing at the Centennial Olympics  

Microsoft Academic Search

Background: The explosion of a bomb 75 to 100 yards away from attendees at a concert who were in the process of being evacuated from Centennial Olympic Park at approximately 1:25 am on July 27, 1996, resulted in a multiple-casualty event involving primarily four hospitals in proximity to the blast. The purpose of this study was to review triage and

DavidV Feliciano; GailV Anderson; GraceS Rozycki; WalterL Ingram; JosephP Ansley; Nicholas Namias; JeffreyP Salomone; JohnD Cantwell

1998-01-01

48

Consensus on items and quantities of clinical equipment required to deal with a mass casualties big bang incident: a national Delphi study  

PubMed Central

Background Major short-notice or sudden impact incidents, which result in a large number of casualties, are rare events. However health services must be prepared to respond to such events appropriately. In the United Kingdom (UK), a mass casualties incident is when the normal response of several National Health Service organizations to a major incident, has to be supported with extraordinary measures. Having the right type and quantity of clinical equipment is essential, but planning for such emergencies is challenging. To date, the equipment stored for such events has been selected on the basis of local clinical judgment and has evolved without an explicit evidence-base. This has resulted in considerable variations in the types and quantities of clinical equipment being stored in different locations. This study aimed to develop an expert consensus opinion of the essential items and minimum quantities of clinical equipment that is required to treat 100 people at the scene of a big bang mass casualties event. Methods A three round modified Delphi study was conducted with 32 experts using a specifically developed web-based platform. Individuals were invited to participate if they had personal clinical experience of providing a pre-hospital emergency medical response to a mass casualties incident, or had responsibility in health emergency planning for mass casualties incidents and were in a position of authority within the sphere of emergency health planning. Each item’s importance was measured on a 5-point Likert scale. The quantity of items required was measured numerically. Data were analyzed using nonparametric statistics. Results Experts achieved consensus on a total of 134 items (54%) on completion of the study. Experts did not reach consensus on 114 (46%) items. Median quantities and interquartile ranges of the items, and their recommended quantities were identified and are presented. Conclusions This study is the first to produce an expert consensus on the items and quantities of clinical equipment that are required to treat 100 people at the scene of a big bang mass casualties event. The findings can be used, both in the UK and internationally, to support decision makers in the planning of equipment for such incidents. PMID:24559111

2014-01-01

49

Hospital management of mass radiological casualties : reassessing exposures from contaminated victims of an exploded radiological dispersal device (RDD).  

SciTech Connect

One of the key issues in the aftermath of an exploded radiological dispersal device from a terrorist event is that of the contaminated victim and the concern among healthcare providers for the harmful exposures they may receive in treating patients, especially if the patient has not been thoroughly decontaminated. This is critically important in the event of mass casualties from a nuclear or radiological incident because of the essential rapidity of acute medical decisions and that those who have life- or limb-threatening injuries may have treatment unduly delayed by a decontamination process that may be unnecessary for protecting the health and safety of the patient or the healthcare provider. To estimate potential contamination of those exposed in a radiological dispersal device event, results were used from explosive aerosolization tests of surrogate radionuclides detonated with high explosives at the Sandia National Laboratories. Computer modeling was also used to assess radiation dose rates to surgical personnel treating patients with blast injuries who are contaminated with any of a variety of common radionuclides. It is demonstrated that exceptional but plausible cases may require special precautions by the healthcare provider, even while managing life-threatening injuries of a contaminated victim from a radiological dispersal device event.

Ansari, Armin (National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA); Harper, Frederick Taylor; Smith, James M. (National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA)

2005-04-01

50

Developing and organizing a trauma system and mass casualty management: some useful observations from the israeli trauma model.  

PubMed

A trauma system is a chain of arrangements and preparedness to provide quality response to injured from the site of injury to the appropriate hospital for the full range of care. Israel has a unique trauma system developed from the experience gained in peace and in war. The system is designed to fit the state's current health system, which is different from the European and American systems. An effective trauma system may potentially manage mass casualty incidence better. The aim of this paper is to discuss learning points to develop a trauma system based on the Israeli trauma model. After participating in a course on developing a trauma system organized by a top Israeli trauma center, a literature search on the topic on the Internet was done using relevant key words like trauma system and disaster management in Israel using the Google search engine in the pubmed, open access journals and websites of trauma organizations. Israel has a unique trauma system of organizing and managing an emergency event, characterized by a central national organization responsible for management, coordination and ongoing quality control. Because of its unique geopolitical situation, the armed forces has a significant role in the system. Investing adequate resources on continuous education, manpower training, motivation, team-work and creation of public volunteers through advocacy is important for capacity building to develop a trauma system. Wisdom, motivation and pragmatism of the Israeli model may be useful to streamline work in skeletal trauma services of developing countries having fewer resources to bring consistency and acceptable standards in trauma care. PMID:23634336

Borgohain, B; Khonglah, T

2013-01-01

51

Creating order from chaos: part II: tactical planning for mass casualty and disaster response at definitive care facilities.  

PubMed

Current events highlight the need for disaster preparedness. We have seen tsunamis, hurricanes, terrorism, and combat in the news every night. There are many variables in a disaster, such as damage to facilities, loss of critical staff members, and overwhelming numbers of casualties. Each medical treatment facility should have a plan for everything from caring for staff members to getting the laundry done and providing enhanced security or mortuary services. Communication and agreements with local, regional, and federal agencies are vital. Then we must train and drill to shape the tools to impose order on chaos and to provide the most care to the greatest number. PMID:17436765

Baker, Michael S

2007-03-01

52

Design and evaluation of a wireless electronic health records system for field care in mass casualty settings  

PubMed Central

Background There is growing interest in the use of technology to enhance the tracking and quality of clinical information available for patients in disaster settings. This paper describes the design and evaluation of the Wireless Internet Information System for Medical Response in Disasters (WIISARD). Materials and methods WIISARD combined advanced networking technology with electronic triage tags that reported victims' position and recorded medical information, with wireless pulse-oximeters that monitored patient vital signs, and a wireless electronic medical record (EMR) for disaster care. The EMR system included WiFi handheld devices with barcode scanners (used by front-line responders) and computer tablets with role-tailored software (used by managers of the triage, treatment, transport and medical communications teams). An additional software system provided situational awareness for the incident commander. The WIISARD system was evaluated in a large-scale simulation exercise designed for training first responders. A randomized trial was overlaid on this exercise with 100 simulated victims, 50 in a control pathway (paper-based), and 50 in completely electronic WIISARD pathway. All patients in the electronic pathway were cared for within the WIISARD system without paper-based workarounds. Results WIISARD reduced the rate of the missing and/or duplicated patient identifiers (0% vs 47%, p<0.001). The total time of the field was nearly identical (38:20 vs 38:23, IQR 26:53–1:05:32 vs 18:55–57:22). Conclusion Overall, the results of WIISARD show that wireless EMR systems for care of the victims of disasters would be complex to develop but potentially feasible to build and deploy, and likely to improve the quality of information available for the delivery of care during disasters. PMID:21709162

Kirsh, D; Griswold, W G; Buono, C; Lyon, J; Rao, R; Chan, T C

2011-01-01

53

Development of the science of mass casualty incident management: reflection on the medical response to the Wenchuan earthquake and Hangzhou bus fire*  

PubMed Central

Objective: In this paper, we review the previous classic research paradigms of a mass casualty incident (MCI) systematically and reflect the medical response to the Wenchuan earthquake and Hangzhou bus fire, in order to outline and develop an improved research paradigm for MCI management. Methods: We searched PubMed, EMBASE, China Wanfang, and China Biology Medicine (CBM) databases for relevant studies. The following key words and medical subject headings were used: ‘mass casualty incident’, ‘MCI’, ‘research method’, ‘Wenchuan’, ‘earthquake’, ‘research paradigm’, ‘science of surge’, ‘surge’, ‘surge capacity’, and ‘vulnerability’. Searches were performed without year or language restriction. After searching the four literature databases using the above listed key words and medical subject headings, related articles containing research paradigms of MCI, 2008 Wenchuan earthquake, July 5 bus fire, and science of surge and vulnerability were independently included by two authors. Results: The current progresses on MCI management include new golden hour, damage control philosophy, chain of survival, and three links theory. In addition, there are three evaluation methods (medical severity index (MSI), potential injury creating event (PICE) classification, and disaster severity scale (DSS)), which can dynamically assess the MCI situations and decisions for MCI responses and can be made based on the results of such evaluations. However, the three methods only offer a retrospective evaluation of MCI and thus fail to develop a real-time assessment of MCI responses. Therefore, they cannot be used as practical guidance for decision-making during MCI. Although the theory of surge science has made great improvements, we found that a very important factor has been ignored—vulnerability, based on reflecting on the MCI response to the 2008 Wenchuan earthquake and July 5 bus fire in Hangzhou. Conclusions: This new paradigm breaks through the limitation of traditional research paradigms and will contribute to the development of a methodology for disaster research. PMID:25471837

Shen, Wei-feng; Jiang, Li-bing; Jiang, Guan-yu; Zhang, Mao; Ma, Yue-feng; He, Xiao-jun

2014-01-01

54

Tsunami Casualty Model  

NASA Astrophysics Data System (ADS)

More than 4500 deaths by tsunamis were recorded in the decade of 1990. For example, the 1992 Flores Tsunami in Indonesia took away at least 1712 lives, and more than 2182 people were victimized by the 1998 Papua New Guinea Tsunami. Such staggering death toll has been totally overshadowed by the 2004 Indian Ocean Tsunami that claimed more than 220,000 lives. Unlike hurricanes that are often evaluated by economic losses, death count is the primary measure for tsunami hazard. It is partly because tsunamis kill more people owing to its short lead- time for warning. Although exact death tallies are not available for most of the tsunami events, there exist gender and age discriminations in tsunami casualties. Significant gender difference in the victims of the 2004 Indian Ocean Tsunami was attributed to women's social norms and role behavior, as well as cultural bias toward women's inability to swim. Here we develop a rational casualty model based on humans' limit to withstand the tsunami flows. The application to simple tsunami runup cases demonstrates that biological and physiological disadvantages also make a significant difference in casualty rate. It further demonstrates that the gender and age discriminations in casualties become most pronounced when tsunami is marginally strong and the difference tends to diminish as tsunami strength increases.

Yeh, H.

2007-12-01

55

Prehospital reflections: diagnosing apnoea at a multiple casualty chemical, biological, radiological and nuclear incident.  

PubMed

During a multiple casualty chemical, biological, radiological and nuclear incident it is imperative that triage is accurately undertaken to use resources effectively and give the greatest chance of survival to those who need it. This reflection explores an option to assist in this matter by proposing a colorimetric breathing detection system, while remembering that this it is untested, may be a useful aid. PMID:21346259

Malpas, Michael

2011-12-01

56

Battlefield triage life signs detection techniques  

NASA Astrophysics Data System (ADS)

Getting to wounded soldiers on the battlefield is a precarious task, and medics have a very high casualty rate. It is therefore a vital importance to prioritize which soldiers to attend to first. The first step is to detect life signs - if a soldier is dead or alive, and prioritize recovery of live soldiers. The second step is to obtain vital signs from live soldiers, and use this to prioritize which are in most urgent need of attention. Our team at Kai Sensors, University of Hawaii and University of Florida is developing Doppler radar heart sensing technology that provides the means to detect life signs, respiration and/or heart beat, at a distance, even for subjects lying motionless, e.g., unconscious subjects, wearing body armor, and hidden from direct view. Since this technology can deliver heart rate information with high accuracy, it may also enable the assessment of a subject's physiological and psychological state based on heart rate variability (HRV) analysis. Thus, the degree of a subject's injury may also be determined. The software and hardware developments and challenges for life signs detection and monitoring for battlefield triage will be discussed, including heart signal detection from all four sides of the human body, detection in the presence of body armor, and the feasibility of HRV parameter extraction.

Boric-Lubecke, Olga; Lin, Jenshan; Park, Byung-Kwon; Li, Changzhi; Massagram, Wansuree; Lubecke, Victor M.; Host-Madsen, Anders

2008-04-01

57

HPV triage for low grade (L-SIL) cytology is appropriate for women over 35 in mass cervical cancer screening using liquid based cytology.  

PubMed

In the experimental arm of a randomised trial, women were tested both for liquid-based cytology and human papillomavirus (HPV) DNA and referred for colposcopy if cytology was ASCUS (atypical cells of undetermined significance) or more severe. We considered those with ASCUS (757) or LSIL (low-grade squamous intraepithelial lesions) (485) and a valid HPV test who received colposcopy. We computed sensitivity, specificity and ROC curves with different values of relative light units (RLU, that are related to viral load) as cut off, using cervical intraepithelial neoplasia grade 2 or more severe (CIN2+) at blind histology review as the endpoint. The area under the receiver operating characteristic (ROC) curve was significantly less among women aged 25-34 years than in those older, both considering ASCUS/AGUS (atypical glandular cells of undetermined significance) (p=0.0355) and LSIL (p=0.0009). At age 35-60 the curves for ASCUS and LSIL were similar, while at age 25-34 the area under the curve for LSIL was significantly less than for ASCUS (p=0.0084). With LSIL cytology, specificity of Hybrid Capture 2 with 2 RLU cut-off was 35.0% (95%CI 28.4-42.1) at age 25-34 and 64.5% (95%CI 58.3-70.3) at age 35-60. In conclusion, triaging by HPV testing performed better in women aged over 35 years than those younger. For older women, HPV triaging should also be considered for managing those with LSIL cytology. PMID:17223540

Ronco, Guglielmo; Cuzick, Jack; Segnan, Nereo; Brezzi, Silvia; Carozzi, Francesca; Folicaldi, Stefania; Dalla Palma, Paolo; Del Mistro, Annarosa; Gillio-Tos, Anna; Giubilato, Pamela; Naldoni, Carlo; Polla, Enzo; Iossa, Anna; Zorzi, Manuel; Confortini, Massimo; Giorgi-Rossi, Paolo

2007-02-01

58

Diagnostic performance of Triage for benzodiazepines: urine analysis of the dose of therapeutic cases.  

PubMed

We evaluated the diagnostic performance of Triage for benzodiazepines in 74 urine specimens from outpatients given therapeutic doses of benzodiazepines and compared the results of EMIT assays. Results obtained in all urine samples were confirmed using liquid chromatography-mass spectrometry (LC-MS). Overall agreement between results of Triage and EMIT assays was 73%. All of the Triage-positive samples were also positive by EMIT assays. Results of Triage and EMIT assays were different for 20 samples obtained from patients given thienodiazepines (etizolam, brotizolam, and clotiazepam) and nitrobenzodiazepines (nitrazepam, flunitrazepam, and clonazepam). LC-MS confirmed parent drugs in urine specimens, consistent with the prescriptions of drugs. The low agreement between Triage and EMIT results in this study might be due to low sensitivity of Triage for thienodiazepines. Thienodiazines are frequently prescribed benzodiazepines, and Triage panel is the most frequently used screening kit in Japan. It should be noted that negative results obtained by a Triage test might not mean the absence of thienodiazepines. PMID:16168176

Kurisaki, Emiko; Hayashida, Makiko; Nihira, Makoto; Ohno, Youkichi; Mashiko, Hirobumi; Okano, Takaaki; Niwa, Shin-ichi; Hiraiwa, Kouichi

2005-09-01

59

Operation Desert Shield: medical aspects of weapons of mass destruction.  

PubMed

Our concern over possible use of weapons of mass destruction against U.S. forces in the Middle East has increased because Iraq has violated the Geneva Protocol of 1925 and the 1972 Biological Weapons Convention, attempted to acquire nuclear capability and delivery systems, and is reported to be developing biological weapons. The Army Medical Department has had no experience, since World War I, in the management and treatment of mass casualties contaminated by chemical agents, and has never treated casualties resulting from the use of nuclear or biological weapons used against our soldiers. Management and diagnosis of casualties will be complicated by their possible exposure to a mixture of chemical warfare and biological warfare agents. Triage is an essential aspect in the management of mass casualties since the number of injured patients will exceed the maximum medical capability to treat each patient on arrival. All levels of medical support must be prepared to protect themselves, their equipment and supplies, and their patients from contamination. In contaminated operations on the integrated battlefield, it will be of utmost importance to incorporate flexibility and innovation to match the medical and tactical situation. PMID:1852275

Knudson, G B

1991-06-01

60

Development of the triage, monitoring and treatment Handbook for Members of the Public Affected by Radiological Terrorism - A European Response  

SciTech Connect

European national emergency response plans have long been focused on accidents at nuclear power plants. Recently, the possible threats by disaffected groups have shifted the focus to being prepared also for malevolent use of radiation that are aimed at creating disruption and panic in the society. The casualties will most likely be members of the public. According to the scenario, the number of affected people can vary from a few to mass casualties. The radiation exposure can range from very low to substantial, possibly combined with conventional injuries. There is a need to develop practicable tools for the adequate response to such acts and more specifically to address European guidelines for triage, monitoring and treatment of exposed people. Although European countries have developed emergency response plans for nuclear accidents they have not all made plans for handling malevolent use of radioactive material. Indeed, there is a need to develop practical guidance on emergency response and medical treatment of the public affected by malevolent acts. Generic guidance on this topic has been published by international organisations. They are, however, not operational documents to be used in emergency situations. The Triage, Monitoring and Treatment (TMT) Handbook aims to strengthen the European ability to efficiently respond to malevolent acts in terms of protecting and treating exposed people. Part of the Handbook is also devoted to public information and communication issues which would contribute to public reassurance in emergency situations. The Handbook will be drafted by European and international experts before it is circulated to all emergency response institutions in Europe that would be a part of the handling of malevolent acts using radioactive material. The institutions would be given a 6 months consultation time with encouragement to test the draft Handbook in national exercises. A workshop will allow feedback from these end users on the content, structure and usefulness of the Handbook before a final version is produced. In order to achieve the project's objectives a consortium has been drawn together including, Belgian Nuclear Research Centre, the Norwegian Radiation Protection Authority, Radiation and Nuclear Safety Authority of Finland, the UK Health Protection Agency, the Central Laboratory for Radiological Protection of Poland and the World Health Organisation. Enviros Consulting is acting as the technical secretariat for the project. The Handbook will aim to harmonise the approaches to handling malevolent acts across Europe. This harmonisation will have an added value on the public confidence in authorities since differing approaches in neighbouring countries could lead to public confusion and mistrust. (authors)

Kruse, P. [Enviros Consulting Limited, Culham Science Centre, Abingdon OX (United Kingdom); Rojas-Palma, C. [Belgian Nuclear Research Centre (SCK-CEN), Radiation Protection Div., Mol (Belgium)

2007-07-01

61

Challenges in presenting high dimensional data to aid in triage in the DARPA virtual soldier project.  

PubMed

One of the goals of the DARPA Virtual Soldier Project is to aid the field medic in the triage of a casualty. In Phase I, we are currently collecting 12 baseline experimental physiological variables and a cardiac gated Computed Tomography (CT) imagery for use in an prototyping a futuristic electronic medical record, the "Holomer". We are using physiological models and Kalman filtering to aid in diagnosis and predict outcomes in relation to cardiac injury. The physiological modeling introduces another few hundred variables. Reducing the complexity of the above into easy-to-read text to aid in the triage by the field medic is the challenge with multiple display solutions. A description of the possible techniques follows. PMID:15718701

Boyd, A D; Wright, Z C; Ade, A S; Bookstein, F; Ogden, J C; Meixner, W; Athey, B D; Morris, T

2005-01-01

62

Modeling casualties in nuclear warfare. Final report  

Microsoft Academic Search

In this report, the authors summarize the casualty criteria currently accepted for the estimation of casualties to the various nuclear environments. For the blast and thermal environments, comparisons are made with criteria currently used in the assessment of conventional weapon casualties. In the area of radiation effects, the report also includes a summary of performance degradation methodology developed in the

J. T. Klopcic; D. L. Watson

1989-01-01

63

Modeling casualties in nuclear warfare. Final report  

SciTech Connect

In this report, the authors summarize the casualty criteria currently accepted for the estimation of casualties to the various nuclear environments. For the blast and thermal environments, comparisons are made with criteria currently used in the assessment of conventional weapon casualties. In the area of radiation effects, the report also includes a summary of performance degradation methodology developed in the DNA Intermediate Nuclear Dose Program and an indication of its relationship to the most recent radiation casualty criteria. Finally, the report concludes with a discussion of the application of these casualty criteria and models in nuclear warfare simulations.

Klopcic, J.T.; Watson, D.L.

1989-07-01

64

Accountability Pressure, Academic Standards, and Educational Triage  

ERIC Educational Resources Information Center

This study aims to determine whether educational accountability promotes educational triage. This study exploits a natural experiment in North Carolina in which standards increased first in math in 2006 and second in reading in 2008 to determine whether an increase in educational standards caused an increase in educational triage at the expense of…

Lauen, Douglas Lee; Gaddis, S. Michael

2012-01-01

65

Nurse triage in theory and in practice  

Microsoft Academic Search

'Nurse Triage' refers to the formal process of early assessment of patients attending an accident and emergency (A&E) department by a trained nurse, to ensure that they receive appropriate attention, in a suitable location, with the requisite degree of urgency. The benefits claimed for nurse triage include better patient outcomes, through clinical management reaching those in greatest need of it

S George; S Read; L Westlake; B Williams; P Pritty; A Fraser-Moodie

1993-01-01

66

Emergency department triage: an ethical analysis  

PubMed Central

Background Emergency departments across the globe follow a triage system in order to cope with overcrowding. The intention behind triage is to improve the emergency care and to prioritize cases in terms of clinical urgency. Discussion In emergency department triage, medical care might lead to adverse consequences like delay in providing care, compromise in privacy and confidentiality, poor physician-patient communication, failing to provide the necessary care altogether, or even having to decide whose life to save when not everyone can be saved. These consequences challenge the ethical quality of emergency care. This article provides an ethical analysis of "routine" emergency department triage. The four principles of biomedical ethics - viz. respect for autonomy, beneficence, nonmaleficence and justice provide the starting point and help us to identify the ethical challenges of emergency department triage. However, they do not offer a comprehensive ethical view. To address the ethical issues of emergency department triage from a more comprehensive ethical view, the care ethics perspective offers additional insights. Summary We integrate the results from the analysis using four principles of biomedical ethics into care ethics perspective on triage and propose an integrated clinically and ethically based framework of emergency department triage planning, as seen from a comprehensive ethics perspective that incorporates both the principles-based and care-oriented approach. PMID:21982119

2011-01-01

67

Eye casualty services in London.  

PubMed

The combined pressures of the European Working Time Directive, 4?h waiting time target, and growing rates of unplanned hospital attendances have forced a major consolidation of eye casualty departments across the country, with the remaining units seeing a rapid increase in demand. We examine the effect of these changes on the provision of emergency eye care in Central London, and see what wider lessons can be learned. We surveyed the managers responsible for each of London's 8 out-of-hours eye casualty services, analysed data on attendance numbers, and conducted detailed interviews with lead clinicians. At London's two largest units, Moorfields Eye Hospital and the Western Eye Hospital, annual attendance numbers have been rising at 7.9% per year (to 76?034 patients in 2010/11) and 9.6% per year (to 31?128 patients in 2010/11), respectively. Using Moorfields as a case study, we discuss methods to increase capacity and efficiency in response to this demand, and also examine some of the unintended consequences of service consolidation including patients travelling long distances to geographically inappropriate units, and confusion over responsibility for out-of-hours inpatient cover. We describe a novel 'referral pathway' developed to minimise unnecessary travelling and delay for patients, and propose a forum for the strategic planning of London's eye casualty services in the future. PMID:23370420

Smith, H B; Daniel, C S; Verma, S

2013-03-01

68

Eye casualty services in London  

PubMed Central

The combined pressures of the European Working Time Directive, 4?h waiting time target, and growing rates of unplanned hospital attendances have forced a major consolidation of eye casualty departments across the country, with the remaining units seeing a rapid increase in demand. We examine the effect of these changes on the provision of emergency eye care in Central London, and see what wider lessons can be learned. We surveyed the managers responsible for each of London's 8 out-of-hours eye casualty services, analysed data on attendance numbers, and conducted detailed interviews with lead clinicians. At London's two largest units, Moorfields Eye Hospital and the Western Eye Hospital, annual attendance numbers have been rising at 7.9% per year (to 76?034 patients in 2010/11) and 9.6% per year (to 31?128 patients in 2010/11), respectively. Using Moorfields as a case study, we discuss methods to increase capacity and efficiency in response to this demand, and also examine some of the unintended consequences of service consolidation including patients travelling long distances to geographically inappropriate units, and confusion over responsibility for out-of-hours inpatient cover. We describe a novel ‘referral pathway' developed to minimise unnecessary travelling and delay for patients, and propose a forum for the strategic planning of London's eye casualty services in the future. PMID:23370420

Smith, H B; Daniel, C S; Verma, S

2013-01-01

69

33 CFR 173.55 - Report of casualty or accident.  

Code of Federal Regulations, 2011 CFR

...2011-07-01 false Report of casualty or accident. 173.55 Section 173.55 Navigation...BOATING SAFETY VESSEL NUMBERING AND CASUALTY AND ACCIDENT REPORTING Casualty and Accident Reporting § 173.55 Report of...

2011-07-01

70

33 CFR 173.55 - Report of casualty or accident.  

...2014-07-01 false Report of casualty or accident. 173.55 Section 173.55 Navigation...BOATING SAFETY VESSEL NUMBERING AND CASUALTY AND ACCIDENT REPORTING Casualty and Accident Reporting § 173.55 Report of...

2014-07-01

71

33 CFR 173.55 - Report of casualty or accident.  

Code of Federal Regulations, 2012 CFR

...2012-07-01 false Report of casualty or accident. 173.55 Section 173.55 Navigation...BOATING SAFETY VESSEL NUMBERING AND CASUALTY AND ACCIDENT REPORTING Casualty and Accident Reporting § 173.55 Report of...

2012-07-01

72

33 CFR 173.55 - Report of casualty or accident.  

Code of Federal Regulations, 2013 CFR

...2013-07-01 false Report of casualty or accident. 173.55 Section 173.55 Navigation...BOATING SAFETY VESSEL NUMBERING AND CASUALTY AND ACCIDENT REPORTING Casualty and Accident Reporting § 173.55 Report of...

2013-07-01

73

33 CFR 173.55 - Report of casualty or accident.  

Code of Federal Regulations, 2010 CFR

...2010-07-01 false Report of casualty or accident. 173.55 Section 173.55 Navigation...BOATING SAFETY VESSEL NUMBERING AND CASUALTY AND ACCIDENT REPORTING Casualty and Accident Reporting § 173.55 Report of...

2010-07-01

74

From the battlefields to the states: the road to recovery. The role of Landstuhl Regional Medical Center in US military casualty care.  

PubMed

The transformation of the modern battlefield with respect to weaponry, modes of transportation, enemy capabilities and location, as well as technological advances, has greatly altered the tactical approach to the mission. Combat casualty care must continually evolve in response to the differences in types of injury, the number and triage of casualties, timing of treatment, and location of care. These battlefield changes have been demonstrated on a large scale in the global war on terrorism, which includes the military operations in Afghanistan and Iraq. The medical response has kept pace with this 21st-century conflict. Even in the new environment of armed conflict and with the advent of new technologies, the principles of managing orthopaedic combat casualties remain clear: preservation of life and limb, skeletal stabilization, and aggressive wound débridement. For United States service members wounded in the current conflicts, Landstuhl Regional Medical Center is a crucial stop along the road to recovery. PMID:17003206

Tenuta, Joachim J

2006-01-01

75

[Emergency department triage: independent nursing intervention?].  

PubMed

The branch hospital triage aimed at, as well as exercised by nurses, has evolved to meet their needs to organize and make visible the nurses' duties. However, it is still not properly considered as independent nursing intervention. Evidencing practice triage nurse in hospital as experienced by their protagonists disclosed the possible causes of this paradoxical competence. In a sample of 41 nurses, of the 52 possible with previous experience in hospital triage in the Emergency Department of the Hospital General Dr. José Molina Orosa in Lanzarote, the nurses themselves carried out an opinion survey that group together statements about different aspects of the triaje nurse. In its results, 65.8% of those polled thought the triaje nursing training to be deficient and even though nearly half 48.7%, was considered competent to decide the level of emergency, 46.3% disagreed to take this task part of their duty. It is conclusive that the training received in hospital triage, regulated and sustained, is deficient, that is the main reason why professionals have their doubts to take on an activity they are not familiar with. Triage systems do not record the entire outcome of the nursing work and nursing methodology does not seem to be quite indicative for this task. PMID:24851339

Corujo Fontes, Sergio José

2014-03-01

76

Evaluating Age in the Field Triage of Injured Persons  

PubMed Central

Study Objective In this study, we evaluated (1) trauma under-triage by age group; (2) the association between age and serious injury after accounting for other field triage criteria and confounders; and (3) the potential impact of a mandatory age triage criterion for field triage. Methods This was a retrospective cohort study of injured children and adults transported by 48 EMS agencies to 105 hospitals in 6 regions of the Western U.S. from 2006 through 2008. We used probabilistic linkage to match EMS records to hospital records, including: trauma registries, state discharge databases and emergency department databases. The primary outcome measure was serious injury, as measured by an Injury Severity Score (ISS) ? 16. We assessed under-triage (ISS ? 16 and triage-negative or transport to a non-trauma center) by age decile and used multivariable logistic regression models to estimate the association (linear and non-linear) between age and ISS ? 16, adjusted for important confounders. We also evaluated the potential impact of age on triage efficiency and trauma center volume. Results 260,027 injured patients were evaluated and transported by EMS over the 3-year study period. Under-triage increased for patients over 60 years of age, reaching approximately 60% for those older than 90 years. There was a strong non-linear association between age and ISS ? 16. For patients not meeting other triage criteria, the probability of serious injury was most notable after 60 years. A mandatory age triage criterion would have decreased under-triage at the expense of over-triage, with one ISS ? 16 patient identified for every 60–65 additional patients transported to major trauma centers. Conclusion Trauma under-triage increases in patients older than 60 years. While the probability of serious injury increases among triage-negative patients with increasing age, the use of a mandatory age triage criterion appears inefficient for improving field triage. PMID:22633339

Nakamura, Yoko; Daya, Mohamud; Bulger, Eileen M.; Schreiber, Martin; Mackersie, Robert; Hsia, Renee Y.; Mann, N. Clay; Holmes, James F.; Staudenmayer, Kristan; Sturges, Zachary; Liao, Michael; Haukoos, Jason; Kuppermann, Nathan; Barton, Erik D.; Newgard, Craig D.

2012-01-01

77

Contribution of forensic autopsy to scene reconstruction in mass fire casualties: A case of alleged arson on a floor consisting of small compartments in a building.  

PubMed

A fire is an important cause of mass disasters, involving various forensic issues. Before dawn on an early morning, 16 male visitors in their twenties to sixties were killed in a possibly incendiary fire at a 'private video parlor' consisting of small compartments in a building. The main causes of death as determined by forensic autopsy were acute carbon monoxide (CO) intoxication for all of the 15 found-dead victims, and hypoxic-ischemic encephalopathy following acute CO intoxication for a victim who died in hospital. Burns were mild (<20% of body surface) in most victims, except for three victims found between the entrance and the estimated fire-outbreak site; thus, identification was completed without difficulty, supported by DNA analysis. Blood carboxyhemoglobin saturation (COHb) was higher for victims found dead in the inner area. Blood cyanide levels were sublethal, moderately correlated to COHb, but were higher in victims found around the estimated fire-outbreak site. There was no evidence of thinner, alcohol or drug abuse, or an attack of disease as a possible cause of an accidental fire outbreak. These observations contribute to evidence-based reconstruction of the fire disaster, and suggest how deaths could have been prevented by appropriate disaster measures. PMID:25311374

Michiue, Tomomi; Ishikawa, Takaki; Oritani, Shigeki; Maeda, Hitoshi

2015-01-01

78

Guidelines for Field Triage of Injured Patients  

PubMed Central

The Centers for Disease Control and Prevention (CDC) has published significant data and trends related to the national public health burden associated with trauma and injury. In the United States (U.S.), injury is the leading cause of death for persons aged 1–44 years. In 2008, approximately 30 million injuries resulted in an emergency department (ED) evaluation; 5.4 million (18%) of these patients were transported by Emergency Medical Services (EMS).1 EMS providers determine the severity of injury and begin initial management at the scene. The decisions to transport injured patients to the appropriate hospital are made through a process known as “field triage.” Since 1986, the American College of Surgeons Committee on Trauma (ACS-COT) has provided guidance for the field triage process though its “Field Triage Decision Scheme.” In 2005, the CDC, with financial support from the National Highway Traffic Safety Administration (NHTSA), collaborated with ASC-COT to convene the initial meeting of the National Expert Panel on Field Triage (the Panel) to revise the decision scheme. This revised version was published in 2006 by ASC-COT, and in 2009 the CDC published a detailed description of the scientific rational for revising the field triage criteria entitled, “Guidelines for Field Triage of Injured Patients.”2–3 In 2011, the CDC reconvened the Panel to review the 2006 Guidelines and recommend any needed changes. We present the methodology, findings and updated guidelines from the Morbidity & Mortality Weekly Report (MMWR) from the 2011 Panel along with commentary on the burden of injury in the U.S., and the role emergency physicians have in impacting morbidity and mortality at the population level. PMID:23447758

McCoy, C. Eric; Chakravarthy, Bharath; Lotfipour, Shahram

2013-01-01

79

Triage Framework for Resource Conservation in a Speaker Identification System  

Microsoft Academic Search

We present a novel framework for triaging (prioritizing and discarding) data to conserve resources for a speaker identification (SID) system. Our work is motivated by applications that require a SID system to process an overwhelming volume of audio data. We design a triage filter whose goal is to conserve recognizer resources while preserving relevant content. We propose triage methods that

A. Jairam; E. Singer; D. A. Reynolds

2007-01-01

80

Machine Learning for Biomedical Literature Triage  

PubMed Central

This paper presents a machine learning system for supporting the first task of the biological literature manual curation process, called triage. We compare the performance of various classification models, by experimenting with dataset sampling factors and a set of features, as well as three different machine learning algorithms (Naive Bayes, Support Vector Machine and Logistic Model Trees). The results show that the most fitting model to handle the imbalanced datasets of the triage classification task is obtained by using domain relevant features, an under-sampling technique, and the Logistic Model Trees algorithm. PMID:25551575

Almeida, Hayda; Meurs, Marie-Jean; Kosseim, Leila; Butler, Greg; Tsang, Adrian

2014-01-01

81

Simulated Casualties and Medics for Emergency Training  

E-print Network

-1976 215573-7453 fax Abstract The MediSim system extends virtual environment technology to allow medical per than presently supported in standard DIS protocols. Casualty simulation begins with a stealth

Badler, Norman I.

82

Accountability Incentives: Do Schools Practice Educational Triage?  

ERIC Educational Resources Information Center

Increasingly frequent journalistic accounts report that schools are responding to No Child Left Behind (NCLB) by engaging in what has come to be known as "educational triage." Although these accounts rely almost entirely on anecdotal evidence, the prospect is of real concern. The NCLB accountability system divides schools into those in which a…

Springer, Matthew G.

2008-01-01

83

Nature, correlates, and consequences of stress-related biological reactivity and regulation in Army nurses during combat casualty simulation.  

PubMed

This study examined the nature, concomitants, and consequences of stress-related biological reactivity and regulation among Army nurses. Saliva was collected, heart rate (HR) and blood pressure (BP) recorded from 38 Army nurses (74% female; mean age 28.5 years [SD=6.5]) before, during, and after participation in the Combat Casualty Stress Scenario (CCSS). Saliva was assayed for cortisol and alpha-amylase (sAA). The CCSS simulates emergency combat rescue, employing two simulated combat casualties, aversive body odors, recorded battlefield sounds, and smoke in a low light environment. Participants locate and conduct preliminary assessments of the simulated patients, triage based on injury severity, initiate treatment, and coordinate medical evacuation by radio. Results revealed large magnitude increases in cortisol, sAA, HR, systolic BP and diastolic BP in response to the CCSS, followed by recovery to baseline levels 30min after the task for all physiological parameters except cortisol. Age, gender, perceived difficulty of the CCSS, and previous nursing experience were associated with individual differences in the magnitude of the physiological responses. Lower levels of performance related to triage and treatment were associated with higher levels of reactivity and slower recovery for some of the physiological measures. The findings raise important questions regarding the utility of integrating measures of the psychobiology of the stress response into training programs designed to prepare first responders to handle highly complex and chaotic rescue situations. PMID:22710003

McGraw, Leigh K; Out, Dorothée; Hammermeister, Jon J; Ohlson, Carl J; Pickering, Michael A; Granger, Douglas A

2013-01-01

84

Reliability and validity of triage systems in paediatric emergency care  

PubMed Central

Background Triage in paediatric emergency care is an important tool to prioritize seriously ill children. Triage can also be used to identify patients who do not need urgent care and who can safely wait. The aim of this review was to provide an overview of the literature on reliability and validity of current triage systems in paediatric emergency care Methods We performed a search in Pubmed and Cochrane on studies on reliability and validity of triage systems in children Results The Manchester Triage System (MTS), the Emergency Severity Index (ESI), the Paediatric Canadian Triage and Acuity Score (paedCTAS) and the Australasian Triage Scale (ATS) are common used triage systems and contain specific parts for children. The reliability of the MTS is good and reliability of the ESI is moderate to good. Reliability of the paedCTAS is moderate and is poor to moderate for the ATS. The internal validity is moderate for the MTS and confirmed for the CTAS, but not studied for the most recent version of the ESI, which contains specific fever criteria for children. Conclusion The MTS and paedCTAS both seem valid to triage children in paediatric emergency care. Reliability of the MTS is good, moderate to good for the ESI and moderate for the paedCTAS. More studies are necessary to evaluate if one triage system is superior over other systems when applied in emergency care. PMID:19712467

van Veen, Mirjam; Moll, Henriette A

2009-01-01

85

Nurses’ Requirements for Relief and Casualty Support in Disasters: A Qualitative Study  

PubMed Central

Background: Nurses are among the most important groups engaged in casualty support, regardless of the cause, and they are one of the largest care groups involved in disasters. Consequently, these workers should gain proper support and skills to enable effective, timely, responsible and ethical emergency responses. Objectives: In this study, we investigated the needs of nurses for proper casualty support in disasters, to facilitate better planning for disaster management. Materials and Methods: This was a qualitative content analysis study. Interviews were performed with 23 nurses, at educational hospitals and the Faculty of Nursing at Kerman Medical University, who had a minimum of five years working experience and assisted in an earthquake disaster. Intensity and snowball sampling were performed. Data was collected through semi-structured interviews. Interviews were transcribed and coded into main themes and subthemes. Results: Four major themes emerged from the data; 1) psychological support, 2) appropriate clinical skills education, 3) appropriate disaster management, supervision and programming, and 4) the establishment of ready for action groups and emergency sites. The participants’ comments highlighted the necessity of training nurses for special skills including emotion management, triage and crush syndrome, and to support nurses' families, provide security, and act according to predefined programs in disasters. Conclusions: There are a wide range of requirements for disaster aid. Proper aid worker selection, frequent and continuous administration of workshops and drills, and cooperation and alignment of different governmental and private organizations are among the suggested initiatives. PMID:25414897

Nekooei Moghaddam, Mahmoud; Saeed, Sara; Khanjani, Narges; Arab, Mansour

2014-01-01

86

46 CFR 4.04-1 - Reports of potential vessel casualty.  

Code of Federal Regulations, 2010 CFR

...2010-10-01 2010-10-01 false Reports of potential vessel casualty. 4.04-1 Section...CASUALTIES AND INVESTIGATIONS Notice of Potential Vessel Casualty § 4.04-1 Reports of potential vessel casualty. A vessel...

2010-10-01

87

Deployed Assessment and Management of mTBI Casualties.  

PubMed

The wars in Afghanistan and Iraq have placed a spotlight on screening, evaluation, and treatment of mild traumatic brain injury, otherwise known as concussion. The author presents a mass casualty case in which a Ranger company medical section assessed and managed 30 Servicemembers (SM) diagnosed with concussion. Through the process of treating these Servicemembers, a consolidated checklist was created based on existing Department of Defense, United States Special Operations Command (USSOCOM), and United States Army Special Operations Command (USASOC) guidelines. During this and subsequent clinical encounters, utilization of this checklist resulted in efficient identification of concussed personnel, appropriate treatment, and documentation. PMID:24048990

Garfin, Benjamin

2013-01-01

88

46 CFR 308.410 - Reporting casualties and filing claims.  

Code of Federal Regulations, 2010 CFR

... Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE War Risk Builder's Risk Insurance § 308.410 Reporting casualties and filing claims. Casualties shall be reported promptly to,...

2010-10-01

89

46 CFR 122.260 - Reports of potential vessel casualty.  

Code of Federal Regulations, 2010 CFR

... 4 2010-10-01 2010-10-01 false Reports of potential vessel casualty. 122.260 Section 122.260 Shipping...Marine Casualties and Voyage Records § 122.260 Reports of potential vessel casualty. (a) An owner, charterer,...

2010-10-01

90

46 CFR 185.260 - Reports of potential vessel casualty.  

Code of Federal Regulations, 2010 CFR

... 7 2010-10-01 2010-10-01 false Reports of potential vessel casualty. 185.260 Section 185.260 Shipping...Marine Casualties and Voyage Records § 185.260 Reports of potential vessel casualty. (a) An owner, charterer,...

2010-10-01

91

Availability of a pediatric trauma center in a disaster surge decreases triage time of the pediatric surge population: a population kinetics model  

PubMed Central

Background The concept of disaster surge has arisen in recent years to describe the phenomenon of severely increased demands on healthcare systems resulting from catastrophic mass casualty events (MCEs) such as natural disasters and terrorist attacks. The major challenge in dealing with a disaster surge is the efficient triage and utilization of the healthcare resources appropriate to the magnitude and character of the affected population in terms of its demographics and the types of injuries that have been sustained. Results In this paper a deterministic population kinetics model is used to predict the effect of the availability of a pediatric trauma center (PTC) upon the response to an arbitrary disaster surge as a function of the rates of pediatric patients' admission to adult and pediatric centers and the corresponding discharge rates of these centers. We find that adding a hypothetical pediatric trauma center to the response documented in an historical example (the Israeli Defense Forces field hospital that responded to the Haiti earthquake of 2010) would have allowed for a significant increase in the overall rate of admission of the pediatric surge cohort. This would have reduced the time to treatment in this example by approximately half. The time needed to completely treat all children affected by the disaster would have decreased by slightly more than a third, with the caveat that the PTC would have to have been approximately as fast as the adult center in discharging its patients. Lastly, if disaster death rates from other events reported in the literature are included in the model, availability of a PTC would result in a relative mortality risk reduction of 37%. Conclusions Our model provides a mathematical justification for aggressive inclusion of PTCs in planning for disasters by public health agencies. PMID:21992575

2011-01-01

92

No Child Overlooked: Mental Health Triage in the Schools  

ERIC Educational Resources Information Center

Mental health problems among children in schools are on the increase. To exercise due diligence in their responsibility to monitor and promote mental health among our nation's children, school counselors may learn from triage systems employed in hospitals, clinics, and mental health centers. The School Counselor's Triage Model provides school…

Wilson, F. Robert; Tang, Mei; Schiller, Kelly; Sebera, Kerry

2009-01-01

93

TRIAGE FRAMEWORK FOR RESOURCE CONSERVATION IN A SPEAKER IDENTIFICATION SYSTEM  

E-print Network

TRIAGE FRAMEWORK FOR RESOURCE CONSERVATION IN A SPEAKER IDENTIFICATION SYSTEM· A. Jairam, E. Singer (prioritizing and discarding) data to conserve resources for a speaker identification (SID) system. Our work and are not necessarily endorsed by the United States Government. ABSTRACT We present a novel framework for triaging

94

Review of a rheumatology triage system: simple, accurate, and effective.  

PubMed

Rheumatology triage systems exist to expedite care for those with inflammatory arthritis (IA). This study presents the first 22-month experience of a simple and unique Canadian university-based triage system. Triage accuracy is analyzed as is the effect on access to care for patients with IA. The triage rheumatologist screens all incoming referral letters to attempt to identify possible diagnoses and, consequently, assigns urgency of assessment. The wait time for patients with IA after introduction of the triage system was compared to a random sample of IA patients from the year preceding the triage system. All newly referred IA patients who were incorrectly triaged as a non-inflammatory process were identified, with a subsequent chart review examining for features that may have influenced the triage status. Three thousand four hundred seventy-six new referrals were seen, with 344 patients receiving a final diagnosis of IA. The median wait time for all patients was 57.0 days, 37.5 days for IA patients, and 25.0 days for IA patients assigned a soon urgency status. Compared to the preceding year, this latter group with inflammatory arthritis was seen 25.0 days sooner (p?triage system correctly identifies patients with IA with an accuracy of 91.0 % and effectively reduces their wait time when assigned an appropriate urgency status. Utilization of this triage system may be universally applicable, accurate, and a cost-effective way to optimize rheumatology patients' access to care. PMID:24173719

Carpenter, Thirza; Katz, Steven J

2014-02-01

95

Yale and the Atomic Bomb Casualty Commission.  

PubMed Central

This is a description, based largely on personal discussions, of the contributions of men from the Yale University School of Medicine to the saga of the immediate and long-term studies on the medical effects of the atomic bombs at Hiroshima and Nagasaki. They played key roles in the immediate studies of bomb effects, in the creation of long-term studies of delayed effects, and in elevating the Atomic Bomb Casualty Commission after 1955 to a position of excellence in its studies and relations with the Japanese. The accumulation of the information presented in this paper derives from research for the preparation of the history of the Atomic Bomb Casualty Commission. In 1975, the commission was passed to Japanese leadership as the Radiation Effects Research Foundation. PMID:6349145

Bowers, J. Z.

1983-01-01

96

Reprioritization of research for combat casualty care.  

PubMed

Since the beginning of the conflicts in Iraq and Afghanistan more than a decade ago, much has been learned with regard to combat casualty care. Although progress has been significant, knowledge gaps still exist. The seventh Extremity War Injuries symposium, held in January 2012, reviewed the current state of knowledge and defined knowledge gaps in acute care, reconstructive care, and rehabilitative care in order to provide policymakers information on the areas in which research funding would be the most beneficial. PMID:22865148

Ficke, James R; Obremskey, William T; Gaines, Robert J; Pasquina, Paul F; Bosse, Michael J; Mamczak, Christiaan N; O'Toole, Robert V; Archer, Kristin R; Born, Christopher T; Fleming, Mark E; Watson, J Tracy; Gordon, Wade T; Stannard, James P; Rispoli, Damian M; Mackenzie, Ellen J; Wenke, Joseph C; Hsu, Joseph R; Pollak, Andrew N; Andersen, Romney C

2012-01-01

97

Field deployable EEG monitor for nerve agent casualties.  

