Sample records for mass casualty triage

  1. Model uniform core criteria for mass casualty triage.

    PubMed

    2011-06-01

    There is a need for model uniform core criteria for mass casualty triage because disasters frequently cross jurisdictional lines and involve responders from multiple agencies who may be using different triage tools. These criteria (Tables 1-4) reflect the available science, but it is acknowledged that there are significant research gaps. When no science was available, decisions were formed by expert consensus derived from the available triage systems. The intent is to ensure that providers at a mass-casualty incident use triage methodologies that incorporate these core principles in an effort to promote interoperability and standardization. At a minimum, each triage system must incorporate the criteria that are listed below. Mass casualty triage systems in use can be modified using these criteria to ensure interoperability. The criteria include general considerations, global sorting, lifesaving interventions, and assignment of triage categories. The criteria apply only to providers who are organizing multiple victims in a discrete geographic location or locations, regardless of the size of the incident. They are classified by whether they were derived through available direct scientific evidence, indirect scientific evidence, expert consensus, and/or are used in multiple existing triage systems. These criteria address only primary triage and do not consider secondary triage. For the purposes of this document the term triage refers to mass-casualty triage and provider refers to any person who assigns primary triage categories to victims of a mass-casualty incident. PMID:21685308

  2. A two-hour intervention using START improves prehospital triage of mass casualty incidents

    Microsoft Academic Search

    Brian L. Risavi; Philip N. Salen; Michael B. Heller; Stephen Arcona

    2001-01-01

    Objective. There are few data concerning the ability of prehospital providers to triage patients in a mass casualty incident (MCI). The authors evaluated the effectiveness of a brief educational intervention on MCI triage with a written scenario and test. The START method (simple triage and rapid treatment) was used. Methods. The authors enrolled and tested 109 prehospital providers consisting of

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

    E-print Network

    Ziya, Serhan

    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

  4. Development and application of triage and medical evacuation system for casualties at sea.

    PubMed

    Xie, Tai; Liu, Xiao-Rong; Chen, Guo-Liang; Qi, Liang; Xu, Zhi-Yin; Liu, Xu-Dong

    2014-01-01

    Traditional triage could not meet the needs of battlefield casualties' care in modern warfare. This paper designs of triage and medical evacuation system for casualties at sea that can quickly address mass-casualty triage, and store and transmit medical information during battlefield treatment and medical evacuation. This system consists of a high-capacity medical information card, a simulated patient generator, a triage classifier and a multifunctional airbag triage vest. PMID:25722870

  5. Prehospital triage and communication performance in small mass casualty incidents: A gauge for disaster preparedness

    Microsoft Academic Search

    Gary A Johnson; Anne Calkins

    1999-01-01

    Because of their infrequency, disasters are difficult to train for. Emergency prehospital personnel frequently participate in small mass casualty incidents (MCIs) (3 to 50 victims). This study sought to examine prehospital performance in small MCIs in areas that are frequently mismanaged in disasters. Prospective data from the resource physician and retrospective data from tape recorded prehospital conversations were collected for

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

    PubMed Central

    2013-01-01

    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

  7. Mass casualty management of a large-scale bioterrorist event: an epidemiological approach that shapes triage decisions.

    PubMed

    Burkle, Frederick M

    2002-05-01

    The threat of a BT event has catalyzed serious reflection on the troublesome issues that come with event management and triage. Such reflection has had the effect of multiplying the efforts to find solutions to what could become a catastrophic public health disaster. Management options are becoming more robust, as are reliable detection devices and rapid access to stockpiled antibiotics and vaccines. There is much to be done, however, especially in the organizing, warehousing, and granting/exercising authority for resource allocations. The introduction of these new options should encourage one to believe that, in time, evolving standards of care will make it possible to rethink the currently unthinkable consequences. Unfortunately the cost of such preparedness is high and out of reach of most governments. Most of the developing world has neither the will nor the means to plan for BT events and remains overwhelmed with basic public health concerns (i.e., water, food, sanitation, shelter) that must take priority. Therefore, developed countries will be expected to respond using international exogenous resources to mitigate the effects of such a disaster. As a result, the state capacity of the effected government will be severely compromised. If triage and management of casualties is further compromised, terrorists will have met their goals. One could argue that health sciences will continue for decades to play catch up with the advanced technology driving potential bioagent weaponry. If one lesson was learned from the review of the former Soviet Union's biological weapons program, it is that the unthinkable remains an option to terrorists who have comparable expertise. It is crucial to develop realistic strategies for a BT event. Triage planning (the process of establishing criteria for health care prioritization) permits society to see cases in the context of diverse moral perspectives, limited resources, and compelling health care demands. This includes a competent and compassionate management and triage system and an in-depth and accurate health information system that appropriately addresses every level of threat or consequence. In a PICE stage I to III BT event resources will be compromised. Triage and management will be one process requiring multiple levels of cooperation, coordination, and decision-making. An immediate challenge to existing emergency medical services systems (EMSS) is the recognition that locally there will be a shift of emphasis and decision-making from prehospital first responders to community public health authorities. The author suggests that a working relationship, in most areas, between EMSS and the public health system is lacking. As priorities shift in a BT event to hospitals and public health care systems, they need to: 1. Improve their capabilities and capacities in surveillance, discovery, and in the consequences of different triage and management decisions and interventions in a BT environment, starting at the local level. 2. Develop triage and management systems (with clear lines of authority) based on public health and epidemiologic requirements, capability, and capacity (triage teams, categories, tags, rapid response, established operational priorities, resource-driven responsible management process), and link local level surveillance systems with those at the national or regional level. 3. Use a triage and management system that reflects the population (cohort) at risk, such as the epidemiologic based SEIRV triage framework. 4. Develop an organizational capacity that uses lateral decision-making skills, pre-hospital outpatient centers for triage-specific treatments, health information systems, and resource-driven hospital level pre-designated protocols appropriate for a surge of unprecedented proportions. Such standards of care, it is recommended, should be set at the local to federal levels and spelled out in existing incident-management system protocols. PMID:12132490

  8. The reality of multiple casualty triage: putting triage theory into practice at the scene of multiple casualty vehicular accidents

    Microsoft Academic Search

    P Arbon; K Zeitz; J Ranse; H Wren; R Elliott; K Driscoll

    2008-01-01

    Objectives:The project investigated the experiences of ambulance paramedics in applying the principles and protocols of prehospital multiple casualty triage at the scene of motor vehicle accidents. Key objectives included investigation of the situational cues and other contextual factors influencing triage practice and the development of recommendations for the future education of ambulance paramedics.Methods:A triangulated approach was used incorporating demographic data,

  9. Game-based mass casualty burn training.

    PubMed

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

    2009-01-01

    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

  10. Simple triage and rapid decontamination of mass casualties with colored clothes pegs (STARDOM-CCP) system against chemical releases.