PubMed

Early recognition and aggressive management of seizure activity is important in the treatment of patients with nerve agent exposure. However, these patients can experience non-convulsive seizures that are difficult to identify without EEG monitoring. In this paper, we discuss the development and testing of a low-cost, field-deployable device that records and displays patient EEG trends over time. The device is optimized for early levels of care for military and mass casualty patients until they can be relocated to medical facilities with more comprehensive monitoring. The device also records pulse oximetry and acceleration information, and patient data are available for later analysis and improvement of treatment protocols. PMID:19964118

McDonnall, Daniel; Hiatt, Scott; Yatsenko, Dimitri; Guillory, K Shane

2009-01-01

98

33 CFR 174.107 - Contents of casualty or accident report form.  

Code of Federal Regulations, 2010 CFR

...2010-07-01 false Contents of casualty or accident report form. 174.107 Section...174.107 Contents of casualty or accident report form. Each form for reporting a vessel casualty or accident must contain the information...

2010-07-01

99

33 CFR 174.107 - Contents of casualty or accident report form.  

Code of Federal Regulations, 2013 CFR

...2013-07-01 false Contents of casualty or accident report form. 174.107 Section...174.107 Contents of casualty or accident report form. Each form for reporting a vessel casualty or accident must contain the information...

2013-07-01

100

33 CFR 174.121 - Forwarding of casualty or accident reports.  

Code of Federal Regulations, 2011 CFR

... false Forwarding of casualty or accident reports. 174.121 Section 174...174.121 Forwarding of casualty or accident reports. Within 30 days of the receipt of a casualty or accident report, each State that has...

2011-07-01

101

33 CFR 174.121 - Forwarding of casualty or accident reports.  

... false Forwarding of casualty or accident reports. 174.121 Section 174...174.121 Forwarding of casualty or accident reports. Within 30 days of the receipt of a casualty or accident report, the reporting...

2014-07-01

102

33 CFR 174.121 - Forwarding of casualty or accident reports.  

Code of Federal Regulations, 2010 CFR

... false Forwarding of casualty or accident reports. 174.121 Section 174...174.121 Forwarding of casualty or accident reports. Within 30 days of the receipt of a casualty or accident report, each State that has...

2010-07-01

103

33 CFR 174.107 - Contents of casualty or accident report form.  

...2014-07-01 false Contents of casualty or accident report form. 174.107 Section...174.107 Contents of casualty or accident report form. Each form for reporting a vessel casualty or accident must contain the information...

2014-07-01

104

Balancing human and system visualization during document triage  

E-print Network

People must frequently sort through and identify relevant materials from a large set of documents. Document triage is a specific form of information collecting where people quickly evaluate a large set of documents from the Internet by reading (or...

Bae, Soon Il

2009-05-15

105

Below the Bubble: “Educational Triage” and the Texas Accountability System  

Microsoft Academic Search

This article uses two dominant traditions in the organizational study of schools—the neoinstitutional and faculty workplace approaches—to explain an urban elementary school’s response to the Texas Accountability System. The findings indicate that teachers, guided by an institutional logic, sought to create the appearance of test score improvement by using a constellation of “educational triage” practices. Educational triage was manifest in

Jennifer Booher-Jennings

2005-01-01

106

The Casualty Actuarial Society: Helping Universities Train Future Actuaries  

ERIC Educational Resources Information Center

The Casualty Actuarial Society (CAS) believes that the most effective way to advance the actuarial profession is to work in partnership with universities. The CAS stands ready to assist universities in creating or enhancing courses and curricula associated with property/casualty actuarial science. CAS resources for university actuarial science…

Boa, J. Michael; Gorvett, Rick

2014-01-01

107

Roadmap: Insurance Studies Property and Casualty Insurance Bachelor of Science  

E-print Network

Roadmap: Insurance Studies ­ Property and Casualty Insurance ­ Bachelor of Science [RE of Macroeconomics 3 Fulfills Kent Core Additional INS 29000 Introduction to Insurance and Risk 3 Semester Five: [15 Credit Hours] BMRT 21052 Professional Selling Techniques 3 INS 49011 Property and Casualty Insurance Law

Sheridan, Scott

108

Effect of a triage course on quality of rating triage codes in a group of university nursing students:a before-after observational study  

PubMed Central

BACKGROUND: Most current triage tools have been tested among hospital nurses groups but there are not similar studies in university setting. In this study we analyzed if a course on a new four-level triage model, triage emergency method (TEM), could improve the quality of rating in a group of nursing students. METHODS: This observational study was conducted with paper scenarios at the University of Parma, Italy. Fifty students were assigned a triage level to 105 paper scenarios before and after a course on triage and TEM. We used weighted kappa statistics to measure the inter-rater reliability of TEM and assessed its validity by comparing the students’ predictions with the triage code rating of a reference standard (a panel of five experts in the new triage method). RESULTS: Inter-rater reliability was K=0.42 (95%CI: 0.37–0.46) before the course on TEM, and K=0.61 (95%CI: 0.56–0.67) after. The accuracy of students’ triage rating for the reference standard triage code was good: 81% (95%CI: 71–90). After the TEM course, the proportion of cases assigned to each acuity triage level was similar for the student group and the panel of experts. CONCLUSION: Among the group of nursing students, a brief course on triage and on a new in-hospital triage method seems to improve the quality of rating codes. The new triage method shows good inter-rater reliability for rating triage acuity and good accuracy in predicting the triage code rating of the reference standard. PMID:25215088

Parenti, Nicola; Bacchi Reggiani, Maria Letizia; Sangiorgi, Diego; Serventi, Vito; Sarli, Leopoldo

2013-01-01

109

Development of a lightweight portable ventilator for far-forward battlefield combat casualty support  

NASA Astrophysics Data System (ADS)

Immediate medical provision substantially reduces the number of fatalities sustained during military operations. However, the shift from large-scale regional conflicts to smaller peacekeeping and humanitarian missions has reduced the military medical support infrastructure. Civilian emergency medical services have long emphasized the 'golden hour' during which a patient must receive definitive medical attention. Without on-scene medical support, injured soldiers must be transported significant distances before receiving advanced medical care, and rapid transport to a medical facility is not always a viable option. Technological solutions enable military medics to deliver advanced medical care on the battlefield. We report here on the development of a small lightweight portable respirator for the treatment of far- forward battlefield casualties. The Far Forward Life Support System (FFLSS) utilizes a combination of COTS (commercial off the shelf) components and custom designed systems to provide ventilatory support to injured combatants. It also incorporates a small IV fluid pump and IV fluids for resuscitation. A microcompressor control system monitors both system performance and patient parameters for system control. Telemetry to a pager-like device worn by the front line medic alerts of any anomalies in ventilator or patient parameters, which will add greatly to triage decisions and resource management. Novel elements of the FLSS design include oxygen generation, low-pressure air generation, available patient suction, and the absence of any high pressure air cylinders. A prototype developed for animal testing will be described in detail as well as further design requirements for the human rated prototype.

Cutchis, Protagoras N.; Smith, Dexter G.; Ko, Harvey W.; Wiesmann, William P.; Pranger, L. Alex

1999-07-01

110

Validation of the Alder Hey Triage Pain Score  

PubMed Central

Aims: To describe the validation and reliability of a new pain tool (the Alder Hey Triage Pain Score, AHTPS) for children at triage in the accident and emergency (A&E) setting. Methods: A new behavioural observational pain tool was developed because of dissatisfaction with available tools and a lack of confidence in self-assessment scores at triage. The study was conducted in a large paediatric A&E department; 575 children (aged 0–16 years) were included. Inter-rater reliability and various aspects of validity were assessed. In addition this tool was compared to the Wong-Baker self-assessment tool.1 The children were concurrently scored by a research nurse and triage nurses to assess inter-rater reliability. Construct validity was assessed by comparing the research nurse's triage score with the research nurse reassessment score after intervention and/or analgesia. Known group construct validity was assessed by comparing the research nurse's score at triage with the level of pain of the condition as judged by the discharge diagnosis. Predictive validity was assessed by comparing the research nurse's AHTPS with the level of analgesia needed by each patient. The AHTPS was also compared to a self-assessment score. Results: A high level of inter-rater reliability, kappa statistic 0.84 (95% CI 0.80 to 0.88), was shown. Construct validity was well demonstrated; known group construct validity and predictive validity were also demonstrated to a varying degree. Conclusions: Results support the use of this observational pain scoring tool in the triage of children in A&E. PMID:15210492

Stewart, B; Lancaster, G; Lawson, J; Williams, K; Daly, J

2004-01-01

111

Redefining Technical Rescue and Casualty Care for SOF: Part 1.  

PubMed

Trauma care in the tactical environment is complex; it requires a unique blend of situational awareness, foresight, medical skill, multitasking, and physical strength. Rescue is a critical, but often over-looked, component of nearly all tactical trauma casualty management. Successful full spectrum casualty management requires proficiency in four areas: casualty access, assessment, stabilization, and extraction. When complex rescue situations arise (casualty removal from roof tops, mountain terrain, collapsed structures, wells, or a karez), casualty care often becomes further complicated. Special Operations units have historically looked to civilian technical rescue techniques and equipment to fill this ?rescue gap.? Similar to the evolution of pre-hospital military medicine from civilian guidelines (e.g. Advanced Trauma Life Support) (ATLS)) to an evidence-based, tactical-specific guideline (Tactical Combat Casualty Care (TCCC)), an evolution is required within the rescue paradigm. This shift from civilian-based technical rescue guidelines towards an Operational Rescue? capability allows tactical variables such as minimal equipment, low light/night vision goggles (NVG) considerations, enemy threats, and variable evacuation times to permeate through the individual rescue skill set. Just as with TCCC, in which the principles of casualty care remain consistent, the practices must be adapted to end-users environment, so it is with rescue. PMID:23536462

McKay, S D; Johnston, J; Callaway, D W

2012-01-01

112

Injury profile of pedal and motor cyclist casualties in Victoria.  

PubMed

The injury profiles of 512 pedal and 667 motor cyclist casualties managed during 1977-80 at four Melbourne teaching hospitals have been analysed using the Abbreviated Injury Scale (1980 revision). Additional comparison has been made between cyclist casualties involved in collisions with another vehicle, in single vehicle accidents and between casualties aged 17 years or more. Pedal cyclist casualties sustained significantly more frequent and severe head injury although the maximum level of injury to any part of the body (maximum abbreviated injury score) was, with the exception of casualties involved in single vehicle accidents, significantly greater in motor cyclist casualties. Head injury occurred in 59% of pedal and 26% of motor cyclist casualties (P less than 0.001); severe head injuries occurred in 9% and 4%, correspondingly. These differences may be explained, at least in part, by the fact that virtually all motor cyclists were protected by safety helmets whereas few pedal cyclists were similarly protected. The following countermeasures are recommended: effective promotion of approved safety helmet wearing in all schools; bulk purchase of helmets through the Ministry of Education for low cost distribution; a Government subsidy to reduce the costs of helmet purchase; legislation for compulsory wearing of approved safety helmets by pedal cyclists. PMID:3868412

McDermott, F T; Klug, G L

1985-10-01

113

Effective Spine Triage: Patterns of Pain  

PubMed Central

Background The most common cause of recurring lost time from work, low back pain is a huge burden on society. Medical training dictates that we must establish a cause for pain before we can treat it and then base our treatment on a recognized and agreed-upon pathology. But in the overwhelming majority of low back pain cases, the issue is nothing more than a minor mechanical malfunction, the inevitable consequence of normal wear and tear. The severity of the pain does not reflect the benign nature of the underlying problem and its limited extent makes a definitive diagnosis impossible. One important component of the solution is improved spinal triage. Using patterns or syndromes in the initial assessment of low back pain is gaining renewed interest and clinical acceptance. Methods Identifying a patient's pain pattern is achieved primarily through an assessment of the patient's history. The patient interview begins with a series of questions to determine the specific syndrome. A subsequent physical examination supports or refutes the findings in history. Combining information from the history with the findings of the physical examination, the clinician has the ability to rule out a number of potentially grim diagnoses. Results More than 90% of back pain patients have benign mechanical problems and their pain can be classified into 4 distinct patterns: 2 back-dominant patterns and 2 leg-dominant patterns. Conclusion A clinical perspective capable of recognizing a defined syndrome at first contact will lead to a better outcome. Most patients with low back pain can be treated successfully with simple, pattern-specific, noninvasive primary management. Patients without a pattern and those who do not respond as anticipated require further investigation and specialized care. PMID:24688339

Hall, Hamilton

2014-01-01

114

Current triage practice and influences affecting clinical decision-making in emergency departments in NSW, Australia  

Microsoft Academic Search

In Australia, as elsewhere, the nature of triage decision making, patient referral, investigations, physical resources, triage policies, educational requirements and clinical expertise is often unclear and differs between organizations (Gerdtz & Bucknell 2000; Standen 1998). The study described here was undertaken in order to explore current triage practices throughout New South Wales (NSW) and to describe the range of clinical

M. Fry; G. Burr

2001-01-01

115

Employees’ views on home-based, after-hours telephone triage by Dutch GP cooperatives  

PubMed Central

Background Dutch out-of-hours (OOH) centers find it difficult to attract sufficient triage staff. They regard home-based triage as an option that might attract employees. Specially trained nurses are supposed to conduct triage by telephone from home for after-hours medical care. The central aim of this research is to investigate the views of employees of OOH centers in The Netherlands on home-based telephone triage in after-hours care. Methods The study is a Q methodology study. Triage nurses, general practitioners (GPs) and managers of OOH centers ranked 36 opinion statements on home-based triage. We interviewed 10 participants to help develop and validate the statements for the Q sort, and 77 participants did the Q sort. Results We identified four views on home-based telephone triage. Two generally favor home-based triage, one highlights some concerns and conditions, and one opposes it out of concern for quality. The four views perceive different sources of credibility for nurse triagists working from home. Conclusion Home-based telephone triage is a controversial issue among triage nurses, GPs and managers of OOH centers. By identifying consensus and dissension among GPs, triagists, managers and regulators, this study generates four perspectives on home-based triage. In addition, it reveals the conditions considered important for home-based triage. PMID:24188407

2013-01-01

116

76 FR 8788 - Riverside Casualty, Inc.; Notice of Application  

Federal Register 2010, 2011, 2012, 2013

...APPLICANT: Riverside Casualty, Inc. (``RCI''). FILING DATES: The application was...3) or 3(c)(6) of the Act. 2. RCI, a Florida corporation, was formed by...the insurance subsidiaries of Captive. RCI will be an ``employees securities...

2011-02-15

117

Do lower income areas have more pedestrian casualties?  

PubMed

Pedestrian and motor vehicle casualties are analyzed for the State of New Jersey with the objective of determining how the income of an area may be associated with casualties. We develop a maximum-likelihood negative binomial model to examine how various spatially defined variables, including road, income, and vehicle ownership, may be associated with casualties using census block-group level data. Due to suspected spatial correlation in the data we also employ a conditional autoregressive Bayesian model using Markov Chain Monte Carlo simulation, implemented with Crimestat software. Results suggest that spatial correlation is an issue as some variables are not statistically significant in the spatial model. We find that both pedestrian and motor vehicle casualties are greater in lower income block groups. Both are also associated with less household vehicle ownership, which is not surprising for pedestrian casualties, but is a surprising result for motor vehicle casualties. Controls for various road categories provide expected relationships. Individual level data is further examined to determine relationships between the location of a crash victim and their residence zip code, and this largely confirms a residual effect associated with both lower income individuals and lower income areas. PMID:23856641

Noland, Robert B; Klein, Nicholas J; Tulach, Nicholas K

2013-10-01

118

A concept for major incident triage: full-scaled simulation feasibility study  

PubMed Central

Background Efficient management of major incidents involves triage, treatment and transport. In the absence of a standardised interdisciplinary major incident management approach, the Norwegian Air Ambulance Foundation developed Interdisciplinary Emergency Service Cooperation Course (TAS). The TAS-program was established in 1998 and by 2009, approximately 15 500 emergency service professionals have participated in one of more than 500 no-cost courses. The TAS-triage concept is based on the established triage Sieve and Paediatric Triage Tape models but modified with slap-wrap reflective triage tags and paediatric triage stretchers. We evaluated the feasibility and accuracy of the TAS-triage concept in full-scale simulated major incidents. Methods The learners participated in two standardised bus crash simulations: without and with competence of TAS-triage and access to TAS-triage equipment. The instructors calculated triage accuracy and measured time consumption while the learners participated in a self-reported before-after study. Each question was scored on a 7-point Likert scale with points labelled "Did not work" (1) through "Worked excellent" (7). Results Among the 93 (85%) participating emergency service professionals, 48% confirmed the existence of a major incident triage system in their service, whereas 27% had access to triage tags. The simulations without TAS-triage resulted in a mean over- and undertriage of 12%. When TAS-Triage was used, no mistriage was found. The average time from "scene secured to all patients triaged" was 22 minutes (range 15-32) without TAS-triage vs. 10 minutes (range 5-21) with TAS-triage. The participants replied to "How did interdisciplinary cooperation of triage work?" with mean 4,9 (95% CI 4,7-5,2) before the course vs. mean 5,8 (95% CI 5,6-6,0) after the course, p < 0,001. Conclusions Our modified triage Sieve tool is feasible, time-efficient and accurate in allocating priority during simulated bus accidents and may serve as a candidate for a future national standard for major incident triage. PMID:20701802

2010-01-01

119

The Atomic Bomb Casualty Commission in retrospect.  

PubMed

For 50 years, the Atomic Bomb Casualty Commission (ABCC) and its successor, the Radiation Effects Research Foundation (RERF), have conducted epidemiological and genetic studies of the survivors of the atomic bombs and of their children. This research program has provided the primary basis for radiation health standards. Both ABCC (1947-1975) and RERF (1975 to date) have been a joint enterprise of the United States (through the National Academy of Sciences) and of Japan. ABCC began in devastated, occupied Japan. Its mission had to be defined and refined. Early research revealed the urgent need for long term study. In 1946, a Directive of President Truman enjoined the National Research Council of the National Academy of Sciences to develop the program. By 1950, ABCC staff exceeded 1,000, and clinical and genetic studies were underway. Budgetary difficulties and other problems almost forced closure in 1953. In 1955, the Francis Report led to a unified epidemiological study. Much progress was made in the next decade, but changing times required founding of a binational nonprofit organization (RERF) with equal participation by Japan and the United States. New programs have been developed and existing ones have been extended in what is the longest continuing health survey ever undertaken. PMID:9576898

Putnam, F W

1998-05-12

120

Children's Cognitive Triage: Optimal Retrieval or Effortful Processing?  

ERIC Educational Resources Information Center

Cognitive triage is the nonmonotonic relationship between the order in which children read words out of long-term memory and the strength of the memory of the words read. Two experiments with 7 and 12 year olds compared the fuzzy-trace theory with an effortful processing explanation. Findings consistently favored the fuzzy-trace theory's…

Brainerd, C. J.; And Others

1990-01-01

121

Data triage enables extreme-scale August 1, 2014  

E-print Network

- 1 - Data triage enables extreme-scale computing August 1, 2014 The growing scale, size, and complexity of computing require prioritization to manage the data. However, resources are lacking to process all of the data fully, either by a computer or the end-user. To deal with the lack of resources, more

122

Ethics of triage in the event of an influenza pandemic.  

PubMed

The prospect of a severe influenza pandemic poses a daunting public health threat to hospitals and the public they serve. The event of a severe influenza pandemic will put hospitals under extreme stress; only so many beds, ventilators, nurses, and physicians will be available, and it is likely that more patients will require medical attention than can be completely treated. Triage is the process of sorting patients in a time of crisis to determine who receives what level of medical attention. How will hospitals sort patients to determine priority for treatment? What criteria will be used? Who will develop these criteria? This article formulates an answer to these questions by constructing a conceptual framework for anticipating and responding to the ethical issues raised by triage in the event of a severe influenza pandemic. PMID:18525374

Tabery, James; Mackett, Charles W

2008-06-01

123

Invariance of cognitive triage in the development of recall in adulthood.  

PubMed

Past research has demonstrated that cognitive triage (weak-strong-weak recall pattern) is a robust effect that optimises children's recall. The aim of the current research was to determine whether adults' free recall also exhibits triage and whether cognitive triage is less marked with older than younger adults' recall. Younger and older adults memorized 16 unrelated words until all items were recalled perfectly. The triage pattern existed for both the younger and older adults' recall and there was evidence for age differences in triage. Our results are consistent with claims of greater verbatim forgetting and increased susceptibility to output interference with age in adulthood. Further research is needed to determine whether fuzzy-trace theory adequately explains the ageing of triage and what factors play a role in the development of this pattern of recall in adulthood. PMID:19468958

Marche, Tammy A; Howe, Mark L; Lane, David G; Owre, Keith P; Briere, Jennifer L

2009-07-01

124

Calibrating urgency: triage decision-making in a pediatric emergency department  

Microsoft Academic Search

Triage, the first step in the assessment of emergency department patients, occurs in a highly dynamic environment that functions\\u000a under constraints of time, physical space, and patient needs that may exceed available resources. Through triage, patients\\u000a are placed into one of a limited number of categories using a subset of diagnostic information. To facilitate this task and\\u000a standardize the triage

Vimla L. Patel; Lily A. Gutnik; Daniel R. Karlin; Martin Pusic

2008-01-01

125

Swedish emergency department triage and interventions for improved patient flows: a national update  

PubMed Central

Background In Scandinavia, emergency department triage and patient flow processes, are under development. In Sweden, the triage development has resulted in two new triage scales, the Adaptive Process Triage and the Medical Emergency Triage and Treatment System. Both these scales have logistic components, aiming to improve patient flows. The aim of this study was to report the development and current status of emergency department triage and patient flow processes in Sweden. Methods In 2009 and 2010 the Swedish Council on Health Technology Assessment sent out a questionnaire to the ED managers in all (74) Swedish hospital emergency departments. The questionnaire comprised questions about triage and interventions to improve patient flows. Results Nearly all (97%) EDs in Sweden employed a triage scale in 2010, which was an increase from 2009 (73%). Further, the Medical Emergency Triage and Treatment System was the triage scale most commonly implemented across the country. The implementation of flow-related interventions was not as common, but more than half (59%) of the EDs have implemented or plan to implement nurse requested X-ray. Conclusions There has been an increase in the use of triage scales in Swedish EDs during the last few years, with acceleration for the past two years. Most EDs have come to use the Medical Emergency Triage and Treatment System, which also indicates regional co-operation. The implementation of different interventions for improved patient flows in EDs most likely is explained by the problem of crowding. Generally, more studies are needed to investigate the economical aspects of these interventions. PMID:22151969

2011-01-01

126

27 CFR 25.282 - Beer lost by fire, theft, casualty, or act of God.  

Code of Federal Regulations, 2010 CFR

... § 25.282 Beer lost by fire, theft, casualty, or act...otherwise rendered unmerchantable by fire, casualty, or act of God...is rendered unmerchantable by fire, casualty, or act of God...or sale. (f) Additional information. The appropriate TTB...

2010-04-01

127

French pre-hospital trauma triage criteria: Does the “pre-hospital resuscitation” criterion provide additional benefit in triage?  

PubMed Central

AIM: To evaluate the performance of the specific French Vittel “Pre-Hospital (PH) resuscitation” criteria in selecting polytrauma patients during the pre-hospital stage and its potential to increase the positive predictive value (PPV) of pre-hospital trauma triage. METHODS: This was a monocentric prospective cohort study of injured adults transported by emergency medical service to a trauma center. Patients who met any of the field trauma triage criteria were considered “triage positive”. Hospital data was statistically linked to pre-hospital records. The primary outcome of defining a “major trauma patient” was Injury Severity Score (ISS) > 16. RESULTS: There were a total of 200 injured patients evaluated over a 2 years period who met at least 1 triage criterion. The number of false positives was 64 patients (ISS < 16). The PPV was 68%. The sensitivity and the negative predictive value could not be evaluated in this study since it only included patients with positive Vittel criteria. The criterion of “PH resuscitation” was present for 64 patients (32%), but 10 of them had an ISS < 16. This was statistically significant in correlation with the severity of the trauma in univariate analysis (OR = 7.2; P = 0.005; 95%CI: 1.6-31.6). However, despite this correlation the overall PPV was not significantly increased by the use of the criterion “PH resuscitation” (68% vs 67.8%). CONCLUSION: The criterion of “pre-hospital resuscitation” was statistically significant with the severity of the trauma, but did not increase the PPV. The use of “pre-hospital resuscitation” criterion could be re-considered if these results are confirmed by larger studies. PMID:25379459

Hornez, Emmanuel; Maurin, Olga; Mayet, Aurélie; Monchal, Tristan; Gonzalez, Federico; Kerebel, Delphine

2014-01-01

128

46 CFR 4.05-1 - Notice of marine casualty.  

Code of Federal Regulations, 2010 CFR

(a) Immediately after the addressing of resultant safety concerns, the owner, agent, master, operator, or person in charge, shall notify the nearest Sector Office, Marine Inspection Office or Coast Guard Group Office whenever a vessel is involved in a marine casualty consisting...

2010-10-01

129

Trends in traffic casualties in South Australia, 1981-2003  

Microsoft Academic Search

ABSTRACT There has been a reduction in traffic fatalities in South Australia between 1981 and 2003, but this has not been accompanied by a fall in the total number of traffic casualties, and even the number of fatalities has declined very little since about 1992. This report throws light on these and related observations. The main data source is TARS,

TP Hutchinson; RWG Anderson; AJ McLean

130

46 CFR 4.05-1 - Notice of marine casualty.  

Code of Federal Regulations, 2013 CFR

(a) Immediately after the addressing of resultant safety concerns, the owner, agent, master, operator, or person in charge, shall notify the nearest Sector Office, Marine Inspection Office or Coast Guard Group Office whenever a vessel is involved in a marine casualty consisting...

2013-10-01

131

46 CFR 4.05-1 - Notice of marine casualty.  

Code of Federal Regulations, 2012 CFR

(a) Immediately after the addressing of resultant safety concerns, the owner, agent, master, operator, or person in charge, shall notify the nearest Sector Office, Marine Inspection Office or Coast Guard Group Office whenever a vessel is involved in a marine casualty consisting...

2012-10-01

132

46 CFR 185.206 - Written report of marine casualty.  

Code of Federal Regulations, 2010 CFR

(a) The owner, master, agent, or person in charge shall, within five days, file a written report of any marine casualty. This written report is in addition to the immediate notice required by 185.202. This written report must be delivered to a Coast Guard Sector Office, or Marine Inspection...

2010-10-01

133

46 CFR 4.05-1 - Notice of marine casualty.  

Code of Federal Regulations, 2011 CFR

(a) Immediately after the addressing of resultant safety concerns, the owner, agent, master, operator, or person in charge, shall notify the nearest Sector Office, Marine Inspection Office or Coast Guard Group Office whenever a vessel is involved in a marine casualty consisting...

2011-10-01

134

Clinical decision support improves quality of telephone triage documentation - an analysis of triage documentation before and after computerized clinical decision support  

PubMed Central

Background Clinical decision support (CDS) has been shown to be effective in improving medical safety and quality but there is little information on how telephone triage benefits from CDS. The aim of our study was to compare triage documentation quality associated with the use of a clinical decision support tool, ExpertRN©. Methods We examined 50 triage documents before and after a CDS tool was used in nursing triage. To control for the effects of CDS training we had an additional control group of triage documents created by nurses who were trained in the CDS tool, but who did not use it in selected notes. The CDS intervention cohort of triage notes was compared to both the pre-CDS notes and the CDS trained (but not using CDS) cohort. Cohorts were compared using the documentation standards of the American Academy of Ambulatory Care Nursing (AAACN). We also compared triage note content (documentation of associated positive and negative features relating to the symptoms, self-care instructions, and warning signs to watch for), and documentation defects pertinent to triage safety. Results Three of five AAACN documentation standards were significantly improved with CDS. There was a mean of 36.7 symptom features documented in triage notes for the CDS group but only 10.7 symptom features in the pre-CDS cohort (p?triage note documentation quality. CDS-aided triage notes had significantly more information about symptoms, warning signs and self-care. The changes in triage documentation appeared to be the result of the CDS alone and not due to any CDS training that came with the CDS intervention. Although this study shows that CDS can improve documentation, further study is needed to determine if it results in improved care. PMID:24645674

2014-01-01

135

Understanding the Triaging and Fixing Processes of Long Lived Bugs Ripon K. Saha, Sarfraz Khurshid, Dewayne E. Perry  

E-print Network

Understanding the Triaging and Fixing Processes of Long Lived Bugs Ripon K. Saha, Sarfraz Khurshid- velopers/managers triage bugs carefully and schedule Email addresses: ripon@utexas.edu (Ripon K. Saha

Perry, Dewayne E.

136

Taxonomic triage and the poverty of phylogeny.  

PubMed Central

Revisionary taxonomy is frequently dismissed as merely descriptive, which belies its strong intellectual content and hypothesis-driven nature. Funding for taxonomy is inadequate and largely diverted to studies of phylogeny that neither improve classifications nor nomenclature. Phylogenetic classifications are optimal for storing and predicting information, but phylogeny divorced from taxonomy is ephemeral and erodes the accuracy and information content of the language of biology. Taxonomic revisions and monographs are efficient, high-throughput species hypothesis-testing devices that are ideal for the World Wide Web. Taxonomic knowledge remains essential to credible biological research and is made urgent by the biodiversity crisis. Theoretical and technological advances and threats of mass species extinctions indicate that this is the time for a renaissance in taxonomy. Clarity of vision and courage of purpose are needed from individual taxonomists and natural history museums to bring about this evolution of taxonomy into the information age. PMID:15253345

Wheeler, Quentin D

2004-01-01

137

Applying Lean: Implementation of a Rapid Triage and Treatment System  

PubMed Central

Objective: Emergency department (ED) crowding creates issues with patient satisfaction, long wait times and leaving the ED without being seen by a doctor (LWBS). Our objective was to evaluate how applying Lean principles to develop a Rapid Triage and Treatment (RTT) system affected ED metrics in our community hospital. Methods: Using Lean principles, we made ED process improvements that led to the RTT system. Using this system, patients undergo a rapid triage with low-acuity patients seen and treated by a physician in the triage area. No changes in staffing, physical space or hospital resources occurred during the study period. We then performed a retrospective, observational study comparing hospital electronic medical record data six months before and six months after implementation of the RTT system. Results: ED census was 30,981 in the six months prior to RTT and 33,926 after. Ambulance arrivals, ED patient acuity and hospital admission rates were unchanged throughout the study periods. Mean ED length of stay was longer in the period before RTT (4.2 hours, 95% confidence interval [CI] = 4.2–4.3; standard deviation [SD] = 3.9) than after (3.6 hours, 95% CI = 3.6–3.7; SD = 3.7). Mean ED arrival to physician start time was 62.2 minutes (95% CI = 61.5–63.0; SD = 58.9) prior to RTT and 41.9 minutes (95% CI = 41.5–42.4; SD = 30.9) after. The LWBS rate for the six months prior to RTT was 4.5% (95% CI = 3.1–5.5) and 1.5% (95% CI = 0.6–1.8) after RTT initiation. Conclusion: Our experience shows that changes in ED processes using Lean thinking and available resources can improve efficiency. In this community hospital ED, use of an RTT system decreased patient wait times and LWBS rates. PMID:21691524

Murrell, Karen L.; Offerman, Steven R.; Kauffman, Mark B.

2011-01-01

138

Recognizing User Interest and Document Value from Reading and Organizing Activities in Document Triage  

E-print Network

to identify useful materials, for example, when they look through web search results. This document triage of documents (e.g. from a search engine). In triage, the attention of the user shifts from document to document. Categories and Subject Descriptors H.3.3 [Information Storage and Retrieval]: Information Search

Moore, J. Michael

139

A Modified Sequential Organ Failure Assessment (MSOFA) Score for Critical Care Triage  

PubMed Central

Objective The Sequential Organ Failure Assessment (SOFA) score has been recommended for triage during a mass influx of critically-ill patients, but requires laboratory measurement of four parameters which may be impractical with constrained resources. We hypothesized that a modified SOFA (MSOFA) score that requires only one laboratory measurement would predict patient outcome as well as the SOFA score. Methods After a retrospective derivation, in a prospective observational study in a 24-bed medical, surgical, and trauma intensive care unit, we determined serial SOFA and MSOFA scores on all patients admitted during calendar year 2008 and compared ability to predict mortality and need for mechanical ventilation. Results 1,770 patients (56% male) with a 30-day mortality of 10.5% were included in the study. Day 1 SOFA and MSOFA scores performed equally well at predicting mortality with an area under the receiver operating curve (AUC) of 0.83 (95% CI: 0.81-0.85) and 0.84 (95% CI 0.82-0.85) respectively (p=0.33 for comparison). Day 3 SOFA and MSOFA predicted mortality for the 828 patients remaining in the ICU with an AUC of 0.78 and 0.79 respectively. Day 5 scores performed less well at predicting mortality. Day 1 SOFA and MSOFA predicted need for mechanical ventilation on Day 3 with an AUC of 0.83 and 0.82 respectively. Mortality for the highest category of SOFA and MSOFA score (>11 points) was 53% and 58% respectively. Conclusions The MSOFA predicts mortality as well as the SOFA and is easier to implement in resource-constrained settings, but using either score as a triage tool would exclude many patients who would otherwise survive. PMID:21149228

Grissom, Colin K.; Brown, Samuel M.; Kuttler, Kathryn G.; Boltax, Jonathan P.; Jones, Jason; Jephson, Al R.; Orme, James F.

2013-01-01

140

Meteorite falls in China and some related human casualty events  

NASA Technical Reports Server (NTRS)

Statistics of witnessed and recovered meteorite falls found in Chinese historical texts for the period from 700 B.C. to A.D. 1920 are presented. Several notable features can be seen in the binned distribution as a function of time. An apparent decrease in the number of meteorite reports in the 18th century is observed. An excess of observed meteorite falls in the period from 1840 to 1880 seems to correspond to a similar excess in European data. A chi sq probability test suggest that the association between the two data sets are real. Records of human casualities and structural damage resulting from meteorite falls are also given. A calculation based on the number of casualty events in the Chinese meteorite records suggests that the probability of a meteroite striking a human is far greater than previous estimates. However, it is difficult to verify the accuracy of the reported casualty events.

Yau, Kevin; Weissman, Paul; Yeomans, Donald

1994-01-01

141

Management of Crush Syndrome Casualties after Disasters  

PubMed Central

After direct impact of the trauma, crush syndrome is the second most frequent cause of death after mass disasters. However, since crush syndrome is quite rare in daily practice, mistakes are frequent in the treatment of these cases. This paper summarizes the etiopathogenesis of traumatic rhabdomyolysis and of crush syndrome-based acute kidney injury. The clinical and laboratory features, prophylaxis, and treatment of crush cases are described as well. The importance of early and energetic fluid resuscitation is underlined for prophylaxis of acute kidney injury. Since there is chaos, and an overwhelming number of victims, logistic drawbacks create a specific problem in the treatment of crush victims after mass disasters. Potential solutions for logistic hurdles and disaster preparedness scenarios have also been provided in this review article. PMID:23908797

Sever, Mehmet Sukru; Vanholder, Raymond

2011-01-01

142

Tactical combat casualty care 2007: evolving concepts and battlefield experience.  

PubMed

The Tactical Combat Casualty Care (TCCC) project begun by the Naval Special Warfare Command and continued by the U.S. Special Operations Command developed a set of tactically appropriate battlefield trauma care guidelines that were initially published in 1996. Transition of these guidelines into use throughout the Department of Defense has been ongoing since that time. The need for updates to the TCCC guidelines was recognized early on and has been carried out by the Committee on Tactical Combat Casualty Care established and operated by the Naval Operational Medicine Institute. The evolution of these guidelines from the 1996 recommendations to the present is described. Numerous reports in the medical literature and collected from combat first responders have documented that TCCC is saving lives on the battlefield and improving the tactical flow of missions on which casualties have occurred. Present challenges to the optimized implementation of TCCC in U.S. combat units include the need to expedite transition of new TCCC techniques and technologies to deploying units, to provide TCCC training for all U.S. combatants, and to ensure adequate funding for the Committee on TCCC. PMID:18154234

Butler, Frank K; Holcomb, John B; Giebner, Stephen D; McSwain, Norman E; Bagian, James

2007-11-01

143

A new methodology for estimating nuclear casualties as a function of time.  

PubMed

The Human Response Injury Profile (HRIP) nuclear methodology provides an estimate of casualties occurring as a consequence of nuclear attacks against military targets for planning purposes. The approach develops user-defined, time-based casualty and fatality estimates based on progressions of underlying symptoms and their severity changes over time. This paper provides a description of the HRIP nuclear methodology and its development, including inputs, human response and the casualty estimation process. PMID:21799345

Zirkle, Robert A; Walsh, Terri J; Disraelly, Deena S; Curling, Carl A

2011-09-01

144

An investigation into the effects of British Summer Time on road traffic accident casualties in Cheshire  

Microsoft Academic Search

OBJECTIVE--To assess the effect of British Summer Time (BST) on road traffic accident casualties and to analyse whether the introduction of year round BST would result in reductions in casualty numbers. DESIGN--A comparative study of road traffic accident data from before and after the onset of BST. SETTING--The county of Cheshire. SUBJECT--Data from a total of 4185 casualties from the

J D Whittaker

1996-01-01

145

DEVELOPMENT OF IT TRIAGE SYSTEM (TRACY) TO SHARE REGIONAL DISASTER MEDICAL INFORMATION  

NASA Astrophysics Data System (ADS)

We developed an IT triage system for collecting disaster medical information in real time. FeliCa cards and card readers are used to obtain the number and cond ition of patients. The system is composed of two elements. First, the number of patie nts for each triage level and the accepted number of patients in each diagnosis and treatment department are obtained in real time, including response for changing triage level. Second, this information can be shared among hospitals, the administration, and residents in real time who are searching for their family. A disaster drill utiliz ing this system was held at the University of Yamanashi Hospital with 450 participants.

Numada, Muneyoshi; Hada, Yasunori; Ohara, Miho; Meguro, Kimiro

146

A survey of the qualifications, special training, and levels of personnel working emergency department triage.  

PubMed

Emergency department triage is a challenging position for the Registered Nurse, and one that requires special qualifications, training, and skills to adequately assess, prioritize, and intervene in a variety of client presentations. This survey, conducted throughout the United States in 1991, reports the varied qualifications and special training required by hospitals for nurses to work triage. The categories of personnel who work triage are also reported. The reasons for the variability and diversity in qualifications and training between geographical zones are discussed, along with some creative suggestions for providing additional education and training. PMID:8229261

Purnell, L

1993-01-01

147

CBRNE TC3: A Hybrid Approach to Casualty Care in the CBRNE Environment.  

PubMed

The implementation of Tactical Combat Casualty Care (TCCC) guidelines for the Operation Enduring Freedom and Operation Iraqi Freedom contingency operations has dramatically reduced preventable combat deaths. A study of these principles and their application to medical treatment in the chemical, biological, radiological, nuclear, and high-yield explosives (CBRNE), weapons of mass destruction (WMD) environment is presented as a potential readiness and force multiplier for units engaged in this area of operations. Preparing medical operators for support of WMD sampling and mitigation missions requires extensive preventive medicine and post-exposure and downrange trauma threat preparedness. Training and equipping CBRN operators with treatment skills and appropriate interventional material requires pre-implementation planning specific to WMD threats (e.g., anthrax, radiation, organophosphates, and contaminated trauma). A scenario-based study reveals the tactics, techniques, and procedures for training, resourcing, and fielding the CBRN operator of the future. PMID:23817878

Strain, John W

2013-01-01

148

Published online 18 March 2004 Taxonomic triage and the poverty of phylogeny  

E-print Network

Published online 18 March 2004 Taxonomic triage and the poverty of phylogeny Quentin D. Wheeler appended as a few lines in a predominantly molecular data matrix. Causes for the decimation of morphology

Sikes, Derek S.

149

Lack of Gender Disparities in Emergency Department Triage of Acute Stroke Patients  

PubMed Central

Introduction Previous literature has shown gender disparities in the care of acute ischemic stroke. Compared to men, women wait longer for brain imaging and are less likely to receive intravenous (IV) tissue plasminogen activator (tPA). Emergency department (ED) triage is an important step in the rapid assessment of stroke patients and is a possible contributor to disparities. It is unknown whether gender differences exist in ED triage of acute stroke patients. Our primary objective was to determine whether gender disparities exist in the triage of acute stroke patients as defined by Emergency Severity Index (ESI) levels and use of ED critical care beds. Methods This was a retrospective, observational study of both ischemic and hemorrhagic stroke patients age ?18 years presenting to a large, urban, academic ED within six hours of symptom onset between January 2010, and December 2012. Primary outcomes were triage to a non-critical ED bed and Emergency Severity Index (ESI) level. Primary outcome data were extracted from electronic medical records by a blinded data manager; secondary outcome data and covariates were abstracted by trained research assistants. We performed bivariate and multivariate analyses. Logistic regression was performed using age, race, insurance status, mode of and time to arrival, National Institutes of Health Stroke Scale, and presence of atypical symptoms as covariates. Results There were 537 patients included in this study. Women were older (75.6 vs. 69.5, p<0.001), and more women had a history of atrial fibrillation (39.8% vs. 25.3%, p<0.001). Compared to 9.5% of men, 10.3% of women were triaged to a non-critical care ED bed (p=0.77); 92.1% of women were triaged as ESI 1 or 2 vs. 93.6% of men (p=0.53). After adjustment, gender was not associated with triage location or ESI level, though atypical symptoms were associated with higher odds of being triaged to a non-critical care bed (aOR 1.98, 95%CI [1.03 – 3.81]) and 3.04 times higher odds of being triaged as ESI 3 vs. ESI 1 or 2 (95% CI [1.36 – 6.82]). Conclusion In a large, urban, academic ED at a primary stroke center, there were no gender differences in triage to critical care beds or ESI levels among acute stroke patients arriving within six hours of symptom onset. These findings suggest that ED triage protocols for stroke patients may be effective in minimizing gender disparities in care.

Madsen, Tracy E.; Choo, Esther K.; Seigel, Todd A.; Palms, Danielle; Silver, Brian

2015-01-01

150

Triaging patients to the ICU: a pilot study of factors influencing admission decisions and patient outcomes  

Microsoft Academic Search

Objective. To assess the appropriateness of ICU triage decisions. Design. Prospective descriptive single-center study. Setting. Ten-bed, medical-surgical ICU in an acute-care 460-bed, tertiary care hospital. Patients. All patients triaged for admission were entered prospectively. Interventions. None. Measurements and main results. Age, underlying diseases, admission diagnoses, Mortality Probability Model (MPM0) score, information available to ICU physicians, and mortality were recorded. Of

Maité Garrouste-Orgeas; Luc Montuclard; Jean-François Timsit; Benoit Misset; Marie Christias; Jean Carlet

2003-01-01

151

Casualty Reporting and Domestic Support for War: The US Experience during the Korean War  

Microsoft Academic Search

The common argument that public support for war is casualty sensitive ignores the fact that casualty figures are not revealed automatically. While the military decides when, and to whom, to release such information, political elites can question, even condemn, how the government goes about this business. After briefly exploring how the US military operated during the two world wars, this

Steven Casey

2010-01-01

152

Tissue Triage and Freezing for Models of Skeletal Muscle Disease  

PubMed Central

Skeletal muscle is a unique tissue because of its structure and function, which requires specific protocols for tissue collection to obtain optimal results from functional, cellular, molecular, and pathological evaluations. Due to the subtlety of some pathological abnormalities seen in congenital muscle disorders and the potential for fixation to interfere with the recognition of these features, pathological evaluation of frozen muscle is preferable to fixed muscle when evaluating skeletal muscle for congenital muscle disease. Additionally, the potential to produce severe freezing artifacts in muscle requires specific precautions when freezing skeletal muscle for histological examination that are not commonly used when freezing other tissues. This manuscript describes a protocol for rapid freezing of skeletal muscle using isopentane (2-methylbutane) cooled with liquid nitrogen to preserve optimal skeletal muscle morphology. This procedure is also effective for freezing tissue intended for genetic or protein expression studies. Furthermore, we have integrated our freezing protocol into a broader procedure that also describes preferred methods for the short term triage of tissue for (1) single fiber functional studies and (2) myoblast cell culture, with a focus on the minimum effort necessary to collect tissue and transport it to specialized research or reference labs to complete these studies. Overall, this manuscript provides an outline of how fresh tissue can be effectively distributed for a variety of phenotypic studies and thereby provides standard operating procedures (SOPs) for pathological studies related to congenital muscle disease. PMID:25078247

Meng, Hui; Janssen, Paul M.L.; Grange, Robert W.; Yang, Lin; Beggs, Alan H.; Swanson, Lindsay C.; Cossette, Stacy A.; Frase, Alison; Childers, Martin K.; Granzier, Henk; Gussoni, Emanuela; Lawlor, Michael W.

2014-01-01

153

Redeye: A Digital Library for Forensic Document Triage  

SciTech Connect

Forensic document analysis has become an important aspect of investigation of many different kinds of crimes from money laundering to fraud and from cybercrime to smuggling. The current workflow for analysts includes powerful tools, such as Palantir and Analyst s Notebook, for moving from evidence to actionable intelligence and tools for finding documents among the millions of files on a hard disk, such as FTK. However, the analysts often leave the process of sorting through collections of seized documents to filter out the noise from the actual evidence to a highly labor-intensive manual effort. This paper presents the Redeye Analysis Workbench, a tool to help analysts move from manual sorting of a collection of documents to performing intelligent document triage over a digital library. We will discuss the tools and techniques we build upon in addition to an in-depth discussion of our tool and how it addresses two major use cases we observed analysts performing. Finally, we also include a new layout algorithm for radial graphs that is used to visualize clusters of documents in our system.