    PubMed

    Okumura, Tetsu; Kondo, Hisayoshi; Nagayama, Hitomi; Makino, Toshiro; Yoshioka, Toshiharu; Yamamoto, Yasuhiro

    2007-01-01

    The efficiency and speed with which first responders, paramedics, and emergency physicians respond to an event caused by the release of a chemical is an important concern in all modern cities worldwide. A system for the initial triage and decontamination of victims of a chemical release was developed using colored clothes pegs of the following seven colors: red, yellow, green, black, white, and blue. Red indicates the need for emergency care, yellow for semi-emergency care, green for non-emergency care, black for expectant, white for dry decontamination, and blue for wet decontamination. The system can be employed as one of the techniques directed at improving the efficiency of decontamination in countries where there is a risk of chemical releases. It is recommended that this system should be adopted internationally and used for both drills and actual events. PMID:17894219

  11. Preparation for mass casualty incidents.

    PubMed

    VandenBerg, Sheri L; Davidson, Scott B

    2015-06-01

    Mass casualty incidents are events where the number of injured patients exceeds the resources of the health care institution to the degree that care may not be available or may be limited for a portion of the casualties. Mass casualty incidents are increasing in frequency throughout the United States. Managing mass casualty incidents has not traditionally been part of the nursing curriculum; however, our changing world requires us to become educated and prepared to respond to these scenarios. This article focuses on intentional explosive disasters and the nursing and institutional response to these incidents. This information is of value to nursing professionals and other health care providers. PMID:25981720

  12. Types of radiation mass casualties and their management.

    PubMed

    Jaworska, Alicja

    2009-01-01

    Management of radiation mass casualty exposure that may occur as a result of nuclear or radiation accident will depend on the type of accident, and of the knowledge about the actual radiation exposure situation for those who might be involved. Management of the public after an accident in a nuclear or radiation installation will follow existing specific emergency plans, and will take advantage of existing radiation monitoring systems. In other radiation mass casualty exposures, whenever accidental or malevolent use of radiation, there will be a requirement to employ screening programs for indentifying and sorting out exposed people (radiological triage), who will need medical treatment and/or other assistance like decontamination and individual dose assessment. In the later stage after the accident the monitoring for dose assessment purposes for those who will need medical or public health assistance will be required. Demand for dose assessment for large groups of individuals may create the need for international assistance. Prompt and credible public information is vital in all radiation emergencies, and it would be even more important in situations when radiation mass casualties result from exposures to nuclear or radiological material out of regulatory control. In such situations unpredictability of the event creates increase in the risk perception and public communication activities of the authorities will be the key element to prevent unnecessary fear and panic, and the measure to reassure the populace. PMID:19861728

  13. 'Just send them all to a burn centre': managing burn resources in a mass casualty incident.

    PubMed

    Conlon, Kathe M; Martin, Shawn

    2011-06-01

    Burn experts estimate that 20-30 per cent of injuries from mass casualty events result in serious burns, many requiring specialised care only available at burn centres. Yet, in the USA there are less then 1,850 burn beds available to provide such a level and quality of care. To address this concern, burn centres are beginning to put into practice new mass casualty triage and transport guidelines that must coordinate with local, regional and federal response plans, while still adhering to an accepted standard of care. This presentation describes how one US burn centre developed and implemented a Homeland Security Exercise and Evaluation Program (HSEEP) designed mass casualty incident (MCI) exercise focused on coordinating 'the right patient to the right facility at the right time', based upon acuity and bed availability. Discussion will enable planners to identify methodologies adaptable for incorporation into catastrophic emergency management operations within their regions. PMID:21835753

  14. Mass casualties in the Oklahoma City bombing.

    PubMed

    Teague, David C

    2004-05-01

    The Alfred P. Murrah Federal Building in Oklahoma City was partially destroyed by a terrorist bomb on April 19, 1995. Injuries were sustained by 759 people, 168 of whom died. Fatalities occurred primarily among victims in the collapse zone of the federal building. Only 83 survivors required hospitalization. Twenty-two surviving victims sustained multiple fractures. Most victims arrived at local emergency departments by private vehicle within 2 hours. More severely injured survivors were transported by ambulance. The closer receiving hospitals used emergency department facilities and minor treatment areas. Few survivors were extricated from the bombing site more than 3 hours after the detonation. Mass casualty plans must provide for improved communications, diversion and retriage from facilities nearest the disaster site, and effective coordination of community and hospital resources. PMID:15187837

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

    PubMed Central

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

    2013-01-01

    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

  16. Some considerations for mass casualty management in radiation emergencies.

    PubMed

    Hopmeier, Michael; Abrahams, Jonathan; Carr, Zhanat

    2010-06-01

    Radiation emergencies are rather new to humankind, as compared to other types of emergencies such as earthquakes, floods, or hurricanes. Fortunately, they are rare, but because of that, planning for response to large-scale radiation emergencies is least understood. Along with the specific technical aspects of response to radiation emergencies, there are some general guiding principles of responding to mass casualty events of any nature, as identified by the World Health Organization in its 2007 manual for mass casualty management systems. The paper brings forward such general considerations as applicable to radiation mass casualty events, including (1) clear lines of communication; (2) scalability of approach; (3) whole-of-health approach; (4) knowledge based approach; and (5) multisectoral approach. Additionally, some key considerations of planning for mass casualty management systems are discussed, namely, health systems surge capacity and networking, risk and resources mapping, and others. PMID:20445382

  17. Mass-Casualty Events at Schools: A National Preparedness Survey

    Microsoft Academic Search

    James Graham; Steve Shirm; Rebecca Liggin; Mary E. Aitken; Rhonda Dick

    2006-01-01

    OBJECTIVE.Recent school shootings and terrorist events have demonstrated the need for well-coordinated planning for school-based mass-casualty events. The objec- tive of this study was to document the preparedness of public schools in the United States for the prevention of and the response to a mass-casualty event. METHODS.A survey was mailed to 3670 school superintendents of public school districts that were

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

    Microsoft Academic Search

    Kirsty Challen; Andrew Bentley; John Bright; Darren Walter

    2007-01-01

    Worst case scenarios for pandemic influenza planning in the US involve over 700,000 patients requiring mechanical ventilation.\\u000a UK planning predicts a 231% occupancy of current level 3 (intensive care unit) bed capacity. Critical care planners need to\\u000a recognise that mortality is likely to be high and the risk to healthcare workers significant. Contingency planning should,\\u000a therefore, be multi-faceted, involving a

  19. An Intelligent 802.11 Triage Tag For Medical Response to Disast ers

    Microsoft Academic Search

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

    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

  20. Modelling mass casualty decontamination systems informed by field exercise data.

    PubMed

    Egan, Joseph R; Amlôt, Richard

    2012-10-01

    In the event of a large-scale chemical release in the UK decontamination of ambulant casualties would be undertaken by the Fire and Rescue Service (FRS). The aim of this study was to track the movement of volunteer casualties at two mass decontamination field exercises using passive Radio Frequency Identification tags and detection mats that were placed at pre-defined locations. The exercise data were then used to inform a computer model of the FRS component of the mass decontamination process. Having removed all clothing and having showered, the re-dressing (termed re-robing) of casualties was found to be a bottleneck in the mass decontamination process during both exercises. Computer simulations showed that increasing the capacity of each lane of the re-robe section to accommodate 10 rather than five casualties would be optimal in general, but that a capacity of 15 might be required to accommodate vulnerable individuals. If the duration of the shower was decreased from three minutes to one minute then a per lane re-robe capacity of 20 might be necessary to maximise the throughput of casualties. In conclusion, one practical enhancement to the FRS response may be to provide at least one additional re-robe section per mass decontamination unit. PMID:23202768

  1. Modelling Mass Casualty Decontamination Systems Informed by Field Exercise Data

    PubMed Central

    Egan, Joseph R.; Amlôt, Richard

    2012-01-01

    In the event of a large-scale chemical release in the UK decontamination of ambulant casualties would be undertaken by the Fire and Rescue Service (FRS). The aim of this study was to track the movement of volunteer casualties at two mass decontamination field exercises using passive Radio Frequency Identification tags and detection mats that were placed at pre-defined locations. The exercise data were then used to inform a computer model of the FRS component of the mass decontamination process. Having removed all clothing and having showered, the re-dressing (termed re-robing) of casualties was found to be a bottleneck in the mass decontamination process during both exercises. Computer simulations showed that increasing the capacity of each lane of the re-robe section to accommodate 10 rather than five casualties would be optimal in general, but that a capacity of 15 might be required to accommodate vulnerable individuals. If the duration of the shower was decreased from three minutes to one minute then a per lane re-robe capacity of 20 might be necessary to maximise the throughput of casualties. In conclusion, one practical enhancement to the FRS response may be to provide at least one additional re-robe section per mass decontamination unit. PMID:23202768

  2. Hepatitis B outbreak following a mass-casualty incident, Australia.

    PubMed

    Italiano, Claire M; Speers, David J; Chidlow, Glenys R; Dowse, Gary K; Robertson, Andrew G; Flexman, James P

    2011-08-01

    On 16 April 2009, a boat carrying 47 Afghan asylum seekers and 2 Indonesian crew exploded in Australian waters, resulting in mass casualties. Of these casualties, 23 persons who suffered significant burns were transferred to Royal Perth Hospital, Perth, Western Australia. One patient was subsequently shown to be a hepatitis B virus (HBV) carrier at the time of the explosion. Over the following months, 3 other patients received a diagnosis of acute hepatitis B, and an additional 4 patients showed serological evidence of recent HBV infection, including 1 patient who was transferred to another Australian city. Molecular typing determined that the strains from the HBV carrier and the acute and recent case patients formed a closely related cluster, and the investigation suggested that transmission occurred at or around the time of the boat explosion. This is the first report of confirmed transmission of HBV following a disaster, and it reinforces the importance of postexposure prophylaxis for HBV in mass casualty situations. PMID:21742838

  3. Loss of cabin pressure in a military transport: a mass casualty with decompression illnesses.

    PubMed

    Johnston, Mickaila J

    2008-04-01

    Presented here is the sudden cabin depressurization of a military C-130 aircraft carrying 66 personnel. They suffered a depressurization from 2134 to 7317 m, resulting in a potential 66-person mass casualty. The aircrew were able to descend to below 3049 m in less than 5 min. They landed in the Kingdom of Bahrain--the nearest hyperbaric recompression facility. Three cases of peripheral neurologic DCS and one case of spinal DCS were identified. Limited manning, unique host nation concerns, and limited available assets led to difficulties in triage, patient transport, and asset allocation. These led to difficult decisions regarding when and for whom to initiate ground level oxygen or hyperbaric recompression therapy. PMID:18457302

  4. Care & Prepare Usability Engineering for Mass Casualty Martin Christof Kindsmller,

    E-print Network

    Lübeck, Universität zu

    emergencies. In order to ensure optimal pre-hospital medi- cal treatment, patients and the severity pre-hospital treatment in the event of a mass casualty incident (MCI) is related to prioritizing resources can manage using rou- tine procedures. It therefore requires exceptional emergency arrangements

  5. Mass casualties and health care following the release of toxic chemicals or radioactive material--contribution of modern biotechnology.

    PubMed

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

    2011-12-01

    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

  6. Predeployment mass casualty and clinical trauma training for US Army forward surgical teams.

    PubMed

    Pereira, Bruno M T; Ryan, Mark L; Ogilvie, Michael P; Gomez-Rodriguez, Juan Carlos; McAndrew, Patrick; Garcia, George D; Proctor, Kenneth G