Bogen, Paul Logasa [ORNL] [ORNL; McKenzie, Amber T [ORNL] [ORNL; Gillen, Rob [ORNL] [ORNL

2013-01-01

154

Validating a vignette-based instrument to study physician decision making in trauma triage  

PubMed Central

Background The evidence supporting the use of vignettes to study physician decision making comes primarily from the study of low-risk decisions and the demonstration of good agreement at the group level between vignettes and actual practice. The validity of using vignettes to predict decision making in more complex, high-risk contexts and at the individual level remains unknown. Methods We had previously developed a vignette-based instrument to study physician decision making in trauma triage. Here, we measured the re-test reliability, internal consistency, known-groups performance, and criterion validity of the instrument. Thirty-two emergency physicians, recruited at a national academic meeting, participated in reliability testing. Twenty-eight trauma surgeons, recruited using personal contacts, participated in known-groups testing. Twenty-eight emergency physicians, recruited from physicians working at hospitals for which we had access to medical records, participated in criterion validity testing. We measured rates of under-triage (the proportion of severely injured patients not transferred to trauma centers) and over-triage (the proportion of patients transferred with minor injuries) on the instrument. For physicians participating in criterion validity testing, we compared rates of triage on the instrument with rates in practice, based on chart review. Results Physicians made similar transfer decisions for cases (? = 0.42, p<0.01) on two administrations of the instrument. Responses were internally consistent (Kuder-Richardson 0.71–0.91). Surgeons had lower rates of under-triage than emergency physicians (13% v. 70%, p<0.01). No correlation existed between individual rates of under- or over-triage on the vignettes and in practice (r = ?0.17, p = 0.4; r = ?0.03, p = 0.85). Conclusions The instrument developed to assess trauma triage decision making performed reliably and detected known group differences. However it did not predict individual physician performance. PMID:24125789

Mohan, Deepika; Fischhoff, Baruch; Farris, Coreen; Switzer, Galen E.; Rosengart, Matthew R.; Yealy, Donald M.; Saul, Melissa; Angus, Derek C.; Barnato, Amber E.

2013-01-01

155

A redundant resource: a pre-planned casualty clearing station for a FIFA 2010 Stadium in Durban.  

PubMed

This report details the background, planning, and establishment of a mass-casualty management area for the Durban Moses Mabhida Stadium at the Natal Mounted Rifles base, by the Department of Health and the eThekwini Fire and Rescue Service, for the Fédération Internationale de Football Association (FIFA) 2010 Soccer World Cup. The report discusses the use of the site during the seven matches played at that stadium, and details the aspects of mass-gathering major incident site planning for football (soccer). The area also was used as a treatment area for other single patient incidents outside of the stadium, but within the exclusion perimeter, and the 22 patients treated by the Casualty Clearing Station (CCS) team are described and briefly discussed. A site-specific patient presentation rate of 0.48 per 10,000 and transport-to-hospital rate (TTHR) of 0.09/10,000 are reported. Lessons learned and implications for future event planning are discussed in the light of the existing literature. PMID:22591650

Hardcastle, Timothy C; Samlal, Sanjay; Naidoo, Rajen; Hendrikse, Steven; Gloster, Alex; Ramlal, Melvin; Ngema, Sibongiseni; Rowe, Michael

2012-10-01

156

State-level Lists of Casualties from the Vietnam Conflict (1957-)  

NSDL National Science Digital Library

The Center for Electronic Records of the US National Archives and Records Administration has recently added this database to its already existing casualty list for the Korean Conflict (discussed in the March 6, 1998 Scout Report). The database, which is only browseable, includes name of casualty, rank, branch of military service, "home of record," date of birth and death, "category of casualty," and an indicator as to whether the remains have been recovered. Records may be sorted alphabetically or by "home of record," within state. The database covers 1957-1995 and contains records for 58,187 individuals.

157

Application of a first impression triage in the Japan railway west disaster.  

PubMed

On April 25, 2005, a Japanese express train derailed into a building, resulting in 107 deaths and 549 injuries. We used "First Impression Triage (FIT)", our new triage strategy based on general inspection and palpation without counting pulse/respiratory rates, and determined the feasibility of FIT in the chaotic situation of treating a large number of injured people in a brief time period. The subjects included 39 patients who required hospitalization among 113 victims transferred to our hospital. After initial assessment with FIT by an emergency physician, patients were retrospectively reassessed with the preexisting the modified Simple Triage and Rapid Treatment (START) methodology, based on Injury Severity Score, probability of survival, and ICU stay. FIT resulted in shorter waiting time for triage. FIT designations comprised 11 red (immediate), 28 yellow (delayed), while START assigned six to red and 32 to yellow. There were no statistical differences between FIT and START in the accuracy rate calculated by means of probability of survival and ICU stay. Overall validity and reliability of FIT determined by outcome assessment were similar to those of START. FIT would be a simple and accurate technique to quickly triage a large number of patients. PMID:23804140

Hashimoto, Atsunori; Ueda, Takahiro; Kuboyama, Kazutoshi; Yamada, Taihei; Terashima, Mariko; Miyawaki, Atsushi; Nakao, Atsunori; Kotani, Joji

2013-01-01

158

Forensic Triage for Mobile Phones with DEC0DE Robert J. Walls Erik Learned-Miller Brian Neil Levine  

E-print Network

Forensic Triage for Mobile Phones with DEC0DE Robert J. Walls Erik Learned-Miller Brian Neil Levine We present DEC0DE, a system for recovering information from phones with unknown storage formats, a critical problem for forensic triage. Because phones have myr- iad custom hardware and software, we examine

Massachusetts at Amherst, University of

159

Triage of Acute Abdominal Pain in Childhood: Clinical Use of a Palm Handheld in a Pediatric Emergency Department  

Microsoft Academic Search

The paper describes design and implementation of a mo- bile clinical triage support system for the evaluation of acute appendicitis in childhood. The MET (Mobile Emergency Triage) system was de- veloped according to the general principles of client- server architecture, with mobile clients running on Palm handhelds. Decision model implemented in MET follows the principles of evidence-based medicine based on

Wojtek Michalowski; Steven Rubin; Roman Slowinski; Szymon Wilk

2004-01-01

160

Patterns of Reading and Organizing Information in Document Triage This research was supported by a grant from Microsoft Corporation.  

E-print Network

the results of this work with others. If the topic is unfamiliar, document triage also includes a period1 Patterns of Reading and Organizing Information in Document Triage This research was supported, Redmond, WA 98052 Corresponding Author: shipman@cs.tamu.edu People engaged in knowledge work must often

Marshall, Cathy

161

Health care triage alternatives and the influence of health insurance, education and race.  

PubMed

The relationship between one of Andersen's enabling factors, health insurance status and the choice of a pharmacist as the initial contact in the health care system was examined via telephone surveys. Eighty-seven percent of the sample reported having some form of health insurance. Of all intended health care provider contacts, pharmacists were selected as the initial contact 21% of the time. Logistic regression identified insurance status, education and race as significant (alpha < 0.05) covariates in the model. The odds ratios generated from the logit model indicated that non-whites, persons with less education and no health insurance were more likely to select a pharmacist for triage. The study concluded that uninsured persons were nearly twice as likely to seek pharmacist triage than insured individuals. Pharmacists may be filling an important triage gap for individuals who have limited financial access to traditional sources of physician care. PMID:8852104

Martin, B C; Perri, M; Kotzan, J A

1996-08-01

162

SimulatedMedical Corpsmen and Casualties for Medical Forces Planning and Training  

E-print Network

medical personnel interacting with simulated casualties. Our technology fosters dual-use applications model is being extended with capabilities for appropriate injury display. A stealth human instructor can Evaluation Semi-automated behavior (protocols) Stealth Instructor Trainee Participant Wound

Badler, Norman I.

163

49 CFR 850.15 - Marine casualty investigation by the Board.  

Code of Federal Regulations, 2011 CFR

(2) The Commandant and the Board agree that the Board shall conduct the investigation, and the casualty involves a public and a nonpublic vessel and at least one fatality or $75,000 in property damage;...

2011-10-01

164

49 CFR 850.15 - Marine casualty investigation by the Board.  

Code of Federal Regulations, 2010 CFR

(2) The Commandant and the Board agree that the Board shall conduct the investigation, and the casualty involves a public and a nonpublic vessel and at least one fatality or $75,000 in property damage;...

2010-10-01

165

49 CFR 850.15 - Marine casualty investigation by the Board.  

Code of Federal Regulations, 2012 CFR

(2) The Commandant and the Board agree that the Board shall conduct the investigation, and the casualty involves a public and a nonpublic vessel and at least one fatality or $75,000 in property damage;...

2012-10-01

166

46 CFR 4.40-15 - Marine casualty investigation by the Board.  

Code of Federal Regulations, 2012 CFR

(2) The Commandant and the Board agree that the Board shall conduct the investigation, and the casualty involves a public and a non-public vessel and at least one fatality or $75,000 in property damage;...

2012-10-01

167

33 CFR 173.81 - Coast Guard forms for numbering and casualty reporting.  

Code of Federal Regulations, 2010 CFR

...81 Coast Guard forms for numbering and casualty reporting. (a) In a State where the Coast Guard is the issuing authority, the following Coast Guard forms must be used: (1) Each application for a certificate of number or renewal...

2010-07-01

168

33 CFR 173.81 - Coast Guard forms for numbering and casualty reporting.  

...81 Coast Guard forms for numbering and casualty reporting. (a) In a State where the Coast Guard is the issuing authority, the following Coast Guard forms must be used: (1) Each application for a certificate of number or renewal...

2014-07-01

169

Marine casualty and pollution database (raw data only) (on CD-ROM). Data file  

SciTech Connect

The Marine Casualty and Pollution Database provides details about marine casualty and pollution incidents investigated by the US Coast Guard Marine Safety Officer. The database is an invaluable source of information to understand particulars and circumstances of marine accidents and pollution incidents. The CD-ROM contains forty data tables derived from marine casualty and pollution investigations conducted by investigators at US Coast Guard Marine Safety Offices throughout the United States. The data collection period began in 1973 and is ongoing. Also included on the CD-ROM are vessel and facility tables with specific information on vessel and facility constitution and operating details. The Coast Guard maintains a comprehensive database on approximately 460,000 US and foreign vessels and 32,000 facilities. Entity and attribute descriptions and suggested solutions to general marine pollution, vessel casualty, and personnel injury and death questions are outlined in the documentation.

NONE

1998-06-01

170

Removal of C-spine protection by A&E triage nurses: a prospective trial of a clinical decision making instrument  

Microsoft Academic Search

Objective: To investigate if triage nurses could safely apply a set of clinical criteria, removing hard collars and spinal boards at initial triage assessment.Methods: The Nexus clinical decision rules were applied by trained triage nurses to patients who attended the department with cervical collars and \\/or on spinal boards. Patients were excluded if they were felt to be in need

E Pitt; D K Pedley; A Nelson; M Cumming; M Johnston

2006-01-01

171

Excelsior Surgical Society Edward D Churchill Lecture. Changes in combat casualty care.  

PubMed

There have been many positive changes in combat casualty care since Desert Storm. The Air Force has made a major change and significant improvement in combat casualty care, which is aided by the United States Army and Navy. The current care is second to none, including rehabilitation. This improvement in care and outcomes is due to the dedication of the doctors, nurses, corpsmen, pilots, and the incredible support services that make it happen. PMID:22626545

Trunkey, Donald

2012-06-01

172

A New Methodology for Chemical, Biological, Radiological, and Nuclear Casualty Estimation over Time  

Microsoft Academic Search

The Human Response Injury Profile (HRIP) methodology incorporates three different agent-specific approaches to provide an estimate of casualties occurring as a consequence of chemical, biological, radiological, and nuclear attacks against military targets for planning purposes. The three approaches — chemical, radiological, and nuclear; non-contagious biological; and contagious biological — all develop user-defined, time-based casualty and fatality estimates based on maps,

Deena S. Disraelly; Terri J. Walsh; Robert A. Zirkle

2010-01-01

173

Variation in Prehospital Use and Uptake of the National Field Triage Decision Scheme  

PubMed Central

Background The Field Triage Decision Scheme is a national guideline that has been implemented widely for prehospital Emergency Medical Services (EMS) and trauma systems. However, little is known about the uptake, modification or variation in field application of triage criteria between trauma systems. Objective To describe and compare the use of field triage criteria by EMS personnel in 6 regions, including the timing of guideline uptake and use of non-guideline criteria. Methods This was a retrospective cohort study of injured children and adults transported by 48 EMS agencies to 105 hospitals (trauma and non-trauma centers) in 6 Western U.S. regions from 2006 through 2008. We used probabilistic linkage to match patient-level prehospital information from multiple sources, including: EMS records, base-hospital phone communication records and trauma registry data files. Triage criteria were evaluated individually and grouped by “steps” (physiologic, anatomic, mechanism and special considerations). We used descriptive statistics to compare the frequency of triage criteria use (overall and between regions) and to evaluate the timing of guideline uptake across multiple versions of the guidelines. Results A total of 260,027 injured patients were evaluated and transported by EMS over the 3-year study period, of whom 46,414 (18%) met at least one field triage criterion and formed the primary sample for analysis. The 3 most common criteria cited (of 33 in use) were: EMS provider judgment (26%), age < 5 or > 55 years (10%) and GCS score <14 (9%). Of the 33 criteria in use, 5 (15%) were previously retired from the guidelines and 7 (21%) were never included in the guidelines. 11,048 (24%) of patients had more than 1 criteria applied (range 1 – 21). There was large variation in the type and frequency of criteria used between systems, particularly among the non-physiologic triage steps. Only 1 of 6 regions had translated the most recent guidelines into field use within 2 years of release. Conclusion There is large variation between regions in the frequency and type of field triage criteria used. Field uptake of guideline revisions appears slow and variable, suggesting opportunities for improvement in dissemination and implementation of updated guidelines. PMID:23452003

Barnett, Andy S.; Wang, N. Ewen; Sahni, Ritu; Hsia, Renee Y.; Haukoos, Jason S.; Barton, Erik D.; Holmes, James F.; Newgard, Craig D.

2013-01-01

174

An Instrument for In-situ Triage of Mars 2020 Rover Samples for Organics and Chronology  

NASA Astrophysics Data System (ADS)

We have developed a prototype instrument for triaging samples for elemental chemistry, organics, and Rb-Sr dates on the Mars 2020 Rover. Determining organic content and rock age are key drivers for Mars Sample Return (MSR). By identifying samples with organics, and potentially a range of dates, we increase near-term science return, while maximizing scientific and political will to compel the ultimate return of samples. Though organics have proven difficult to identify in-situ, understanding their distribution and variety could provide key constraints on the possibility of life; on the other hand, datable outcrops are clearly present at a range of potential landing sites, and could provide insight into the evolution of both local and global geology, and the history of solar system bombardment. Our instrument uses laser desorption resonance ionization mass spectrometry (LDRIMS) for Rb-Sr dates, and a subset of the LDRIMS lasers for L2MS measurements of organics. With LDRIMS, a sample is placed in a time-of-flight (TOF) mass spectrometer and surface atoms, molecules, and ions are desorbed with a 213 nm laser. The plume of expanding atoms is present for many ?s, during which it is first illuminated with laser light tuned to ionize only Sr, and then 1-3 ?s later, Rb . This eliminates isobars for Rb and Sr, and insures that the measured atoms come from the same ablation event, and hence target materials. L2MS uses high-power IR laser ablation to desorb neutral organic molecules, followed by a second, UV laser beam for ionization. Advantages of L2MS include the measurement of a wide array of elements, and it is one of the most sensitive available organic detection methods, with demonstrated detection to 10-18. We have previously demonstrated dates on granites with an average of 1.727×0.087 Ga (MSWD=1; ×0.062 for MSWD=2); both values have a precision and accuracy exceeding that called for by NASA. Finally, we have demonstrated ppm-level detections of organics in the Murchison meteorite using L2MS that closely match previously results (Fig. 1). In conclusion, we ultimately seek to enhance the characterization of landing sites on Mars by providing in-situ triage of potential samples for Earth return, improving the odds of returning relevant samples, and enhancing near-term science return. Figure 1: L2MS spectrum of Murchison organics present at ~10 ppm taken with dating instrument (blue), compared with previous results of Spencer et al, 2008 (red). The red peak at ~100 AMU is a standard, and that blue BPA peaks from 210-230 AMU are from the mounting epoxy. Note that both long period and short period stucture correlate, despite different sample sources, and 5 years between measurements.

Anderson, F.; Whitaker, T.; Andrews, J.

2013-12-01

175

Classifying free-text triage chief complaints into syndromic categories with natural language processing  

Microsoft Academic Search

Objective: Develop and evaluate a natural language processing application for classifying chief complaints into syndromic categories for syndromic surveillance. Introduction: Much of the input data for artificial intelligence applications in the medical field are free-text patient medical records, including dictated medical reports and triage chief complaints. To be useful for automated systems, the free-text must be translated into encoded form.

Wendy Webber Chapman; Lee M. Christensen; Michael M. Wagner; Peter J. Haug; Oleg Ivanov; John N. Dowling; Robert T. Olszewski

2005-01-01

176

Results of delayed triage by HPV testing and cytology in the Norwegian Cervical Cancer Screening Programme.  

PubMed

Abstract Background. High-risk human papilloma virus (hrHPV) testing was added to the cytology triage of women with equivocal screening smears in the Norwegian programme for cervical cancer screening in 2005. In this population-based observational before and after study we assessed the effect of changing the screening algorithm. Material and methods. In periods before and after the change 75 852 and 66 616 women, respectively, were eligible for triage, i.e. they had smear results of unsatisfactory, atypical squamous cells of undetermined significance (ASC-US), or low-grade squamous intraepithelial lesion (LSIL) at routine screening. The triage was delayed as supplementary testing started six months after the initial screening. The groups were compared with respect to results of triage and later three-year cumulative incidence of cervical intraepithelial neoplasia grade 2 or worse (CIN2+). Results. Before and after the change in the screening algorithm 5.2% (3964/75 852) and 8.1% (5417/66 616) of women, respectively, were referred to colposcopy. Among women referred to colposcopy cumulative incidence of CIN2+ (positive predictive value of referral) increased from 42.0% [95% confidence interval (CI): 40.3 - 43.7%] in the period with cytology only to 48.0% (95% CI 46.6 - 49.4%) after the start of HPV testing. For women recalled to ordinary screening the three-year cumulative incidence decreased from 2.7% (95% CI 2.5 - 2.9%) to 1.0% (95% CI 0.9 - 1.2%) during the same period. Among women with LSIL at routine screening and HPV testing in triage, 52.5% (1976/3766) were HPV positive. Conclusion. The new algorithm with HPV testing implemented in 2005 resulted in an increased rate of referral to colposcopy, but in a better risk stratification with respect to precancerous disease. PMID:24957553

Haldorsen, Tor; Skare, Gry Baadstrand; Ursin, Giske; Bjørge, Tone

2015-02-01

177

Managing Multiple-Casualty Incidents: A Rural Medical Preparedness Training Assessment  

E-print Network

emergency department bed capacity, and trauma victims. The authors also tested participants' knowledge in the areas of communications, incident command systems (ICS), and triage. Methods: Participants attended exercises were conducted. The one-hour trainings focused on communications, National Incident Management

Maxwell, Bruce D.

178

Benefits of multidisciplinary collaboration for earthquake casualty estimation models: recent case studies  

NASA Astrophysics Data System (ADS)

Earthquake casualty loss estimation, which depends primarily on building-specific casualty rates, has long suffered from a lack of cross-disciplinary collaboration in post-earthquake data gathering. An increase in our understanding of what contributes to casualties in earthquakes involve coordinated data-gathering efforts amongst disciplines; these are essential for improved global casualty estimation models. It is evident from examining past casualty loss models and reviewing field data collected from recent events, that generalized casualty rates cannot be applied globally for different building types, even within individual countries. For a particular structure type, regional and topographic building design effects, combined with variable material and workmanship quality all contribute to this multi-variant outcome. In addition, social factors affect building-specific casualty rates, including social status and education levels, and human behaviors in general, in that they modify egress and survivability rates. Without considering complex physical pathways, loss models purely based on historic casualty data, or even worse, rates derived from other countries, will be of very limited value. What’s more, as the world’s population, housing stock, and living and cultural environments change, methods of loss modeling must accommodate these variables, especially when considering casualties. To truly take advantage of observed earthquake losses, not only do damage surveys need better coordination of international and national reconnaissance teams, but these teams must integrate difference areas of expertise including engineering, public health and medicine. Research is needed to find methods to achieve consistent and practical ways of collecting and modeling casualties in earthquakes. International collaboration will also be necessary to transfer such expertise and resources to the communities in the cities which most need it. Coupling the theories and findings from the field surveys with experiments would also be advantageous as it is not always be possible to validate theories and models with actual earthquake data. In addition, colleagues in other disciplines will benefit from being introduced to the loss algorithms, methodologies and advances familiar to the engineering community, to help dissemination in earthquake mitigation and preparedness programs. It follows that new approaches to loss estimation must include a progressive assessment of what contributes to the final casualty value. In analyzing recent earthquakes, testing common hypotheses, talking to local and international researchers in the field, interviewing search and rescue and medical personnel, and comparing notes with colleagues who have visited other events, the author has developed a list of contributory factors to formulate fatality rates for use in earthquake loss estimation models. In this presentation, we will first look at the current state of data collection and assessment in casualty loss estimation. Then, the analyses of recent earthquake field data, which provide important insights to the contributory factors of fatalities in earthquakes, will be explored. The benefits of a multi-disciplinary approach in deriving fatality rates for masonry buildings will then be examined in detail.

So, E.

2010-12-01

179

Acute respiratory distress syndrome in combat casualties: military medicine and advances in mechanical ventilation.  

PubMed

Military medicine has made numerous enduring contributions to the advancement of pulmonary medicine. Acute respiratory distress syndrome was first recognized as a complication in battlefield casualties in World War I and continued to play a significant role in the treatment of casualties through the Vietnam War. Innovative surgeons during World War II devised methods to assist their patients with positive pressure breathing. This concept was later adopted and applied to the development of mechanical ventilation in the late 1940s and early 1950s. The continued treatment of acute respiratory distress syndrome in combat casualties by military physicians has provided a major impetus for advances in modern mechanical ventilation and intensive care unit medicine. PMID:17153538

Morris, Michael James

2006-11-01

180

Occupational safety data and casualty rates for the uranium fuel cycle. [Glossaries  

SciTech Connect

Occupational casualty (injuries, illnesses, fatalities, and lost workdays) and production data are presented and used to calculate occupational casualty incidence rates for technologies that make up the uranium fuel cycle, including: mining, milling, conversion, and enrichment of uranium; fabrication of reactor fuel; transportation of uranium and fuel elements; generation of electric power; and transmission of electric power. Each technology is treated in a separate chapter. All data sources are referenced. All steps used to calculate normalized occupational casualty incidence rates from the data are presented. Rates given include fatalities, serious cases, and lost workdays per 100 man-years worked, per 10/sup 12/ Btu of energy output, and per other appropriate units of output.

O'Donnell, F.R.; Hoy, H.C.

1981-10-01

181

Smartphone teledermoscopy referrals: a novel process for improved triage of skin cancer patients.  

PubMed

In this open, controlled, multicentre and prospective observational study, smartphone teledermoscopy referrals were sent from 20 primary healthcare centres to 2 dermatology departments for triage of skin lesions of concern using a smartphone application and a compatible digital dermoscope. The outcome for 816 patients referred via smartphone teledermoscopy was compared with 746 patients referred via the traditional paper-based system. When surgical treatment was required, the waiting time was significantly shorter using teledermoscopy for patients with melanoma, melanoma in situ, squamous cell carcinoma, squamous cell carcinoma in situ and basal cell carcinoma. Triage decisions were also more reliable with teledermoscopy and over 40% of the teledermoscopy patients could potentially have avoided face-to-face visits. Only 4 teledermoscopy referrals (0.4%) had to be excluded due to poor image quality. Smartphone teledermoscopy referrals allow for faster and more efficient management of patients with skin cancer as compared to traditional paper referrals. PMID:24923283

Börve, Alexander; Gyllencreutz, Johan Dahlén; Terstappen, Karin; Backman, Eva Johansson; Aldenbratt, Anette; Danielsson, Markus; Gillstedt, Martin; Sandberg, Carin; Paoli, John

2015-01-15

182

Ebola Triage Screening and Public Health: The New "Vital Sign Zero"  

PubMed

During public health emergencies of international concern such as the 2014 Ebola event, health care leaders need to educate clinicians on the front lines to make uncomfortable, but real triage decisions that focus on optimization of population health outcomes over individual care. Health care workers must consider their own protection first before direct contact with potentially contagious patients. In an era of globalization and emerging infectious disease, routine triage including evaluation of the standard vital signs must shift to include public health considerations with immediate consequences. A new "vital sign zero" should be taken at the time of initial patient evaluation to assess for risk and exposure to potentially contagious infectious diseases. PMID:25351634

Koenig, Kristi L

2014-10-29

183

Manchester Triage System version II and resource utilisation in the emergency department.  

PubMed

Emergency department (ED) triage systems aim to direct the best clinical assistance to those who are in the greatest urgency and guarantee that resources are efficiently applied. The study's purpose was to determine whether the Manchester Triage System (MTS) second version is a useful instrument for determining the risk of hospital admission, intrahospital death and resource utilisation in ED and to compare it with the MTS first version. This was a prospective study of patients that attended the ED at a large hospital. It comprised a total of 25,218 cases that were triaged between 11 July and 13 October 2011. The MTS codes were grouped into two clusters: red and orange into a 'high acuity/priority' (HP) cluster, and yellow, green and blue into a 'low acuity/priority' cluster. The risk of hospital admission in the HP cluster was 4.86 times that of the LP cluster for both admission route and ages. The percentage of patient hospital admission between medical and surgical specialties, in high and low priority clusters, was similar. We found the risk of death in the HP cluster to be 5.58 times that of the risk of the low acuity/priority cluster. The MTS had an inconsistent association relative to the utilisation of x-ray, while it seemed to portray a consistent association between ECG and laboratory utilisation and MTS cluster. There were no differences between medical and surgical specialities risk of admission. This suggests that improvements were made in the second version of MTS, particularly in the discriminators of patients triaged to surgical specialties, because this was not true for the first version of MTS. PMID:23345313

Santos, André Peralta; Freitas, Paulo; Martins, Henrique Manuel Gil

2014-02-01

184

Making an IMPACT on emergency department flow: improving patient processing assisted by consultant at triage  

PubMed Central

Objectives: To assess whether initial patient consult by senior clinicians reduces numbers of patients waiting to be seen as an indirect measure of waiting time throughout the emergency department (ED). Methods: An emergency medicine consultant and a senior ED nurse (G or F grade), known as the IMPACT team, staffed the triage area for four periods of four hours per week, Monday to Friday between 9 am to 5 pm for three months between December 2001 and February 2002 when staffing levels permitted. Patients normally triaged by a nurse in this area instead had an early consultation with the IMPACT team. Data were collected prospectively on all patients seen by the IMPACT team. The number of patients waiting to be seen (for triage, in majors and in minors) was assessed every two hours during the IMPACT sessions and at corresponding times when no IMPACT team was operational. Results: There was an overall reduction in the number of patients waiting to be seen in the department from 18.3 to 5.5 (p<0.0001) at formal two hourly assessments. The largest difference was seen in minors. Of the patients seen at triage by the IMPACT team, 48.9% were discharged home immediately after assessment and treatment. With the IMPACT team present, no patient waited more than four hours for initial clinical consult. Conclusions: By using a senior clinical team for initial patient consultation, the numbers of patients waiting fell dramatically throughout the ED. Many patients can be effectively treated and discharged after initial consult by the IMPACT team. PMID:15333523

Terris, J; Leman, P; O'Connor, N; Wood, R

2004-01-01

185

46 CFR 4.05-10 - Written report of marine casualty.  

Code of Federal Regulations, 2010 CFR

(a) The owner, agent, master, operator, or person in charge shall, within five days, file a written report of any marine casualty required to be reported under § 4.05-1. This written report is in addition to the immediate notice required by §...

2010-10-01

186

The Battle of Bentonville: Caring for Casualties of the Civil War. Teaching with Historic Places.  

ERIC Educational Resources Information Center

At the First Battle of Manassas (Virginia) in 1861 many Union doctors fled the battlefield in fear. Those who remained found themselves without adequate medical supplies or ambulances for their patients. As the U.S. Civil War progressed and casualties mounted, military surgeons became more adept at caring for the wounded. By the Battle of…

Goode, John C.; Beck, Elaine

187

Modelling the effects of land use and temporal factors on child pedestrian casualties  

Microsoft Academic Search

This study investigates the suitability of land use variables in predicting the number of child pedestrian casualties; a subject of concern in Great Britain despite sustained improvements in road safety over the past decade. The relationship between land use and transport is used to establish a link between land use and child pedestrian travel; trip attractors and generators are considered

Dilum Dissanayake; James Aryaija; D. M. Priyantha Wedagama

2009-01-01

188

46 CFR 4.05-10 - Written report of marine casualty.  

(a) The owner, agent, master, operator, or person in charge shall, within five days, file a written report of any marine casualty required to be reported under § 4.05-1. This written report is in addition to the immediate notice required by §...

2014-10-01

189

46 CFR 4.05-5 - Substance of marine casualty notice.  

The notice required in § 4.05-1 must include the name and official number of the vessel involved, the name of the vessel's owner or agent, the nature and circumstances of the casualty, the locality in which it occurred, the nature and extent of injury to persons, and the damage to...

2014-10-01

190

46 CFR 4.05-10 - Written report of marine casualty.  

Code of Federal Regulations, 2013 CFR

(a) The owner, agent, master, operator, or person in charge shall, within five days, file a written report of any marine casualty required to be reported under § 4.05-1. This written report is in addition to the immediate notice required by §...

2013-10-01

191

33 CFR 164.61 - Marine casualty reporting and record retention.  

(2) 30 days after the return of the vessel to a United States port if the vessel departs the navigable waters of the United States within 30 days after the marine casualty. [CGD 74-77, 42 FR 5956, Jan. 31,...

2014-07-01

192

46 CFR 4.05-10 - Written report of marine casualty.  

Code of Federal Regulations, 2011 CFR

(a) The owner, agent, master, operator, or person in charge shall, within five days, file a written report of any marine casualty required to be reported under § 4.05-1. This written report is in addition to the immediate notice required by §...

2011-10-01

193

Eating Order: A 13-Week Trust Model Class for Dieting Casualties  

ERIC Educational Resources Information Center

Chronic dieting distorts eating behaviors and causes weight escalation. Desperation about losing weight results in pursuit of extreme weight loss measures. Instead of offering yet another diet, nutrition educators can teach chronic dieters (dieting casualties) to develop eating competence. Eating Order, a 13-week class for chronic dieters based on…

Jackson, Elizabeth G.

2008-01-01

194

Calculating trauma triage precision: effects of different definitions of major trauma  

PubMed Central

Background Triage is the process of classifying patients according to injury severity and determining the priority for further treatment. Although the term “major trauma” represents the reference against which over- and undertriage rates are calculated, its definition is inconsistent in the current literature. This study aimed to investigate the effects of different definitions of major trauma on the calculation of perceived over- and undertriage rates in a Norwegian trauma cohort. Methods We performed a retrospective analysis of patients included in the trauma registry of a primary, referral trauma centre. Two “traditional” definitions were developed based on anatomical injury severity scores (ISS >15 and NISS >15), one “extended” definition was based on outcome (30-day mortality) and mechanism of injury (proximal penetrating injury), one ”extensive” definition was based on the “extended” definition and on ICU resource consumption (admitted to the ICU for >2?days and/or transferred intubated out of the hospital in ?2?days), and an additional four definitions were based on combinations of the first four. Results There were no significant differences in the perceived under- and overtriage rates between the two “traditional” definitions (NISS >15 and ISS >15). Adding “extended” and “extensive” to the “traditional” definitions also did not significantly alter perceived under- and overtriage. Defining major trauma only in terms of the mechanism of injury and mortality, with or without ICU resource consumption (the “extended” and “extensive” groups), drastically increased the perceived overtriage rates. Conclusion Although the proportion of patients who were defined as having sustained major trauma increased when NISS-based definitions were substituted for ISS-based definitions, the outcomes of the triage precision calculations did not differ significantly between the two scales. Additionally, expanding the purely anatomic definition of major trauma by including proximal penetrating injury, 30-day mortality, ICU LOS greater than 2?days and transferred intubated out of the hospital at ?2?days did not significantly influence the perceived triage precision. We recommend that triage precision calculations should include anatomical injury scaling according to NISS. To further enhance comparability of trauma triage calculations, researchers should establish a consensus on a uniform definition of major trauma. PMID:22902009

2012-01-01

195

A lean case study in an oncological hospital: implementation of a telephone triage system in the emergency service  

PubMed Central

Lean practices and thinking have increased substantially in the last few years. Applications of lean practices to health care are found worldwide. Despite that, new contributions are required because the application of lean thinking to hospitals has a long way to go. Lean practices and thinking do not include, in the literature or practice programs, any references to triage systems in health care units. The common triage systems require physical presence, but there are alternative methods to avoid the need to move patients: these alternative triage systems, given their characteristics, may be included in the spectrum of lean practices. Currently, patients that are already known to suffer from cancer are encouraged to go to hospital (public or private, with an oncological focus) when facing side effects from chemotherapy or radiation treatments; they are then submitted to a triage system (present themselves to the hospital for examination). The authors of this paper propose the introduction of telephone or email triage for impaired patients as a valid substitute for moving them physically, thereby often avoiding several unnecessary moves. This approach has, in fact, characteristics similar to a lean practice in that it reduces costs and maintains, if done properly, the overall service offered. The proposed ‘remote’ triage emerged from the results of a large survey sent to patients and also as the outcome of a set of semistructured interviews conducted with hospital nurses. With the results they obtained, the authors felt comfortable proposing this approach both to public and private hospitals, because the study was conducted in the most important, largest, and best-known oncological unit in Spain. As a final result, the health care unit studied is now taking the first steps to implement a remote triage system by telephone, and has begun to reduce the previously necessary movement of impaired patients. PMID:24376365

de Carvalho, José Crespo; Ramos, Madalena; Paixão, Carina

2014-01-01

196

Optimal Triage Test Characteristics to Improve the Cost-Effectiveness of the Xpert MTB/RIF Assay for TB Diagnosis: A Decision Analysis  

PubMed Central

Background High costs are a limitation to scaling up the Xpert MTB/RIF assay (Xpert) for the diagnosis of tuberculosis in resource-constrained settings. A triaging strategy in which a sensitive but not necessarily highly specific rapid test is used to select patients for Xpert may result in a more affordable diagnostic algorithm. To inform the selection and development of particular diagnostics as a triage test we explored combinations of sensitivity, specificity and cost at which a hypothetical triage test will improve affordability of the Xpert assay. Methods In a decision analytical model parameterized for Uganda, India and South Africa, we compared a diagnostic algorithm in which a cohort of patients with presumptive TB received Xpert to a triage algorithm whereby only those with a positive triage test were tested by Xpert. Findings A triage test with sensitivity equal to Xpert, 75% specificity, and costs of US$5 per patient tested reduced total diagnostic costs by 42% in the Uganda setting, and by 34% and 39% respectively in the India and South Africa settings. When exploring triage algorithms with lower sensitivity, the use of an example triage test with 95% sensitivity relative to Xpert, 75% specificity and test costs $5 resulted in similar cost reduction, and was cost-effective by the WHO willingness-to-pay threshold compared to Xpert for all in Uganda, but not in India and South Africa. The gain in affordability of the examined triage algorithms increased with decreasing prevalence of tuberculosis among the cohort. Conclusions A triage test strategy could potentially improve the affordability of Xpert for TB diagnosis, particularly in low-income countries and with enhanced case-finding. Tests and markers with lower accuracy than desired of a diagnostic test may fall within the ranges of sensitivity, specificity and cost required for triage tests and be developed as such. PMID:24367555

van’t Hoog, Anna H.; Cobelens, Frank; Vassall, Anna; van Kampen, Sanne; Dorman, Susan E.; Alland, David; Ellner, Jerrold

2013-01-01

197

Development and implementation of a custom integrated database with dashboards to assist with hematopathology specimen triage and traffic  

PubMed Central

Background: At some institutions, including ours, bone marrow aspirate specimen triage is complex, with hematopathology triage decisions that need to be communicated to downstream ancillary testing laboratories and many specimen aliquot transfers that are handled outside of the laboratory information system (LIS). We developed a custom integrated database with dashboards to facilitate and streamline this workflow. Methods: We developed user-specific dashboards that allow entry of specimen information by technologists in the hematology laboratory, have custom scripting to present relevant information for the hematopathology service and ancillary laboratories and allow communication of triage decisions from the hematopathology service to other laboratories. These dashboards are web-accessible on the local intranet and accessible from behind the hospital firewall on a computer or tablet. Secure user access and group rights ensure that relevant users can edit or access appropriate records. Results: After database and dashboard design, two-stage beta-testing and user education was performed, with the first focusing on technologist specimen entry and the second on downstream users. Commonly encountered issues and user functionality requests were resolved with database and dashboard redesign. Final implementation occurred within 6 months of initial design; users report improved triage efficiency and reduced need for interlaboratory communications. Conclusions: We successfully developed and implemented a custom database with dashboards that facilitates and streamlines our hematopathology bone marrow aspirate triage. This provides an example of a possible solution to specimen communications and traffic that are outside the purview of a standard LIS. PMID:25250187

Azzato, Elizabeth M.; Morrissette, Jennifer J. D.; Halbiger, Regina D.; Bagg, Adam; Daber, Robert D.

2014-01-01

198

Improving prehospital trauma management for skiers and snowboarders - need for on-slope triage?  

PubMed Central

Background Injuries from skiing and snowboarding became a major challenge for emergency care providers in Switzerland. In the alpine setting, early assessment of injury and health status is essential for the initiation of adequate means of care and transport. Nevertheless, validated standardized protocols for on-slope triage are missing. This article can assist in understanding the characteristics of injured winter sportsmen and exigencies for future on-slope triage protocols. Methods Six-year review of trauma cases in a tertiary trauma centre. Consecutive inclusion of all injured skiers and snowboarders aged >15 (total sample) years with predefined, severe injury to the head, spine, chest, pelvis or abdomen (study sample) presenting at or being transferred to the study hospital. Descriptive analysis of age, gender and injury pattern. Results Amongst 729 subjects (total sample) injured from skiing or snowboarding, 401 (55%, 54% of skiers and 58% of snowboarders) suffered from isolated limb injury. Amongst the remaining 328 subjects (study sample), the majority (78%) presented with monotrauma. In the study sample, injury to the head (52%) and spine (43%) was more frequent than injury to the chest (21%), pelvis (8%), and abdomen (5%). The three most frequent injury combinations were head/spine (10% of study sample), head/thorax (9%), and spine/thorax (6%). Fisher's exact test demonstrated an association for injury combinations of head/thorax (p < 0.001), head/abdomen (p = 0.019), and thorax/abdomen (p < 0.001). Conclusion The data presented and the findings from previous investigations indicate the need for development of dedicated on-slope triage protocols. Future research must address the validity and practicality of diagnostic on-slope tests for rapid decision making by both professional and lay first responders. Thus, large-scale and detailed injury surveillance is the future research priority. PMID:21521524

2011-01-01

199

Emergency Medical Text Classifier: New system improves processing and classification of triage notes  

PubMed Central

Objective Automated syndrome classification aims to aid near real-time syndromic surveillance to serve as an early warning system for disease outbreaks, using Emergency Department (ED) data. We present a system that improves the automatic classification of an ED record with triage note into one or more syndrome categories using the vector space model coupled with a ‘learning’ module that employs a pseudo-relevance feedback mechanism. Materials and Methods: Terms from standard syndrome definitions are used to construct an initial reference dictionary for generating the syndrome and triage note vectors. Based on cosine similarity between the vectors, each record is classified into a syndrome category. We then take terms from the top-ranked records that belong to the syndrome of interest as feedback. These terms are added to the reference dictionary and the process is repeated to determine the final classification. The system was tested on two different datasets for each of three syndromes: Gastro-Intestinal (GI), Respiratory (Resp) and Fever-Rash (FR). Performance was measured in terms of sensitivity (Se) and specificity (Sp). Results: The use of relevance feedback produced high values of sensitivity and specificity for all three syndromes in both test sets: GI: 90% and 71%, Resp: 97% and 73%, FR: 100% and 87%, respectively, in test set 1, and GI: 88% and 69%, Resp: 87% and 61%, FR: 97% and 71%, respectively, in test set 2. Conclusions: The new system for pre-processing and syndromic classification of ED records with triage notes achieved improvements in Se and Sp. Our results also demonstrate that the system can be tuned to achieve different levels of performance based on user requirements. PMID:25379126

Haas, Stephanie W.; Travers, Debbie; Waller, Anna; Mahalingam, Deepika; Crouch, John; Schwartz, Todd A.; Mostafa, Javed

2014-01-01

200

The Pediatric Assessment Triangle: Accuracy of Its Application by Nurses in the Triage of Children  

PubMed Central

Introduction The Pediatric Assessment Triangle (PAT) is a rapid evaluation tool that establishes a child’s clinical status and his or her category of illness to direct initial management priorities. Recently the PAT has been incorporated widely into the pediatric resuscitation curriculum. Although intuitive, its performance characteristics have yet to be quantified. The purpose of this research is to determine quantitatively its accuracy, reliability, and validity as applied by nurses at triage. Methods In this prospective observational study, triage nurses performed the PAT on all patients presenting to the pediatric emergency department of an urban teaching hospital. Researchers performed blinded chart review using the physician’s initial assessment and final diagnosis as the criterion standard for comparison. Results A total of 528 children were included in the analysis. Likelihood ratios (LRs) were found for instability and category of pathophysiology using the PAT. Children deemed stable by initial PAT were almost 10 times more likely to be stable on further assessment (LR 0.12, 95% confidence interval [CI] 0.06-0.25). The PAT further specified categories of pathophysiology: respiratory distress (LR+ 4, 95% CI 3.1-4.8), respiratory failure (LR+ 12, 95% CI 4.0-37), shock (LR+ 4.2, 95% CI 3.1-5.6), central nervous system/metabolic disorder (LR+ 7, 95% CI 4.3-11), and cardiopulmonary failure (LR+ 49, 95% CI 20-120). Discussion The structured assessment of the initial PAT, as performed by nurses in triage, readily and reliably identifies high-acuity pediatric patients and their category of pathophysiology. The PAT is highly predictive of the child’s clinical status on further evaluation. PMID:22831826

Horeczko, Timothy; Enriquez, Brianna; McGrath, Nancy E.; Gausche-Hill, Marianne; Lewis, Roger J.

2015-01-01

201

The metrics of death: emotions and the effects of casualties on public opinion in militarized disputes and terrorism  

E-print Network

model in which the characteristics of the casualty event generate emotional reactions. The emotional response affects the way information about the event is processed by individuals, and alters individual’s support of aggressive/non-aggressive foreign...

Mosher, Katrina N.

2009-05-15

202

Tactical Combat Casualty Care in the Canadian Forces: lessons learned from the Afghan war  

PubMed Central

Tactical Combat Casualty Care (TCCC) is intended to treat potentially preventable causes of death on the battlefield, but acknowledges that application of these treatments may place the provider and even the mission in jeopardy if performed at the wrong time. Therefore, TCCC classifies the tactical situation with respect to health care provision into 3 phases (care under fire, tactical field care and tactical evacuation) and only permits certain interventions to be performed in specific phases based on the danger to the provider and casualty. In the 6 years that the Canadian Forces (CF) have been involved in sustained combat operations in Kandahar, Afghanistan, more than 1000 CF members have been injured and more than 150 have been killed. As a result, the CF gained substantial experience delivering TCCC to wounded soldiers on the battlefield. The purpose of this paper is to review the principles of TCCC and some of the lessons learned about battlefield trauma care during this conflict. PMID:22099324

Savage, Erin; Forestier, Colleen; Withers, Nicholas; Tien, Homer; Pannell, Dylan

2011-01-01

203

When Do Their Casualties Count? Exploring Wartime Decisions that Pit Security Against Harm  

E-print Network

can temper and dominate military casualties. Looking at data on political and media activity and at public opinion polls, Larson (1996) found that the U.S. public regularly determined their support of a war using a cost-benefit calculation?not just... .......................................... 12 Just War and the Law of War ......................................................... 14 Decision Making and the Individual in IR ..................................... 18 Risk, Framing, and Prospect Theory...

Roblyer, Dwight Andrew

2011-02-22

204

Death and Doctrine: U.S. Army Officers' Perceptions of American Casualty Aversion, 1970-1999  

E-print Network

of Graduate Studies of Texas A&M University in partial fulfillment of the requirements for the degree of MASTER OF ARTS Approved by: Chair of Committee, Brian McAllister Linn Committee Members, Joseph G. Dawson, III James S. Burk David Vaught... Military Academy; M.A., Webster University Chair of Advisory Committee: Dr. Brian McAllister Linn While academics and commentators have devoted considerable energy to analyzing the relationship between United States military casualties and the reaction...

Johnson, Daniel I.