    2010-07-01

    Since the beginning of the program in 2002, 84 Forward Surgical Teams (FSTs) have rotated through the Army Trauma Training Center (ATTC) at the University of Miami/Ryder Trauma Center including all those deployed to Iraq and Afghanistan. The purpose of this study was to provide the latest updates of our experience with FSTs at the ATTC. Before deployment, each FST participates in a 2-week training rotation at the ATTC. The rotation is divided into 3 phases. Phase 1 is to refresh FST knowledge regarding the initial evaluation and management of the trauma patient. Phase 2 is the clinical phase and is conducted entirely at the Ryder Trauma Center. The training rotation culminates in phase 3, the Capstone exercise. During the Capstone portion of their training, the entire 20-person FST remains at the Ryder Trauma Center and is primarily responsible for the evaluation and resuscitation of all patients arriving over a 24-hour period. Subject awareness concerning their role within the team improved from 71% to 95%, indicating that functioning as a team in the context of the mass casualty training exercise along with clinical codes was beneficial. The clinical component of the rotation was considered by 47% to be the most valuable aspect of the training. Our experience strongly suggests that a multimodality approach is beneficial for preparing a team of individuals with minimal combat (or trauma) experience for the rigors of medical care and triage on the battlefield. The data provided by participants rotating through the ATTC show that through clinical exposure and simulation over a 2-week period, FST performance is optimized by defining provider roles and improving communication. The mass casualty training exercise is a vital component of predeployment training that participants feel is valuable in preparing them for the challenges that lay ahead. PMID:20613574

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

    PubMed Central

    2013-01-01

    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

  8. Mass casualty care in an expeditionary environment: developing local knowledge and expertise in context.

    PubMed

    De Jong, Marla J; Benner, Richard; Benner, Patricia; Richard, Maggie L; Kenny, Deborah J; Kelley, Patricia; Bingham, Mona; Debisette, Annette Tyree

    2010-01-01

    To discover new experience-based clinical and care delivery knowledge learned in the Iraq and Afghanistan combat zones, 107 Air Force, Army, and Navy nurses were interviewed. Eight areas of experiential knowledge were identified in the new care delivery system that featured rapid transport, early trauma and surgical care, and expeditious aeromedical evacuation: (1) organizing for mass casualties, (2) uncertainty about incoming casualties, (3) developing systems to track patients, (4) resource utilization, (5) ripple effects of a mass casualty event, (6) enlarging the scope of nursing practice, (7) operating medical facilities under attack, and (8) nurse emotions related to mass casualties. PMID:20234239

  9. Managing bioterrorism mass casualties in an emergency department: lessons learned from a rural community hospital disaster drill.

    PubMed

    Vinson, Eric

    2007-01-01

    Bioterrorism represents a threat for which most emergency departments (EDs) are ill prepared. In order to develop an evidence-based plan for ED and hospital management of contaminated patients, a review was conducted of the most effective strategies developed during the severe acute respiratory syndrome (SARS) epidemic, as well as Centers for Disease Control and Prevention and military guidelines on biowarfare. Six basic steps were identified: 1) lock down the hospital and control access to the ED; 2) protect emergency care personnel with appropriate personal protective equipment; 3) decontaminate and triage patients; 4) isolate patients; 5) treat patients with appropriate medications or measures, including decontamination of wounds; and 6) use restrictive admission and transfer guidelines. By emphasizing these six basic concepts, a rural ED passed an annual state-run bioterrorism mass-casualty drill. The drill provided health care personnel with the knowledge and skills necessary to prepare for future bioterrorism casualties. These same concepts could also be used to manage highly virulent viral or bacterial outbreaks. PMID:17306750

  10. Mass Casualty Incident Response and Aeromedical Evacuation in Antarctica

    PubMed Central

    Mills, Christopher N.; Mills, Gregory H.

    2011-01-01

    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

  11. Self-care Decontamination within a Chemical Exposure Mass-casualty Incident.

    PubMed

    Monteith, Raymond G; Pearce, Laurie D R

    2015-06-01

    Growing awareness and concern for the increasing frequency of incidents involving hazardous materials (HazMat) across a broad spectrum of contaminants from chemical, biological, radiological, and nuclear (CBRN) sources indicates a clear need to refine the capability to respond successfully to mass-casualty contamination incidents. Best results for decontamination from a chemical agent will be achieved if done within minutes following exposure, and delays in decontamination will increase the length of time a casualty is in contact with the contaminate. The findings presented in this report indicate that casualties involved in a HazMat/CBRN mass-casualty incident (MCI) in a typical community would not receive sufficient on-scene care because of operational delays that are integral to a standard HazMat/CBRN first response. This delay in response will mean that casualty care will shift away from the incident scene into already over-tasked health care facilities as casualties seek aid on their own. The self-care decontamination protocols recommended here present a viable option to ensure decontamination is completed in the field, at the incident scene, and that casualties are cared for more quickly and less traumatically than they would be otherwise. Introducing self-care decontamination procedures as a standard first response within the response community will improve the level of care significantly and provide essential, self-care decontamination to casualties. The process involves three distinct stages which should not be delayed; these are summarized by the acronym MADE: Move/Assist, Disrobe/Decontaminate, Evaluate/Evacuate. Monteith RG , Pearce LDR . Self-care decontamination within a chemical exposure mass-casualty incident. Prehosp Disaster Med. 2015;30(3):1-9. PMID:25915603

  12. The Design of a Decentralized Electronic Triage System

    PubMed Central

    Massey, Tammara; Gao, Tia; Welsh, Matt; Sharp, Jonathan H.; Sarrafzadeh, Majid

    2006-01-01

    The Advanced Health and Disaster Aid Network (AID-N) project seeks to identify unmet needs of emergency response teams in the Washington, DC area during mass casualty incidents and conduct feasibility tests of technology-based solutions. The decentralized electronic triage and sensing system uses low power, electronic triage sensors to monitor the vital signs of patients and provide location tracking capabilities. The robust, decentralized location tracking software runs on a small, embedded system with limited memory and computational power that efficiently locates patients. A field study demonstrates the process of current emergency procedures and the design implications of the prototype. This field study, along with the hardware and software architecture of the electronic triage system, lay the foundation for a reliable, decentralized sensor deployment that will continuously extend network coverage during a mass casualty incident. PMID:17238400

  13. An Intelligent 802.11 Triage Tag For Medical Response to Disasters

    PubMed Central

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

    2005-01-01

    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

  14. Carbamate poisoning: treatment recommendations in the setting of a mass casualties event.

    PubMed

    Rosman, Yossi; Makarovsky, Igor; Bentur, Yedidia; Shrot, Shai; Dushnistky, Tsvika; Krivoy, Amir

    2009-11-01

    The threat of using chemical compounds by terrorists as weapons of mass casualties has been a rising concern in recent years. Carbamates, a group of reversible acetylcholinesterase inhibitors, could be potentially involved in such toxic mass casualty events because they can cause cholinergic crisis that could lead to fatality, similar to that of organophosphate poisoning. The medical management of carbamate poisoning consists of supportive measures and specific antidotal treatment, that is, the anticholinergic compound atropine. The administration of oximes, acetylcholinesterase reactivators, in carbamate poisoning is controversial because of the potential toxicity of oximes in conjunction with carbamate especially in the case of the carbamate--"carbaryl" poisoning. However, recent data suggest that this concern may be unwarranted. In this article, we review the current data regarding the pros and cons of using oximes against carbamates poisoning in a mass casualties event scenario. We also propose a new decision-making algorithm for the medical first responders in a mass casualties event suspected to be caused by a cholinergic substance (organophosphate or carbamate). According to this algorithm, treatment should consist of atropine and oxime regardless of the exact toxic compound involved. We speculate that in a mass casualties event, the benefits of using oximes outweigh the low level of potential risk. PMID:19931761

  15. Mass-casualty triage: time for an evidence-based approach. -...

    Science.gov Websites

    Manual NCBI News PubMed PubMed Central (PMC) PubMed Clinical Queries PubMed Health All Literature Resources... Proteins BioSystems BLAST (Basic Local Alignment Search Tool)...

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

    PubMed

    Duchateau, François-Xavier; Verner, Laurent

    2012-01-01

    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

  17. Secondary Casualty Information: Casualty Uncertainty, Female Casualties, and Wartime Support

    Microsoft Academic Search

    Scott Sigmund Gartner

    2008-01-01

    I develop a theory of wartime public opinion that identifies different types of casualty information and the varied roles they play. These roles include Primary Casualty Information (e.g., monthly casualties), which directly influences opinion; Contextual Casualty Information (e.g., enemy casualties), which mitigates the effect of primary casualties; and two new concepts, Casualty Uncertainty, the inability of individuals to infer casualty

  18. The advanced health and disaster aid network: a light-weight wireless medical system for triage.

    PubMed

    Tia Gao; Massey, T; Selavo, L; Crawford, D; Bor-Rong Chen; Lorincz, K; Shnayder, V; Hauenstein, L; Dabiri, F; Jeng, J; Chanmugam, A; White, D; Sarrafzadeh, M; Welsh, M

    2007-09-01

    Advances in semiconductor technology have resulted in the creation of miniature medical embedded systems that can wirelessly monitor the vital signs of patients. These lightweight medical systems can aid providers in large disasters who become overwhelmed with the large number of patients, limited resources, and insufficient information. In a mass casualty incident, small embedded medical systems facilitate patient care, resource allocation, and real-time communication in the advanced health and disaster aid network (AID-N). We present the design of electronic triage tags on lightweight, embedded systems with limited memory and computational power. These electronic triage tags use noninvasive, biomedical sensors (pulse oximeter, electrocardiogram, and blood pressure cuff) to continuously monitor the vital signs of a patient and deliver pertinent information to first responders. This electronic triage system facilitates the seamless collection and dissemination of data from the incident site to key members of the distributed emergency response community. The real-time collection of data through a mesh network in a mass casualty drill was shown to approximately triple the number of times patients that were triaged compared with the traditional paper triage system. PMID:23852414

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

    PubMed

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

    2014-01-01

    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

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

    PubMed

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

    2015-02-01

    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

  1. Mass casualty incident surveillance and monitoring using identity aware video analytics.

    PubMed

    Yu, Xunyi; Ganz, Aura

    2010-01-01

    In this paper, we propose an identity aware video analytic system that can assist securing the perimeter of a mass casualty incident scene and generate identity annotated video records for forensics and training purposes. Establishing a secure incident scene perimeter and enforcing access control to different zones is a demanding task for current video surveillance systems which lack the ability to provide the identity of the target and its security clearance. Our system which combines active RFID sensors with video analytic tools recovers the identity of the target enabling the activation of suitable alert policies. The system also enables annotation of incident scene video with identity metadata, facilitating the incident response process reconstruction for forensics analysis and emergency response training. PMID:21096870

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

    Microsoft Academic Search

    Armin Ansari; Frederick Taylor Harper; James M. Smith

    2005-01-01

    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

  3. Triage in the defence medical services.

    PubMed

    Horne, Simon T; Vassallo, J

    2015-06-01

    Triage of patients into categories according to their need for intervention is a core part of military medical practice. This article reviews how triage has evolved in the Defence Medical Services and how it might develop in the context of recent research. In particular, a simple model demonstrates that the ideal sensitivity and specificity of a triage system depends upon the availability of transport and the capacity of the receiving units. As a result, we may need to fundamentally change the way we approach triage in order to optimise outcomes-especially if casualty evacuation timelines become longer and smaller medical units more prevalent on future operations. Some pragmatic options for change are discussed. Finally, other areas of current research around triage are highlighted, perhaps showing where triage may go next. PMID:24951629

  4. Factors influencing injury severity score regarding Thai military personnel injured in mass casualty incident April 10, 2010: lessons learned from armed conflict casualties: a retrospective study

    PubMed Central

    2012-01-01

    Background Political conflicts in Bangkok, Thailand have caused mass casualties, especially the latest event April 10, 2010, in which many military personnel were injured. Most of them were transferred to Phramongkutklao Hospital, the largest military hospital in Thailand. The current study aimed to assess factors influencing Injury Severity Score (ISS) regarding Thai military personnel injured in the mass casualty incident (MCI) April 10, 2010. Methods A total of 728 injured soldiers transferred to Phramongkutklao Hospital were reviewed. Descriptive statistics was used to display characteristics of the injuries, relationship between mechanism of injury and injured body regions. Multiple logistic regressions were used to calculate the adjusted odds ratio (adjusted OR) of ISS comparing injured body region categories. Results In all, 153 subjects defined as major data category were enrolled in this study. Blast injury was the most common mechanism of injury (90.2%). These victims displayed 276 injured body regions. The most common injured body region was the extremities (48.5%). A total of 18 patients (11.7%) had an ISS revealing more than 16 points. Three victims who died were expected to die due to high Trauma and Injury Severity Score (TRISS). However, one with high TRISS survived. Factors influencing ISS were age (p = 0.04), abdomen injury (adjusted OR = 29.9; 95% CI, 5.8-153.5; P < 0.01), head & neck injury (adjusted OR = 13.8; 95% CI, 2.4-80.4; P < 0.01) and chest injury (adjusted OR = 9.9; 95% CI, 2.1-47.3; P < 0.01). Conclusions Blast injury was the most common mechanism of injury among Thai military personnel injured in the MCI April 10, 2010. Age and injured body region such as head & neck, chest and abdomen significantly influenced ISS. These factors should be investigated for effective medical treatment and preparing protective equipment to prevent such injuries in the future. PMID:22214518