2011-08-08

205

Consistent Measurement of Property-Casualty Risk-Based Capital Adequacy  

Microsoft Academic Search

This paper is a review and case study of Butsic's expected policyholder deficit (EPD) framework for mea surement and maintenance of risk-based capital adequacy for property-casualty insurance companies, the promise of which is that long term solvency protection can be achieved by periodic assessment and adjustment of risk-based capital using a consistent and short time horizon, e.g., one year, for

Michael G. Wacek

206

Precision of field triage in patients brought to a trauma centre after introducing trauma team activation guidelines  

PubMed Central

Background Field triage is important for regional trauma systems providing high sensitivity to avoid that severely injured are deprived access to trauma team resuscitation (undertriage), yet high specificity to avoid resource over-utilization (overtriage). Previous informal trauma team activation (TTA) at Ulleval University Hospital (UUH) caused imprecise triage. We have analyzed triage precision after introduction of TTA guidelines. Methods Retrospective analysis of 7 years (2001–07) of prospectively collected trauma registry data for all patients with TTA or severe injury, defined as at least one of the following: Injury Severity Score (ISS) > 15, proximal penetrating injury, admitted ICU > 2 days, transferred intubated to another hospital within 2 days, dead from trauma within 30 days. Interhospital transfers to UUH and patients admitted by non-healthcare personnel were excluded. Overtriage is the fraction of TTA where patients are not severely injured (1-positive predictive value); undertriage is the fraction of severely injured admitted without TTA (1-sensitivity). Results Of the 4 659 patients included in the study, 2 221 (48%) were severely injured. TTA occurred 4 440 times, only 2 002 of which for severely injured (overtriage 55%). Overall undertriage was 10%. Mechanism of injury was TTA criterion in 1 508 cases (34%), of which only 392 were severely injured (overtriage 74%). Paramedic-manned prehospital services provided 66% overtriage and 17% undertriage, anaesthetist-manned services 35% overtriage and 2% undertriage. Falls, high age and admittance by paramedics were significantly associated with undertriage. A Triage-Revised Trauma Score (RTS) < 12 in the emergency department reduced the risk for undertriage compared to RTS = 12 (normal value). Field RTS was documented by anaesthetists in 64% of the patients compared to 33% among paramedics. Patients subject to undertriage had an ISS-adjusted Odds Ratio for 30-day mortality of 2.34 (95% CI 1.6–3.4, p < 0.001) compared to those correctly triaged to TTA. Conclusion Triage precision had not improved after TTA guideline introduction. Anaesthetists perform precise trauma triage, whereas paramedics have potential for improvement. Skewed mission profiles makes comparison of differences in triage precision difficult, but criteria or the use of them may contribute. Massive undertriage among paramedics is of grave concern as patients exposed to undertriage had increased risk of dying. PMID:19134177

Rehn, Marius; Eken, Torsten; Krüger, Andreas Jorstad; Steen, Petter Andreas; Skaga, Nils Oddvar; Lossius, Hans Morten

2009-01-01

207

Casualty Risk Assessment Controlled Re-Entry of EPS - Ariane 5ES - ATV Mission  

NASA Astrophysics Data System (ADS)

To fulfil its mission of compliance check to the French Space Operations Act, CNES has developed ELECTRA© tool in order to estimate casualty risk induced by a space activity (like rocket launch, controlled or un-controlled re-entry on Earth of a space object). This article describes the application of such a tool for the EPS controlled re-entry during the second Ariane 5E/S flight (Johannes Kepler mission has been launched in February 2011). EPS is the Ariane 5E/S upper composite which is de-orbited from a 260 km circular orbit after its main mission (release of the Automated Transfer Vehicle - ATV). After a brief description of the launcher, the ATV-mission and a description of all the failure cases taken into account in the mission design (which leads to "back-up scenarios" into the flight software program), the article will describe the steps which lead to the casualty risk assessment (in case of failure) with ELECTRA©. In particular, the presence on board of two propulsive means of de-orbiting (main engine of EPS, and 4 ACS longitudinal nozzles in case of main engine failure or exhaustion) leads to a low remaining casualty risk.

Arnal, M.-H.; Laine, N.; Aussilhou, C.

2012-01-01

208

Current concepts in fluid resuscitation for prehospital care of combat casualties.  

PubMed

Historically, hemorrhage accounts for the primary cause of death on the battlefield in conventional warfare. In addition, hemorrhage was associated with 85% of potentially survivable deaths in the current conflicts, approximately two-thirds of which were from noncompressible injuries. Future combat casualty care strategies suggest the likelihood of long transport times or significant time delays in evacuation of casualties. In addition, there are logistical limitations to providing large volumes of resuscitation fluid far-forward, and current guidelines do not recommend infusing large volumes of fluid until bleeding is controlled. Since the medic has few options for treating noncompressible injuries short of infusing fluid to maintain a blood pressure, the concept of damage control resuscitation was developed to promote hemostatic resuscitation. Damage control resuscitation recommends limiting the amount of crystalloids or colloids infused and using plasma and other blood products in more optimal ratios for the treatment of severe hemorrhage to improve battlefield survival and to reduce or prevent early and late deleterious sequelae. Taken together, these efforts have important implications towards the development of optimal fluid resuscitation strategies for stabilization of the combat casualty. PMID:21607903

Dubick, Michael A

2011-01-01

209

Instruments to assess patient satisfaction after teleconsultation and triage: a systematic review  

PubMed Central

Background Patient satisfaction is crucial for the acceptance, use, and adherence to recommendations from teleconsultations regarding health care requests and triage services. Objectives Our objectives are to systematically review the literature for multidimensional instruments that measure patient satisfaction after teleconsultation and triage and to compare these for content, reliability, validity, and factor analysis. Methods We searched Medline, the Cumulative Index to Nursing and Allied Health Literature, and PsycINFO for literature on these instruments. Two reviewers independently screened all obtained references for eligibility and extracted data from the eligible articles. The results were presented using summary tables. Results We included 31 publications, describing 16 instruments in our review. The reporting on test development and psychometric characteristics was incomplete. The development process, described by ten of 16 instruments, included a review of the literature (n=7), patient or stakeholder interviews (n=5), and expert consultations (n=3). Four instruments evaluated factor structure, reliability, and validity; two of those four demonstrated low levels of reliability for some of their subscales. Conclusion A majority of instruments on patient satisfaction after teleconsultation showed methodological limitations and lack rigorous evaluation. Users should carefully reflect on the content of the questionnaires and their relevance to the application. Future research should apply more rigorously established scientific standards for instrument development and psychometric evaluation. PMID:25028538

Allemann Iseli, Martina; Kunz, Regina; Blozik, Eva

2014-01-01

210

Triage Management, Survival, and the Law in the Age of Ebola.  

PubMed

Liberia, Sierra Leone, and Guinea lack the public health infrastructure, economic stability, and overall governance to stem the spread of Ebola. Even with robust outside assistance, the epidemiological data have not improved. Vital resource management is haphazard and left to the discretion of individual Ebola treatment units. Only recently has the International Health Regulations (IHR) and World Health Organization (WHO) declared Ebola a Public Health Emergency of International Concern, making this crisis their fifth ongoing level 3 emergency. In particular, the WHO has been severely compromised by post-2003 severe acute respiratory syndrome (SARS) staffing, budget cuts, a weakened IHR treaty, and no unambiguous legal mandate. Population-based triage management under a central authority is indicated to control the transmission and ensure fair and decisive resource allocation across all triage categories. The shared responsibilities critical to global health solutions must be realized and the rightful attention, sustained resources, and properly placed legal authority be assured within the WHO, the IHR, and the vulnerable nations. (Disaster Med Public Health Preparedness. 2014;0:1-6). PMID:25343493

Burkle, Frederick M; Burkle, Christopher M

2014-10-24

211

Timing of troponin T measurements in triage of pulmonary embolism patients  

PubMed Central

Aim To determine the appropriate timing of cardiac troponin T (cTnT) measurement for the early triage of pulmonary embolism (PE) patients. Methods In this single-center prospective study, PE was confirmed in all patients using computed tomography. 104 consecutive patients were divided into three groups (high-risk, intermediate, and low-risk) based on their hemodynamic status and echocardiographic signs of right ventricular dysfunction. cTnT levels were measured on admission and then after 6, 24, 48, and 72 hours with threshold values greater than 0.1 ng/mL. Results Intermediate-risk PE patients had higher cTnT levels than low-risk patients already in the first measurement (P?=?0.037). Elevated cTnT levels significantly correlated with disease severity after 6 hours (intermediate vs low risk patients, P?=?0.016, all three groups, P?=?0.009). Conclusion In hemodynamically stable patients, increased cTnT level on admission differentiated intermediate from low-risk patients and could be used as an important element for the appropriate triage of patients. PMID:24382851

Bulj, Nikola; Poto?njak, Ines; Sharma, Mirella; Pintari?, Hrvoje; Degoricija, Vesna

2013-01-01

212

Investigating respiratory variation using a forehead reflectance pulse oximeter to identify airway obstruction for automated remote triage  

Microsoft Academic Search

An automated triage system called ARTEMIS has been developed in an effort to improve combat and multicasualty care within the battlefield or disaster zone. The status of airway, breathing, and circulation is critical in these types of situations. This preliminary study uses sleep apnea patients to determine whether certain features can be extracted from the photoplethysmograph of a Nonin® forehead

Janelle M. Chang; Susan P. McGrath; George T. Blike

2005-01-01

213

77 FR 52746 - Medical Countermeasures for a Burn Mass Casualty Incident  

Federal Register 2010, 2011, 2012, 2013

...collaboration.fda.gov/common/help/en/support/meeting_test.htm. To get a quick overview...resuscitation, wound management, pain relief, and nutritional- and airway/breathing support in the initial post-injury period. The...

2012-08-30

214

Application and prospect of a high-resolution remote sensing and geo-information system in estimating earthquake casualties  

NASA Astrophysics Data System (ADS)

An accurate estimation of a casualty rate is critical in response to earthquake disasters, and could allow an increase in the survival rate. Building damage is considered to be a major cause of earthquake casualties in developing countries. High-resolution satellite imagery (HRSI) can be used to detect the building damage in a period of a short time. This makes it possible to use a model to estimate earthquake casualties immediately after the occurrence of an earthquake. With respect to the capability of HRSI, this study built a new model for estimating the casualty rate in an earthquake disaster based on remote sensing and a geographical information system. Three groups of earthquake data, the 2003 Bam earthquake, the 2008 Wenchuan earthquake, and the 2010 Yushu earthquake, were used to evaluate this model. The results indicated that our new model significantly improved the accuracy in predicting the casualty rate. The parameters used in the model vary between developed and developing countries. This study could provide valuable information for a more efficient rescue operation in response to earthquakes.

Feng, T.; Hong, Z.; Fu, Q.; Ma, S.; Jie, X.; Wu, H.; Jiang, C.; Tong, X.

2014-08-01

215

Rapid Analytical Methods for On-Site Triage for Traumatic Brain Injury  

NASA Astrophysics Data System (ADS)

Traumatic brain injury (TBI) results from an event that causes rapid acceleration and deceleration of the brain or penetration of the skull with an object. Responses to stimuli and questions, loss of consciousness, and altered behavior are symptoms currently used to justify brain imaging for diagnosis and therapeutic guidance. Tests based on such symptoms are susceptible to false-positive and false-negative results due to stress, fatigue, and medications. Biochemical markers of neuronal damage and the physiological response to that damage are being identified. Biosensors capable of rapid measurement of such markers in the circulation offer a solution for on-site triage, as long as three criteria are met: (a) Recognition reagents can be identified that are sufficiently sensitive and specific, (b) the biosensor can provide quantitative assessment of multiple markers rapidly and simultaneously, and (c) both the sensor and reagents are designed for use outside the laboratory.

North, Stella H.; Shriver-Lake, Lisa C.; Taitt, Chris R.; Ligler, Frances S.

2012-07-01

216

Triage After Hospitalization with Advanced Heart Failure: The ESCAPE Risk Model and Discharge Score  

PubMed Central

Objectives Identifying high-risk heart failure (HF) patients at hospital discharge may allow more effective triage to management strategies. Background HF severity at presentation predicts outcomes, but the prognostic importance of clinical status changes due to interventions is less well described. Methods Predictive models using variables obtained during hospitalization were created using data from ESCAPE and internally validated by bootstrapping method. Model coefficients were converted to an additive risk score. Additionally, data from the FIRST (Flolan International Randomized Survival Trial) was used to externally validate this model. Results Patients discharged with complete data (n=423) had 6-month mortality and death or rehospitalization rates of 18.7% and 64%. Discharge risk factors for mortality included BNP, per doubling (Hazard Ration [HR]: 1.42, 95% confidence interval [CI]: 1.15–1.75), cardiopulmonary resuscitation or mechanical ventilation during hospitalization (HR: 2.54, 95% CI: 1.12–5.78), blood urea nitrogen, per 20-U increase) (HR: 1.22, 95% CI: 0.96–1.55), serum sodium, per unit increase (HR: 0.93, 95% CI: 0.87–0.99), age >70 (HR: 1.05, 95% CI: 0.51–2.17), daily loop diuretic, furosemide equivalents >240 mg (HR: 1.49, 95% CI: 0.68–3.26), lack of beta-blocker (HR: 1.28, 95% CI: 0.68–2.41), and 6-minute walk, per 100 feet increase (HR: 0.955, 95% CI: 0.99–1.00; c index 0.76. A simplified discharge score discriminated mortality risk from 5% (score=0) to 94% (score =8). Bootstrap validation demonstrated good internal validation of the model (c index 0.78, 95% CI: 0.68–0.83). Conclusions The ESCAPE discharge risk model and score refine risk assessment after inhospital therapy for advanced decompensated systolic HF, allowing clinicians to focus surveillance and triage for early life-saving interventions in this high-risk population. PMID:20185037

O’Connor, Christopher M.; Hasselblad, Vic; Mehta, Rajendra H.; Tasissa, Gudaye; Califf, Robert M.; Fiuzat, Mona; Rogers, Joseph G.; Leier, Carl V.; Stevenson, Lynne W.

2013-01-01

217

Improving the Manchester Triage System for Pediatric Emergency Care: An International Multicenter Study  

PubMed Central

Objectives This multicenter study examines the performance of the Manchester Triage System (MTS) after changing discriminators, and with the addition use of abnormal vital sign in patients presenting to pediatric emergency departments (EDs). Design International multicenter study Settings EDs of two hospitals in The Netherlands (2006–2009), one in Portugal (November–December 2010), and one in UK (June–November 2010). Patients Children (<16years) triaged with the MTS who presented at the ED. Methods Changes to discriminators (MTS 1) and the value of including abnormal vital signs (MTS 2) were studied to test if this would decrease the number of incorrect assignment. Admission to hospital using the new MTS was compared with those in the original MTS. Likelihood ratios, diagnostic odds ratios (DORs), and c-statistics were calculated as measures for performance and compared with the original MTS. To calculate likelihood ratios and DORs, the MTS had to be dichotomized in low urgent and high urgent. Results 60,375 patients were included, of whom 13% were admitted. When MTS 1 was used, admission to hospital increased from 25% to 29% for MTS ‘very urgent’ patients and remained similar in lower MTS urgency levels. The diagnostic odds ratio improved from 4.8 (95%CI 4.5–5.1) to 6.2 (95%CI 5.9–6.6) and the c-statistic remained 0.74. MTS 2 did not improve the performance of the MTS. Conclusions MTS 1 performed slightly better than the original MTS. The use of vital signs (MTS 2) did not improve the MTS performance. PMID:24454699

Seiger, Nienke; van Veen, Mirjam; Almeida, Helena; Steyerberg, Ewout W.; van Meurs, Alfred H. J.; Carneiro, Rita; Alves, Claudio F.; Maconochie, Ian; van der Lei, Johan; Moll, Henriëtte A.

2014-01-01

218

Rapid Clinical Assessment to Facilitate the Triage of Adults with Falciparum Malaria, a Retrospective Analysis  

PubMed Central

Background Most adults dying from falciparum malaria will die within 48 hours of their hospitalisation. An essential component of early supportive care is the rapid identification of patients at greatest risk. In resource-poor settings, where most patients with falciparum malaria are managed, decisions regarding patient care must frequently be made using clinical evaluation alone. Methods We retrospectively analysed 4 studies of 1801 adults with severe falciparum malaria to determine whether the presence of simple clinical findings might assist patient triage. Results If present on admission, shock, oligo-anuria, hypo- or hyperglycaemia, an increased respiratory rate, a decreased Glasgow Coma Score and an absence of fever were independently predictive of death. The variables were used to construct a simple clinical algorithm. When applied to the 1801 patients, this algorithm’s positive predictive value for survival to 48 hours was 99.4 (95% confidence interval (CI) 97.8–99.9) and for survival to discharge 96.9% (95% CI 94.3–98.5). In the 712 patients receiving artesunate, the algorithm’s positive predictive value for survival to 48 hours was 100% (95% CI 97.3–100) and to discharge was 98.5% (95% CI 94.8–99.8). Conclusions Simple clinical findings are closely linked to the pathophysiology of severe falciparum malaria in adults. A basic algorithm employing these indices can facilitate the triage of patients in settings where intensive care services are limited. Patients classified as low-risk by this algorithm can be safely managed initially on a general ward whilst awaiting senior clinical review and laboratory data. PMID:24489828

Hanson, Josh; Lee, Sue J.; Mohanty, Sanjib; Faiz, M. Abul; Anstey, Nicholas M.; Price, Ric N.; Charunwatthana, Prakaykaew; Yunus, Emran Bin; Mishra, Saroj K.; Tjitra, Emiliana; Rahman, Ridwanur; Nosten, Francois; Htut, Ye; Maude, Richard J.; Thi Hong Chau, Tran; Phu, Nguyen Hoan; Hien, Tran Tinh; White, Nicholas J.; Day, Nicholas P. J.; Dondorp, Arjen M.

2014-01-01

219

HPV mRNA Is More Specific than HPV DNA in Triage of Women with Minor Cervical Lesions  

PubMed Central

Background In Norway, repeat cytology and HPV testing comprise delayed triage of women with minor cytological lesions. The objective of this study was to evaluate HPV DNA and HPV mRNA testing in triage of women with an ASC-US/LSIL diagnosis. Materials and Methods We used repeat cytology, HPV DNA testing (Cobas 4800) and HPV mRNA testing (PreTect HPV-Proofer) to follow up 311 women aged 25–69 years with ASC-US/LSIL index cytology. Results Of 311 women scheduled for secondary screening, 30 women (9.6%) had ASC-H/HSIL cytology at triage and 281 women (90.4%) had ASC-US/LSIL or normal cytology. The HPV DNA test was positive in 92 (32.7%) of 281 instances, and 37 (13.2%) were mRNA positive. Of the 132 women with repeated ASC-US/LSIL, we received biopsies from 97.0% (65/67) of the DNA-positive and 92.9% (26/28) of the mRNA-positive cases. The positive predictive values for CIN2+ were 21.5% (14/65) for DNA positive and 34.6% (9/26) for mRNA positive (ns). The odds ratio for being referred to colposcopy in DNA-positive cases were 2.8 times (95% CI: 1.8–4.6) higher that of mRNA-positive cases. Compared to the mRNA test, the DNA test detected four more cases of CIN2 and one case of CIN3. Conclusions The higher positivity rate of the DNA test in triage leads to higher referral rate for colposcopy and biopsy, and subsequent additional follow-up of negative biopsies. By following mRNA-negative women who had ASC-US/LSIL at triage with cytology, the additional cases of CIN2+ gained in DNA screening can be discovered. Our study indicates that in triage of repeated ASC-US/LSIL, HPV mRNA testing is more specific and is more relevant in clinical use than an HPV DNA test. PMID:25405981

Sørbye, Sveinung Wergeland; Fismen, Silje; Gutteberg, Tore Jarl; Mortensen, Elin Synnøve; Skjeldestad, Finn Egil

2014-01-01

220

Helicopter Emergency Medical Services (HEMS) over-triage and the financial implications for major trauma centres in NSW, Australia  

PubMed Central

Background In NSW Australia, a formal trauma system including the use of helicopter emergency medical services (HEMS) has existed for over 20 years. Despite providing many advantages in NSW, HEMS patients are frequently over-triaged; leading to financial implications for major trauma centres that receive HEMS patients. The aim of this study was to investigate the financial implications of HEMS over-triage from the perspective of major trauma centres in NSW. Methods The study sample included all trauma patients transported via HEMS to 12 major trauma centres in NSW during the period: 1 July 2008 to 30 June 2009. Clinical data were gathered from individual hospital trauma registries and merged with financial information obtained from casemix units at respective hospitals. HEMS over-triage was estimated based on the local definition of minor to moderate trauma (ISS?12) and hospital length of stay of less than 24 hrs. The actual treatment costs were determined and compared to state-wide peer group averages to obtain estimates of potential funding discrepancies. Results A total of 707 patients transported by HEMS were identified, including 72% pre-hospital (PH; n=507) and 28% inter-hospital (IH; n=200) transports. Over-triage was estimated at 51% for PH patients and 29% for IH patients. Compared to PH patients, IH patients were more costly to treat on average (IH: $42,604; PH: $25,162), however PH patients were more costly overall ($12,329,618 [PH]; $8,265,152 [IH]). When comparing actual treatment costs to peer group averages we found potential funding discrepancies ranging between 4% and 32% across patient groups. Using a sensitivity analysis, the potential funding discrepancy increased with increasing levels of over-triage. Conclusions HEMS patients are frequently over-triaged in NSW, leading to funding implications for major trauma centres. In general, HEMS patient treatment costs are higher than the peer group average and the potential funding discrepancy varies by injury severity and the type of transport performed. Although severely injured HEMS patients are more costly to treat, HEMS patients with minor injuries make up the majority of HEMS transports and have larger relative potential funding discrepancies. Future episode funding models need to account for the variability of trauma patients and the proportion of patients transported via HEMS. PMID:23815080

2013-01-01

221

A low-bandwidth graphical user interface for high-speed triage of potential items of interest in video imagery  

NASA Astrophysics Data System (ADS)

In this paper, we introduce a user interface called the "Threat Chip Display" (TCD) for rapid human-in-the-loop analysis and detection of "threats" in high-bandwidth imagery and video from a list of "Items of Interest" (IOI), which includes objects, targets and events that the human is interested in detecting and identifying. Typically some front-end algorithm (e.g., computer vision, cognitive algorithm, EEG RSVP based detection, radar detection) has been applied to the video and has pre-processed and identified a potential list of IOI. The goal of the TCD is to facilitate rapid analysis and triaging of this list of IOI to detect and confirm actual threats. The layout of the TCD is designed for ease of use, fast triage of IOI, and a low bandwidth requirement. Additionally, a very low mental demand allows the system to be run for extended periods of time.

Huber, David J.; Khosla, Deepak; Martin, Kevin; Chen, Yang

2013-06-01

222

Full-Body X-Ray Imaging to Facilitate Triage: A Potential Aid in High-Volume Emergency Departments  

PubMed Central

The levels of traumatic injury seen in South African emergency departments (EDs) are epidemic. This is coupled with a severe lack of resources and adequately trained emergency staff. The Lodox Statscan (LS) is an X-ray scanner capable of producing rapid, low-dose, and full-body X-ray images. In this paper, a new trauma protocol—the Johannesburg trauma protocol—that implements LS scanning on entry to the ED as a triage tool is reported. A case study illustrating the use of LS to triage 63 patients in a single Saturday shift at a level 1 Trauma Centre is also presented. Because of the ability to rapidly and safely provide X-ray imaging information to support clinical decision making, the LS could be a useful tool to aid in resource allocation to improve treatment of the high levels of trauma patients that present to South African EDs daily. PMID:24205438

Whiley, S. P.; Alves, H.; Grace, S.

2013-01-01

223

Full-body x-ray imaging to facilitate triage: a potential aid in high-volume emergency departments.  

PubMed

The levels of traumatic injury seen in South African emergency departments (EDs) are epidemic. This is coupled with a severe lack of resources and adequately trained emergency staff. The Lodox Statscan (LS) is an X-ray scanner capable of producing rapid, low-dose, and full-body X-ray images. In this paper, a new trauma protocol-the Johannesburg trauma protocol-that implements LS scanning on entry to the ED as a triage tool is reported. A case study illustrating the use of LS to triage 63 patients in a single Saturday shift at a level 1 Trauma Centre is also presented. Because of the ability to rapidly and safely provide X-ray imaging information to support clinical decision making, the LS could be a useful tool to aid in resource allocation to improve treatment of the high levels of trauma patients that present to South African EDs daily. PMID:24205438

Whiley, S P; Alves, H; Grace, S

2013-01-01

224

Development of a triage engine enabling behavior recognition and lethal arrhythmia detection for remote health care system.  

PubMed

For ubiquitous health care systems which continuously monitor a person's vital signs such as electrocardiogram (ECG), body surface temperature and three-dimensional (3D) acceleration by wireless, it is important to accurately detect the occurrence of an abnormal event in the data and immediately inform a medical doctor of its detail. In this paper, we introduce a remote health care system, which is composed of a wireless vital sensor, multiple receivers and a triage engine installed in a desktop personal computer (PC). The middleware installed in the receiver, which was developed in C++, supports reliable data handling of vital data to the ethernet port. On the other hand, the human interface of the triage engine, which was developed in JAVA, shows graphics on his/her ECG data, 3D acceleration data, body surface temperature data and behavior status in the display of the desktop PC and sends an urgent e-mail containing the display data to a pre-registered medical doctor when it detects the occurrence of an abnormal event. In the triage engine, the lethal arrhythmia detection algorithm based on short time Fourier transform (STFT) analysis can achieve 100 % sensitivity and 99.99 % specificity, and the behavior recognition algorithm based on the combination of the nearest neighbor method and the Naive Bayes method can achieve more than 71 % classification accuracy. PMID:22254766

Sugano, Hiroto; Hara, Shinsuke; Tsujioka, Tetsuo; Inoue, Tadayuki; Nakajima, Shigeyoshi; Kozaki, Takaaki; Namkamura, Hajime; Takeuchi, Kazuhide

2011-01-01

225

Low micronutrient intake may accelerate the degenerative diseases of aging through allocation of scarce micronutrients by triage  

PubMed Central

Inadequate dietary intakes of vitamins and minerals are widespread, most likely due to excessive consumption of energy-rich, micronutrient-poor, refined food. Inadequate intakes may result in chronic metabolic disruption, including mitochondrial decay. Deficiencies in many micronutrients cause DNA damage, such as chromosome breaks, in cultured human cells or in vivo. Some of these deficiencies also cause mitochondrial decay with oxidant leakage and cellular aging and are associated with late onset diseases such as cancer. I propose DNA damage and late onset disease are consequences of a triage allocation response to micronutrient scarcity. Episodic shortages of micronutrients were common during evolution. Natural selection favors short-term survival at the expense of long-term health. I hypothesize that short-term survival was achieved by allocating scarce micronutrients by triage, in part through an adjustment of the binding affinity of proteins for required micronutrients. If this hypothesis is correct, micronutrient deficiencies that trigger the triage response would accelerate cancer, aging, and neural decay but would leave critical metabolic functions, such as ATP production, intact. Evidence that micronutrient malnutrition increases late onset diseases, such as cancer, is discussed. A multivitamin-mineral supplement is one low-cost way to ensure intake of the Recommended Dietary Allowance of micronutrients throughout life. PMID:17101959

Ames, Bruce N.

2006-01-01

226

Spatial-temporal patterns in Mediterranean carnivore road casualties: Consequences for mitigation  

USGS Publications Warehouse

Many carnivores have been seriously impacted by the expansion of transportation systems and networks; however we know little about carnivore response to the extent and magnitude of road mortality, or which age classes may be disproportionately impacted. Recent research has demonstrated that wildlife-vehicle-collisions (WVC) involving carnivores are modulated by temporal and spatial factors. Thus, we investigated road mortality on a guild of small and medium-sized carnivores in southern Portugal using road-kill data obtained from a systematic 36 months monitoring period along highways (260 km) and national roads (314 km) by addressing the following questions: (a) which species and age class are most vulnerable to WVC? (b) are there temporal and/or spatial patterns in road-kill? and (c) which life-history and/or spatial factors influence the likelihood of collisions? We recorded a total of 806 carnivore casualties, which represented an average of 47 ind./100 km/year. Red fox and stone marten had the highest mortality rates. Our findings highlight three key messages: (1) the majority of road-killed individuals were adults of common species; (2) all carnivores, except genets, were more vulnerable during specific life-history phenological periods: higher casualties were observed when red fox and stone marten were provisioning young, Eurasian badger casualties occurred more frequently during dispersal, and higher Egyptian mongoose mortality occurred during the breeding period; and (3) modeling demonstrated that favorable habitat, curves in the road, and low human disturbance were major contributors to the deadliest road segments. Red fox carcasses were more likely to be found on road sections with passages distant from urban areas. Conversely, stone marten mortalities were found more often on national roads with high of cork oak woodland cover; Egyptian mongoose and genet road-kills were found more often on road segments close to curves. Based on our results, two key mitigation measures should help to reduce WVC in Portugal. The first involves the improvement of existing crossings with buried and small mesh size fence to guide the individuals towards to the passages, in road segments with high traffic volume (>1200 vehicles/night) and located in preferred carnivore habitats. The second mitigation involves cutting or removal of dense vegetation in verges of road segments with curves to aid motorists in seeing animals about to cross. ?? 2008 Elsevier Ltd.

Grilo, C.; Bissonette, J.A.; Santos-Reis, M.

2009-01-01

227

Industry, incidents and casualties in South West England: what is their relationship and are there social inequalities in their distribution?  

PubMed

This ecological study aimed, through the analysis of 1,146 wards in the South West of England (1998-2002), firstly, to examine whether chemical incidents and public casualties are more likely near complex industry (emissions to land, air or water: Integrated Pollution Control industry, IPC) or industry with emissions to air only (Local Air Pollution Control industry, LAPC). Secondly, the study examined whether industry, incidents and casualties are found close to deprivation. Social inequalities were examined across quintiles of wards. Fifty-two wards (4.5%) contained an IPC industry and 712 (62.1%) an LAPC. Incidents occurred in 132 wards (11.5%), with casualties in 59 (5.1%). Chemical incidents occurred more frequently in wards with LAPC (152, IPC 20); the same was true of casualties (211, 12). With each additional LAPC site in a ward, the risk of an incident rose by 22% (95% confidence interval [CI] 8-38%), suggesting a dose-response relationship. No clear social inequalities were found. In the South West of England, the public are more likely to be affected by an incident occurring at a simple LAPC site rather than a complex IPC site. This has implications for emergency planning which, at present, focusses most attention on the larger, more complex IPC sites. PMID:19031101

Scott, Paul; Brown, Paul; Verne, Julia; James, Jody; Gordon, Alistair; Sarangi, Joyshri; Sterne, Jonathan A C

2009-04-01

228

Daily variation in natural disaster casualties: information flows, safety, and opportunity costs in tornado versus hurricane strikes.  

PubMed

Casualties from natural disasters may depend on the day of the week they strike. With data from the Spatial Hazard Events and Losses Database for the United States (SHELDUS), daily variation in hurricane and tornado casualties from 5,043 tornado and 2,455 hurricane time/place events is analyzed. Hurricane forecasts provide at-risk populations with considerable lead time. Such lead time allows strategic behavior in choosing protective measures under hurricane threat; opportunity costs in terms of lost income are higher during weekdays than during weekends. On the other hand, the lead time provided by tornadoes is near zero; hence tornados generate no opportunity costs. Tornado casualties are related to risk information flows, which are higher during workdays than during leisure periods, and are related to sheltering-in-place opportunities, which are better in permanent buildings like businesses and schools. Consistent with theoretical expectations, random effects negative binomial regression results indicate that tornado events occurring on the workdays of Monday through Thursday are significantly less lethal than tornados that occur on weekends. In direct contrast, and also consistent with theory, the expected count of hurricane casualties increases significantly with weekday occurrences. The policy implications of observed daily variation in tornado and hurricane events are considered. PMID:23126406

Zahran, Sammy; Tavani, Daniele; Weiler, Stephan

2013-07-01

229

Triage and Management of Accidental Laboratory Exposures to Biosafety Level-3 and -4 Agents  

PubMed Central

The recent expansion of biocontainment laboratory capacity in the United States has drawn attention to the possibility of occupational exposures to BSL-3 and -4 agents and has prompted a reassessment of medical management procedures and facilities to deal with these contingencies. A workshop hosted by the National Interagency Biodefense Campus was held in October 2007 and was attended by representatives of all existing and planned BSL-4 research facilities in the U.S. and Canada. This report summarizes important points of discussion and recommendations for future coordinated action, including guidelines for the engineering and operational controls appropriate for a hospital care and isolation unit. Recommendations pertained to initial management of exposures (ie, immediate treatment of penetrating injuries, reporting of exposures, initial evaluation, and triage). Isolation and medical care in a referral hospital (including minimum standards for isolation units), staff recruitment and training, and community outreach also were addressed. Workshop participants agreed that any unit designated for the isolation and treatment of laboratory employees accidentally infected with a BSL-3 or -4 pathogen should be designed to maximize the efficacy of patient care while minimizing the risk of transmission of infection. Further, participants concurred that there is no medically based rationale for building care and isolation units to standards approximating a BSL-4 laboratory. Instead, laboratory workers accidentally exposed to pathogens should be cared for in hospital isolation suites staffed by highly trained professionals following strict infection control procedures. PMID:19634998

Rodak, Colleen; Bray, Mike; Davey, Richard T.

2009-01-01

230

Combat casualties undergoing lifesaving interventions have decreased heart-rate complexity at multiple time scales  

PubMed Central

Purpose We found that heart-rate (HR) complexity metrics, such as sample entropy (SampEn), identified trauma patients receiving lifesaving interventions (LSIs). We now aimed: 1) to test a new multiscale entropy (MSE) index; 2) to compare it to single-scale measures including SampEn; and 3) to assess different parameter values for calculation of SampEn and MSE. Methods This was a study of combat casualties in an Emergency Department (ED) in Iraq. ECGs of 70 acutely injured adults were recorded. Twelve underwent LSIs and 58 did not. LSIs included endotracheal intubation (9); tube thoracostomy (9); and emergency transfusion (4). From each ECG, a segment of 800 consecutive beats was selected. Off-line, R waves were detected and R-to-R (RR) interval time series were generated. SampEn, MSE, and time-domain measures of HR variability (mean HR, standard deviation, pNN20, pNN50, rMSSD) were computed. Results Differences in mean HR (LSI=111±33, NonLSI=90±17) were not significant. Systolic arterial pressure was statistically but not clinically different (LSI=123±19, NonLSI=135±19). SampEn (LSI=0.90±0.42, NonLSI=1.19±0.35, p<0.05) and MSE index (LSI = 2.58±2.55, NonLSI=5.67±2.48, p<0.001) differed significantly. Conclusions Complexity of HR dynamics over a range of time scales was lower in high-risk than in low-risk combat casualties and outperformed traditional vital signs. PMID:24140167

Cancio, Leopoldo C.; Batchinsky, Andriy I.; Baker, William L.; Necsoiu, Corina; Salinas, José; Goldberger, Ary L.; Costa, Madalena D.

2013-01-01

231

The impact of using computer decision-support software in primary care nurse-led telephone triage: Interactional dilemmas and conversational consequences.  

PubMed

Telephone triage represents one strategy to manage demand for face-to-face GP appointments in primary care. Although computer decision-support software (CDSS) is increasingly used by nurses to triage patients, little is understood about how interaction is organized in this setting. Specifically any interactional dilemmas this computer-mediated setting invokes; and how these may be consequential for communication with patients. Using conversation analytic methods we undertook a multi-modal analysis of 22 audio-recorded telephone triage nurse-caller interactions from one GP practice in England, including 10 video-recordings of nurses' use of CDSS during triage. We draw on Goffman's theoretical notion of participation frameworks to make sense of these interactions, presenting 'telling cases' of interactional dilemmas nurses faced in meeting patient's needs and accurately documenting the patient's condition within the CDSS. Our findings highlight troubles in the 'interactional workability' of telephone triage exposing difficulties faced in aligning the proximal and wider distal context that structures CDSS-mediated interactions. Patients present with diverse symptoms, understanding of triage consultations, and communication skills which nurses need to negotiate turn-by-turn with CDSS requirements. Nurses therefore need to have sophisticated communication, technological and clinical skills to ensure patients' presenting problems are accurately captured within the CDSS to determine safe triage outcomes. Dilemmas around how nurses manage and record information, and the issues of professional accountability that may ensue, raise questions about the impact of CDSS and its use in supporting nurses to deliver safe and effective patient care. PMID:25514212

Murdoch, Jamie; Barnes, Rebecca; Pooler, Jillian; Lattimer, Valerie; Fletcher, Emily; Campbell, John L

2015-02-01

232

Question design in nurse-led and GP-led telephone triage for same-day appointment requests: a comparative investigation  

PubMed Central

Objective To compare doctors’ and nurses’ communication with patients in primary care telephone triage consultations. Design Qualitative comparative study of content and form of questions in 51 telephone triage encounters between practitioners (general practitioners (GPs)=29; nurses=22) and patients requesting a same-day appointment in primary care. Audio-recordings of nurse-led calls were synchronised with video recordings of nurse's use of computer decision support software (CDSS) during triage. Setting 2 GP practices in Devon and Warwickshire, UK. Participants 4 GPs and 29 patients; and 4 nurses and 22 patients requesting a same-day face-to-face appointment with a GP. Main outcome measure Form and content of practitioner-initiated questions and patient responses during clinical assessment. Results A total of 484 question–response sequences were coded (160 GP; 324 N). Despite average call lengths being similar (GP=4?min, 37?s, (SD=1?min, 26?s); N=4?min, 39?s, (SD=2?min, 22?s)), GPs and nurses differed in the average number (GP=5.51, (SD=4.66); N=14.72, (SD=6.42)), content and form of questions asked. A higher frequency of questioning in nurse-led triage was found to be due to nurses’ use of CDSS to guide telephone triage. 89% of nurse questions were oriented to asking patients about their reported symptoms or to wider-information gathering, compared to 54% of GP questions. 43% of GP questions involved eliciting patient concerns or expectations, and obtaining details of medical history, compared to 11% of nurse questions. Nurses using CDSS frequently delivered questions designed as declarative statements requesting confirmation and which typically preferred a ‘no problem’ response. In contrast, GPs asked a higher proportion of interrogative questions designed to request information. Conclusions Nurses and GPs emphasise different aspects of the clinical assessment process during telephone triage. These different styles of triage have implications for the type of information available following nurse-led or doctor-led triage, and for how patients experience triage. PMID:24598305

Murdoch, Jamie; Barnes, Rebecca; Pooler, Jillian; Lattimer, Val; Fletcher, Emily; Campbell, John L

2014-01-01

233

A Study of Amplicor HPV DNA Detection in the ASCUS-LSIL Triage Study  

PubMed Central

We analyzed the performance of Amplicor for detecting carcinogenic human papillomavirus infections and cervical precancer in women with an atypical squamous cells of undetermined significance (ASCUS) Pap and compared the results to Hybrid Capture 2 (hc2) in the ASCUS and low-grade squamous intraepithelial lesion (LSIL) triage study (ALTS). Baseline specimens collected from women referred into ALTS based on an ASCUS Pap result were prospectively tested by hc2 and retrospectively tested by Amplicor (n=3,277). Following receiver-operator-characteristics curve analysis, Amplicor performance was analyzed at three cutoffs (0.2; 1.0; 1.5). Paired Amplicor and hc2 results were compared for the detection of 2-year cumulative cervical intraepithelial neoplasia (CIN) grade 3 and more severe disease outcomes (CIN3+) and for the detection of 13 targeted carcinogenic HPV types. Amplicor at the 0.2 cutoff had a higher sensitivity for the detection of CIN3+ (95.8% vs 92.6%, p=0.01) but a much lower specificity (38.9% vs. 50.6%, p<0.001) than hc2. Amplicor at the 1.5 cutoff had an identical sensitivity for the detection of CIN3+ (92.6%) and a slightly lower specificity (47.5%), p<0.001). The positive predictive value of hc2 was higher at all Amplicor cutoffs, while referral rates were significantly lower (53.2% for hc2 vs. 64.1% at the 0.2 cutoff and 56.0% at the 1.5 cutoff, p<0.001). Amplicor was more analytically specific for detecting targeted carcinogenic HPV types than hc2. Amplicor at the 1.5 cutoff had comparable performance to hc2. While Amplicor missed more disease related to non-targeted types, hc2 was more likely to miss disease related to targeted types. PMID:19423515

Wentzensen, Nicolas; Gravitt, Patti E.; Solomon, Diane; Wheeler, Cosette M.; Castle, Philip E.

2009-01-01

234

Prediction scores or gastroenterologists’ Gut Feeling for triaging patients that present with acute upper gastrointestinal bleeding  

PubMed Central

Introduction Several prediction scores for triaging patients with upper gastrointestinal (GI) bleeding have been developed, yet these scores have never been compared to the current gold standard, which is the clinical evaluation by a gastroenterologist. The aim of this study was to assess the added value of prediction scores to gastroenterologists’ Gut Feeling in patients with a suspected upper GI bleeding. Methods We prospectively evaluated Gut Feeling of senior gastroenterologists and asked them to estimate: (1) the risk that a clinical intervention is needed; (2) the risk of rebleeding; and (3) the risk of mortality in patients presenting with suspected upper GI bleeding, subdivided into low, medium, or high risk. The predictive value of the gastroenterologists’ Gut Feeling was compared to the Blatchford and Rockall scores for various outcomes. Results We included 974 patients, of which 667 patients (68.8%) underwent a clinical intervention. During the 30-day follow up, 140 patients (14.4%) developed recurrent bleeding and 44 patients (4.5%) died. Gut Feeling was independently associated with all studied outcomes, except for the predicted mortality after endoscopy. Predictive power, based on the AUC of the Blatchford and Rockall prediction scores, was higher than the Gut Feeling of the gastroenterologists. However, combining both the Blatchford and Rockall scores and the Gut Feeling yielded the highest predictive power for the need of an intervention (AUC 0.88), rebleeding (AUC 0.73), and mortality (AUC 0.71 predicted before and 0.77 predicted after endoscopy, respectively). Conclusions Gut Feeling is an independent predictor for the need of a clinical intervention, rebleeding, and mortality in patients presenting with upper GI bleeding; however, the Blatchford and Rockall scores are stronger predictors for these outcomes. Combining Gut Feeling with the Blatchford and Rockall scores resulted in the most optimal prediction. PMID:25360303

van Oijen, MGH; Kessels, K; Hemmink, M; Weusten, BLAM; Timmer, R; Hazen, WL; van Lelyveld, N; Vermeijden, JR; Curvers, WL; Baak, LC; Verburg, R; Bosman, JH; de Wijkerslooth, LRH; de Rooij, J; Venneman, NG; Pennings, M; van Hee, K; Scheffer, RCH; van Eijk, RL; Meiland, R; Siersema, PD; Bredenoord, AJ

2014-01-01

235

The effect of a charted history of depression on emergency department triage and outcomes in patients with acute myocardial infarction  

PubMed Central

Background Patients with acute myocardial infarction may have worse outcomes if they also have a history of depression. The early management of acute myocardial infarction is known to influence outcomes, and patients with a coexisting history of depression may be treated differently in the emergency department than those without one. Our goal was to determine whether having a charted history of depression was associated with a lower-priority emergency department triage score and worse performance on quality-of-care indices. Methods We conducted a retrospective population-based cohort analysis involving patients with acute myocardial infarction admitted to 96 acute care hospitals in the province of Ontario from April 2004 to March 2005. We calculated the adjusted odds of low-priority triage (Canadian Emergency Department Triage and Acuity Scale score of 3, 4 or 5) for patients with acute myocardial infarction who had a charted history of depression. We compared these odds with those for patients having a charted history of asthma or chronic obstructive pulmonary disease (COPD). Secondary outcome measures were the odds of meeting benchmark door-to-electrocardiogram, door-to-needle and door-to-balloon times. Results Of 6784 patients with acute myocardial infarction, 680 (10.0%) had a past medical history of depression documented in their chart. Of these patients, 39.1% (95% confidence interval [CI] 35.3%–42.9%) were assigned a low-priority triage score, as compared with 32.7% (95% CI 31.5%–33.9%) of those without a charted history of depression. The adjusted odds of receiving a low-priority triage score with a charted history of depression were 1.26 (p = 0.01) versus 0.88 (p = 0.23) with asthma and 1.12 (p = 0.24) with COPD. For patients with a charted history of depression, the median door-to-electrocardiogram time was 20.0 minutes (v. 17.0 min for the rest of the cohort), median door-to-needle time was 53.0 (v. 37.0) minutes, and median door-to-balloon time was 251.0 (v. 110.0) minutes. The adjusted odds of missing the benchmark time with a charted history of depression were 1.39 (p < 0.001) for door-to-electrocardiogram time, 1.62 (p = 0.047) for door-to-needle time and 9.12 (p = 0.019) for door-to-balloon time. Interpretation Patients with acute myocardial infarction who had a charted history of depression were more likely to receive a low-priority emergency department triage score than those with other comorbidities and to have worse associated performance on quality indicators in acute myocardial infarction care. PMID:21398248

Atzema, Clare L.; Schull, Michael J.; Tu, Jack V.

2011-01-01

236

EDs credit drills, community engagement with helping them manage casualties from tornado crises.  

PubMed

Emergency department leaders at DCH Regional Medical Center in Tuscaloosa, AL, and Cullman Regional Medical Center in Cullman, AL, credit their regular practice drills with helping them deal with unprecedented demand when deadly tornadoes swept through the South this past April. Both facilities used the hospital instant command structure (HICS) to mobilize the resources needed to care for the surge in patients, and say the approach worked well in helping them meet the needs of their communities. However, the crises also showcased opportunities for improvement. The ED at DCH Regional Medical Center saw more than 600 patients on the day of the storm, a three-fold increase in the hospital's typical volume. CRMC treated 99 patients in the seven hours immediately following the storm when it usually treats 114 patients per day. In addition to a big surge in patients, both hospitals dealt with power outages that limited access to some services such as radiology. Triage proved particularly challenging at DCH Regional Medical Center, as patients flowed into the hospital from numerous access points. The hospital plans to assign coordinators to each area of the hospital to better manage the influx in the future. When reviewing emergency operations plans, Joint Commission reviewers often find deficiencies in hazard vulnerability analyses as well as the processes used to determine the emergency credentials of licensed independent practitioners. PMID:21749003

2011-07-01

237

Dentistry and mass disaster - a review.  