  5. Improving emergency medical dispatching with emphasis on mass-casualty incidents.

    PubMed

    Kleinoscheg, Gabriel; Burgsteiner, Harald; Bernroider, Martin; Kiechle, Günter; Obermayer, Maria

    2014-01-01

    Dispatching ambulances is a demanding and stressful task for dispatchers. This is especially true in case of mass-casualty incidents. Therefore, the aim of this work was to investigate if and to what extent the dispatch operation of the Red Cross Salzburg can be optimized on such occasions with a computerized system. The basic problem of a dynamic multi-vehicle Dial-a-Ride Problem with time windows was enhanced according to the requirements of the Red Cross Salzburg. The general objective was to minimize the total mileage covered by ambulances and the waiting time of patients. Furthermore, in case of emergencies suitable adaptions to a plan should be carried out automatically. Consequently, the problem is solved by using the Adaptive Large Neighborhood Search. Evaluation results indicate that the system outperforms a human dispatcher by between 2.5% and 36% within 1 minute of runtime concerning total costs. Moreover, the system's response time in case that a plan has to be updated is less than 1 minute on average. PMID:24825692

  6. Medical Treatment of Radiological Casualties: Current Concepts

    Microsoft Academic Search

    Kristi L. Koenig; Ronald E. Goans; Richard J. Hatchett

    2005-01-01

    The threat of radiologic or nuclear terrorism is increasing, yet many physicians are unfamiliar with basic treatment principles for radiologic casualties. Patients may present for care after a covert radiation exposure, requiring an elevated level of suspicion by the physician. Traditional medical and surgical triage criteria should always take precedence over radiation exposure management or decontamina- tion. External contamination from

  7. Clinical review: The role of the intensive care physician in mass casualty incidents: planning, organisation, and leadership

    PubMed Central

    Shirley, Peter J; Mandersloot, Gerlinde

    2008-01-01

    There is a long-standing, broad assumption that hospitals will ably receive and efficiently provide comprehensive care to victims following a mass casualty event. Unfortunately, the majority of medical major incident plans are insufficiently focused on strategies and procedures that extend beyond the pre-hospital and early-hospital phases of care. Recent events underscore two important lessons: (a) the role of intensive care specialists extends well beyond the intensive care unit during such events, and (b) non-intensive care hospital personnel must have the ability to provide basic critical care. The bombing of the London transport network, while highlighting some good practices in our major incident planning, also exposed weaknesses already described by others. Whilst this paper uses the events of the 7 July 2005 as its point of reference, the lessons learned and the changes incorporated in our planning have generic applications to mass casualty events. In the UK, the Department of Health convened an expert symposium in June 2007 to identify lessons learned from 7 July 2005 and disseminate them for the benefit of the wider medical community. The experiences of clinicians from critical care units in London made a large contribution to this process and are discussed in this paper. PMID:18492221

  8. Disaster preparedness and triage: justice and the common good.

    PubMed

    Veatch, Robert M

    2005-07-01

    "Triage" is a term generally referring to the social practice of sorting or categorizing. While it originally had an innocent, commercial meaning referring to sorting crops according to quality, the term quickly took on a more ominous meaning referring to classifying battlefield casualties into three groups: those too well-off to be treated and then, among those more seriously wounded, one group that will get medical attention and another that will not. The moral problem is how to distinguish between the latter two groups. The Hippocratic oath has been utterly useless in helping us do this sorting, since the oath commands the clinician to remain loyal to the individual patient and give no attention to the choice between two patients with different needs. Baker and Strosberg show that historically the British sorted following utilitarian principles, giving priority to the patients who could benefit the most even if they were not in greatest need, while the French arranged patients who could be helped in order of greatest need even if it was not maximally efficient to do so. Understanding how contemporary organ transplant policy utilizes triage can help us clarify our mass disaster triage policy. Two organ transplant examples--tissue typing for kidneys and geographical priority for allocating livers--show that American social policy, when forced to choose between allocating on the basis of efficiency or allocating on the basis of justice, will consider both principles, but give equal or dominant priority to justice--even though this priority is understood to be relatively inefficient. Since health care professionals have a recognized preference for efficiency over justice and lay people are inclined towards justice, leaving mass disaster triage policy in the hands of health professionals will predictably structure the policy in a way that conflicts with the moral priorities of the lay population. Formal public debate that recognizes the conflict between efficiency and equity--professional and lay priorities--is therefore essential. PMID:16021317

  9. Management of casualties from the bombing at the Centennial Olympics

    Microsoft Academic Search

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

    1998-01-01

    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

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

    PubMed Central

    2014-01-01

    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

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

    SciTech Connect

    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

    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.

  12. Design and characterisation of a novel in vitro skin diffusion cell system for assessing mass casualty decontamination systems.

    PubMed

    Matar, H; Larner, J; Kansagra, S; Atkinson, K L; Skamarauskas, J T; Amlot, R; Chilcott, R P

    2014-06-01

    The efficient removal of contaminants from the outer surfaces of the body can provide an effective means of reducing adverse health effects associated with incidents involving the accidental or deliberate release of hazardous materials. Showering with water is frequently used by first responders as a rapid method of mass casualty decontamination (MCD). However, there is a paucity of data on the generic effectiveness and safety of aqueous decontamination systems. To address these issues, we have developed a new in vitro skin diffusion cell system to model the conditions of a common MCD procedure ("ladder pipe system"). The new diffusion cell design incorporates a showering nozzle, an air sampling port for measurement of vapour loss and/aerosolisation, adjustable (horizontal to vertical) skin orientation and a circulating manifold system (to maintain a specified flow rate, temperature and pressure of shower water). The dermal absorption characteristics of several simulants (Invisible Red S, curcumin and methyl salicylate) measured with the new in vitro model were in good agreement with previous in vitro and in vivo studies. Moreover, these initial studies have indicated that whilst flow rate and water temperature are important factors for MCD, the presence of clothing during showering may (under certain circumstances) cause transfer and spreading of contaminants to the skin surface. PMID:24412538

  13. TRIAGE DOSE ASSESSMENT FOR PARTIAL-BODY EXPOSURE: DICENTRIC ANALYSIS

    PubMed Central

    Moroni, Maria; Pellmar, Terry C.