PubMed

Mass disaster situations may arise from natural or manmade circumstances like bioterrorism and dentists or dental responders have significant roles in human identification, following such occurrences. The various roles of dentists in mass disaster management, that include bio surveillance and notification, diagnosis and monitoring, triage, referrals of patients, immunizations, decontamination and infection control would be considered. The varying extents of use of forensic dental techniques and the resulting positive impacts made on human identification will also be included. The importance of preparation by way of special training for the dental personnel, mass disaster rehearsal, and use of modern day technology will be stressed on. PMID:25177658

Nathan, Mark David Edward; Sakthi, D Sri

2014-07-01

238

Mutation, radiation, and species survival: The genetics studies of the Atomic Bomb Casualty Commission in Hiroshima and Nagasaki, Japan  

Microsoft Academic Search

This is an analysis of the work of the Atomic Bomb Casualty Commission, an American agency which studied the effects of radiation on survivors of the atomic bombings at Hiroshima and Nagasaki, Japan, 1947-1975. Funded by the U.S. Atomic Energy Commission and directed by the National Academy of Sciences-National Research Council, the ABCC was the largest and longest medical study

Lindee

1990-01-01

239

Impact of the ABCDE triage in primary care emergency department on the number of patient visits to different parts of the health care system in Espoo City  

PubMed Central

Background Many Finnish emergency departments (ED) serve both primary and secondary health care patients and are therefore referred to as combined emergency departments. Primary care doctors are responsible for the initial assessment and treatment. They, thereby, also regulate referral and access to secondary care. Primary health care EDs are easy for the public to access, leading to non-acute patient visits to the emergency department. This has caused increased queues and unnecessary difficulties in providing immediate treatment for urgent patients. The primary aim of this study was to assess whether the flow of patients was changed by implementing the ABCDE-triage system in the EDs of Espoo City, Finland. Methods The numbers of monthly visits to doctors were recorded before and after intervention in Espoo primary care EDs. To study if the implementation of the triage system redirects patients to other health services, the numbers of monthly visits to doctors were also scored in the private health care, the public sector health services of Espoo primary care during office hours and local secondary health care ED (Jorvi hospital). A face-to-face triage system was applied in the primary care EDs as an attempt to provide immediate treatment for the most acute patients. It is based on the letters A (patient sent directly to secondary care), B (to be examined within 10 min), C (to be examined within 1 h), D (to be examined within 2 h) and E (no need for immediate treatment) for assessing the urgency of patients' treatment needs. The first step was an initial patient assessment by a health care professional (triage nurse). The introduction of this triage system was combined with information to the public on the "correct" use of emergency services. Results After implementation of the ABCDE-triage system the number of patient visits to a primary care doctor decreased by up to 24% (962 visits/month) as compared to the three previous years in the EDs. The Number of visits to public sector GPs during office hours did not alter. Implementation of ABCDE-triage combined with public guidance was associated with decreased total number of doctor visits in public health care. During same period, the number of patient visits in the private health care increased. Simultaneously, the number of doctor visits in secondary health care ED did not alter. Conclusions The present ABCDE-triage system combined with public guidance may reduce patient visits to primary health care EDs but not to the secondary health care EDs. Limiting the access of less urgent patients to ED may redirect the demands of patients to private sector rather than office hours GP services. PMID:22217300

2012-01-01

240

Global earthquake casualties due to secondary effects: A quantitative analysis for improving rapid loss analyses  

USGS Publications Warehouse

This study presents a quantitative and geospatial description of global losses due to earthquake-induced secondary effects, including landslide, liquefaction, tsunami, and fire for events during the past 40 years. These processes are of great importance to the US Geological Survey's (USGS) Prompt Assessment of Global Earthquakes for Response (PAGER) system, which is currently being developed to deliver rapid earthquake impact and loss assessments following large/significant global earthquakes. An important question is how dominant are losses due to secondary effects (and under what conditions, and in which regions)? Thus, which of these effects should receive higher priority research efforts in order to enhance PAGER's overall assessment of earthquakes losses and alerting for the likelihood of secondary impacts? We find that while 21.5% of fatal earthquakes have deaths due to secondary (non-shaking) causes, only rarely are secondary effects the main cause of fatalities. The recent 2004 Great Sumatra-Andaman Islands earthquake is a notable exception, with extraordinary losses due to tsunami. The potential for secondary hazards varies greatly, and systematically, due to regional geologic and geomorphic conditions. Based on our findings, we have built country-specific disclaimers for PAGER that address potential for each hazard (Earle et al., Proceedings of the 14th World Conference of the Earthquake Engineering, Beijing, China, 2008). We will now focus on ways to model casualties from secondary effects based on their relative importance as well as their general predictability. ?? Springer Science+Business Media B.V. 2009.

Marano, K.D.; Wald, D.J.; Allen, T.I.

2010-01-01

241

Improving PAGER's real-time earthquake casualty and loss estimation toolkit: a challenge  

USGS Publications Warehouse

We describe the on-going developments of PAGER’s loss estimation models, and discuss value-added web content that can be generated related to exposure, damage and loss outputs for a variety of PAGER users. These developments include identifying vulnerable building types in any given area, estimating earthquake-induced damage and loss statistics by building type, and developing visualization aids that help locate areas of concern for improving post-earthquake response efforts. While detailed exposure and damage information is highly useful and desirable, significant improvements are still necessary in order to improve underlying building stock and vulnerability data at a global scale. Existing efforts with the GEM’s GED4GEM and GVC consortia will help achieve some of these objectives. This will benefit PAGER especially in regions where PAGER’s empirical model is less-well constrained; there, the semi-empirical and analytical models will provide robust estimates of damage and losses. Finally, we outline some of the challenges associated with rapid casualty and loss estimation that we experienced while responding to recent large earthquakes worldwide.

Jaiswal, K.S.; Wald, D.J.

2012-01-01

242

Brachial plexus injury management in military casualties: who, what, when, why, and how.  

PubMed

The Global War on Terrorism has achieved an unprecedented 90% casualty survival rate because of far forward surgical support, rapid transport, and body armor. Despite the remarkable protection body armor affords, peripheral nerve injuries continue to occur. The brachial plexus in particular is still susceptible to penetrating trauma through the axilla as well as blunt mechanisms. We report 1,818 individuals with reported cases of peripheral nerve injury, 97 of which had brachial plexus injury incident from Operation Iraqi Freedom and Operation Enduring Freedom. We suspect that true prevalence is higher as initial focus on vascular and orthopedic reconstruction in complex shoulder injuries may overlook brachial plexus lesions. Accordingly, emergency physicians, general and orthopedic trauma surgeons, and vascular surgeons should all consider the possibility of brachial plexus and other peripheral nerve injury for early and appropriate referral to surgeons (plastic, orthopedic, or neurosurgical) for further evaluation and reconstruction. The latter group should be familiar with appropriate modern diagnostic and initial as well as salvage therapeutic options. PMID:24902131

Chambers, James A; Hiles, Claire L; Keene, Brian P

2014-06-01

243

[Formation of therapeutic group of casualties in local wars and armed conflicts].  

PubMed

The necessity of improvement of the therapeutic care organization in the RF Armed Forces is dictated by the existing military threats. Conflicts between states or within a single country along with inefficiency of diplomatic, social and political efforts may lead to armed conflicts or local wars. Analysis of medical support results shows the consistent prevalence of therapeutic group of casualties in the overall structure of medical losses. 35-50% of all sanitary losses is accounted for by somatic diseases. Moreover, their structure is similar to the structure of the army's peacetime morbidity rate. Respiratory diseases head the list of somatic diseases in military personnel. Next--diseases of the digestive and circulatory systems. One of the most important tasks for physicians in wartime is early diagnosis and treatment of visceral pathology in the wounded. An additional point is that the use of tactical nuclear weapons during the armed conflict or local war cannot be completely excluded. There is also a real risk of nuclear and chemical facilities damage, with consequences that are comparable to the use of nuclear or chemical weapons. Thus, in the course of armed conflict or local war, military physicians can meet all possible therapeutic spectrum of pathology: from visceral pathology of peace and wartime to combat related therapeutic pathology. PMID:23156105

Khalimov, Iu Sh; Tkachuk, N A; Zhekalov, A N

2012-09-01

244

Performance and reliability of the CPB/ECMO Initiative Forward Lines Casualty Management System.  

PubMed

The Cleveland Clinic Foundation CPB/ECMO Initiative Forward Casualty Management System is an economical, compact, transportable, disposable system designed to permit a rapid expansion of trauma management services requiring cardiopulmonary bypass (CPB) or extracorporeal membrane oxygenation (ECMO) pulmonary support. The system, composed of a rotary blood pump, a pump motor driver, and an electronic control console as the blood pumping subsystem, also includes commonly used compatible commercial oxygenators, venous reservoirs, and cannulae. In vitro durability testing accumulated over 100 hours without failure. In vivo reliability was tested in 10 calves under general anesthesia during 6 hours of CPB and ECMO under full heparinization at nominal operating conditions of 4-5 l/min and 2-4 l/min blood flow respectively, and mean arterial pressures between 65 and 100 mm Hg. A mean time to failure of 57 hours was reached during the animal series. Results of these test series demonstrated that this system has the capability to reliably operate during a 6-hour conventional CPB or ECMO procedure, while providing flexibility and ease of use for the operator. PMID:16340350

Casas, Fernando; Reeves, Andrew; Dudzinski, David; Weber, Stephan; Lorenz, Markus; Akiyama, Masatoshi; Kamohara, Keiji; Kopcak, Michael; Ootaki, Yoshio; Zahr, Firas; Sinkewich, Martin; Foster, Robert; Fukamachi, Kiyotaka; Smith, William A

2005-01-01

245

Advances in a framework to compare bio-dosimetry methods for triage in large-scale radiation events.  

PubMed

Planning and preparation for a large-scale nuclear event would be advanced by assessing the applicability of potentially available bio-dosimetry methods. Using an updated comparative framework the performance of six bio-dosimetry methods was compared for five different population sizes (100-1,000,000) and two rates for initiating processing of the marker (15 or 15,000 people per hour) with four additional time windows. These updated factors are extrinsic to the bio-dosimetry methods themselves but have direct effects on each method's ability to begin processing individuals and the size of the population that can be accommodated. The results indicate that increased population size, along with severely compromised infrastructure, increases the time needed to triage, which decreases the usefulness of many time intensive dosimetry methods. This framework and model for evaluating bio-dosimetry provides important information for policy-makers and response planners to facilitate evaluation of each method and should advance coordination of these methods into effective triage plans. PMID:24729594

Flood, Ann Barry; Boyle, Holly K; Du, Gaixin; Demidenko, Eugene; Nicolalde, Roberto J; Williams, Benjamin B; Swartz, Harold M

2014-06-01

246

MicroRNA Detection in Cervical Exfoliated Cells as a Triage for Human Papillomavirus–Positive Women  

PubMed Central

Background Papanicolaou (Pap) triage, with high specificity, has been recommended for primary Human papillomavirus (HPV) testing but is flawed by poor sensitivity and cytologist dependence. We evaluated the potential role of microRNA (miRNA) detection in cervical exfoliated cells in HPV-positive women from a clinic-based population. Methods Primary HPV testing as well as Pap test were performed on all eligible women. Six miRNAs (miR-424/miR-375/miR-34a/miR-218/miR-92a/miR-93) were detected by RT-qPCR in cervical exfoliated cells. All HPV-positive women underwent colposcopy and further biopsy if indicated. Mann–Whitney U test, the receiver operating characteristic curve, logistic regression, and Pearson’s Chi-square were used to assess data. All tests of statistical significance were two-sided. Results A total of 1021 eligible HPV-positive women were enrolled. The expression of miR-424/miR-375/miR-34a/miR-218 in high-grade cervical intraepithelial neoplasia (CIN) and abnormal cytology was statistically significantly lower than that in low-grade CIN and normal cytology, respectively (all P < .05). Compared with the Pap test, both miR-424 and miR-375 detection achieved higher sensitivity (76.0% and 74.9% vs 63.8%, P < .05), higher negative predictive value (NPV) (85.7% and 85.4% vs 79.3%, P < .05), and comparable specificity while identifying CIN2 or worse (CIN2+). Similar results were achieved while identifying CIN3+. Multi-marker panels based on miR-424, miR-375, and miR-218 further improved the performance over any single miRNA test or Pap test. Conclusion Single miR-424 or miR-375 detection and miR-424/miR-375/miR-218–based multimarker panels in cervical exfoliated cells show superior performance over Pap triage for high-grade CIN identification in a clinic-based population. Detection of miRNA may provide a new triage option for HPV-positive women. PMID:25190727

Tian, Qifang; Li, Yang; Wang, Fenfen; Li, Ying; Xu, Junfen; Shen, Yuanming; Ye, Feng; Wang, Xinyu; Cheng, Xiaodong; Chen, Yaxia; Wan, Xiaoyun; Lu, Weiguo

2014-01-01

247

Facilitating Real-time Triage of Astronomical Data with Open Source Software  

NASA Astrophysics Data System (ADS)

Relatively bright, millisecond-duration pulses of radio-frequency energy have been discovered recently at the Parkes radio telescope in Australia. These Fast Radio Bursts (FRBs) have properties consistent with extragalactic origin, and they may represent the discovery of a completely new class of astronomical objects. Models for the generation of these events are poorly constrained, in part because the Parkes radio telescope can locate the direction of the pulses to about 15 arcminute (60 arcminutes = 1 degree) precision. The Very Long Baseline Array (VLBA) is a network of 10 telescopes distributed across the United States. If it were to detect such a pulse, it could provide exceptionally precise localization of the pulse's direction (to better than a nanoradian), thus allowing possible identification of the celestial object from which the pulse originated. The challenge is that the data rate from the VLBA antennas can be as large as 20 Gb/s, and the VLBA was not designed to store the data from the individual antennas for any significant length of time. The VLBA Fast Radio Transients (V-FASTR) experiment has developed a real-time, scalable data 'triage' system that makes use of algorithms capable of discovering meaningful signals, and open source code stewarded at the Apache Software Foundation. This system is designed to identify potential FRBs during real-time processing of the VLBA data stream, save only the relevant bits for further (off-line) processing, and curate the data products. As such, the V-FASTR experiment exemplifies the software design for a distributed sensor network that generates data at rates requiring real-time or near-real-time processing. Building flexible portals and applications has become vital with the constantly expanding astronomical data. The V-FASTR collaborative review portal is built using the Apache OODT Balance framework due to the ease at which it integrates with the flexible search capabilities of Apache Solr. We utilize Apache OODT to dump metadata information about each V-FASTR candidate detection from the File Management service into Apache Solr to make data available for inspection through our web portal. Scientists log into the portal daily to either discard spurious detections or preserve interesting ones for follow-up. The Apache OODT Curator provides the service for updating the File Manager catalog (and ultimately Solr on resync) based on the tagging and collaborative review that occurs using the V-FASTR portal. V-FASTR has leveraged open source solutions to effectively and quickly build and deploy an operational software system to handle the large data set produced by VLBA. Our solutions are not specific to the astronomical domain, as shown by the adoption in a number of other science domains including Earth, planetary, and biomedicine that are using similar Open Source software technologies.

Khudikyan, S.; Mattmann, C. A.; Cinquini, L.; Hart, A. F.; Thompson, D. R.; Wagstaff, K.; Burke-Spolaor, S.; Tingay, S.; Wayth, R.; Deller, A.; Majid, W.; Lazio, J.; Jones, D. L.

2013-12-01

248

Patient safety culture in Norwegian primary care: A study in out-of-hours casualty clinics and GP practices  

PubMed Central

Abstract Objective. This study aimed to investigate patient safety attitudes amongst health care providers in Norwegian primary care by using the Safety Attitudes Questionnaire, in both out-of-hours (OOH) casualty clinics and GP practices. The questionnaire identifies five major patient safety factors: Teamwork climate, Safety climate, Job satisfaction, Perceptions of management, and Working conditions. Design. Cross-sectional study. Statistical analysis included multiple linear regression and independent samples t-tests. Setting. Seven OOH casualty clinics and 17 GP practices in Norway. Subjects. In October and November 2012, 510 primary health care providers working in OOH casualty clinics and GP practices (316 doctors and 194 nurses) were invited to participate anonymously. Main outcome measures. To study whether patterns in patient safety attitudes were related to professional background, gender, age, and clinical setting. Results. The overall response rate was 52%; 72% of the nurses and 39% of the doctors answered the questionnaire. In the OOH clinics, nurses scored significantly higher than doctors on Safety climate and Job satisfaction. Older health care providers scored significantly higher than younger on Safety climate and Working conditions. In GP practices, male health professionals scored significantly higher than female on Teamwork climate, Safety climate, Perceptions of management and Working conditions. Health care providers in GP practices had significant higher mean scores on the factors Safety climate and Working conditions, compared with those working in the OOH clinics. Conclusion. Our study showed that nurses scored higher than doctors, older health professionals scored higher than younger, male GPs scored higher than female GPs, and health professionals in GP practices scored higher than those in OOH clinics – on several patient safety factors. PMID:25263763

Hofoss, Dag; Hansen, Elisabeth Holm; Deilkås, Ellen Catharina Tveter

2014-01-01

249

Are you bleeding? Validation of a machine-learning algorithm for determination of blood volume status: application to remote triage.  

PubMed

Due to limited remote triage monitoring capabilities, combat medics cannot currently distinguish bleeding soldiers from those engaged in combat unless they have physical access to them. The purpose of this study was to test the hypothesis that low-level physiological signals can be used to develop a machine-learning algorithm for tracking changes in central blood volume that will subsequently distinguish central hypovolemia from physical activity. Twenty-four subjects underwent central hypovolemia via lower body negative pressure (LBNP), and a supine-cycle exercise protocol. Exercise workloads were determined by matching heart rate responses from each LBNP level. Heart rate and stroke volume (SV) were measured via Finometer. ECG, heat flux, skin temperature, galvanic skin response, and two-axis acceleration were obtained from an armband (SenseWear Pro2) and used to develop a machine-learning algorithm to predict changes in SV as an index of central blood volume under both conditions. The algorithm SV was retrospectively compared against Finometer SV. A model was developed to determine whether unknown data points could be correctly classified into these two conditions using leave-one-out cross-validation. Algorithm vs. Finometer SV values were strongly correlated for LBNP in individual subjects (mean r = 0.92; range 0.75-0.98), but only moderately correlated for exercise (mean r = 0.50; range -0.23-0.87). From the first level of LBNP/exercise, the machine-learning algorithm was able to distinguish between LBNP and exercise with high accuracy, sensitivity, and specificity (all ?90%). In conclusion, a machine-learning algorithm developed from low-level physiological signals could reliably distinguish central hypovolemia from exercise, indicating that this device could provide battlefield remote triage capabilities. PMID:24408992

Rickards, Caroline A; Vyas, Nisarg; Ryan, Kathy L; Ward, Kevin R; Andre, David; Hurst, Gennifer M; Barrera, Chelsea R; Convertino, Victor A

2014-03-01

250

Methylphenidate intoxications in children and adults: exposure circumstances and evidence-based dose threshold for pre-hospital triage.  

PubMed

Abstract Context. Methylphenidate intoxications mostly have a relatively mild course, although serious complications can occur. Objective. We aimed to characterize methylphenidate exposures and reassess our current dose threshold for hospital referral (2 mg/kg). Methods. In a prospective follow-up study, we analysed 364 consecutive methylphenidate exposures that were reported to the Dutch Poisons Information Center. Patients and/or physicians were surveyed by telephone using standardized questionnaires. Three physicians independently scored the observed severity of the intoxication of each patient as 'no/mild' (observation at home) or 'moderate/severe' (hospital referral necessary). Results. Unintentional exposures (40%) mostly occurred at home involving the patients' own medication or those from a family member. Compared to unintentionally exposed patients, intentionally exposed patients were exposed to relatively high methylphenidate doses (3.1 vs 1.6 mg/kg), more often used immediate release methylphenidate formulations (62 vs 34%) and more frequently had concomitant exposures (71 vs 17%). Severe symptoms like convulsions or coma were reported only in patients with concomitant exposures. Following exposure to methylphenidate only (i.e. no concomitant exposures), the most commonly reported symptoms were dry mucosa, headache, agitation, sleepiness and tachycardia. Our results show that the reported methylphenidate dose is predictive of the observed severity of the intoxication and can therefore aid in pre-hospital triage. Conclusion. We increased our current dose threshold for hospital referral from 2 to 3 mg/kg. In addition, we will refer patients at lower doses when clinical symptoms indicate the need for hospital referral. Application of this new dose threshold optimizes triage, thereby reducing unnecessary hospital referral and thus costs, without jeopardising patient safety. PMID:25650984

Hondebrink, Laura; Rietjens, Saskia J; Hunault, Claudine C; Pereira, Rob R; Kelleci, Nuriye; Yasar, Gulhan; Ghebreslasie, Ariam; Lo-A-Foe, Cindy; De Vries, Irma; Meulenbelt, Jan

2015-03-01

251

A Promising DNA Methylation Signature for the Triage of High-Risk Human Papillomavirus DNA-Positive Women  

PubMed Central

High-risk human papillomavirus (hrHPV)-DNA testing is frequently performed parallel to cytology for the detection of high-grade dysplasia and cervical cancer particularly in women above 30 years of age. Although highly sensitive, hrHPV testing cannot distinguish between HPV-positive women with or without clinically relevant lesions. However, in principle discrimination is possible on the basis of DNA methylation markers. In order to identify novel DNA regions which allow an effective triage of hrHPV-positive cases, hypermethylated DNA enriched from cervical cancers was compared with that from cervical scrapes of HPV16-positive cases with no evidence for disease by CpG island microarray hybridization. The most promising marker regions were validated by quantitative methylation-specific PCR (qMSP) using DNA from archived cervical tissues and cervical scrapes. The performance of these markers was then determined in an independent set of 217 hrHPV-positive cervical scrapes from outpatients with histopathological verification. A methylation signature comprising the 5? regions of the genes DLX1, ITGA4, RXFP3, SOX17 and ZNF671 specific for CIN3 and cervical cancer (termed CIN3+) was identified and validated. A high detection rate of CIN3+ was obtained if at least 2 of the 5 markers were methylated. In the subsequent cross-sectional study all cervical carcinomas (n?=?19) and 56% (13/23) of CIN3 were identified by this algorithm. Only 10% (11/105) of hrHPV-positive women without histological evidence of cervical disease were scored positive by the methylation assay. Of note is that the detection rate of CIN3 differed between age groups. Eight of nine CIN3 were detected among women ?30 years of age but only five of fourteen among <30 year old group (p?=?0.03). The specificity for CIN3+ in the older age group was 76.6% (95% CI 65.6–85.5%). Clinical validation studies are required to determine the usefulness of these novel markers for triage after primary hrHPV testing in a cervical cancer screening setting. PMID:24647315

Hansel, Alfred; Steinbach, Daniel; Greinke, Christiane; Schmitz, Martina; Eiselt, Juliane; Scheungraber, Cornelia; Gajda, Mieczyslaw; Hoyer, Heike; Runnebaum, Ingo B.; Dürst, Matthias

2014-01-01

252

A promising DNA methylation signature for the triage of high-risk human papillomavirus DNA-positive women.  

PubMed

High-risk human papillomavirus (hrHPV)-DNA testing is frequently performed parallel to cytology for the detection of high-grade dysplasia and cervical cancer particularly in women above 30 years of age. Although highly sensitive, hrHPV testing cannot distinguish between HPV-positive women with or without clinically relevant lesions. However, in principle discrimination is possible on the basis of DNA methylation markers. In order to identify novel DNA regions which allow an effective triage of hrHPV-positive cases, hypermethylated DNA enriched from cervical cancers was compared with that from cervical scrapes of HPV16-positive cases with no evidence for disease by CpG island microarray hybridization. The most promising marker regions were validated by quantitative methylation-specific PCR (qMSP) using DNA from archived cervical tissues and cervical scrapes. The performance of these markers was then determined in an independent set of 217 hrHPV-positive cervical scrapes from outpatients with histopathological verification. A methylation signature comprising the 5' regions of the genes DLX1, ITGA4, RXFP3, SOX17 and ZNF671 specific for CIN3 and cervical cancer (termed CIN3+) was identified and validated. A high detection rate of CIN3+ was obtained if at least 2 of the 5 markers were methylated. In the subsequent cross-sectional study all cervical carcinomas (n?=?19) and 56% (13/23) of CIN3 were identified by this algorithm. Only 10% (11/105) of hrHPV-positive women without histological evidence of cervical disease were scored positive by the methylation assay. Of note is that the detection rate of CIN3 differed between age groups. Eight of nine CIN3 were detected among women ?30 years of age but only five of fourteen among <30 year old group (p?=?0.03). The specificity for CIN3+ in the older age group was 76.6% (95% CI 65.6-85.5%). Clinical validation studies are required to determine the usefulness of these novel markers for triage after primary hrHPV testing in a cervical cancer screening setting. PMID:24647315

Hansel, Alfred; Steinbach, Daniel; Greinke, Christiane; Schmitz, Martina; Eiselt, Juliane; Scheungraber, Cornelia; Gajda, Mieczyslaw; Hoyer, Heike; Runnebaum, Ingo B; Dürst, Matthias

2014-01-01

253

Optically stimulated luminescence (OSL) of tooth enamel and its potential use in post-radiation exposure triage.  

PubMed

Optically stimulated luminescence (OSL) properties of dental enamel are discussed with a view to the development of an in vivo dose assessment technique for medical triage following a radiological/nuclear accident or terrorist event. In the OSL technique, past radiation exposure is assessed by stimulating the sample with light of one wavelength and monitoring the luminescence at another wavelength, under the assumption that the luminescence originates from the recombination of radiation-induced charges trapped at metastable defects in the enamel and that the intensity of the luminescence signal is in proportion to the absorbed radiation dose. Several primary findings emerged from this research: (a) sensitivities varied considerably between different teeth and also between fragments of the same tooth, (b) OSL signals were found to decay rapidly during the first 12 h after irradiation and more slowly afterward, (c) the fading rate of the luminescence signal varied between fragments, and (d) blue light stimulation yields greater sensitivity than infra-red stimulation, while the OSL signal obtained with a high-intensity pulsed green-light laser was found not to be correlated with the radiation dose. Significant challenges remain to developing a practical in vivo technique, including the development of calibration procedures and lowering minimum detectable doses. PMID:20065717

Dewitt, R; Klein, D M; Yukihara, E G; Simon, S L; McKeever, S W S

2010-02-01

254

High-Content Phenotypic Screening and Triaging Strategy to Identify Small Molecules Driving Oligodendrocyte Progenitor Cell Differentiation.  

PubMed

Multiple Sclerosis is a demyelinating disease of the CNS and the primary cause of neurological disability in young adults. Loss of myelinating oligodendrocytes leads to neuronal dysfunction and death and is an important contributing factor to this disease. Endogenous oligodendrocyte precursor cells (OPCs), which on differentiation are responsible for replacing myelin, are present in the adult CNS. As such, therapeutic agents that can stimulate OPCs to differentiate and remyelinate demyelinated axons under pathologic conditions may improve neuronal function and clinical outcome. We describe the details of an automated, cell-based, morphometric-based, high-content screen that is used to identify small molecules eliciting the differentiation of OPCs after 3 days. Primary screening was performed using rat CG-4 cells maintained in culture conditions that normally support a progenitor cell-like state. From a library of 73,000 diverse small molecules within the Sanofi collection, 342 compounds were identified that increased OPC morphological complexity as an indicator of oligodendrocyte maturation. Subsequent to the primary high-content screen, a suite of cellular assays was established that identified 22 nontoxic compounds that selectively stimulated primary rat OPCs but not C2C12 muscle cell differentiation. This rigorous triaging yielded several chemical series for further expansion and bio- or cheminformatics studies, and their compelling biological activity merits further investigation. PMID:25394729

Peppard, Jane V; Rugg, Catherine A; Smicker, Matthew A; Powers, Elaine; Harnish, Erica; Prisco, Joy; Cirovic, Dragan; Wright, Paul S; August, Paul R; Chandross, Karen J

2014-11-13

255

Human papillomavirus testing 2007-2012: Co-testing and triage utilization and impact on subsequent clinical management.  

PubMed

In the United States, high-risk human papillomavirus (HPV) testing is recommended for women with atypical squamous cells of unknown significance (ASC-US) cytology, and co-testing with cytology and HPV is a recommended option for screening women aged ?30 years. No population-based data are available to examine utilization of HPV testing in the United States. Using the New Mexico HPV Pap Registry data resource, we describe population trends (2007-2012) in utilization and positivity rates for HPV testing as a routine co-testing screening procedure and for triage of ASC-US and other cytologic outcomes. For women aged 30-65 years co-testing increased from 5.2% in 2007 to 19.1% in 2012 (p?

Cuzick, Jack; Myers, Orrin; Hunt, William C; Saslow, Debbie; Castle, Philip E; Kinney, Walter; Waxman, Alan; Robertson, Michael; Wheeler, Cosette M

2014-11-19

256

Efficacy of multi-detector coronary computed tomography angiography in comparison with exercise electrocardiogram in the triage of patients of low risk acute chest pain  

PubMed Central

Objectives To compare the safety and diagnostic efficacy of coronary computed tomography angiography (CTA) with exercise electrocardiography (XECG) in triaging patients of low risk acute chest pain. Background Noninvasive assessment of coronary stenosis by CTA may improve early and accurate triage of patients presenting with acute chest pain to the emergency department (ED). Methods Low risk patients of possible acute coronary syndrome (ACS) were included in the study. The patients in CTA arm with significant stenosis (?50%) underwent catheterization, while those with no or intermediate stenosis (<50%) were discharged from ED and followed up periodically for six months for major adverse cardiovascular events (MACE). The same protocol was applied for XECG arm. Outcomes included: safety and diagnostic efficacy. Results A total of 81 (41 CTA and 40 XECG) patients were enrolled. In this study CTA was observed to be 100% sensitive and 95.7% specific in diagnosing MACE in low risk patients of chest pain presenting to the ED, with a PPV of 94.7% and an NPV of 100%.The overall diagnostic efficacy was 97.6%. XECG was observed to be 72.7% sensitive and 96.6% specific in diagnosing MACE with a PPV of 88.9% and NPV of 90.3% in low risk chest pain patients presenting to the ED. The overall diagnostic accuracy was 90%. Conclusion CTA is an excellent diagnostic tool in ED patients with low risk of ACS, with minimum time delay as compared to XECG, and also is safe for triaging such patients. PMID:25173203

Nagori, M.; Narain, V.S.; Saran, R.K.; Dwivedi, S.K.; Sethi, R.

2014-01-01

257

Ultrasound in obstetric triage ? ? CNMs and CMs and midwifes as used herein refer to those practitioners who are certified by the American College of Nurse-Midwives (ACNM) or the ACNM Certification Council, Inc. (ACC); midwifery refers to the profession as practiced in accordance with the standards promulgated by the ACNM  

Microsoft Academic Search

The use of limited ultrasound as a tool in obstetric triage has become increasingly popular. While most midwives only perform ultrasound in the third trimester, some institutions do include earlier sonographic testing as part of the midwifery management plan. This article addresses the professional issues related to limited ultrasound in obstetric triage protocol, the education and training needed to acquire

Gwen Spears; Joyce Griffin

1999-01-01

258

Triage of Women with Minor Cervical Lesions: Data Suggesting a “Test and Treat” Approach for HPV E6/E7 mRNA Testing  

PubMed Central

Background Human papillomavirus (HPV) testing is included in the cervical cancer screening program in the triage of women with equivocal (ASC-US) or low-grade (LSIL) cytological lesions. These women have an increased risk for developing high grade dysplasia and cancer (CIN2+) compared to women with normal cytology. However, in order to avoid unnecessary follow-up, as well as overtreatment, a high positive predictive value (PPV) of the triage test is important. Methodology/Principal Findings The HPV test PreTect HPV-Proofer, detecting E6/E7 mRNA from the HPV types 16, 18, 31, 33 and 45, is used as triage test together with repeat cytology. PPV data for HPV E6/E7 mRNA testing during the period from January 2006 up to June 2009 are reported. In total, 406 of 2099 women (19.3%) had a positive HPV test result. Of the women with a positive test result and with a histological diagnosis (n?=?347), 243 women had histological high-grade dysplasia or cancer (CIN2+), giving a PPV of 70.0% (95% confidence interval [CI], 65.2%–74.8%). For HPV 16 or HPV 33 positive women above 40 years of age, the PPV was 83.7% (95% CI, 73.3%–94.0%) and 84.6% (95% CI, 65.0%–100.0%) respectively. The PPV of test positive women with HSIL cytology was 94.2% (95% CI, 88.7%–99.7%). Conclusions When the result in triage is HPV mRNA positive, our data suggest direct treatment for women above 40 years of age or for women with a concurrent cytological HSIL diagnosis, contributing to better clinical safety for these women. In addition, by decreasing the time to treatment, thereby reducing the number of recalls, the patient management algorithm will be considerably improved, in turn reducing follow-up costs as well as unnecessary psychological stress among patients. PMID:20856930

Sørbye, Sveinung Wergeland; Fismen, Silje; Gutteberg, Tore; Mortensen, Elin Synnøve

2010-01-01

259

Triage of oxidation-prone proteins by Sqstm1/p62 within the mitochondria  

SciTech Connect

Highlights: {yields} The mitochondrion contains its own protein quality control system. {yields} p62 localizes within the mitochondria and forms mega-dalton sized complexes. {yields} p62 interacts with oxidation-prone proteins and the proteins of quality control. {yields} In vitro delivery of p62 improves mitochondrial functions. {yields} p62 is implicated as a participant in mitochondrial protein quality control. -- Abstract: As the mitochondrion is vulnerable to oxidative stress, cells have evolved several strategies to maintain mitochondrial integrity, including mitochondrial protein quality control mechanisms and autophagic removal of damaged mitochondria. Involvement of an autophagy adaptor, Sqstm1/p62, in the latter process has been recently described. In the present study, we provide evidence that a portion of p62 directly localizes within the mitochondria and supports stable electron transport by forming heterogeneous protein complexes. Matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF) of mitochondrial proteins co-purified with p62 revealed that p62 interacts with several oxidation-prone proteins, including a few components of the electron transport chain complexes, as well as multiple chaperone molecules and redox regulatory enzymes. Accordingly, p62-deficient mitochondria exhibited compromised electron transport, and the compromised function was partially restored by in vitro delivery of p62. These results suggest that p62 plays an additional role in maintaining mitochondrial integrity at the vicinity of target machineries through its function in relation to protein quality control.

Lee, Minjung [Department of Molecular Cell Biology, Sungkyunkwan University School of Medicine and Samsung Biomedical Research Institute, Suwon-Si, Kyonggi-Do (Korea, Republic of)] [Department of Molecular Cell Biology, Sungkyunkwan University School of Medicine and Samsung Biomedical Research Institute, Suwon-Si, Kyonggi-Do (Korea, Republic of); Shin, Jaekyoon, E-mail: jkshin@med.skku.ac.kr [Department of Molecular Cell Biology, Sungkyunkwan University School of Medicine and Samsung Biomedical Research Institute, Suwon-Si, Kyonggi-Do (Korea, Republic of)] [Department of Molecular Cell Biology, Sungkyunkwan University School of Medicine and Samsung Biomedical Research Institute, Suwon-Si, Kyonggi-Do (Korea, Republic of)

2011-09-16

260

Influence of Age-Related Stature on the Frequency of Body Region Injury and Overall Injury Severity in Child Pedestrian Casualties  

Microsoft Academic Search

Objective. The current study aims to evaluate the influence of age-related stature on the frequency of body region injury and overall injury severity in children involved in pedestrian versus motor vehicle collisions (PMVCs).Methods. A trauma registry including the coded injuries sustained by 1,590 1- to 15-year-old pedestrian casualties treated at a level-one trauma center was categorized by stature-related age (1–3,

B. Johan Ivarsson; Jeff R. Crandall; Masayoshi Okamoto

2006-01-01

261

Minimizing casualties in biological and chemical threats (war and terrorism): the importance of information to the public in a prevention program.  

PubMed

The most effective means of defending against biological or chemical warfare, whether in war or as a result of terror, is the use of primary prevention. The main goal of such a prevention program is to minimize the human loss by reducing the number of casualties (fatalities, physical wounds, and psychological injury). A secondary objective is to prevent the widespread sense of helplessness in the general population. These two aims complement each other. The more the public is active in defending itself, rather than viewing itself as helpless, the lesser the expected number of casualties of any kind. In order to achieve these two goals, educating the civilian population about risk factors and pointing out appropriate defensive strategies is critical. In the absence of an effective prevention program and active participation by the public, there is a high risk for massive numbers of physical and psychological casualties. An essential ingredient of any preventive program, which ultimately may determine the success or failure of all other protective actions, is early, gradual dissemination of information and guidance to the public, so that citizens can become active participants in the program. The public needs to be given information concerning the nature of the threat and effective methods of coping with it, should an unconventional attack occur. Lack of such adaptive behavior (such as wearing protective gear) is likely to bring about vast numbers of physical and psychological casualties. These large numbers may burden the medical, political, and public safety systems beyond their ability to manage. Failure to provide reasonable prevention and effective interventions can lead to a destruction of the social and emotional fabric of individuals and the society. Furthermore, inadequate preparation, education, and communication can result in the development of damaging mistrust of the political and military leadership, disintegration of social and political structures, and perhaps, even risk the collapse of the democracy. PMID:15453157

Noy, Shabtai

2004-01-01

262

Disaster medicine through Google Glass.  

PubMed

Nontechnical skills can make a difference in the management of disasters and mass casualty incidents and any tool helping providers in action might improve their ability to respond to such events. Google Glass, released by Google as a new personal communication device, could play a role in this field. We recently tested Google Glass during a full-scale exercise to perform visually guided augmented-reality Simple Triage and Rapid Treatment triage using a custom-made application and to identify casualties and collect georeferenced notes, photos, and videos to be incorporated into the debriefing. Despite some limitations (battery life and privacy concerns), Glass is a promising technology both for telemedicine applications and augmented-reality disaster response support to increase operators' performance, helping them to make better choices on the field; to optimize timings; and finally represents an excellent option to take professional education to a higher level. PMID:25460812

Carenzo, Luca; Barra, Federico Lorenzo; Ingrassia, Pier Luigi; Colombo, Davide; Costa, Alessandro; Della Corte, Francesco

2014-11-27

263

Cost and logistics of alternative roll-out options for implementing human papillomavirus testing as a triage in cervical screening: results of the sentinel sites study  

PubMed Central

Background: Previous studies have indicated that human papillomavirus (HPV) testing as a triage for managing equivocal cytology is cost-effective. The aim of this study was to assess the costs of alternative roll-out options. Methods: Detailed cost estimates were collected from six laboratories where HPV triage had been implemented. Costs were assessed for the two different service delivery models that were implemented; a ‘hub and spoke model' of central HPV testing in a microbiology laboratory with separate cytology laboratories, and an ‘integrated model' where HPV testing was conducted within the cytology laboratory. Results: Comparison of alternative delivery models indicated that setting up HPV processing within existing cytology laboratory, i.e., an ‘integrated cytology/HPV laboratory' generated savings in staff time amounting to between £2.54 and 4.86 per sample processed. Running full HPV testing batches was also an important consideration. For full batches to be run on a twice weekly basis requires having no more than two laboratories per Strategic Health Authority. Conclusions: To be cost-efficient, and to meet turn-around times, HPV testing needs to be conducted at integrated cytology/HPV testing centres with sufficient throughput to run full batches of HPV tests. PMID:23037717

Legood, R; Sadique, Z; Patnick, J; Kitchener, H; Kelly, R; Moss, S

2012-01-01

264

Analysis of clothing and urine from Moscow theatre siege casualties reveals carfentanil and remifentanil use.  

PubMed

On October 26, 2002, Russian Special Forces deployed a chemical aerosol against Chechen terrorists to rescue hostages in the Dubrovka theatre. Its use confirmed Russian military interest in chemicals with effects on personnel and caused 125 deaths through a combination of the aerosol and inadequate medical care. This study provides evidence from liquid chromatography-tandem mass spectrometry analysis of extracts of clothing from two British survivors, and urine from a third survivor, that the aerosol comprised a mixture of two anaesthetics--carfentanil and remifentanil--whose relative proportions this study was unable to identify. Carfentanil and remifentanil were found on a shirt sample and a metabolite called norcarfentanil was found in a urine sample. This metabolite probably originated from carfentanil. PMID:23002178

Riches, James R; Read, Robert W; Black, Robin M; Cooper, Nicholas J; Timperley, Christopher M

2012-01-01

265

HPV DNA testing improves CIN2+ risk stratification and detection of CIN2+ in delayed triage of ASCUS and LSIL. A population-based follow-up study from Western Norway.  

PubMed

In Norway, Pap smears with atypical squamous cells of uncertain significance (ASCUS) and low-grade squamous intraepithelial lesions (LSIL) are triaged after 6 months. The aim of the study was to evaluate effects of implementing human papillomavirus (HPV) test (2005) in delayed triage of ASCUS and LSIL in a cohort of women from Western Norway. After a survey of 119,469 cervical Pap smears during 2005-2007, a total of 1055 women with an index ASCUS or LSIL were included in the study and followed up for 3-6 years with respect to progression into cervical intraepithelial neoplasia grade 2 or worse (CIN2+). Overall sensitivity for detection of CIN2+ with HPV testing and cytology was 96% and 72%, respectively. The sensitivity for detection of CIN2+ was not affected by age, but the specificity of the HPV test increased with age. Thus, for the age groups <34 years, 34-50 years, and >50 years, the specificity of a positive HPV test to detect CIN2+ was 47%, 71%, and 82%, respectively. Positive predictive values for CIN2+ in women with positive cytology, positive HPV test, negative cytology, negative HPV test, or negative HPV and cytology tests were 52%, 41%, 8%, 1.5%, and 0.4%, respectively. HPV testing resulted in a net 22% increased detection of CIN2+. Fifty-six percent of CIN2+ was detected at an earlier time point with HPV testing in triage. Implementation of HPV testing in delayed triage of ASCUS and LSIL improved the stratification of CIN2+ risk and increased CIN2+ detection and at an earlier time point than with triage by cytology alone. PMID:24403090

Budal, Elisabeth B; Haugland, Hans K; Skar, Robert; Maehle, Bjørn O; Bjørge, Tone; Vintermyr, Olav K

2014-02-01

266

Comparison of CATs, CURB-65 and PMEWS as Triage Tools in Pandemic Influenza Admissions to UK Hospitals: Case Control Analysis Using Retrospective Data  

PubMed Central

Triage tools have an important role in pandemics to identify those most likely to benefit from higher levels of care. We compared Community Assessment Tools (CATs), the CURB-65 score, and the Pandemic Medical Early Warning Score (PMEWS); to predict higher levels of care (high dependency - Level 2 or intensive care - Level 3) and/or death in patients at or shortly after admission to hospital with A/H1N1 2009 pandemic influenza. This was a case-control analysis using retrospectively collected data from the FLU-CIN cohort (1040 adults, 480 children) with PCR-confirmed A/H1N1 2009 influenza. Area under receiver operator curves (AUROC), sensitivity, specificity, positive predictive values and negative predictive values were calculated. CATs best predicted Level 2/3 admissions in both adults [AUROC (95% CI): CATs 0.77 (0.73, 0.80); CURB-65 0.68 (0.64, 0.72); PMEWS 0.68 (0.64, 0.73), p<0.001] and children [AUROC: CATs 0.74 (0.68, 0.80); CURB-65 0.52 (0.46, 0.59); PMEWS 0.69 (0.62, 0.75), p<0.001]. CURB-65 and CATs were similar in predicting death in adults with both performing better than PMEWS; and CATs best predicted death in children. CATs were the best predictor of Level 2/3 care and/or death for both adults and children. CATs are potentially useful triage tools for predicting need for higher levels of care and/or mortality in patients of all ages. PMID:22509303

Myles, Puja R.; Nguyen-Van-Tam, Jonathan S.; Lim, Wei Shen; Nicholson, Karl G.; Brett, Stephen J.; Enstone, Joanne E.; McMenamin, James; Openshaw, Peter J. M.; Read, Robert C.; Taylor, Bruce L.; Bannister, Barbara; Semple, Malcolm G.

2012-01-01

267

Satisfaction and Public Health Cost of a Statewide Influenza Nurse Triage Line in Response to Pandemic H1N1 Influenza  

PubMed Central

Background The 2009 H1N1 pandemic strained healthcare systems. There was a need for supportive services, rapid antiviral access, and minimization of unnecessary healthcare contacts particularly face-to-face interactions. In response, the Minnesota Department of Health (MDH) launched a telephone-based nurse triage line (NTL) called the Minnesota FluLine coordinating all major MN healthcare systems with NTLs to form a single toll-free number triage service. Callers were evaluated for symptoms of influenza-like illness (ILI) and were prescribed an antiviral if indicated, using nurse administered protocols. Methods To determine caller outcomes, associated healthcare seeking, and satisfaction a telephone survey of Minnesota FluLine callers was conducted using a 5% random sample of those who completed the protocol and those who did not. Results Of 6,122 callers with ILI who began the nurse protocol administered by the contract NTL, 1,221 people were contacted for the survey and 325 agreed to participate; response rate was 26%. Of those who completed the nurse protocol 73% said they would have sought healthcare without the Minnesota FluLine, 89% reported the service was moderately or very helpful, and 91% reported being satisfied or very satisfied. Of those not completing the protocol, 50% reported the service was moderately or very helpful and 50% reported being satisfied or very satisfied. 72% of qualitative responses to open-ended questions were positive regarding the MN FluLine. Cost to MDH for operating the Minnesota FluLine service was $331,226 to service 27,391 callers ($12.09/call). Discussion The Minnesota FluLine diverted patients with mild ILI symptoms away from acute care visits at low cost and had a high rate of satisfaction among callers. Early intervention likely prevented morbidity and possibly additional cases. NTLs are powerful and flexible tools for pandemic response and should be considered as an important tool for future emergency responses. PMID:23335953

Spaulding, Alicen B.; Radi, Deborah; Macleod, Heather; Lynfield, Ruth; Larson, Michelle; Hyduke, Terri; Dehnel, Peter; DeVries, Aaron S.

2013-01-01

268

Development and Evaluation of Evidence-Informed Clinical Nursing Protocols for Remote Assessment, Triage and Support of Cancer Treatment-Induced Symptoms  

PubMed Central

The study objective was to develop and evaluate a template for evidence-informed symptom protocols for use by nurses over the telephone for the assessment, triage, and management of patients experiencing cancer treatment-related symptoms. Guided by the CAN-IMPLEMENT© methodology, symptom protocols were developed by, conducting a systematic review of the literature to identify clinical practice guidelines and systematic reviews, appraising their quality, reaching consensus on the protocol template, and evaluating the two symptom protocols for acceptability and usability. After excluding one guideline due to poor overall quality, the symptom protocols were developed using 12 clinical practice guidelines (8 for diarrhea and 4 for fever). AGREE Instrument (Appraisal of Guidelines for Research and Evaluation) rigour domain subscale ratings ranged from 8% to 86% (median 60.1 diarrhea; 40.5 fever). Included guidelines were used to inform the protocols along with the Edmonton Symptom Assessment System questionnaire to assess symptom severity. Acceptability and usability testing of the symptom populated template with 12 practicing oncology nurses revealed high readability (n = 12), just the right amount of information (n = 10), appropriate terms (n = 10), fit with clinical work flow (n = 8), and being self-evident for how to complete (n = 5). Five nurses made suggestions and 11 rated patient self-management strategies the highest for usefulness. This new template for symptom protocols can be populated with symptom-specific evidence that nurses can use when assessing, triaging, documenting, and guiding patients to manage their-cancer treatment-related symptoms. PMID:23476759

Stacey, Dawn; Macartney, Gail; Carley, Meg; Harrison, Margaret B.; (COSTaRS), The Pan-Canadian Oncology Symptom Triage and Remote Support Group

2013-01-01

269

Prehospital and emergency care research at the US Army Institute of Surgical Research: enabling the next great leap in combat casualty survival.  