    2009-01-01

    Partial-body biodosimetry is likely to be required after a radiological or nuclear exposure. Clinical signs and symptoms, distribution of dicentrics in circulating blood cells, organ-specific biomarkers, physical signals in teeth and nails all can provide indications of non-homogeneous exposures. Organ specific biomarkers may provide early warning regarding physiological systems at risk after radiation injury. Use of a combination of markers and symptoms will be needed for clinical insights for therapeutic approaches. Analysis of dicentrics, a marker specific for radiation injury, is the “Gold standard” of biodosimetry and can reveal partial-body exposures. Automation of sample processing for dicentric analysis can increase throughput with customization of off-the-shelf technologies for cytogenetic sample processing and information management. Automated analysis of the metaphase spreads is currently limited but improvements are in development. Our efforts bridge the technological gaps to allow the use of dicentric chromosome assay (DCA) for risk-based stratification of mass casualties. This article summarizes current knowledge on partial-body cytogenetic dose assessment synthesizing information leading to the proposal of an approach to triage dose prediction in radiation mass casualties, based on equivalent whole-body doses under partial-body exposure conditions and assesses the validity of using this model. An initial screening using only 20 metaphase spreads per subject can confirm irradiation above 2-Gy. A subsequent increase to 50 metaphases improves dose determination to allow risk stratification for clinical triage. Metaphases evaluated for inhomogeneous distribution of dicentrics can reveal partial-body exposures. We tested the validity of this approach in an in vitro model that simulates partial-body irradiation by mixing irradiated and un-irradiated lymphocytes in various proportions. Our preliminary results support the notion that this approach will be effective under a range of conditions including some partial-body exposures, but may have limitations with low doses or small proportions of irradiated body. Our studies address an important problem in the diagnosis of partial-body irradiation and dose assessment in mass casualties and propose a solution. However, additional work is needed to fully develop and validate the application of DCA to partial-body exposures. PMID:20065689

  14. The Boston Marathon Bombings Mass Casualty Incident: One Emergency Department's Information Systems Challenges and Opportunities.

    PubMed

    Landman, Adam; Teich, Jonathan M; Pruitt, Peter; Moore, Samantha E; Theriault, Jennifer; Dorisca, Elizabeth; Harris, Sheila; Crim, Heidi; Lurie, Nicole; Goralnick, Eric

    2015-07-01

    Emergency department (ED) information systems are designed to support efficient and safe emergency care. These same systems often play a critical role in disasters to facilitate real-time situation awareness, information management, and communication. In this article, we describe one ED's experiences with ED information systems during the April 2013 Boston Marathon bombings. During postevent debriefings, staff shared that our ED information systems and workflow did not optimally support this incident; we found challenges with our unidentified patient naming convention, real-time situational awareness of patient location, and documentation of assessments, orders, and procedures. As a result, before our next mass gathering event, we changed our unidentified patient naming convention to more clearly distinguish multiple, simultaneous, unidentified patients. We also made changes to the disaster registration workflow and enhanced roles and responsibilities for updating electronic systems. Health systems should conduct disaster drills using their ED information systems to identify inefficiencies before an actual incident. ED information systems may require enhancements to better support disasters. Newer technologies, such as radiofrequency identification, could further improve disaster information management and communication but require careful evaluation and implementation into daily ED workflow. PMID:24997562

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

    PubMed Central

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

    2014-01-01

    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

  16. Casualty Assistance: An Overview

    MedlinePLUS

    ... is being held DUSTWUN, or duty status - whereabouts unknown - transitory casualty status, applicable only to military personnel, ... missing or deceased EAWUN, or excused absence - whereabouts unknown - for civilians Injured or ill Interned - known to ...

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

    Microsoft Academic Search

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

    2005-01-01

    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 \\

  18. Recent advances in medical device triage technologies for chemical, biological, radiological, and nuclear events.

    PubMed

    Lansdowne, Krystal; Scully, Christopher G; Galeotti, Loriano; Schwartz, Suzanne; Marcozzi, David; Strauss, David G

    2015-06-01

    In 2010, the US Food and Drug Administration (Silver Spring, Maryland USA) created the Medical Countermeasures Initiative with the mission of development and promoting medical countermeasures that would be needed to protect the nation from identified, high-priority chemical, biological, radiological, or nuclear (CBRN) threats and emerging infectious diseases. The aim of this review was to promote regulatory science research of medical devices and to analyze how the devices can be employed in different CBRN scenarios. Triage in CBRN scenarios presents unique challenges for first responders because the effects of CBRN agents and the clinical presentations of casualties at each triage stage can vary. The uniqueness of a CBRN event can render standard patient monitoring medical device and conventional triage algorithms ineffective. Despite the challenges, there have been recent advances in CBRN triage technology that include: novel technologies; mobile medical applications ("medical apps") for CBRN disasters; electronic triage tags, such as eTriage; diagnostic field devices, such as the Joint Biological Agent Identification System; and decision support systems, such as the Chemical Hazards Emergency Medical Management Intelligent Syndromes Tool (CHEMM-IST). Further research and medical device validation can help to advance prehospital triage technology for CBRN events. Lansdowne K , Scully CG , Galeotti L , Schwartz S , Marcozzi D , Strauss DG . Recent advances in medical device triage technologies for chemical, biological, radiological, and nuclear events. Prehosp Disaster Med. 2015;30(3):1-4. PMID:25868677

  19. Earthquakes and trauma: review of triage and injury-specific, immediate care.

    PubMed

    Gautschi, Oliver P; Cadosch, Dieter; Rajan, Gunesh; Zellweger, René

    2008-01-01

    Earthquakes present a major threat to mankind. Increasing knowledge about geophysical interactions, progressing architectural technology, and improved disaster management algorithms have rendered modern populations less susceptible to earthquakes. Nevertheless, the mass casualties resulting from earthquakes in Great Kanto (Japan), Ancash (Peru), Tangshan (China), Guatemala, Armenia, and Izmit (Turkey) or the recent earthquakes in Bhuj (India), Bam (Iran), Sumatra (Indonesia) and Kashmir (Pakistan) indicate the devastating effect earthquakes can have on both individual and population health. Appropriate preparation and implementation of crisis management algorithms are of utmost importance to ensure a large-scale medical-aid response is readily available following a devastating event. In particular, efficient triage is vital to optimize the use of limited medical resources and to effectively mobilize these resources so as to maximize patient salvage. However, the main priorities of disaster rescue teams are the rescue and provision of emergency care for physical trauma. Furthermore, the establishment of transport evacuation corridors, a feature often neglected, is essential in order to provide the casualties with a chance for survival. The optimal management of victims under such settings is discussed, addressing injuries of the body and psyche by means of simple diagnostic and therapeutic procedures globally applicable and available. PMID:18557301

  20. Tsunami Casualty Model

    NASA Astrophysics Data System (ADS)

    Yeh, H.