PubMed

Minimizing preventable death continues to be a primary focus of the combat casualty care research community, and of the Army Medical Department as a whole. Toward that end, tremendous successes have been realized in resuscitative surgery, critical care, rehabilitation, preventive medicine, and in our collective ability to project effective medical care into the most austere locations throughout the globe. Innovation in the care rendered outside of theater hospitals or strategic air evacuation conveyances, however, has not kept the same pace. The US military experience in World War II, Korea, and Vietnam served as a prime source for the development of the tactics, techniques, and procedures which spawned modern civilian sector trauma care and emergency medical services. But this ascendance was driven by the dedicated medics, corpsmen, physicians, nurses, and allied health practitioners from those conflicts who left the military for the civilian sector, leaving their replacements, in many cases, to repeat the same mistakes, and to relearn hard lessons that otherwise might have been assimilated had they been effectively captured and integrated into doctrine and training. A prime example of this phenomenon is the recent acknowledgement of the "en route care gap" existing in tactical medical evacuation. The US Army Institute of Surgical Research (USAISR) and the Army emergency medicine community have made a significant commitment toward elucidating the requirements, capability gaps, and a way-forward in search of the development of an integrated prehospital combat casualty care system, nested within the Joint Theater Trauma System. This paper examines specific research programs, concept development, and collaborations with other Army, joint, and civilian center organizations which comprise the USAISR Prehospital and Emergency Care Research Program, including the Remote Damage Control Resuscitation initiative, Emergency Telemedical Direction of Role-I providers, Combat Medical Voice Documentation System, and establishment of the Remote Trauma Outcomes Research Network. PMID:21607910

Gerhardt, Robert T

2011-01-01

270

The formation and design of the 'Acute Admission Database'- a database including a prospective, observational cohort of 6279 patients triaged in the emergency department in a larger Danish hospital  

PubMed Central

Background Management and care of the acutely ill patient has improved over the last years due to introduction of systematic assessment and accelerated treatment protocols. We have, however, sparse knowledge of the association between patient status at admission to hospital and patient outcome. A likely explanation is the difficulty in retrieving all relevant information from one database. The objective of this article was 1) to describe the formation and design of the 'Acute Admission Database', and 2) to characterize the cohort included. Methods All adult patients triaged at the Emergency Department at Hillerød Hospital and admitted either to the observationary unit or to a general ward in-hospital were prospectively included during a period of 22 weeks. The triage system used was a Danish adaptation of the Swedish triage system, ADAPT. Data from 3 different data sources was merged using a unique identifier, the Central Personal Registry number; 1) Data from patient admission; time and date, vital signs, presenting complaint and triage category, 2) Blood sample results taken at admission, including a venous acid-base status, and 3) Outcome measures, e.g. length of stay, admission to Intensive Care Unit, and mortality within 7 and 28 days after admission. Results In primary triage, patients were categorized as red (4.4%), orange (25.2%), yellow (38.7%) and green (31.7%). Abnormal vital signs were present at admission in 25% of the patients, most often temperature (10.5%), saturation of peripheral oxygen (9.2%), Glasgow Coma Score (6.6%) and respiratory rate (4.8%). A venous acid-base status was obtained in 43% of all patients. The majority (78%) had a pH within the normal range (7.35-7.45), 15% had acidosis (pH < 7.35) and 7% had alkalosis (pH > 7.45). Median length of stay was 2 days (range 1-123). The proportion of patients admitted to Intensive Care Unit was 1.6% (95% CI 1.2-2.0), 1.8% (95% CI 1.5-2.2) died within 7 days, and 4.2% (95% CI 3.7-4.7) died within 28 days after admission. Conclusions Despite challenges of data registration, we succeeded in creating a database of adequate size and data quality. Future studies will focus on the association between patient status at admission and patient outcome, e.g. admission to Intensive Care Unit or in-hospital mortality. PMID:22490233

2012-01-01

271

Surge Capacity and Capability. A Review of the History and Where the Science is Today Regarding Surge Capacity during a Mass Casualty Disaster  

PubMed Central

Disasters which include countless killed and many more injured, have occurred throughout recorded history. Many of the same reports of disaster also include numerous accounts of individuals attempting to rescue those in great peril and render aid to the injured and infirmed. The purpose of this paper is to briefly discuss the transition through several periods of time with managing a surge of many patients. This review will focus on the triggering event, injury and illness, location where the care is provided and specifically discuss where the science is today. PMID:24795873

Kearns, Randy D.; Cairns, Bruce A.; Cairns, Charles B.

2014-01-01

272

Prognostic value of angiographic lesion complexity in patients with acute coronary syndromes undergoing percutaneous coronary intervention (from the acute catheterization and urgent intervention triage strategy trial).  

PubMed

Although lesion complexity is predictive of outcomes after balloon angioplasty, it is unclear whether complex lesions continue to portend a worse prognosis in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) with contemporary interventional therapies. We sought to assess the impact of angiographic lesion complexity, defined by the modified American College of Cardiology/American Heart Association classification, on clinical outcomes after PCI in patients with ACS and to determine whether an interaction exists between lesion complexity and antithrombin regimen outcomes after PCI. Among the 3,661 patients who underwent PCI in the Acute Catheterization and Urgent Intervention Triage strategy study, patients with type C lesions (n = 1,654 [45%]) had higher 30-day rates of mortality (1.2% vs 0.6%, p = 0.049), myocardial infarction (9.2% vs 6.3%, p = 0.0006), and unplanned revascularization (4.3% vs 3.1%, p = 0.04) compared with those without type C lesions. In multivariate analysis, type C lesions were independently associated with myocardial infarction (odds ratio [95% confidence interval] = 1.37 [1.04 to 1.80], p = 0.02) and composite ischemia (odds ratio [95% confidence interval] = 1.49 [1.17 to 1.88], p = 0.001) at 30 days. Bivalirudin monotherapy compared with heparin plus a glycoprotein IIb/IIIa inhibitor reduced major bleeding complications with similar rates of composite ischemic events, regardless of the presence of type C lesions. There were no interactions between antithrombotic regimens and lesion complexity in terms of composite ischemia and major bleeding (p [interaction] = 0.91 and 0.80, respectively). In conclusion, patients with ACS with type C lesion characteristics undergoing PCI have an adverse short-term prognosis. Treatment with bivalirudin monotherapy reduces major hemorrhagic complications irrespective of lesion complexity with comparable suppression of adverse ischemic events as heparin plus glycoprotein IIb/IIIa inhibitor. PMID:25312637

Goto, Kenji; Lansky, Alexandra J; Ng, Vivian G; Pietras, Cody; Nargileci, Erol; Mehran, Roxana; Parise, Helen; Feit, Frederick; Ohman, E Magnus; White, Harvey D; Bertrand, Michel E; Desmet, Walter; Hamon, Martial; Stone, Gregg W

2014-12-01

273

An introductory characterization of a combat-casualty-care relevant swine model of closed head injury resulting from exposure to explosive blast.  

PubMed

Explosive blast has been extensively used as a tactical weapon in Operation Iraqi Freedom (OIF) and more recently in Operation Enduring Freedom(OEF). The polytraumatic nature of blast injuries is evidence of their effectiveness,and brain injury is a frequent and debilitating form of this trauma. In-theater clinical observations of brain-injured casualties have shown that edema, intracranial hemorrhage, and vasospasm are the most salient pathophysiological characteristics of blast injury to the brain. Unfortunately, little is known about exactly how an explosion produces these sequelae as well as others that are less well documented. Consequently, the principal objective of the current report is to present a swine model of explosive blast injury to the brain. This model was developed during Phase I of the DARPA (Defense Advanced Research Projects Agency) PREVENT (Preventing Violent Explosive Neurotrauma) blast research program. A second objective is to present data that illustrate the capabilities of this model to study the proximal biomechanical causes and the resulting pathophysiological, biochemical,neuropathological, and neurological consequences of explosive blast injury to the swine brain. In the concluding section of this article, the advantages and limitations of the model are considered, explosive and air-overpressure models are compared, and the physical properties of an explosion are identified that potentially contributed to the in-theater closed head injuries resulting from explosions of improvised explosive devices (IEDs). PMID:19215189

Bauman, Richard A; Ling, Geoffrey; Tong, Lawrence; Januszkiewicz, Adolph; Agoston, Dennis; Delanerolle, Nihal; Kim, Young; Ritzel, Dave; Bell, Randy; Ecklund, James; Armonda, Rocco; Bandak, Faris; Parks, Steven

2009-06-01

274

Diagnostic Performance of High-Sensitivity Troponin T, Myeloperoxidase, and Pregnancy-Associated Plasma Protein A Assays for Triage of Patients with Acute Myocardial Infarction  

PubMed Central

Background Early diagnosis is the cornerstone of management of acute myocardial infarction (AMI). We aimed to compare the diagnostic accuracy of high-sensitivity troponin T (hs-cTnT) with myeloperoxidase (MPO) and pregnancy-associated plasma protein A (PAPP-A) for early diagnosis of AMI in patients at the time of presentation to the emergency department (ED). Methods We enrolled 289 patients who presented at the ED of the National Institute of Heart Disease (NIHD) Rawalpindi, Pakistan, within 4 hr of onset of chest pain. Clinical assessment, electrocardiography (ECG), and angiography were carried out. Blood samples were collected at 0, 3, 6, and 12 hr. Analyses of plasma hs-cTnT, MPO, and PAPP-A were carried out using commercial kits. Results Out of 289 subjects who presented to the ED, we diagnosed 180 patients with coronary heart disease as having AMI (N= 61) and 119 as without AMI (stable coronary artery disease, N=61; unstable angina, N=58). Compared to non-AMI patients, the patients with AMI had significantly higher levels (represented here as median [inter quartile range]) of plasma hs-cTnT (136 [39-370] vs. 12 [7-21] ng/L), MPO (906 [564-1,631] vs. 786 [351-1,299] pmol/L) and PAPP-A (5.78 [2.67-13.4] vs. 2.8 [1.8-4.9] mIU/L). Receiver operator characteristic curves (95% CI) for hs-cTnT (0.952 [0.909-0.978]) were significantly higher (P<0.001) than those for MPO (0.886 [0.830-0.929]) and PAPP-A (0.797 [0.730-0.854]), with AMI sensitivity and specificity percentages of 87% and 98% (hs-cTnT), 82% and 84% (MPO), and 65% and 87% (PAPP-A), respectively. Conclusions The diagnostic performance of hs-cTnT was superior to that of MPO and PAPP-A for early triage and diagnosis of AMI among patients of coronary heart disease presenting with chest pain to the ED. PMID:21779191

Sharif, Mariam S; Khan, Farooq Ahmad

2011-01-01

275

Effect of anemia on frequency of short- and long-term clinical events in acute coronary syndromes (from the Acute Catheterization and Urgent Intervention Triage Strategy Trial).  

PubMed

There are limited data on the impact of anemia on clinical outcomes in unstable angina and non-ST-segment elevation myocardial infarction treated with an early invasive strategy. We sought to determine the short- and long-term clinical events among patients with and without anemia enrolled in the Acute Catheterization and Urgent Intervention Triage Strategy (ACUITY) trial. Anemia was defined as baseline hemoglobin of <13 g/dl for men and <12 g/dl for women. The primary end points were composite ischemia (death, myocardial infarction, or unplanned revascularization for ischemia) and major bleeding assessed in-hospital, at 1 month, and at 1 year. Among the 13,819 patients in the ACUITY trial, information regarding anemia was available in 13,032 (94.3%), 2,199 of whom (16.9%) had anemia. Patients with anemia compared with those without anemia had significantly increased adverse event rates in-hospital (composite ischemia 6.6% vs 4.8%, p = 0.0004; major bleeding 7.3% vs 3.3%, p <0.0001), at 1 month (composite ischemia 10% vs 7.2%, p <0.0001, major bleeding 8.8% vs 3.9%, p <0.0001), and 1 year (composite ischemia 21.7% vs 15.3%, p <0.0001). Anemia was an independent predictor of death at 1 year (hazard ratio 1.77, 95% confidence interval [CI] 1.29 to 2.44, p = 0.0005). Composite ischemia was significantly more common among patients who developed in-hospital non-coronary artery bypass surgery major bleeding compared with those who did not (anemic patients 1-year relative risk 2.19, 95% CI 1.67 to 2.88, p <0.0001; nonanemic patients relative risk 2.16, 95% CI 1.76 to 2.65, p <0.0001). In conclusion, in the ACUITY trial, baseline anemia was strongly associated with adverse early and late clinical events, especially in those who developed major bleeding. PMID:25438908

Kunadian, Vijay; Mehran, Roxana; Lincoff, A Michael; Feit, Frederick; Manoukian, Steven V; Hamon, Martial; Cox, David A; Dangas, George D; Stone, Gregg W

2014-12-15

276

Implementing wait-time reductions under Ontario government benchmarks (Pay-for-Results): a Cluster Randomized Trial of the Effect of a Physician-Nurse Supplementary Triage Assistance team (MDRNSTAT) on emergency department patient wait times  

PubMed Central

Background Internationally, emergency departments are struggling with crowding and its associated morbidity, mortality, and decreased patient and health-care worker satisfaction. The objective was to evaluate the addition of a MDRNSTAT (Physician (MD)-Nurse (RN) Supplementary Team At Triage) on emergency department patient flow and quality of care. Methods Pragmatic cluster randomized trial. From 131 weekday shifts (8:00–14:30) during a 26-week period, we randomized 65 days (3173 visits) to the intervention cluster with a MDRNSTAT presence, and 66 days (3163 visits) to the nurse-only triage control cluster. The primary outcome was emergency department length-of-stay (EDLOS) for patients managed and discharged only by the emergency department. Secondary outcomes included EDLOS for patients initially seen by the emergency department, and subsequently consulted and admitted, patients reaching government-mandated thresholds, time to initial physician assessment, left-without being seen rate, time to investigation, and measurement of harm. Results The intervention’s median EDLOS for discharged, non-consulted, high acuity patients was 4:05 [95th% CI: 3:58 to 4:15] versus 4:29 [95th% CI: 4:19–4:38] during comparator shifts. The intervention’s median EDLOS for discharged, non-consulted, low acuity patients was 1:55 [95th% CI: 1:48 to 2:05] versus 2:08 [95th% CI: 2:02–2:14]. The intervention’s median physician initial assessment time was 0:55 [95th% CI: 0:53 to 0:58] versus 1:21 [95th% CI: 1:18 to 1:25]. The intervention’s left-without-being-seen rate was 1.5% versus 2.2% for the control (p = 0.06). The MDRNSTAT subgroup analysis resulted in significant decreases in median EDLOS for discharged, non-consulted high (4:01 [95th% CI: 3:43–4:16]) and low acuity patients (1:10 95th% CI: 0:58–1:19]), as well as physician initial assessment time (0:25 [95th% CI: 0:23–0:26]). No patients returned to the emergency department after being discharged by the MDRNSTAT at triage. Conclusions The intervention reduced delays and left-without-being-seen rate without increased return visits or jeopardizing urgent care of severely ill patients. Trial registration number NCT00991471 ClinicalTrials.gov PMID:24207160

2013-01-01

277

Diagnosing Delirium in Older Emergency Department Patients: Validity and Reliability of the Delirium Triage Screen and the Brief Confusion Assessment Method  

PubMed Central

Background Delirium is a common form of acute brain dysfunction with prognostic significance. Health care professionals caring for older emergency department (ED) patients miss delirium approximately 75% of cases. This error results from a lack of available measures that can be performed rapidly enough to be incorporated into clinical practice. Therefore, we developed and evaluated a novel two-step approach to delirium surveillance for the ED. Methods This prospective observational study was conducted at an academic ED in patients ? 65 years old. A research assistant (RA) and physician performed the Delirium Triage Screen (DTS), designed to be a highly sensitive rule-out test, and the Brief Confusion Assessment Method (bCAM), designed to be a highly specific rule-in test for delirium. The reference standard for delirium was a comprehensive psychiatrist assessment using Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) criteria. All assessments were independently conducted within 3 hours of each other. Sensitivities, specificities, and likelihood ratios with their 95% confidence intervals (95%CI) were calculated. Results Of 406 enrolled patients, 50 (12.3%) had delirium diagnosed by the psychiatrist reference standard. The DTS was 98.0% (95%CI: 89.5% – 99.5%) sensitive with an expected specificity of approximately 55% for both raters. The DTS’ negative likelihood ratio was 0.04 (95%CI: 0.01 – 0.25) in both raters. As the complement, the bCAM had a specificity of 95.8% (95%CI: 93.2% – 97.4%) and 96.9% (95%CI: 94.6% – 98.3%) and a sensitivity of 84.0% (95%CI: 71.5% – 91.7%) and 78.0% (95%CI: 64.8% – 87.2%) when performed by the physician and RA, respectively. The positive likelihood ratios for the bCAM were 19.9 (95%CI: 12.0 – 33.2) and 25.2 (95%CI: 13.9 – 46.0), respectively. If the RA DTS was followed by the physician bCAM, the sensitivity of this combination was 84.0% (95%CI: 71.5% – 91.7%) and the specificity was 95.8% (95%CI: 93.2% – 97.4%). If the RA performed both the DTS and bCAM, this combination was 78.0% (95%CI: 64.8% – 87.2%) sensitive and 97.2% (95%CI: 94.9% – 98.5%) specific. If the physician performed both the DTS and bCAM, this combination was 82.0% (95%CI: 69.2% – 90.2%) sensitive and 95.8% (95CI: 93.2% – 97.4%) specific. Conclusions In older ED patients, this two-step approach (highly sensitive DTS followed by highly specific bCAM) may enable healthcare professionals, regardless of clinical background, to efficiently screen for delirium. Larger, multi-centered trials are needed to confirm these findings and to determine the impact of these assessments on delirium recognition in the ED. PMID:23916018

Han, Jin H.; Wilson, Amanda; Vasilevskis, Eduard E.; Shintani, Ayumi; Schnelle, John F.; Dittus, Robert S.; Graves, Amy J.; Storrow, Alan B.; Shuster, John; Ely, E. Wesley

2013-01-01

278

Pollution risk from marine casualties  

SciTech Connect

In the oil tanker, oil shipping industry, there is no single fail-safe design that can ensure spill-free protection under all possible circumstances. Regulatory efforts have focused on design improvements that can be incorporated with out destroying the basic mission. Good examples are the IMO requirements for segregated ballast tanks, crude oil washing, and inert gas systems which have become mandatory over the last 15 years. They have contributed much to reduce pollution and enhance safety of life at sea. In contrast, the double-hull design, which has been mandated for new vessels operating in US waters, adds 15% to 20% more to a vessel's construction cost with no offsetting income. Most ship owners are not enamored with the double hull requirement, which will not necessarily save them from ruinous financial exposure to unlimited liability if involved in a major oil spill in the US, even if all reasonable safety precautions have been followed. There are no physical features in a ship that offset operational shortcomings such as an incompentent crew, poor operating procedures, or a lack of navigational aids. The problem in the industry is not vessel age or deficiencies in design, nor lack of safety rules and regulations. The problem is one of poor enforcement, which accounts for most of the operational inadequacies evidenced in vessels. But above all, safe marine operations depend on people. The human element remains the most important part of the safety equation.

Kurz, G.E.

1993-04-01

279

Truth was an early casualty  

SciTech Connect

At a May 1986 press conference in Moscow-held just 11 days after the accident at the Chernobyl Nuclear Power Station-the cult of high technology was unabashedly preached to an auditorium full of shocked news correspondents and invited guests. When questioned as to the number of fatalities the accident had caused and the impact of the accident on Soviet society and the Soviet nuclear industry, A.M. Petrosyants (then chairman of the Soviet State Committee on the Utilization of Atomic Energy) responded: {open_quotes}Science requires victims.{close_quotes} The Soviet system numbered its victims in the millions. In a sense, the Chernobyl accident was just one of the many misfortunes misrepresented by the Soviet government over the decades in its continuing effort to shape public perceptions of domestic disasters, natural and manmade. And yet, the international character of the Chernobyl accident, the fact that radioactive fallout knows no national boundaries, made it a watershed event. The accident exposed glaring weaknesses in the Soviet system: its backward technology, its sloppy safety standards, its inability to admit failure. And it brought to the surface many of the injustices, inefficiencies, and secrets that the Soviet government had tried to keep hidden. With the world`s spotlight focused on Chernobyl, General Secretary Mikhail Gorbachev was left with little choice other than to prove to the West his dedication to reform by more fully implementing his recently announced policy of glasnost or `openness.` In turn, glasnost was a major factor that led to the demise of the Soviet Union, which embodied a system that was fundamentally at odds with freedom of expression and accessibile information. Unfortunately, old habits die hard. Ten years after the accident, many nuclear bureaucrats in the former Soviet Union, partiularly in Russia, are still too secretive and too much given to obfuscation.

Sich, A.R.

1996-05-01

280

California Casualty First Aid America  

E-print Network

and Wellness Center HEALTH AND FITNESS American Diabetes Association American Heart Association American Red Market Tustin MEDICAL Anaheim Eye Care Anaheim Regional Medical Center Anthem Blue Cross Delta Dental Dreamworks Dental & Implant Center Gentle Dental Greater Newport Physicians Health Net, Inc. Hoag Hospital

Rose, Michael R.

281

Introduction to Casualty Actuarial Science  

E-print Network

1. Written Premium Risk. ? Pricing. 2. Earned Premium Risk. ? Reserving ... underwriting income. Definitions. Page 4. 4. Ken Fikes, FCAS, MAAA. Definitions. ? Accounting Aspects of Loss Reserves. Assets. Liabilities. Surplus. Balance ... Radical changes in product lines .... APPLIED TO A NON-INSURANCE EXAMPLE.

Ken Fikes

2011-11-15

282

Mass loss  

NASA Technical Reports Server (NTRS)

Observational evidence for mass loss from cool stars is reviewed. Spectra line profiles are used for the derivation of mass-loss rates with the aid of the equation of continuity. This equation implies steady mass loss with spherical symmetry. Data from binary stars, Mira variables, and red giants in globular clusters are examined. Silicate emission is discussed as a useful indicator of mass loss in the middle infrared spectra. The use of thermal millimeter-wave radiation, Very Large Array (VLA) measurement of radio emission, and OH/IR masers are discussed as a tool for mass loss measurement. Evidence for nonsteady mass loss is also reviewed.

Goldberg, Leo

1987-01-01

283

Mass spectrometry.  

NASA Technical Reports Server (NTRS)

Review of the current state of mass spectrometry, indicating its unique importance for advanced scientific research. Mass spectrometry applications in computer techniques, gas chromatography, ion cyclotron resonance, molecular fragmentation and ionization, and isotope labeling are covered. Details are given on mass spectrometry applications in bio-organic chemistry and biomedical research. As the subjects of these applications are indicated alkaloids, carbohydrates, lipids, terpenes, quinones, nucleic acid components, peptides, antibiotics, and human and animal metabolisms. Particular attention is given to the mass spectra of organo-inorganic compounds, inorganic mass spectrometry, surface phenomena such as secondary ion and electron emission, and elemental and isotope analysis. Further topics include mass spectrometry in organic geochemistry, applications in geochronology and cosmochemistry, and organic mass spectrometry.

Burlingame, A. L.; Johanson, G. A.

1972-01-01

284

Mass Wasting  

NSDL National Science Digital Library

Mass Wasting is a course handout designed to initiate discussion on the factors involved in mass wasting (eg. creep, solifluction, falls, slides, and flows) and the methods used to prevent mass wasting. Definitions are given for key terms such as angle of repose and lahars. Photographs illustrate the effects of rockslides and slumps. Links are provided to the online Physical Geology resources at Georgia Perimeter College.

Pamela Gore

1998-11-28

285

Quark masses  

Microsoft Academic Search

We review the current information about the eigenvalues of the quark mass matrix. The theoretical problems involved in a determination of the running masses mu, md, ms, mc and mb from experiment are discussed with the aim of getting reliable numerical values equipped with error bars that represent a conservative estimate of remaining uncertainties.

J. Gasser; H. Leutwyler

1982-01-01

286

Atmospheric Mass  

NSDL National Science Digital Library

This is a lesson about the amount of atmosphere a planet is likely to have. Learners will look for the relationship between atmospheric mass and other characteristics of the planet. When the results are not completely conclusive, the students explore possible causes of discrepancies in the data. They conclude that gravity, mass and diameter all have a role in determining atmospheric mass. The lesson models scientific inquiry using the 5E instructional model and includes teacher notes, prerequisite concepts, common misconceptions, student journal and reading. This is lesson 11 in the Astro-Venture Astronomy Unit. The lessons are designed for educators to use in conjunction with the Astro-Venture multimedia modules.

287

Mass Extinction  

NSDL National Science Digital Library

In this video segment adapted from NOVA scienceNOW, learn about a chain of events, including ancient volcanoes, global warming, and deadly gases, which may have caused Earth's greatest mass extinction 250 million years ago.

WGBH Educational Foundation

2009-11-02

288

Masses & Springs  

NSDL National Science Digital Library

In this online activity, learners use a realistic mass and spring laboratory. They hang masses from springs and adjust the spring stiffness and damping. Learners can even slow time and transport the lab to different planets! A chart shows the kinetic, potential, and thermal energy for each spring. Use this activity for a lesson on Hooke's Law and Conservation of Energy. This activity includes an online simulation, sample learning goals, a teacher's guide, and translations in over 30 languages.

Michael Dubson

2011-01-01

289

Mass action  

NSDL National Science Digital Library

In the first part of this video, we derive the law of mass action from one example of a picture of molecular collisions. For this course, we use the "law of mass action" to refer to an idea that chemical reaction kinetic rates can be expressed using products of the abundances of reactants raised to exponents. Studying cooperativity and Hill functions in the second part of the video allows us to investigate a simple example of bistability in the third video segment.

2013-06-21

290

Mass Wasting  

NSDL National Science Digital Library

First, Professor Stephen Nelson at Tulane University provides a straightforward description of mass wasting and recent disasters around the world (1). Visitors can find helpful illustrations of slumps and rock slides as well as a chart depicting the different processes that occur with varying velocities and water content. The second website, provided by Pamela Gore at Georgia Perimeter College, presents the factors involved with mass wasting and mass wasting processes (2). Visitors can find excellent real-life images of creep, rock slides, and talus slopes. Next, North Dakota State University illustrates creep, earthflow, slope failure, and slumps (3). The website furnishes images of mass wasting processes and explains the physical characteristics of the landscape. Fourth, the California State University at Long Beach discusses the causes, prevention, and types of mass wasting (4). Visitors can learn about the mass wasting disasters that occurred at La Conchita, Portuguese Bend, Mount Huascaran, Cable Canyon, and Vaiont Dam. Next, Professor Pidwirny at Okanagan University College offers an online text describing hillslope stability and mass movement (5). Students can learn about soil creep through a simple animation. The sixth website, developed by Natural Resources Canada, furnishes an interactive map of landslides in Canada (6). Users can select to view historic landslides, bedrock geology, surficial geology, and more. Next, the USGS offers information on the National Landslides Hazards Program, the National Landslide Information Center, and recent landslide events (7). Users can find a tutorial on landslides, real-time monitoring active of landslides, and related research projects. Lastly, at the Oswego State University of New York visitors can test their knowledge of mass wasting processes through a short quiz (8).

291

Air Masses  

NSDL National Science Digital Library

In this activity, students will examine the physical characteristics of several types of air masses (bodies of air that resemble the characteristics of the land surfaces beneath them). By analyzing maps of air temperature and of dewpoint temperature (prepared by the teacher), they will discover that air masses can be identified and defined by their temperature and moisture content. Student worksheets and links to the necessary maps are provided.

292

Inertial Mass  

NSDL National Science Digital Library

The inertial balance is one device that can help students to quantify the quality of inertia--a body's resistance to a change in movement--in more generally understood terms of mass. In this hands-on activity, students use the inertial balance to develop a more quantitative idea of what mass means in an inertial sense. The activity also helps students refine their ability to use numerical data and line graphs as a tool for making predictions.

King, Kenneth P.

2007-12-01

293

Nationwide program of education for undergraduates in the field of disaster medicine: development of a core curriculum centered on blended learning and simulation tools.  

PubMed

In recent years, effective models of disaster medicine curricula for medical schools have been established. However, only a small percentage of medical schools worldwide have considered at least basic disaster medicine teaching in their study program. In Italy, disaster medicine has not yet been included in the medical school curriculum. Perceiving the lack of a specific course on disaster medicine, the Segretariato Italiano Studenti in Medicina (SISM) contacted the Centro di Ricerca Interdipartimentale in Medicina di Emergenza e dei Disastri ed Informatica applicata alla didattica e alla pratica Medica (CRIMEDIM) with a proposal for a nationwide program in this field. Seven modules (introduction to disaster medicine, prehospital disaster management, definition of triage, characteristics of hospital disaster plans, treatment of the health consequences of different disasters, psychosocial care, and presentation of past disasters) were developed using an e-learning platform and a 12-hour classroom session which involved problem-based learning (PBL) activities, table-top exercises, and a computerized simulation (Table 1). The modules were designed as a framework for a disaster medicine curriculum for undergraduates and covered the three main disciplines (clinical and psychosocial, public health, and emergency and risk management) of the core of "Disaster Health" according to the World Association for Disaster and Emergency Medicine (WADEM) international guidelines for disaster medicine education. From January 2011 through May 2013, 21 editions of the course were delivered to 21 different medical schools, and 524 students attended the course. The blended approach and the use of simulation tools were appreciated by all participants and successfully increased participants' knowledge of disaster medicine and basic competencies in performing mass-casualty triage. This manuscript reports on the designing process and the initial outcomes with respect to learners' achievements and satisfaction of a 1-month educational course on the fundamentals of disaster medicine. This experience might represent a valid and innovative solution for a disaster medicine curriculum for medical students that is easily delivered by medical schools. Table 1 List of Modules and Topics Module Topics 1. Introduction to disaster medicine and public health during emergencies - Modern taxonomy of disaster and common disaster medicine definitions - Differences between disaster and emergency medicine - Principles of public health during disasters - Different phases of disaster management 2. Prehospital disaster management - Mass-casualty disposition, treatment area, and transport issues - Disaster plans and command-and-control chain structure - Functional response roles 3. Specific disaster medicine and triage procedures in the - Mass-casualty triage definitions and principles management of disasters - Different methodologies and protocols - Patient assessment, triage levels and tags 4. Hospital disaster preparedness and response - Hospital disaster laws - Hospital preparedness plans for in-hospital and out-hospital disasters with an all-hazard approach - Medical management for a massive influx of casualties 5. Health consequences of different disasters - Characteristics of different types of disasters - Health impact of natural and man-made disasters - Disaster-related injury after exposure to a different disasters with an all-hazard approach 6. Psychosocial care - Techniques to deal with psychic reactions caused by exposure to disaster scenarios - Treatment approaches to acute and delayed critical incident stress reactions 7. Presentation of past disasters and public health emergencies, and Case study: review of assistance experiences - Haiti earthquake - Cholera outbreaks in Haiti - National and international disaster response mechanism Ingrassia PL , Ragazzoni L , Tengattini M , Carenzo L , Della Corte F . Nationwide program of education for undergraduates in the field of disaster medicine: development of a core curriculum centered on blended lear

Ingrassia, Pier Luigi; Ragazzoni, Luca; Tengattini, Marco; Carenzo, Luca; Della Corte, Francesco

2014-10-01

294

The Laser Ablation Ion Funnel: Sampling for in situ Mass Spectrometry on Mars  

NASA Technical Reports Server (NTRS)

A considerable investment has been made by NASA and other space agencies to develop instrumentation suitable for in situ analytical investigation of extra terrestrial bodies including various mass spectrometers (time-of-flight, quadrupole ion trap, quadrupole mass filters, etc.). However, the front-end sample handling that is needed to collect and prepare samples for interrogation by such instrumentation remains underdeveloped. Here we describe a novel approach tailored to the exploration of Mars where ions are created in the ambient atmosphere via laser ablation and then efficiently transported into a mass spectrometer for in situ analysis using an electrodynamic ion funnel. This concept would enable elemental and isotopic analysis of geological samples with the analysis of desorbed organic material a possibility as well. Such an instrument would be suitable for inclusion on all potential missions currently being considered such as the Mid-Range Rover, the Astrobiology Field Laboratory, and Mars Sample Return (i.e., as a sample pre-selection triage instrument), among others.

Johnson, Paul V.; Hodyss, Robert; Tang, Keqi; Brinckerhoff, William B.; Smith, Richard D.

2011-01-01

295

Mass Extinction  

NSDL National Science Digital Library

This video highlights a team of scientists who work on reconstructing the mass extinction that occurred 250 million years ago, the end of the Permian Period, and wiped out the majority of life on our planet, resetting the evolution of life. Clues suggest that deadly bacteria might have set off a chemical chain reaction that poisoned the Permian seas and atmosphere.

NOVA scienceNOW

296

Neutrino mass  

SciTech Connect

Neutrinos play a dominant role in both particle physics, astrophysics, and cosmology. In the our present understanding of the strong, weak, and electromagnetic forces, the group structure of the Standard Model is SU(3){sub C} {circle_times} SU(2){sub L} {circle_times} U(I){sub EM}. In the Weinberg-Salam-Glashow Standard Electroweak Model, left-handed neutrinos sit in a doublet, while right-handed neutrinos are in a singlet, and therefore do not interact with the other known particles. Also in this model, the neutrinos are intrinsically massless. However, while the W-S-G model provides an amazingly accurate picture of our present cold Universe, It has a number of deficits. The Standard Model does not explain the origin of the group structure, It does not reduce the number of coupling constants required, nor does it offer any prediction for the physical masses of the particles. Thus, it is generally assumed that the Standard Model is but a subset of some larger gauge theory. A wide variety of Grand Unified field Theories (GUTs), Super Symmetric Models (SUSY), and Superstring models have been proposed as the model for this larger structure. In general, these models predict nonzero neutrino masses and contain mechanisms that provide for lepton-number violation. Thus, a variety of new phenomena are predicted, including finite neutrino masses and the possibility that neutrinos can oscillate from one type to another. This report looks at the possibility of detecting neutrino vat mass.

Bowles, T.J.

1993-04-01

297

Neutrino mass  

SciTech Connect

Neutrinos play a dominant role in both particle physics, astrophysics, and cosmology. In the our present understanding of the strong, weak, and electromagnetic forces, the group structure of the Standard Model is SU(3)[sub C] [circle times] SU(2)[sub L] [circle times] U(I)[sub EM]. In the Weinberg-Salam-Glashow Standard Electroweak Model, left-handed neutrinos sit in a doublet, while right-handed neutrinos are in a singlet, and therefore do not interact with the other known particles. Also in this model, the neutrinos are intrinsically massless. However, while the W-S-G model provides an amazingly accurate picture of our present cold Universe, It has a number of deficits. The Standard Model does not explain the origin of the group structure, It does not reduce the number of coupling constants required, nor does it offer any prediction for the physical masses of the particles. Thus, it is generally assumed that the Standard Model is but a subset of some larger gauge theory. A wide variety of Grand Unified field Theories (GUTs), Super Symmetric Models (SUSY), and Superstring models have been proposed as the model for this larger structure. In general, these models predict nonzero neutrino masses and contain mechanisms that provide for lepton-number violation. Thus, a variety of new phenomena are predicted, including finite neutrino masses and the possibility that neutrinos can oscillate from one type to another. This report looks at the possibility of detecting neutrino vat mass.

Bowles, T.J.

1993-01-01

298

Mass Wasting  

NSDL National Science Digital Library

This site contains 12 questions on the topic of mass wasting, which covers mudslides, lahars, landslides and more. This is part of the Principles of Earth Science course at the University of South Dakota. Users submit their answers and are provided immediate feedback.

Timothy Heaton

299

Higher Education: A Time for Triage?  

Microsoft Academic Search

Higher education faces unprecedented challenges. The confluence of changing economic and demographic tends; new patterns of federal and state spending; more explicit expectations by students and their families for affordable, accessible education; and heightened scrutiny by those who claim a legitimate interest in higher education is inescapably altering the environment in which this system operates. Higher education will never again

J. J. Lagowski

1995-01-01

300

8(E) TRIAGE CHEMICAL STUDIES DATABASE (TSCA)  

EPA Science Inventory

The Toxic Substances Control Act (TSCA) gives the Environmental Protection Agency (EPA) the authority and responsibility to identify and control chemical hazards to human health or the environment. TSCA gives the EPA authority to gather certain kinds of basic information on chemi...

301

Is conservation triage just smart decision making?  

E-print Network

, Israel 3 Australian Research Council Centre of Excellence for Coral Reef Studies, James Cook University at imminent risk of extinction, declining habitat extent and condition, uncer- tainty about the likelihood

Kark, Salit

302

An Automated Method to Quantify Radiation Damage in Human Blood Cells  

SciTech Connect

Cytogenetic analysis of blood lymphocytes is a well established method to assess the absorbed dose in persons exposed to ionizing radiation. Because mature lymphocytes circulate throughout the body, the dose to these cells is believed to represent the average whole body exposure. Cytogenetic methods measure the incidence of structural aberrations in chromosomes as a means to quantify DNA damage which occurs when ionizing radiation interacts with human tissue. Methods to quantify DNA damage at the chromosomal level vary in complexity and tend to be laborious and time consuming. In a mass casualty scenario involving radiological/nuclear materials, the ability to rapidly triage individuals according to radiation dose is critically important. For high-throughput screening for dicentric chromosomes, many of the data collection steps can be optimized with motorized microscopes coupled to automated slide scanning platforms.

Gordon K. Livingston, Mark S. Jenkins and Akio A. Awa

2006-07-10

303

Characterization of environmental samples using ion trap-secondary ion mass spectrometry  

SciTech Connect

The detection of chemical warfare agent residues on environmental surfaces is an important analytical activity because of the potential for proliferation of these weapons, and for environmental monitoring in areas where they are stored. Historically, one of the most widely used agents has been bis(2-chloroethyl) sulfide, also known as mustard gas and HD. It was initially used in combat in 1917; by the end of the First World War, more than 16% of all casualties were due to chemicals, in most cases mustard. Manufacture of mustard is continuing to this day; consequently, there are ongoing opportunities for exposure. 2-Chloroethyl ethyl sulfide (CEES) is used as a simulant for mustard (HD) in a study to develop secondary ion mass spectrometry (SIMS) for rapid, semi-quantitative detection of mustard on soil. Using SIMS with single stage mass spectrometry, a signature for CEES can be unequivocally observed only at the highest concentrations (0.1 monolayer and above). Selectivity and sensitivity are markedly improved employing multiple-stage mass spectrometry using an ion trap. C{sub 2}H{sub 5}SC{sub 2}H{sub 4}{sup +} from CEES eliminates C{sub 2}H{sub 4} and H{sub 2}S, which are highly diagnostic. CEES was detected at 0.0012 monolayer on soil. A single analysis could be conducted in under 5 minutes.

Groenewold, G.S.; Appelhans, A.D.; Ingram, J.C.

1998-02-01

304

Use of High-Throughput Mass Spectrometry to Reduce False Positives in Protease uHTS Screens.  

PubMed

As a label-free technology, mass spectrometry (MS) enables assays to be generated that monitor the conversion of substrates with native sequences to products without the requirement for substrate modifications or indirect detection methods. Although traditional liquid chromatography (LC)-MS methods are relatively slow for a high-throughput screening (HTS) paradigm, with cycle times typically ?60?s per sample, the Agilent RapidFire High-Throughput Mass Spectrometry (HTMS) System, with a cycle time of 5-7?s per sample, enables rapid analysis of compound numbers compatible with HTS. By monitoring changes in mass directly, HTMS assays can be used as a triaging tool by eliminating large numbers of false positives resulting from fluorescent compound interference or from compounds interacting with hydrophobic fluorescent dyes appended to substrates. Herein, HTMS assays were developed for multiple protease programs, including cysteine, serine, and aspartyl proteases, and applied as a confirmatory assay. The confirmation rate for each protease assay averaged <30%, independent of the primary assay technology used (i.e., luminescent, fluorescent, and time-resolved fluorescent technologies). Importantly, >99% of compounds designed to inhibit the enzymes were confirmed by the corresponding HTMS assay. Hence, HTMS is an effective tool for removing detection-based false positives from ultrahigh-throughput screening, resulting in hit lists enriched in true actives for downstream dose response titrations and hit-to-lead efforts. PMID:25336354

Adam, Gregory C; Meng, Juncai; Rizzo, Joseph M; Amoss, Adam; Lusen, Jeffrey W; Patel, Amita; Riley, Daniel; Hunt, Rachel; Zuck, Paul; Johnson, Eric N; Uebele, Victor N; Hermes, Jeffrey D

2015-02-01

305

War casualties on the home front  

SciTech Connect

On May 12, 1942, at Christopher coal mine No. 3 in Osage, West Virginia, a continent away from the frontlines of World War II, Superintendent Ed O'Neil saw the mine ventilation fan suddenly run backwards, propelled by a strong gust of air that tore the belt off the huge blower. The second shift mantrip of 115 coal miners, traversing the drift mouth for the 3:00 p.m. shift, ground to an uneasy halt. The article recounts the tragic consequences of this incident. It also tells of other events affecting coal miners during World War I and World War II.

Brenda J. Flinn

2005-11-01

306

WHO: the casualties and compromises of renewal.  

PubMed

The World Health Organization is the leading international agency in health. WHO's reputation reached a peak in the 1970s with the then director-general Halfdan Mahler's advocacy of Health for All by the Year 2000 and the successful worldwide eradication of smallpox. The 1980s and 1990s saw WHO lose much of its authority. Too easily, the blame was put on one man-Mahler's successor, Hiroshi Nakajima. In 1998, Gro Harlem Brundtland, Figure 1 a former Prime Minister of Norway, took office and WHO began a period of major strategic and structural reform. Almost 4 years into her first term as director-general, I visited WHO's headquarters in Geneva to learn about Dr Brundtland's successes and failures. Figure 2 The ground rules of my visit were that I could talk with anybody and attend almost any meeting (budget discussions were excluded). I interviewed Dr Brundtland, executive directors, members of the staff association, and directors and project managers of programmes such as StopTB, Roll Back Malaria, HIV-AIDS, violence prevention, polio eradication, essential drugs and medicines, and sustainable development. At senior levels, WHO is confident and clear about its purpose-in a way that matches Mahler's vision and goes beyond it in results. Brundtland told me that her most important achievements were to have "strengthened the credibility of WHO" and to have "raised the awareness of health on to the political and global development agendas". But there is a troubling schism between the aspirations of its leadership and the realities faced by the organisation on the ground. Rapid change during the past 4 years has reinvigorated WHO's mandate, but poor management has created new tensions that the organisation's leadership seems unwilling to address. PMID:12047986

Horton, Richard

2002-05-01

307

Simulation for trauma and combat casualty care.  

PubMed

Training medical providers to care for traumatically injured patients is a difficult undertaking and currently used training strategies are often suboptimal. The further strains placed on trauma care in the military environment only add to the challenge. Simulation applications ranging from simple physical models to complex, computer-based virtual reality systems have either been developed or are being developed to help support and improve trauma care training. Several of these applications have been shown to be as good as or better than the standard training methods they are designed to replace. Simulators are available for training in the treatment of disorders of the airway, difficulty with breathing, and problems dealing with circulation as well as various non-life-threatening but disabling injuries. Some of these simulators have already drastically changed how the standard Advanced Trauma Life Support course is taught. Advances in both technology and application of simulators will continue to affect trauma skills training for the foreseeable future. PMID:16754168

Matt Ritter, E; Bowyer, Mark W

2005-01-01

308

Regenerative medicine applications in combat casualty care.  

PubMed

The purpose of this report is to describe regenerative medicine applications in the management of complex injuries sustained by service members injured in support of the wars in Afghanistan and Iraq. Improvements in body armor, resuscitative techniques and faster transport have translated into increased patient survivability and more complex wounds. Combat-related blast injuries have resulted in multiple extremity injuries, significant tissue loss and amputations. Due to the limited availability and morbidity associated with autologous tissue donor sites, the introduction of regenerative medicine has been critical in managing war extremity injuries with composite massive tissue loss. Through case reports and clinical images, this report reviews the application of regenerative medicine modalities employed to manage combat-related injuries. It illustrates that the novel use of hybrid reconstructions combining traditional and regenerative medicine approaches are an effective tool in managing wounds. Lessons learned can be adapted to civilian care. PMID:24750059

Fleming, Mark E; Bharmal, Husain; Valerio, Ian

2014-03-01

309

Don't Become a Blizzard Casualty  

MedlinePLUS

... not be available after 04/27/2015) By Robert Preidt Tuesday, January 27, 2015 Related MedlinePlus Page ... be outdoors, staying warm is critical, said Dr. Robert Glatter, an emergency physician at Lenox Hill Hospital ...

310

Advanced Technology Applications for Combat Casualty Care  

NASA Technical Reports Server (NTRS)

Exploration Medical Capability (ExMC) is an element of NASA s Human Research Program (HRP). ExMC s goal is to address the risk of the "Inability to Adequately Recognize or Treat an Ill or Injured Crewmember." This poster highlights the approach ExMC has taken to address this goal and our current areas of interest. The Space Medicine Exploration Medical Condition List (SMEMCL) was created to identify medical conditions of concern during exploration missions. The list was derived from space flight medical incidents, the shuttle medical checklist, the International Space Station medical checklist, and expert opinion. The conditions on the list were prioritized according to mission type by a panel comprised of flight surgeons, physician astronauts, engineers, and scientists. From the prioritized list, the ExMC element determined the capabilities needed to address the medical conditions of concern. Where such capabilities were not currently available, a gap was identified. The element s research plan outlines these gaps and the tasks identified to achieve the desired capabilities for exploration missions.

Watkins, Sharmila; Baumann, David; Wu, Jimmy

2010-01-01

311

Seismic Life Detector for battlefield casualty assessment  

Microsoft Academic Search

The Southwest Research Institute Life Detector is a hand-held, battery-operated seismometer. It is capable of detecting cardiac induced chest wall vibrations through heavy clothing and protective garments. A rule-based algorithm is used to analyze the detected signals to provide an indication of the heart beat and to compute the heart rate.

H. Herbert Peel; Jonathan P. Jaeb; Reuben W. Edgar

1992-01-01

312

A head mounted infrared imager for treating the wounded on the battlefield  

Microsoft Academic Search

The use of a head mounted infrared imaging system for battlefield combat casualty care in total darkness without illuminating the wounded or the medic could greatly increase their survival rate. The head mounted unit will allow the visualization of the wounds in order to institute triage. The visualization of the wounds will allow treatment on the battlefield and allow evacuation

D. Gene Luther; James E. Davidson; Rodney W. Cromer; Jonathan F. Head

1997-01-01

313

Advanced Trauma Life Support aboard RFA Argus.  

PubMed

The Advanced Trauma Life Support (ATLS) system was adopted for casualty reception and resuscitation. ATLS permitted well-informed triage decisions to be made, coupled with appropriate initial, possibly life-saving, treatment. The training given on board has continued to benefit patients treated by ex-Argus staff in their peacetime roles. PMID:1453364

Greenslade, G L; Taylor, R H

1992-01-01

314

The Threat of Biological Weapons: Prophylaxis and Mitigation of Psychological and Social Consequences  

Microsoft Academic Search

The microbial world is mysterious, threatening, and frightening to most people. The stressors associated with a biological terrorist attack could create high numbers of acute and potentially chronic psychiatric casualties who must be recognized, diagnosed, and treated to facilitate triage and medical care. Media communications, planning for quarantine and decontamination, and the role of community leaders are important to the

Harry C. Holloway; Ann E. Norwood; Carol S. Fullerton; Charles C. Engel; Robert J. Ursano

315

THE VIEW FROM THE TRENCHES: PART 2–TECHNICAL CONSIDERATIONS FOR EPR SCREENING  

PubMed Central

There is growing awareness of the need for methodologies that can be used retrospectively to provide the biodosimetry needed to carry out screening and triage immediately after an event in which large numbers of people have potentially received clinically significant doses of ionizing radiation. The general approach to developing such methodologies has been a technology centric one, often ignoring the system integrations considerations that are key to their effective use. In this study an integrative approach for the evaluation and development of a physical biodosimetry technology was applied based on in vivo electron paramagnetic resonance (EPR) dosimetry. The EPR measurements are based on physical changes in tissues whose magnitudes are not affected by the factors that can confound biologically-based assessments. In this study the use of a pilot simulation exercise to evaluate an experimental EPR system and gather stakeholders’ feedback early on in the development process is described. The exercise involved: ten non-irradiated participants, representatives from a local fire department; Department of Homeland Security certified exercise evaluators, EPR experts, physicians; and a human factors engineer. Stakeholders were in agreement that the EPR technology in its current state of development could be deployed for the screening of mass casualties. Furthermore, stakeholders’ recommendations will be prioritized and incorporated in future developments of the EPR technique. While the results of this exercise were aimed specifically at providing feedback for the development of EPR dosimetry for screening mass casualties, the methods and lessons learned are likely to be applicable to other biodosimetric methods. PMID:20065674

Nicolalde, Roberto J.; Gougelet, Robert M.; Rea, Michael; Williams, Benjamin B.; Dong, Ruhong; Kmiec, Maciej M.; Lesniewski, Piotr N.; Swartz, Harold M.

2014-01-01

316

OPERATIONAL GUIDANCE FOR RADIATION EMERGENCY RESPONSE ORGANISATIONS IN EUROPE FOR USING BIODOSIMETRIC TOOLS DEVELOPED IN EU MULTIBIODOSE PROJECT.  

PubMed

In the event of a large-scale radiological emergency, the triage of individuals according to their degree of exposure forms an important initial step of the accident management. Although clinical signs and symptoms of a serious exposure may be used for radiological triage, they are not necessarily radiation specific and can lead to a false diagnosis. Biodosimetry is a method based on the analysis of radiation-induced changes in cells of the human body or in portable electronic devices and enables the unequivocal identification of exposed people who should receive medical treatment. The MULTIBIODOSE (MBD) consortium developed and validated several biodosimetric assays and adapted and tested them as tools for biological dose assessment in a mass-casualty event. Different biodosimetric assays were validated against the 'gold standard' of biological dosimetry-the dicentric assay. The assays were harmonised in such a way that, in an emergency situation, they can be run in parallel in a network of European laboratories. The aim of this guidance is to give a concise overview of the developed biodosimetric tools as well as how and when they can be used in an emergency situation. PMID:25274532

Jaworska, Alicja; Ainsbury, Elizabeth A; Fattibene, Paola; Lindholm, Carita; Oestreicher, Ursula; Rothkamm, Kai; Romm, Horst; Thierens, Hubert; Trompier, Francois; Voisin, Philippe; Vral, Anne; Woda, Clemens; Wojcik, Andrzej

2014-10-01

317

Primary mass standard based on atomic masses  

NASA Astrophysics Data System (ADS)

The paper summarises the activities of several national and international Metrology Institutes in replacing the kilogram artefact, the unit of mass, by the mass of a certain number of atoms, in particular the atomic masses of silicon or bismuth. This task is based on two different experiments: a very accurate determination of the Avogadro constant, NA, measuring the density and lattice parameter of an enriched silicon-28 crystal, and the accumulation of decelerated bismuth-209 ions by using a mass separator. The relative measurement uncertainties reached so far are in the first case 2 parts in 107, and in the latter several part in 104. The bismuth experiment is still in an early state of the work. The ratios between the masses of 28Si or 209Bi, respectively, and the present atomic mass standard, the mass of 12C, can be determined with an accuracy now approaching 10-10 using high precision Penning traps mass spectrometers.

Becker, Peter; Gläser, Michael

2006-04-01

318

Alienation, Mass Society and Mass Culture.  

ERIC Educational Resources Information Center

This monograph examines the nature of alienation in mass society and mass culture. Conceptually based on the "Gemeinschaft-Gesellschaft" paradigm of sociologist Ferdinand Tonnies, discussion traces the concept of alienation as it appears in the philosophies of Hegel, Marx, Kierkegaard, Sartre, and others. Dwight Macdonald's "A Theory of Mass

Dam, Hari N.

319

Multi-parameter dose estimations in radiation biodosimetry using the automated cytokinesis-block micronucleus assay with imaging flow cytometry.  

PubMed

The cytokinesis-block micronucleus (CBMN) assay is an established technique in radiation biological dosimetry for estimating the dose to an individual by measuring the frequency of micronuclei (MN) in binucleated lymphocyte cells (BNCs). The assay has been partially automated using slide-scoring algorithms, but an automated multiparameter method without the need of the slide-making procedure would be advantageous to further increase throughput for application in mass casualty events. The development of the ImageStreamX (ISX) imaging flow cytometer has made it possible to adapt the CBMN assay to an automated imaging flow cytometry (FCM) method. The protocol and analysis presented in this work tailor and expand the assay to a multiparameter biodosimetry tool. Ex vivo irradiated whole blood samples were cultured, processed, and analyzed on the ISX and BNCs, MN, and mononuclear cells were imaged, identified, and enumerated automatically and simultaneously. Details on development of the method, gating strategy, and dose response curves generated for the rate of MN per BNC, percentage of mononuclear cells as well as the replication index are presented. Results indicate that adapting the CBMN assay for use in imaging FCM has produced a rapid, robust, multiparameter analysis method with higher throughput than is currently available with standard microscopy. We conclude that the ISX-CBMN method may be an advantageous tool following a radiological event where triage biodosimetry must be performed on a large number of casualties. PMID:25154929

Rodrigues, M A; Beaton-Green, L A; Kutzner, B C; Wilkins, R C

2014-10-01

320

Mass spectrometer calibration standard  

NASA Technical Reports Server (NTRS)

Inert perfluorinated alkane and alkyl ethers mixture is used to calibrate mass spectrometer. Noncontaminating, commercially-available liquid provides series of reproducible reference peaks over broad mass spectrum that ranges over mass numbers from 1 to 200.

Ross, D. S.

1978-01-01

321

Inflammatory fatty masses of the abdomen.  

PubMed

While omental infarction (OI) and acute epiploic appendagitis (AEA) often clinically mimic surgical abdomen, their management is distinct. As such, accurate and timely diagnosis is essential to follow medical management. Computed tomography and ultrasound imaging, utilized routinely in the evaluation of acute abdominal pain in the emergent setting, facilitate diagnosis and appropriate management of OI and AEA. The awareness of the clinical manifestations and imaging features of OI, AEA, and their mimics allow the radiologist to play a decisive role in triaging patients into surgical and medical management groups. PMID:18853843

Garg, Alpa G; Singh, Ajay K

2008-10-01

322

Ultra High Mass Range Mass Spectrometer System  

DOEpatents

Applicant's present invention comprises mass spectrometer systems that operate in a mass range from 1 to 10.sup.16 DA. The mass spectrometer system comprising an inlet system comprising an aerodynamic lens system, a reverse jet being a gas flux generated in an annulus moving in a reverse direction and a multipole ion guide; a digital ion trap; and a thermal vaporization/ionization detector system. Applicant's present invention further comprises a quadrupole mass spectrometer system comprising an inlet system having a quadrupole mass filter and a thermal vaporization/ionization detector system. Applicant's present invention further comprises an inlet system for use with a mass spectrometer system, a method for slowing energetic particles using an inlet system. Applicant's present invention also comprises a detector device and a method for detecting high mass charged particles.

Reilly, Peter T. A. [Knoxville, TN

2005-12-06

323

Mass and Elite Views on Nuclear Security: US National Security Surveys 1993-1999  

SciTech Connect

This is the fourth report in an ongoing series of studies examining how US perspectives about nuclear security are evolving in the post-Cold War era. In Volume 1 the authors present findings from a nationwide telephone survey of randomly selected members of the US general public conducted from 13 September to 14 October 1999. Results are compared to findings from previous surveys in this series conducted in 1993, 1995, and 1997, and trends are analyzed. Key areas of investigation reported in Volume 1 include evolving perceptions of nuclear weapons risks and benefits, preferences for related policy and spending issues, and views about three emerging issue areas: deterrent utility of precision guided munitions; response options to attacks in which mass casualty weapons are used; and expectations about national missile defenses. In this volume they relate respondent beliefs about nuclear security to perceptions of nuclear risks and benefits and to policy preferences. They develop causal models to partially explain key preferences, and they employ cluster analysis to group respondents into four policy relevant clusters characterized by similar views and preferences about nuclear security within each cluster. Systematic links are found among respondent demographic characteristics, perceptions of nuclear risks and benefits, policy beliefs, and security policy and spending preferences. In Volume 2 they provide analysis of in-depth interviews with fifty members of the US security policy community.

HERRON,KERRY G.; JENKINS-SMITH,HANK C.; HUGHES,SCOTT D.

2000-06-01

324

Mass spectrometric immunoassay  

DOEpatents

Rapid mass spectrometric immunoassay methods for detecting and/or quantifying antibody and antigen analytes utilizing affinity capture to isolate the analytes and internal reference species (for quantification) followed by mass spectrometric analysis of the isolated analyte/internal reference species. Quantification is obtained by normalizing and calibrating obtained mass spectrum against the mass spectrum obtained for an antibody/antigen of known concentration.

Nelson, Randall W (Phoenix, AZ); Williams, Peter (Phoenix, AZ); Krone, Jennifer Reeve (Granbury, TX)

2007-12-04

325

Le meurtrier de masse  

Microsoft Academic Search

Multicide and other mass killing are sufficiently dramatic to excite great interest from clinicians, criminologists and behavioural scientists. A review of avaible literature on the topic is presented and analysed, in order to define mass murder and to learn about sociodemography and psychopathology of mass killers. Mass homicide is typically defined as the intentional killing of multiple individuals, injuring five

Y. Auxéméry

2011-01-01

326

Mass of the Earth  

NSDL National Science Digital Library

In this activity, learners use basic measurements of the Earth and pieces of rock and iron to estimate the mass of the Earth. Learners will calculate mass, volume, and density, convert units, and employ the water displacement method. To calculate an even more accurate estimate of the mass of the Earth, this resource includes optional instructions on how to measure the iron core mass.

Muller, Eric

2010-01-01

327

Mass spectrometric immunoassay  

DOEpatents

Rapid mass spectrometric immunoassay methods for detecting and/or quantifying antibody and antigen analytes utilizing affinity capture to isolate the analytes and internal reference species (for quantification) followed by mass spectrometric analysis of the isolated analyte/internal reference species. Quantification is obtained by normalizing and calibrating obtained mass spectrum against the mass spectrum obtained for an antibody/antigen of known concentration.

Nelson, Randall W; Williams, Peter; Krone, Jennifer Reeve

2013-07-16

328

Linear mass actuator  

NASA Technical Reports Server (NTRS)

A linear mass actuator includes an upper housing and a lower housing connectable to each other and having a central passageway passing axially through a mass that is linearly movable in the central passageway. Rollers mounted in the upper and lower housings in frictional engagement with the mass translate the mass linearly in the central passageway and drive motors operatively coupled to the roller means, for rotating the rollers and driving the mass axially in the central passageway.

Holloway, Sidney E., III (inventor); Crossley, Edward A., Jr. (inventor); Jones, Irby W. (inventor); Miller, James B. (inventor); Davis, C. Calvin (inventor); Behun, Vaughn D. (inventor); Goodrich, Lewis R., Sr. (inventor)

1992-01-01

329

Heavy quark masses  

NASA Technical Reports Server (NTRS)

In the large quark mass limit, an argument which identifies the mass of the heavy-light pseudoscalar or scalar bound state with the renormalized mass of the heavy quark is given. The following equation is discussed: m(sub Q) = m(sub B), where m(sub Q) and m(sub B) are respectively the mass of the heavy quark and the mass of the pseudoscalar bound state.

Testa, Massimo

1990-01-01

330

Imaging mass spectrometer with mass tags  

DOEpatents

A method of analyzing biological material by exposing the biological material to a recognition element, that is coupled to a mass tag element, directing an ion beam of a mass spectrometer to the biological material, interrogating at least one region of interest area from the biological material and producing data, and distributing the data in plots.

Felton, James S.; Wu, Kuang Jen J.; Knize, Mark G.; Kulp, Kristen S.; Gray, Joe W.

2013-01-29

331

Mass - Comparing Masses Without Use of Gravity  

NSDL National Science Digital Library

This web page gives instructions for performing mass measurements in the same method used by astronauts on the Skylab space station. Using a hacksaw blade, clamps, bolts, and a watch, the experiment shows how mass may be measured without recourse to gravity. The activity is the third of a 3-part teaching module on mass, developed by the educational website "From Stargazers to Starships". The first section discusses how such measurements were actually conducted in 1973 aboard "Skylab," and the second gives background information on the Skylab mission.

Stern, David

2005-01-04

332

Improved Jänecke mass formula  

NASA Astrophysics Data System (ADS)

In this paper we improve an empirical mass formula constructed by Jänecke and collaborators. This formula is enlightened by the Garvey-Kelson mass relations. The new version of the Jänecke formula reproduces 2275 atomic masses with neutron number N ?10 and proton number Z ?6 , at an average accuracy of 128 keV, by employing 576 parameters. The predictive power of our formula is exemplified by comparison with predicted results of other mass models.

He, Z.; Bao, M.; Zhao, Y. M.; Arima, A.

2014-11-01

333

On the graviton mass  

Microsoft Academic Search

It was suggested that observations of the solar system exclude massive gravity, in the sense that the graviton mass must be rigorously zero. This is because there is a discontinuity in the linearized gravity theory at graviton mass equal to zero. The linearized Schwarzschild metric is not recovered for infinitesimal graviton mass, contradicting observations on light deviation by the Sun

Andrei Gruzinov

2005-01-01

334

On Defining Mass  

ERIC Educational Resources Information Center

Though central to any pedagogical development of physics, the concept of mass is still not well understood. Properly defining mass has proven to be far more daunting than contemporary textbooks would have us believe. And yet today the origin of mass is one of the most aggressively pursued areas of research in all of physics. Much of the excitement…

Hecht, Eugene

2011-01-01

335

Mass spectrometer mixture calibrations  

Microsoft Academic Search

Mass spectrometric analyses of hydrogen isotope mixtures can be difficult to make for a number of reasons. The most difficult problem is the possibility of confronting extremely great and extremely small relative mass differences in the same analysis. Commercial mass spectrometers are now available that can overcome these problems. The analytical capabilities and limitations of these instruments will be discussed.

Hicks

1986-01-01

336

What is Mass Spectrometry?  

NSDL National Science Digital Library

This site from the American Society for Mass Spectrometry includes information about what mass spectometry is and how it is used. It has many useful figures and references to other materials. The material answers questions such as "What is mass spectrometry and what can it do for you?"

Chiu, Chia M.

337

MassMass transfer andtransfer and MassMass transfer andtransfer and  

E-print Network

coefficientcoefficient /1/1 Mass flow species A:interface a p A = A mol/s M f1 (L) 2 (G) Mass transfer rate per area: A = A/a = "A mol/(m2·s) 1 (L) 2 (G) xi C1.i M t f ffi i t k x C y 1.i AA !!! Mass transfer coefficients - Värme- och strömningsteknik Biskopsgatan 8, 20500 �bo 3/44 p g and cA,interfaceB boundary MassMass heat

Zevenhoven, Ron

338

Fourier Transform Mass Spectrometry  

PubMed Central

This article provides an introduction to Fourier transform-based mass spectrometry. The key performance characteristics of Fourier transform-based mass spectrometry, mass accuracy and resolution, are presented in the view of how they impact the interpretation of measurements in proteomic applications. The theory and principles of operation of two types of mass analyzer, Fourier transform ion cyclotron resonance and Orbitrap, are described. Major benefits as well as limitations of Fourier transform-based mass spectrometry technology are discussed in the context of practical sample analysis, and illustrated with examples included as figures in this text and in the accompanying slide set. Comparisons highlighting the performance differences between the two mass analyzers are made where deemed useful in assisting the user with choosing the most appropriate technology for an application. Recent developments of these high-performing mass spectrometers are mentioned to provide a future outlook. PMID:21742802

Scigelova, Michaela; Hornshaw, Martin; Giannakopulos, Anastassios; Makarov, Alexander

2011-01-01

339

Mass drivers. 3: Engineering  

NASA Technical Reports Server (NTRS)

The last of a series of three papers by the Mass-Driver Group of the 1977 Ames Summer Study is presented. It develops the engineering principles required to implement the basic mass-driver. Optimum component mass trade-offs are derived from a set of four input parameters, and the program used to design a lunar launcher. The mass optimization procedures is then incorporated into a more comprehensive mission optimization program called OPT-4, which evaluates an optimized mass-driver reaction engine and its performance in a range of specified missions. Finally, this paper discusses, to the extent that time permitted, certain peripheral problems: heating effects in buckets due to magnetic field ripple; an approximate derivation of guide force profiles; the mechanics of inserting and releasing payloads; the reaction mass orbits; and a proposed research and development plan for implementing mass drivers.

Arnold, W.; Bowen, S.; Cohen, S.; Fine, K.; Kaplan, D.; Kolm, M.; Kolm, H.; Newman, J.; Oneill, G. K.; Snow, W.

1979-01-01

340

Earthquake triggering of landslides in highly jointed rock masses: Reconstruction of the 1783 Scilla rock avalanche (Italy)  

NASA Astrophysics Data System (ADS)

The Scilla rock avalanche occurred on 6 February 1783 along the coast of the Calabria region (southern Italy), close to the Messina Strait. It was triggered by a mainshock of the “Terremoto delle Calabrie” seismic sequence, and it induced a tsunami wave responsible for more than 1500 casualties along the neighbouring Marina Grande beach. Based on subaerial and submarine surveys, a 5 × 106 m3 subaerial landslide was identified together with a 3 × 106 m3 submarine scar area, whereas block deposits are present in both the subaerial and submerged regions. A detailed geological reconstruction of the slope was obtained and a geomechanical characterisation of the metamorphic rocks involved in the landslide was performed. Based on this reconstruction, intense jointing conditions of the rock mass can be related to main fault zones parallel and normally oriented to the actual coastline. An engineering geology model of the landslide was devised according to an equivalent continuum approach to evaluate both stiffness and strength of the rock mass within the slope. A finite difference stress-strain numerical modelling of the Scilla landslide was performed under dynamic conditions to back-analyse the landslide trigger as well as local seismic amplifications. This modelling gave new insights into the physical interactions between seismic inputs and slopes, as it demonstrated the fundamental role played by i) the interaction between the seismic input and geological setting of unsheared rock slopes (i.e., without preexisting landslide masses), ii) cumulated strain effects due to seismic sequences, and iii) jointing conditions of the involved rock masses responsible for the seismic amplification of the landslide-prone volume, driving it toward failure conditions.

Bozzano, Francesca; Lenti, Luca; Martino, Salvatore; Montagna, Alfredo; Paciello, Antonella

2011-06-01

341

Top quark mass measurements  

SciTech Connect

The top quark, with its extraordinarily large mass (nearly that of a gold atom), plays a significant role in the phenomenology of EWSB in the Standard Model. In particular, the top quark mass when combined with the W mass constrains the mass of the as yet unobserved Higgs boson. Thus, a precise determination of the mass of the top quark is a principal goal of the CDF and D0 experiments. With the data collected thus far in Runs 1 and 2 of the Tevatron, CDF and D0 have measured the top quark mass in both the lepton+jets and dilepton decay channels using a variety of complementary experimental techniques. The author presents an overview of the most recent of the measurements.

Hill, Christopher S.; /UC, Santa Barbara

2004-12-01

342

Mass of Ca-36  

E-print Network

('He, He)' Ca reaction has been used to provide the first observation of the nuclide ' Ca. The Q value and mass excess were found to be ?57.58~0.04 and ?6.44+0.04 MeV, respectively. The new mass completes four members of the A = 36 isobaric quintet... with the 'He mass excess of 31.601 +0.013 MeV, ' we find the reaction Q value to be ?57.58+ 0.04 MeV, and the mass of "Ca to be ?6.44+ 0.04 MeV. DISCUSSION The mass of "Ca constitutes the fourth mea- sured mass of the A = 36 quintet. The properties TABLE...

Tribble, Robert E.; Cossairt, J. D.; Kenefick, R. A.

1977-01-01

343

Environmental Mass Spectrometry  

NASA Astrophysics Data System (ADS)

Environmental mass spectrometry is an important branch of science because it provides many of the data that underlie policy decisions that can directly influence the health of people and ecosystems. Environmental mass spectrometry is currently undergoing rapid development. Among the most relevant directions are a significant broadening of the lists of formally targeted compounds; a parallel interest in nontarget chemicals; an increase in the reliability of analyses involving accurate mass measurements, tandem mass spectrometry, and isotopically labeled standards; and a shift toward faster high-throughput analysis, with minimal sample preparation, involving various approaches, including ambient ionization techniques and miniature instruments. A real revolution in analytical chemistry could be triggered with the appearance of robust, simple, and sensitive portable mass spectrometers that can utilize ambient ionization techniques. If the cost of such instruments is reduced to a reasonable level, mass spectrometers could become valuable household devices.

Lebedev, Albert T.

2013-06-01

344

Energy-mass conversion  

NSDL National Science Digital Library

How do physicists make new particles? In this page of a particle physics tutorial, students are introduced to the concept of converting kinetic energy to mass. Students read that low-mass particles placed into an accelerator can be smashed together to produce more massive particles through the conversion of energy to mass. They see an example in which two pieces of fruit are accelerated and smashed, and additional types of fruit are produced. Copyright 2005 Eisenhower National Clearinghouse

Group, Lawrence B.

2002-01-01

345

Associations between cycling skill, general motor competence and body mass index in 9-year-old children.  

PubMed

Learning to ride a bicycle is an important milestone in a child's life. Unfortunately, young traffic casualties remain overrepresented in traffic reports, with single-bicycle crashes as principal cause in children. This correlational, cross-sectional study focuses on the association between cycling skills and two intrinsic characteristics: general motor competence and body mass index (BMI). Therefore, general motor competence, BMI and practical cycling competence were measured in 9-year-old children (n = 40). Significant correlations were found between cycling skills and general motor competence (r = 0.434, p ? 0.01), and between cycling skills and BMI (r = - 0.400, p ? 0.05). A multiple regression analysis revealed that children's general motor quotient and BMI together predicted 19% of cycling skill score. These findings indicate that general motor competence and bicycle skills are not independent of each other stressing the importance of young children's characteristics when actively participating in traffic. In addition, BMI might be negatively associated with the development of cycling skills in children. PMID:25351715

Linus, Zeuwts; Fabian, Ducheyne; Pieter, Vansteenkiste; Eva, D'Hondt; Greet, Cardon; Matthieu, Lenoir

2014-10-29

346

Interpretation of Conventional Mass  

NASA Astrophysics Data System (ADS)

The conventional mass is not a precise physical quantity but useful virtual one in mass metrology. Because the precise level of conventional mass is related to the OIML class, it is necessary to check if the assignment of weight class is under control. The documents of OIML (International Organization of Legal Metrology) D 28 and R 111 describe the limitation of the quantity in real application. In this presentation, we are trying to interpret and review the concept of conventional mass, for example, by estimating buoyancy deviation and maximum permissible error, in weight calibrations in Korea. Note from Publisher: This article contains the abstract only.

Lee, Sungjun; Kim, Kwang Pyo

347

Nuclear Masses in Astrophysics  

E-print Network

Among all nuclear ground-state properties, atomic masses are highly specific for each particular combination of N and Z and the data obtained apply to a variety of physics topics. One of the most crucial questions to be addressed in mass spectrometry of unstable radionuclides is the one of understanding the processes of element formation in the Universe. To this end, accurate atomic mass values of a large number of exotic nuclei participating in nucleosynthesis are among the key input data in large-scale reaction network calculations. In this paper, a review on the latest achievements in mass spectrometry for nuclear astrophysics is given.

Christine Weber; Klaus Blaum; Hendrik Schatz

2008-12-09

348

Light Quark Mass Reweighting  

E-print Network

We present a systematic study of the effectiveness of light quark mass reweighting. This method allows a single lattice QCD ensemble, generated with a specific value of the dynamical light quark mass, to be used to determine results for other, nearby light dynamical quark masses. We study two gauge field ensembles generated with 2+1 flavors of dynamical domain wall fermions with light quark masses m_l=0.02 (m_\\pi=620 MeV) and m_l=0.01 (m_\\pi=420 MeV). We reweight each ensemble to determine results which could be computed directly from the other and check the consistency of the reweighted results with the direct results. The large difference between the 0.02 and 0.01 light quark masses suggests that this is an aggressive application of reweighting as can be seen from fluctuations in the magnitude of the reweighting factor by four orders of magnitude. Never-the-less, a comparison of the reweighed topological charge, average plaquette, residual mass, pion mass, pion decay constant, and scalar correlator between these two ensembles shows agreement well described by the statistical errors. The issues of the effective number of configurations and finite sample size bias are discussed. An examination of the topological charge distribution implies that it is more favorable to reweight from heavier mass to lighter quark mass.

Qi Liu; Norman H. Christ; Chulwoo Jung

2012-06-01

349

MassTRIX: mass translator into pathways.  

PubMed

Recent technical advances in mass spectrometry (MS) have brought the field of metabolomics to a point where large numbers of metabolites from numerous prokaryotic and eukaryotic organisms can now be easily and precisely detected. The challenge today lies in the correct annotation of these metabolites on the basis of their accurate measured masses. Assignment of bulk chemical formula is generally possible, but without consideration of the biological and genomic context, concrete metabolite annotations remain difficult and uncertain. MassTRIX responds to this challenge by providing a hypothesis-driven approach to high precision MS data annotation. It presents the identified chemical compounds in their genomic context as differentially colored objects on KEGG pathway maps. Information on gene transcription or differences in the gene complement (e.g. samples from different bacterial strains) can be easily added. The user can thus interpret the metabolic state of the organism in the context of its potential and, in the case of submitted transcriptomics data, real enzymatic capacities. The MassTRIX web server is freely accessible at http://masstrix.org. PMID:18442993

Suhre, Karsten; Schmitt-Kopplin, Philippe

2008-07-01

350

MassTRIX: mass translator into pathways  

PubMed Central

Recent technical advances in mass spectrometry (MS) have brought the field of metabolomics to a point where large numbers of metabolites from numerous prokaryotic and eukaryotic organisms can now be easily and precisely detected. The challenge today lies in the correct annotation of these metabolites on the basis of their accurate measured masses. Assignment of bulk chemical formula is generally possible, but without consideration of the biological and genomic context, concrete metabolite annotations remain difficult and uncertain. MassTRIX responds to this challenge by providing a hypothesis-driven approach to high precision MS data annotation. It presents the identified chemical compounds in their genomic context as differentially colored objects on KEGG pathway maps. Information on gene transcription or differences in the gene complement (e.g. samples from different bacterial strains) can be easily added. The user can thus interpret the metabolic state of the organism in the context of its potential and, in the case of submitted transcriptomics data, real enzymatic capacities. The MassTRIX web server is freely accessible at http://masstrix.org PMID:18442993

Suhre, Karsten; Schmitt-Kopplin, Philippe

2008-01-01

351

Mass vs. Weight: Air Powered Mass  

NSDL National Science Digital Library

In this video from NASA's Teaching From Space initiative, astronauts on board the International Space Station conduct an experiment using an air gun to exert a consistent force on two difference masses -- an empty water bag and a full water bag.

WNET

2011-11-01

352

Mass/Weight Connection  

NSDL National Science Digital Library

Students will recognize that the mass of an object is a measure that is independent of gravity. If they can effectively complete the guided inquiry activity as well as the short writing summary to reinforce what they learned, they will gain a foundation for understanding the difference between mass and weight.

King, Lance

2011-07-26

353

Force, mass and acceleration  

Microsoft Academic Search

Force, mass and acceleration are everyday words but often used inaccurately. Force is a physical influence, which when applied to an object causes it to accelerate in the direction from which it was applied. Mass is the amount of matter in an object and is expressed in kilograms. Acceleration is the rate of change of velocity of an object in

Phil Dalrymple; Richard Griffiths

2005-01-01

354

The Origins of Mass  

SciTech Connect

The Higgs boson was discovered in July of 2012 and is generally understood to be the origin of mass. While those statements are true, they are incomplete. It turns out that the Higgs boson is responsible for only about 2% of the mass of ordinary matter. In this dramatic new video, Dr. Don Lincoln of Fermilab tells us the rest of the story.

Lincoln, Don

2014-07-30

355

Environmental Geomorphology Mass Wasting  

NSDL National Science Digital Library

J. Bret Bennington of Hofstra University has created this simple website discussing many issues in geomorphology. The article discusses mass wasting, normal force, shear force, colluvium, landslides, rockfall, rockslide, slumping, earth flow, mud flow, debris avalanche, and different devastating mass wasting events. Although visually basic, this resource still contains valuable information about many different topics in this discipline.

Bennington, J. Bret

356

MassMass transfer andtransfer and MassMass transfer andtransfer and  

E-print Network

equations are not available.available. Experimental work on test facilities is very e ensi eexpensive as a tool PROBLEM Are balance equations (mass energy ) known? noyes (mass, energy, ...) known? Can balance analysisSolve balance equations C d t d l l relevant parameters SOLUTION Conduct model-scale experiments

Zevenhoven, Ron

357

Mass Storage Systems.  

ERIC Educational Resources Information Center

Presents an overview of the mass storage market and discusses mass storage systems as part of computer networks. Systems for personal computers, workstations, minicomputers, and mainframe computers are described; file servers are explained; system integration issues are raised; and future possibilities are suggested. (LRW)

Ranade, Sanjay; Schraeder, Jeff

1991-01-01

358

Imaging of wrist masses  

Microsoft Academic Search

The wrist is a complex structure with an extensive differential diagnosis for a presenting mass. However, the vast majority of hand and wrist masses are benign, and many of these have a distinctive radiographic appearance. In this article, the imaging characteristics of the most common entities are reviewed with particular attention to magnetic resonance appearance. The 3 most common hand

Vu Nguyen; James Choi; Kirkland W Davis

2004-01-01

359

Gas Chromatography -Mass Spectrometry  

E-print Network

GCMS - 1 Gas Chromatography - Mass Spectrometry GC-MS ANALYSIS OF ETHANOL AND BENZENE IN GASOLINE Last updated: June 17, 2014 #12;GCMS - 2 Gas Chromatography - Mass Spectrometry GC-MS ANALYSIS). The goal of this experiment is to separate the components in a sample of gasoline using Gas Chromatography

Nizkorodov, Sergey

360

W mass and properties  

SciTech Connect

Precise measurements of the mass and width of the W boson are sensitive to radiative corrections and can be used to place limits on new physics beyond the Standard Model and validate the consistency of the model. In particular, the W boson mass constrains the mass of the, as yet unobserved, Higgs boson and the width can be used to place limits on the existence of new particles that couple to the W. Results are presented from p{bar p} collisions recorded by the CDF and D0 experiments at the Fermilab Tevatron collider, operating at a center of mass energy of 1.96 TeV. The uncertainty on the W mass is determined to be 76 MeV by CDF and the width, by D0, to be 2011 {+-} 90 (stat.) {+-} 107 (syst.) MeV.

Lancaster, Mark; /University Coll. London

2005-11-01

361

Giant mediastinal mass: thymolipoma.  

PubMed

A 26-year-old man presented with shortness of breath on exertion that was gradually getting worse. His history revealed a mass in the left hemithorax that had been growing on follow-ups. Physical examination only showed that the respiratory sounds were fainter on the left. Thoracic computerized tomography was performed to elucidate the left hemithorax lesion seen on chest x-ray and a giant mass of lipid density extending from the anterior mediastinum to the diaphragm and filling almost the entire left hemithorax was observed. Total excision of the 25 × 21 × 8 cm mass weighing 1580 g was performed with a left thoracotomy. The histopathology investigation of the mass was reported as thymolipoma. The case was presented because it is a rare mediastinal mass. PMID:21606717

Alar, Timuçin; Ozçelik, Cemal; Kilnç, Nihal

2011-05-01

362

Probabilistic Mass Growth Uncertainties  

NASA Technical Reports Server (NTRS)

Mass has been widely used as a variable input parameter for Cost Estimating Relationships (CER) for space systems. As these space systems progress from early concept studies and drawing boards to the launch pad, their masses tend to grow substantially, hence adversely affecting a primary input to most modeling CERs. Modeling and predicting mass uncertainty, based on historical and analogous data, is therefore critical and is an integral part of modeling cost risk. This paper presents the results of a NASA on-going effort to publish mass growth datasheet for adjusting single-point Technical Baseline Estimates (TBE) of masses of space instruments as well as spacecraft, for both earth orbiting and deep space missions at various stages of a project's lifecycle. This paper will also discusses the long term strategy of NASA Headquarters in publishing similar results, using a variety of cost driving metrics, on an annual basis. This paper provides quantitative results that show decreasing mass growth uncertainties as mass estimate maturity increases. This paper's analysis is based on historical data obtained from the NASA Cost Analysis Data Requirements (CADRe) database.

Plumer, Eric; Elliott, Darren

2013-01-01

363

Mass spectrometric immunoassay.  

PubMed

A new, general method of immunoassay is demonstrated. The approach is based on the microscale immunoaffinity capture of target antigens followed by mass-specific identification and quantitation using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. Immunoaffinity capture of antigens effectively overcomes signal suppression effects typically encountered during traditional matrix-assisted laser desorption/ionization analysis of complex biological mixtures while simultaneously concentrating the analyte into a small volume. Mass spectrometric detection of antigens is unambiguous, as antigen signals are observed at characteristic mass-to-charge values in the mass spectrum, offering a high level of immunity to artifacts due to nonbiospecific retention of mixture components. However, the most important aspect of such mass-specific detection is the ability to use a single assay to screen biological systems for the presence of multiple, mass-resolved antigens. Analyte quantitation is possible by using a single antibody to capture both the antigen and an antigen variant which has been chemically modified to have a different mass. With proper calibration, the relative signal intensities of the two species in the mass spectrum can be used to determine the antigen concentration. Sample incubation and processing methods were such that a typical analysis could be performed in less than 1 h while subnanomolar sensitivities were maintained. The technique has been used for the rapid, selective, and quantitative screening of human blood for the presence of myotoxin a, and Mojave toxin form the venoms of the prairie rattlesnakes, Crotalus viridis viridis, and and the Mojave rattlesnake, Crotalus scutulatus scutulatus. PMID:15134097

Nelson, R W; Krone, J R; Bieber, A L; Williams, P

1995-04-01

364

Masses of Skyrmions  

SciTech Connect

When realistic enough for the description of mesons, Skyrme-type effective Lagrangians proposed so far predict masses that are too high for the nucleon. We attempt to solve this problem by investigating the effects of the quartic term originated by the {epsilon} meson ({ital J}{sup {ital PC}}=0{sup ++},{ital I}=0) when stabilized by a sixth-order term. The possibility of new types of solutions for the Euler-Lagrange equations giving rise to a phase boundary within the soliton is explored. They are found to have the nice property of lowering significantly the soliton mass and hence the baryon masses.

Lacombe, M.; Loiseau, B.; Vinh Mau, R. (Division de Physique Theorique, Institut de Physique Nucleaire, 91406 Orsay CEDEX, France (FR) Laboratoire de Physique Theorique des Particules Elementaires, Universite Pierre et Marie Curie, 75252 Paris CEDEX, France (FR)); Cottingham, W.N. (Physics Department, University of Bristol, Bristol, BS8 1TH, England (UK))

1989-11-01

365

Microlens Mass Functions  

E-print Network

A non-parametric statistical model is constructed to directly relate The distribution of observed microlens timescales to that of the mass Function of the population from which the lenses are drawn, corrected For observational selection based on timescales and event amplifications. Explicit distributions are derived for microlensing impact parameters and maximum amplifications; both are shown to be statistically independent of all other parameters in the problem, including lens mass. The model is used to demonstrate that the narrow range of microlens timescales observed toward the Large Magellanic Cloud (LMC) is probably not consistent with lensing by a widely distributed spheroidal population of large velocity dispersion, as expected of a dark halo; but is consistent with lensing within a rotating thick disk. Poor numerical conditioning on the statistical connection between lens masses and event timescales, and small number statistics, severely limit the mass function information obtainable from current microlensing surveys toward the LMC.

William D. Heacox

2005-10-10

366

Nevan Krogan: Mass Spectrometry  

NSDL National Science Digital Library

This lecture from the iBioSeminars project, presented by Nevan Krogan of the Department of Cellular and Molecular Pharmacology at UC-San Francisco, covers mass spectrometry and its application to molecular biology. Mass spectrometry is a powerful tool for elucidating the elemental composition of a sample or molecule. More recently, it has been used to characterize biological material, in particular proteins and protein complexes, in a variety of organisms. This lecture will review the underlying principles of how a mass spectrometer works, discuss up to date instrumentation that is presently being used in the biological research setting and provide specific examples of how mass spectrometry is being used to reveal functional insight into different biological systems. The video runs 27:36 and can be downloaded in a number of formats: QuickTime, MP4, M4V, and PPT. The video can also be streamed through YouTube or iTunes U.

Krogan, Nevan

2013-07-12

367

Mass and Weight Lesson  

NSDL National Science Digital Library

This exercise is designed to look at the difference between mass and weight, and to move students from a misconception of objects in space being weightless to objects in space being in free fall, and experiencing microgravity.

Joiner, David; The Shodor Education Foundation, Inc.

368

Conservation of Mass  

NSDL National Science Digital Library

The representation is a chemical reaction between zinc and sulfur atoms to form zinc sulfide. The reactants and products are compared on two sides of a pan balance to illustrate that the total mass remains the same.

369

Tritium neutrino mass experiments  

SciTech Connect

The current status of the experimental search for neutrino mass is reviewed, with emphasis on direct kinematic methods, such as the beta decay of tritium. The situation concerning the electron neutrino mass as measured in tritium beta decay is essentially unchanged from a year ago, although a great deal of experimental work is in progress. The ITEP group continues to find evidence for a nonzero mass, now slightly revised to 26(5) eV. After correcting for recently discovered errors in the energy loss distribution and source thickness, however, the Z/umlt u/rich group still claims and upper limit of 18 eV. There may be evidence for neutrino mass and mixing in the SN1987a data, in the same range suggested by the ITEP experiment. 42 refs., 3 figs.

Robertson, R.G.H.

1988-01-01

370

MassTransitMag  

NSDL National Science Digital Library

The MassTransit website is dedicated to "Better Transit Through Better Management", and their offerings include industry news, email newsletters, video profiles, and opinion pieces about the world of mass transit. The site is mostly dedicated to providing information about mass transit systems in the United States, though visitors will note that there is some coverage of international transit systems as well. The "Current Issue" section includes full-text version of most of the articles found in the print issue, along with an archive dating back to 2005. For more up-to-the minute coverage of transit affairs, the "Daily News" area digests ongoing legislation, transit improvements, and long-range plan updates from a variety of sources. The "MassTransit Interactive" area allows users to read and comment on editor's comments on the news affecting the transit world, including issues such as federal funding mechanisms, light-rail initiatives, and union contracts.

371

Evidence for Hidden Mass  

NSDL National Science Digital Library

In this activity, students will interpret and analyze the information presented on the Evidence for Hidden Mass graph. They will observe trends in the graphs, and use it to determine if there is evidence for hidden mass. This is Activity 6b in the educators guide that is designed for use with The Hidden Lives of Galaxies poster These activities are appropriate for students with a range of abilities and learning styles.

372

Transilluminating testicular mass  

PubMed Central

Testicular tumor in prepubertal age group is uncommon. Most of the testicular tumors are benign in this age group and present as painless, hard testicular mass. We present a case where a 7 year male child presented to us with painless scrotal swelling, which was cystic and transilluminating, clinically mimicking as hydrocele. On ultrasonography, the mass was solid. Orchidectomy was performed and histopathology revealed mature cystic teratoma. PMID:21731217

Mahalik, Santosh Kumar; Prasad, Alpana; Bhalla, Suneeta; Kulshrestha, Rajeev

2011-01-01

373

Solids mass flow determination  

DOEpatents

Method and apparatus for determining the mass flow rate of solids mixed with a transport fluid to form a flowing mixture. A temperature differential is established between the solids and fluid. The temperature of the transport fluid prior to mixing, the temperature of the solids prior to mixing, and the equilibrium temperature of the mixture are monitored and correlated in a heat balance with the heat capacities of the solids and fluid to determine the solids mass flow rate.

Macko, Joseph E. (Hempfield Township, Westmoreland County, PA)

1981-01-01

374

Mass spectroscopic facility  

NASA Technical Reports Server (NTRS)

A mass spectrometer system is described. The investigations to be conducted with the completed facility will be concerned with the high-temperature out-gassing behavior of quartz ampoules and the vapor composition in crystal growth experiments. These will give some insight on the prevailing transport mechanisms in these crystal growth experiments and supply a realistic basis for the numerical modeling of heat and mass transfer in these systems.

Rosenberger, Franz

1987-01-01

375

Mass Movements Information  

NSDL National Science Digital Library

Florida International University has created this site to provide information on the causes and effects of mass movements including examples of specific occurrences that caused large amounts of damage and loss of life. Mass movements can cause both social and economic impacts on people and structures. Diagrams and images help to enhance the theories and methods described on this page. This is a nice resource for a general overview of this rather specific topic. External links to other related topics are included.

376

Masses for Four Cepheids  

NASA Astrophysics Data System (ADS)

Velocities from IUE high dispersion spectra have provided mass ratios between a Cepheid and a blue companion for the systems SU Cyg, S Mus, and V636 Sco. The proposed IUE high dispersion observations will produce a mass ratio for a new system, U Aql. with a percentage error as low as 14%. depending on the orbital velocity amplitude of the companion. They will also provide a second optimal spectrum for both S Mus and V636 Sco which will confirm the previous results at the second velocity extremum, reduce the uncertainty in the mass ratio by sqrt 2 to 14%. and also provide an error estimate from comparison with the previous spectrum. For AW Per a spectrum will provide a preliminary mass function. confirmation that it is not a triple system, and information about the rotational velocity for a system which can be resolved by Hubble Space Telescope. These results, together with the SU Cyg results, are the only mass determinations for Cepheids to decide between the discordant evolutionary and pulsational masses.

Bohm-Vitense, Erika

377

Masses for Four Cepheids  

NASA Astrophysics Data System (ADS)

Velocities from IUE high dispersion spectra have provided mass ratios between a Cepheid and a blue companion for the systems SIT Cyg, S Mus, and V636 Sco. The proposed IUE high dispersion observations will produce a mass ratio for a new system, U Aql, with a percentage error as low as 14%, depending on the orbital velocity amplitude of the companion. They will also provide a second optimal spectrum for both S Mus and V636 Sco which will confirm the previous results at the second velocity extremum, reduce the uncertainty in the mass ratio by sqrt2 to 14%, and also provide an error estimate from comparison with the previous spectrum. For AW Per a spectrum will provide a preliminary mass function. confirmation that it is not a triple system, and information about the rotational velocity for a system which can be resolved by Hubble Space Telescope. These results, together with the SU Cyg results, are the only mass determinations for Cepheids to decide between the discordant evolutionary and pulsational masses.

Bohm-Vitense, Erika

378

Deconstructed Transverse Mass Variables  

E-print Network

Traditional searches for R-parity conserving natural supersymmetry (SUSY) require large transverse mass and missing energy cuts to separate the signal from large backgrounds. SUSY models with compressed spectra inherently produce signal events with small amounts of missing energy that are hard to explore. We use this difficulty to motivate the construction of "deconstructed" transverse mass variables which are designed preserve information on both the norm and direction of the missing momentum. We demonstrate the effectiveness of these variables in searches for the pair production of supersymmetric top-quark partners which subsequently decay into a final state with an isolated lepton, jets and missing energy. We show that the use of deconstructed transverse mass variables extends the accessible compressed spectra parameter space beyond the region probed by traditional methods. The parameter space can further be expanded to neutralino masses that are larger than the difference between the stop and top masses. In addition, we also discuss how these variables allow for novel searches of single stop production, in order to directly probe unconstrained stealth stops in the small stop- and neutralino-mass regime. We also demonstrate the utility of these variables for generic gluino and stop searches in all-hadronic final states. Overall, we demonstrate that deconstructed transverse variables are essential to any search wanting to maximize signal separation from the background when the signal has undetected particles in the final state.

Ahmed Ismail; Reinhard Schwienhorst; Joseph S. Virzi; Devin G. E. Walker

2014-09-09

379

Rapid scanning mass spectrometer  

SciTech Connect

Mass spectrometers and residual gas analyzers (RGA) are used in a variety of applications for analysis of volatile and semi-volatile materials. Analysis is performed by detecting fragments of gas molecules, based on their mass to charge ratio, which are generated in the mass spectrometer. When used as a detector for a gas chromatograph, they function as a means to quantitatively identify isolated volatile species which have been separated from other species via the gas chromatograph. Vacuum Technology, Inc., (VTI) produces a magnetic sector mass spectrometer/RGA which is used in many industrial and laboratory environments. In order to increase the utility of this instrument, it is desirable to increase the mass scanning speed, thereby increasing the number of applications for which it is suited. This project performed the following three upgrades on the computer interface. (1) A new electrometer was designed and built to process the signal from the detector. This new electrometer is more sensitive, over 10 times faster, and over 100 times more stable than the electrometer it will replace. (2) The controller EPROM was reprogrammed with new firmware. This firmware acts as an operating system for the interface and is used to shuttle communications between the PC and the AEROVAC mass spectrometer. (3) The voltage regulator which causes the ion selector voltage to ramp to allow ions of selected mass to be sequentially detected was redesigned and prototyped. The redesigned voltage regulator can be ramped up or down more than 100 times faster than the existing regulator. These changes were incorporated into a prototype unit and preliminary performance testing conducted. Results indicated that scanning speed was significantly increased over the unmodified version.

Leckey, J.H. [Lockheed Martin Energy Systems, Inc., Oak Ridge, TN (United States); Boeckmann, M.D. [Vacuum Technology, Inc., Oak Ridge, TN (United States)

1996-11-25

380

Greenland Ice Sheet Mass Balance  

NASA Technical Reports Server (NTRS)

Mass balance equation for glaciers; areal distribution and ice volumes; estimates of actual mass balance; loss by calving of icebergs; hydrological budget for Greenland; and temporal variations of Greenland mass balance are examined.

Reeh, N.

1984-01-01

381

Atomic mass compilation 2012  

SciTech Connect

Atomic mass reflects the total binding energy of all nucleons in an atomic nucleus. Compilations and evaluations of atomic masses and derived quantities, such as neutron or proton separation energies, are indispensable tools for research and applications. In the last decade, the field has evolved rapidly after the advent of new production and measuring techniques for stable and unstable nuclei resulting in substantial ameliorations concerning the body of data and their precision. Here, we present a compilation of atomic masses comprising the data from the evaluation of 2003 as well as the results of new measurements performed. The relevant literature in refereed journals and reports as far as available, was scanned for the period beginning 2003 up to and including April 2012. Overall, 5750 new data points have been collected. Recommended values for the relative atomic masses have been derived and a comparison with the 2003 Atomic Mass Evaluation has been performed. This work has been carried out in collaboration with and as a contribution to the European Nuclear Structure and Decay Data Network of Evaluations.

Pfeiffer, B., E-mail: bpfeiffe@uni-mainz.de [II. Physikalisches Institut, Justus-Liebig-Universität Gießen, Gießen (Germany); GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt (Germany); Venkataramaniah, K. [Sri Sathya Sai Institute of Higher Learning, Prasanthinilayam (India)] [Sri Sathya Sai Institute of Higher Learning, Prasanthinilayam (India); Czok, U. [II. Physikalisches Institut, Justus-Liebig-Universität Gießen, Gießen (Germany)] [II. Physikalisches Institut, Justus-Liebig-Universität Gießen, Gießen (Germany); Scheidenberger, C. [GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt (Germany) [GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt (Germany); II. Physikalisches Institut, Justus-Liebig-Universität Gießen, Gießen (Germany)

2014-03-15

382

Tau Lepton Mass Measurements  

SciTech Connect

The authors present the preliminary results from the precision measurement of the mass of the tau lepton using 423 fb{sup -1} of data collected at BABAR. Using a pseudomass endpoint method, they determine the mass to be 1776.68 {+-} 0.12(stat) {+-} 0.41(syst) MeV. They also measure the mass difference between the T{sup +} and T{sup -}, and obtain M{sub +}-M{sub -}/M{sub AVG} = (-3.5 {+-} 1.3) x 10{sup -4}. This results in a limit of -5.6 x 10{sup -4} < M{sub +}-M{sub -}/M{sub AVG} < -1.4 x 10{sup -4} at 90% CL.

Lund, P.; /UC, Irvine

2009-08-05

383

Bioreactor Mass Transport Studies  

NASA Technical Reports Server (NTRS)

The objectives of the proposed research efforts were to develop both a simulation tool and a series of experiments to provide a quantitative assessment of mass transport in the NASA rotating wall perfused vessel (RWPV) bioreactor to be flown on EDU#2. This effort consisted of a literature review of bioreactor mass transport studies, the extension of an existing scalar transport computer simulation to include production and utilization of the scalar, and the evaluation of experimental techniques for determining mass transport in these vessels. Since mass transport at the cell surface is determined primarily by the relative motion of the cell assemblage and the surrounding fluid, a detailed assessment of the relative motion was conducted. Results of the simulations of the motion of spheres in the RWPV under microgravity conditions are compared with flight data from EDU#1 flown on STS-70. The mass transport across the cell membrane depends upon the environment, the cell type, and the biological state of the cell. Results from a literature review of cell requirements of several scalars are presented. As a first approximation, a model with a uniform spatial distribution of utilization or production was developed and results from these simulations are presented. There were two candidate processes considered for the experimental mass transport evaluations. The first was to measure the dissolution rate of solid or gel beads. The second was to measure the induced fluorescence of beads as a stimulant (for example hydrogen peroxide) is infused into the vessel. Either technique would use video taped images of the process for recording the quantitative results. Results of preliminary tests of these techniques are discussed.

Kleis, Stanley J.; Begley, Cynthia M.

1997-01-01

384

Mass determination of neutrinos  

NASA Technical Reports Server (NTRS)

A time-energy correlation method has been developed to determine the signature of a nonzero neutrino mass in a small sample of neutrinos detected from a distant source. The method is applied to the Kamiokande II (Hirata et al., 1987) and IMB (Bionta et al., 1987) observations of neutrino bursts from SN 1987A. Using the Kamiokande II data, the neutrino rest mass is estimated at 2.8 + 2.0, - 1.4 eV and the initial neutrino pulse is found to be less than 0.3 sec full width, followed by an emission tail lasting at least 10 sec.

Chiu, Hong-Yee

1988-01-01

385

Mass of Ne-16  

E-print Network

PHYSICAL REVIEWER C VOLUME 27, NUMBER 1 Mass of ' Ne JANUARY 1983 C. J. Woodward, * R. E. Tribble, and D. M. Tanner Cyclotron Institute, Texas A&M University, College Station, Texas 77843 (Received 23 August 1982) The mass of ' Ne has been... 1983 The American Physical Society 28 C. J. WOODWARD, R. E. TRIBBLE, AND D. M. TANNER 27 tron rf. A 0.3 mm Kapton absorber foil was insert- ed after the proportional counter in order to ensure that the He particles stopped in the Si detector...

Woodward, C. J.; Tribble, Robert E.; Tanner, D. M.

1983-01-01

386

Ballistics/mass properties  

NASA Technical Reports Server (NTRS)

The propulsion performance and reconstructed mass properties data from Morton Thiokol's RSRM-4 motors, which were assigned to the STS-30R launch, are presented. The composite type solid propellant burn rates were close to predicted. The performance of the pair of motors were compared to some CEI Specification CPW1-3600 for compliance. Some aspects of the CEI Specification could not be compared because of low sampling of data. The performance of the motors were well within the CEI specification requirements. Post flight reconstructured RSRM mass properties are within expected values for the RSRM quarterweight and halfweight configurations.

Drendel, Albert S.; Richards, M. C.

1989-01-01

387

Mass spectrometers: instrumentation  

NASA Astrophysics Data System (ADS)

Developments in mass spectrometry instrumentation over the past three years are reviewed. The subject is characterized by an enormous diversity of designs, a high degree of competition between different laboratories working with either different or similar techniques and by extremely rapid progress in improving analytical performance. Instruments can be grouped into genealogical charts based on their physical and conceptual interrelationships. This is illustrated using mass analyzers of different types. The time course of development of particular instrumental concepts is illustrated in terms of the s-curves typical of cell growth. Examples are given of instruments which are at the exponential, linear and mature growth stages. The prime examples used are respectively: (i) hybrid instruments designed to study reactive collisions of ions with surfaces: (ii) the Paul ion trap; and (iii) the triple quadrupole mass spectrometer. In the area of ion/surface collisions, reactive collisions such as hydrogen radical abstraction from the surface by the impinging ion are studied. They are shown to depend upon the chemical nature of the surface through the use of experiments which utilize self-assembled monolayers as surfaces. The internal energy deposited during surface-induced dissociation upon collision with different surfaces in a BEEQ instrument is also discussed. Attention is also given to a second area of emerging instrumentation, namely technology which allows mass spectrometers to be used for on-line monitoring of fluid streams. A summary of recent improvements in the performance of the rapidly developing quadrupole ion trap instrument illustrates this stage of instrument development. Improvements in resolution and mass range and their application to the characterization of biomolecules are described. The interaction of theory with experiment is illustrated through the role of simulations of ion motion in the ion trap. It is emphasized that mature instruments play a dominant role in most work using mass spectrometers. This is illustrated with recent results on the chemistry of C+.60 including the formation of covalent adducts with aromatic compounds. Quantitative analysis of methylated nucleosides and structural studies of the anti-cancer drug taxol are also discussed. A compendium of mass spectrometers constructed over the past three years is provided. This includes a variety of hybrid instruments, combinations of sector mass spectrometers with traps, instruments designed to study collision dynamics, and many more.

Cooks, R. G.; Hoke, S. H., II; Morand, K. L.; Lammert, S. A.

1992-09-01

388

Mass of Si-24  

E-print Network

PHYSICAL REVIEW C VOLUME 22, NUMBER 1 JULY 1980 Mass of Si R. E. Tribble, D. M. Tanner, and A. F. Zeller* Cyclotron Institute and Physics Department, Texas A&M University, College Station, Texas 77843 (Received 11 January 1980) The Si( He, 'He... the role of a nuclear cdi than to accur- ately account for the trivial Coulomb contribution to the IMME coefficients. In addition to testing the IMME, mass measurements in isobaric quar- tets and quintets determine Coulomb energies rather far from...

Tribble, Robert E.; Tanner, D. M.; Zeller, A. F.

1980-01-01

389

Mass, Area, Volume  

NSDL National Science Digital Library

In this activity (page 18 of PDF), learners will measure the volume of impact craters created by projectiles of different masses. They will also draw connections between the mass of the projectile and the volume of crater it creates. This lesson also includes extension activities: Analyzing the formula for the volume of sphere (p46-50), and calculating the volume of a crater (p32-35). The Moon Math: Craters! guide follows a 5E approach, applying concepts of geometry, modeling, data analysis to the NASA lunar spacecraft mission, LCROSS.

Nasa

2012-05-08

390

Galaxy cosmological mass function  

NASA Astrophysics Data System (ADS)

Aims: This paper studies the galaxy cosmological mass function (GCMF) in a semi-empirical relativistic approach that uses observational data provided by recent galaxy redshift surveys. Methods: Starting from a previously presented relation between the mass-to-light ratio, the selection function obtained from the luminosity function (LF) data and the luminosity density, the average luminosity L, and the average galactic mass ?g were computed in terms of the redshift. ?g was also alternatively estimated by means of a method that uses the galaxy stellar mass function (GSMF). Comparison of these two forms of deriving the average galactic mass allowed us to infer a possible bias introduced by the selection criteria of the survey. We used the FORS Deep Field galaxy survey sample of 5558 galaxies in the redshift range 0.5 mass-to-light ratio and its GSMF data. Results: Assuming ?g0 ? 1011?? as the local value of the average galactic mass, the LF approach results in LB ? (1 + z)(2.40 ± 0.03) and ?g ? (1 + z)(1.1 ± 0.2). However, using the GSMF results to calculate the average galactic mass produces ?g ? (1 + z)(- 0.58 ± 0.22). We chose the latter result because it is less biased. We then obtained the theoretical quantities of interest, such as the differential number counts, to finally calculate the GCMF, which can be fitted by a Schechter function, but whose fitted parameter values are different from the values found in the literature for the GSMF. Conclusions: This GCMF behavior follows the theoretical predictions from the cold dark matter models in which the less massive objects form first, followed later by more massive ones. In the range 0.5

Lopes, Amanda R.; Iribarrem, Alvaro; Ribeiro, Marcelo B.; Stoeger, William R.

2014-12-01

391

Photon: history, mass, charge  

E-print Network

The talk consists of three parts. ``History'' briefly describes the emergence and evolution of the concept of photon during the first two decades of the 20th century. ``Mass'' gives a short review of the literature on the upper limit of the photon's mass. ``Charge'' is a critical discussion of the existing interpretation of searches for photon charge. Schemes, in which all photons are charged, are grossly inconsistent. A model with three kinds of photons (positive, negative and neutral) seems at first sight to be more consistent, but turns out to have its own serious problems.

L. B. Okun

2006-02-03

392

Evaluation of a specific score for air medical evacuation triage.  

PubMed

Age, local resources, and locations have been identified as independent factors indicating the need for immediate air medical evacuation. This preliminary case-control study aimed to evaluate the relevance of a score from 0 to 6 based on these criteria and to identify thresholds. The 3-step scale we obtained may help in prioritizing repatriation requests. PMID:21382568

Duchateau, François-Xavier; Verner, Laurent

2011-01-01

393

Fuzzy-Trace Theory and Cognitive Triage in Memory Development.  

ERIC Educational Resources Information Center

Examined a theoretical interpretation of recall as a system in which the influences of memory strength, episodic activation, and output interference must be balanced to maximize recall. Children never recalled stronger words before weaker words. As learning progressed, a weaker-stronger-weaker ordering of recalled words emerged. (BC)

Brainerd, C. J.; And Others

1991-01-01

394

Educational Triage in Open Distance Learning: Walking a Moral Tightrope  

ERIC Educational Resources Information Center

Higher education, and more specifically, distance education, is in the midst of a rapidly changing environment. Higher education institutions increasingly rely on the harvesting and analyses of student data to inform key strategic decisions across a wide range of issues, including marketing, enrolment, curriculum development, the appointment of…

Prinsloo, Paul; Slade, Sharon

2014-01-01

395

THE RABIT: A RAPID AUTOMATED BIODOSIMETRY TOOL FOR RADIOLOGICAL TRIAGE  

E-print Network

cooperation can emerge. Bernard Crespi A hydrogen bomb is an example of mankind's enormous capacity-cooperatively developed nuclear weapons. This is a key insight because it integrates the theory of cooperation's studies of global nuclear war [6]. Two parties may either cooperate or defect. The highest joint payoff

396

Wildfire Restoration and Rehabilitation: Triage in Pursuit of Resilience  

Technology Transfer Automated Retrieval System (TEKTRAN)

This paper reports on the synthesis of "Wildfire Rehabilitation and Restoration" workshop that was part of a larger conference-workshop "Wildfires and Invasive Plants in American Deserts" sponsored by the Society for Range Management in Reno, Nevada in December 2008. The workshop started out with i...

397

Letters Response Finite conservation funds mean triage is unavoidable  

E-print Network

of Jerusalem, Jerusalem 91904, Israel 3 Australian Research Council Centre of Excellence for Coral Reef Studies and Kesler [3] and Parr and colleagues [4] from the Alliance for Zero Extinction (AZE) argue against the use of funding are several orders of magnitude below what is needed to return rates of extinction to natural

Kark, Salit

398

Intervention Adherence for Research and Practice: Necessity or Triage Outcome?  

ERIC Educational Resources Information Center

Intervention integrity or adherence describes qualities of carrying out an intervention plan and in research is fundamentally linked to experimental validity questions addressed by measurement of independent and dependent variables. Integrity has been well described in conceptual writing but has been a continuing thorny subject in research and…

Barnett, David; Hawkins, Renee; Lentz, F. Edward, Jr.

2011-01-01

399

APPLYING SATELLITE IMAGERY TO TRIAGE ASSESSMENT OF ECOSYSTEM HEALTH  

EPA Science Inventory

Considerable evidence documents that certain changes in vegetation and soils result in irreversibly degraded rangeland ecosystems. We used Advanced Very High Resolution Radiometer (AVHRR)imagery to develop calibration patterns of change in the Normalized Difference Vegetation Ind...

400

Static-light meson masses from twisted mass lattice QCD  

E-print Network

Static-light meson masses from twisted mass lattice QCD Karl Jansen, Chris Michael, Andrea Shindler-light meson masses from twisted mass lattice QCD", July 16, 2008 #12;Introduction · Static-light meson: a bound state of an infinitely heavy quark and a light quark ("a B-meson in leading order"). · Static

401

Mass resolution and mass accuracy: how much is enough?  

PubMed

Accurate mass measurement requires the highest possible mass resolution, to ensure that only a single elemental composition contributes to the mass spectral peak in question. Although mass resolution is conventionally defined as the closest distinguishable separation between two peaks of equal height and width, the required mass resolving power can be ?10× higher for equal width peaks whose peak height ratio is 100?:?1. Ergo, minimum resolving power requires specification of maximum dynamic range, and is thus 10-100× higher than the conventional definition. Mass resolving power also depends on mass-to-charge ratio. Mass accuracy depends on mass spectral signal-to-noise ratio and digital resolution. Finally, the reliability of elemental composition assignment can be improved by resolution of isotopic fine structure. Thus, the answer to the question of "how much is enough mass resolving power" requires that one first specify S/N ratio, dynamic range, digital resolution, mass-to-charge ratio, and (if available) isotopic fine structure. The highest available broadband mass resolving power and mass accuracy is from Fourier transform ion cyclotron resonance mass spectrometry. Over the past five years, FT-ICR MS mass accuracy has improved by about an order of magnitude, based on higher magnetic field strength, conditional averaging of time-domain transients, better mass calibration (spectral segmentation; inclusion of a space charge term); radially dispersed excitation; phase correction to yield absorption-mode display; and new ICR cell segmentation designs. PMID:24349928

G Marshall, Alan; T Blakney, Greg; Chen, Tong; K Kaiser, Nathan; M McKenna, Amy; P Rodgers, Ryan; M Ruddy, Brian; Xian, Feng

2013-01-01

402

The use of mass defect in modern mass spectrometry.  

PubMed

Mass defect is defined as the difference between a compound's exact mass and its nominal mass. This concept has been increasingly used in mass spectrometry over the years, mainly due to the growing use of high resolution mass spectrometers capable of exact mass measurements in many application areas in analytical and bioanalytical chemistry. This article is meant as an introduction to the different uses of mass defect in applications using modern MS instrumentation. Visualizing complex mass spectra may be simplified with the concept of Kendrick mass by plotting nominal mass as a function of Kendrick mass defect, based on hydrocarbons subunits, as well as slight variations on this theme. Mass defect filtering of complex MS data has been used for selectively detecting compounds of interest, including drugs and their metabolites or endogenous compounds such as peptides and small molecule metabolites. Several strategies have been applied for labeling analytes with reagents containing unique mass defect features, thus shifting molecules into a less noisy area in the mass spectrum, thus increasing their detectability, especially in the area of proteomics. All these concepts will be covered to introduce the interested reader to the plethora of possibilities of mass defect analysis of high resolution mass spectra. PMID:22359333

Sleno, Lekha

2012-02-01

403

Transverse Mass Kink  

SciTech Connect

We present a study of the collider observable m{sub T2} applied for pair-produced superparticles decaying to visible particles and a pair of invisible lightest supersymmetric particles (LSPs) at the LHC experiment. We also investigate the possibility to measure the top quark mass using the m{sub T2}.

Cho, W. S.; Choi, K.; Kim, Y. G.; Park, C. B. [Department of Physics, KAIST, Daejeon 305-701 (Korea, Republic of)

2008-11-23

404

Weathering and mass wasting  

NSDL National Science Digital Library

This class exercise is an opportunity for students to apply textbook information about weathering and mass wasting to local and nationally-recognized surface features, such as Stone Mountain (GA), Half Dome (CA), and others. It also serves as an introduction to the use of Google Earth as an analytical tool for calculating distances, slopes, and evaluating landforms. Designed for a geomorphology course

Clayton, Jordan

405

Masses and Springs  

NSDL National Science Digital Library

In this interactive simulation adapted from the University of Colorado's Physics Education Technology project, hang various masses from different springs and see the kinetic, potential, and thermal energy of each spring system. You can even slow time or move your demonstration to another planet.

Foundation, Wgbh E.

2007-04-19

406

Engineering rock mass classifications  

Microsoft Academic Search

This book is a reference on rock mass classification, consolidating into one handy source information widely scattered through the literature. Includes new, unpublished material and case histories. Presents the fundamental concepts of classification schemes and critically appraises their practical application in industrial projects such as tunneling and mining.

Z. T. Bieniawski

1989-01-01

407

Mass transfer andMass transfer and Mass transfer andMass transfer and  

E-print Network

- kemiteknik - Värme- och strömningssteknik Biskopsgatan 8, 20500 �bo 1/24 6.16.1 ForcedForced for mass transfer with convection: I l f d fl d b (l b l )­ Internal forced flow: inside a tube (laminar or turbulent) ­ External forced flow: around an obstacle (laminar or turbulent) ­ Natural convection Ro

Zevenhoven, Ron

408

Mass Psychogenic Illness  

MedlinePLUS

... a racing heart, a stomachache or diarrhea. Your body can have a similar strong reaction to other stressful situations. Outbreaks of mass psychogenic illness show us how stress and other people's feelings and behavior can affect the way we feel. People who feel sick ...

409

Mass Spectrometry Video  

NSDL National Science Digital Library

This video, distributed on YouTube by the Royal Society of Chemistry is on the basic principles of mass spectrometry, using a magnetic sector instrument to demonstrate how specific m/z ratios can be selected. The theory and operation of MS, including the chemistry of ionization and fragmentation is described at an introductory level. There is also an excellent example of the use of high resolution MS to differentiate between nominal mass and actual mass. The video does a very good job of explaining the concept such that only a little background knowledge is required. The video is short enough (6 mins), that it would be very useful in a class setting or for students outside of class. The ultimate strength of this video is the general nature of the content that makes it appealing to a wide audience. The video may be most appropriate in a lower-level general education science course (i.e forensic science) or as a quick orientation video for instrumental analysis students prior to introducing mathematical or operational concepts. This video would also be helpful for a lay science person who wishes to learn more about mass spectrometry from a general interest perspective.

2011-06-08

410

Mass - Metric Weight.  

ERIC Educational Resources Information Center

This autoinstructional program, developed for high, medium and low level achievers, is directed toward a course in general science in middle schools. Mathematics of fractions and decimals is described as a prerequisite to the use of the packet. Two behavioral objectives are listed. Both involve the students' determining mass, first to the nearest…

Sisk, Diane

411

Is Mass Transit Possible?  

ERIC Educational Resources Information Center

Mass transit is possible in the United States, but only if the form it takes offers americans the quality of ride--cheap, private and rapid--they now have in the automobile. If these criteria are not achieved, Americans will continue to drive. (BT)

Environmental Science and Technology, 1975

1975-01-01

412

0++ glueball mass  

NASA Astrophysics Data System (ADS)

An approximate vacuum wave functional ?0 is proposed for (2+1)-dimensional Yang-Mills theories. Using ?0, one can compute the 0++ glueball mass MG in terms of the string tension. By using the idea of dimensional reduction, a prediction for MG can be made in 3+1 dimensions. One finds MG~1.5 GeV.

Samuel, Stuart

1997-04-01

413

Center of Mass 2  

NSDL National Science Digital Library

This activity is inquiry because students have likely never used this method for determining center of mass. The activity is also useful when building soda bottle rockets for estimating the center of pressure. Students can make a cardboard cutout of the p

Horton, Michael

2009-05-30

414

Galileo Probe Mass Spectrometer  

NASA Technical Reports Server (NTRS)

During the past year, the Principal Investigator's research carried out under this contract has focused on an analysis of the implications of Galileo Probe Mass Spectrometer (GPMS) results for the origin of Jupiter's atmosphere and the origin of the ice and other possible volatiles on the Galilean satellites.

Owen, Tobias C.

1998-01-01

415

Stateline: Critical Mass  

ERIC Educational Resources Information Center

In Physics "critical mass" refers to the minimum amount of fissionable material required to sustain a chain reaction. The adoption of state education policy isn't often equated with this concept, but occasionally solutions and ideas seem to gather around a common problem. If the solution at hand is simple, easily understood, and strengthened with…

Christie, Kathy

2005-01-01

416

STUDENT ORGANIZATION MASS FUNDING  

E-print Network

#12;On-Campus NOT Auto-Bill $ These MSU Offices DO NOT Auto Bill: $ Conference Services $ ASMSUSTUDENT ORGANIZATION MASS FUNDING ORIENTATION 2014-2015 MSU Office of Activities & Engagement #12;Who are we? ! Office of Activities & Engagement (OAE) ! Kathy Tanner, OAE Director ! ktanner

Lawrence, Rick L.

417

Mass Spectrometer Simulator  

NSDL National Science Digital Library

From the Colby College Chemistry Department, this tutorial will help visitors understand what happens inside a mass spectrometer. Users are able to select various parts of the instrument to learn and see what happens inside: the vaporization chamber, the ionization chamber, the accelerator plates, the curved chamber, and the detector. Shockwave is required to use the learning activity.

Mundy, Bradford P., 1938-; Poon, Thomas, 1968-

2013-07-25

418

I-Mass: International Mass Spectrometry Web Resource  

NSDL National Science Digital Library

Coined as "Mass Spectroscopy's Web Address," this is a site with information for and about mass spectrometry. It features news and articles related to mass spectrometry, gleans important updates from scientific journals on mass spectroscopy, and provides conference and career links. The page also features links to classic articles, definitions, history, Nobel Prizes, protocols, resources, techniques, troubleshooting and tutorials. A link to a repository for jobs involving mass spectroscopy is also given.

2009-04-09

419

Rapid 3D video/laser sensing and digital archiving with immediate on-scene feedback for 3D crime scene/mass disaster data collection and reconstruction  

NASA Astrophysics Data System (ADS)

We describe a system for rapid and convenient video data acquisition and 3-D numerical coordinate data calculation able to provide precise 3-D topographical maps and 3-D archival data sufficient to reconstruct a 3-D virtual reality display of a crime scene or mass disaster area. Under a joint U.S. army/U.S. Air Force project with collateral U.S. Navy support, to create a 3-D surgical robotic inspection device -- a mobile, multi-sensor robotic surgical assistant to aid the surgeon in diagnosis, continual surveillance of patient condition, and robotic surgical telemedicine of combat casualties -- the technology is being perfected for remote, non-destructive, quantitative 3-D mapping of objects of varied sizes. This technology is being advanced with hyper-speed parallel video technology and compact, very fast laser electro-optics, such that the acquisition of 3-D surface map data will shortly be acquired within the time frame of conventional 2-D video. With simple field-capable calibration, and mobile or portable platforms, the crime scene investigator could set up and survey the entire crime scene, or portions of it at high resolution, with almost the simplicity and speed of video or still photography. The survey apparatus would record relative position, location, and instantly archive thousands of artifacts at the site with 3-D data points capable of creating unbiased virtual reality reconstructions, or actual physical replicas, for the investigators, prosecutors, and jury.

Altschuler, Bruce R.; Oliver, William R.; Altschuler, Martin D.

1996-02-01

420

Mass spectrometry with accelerators.  

PubMed

As one in a series of articles on Canadian contributions to mass spectrometry, this review begins with an outline of the history of accelerator mass spectrometry (AMS), noting roles played by researchers at three Canadian AMS laboratories. After a description of the unique features of AMS, three examples, (14)C, (10)Be, and (129)I are given to illustrate the methods. The capabilities of mass spectrometry have been extended by the addition of atomic isobar selection, molecular isobar attenuation, further ion acceleration, followed by ion detection and ion identification at essentially zero dark current or ion flux. This has been accomplished by exploiting the techniques and accelerators of atomic and nuclear physics. In 1939, the first principles of AMS were established using a cyclotron. In 1977 the selection of isobars in the ion source was established when it was shown that the (14)N(-) ion was very unstable, or extremely difficult to create, making a tandem electrostatic accelerator highly suitable for assisting the mass spectrometric measurement of the rare long-lived radioactive isotope (14)C in the environment. This observation, together with the large attenuation of the molecular isobars (13)CH(-) and (12)CH?2(-) during tandem acceleration and the observed very low background contamination from the ion source, was found to facilitate the mass spectrometry of (14)C to at least a level of (14)C/C ~ 6 × 10(-16), the equivalent of a radiocarbon age of 60,000 years. Tandem Accelerator Mass Spectrometry, or AMS, has now made possible the accurate radiocarbon dating of milligram-sized carbon samples by ion counting as well as dating and tracing with many other long-lived radioactive isotopes such as (10)Be, (26)Al, (36)Cl, and (129)I. The difficulty of obtaining large anion currents with low electron affinities and the difficulties of isobar separation, especially for the heavier mass ions, has prompted the use of molecular anions and the search for alternative methods of isobar separation. These techniques are discussed in the latter part of the review. PMID:22031277

Litherland, A E; Zhao, X-L; Kieser, W E

2011-01-01

421

Galaxy Cosmological Mass Function  

E-print Network

We study the galaxy cosmological mass function (GCMF) in a semi-empirical relativistic approach using observational data provided by galaxy redshift surveys. Starting from the theory of Ribeiro & Stoeger (2003, arXiv:astro-ph/0304094) between the mass-to-light ratio, the selection function obtained from the luminosity function (LF) data and the luminosity density, the average luminosity $L$ and the average galactic mass $\\mathcal{M}_g$ are computed in terms of the redshift. $\\mathcal{M}_g$ is also alternatively estimated by a method that uses the galaxy stellar mass function (GSMF). Comparison of these two forms of deriving the average galactic mass allows us to infer a possible bias introduced by the selection criteria of the survey. We used the FORS Deep Field galaxy survey sample of 5558 galaxies in the redshift range $0.5 Schechter parameters in the B-band, as well as this sample's stellar mass-to-light ratio and its GSMF data. Assuming ${\\mathcal{M}_{g_0}} \\approx 10^{11} \\mathcal{M}_\\odot$ as the local value of the average galactic mass, the LF approach results in $L_{B} \\propto (1+z)^{(2.40 \\pm 0.03)}$ and $\\mathcal{M}_g \\propto (1+z)^{(1.1\\pm0.2)}$. However, using the GSMF results produces $\\mathcal{M}_g \\propto (1+z)^{(-0.58 \\pm 0.22)}$. We chose the latter result as it is less biased. We then obtained the theoretical quantities of interest, such as the differential number counts, to calculate the GCMF, which can be fitted by a Schechter function. The derived GCMF follows theoretical predictions in which the less massive objects form first, being followed later by more massive ones. In the range $0.5 < z < 2.0$ the GCMF has a strong variation that can be interpreted as a higher rate of galaxy mergers or as a strong evolution in the star formation history of these galaxies.

Amanda R. Lopes; Alvaro Iribarrem; Marcelo B. Ribeiro; William R. Stoeger

2014-12-03

422

Rotation and Mass Loss  

NASA Astrophysics Data System (ADS)

Stellar rotation can play an important role in structuring and enhancing the mass loss from massive stars. Initial 1D models focussed on the expected centrifugal enhancement of the line-driven mass flux from the equator of a rotating star, but the review here emphasizes that the loss of centrifugal support away from the stellar surface actually limits the steady mass flux to just the point-star CAK value, with models near critical rotation characterized by a slow, subcritical acceleration. Recent suggestions that such slow outflows might have high enough density to explain disks in Be or B[e] stars are examined in the context of 2D simulations of the ``Wind Compressed Disk'' (WCD) paradigm, together with a review of the tendency for poleward components of the line-driving force to inhibit WCD formation. When one accounts for equatorial gravity darkening, the net tendency is in fact for the relatively bright regions at higher latitude to drive a faster, denser ``bipolar'' outflow. I discuss the potential relevance for the bipolar form of nebulae from LBV stars like ? Carinae, but emphasize that, since the large mass loss associated with the eruption of eta Carinae's Homunculus would heavily saturate line-driving, explaining its bipolar form requires development of analogous models for continuum-driven mass loss. I conclude with a discussion of how radiation seems inherently ill-suited to supporting or driving a geometrically thin, but optically thick disk or disk outflow. The disks inferred in Be and B[e] stars may instead be centrifugally ejected, with radiation inducing an ablation flow from the disk surface, and thus perhaps playing a greater role in destroying (rather than creating) an orbiting, circumstellar disk.

Owocki, S.

2008-06-01

423

Mass Spectrometry and Biotechnology Resource  

NSDL National Science Digital Library

Ionsource is a website that provides access to an index of resources including tutorials, links to downloadable sites, jobs and conference information involving mass spectrometry and biotechnology subjects. Examples of tutorials include lessons on atomic mass and amino acid residue mass. For a review of mass spectrometry or biotechnology or for an introduction, this site provides a well-rounded source of information.

2007-01-11

424

Method for calibrating mass spectrometers  

DOEpatents

A method whereby a mass spectra generated by a mass spectrometer is calibrated by shifting the parameters used by the spectrometer to assign masses to the spectra in a manner which reconciles the signal of ions within the spectra having equal mass but differing charge states, or by reconciling ions having known differences in mass to relative values consistent with those known differences. In this manner, the mass spectrometer is calibrated without the need for standards while allowing the generation of a highly accurate mass spectra by the instrument.

Anderson, Gordon A [Benton City, WA; Brands, Michael D [Richland, WA; Bruce, James E [Schwenksville, PA; Pasa-Tolic, Ljiljana [Richland, WA; Smith, Richard D [Richland, WA

2002-12-24

425

Single event mass spectrometry  

DOEpatents

A means and method for single event time of flight mass spectrometry for analysis of specimen materials. The method of the invention includes pulsing an ion source imposing at least one pulsed ion onto the specimen to produce a corresponding emission of at least one electrically charged particle. The emitted particle is then dissociated into a charged ion component and an uncharged neutral component. The ion and neutral components are then detected. The time of flight of the components are recorded and can be used to analyze the predecessor of the components, and therefore the specimen material. When more than one ion particle is emitted from the specimen per single ion impact, the single event time of flight mass spectrometer described here furnis This invention was made with Government support under Contract No. W-7405-ENG82 awarded by the Department of Energy. The Government has certain rights in the invention.

Conzemius, Robert J. (Ames, IA)

1990-01-16

426

Earth? Mass Variability  

E-print Network

The perturbation of the Earth caused by variability of mass of Earth as additional reason with gravity of celestial bodies and shape of the Earth. The Earth eating and collecting matters from space and loss or eject matters to space through its flying in the space around the Sun. The source of the rising in the global sea level is not closed in global warming and icebergs, but the outer space is the additional important source for this rising. The Earth eats waters from space in unknown mechanism. The mass of the Earth become greater in November i.e. before transit apoapsis two months, and become latter in February i.e. after transit apoapsis to two months.

Ramy Mawad

2014-02-12

427

Linear Proof Mass Actuator  

NASA Technical Reports Server (NTRS)

This paper describes the mechanical design, analysis, fabrication, testing, and lessons learned by developing a uniquely designed spaceflight-like actuator. The linear proof mass actuator (LPMA) was designed to attach to both a large space structure and a ground test model without modification. Previous designs lacked the power to perform in a terrestrial environment while other designs failed to produce the desired accelerations or frequency range for spaceflight applications. Thus, the design for a unique actuator was conceived and developed at NASA Langley Research Center. The basic design consists of four large mechanical parts (mass, upper housing, lower housing, and center support) and numerous smaller supporting components including an accelerometer, encoder, and four drive motors. Fabrication personnel were included early in the design phase of the LPMA as part of an integrated manufacturing process to alleviate potential difficulties in machining an already challenging design. Operating testing of the LPMA demonstrated that the actuator is capable of various types of load functions.

Holloway, Sidney E., III

1994-01-01

428

Nanoscale mass conveyors  

DOEpatents

A mass transport method and device for individually delivering chargeable atoms or molecules from source particles is disclosed. It comprises a channel; at least one source particle of chargeable material fixed to the surface of the channel at a position along its length; a means of heating the channel; and a means for applying an controllable electric field along the channel, whereby the device transports the atoms or molecules along the channel in response to applied electric field. In a preferred embodiment, the mass transport device will comprise a multiwalled carbon nanotube (MWNT), although other one dimensional structures may also be used. The MWNT or other structure acts as a channel for individual or small collections of atoms due to the atomic smoothness of the material. Also preferred is a source particle of a metal such as indium. The particles move by dissociation into small units, in some cases, individual atoms. The particles are preferably less than 100 nm in size.

Regan, Brian C. (Oakland, CA); Aloni, Shaul (Albany, CA); Zettl, Alexander K. (Kensington, CA)

2008-03-11

429

Experiments with probe masses  

PubMed Central

It is reasonable to regard the experiments performed by C. Coulomb and H. Cavendish in the end of the 18th century as the beginning of laboratory experimental physics. These outstanding scientists have measured forces (accelerations) produced by electric charges and by gravitational “charges” on probe masses that were attached to torque balance. Among the variety of different research programs and projects existing today, experiments with probe masses are still playing an important role. In this short review, the achieved and planned sensitivities of very challenging LIGO (Laser Interferometer Gravitational wave Observatory) and LISA (Laser Interferometer Space Antennae) projects are described, and a list of nonsolved problems is discussed as well. The role of quantum fluctuations in high precision measurements is also outlined. Apart from these main topics, the limitations of sensitivity caused by cosmic rays and the prospects of clock frequency stability are presented. PMID:17296944

Braginsky, V. B.

2007-01-01

430

Imaging of wrist masses.  

PubMed

The wrist is a complex structure with an extensive differential diagnosis for a presenting mass. However, the vast majority of hand and wrist masses are benign, and many of these have a distinctive radiographic appearance. In this article, the imaging characteristics of the most common entities are reviewed with particular attention to magnetic resonance appearance. The 3 most common hand and wrist lesions include ganglion cysts, giant cell tumors of the tendon sheath, and hemangiomas. Other common lesions that can be diagnosed radiographically include lipomas, neural sheath tumors, infection and inflammation, and variant soft-tissue or bony structures. The appearance of the fibrolipomatous hamartoma will also be demonstrated because this is a radiographically distinctive, though rare, lesion. PMID:15306759

Nguyen, Vu; Choi, James; Davis, Kirkland W

2004-01-01

431

Electrospray Ionization Mass Spectrometry  

SciTech Connect

Electrospray Ionization (ESI) is a process whereby gas phase ions are created from molecules in solution. As a solution exits a narrow tube in the presence of a strong electric field, an aerosol of charged droplets are is formed that produces gas phase ions as they it desolvates. ESI-MS comprises the creation of ions by ESI and the determination of their mass to charge ratio (m/z) by MS.

Kelly, Ryan T.; Marginean, Ioan; Tang, Keqi

2014-06-13

432

Mapping Dirac gaugino masses  

NASA Astrophysics Data System (ADS)

We investigate the mapping of Dirac gaugino masses through regions of strong coupling, focussing on SQCD with an adjoint. These models have a well-known Kutasov duality, under which a weakly coupled electric UV description can flow to a different weakly coupled magnetic IR description. We provide evidence to show that Dirac gaugino mass terms map as under such a flow, where the coupling ? appears in the superpotential of the canonically normalised theory as W ? ?X k+1. This combination is an RG-invariant to all orders in perturbation theory, but establishing the mapping in its entirety is not straightforward because Dirac masses are not the spurions of holomorphic couplings in the = 1 theory. To circumvent this, we first present evidence that deforming the Kutasov theory can make it flow to an = 2 theory with parametrically small = 1 deformations. This is shown to happen perturbatively in the weakly coupled theory, and we also identify the higgsing mechanism that has to take place in the dual theory. This is seen to occur correctly even when both theories are at strong coupling. Using harmonic superspace techniques we then identify the prepotential that can induce the same = 1 deformations in the presence of electric and magnetic FI-terms. We show that the correct = 1 scalar potential and fermion lagrangian are generated. It is then shown that pure Dirac mass terms can be induced by the same mechanism, and we find that the proposed RG-invariant is indeed preserved under = 2 duality, and thence along the flow to the dual = 1 Kutasov theories. Possible phenomenological applications are discussed.

Abel, Steven; Busbridge, Daniel

2013-11-01

433

Mass Balance Model  

NSDL National Science Digital Library

In this JAVA-based interactive modeling activity, students are introduced to the concept of mass balance, flow rates, and equilibrium using a simple water bucket model. Students can vary flow rate into the bucket, initial water level in the bucket, and residence time of water in the bucket. After running the model, the bucket's water level as a function of time is presented graphically and in tabular form.

Mackay, Robert; Science Education Resource Center, Starting P.

434

Higher mass bottomonia  

E-print Network

We show the results of a quark model calculation of the bottomonium spectrum with self energy corrections due to the coupling to the meson-meson continuum. The bare masses used in the calculation are computed within the relativized quark model by Godfrey and Isgur. We also give results for the open-bottom strong decay amplitudes of higher bottomonia in a 3P0 model.

J. Ferretti; E. Santopinto

2014-11-19

435

Active Mass Under Pressure  

E-print Network

After a historical introduction to Poisson's equation for Newtonian gravity, its analog for static gravitational fields in Einstein's theory is reviewed. It appears that the pressure contribution to the active mass density in Einstein's theory might also be noticeable at the Newtonian level. A form of its surprising appearance, first noticed by Richard Chase Tolman, was discussed half a century ago in the Hamburg Relativity Seminar and is resolved here.

Juergen Ehlers; Istvan Ozsvath; Engelbert Schucking

2005-05-10

436

Mass extinction: a commentary.  

PubMed

Four neocatastrophist claims about mass extinction are currently being debated; they are that: 1, the late Cretaceous mass extinction was caused by large body impact; 2, as many as five other major extinctions were caused by impact; 3, the timing of extinction events since the Permian is uniformly periodic; and 4, the ages of impact craters on Earth are also periodic and in phase with the extinctions. Although strongly interconnected the four claims are independent in the sense that none depends on the others. Evidence for a link between impact and extinction is strong but still needs more confirmation through bed-by-bed and laboratory studies. An important area for future research is the question of whether extinction is a continuous process, with the rate increasing at times of mass extinctions, or whether it is episodic at all scales. If the latter is shown to be generally true, then species are at risk of extinction only rarely during their existence and catastrophism, in the sense of isolated events of extreme stress, is indicated. This is line of reasoning can only be considered an hypothesis for testing. In a larger context, paleontologists may benefit from a research strategy that looks to known Solar System and Galactic phenomena for predictions about environmental effects on earth. The recent success in the recognition of Milankovitch Cycles in the late Pleistocene record is an example of the potential of this research area. PMID:11542114

Raup, D M

1987-01-01

437

Nonlinear pulsation masses  

SciTech Connect

The advent of nonlinear pulsation theory really coincides with the development of the large computers after the second world war. Christy and Stobbie were the first to make use of finite difference techniques on computers to model the bumps'' observed in the classical Cepheid light and velocity curves, the so-called Hertzsprung'' sequence. Following this work a more sophisticated analysis of the light and velocity curves from the models was made by Simon and Davis using Fourier techniques. Recently a simpler amplitude equation formalism has been developed that helps explain this resonance mechanism. The determination of Population I Cepheid masses by nonlinear methods will be discussed. For the lower mass objects, such as RR Lyrae and BL Her. stars, we find general agreement using evolutionary masses and nonlinear pulsation theory. An apparent difficulty of nonlinear pulsation theory occurs in the understanding of double'' mode pulsation, which will also be discussed. Recent studies in nonlinear pulsation theory have dealt with the question of mode selection, period doubling and the trends towards chaotic behavior such as is observed in the transition from W Virginis to RV Tauri-like stars. 10 refs., 1 fig., 2 tabs.

Davis, C.G.

1990-01-01

438

Isotope Ratio Mass Spectrometry.  

PubMed

Isotope Ratio Mass Spectrometry (IRMS) is a specialized technique used to provide information about the geographic, chemical, and biological origins of substances. The ability to determine the source of an organic substance stems from the relative isotopic abundances of the elements which comprise the material. Because the isotope ratios of elements such as carbon, hydrogen, oxygen, sulfur, and nitrogen can become locally enriched or depleted through a variety of kinetic and thermodynamic factors, measurement of the isotope ratios can be used to differentiate between samples which otherwise share identical chemical compositions. Several sample introduction methods are now available for commercial isotope ratio mass spectrometers. Combustion is most commonly used for bulk isotopic analysis, whereas gas and liquid chromatography are predominately used for the real-time isotopic analysis of specific compounds within a mixture. Here, highlights of advances in instrumentation and applications within the last three years are provided to illustrate the impact of this rapidly growing area of research. Some prominent new applications include authenticating organic food produce, ascertaining whether or not African elephants are guilty of night-time raids on farmers' crops, and linking forensic drug and soil samples from a crime scene to a suspected point of origin. For the sake of brevity, we focus this Minireview on the isotope ratio measurements of lighter-elements common to organic sources; we do not cover the equally important field of inorganic isotope ratio mass spectrometry. PMID:19173039

Muccio, Zeland; Jackson, Glen P

2009-02-01

439

Mass and radius formulas for low-mass neutron stars  

E-print Network

Neutron stars, produced at the death of massive stars, are often regarded as giant neutron-rich nuclei. This picture is especially relevant for low-mass (below about solar mass) neutron stars, where non-nucleonic components are not expected to occur. Due to the saturation property of nucleonic matter, leading to the celebrated liquid-drop picture of atomic nuclei, empirical nuclear masses and radii can be approximately expressed as function of atomic mass number. It is, however, not straightforward to express masses and radii of neutron stars even in the low-mass range where the structure is determined by a balance between the pressure of neutron-rich nucleonic matter and the gravity. Such expressions would be of great use given possible simultaneous mass and radius measurements. Here we successfully construct theoretical formulas for the masses and radii of low-mass neutron stars from various models that are consistent with empirical masses and radii of stable nuclei. In this process, we discover a new equation-of-state parameter that characterizes the structure of low-mass neutron stars. This parameter, which plays a key role in connecting the mass-radius relation of the laboratory nuclei to that of the celestial objects, could be constrained from future observations of low-mass neutron stars.

Hajime Sotani; Kei Iida; Kazuhiro Oyamatsu; Akira Ohnishi

2013-12-31

440

The Casualties of the Twenty-First-Century Community College  

ERIC Educational Resources Information Center

This article discusses academic freedom that is currently under threat at many public two-year schools, which serve almost one-half of the nation's first-year college students. The growing reliance on part-time faculty exacerbates the problem, with many adjuncts feeling muzzled for fear of losing their jobs. The problem of academic freedom at…

Wilson, David McKay

2010-01-01