    2007-12-01

    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.

  1. Medical response of a physician and two nurses to the mass-casualty event resulting in the Phi Phi Islands from the tsunami.

    PubMed

    Ammartyothin, Surasak; Ashkenasi, Issac; Schwartz, Dagan; Leiba, Adi; Nakash, Guy; Pelts, Rami; Goldberg, Avishay; Bar-Dayan, Yaron

    2006-01-01

    The Phi Phi Islands are isolated islands located about one hour by ship from the mainland in Krabi province of Thailand. There is a small medical facility where the director is the one physician that provides care to residents and tourists. This small medical facility faced an enormous mass casualty incident due to the 2004 Tsunami. The hospital was damaged by the Tsunami wave and was not functional, one crew member died and another was injured. Medical care and evacuation posed a unique problem in the Phi Phi Islands due to remoteness, limited medical resources, lack of effective communication with the main land and the large number of victims. An alternative medical facility was located in a nearby hotel. The crew included the medical director, two nurses, two additional staff members, 10 local volunteers, and hotel staff members. The medical crew had to treat 600-700 casualties in 24 hours. Most of the victims were mildly injured, but approximately 100 (15%) of the victims could not walk due to their injuries. The medical director, made a conscious decision to initially treat only circulation ("C") problems, by controlling external hemorrhages. This decision was driven by the lack of equipment and personnel to deal with airway ("A") and breathing ("B") problems. In the post-disaster debriefing, the Phi Phi Island hospital physician noted five major lessons concerning disaster management in such extreme situation in a small facility located in a remote area: (1) effective resistant communication facilities must be ensured; (2) clear, simple "evacuation plans" should be made in advance; (3) plans should be made to ensure automatic reinforcement of remote areas with evacuation vehicles, medical equipment and medical personnel; (4) efficient cooperation with medical volunteers must be planned and drilled; and (5) every team member of such a hospital must participate in an educational program and periodic drills should be done to improve the disaster and emergency medicine capabilities. This case report is an example for caregivers all over the world, of an amazing lesson of leadership and courage. PMID:16892887

  2. An artificial neural network derived trauma outcome prediction score as an aid to triage for non-clinicians.

    PubMed

    Pearl, Adrian; Bar-Or, Raphael; Bar-Or, David

    2008-01-01

    In mass casualty events Emergency Medical Service Providers (EMS) choose treatment at Scene or a "scoop and run" approach. The latter requires clinically trained personnel at the reception site to triage patients. Current methodology based on Revised Trauma Score (tRTS) requires use of Glasgow Coma Scale, a method reliant on experience and clinical knowledge. This makes the system subjective and often inadequate for non-clinicians. This project attempts to develop a simplified outcome prediction score using an artificial neural network for use by a non-clinically trained EMS to aid triage. The project uses National Trauma Data Bank, Version 6.1. Tiberius Data Mining Software created Neural Network models. Variables considered were values that could easily be obtained during an event. Binary values were used for low SBP and low Respiratory Rate, coded using the RTS scoring table as a basis, and age indicators. A modified motor component of Glasgow Coma Score was created to negate the need for clinical knowledge. Best performing models, identified by Gini coefficient and ability to predict mortality, were with 8 and 10 neurons. On mortality prediction all even numbers of hidden neurons have similar performances. Training sets were compared to test sets, and found to be identical in Gini coefficient and performance. Models performed well in predicting mortality compared to standard outcome predictors. Possible additional variables such as gender or ethnicity might improve the Neural Network predictive ability. Pulse appears an essential variable not recorded by the NTDB. PMID:18487740

  3. Operation Desert Shield: Medical aspects of weapons of mass destruction

    SciTech Connect

    Knudson, G.B. (Department of Pathology, Letterman Army Medical Center, Presidio of San Francisco, CA (USA))

    1991-06-01

    The authors 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.

  4. Garden Path Repair: Diagnosis and Triage.

    ERIC Educational Resources Information Center

    Fodor, Janet Dean; Inoue, Atsu

    2000-01-01

    To determine whether triage--which determines the probable revisability of a structure--is a feature of human parsing, its scope must be established. This study compares four hypotheses about how much work triage can do. Identifies empirical predictions that differentiate diagnosis with triage from simple basic diagnosis. What little evidence…

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

    PubMed

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

    2005-09-01

    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

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

    PubMed

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

    2005-01-01

    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

  7. 46 CFR 185.202 - Notice of casualty.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ...2010-10-01 2010-10-01 false Notice of casualty. 185.202 Section 185.202 Shipping COAST GUARD, DEPARTMENT OF HOMELAND...OPERATIONS Marine Casualties and Voyage Records § 185.202 Notice of casualty. (a)...

  8. Accountability Pressure, Academic Standards, and Educational Triage

    ERIC Educational Resources Information Center

    Lauen, Douglas Lee; Gaddis, S. Michael

    2012-01-01

    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…

  9. Infrared imaging-based combat casualty care system

    NASA Astrophysics Data System (ADS)

    Davidson, James E., Sr.

    1997-08-01

    A Small Business Innovative Research (SBIR) contract was recently awarded to a start up company for the development of an infrared (IR) image based combat casualty care system. The company, Medical Thermal Diagnostics, or MTD, is developing a light weight, hands free, energy efficient uncooled IR imaging system based upon a Texas Instruments design which will allow emergency medical treatment of wounded soldiers in complete darkness without any type of light enhancement equipment. The principal investigator for this effort, Dr. Gene Luther, DVM, Ph.D., Professor Emeritus, LSU School of Veterinary Medicine, will conduct the development and testing of this system with support from Thermalscan, Inc., a nondestructive testing company experienced in IR thermography applications. Initial research has been done with surgery on a cat for feasibility of the concept as well as forensic research on pigs as a close representation of human physiology to determine time of death. Further such studies will be done later as well as trauma studies. IR images of trauma injuries will be acquired by imaging emergency room patients to create an archive of emergency medical situations seen with an infrared imaging camera. This archived data will then be used to develop training material for medical personnel using the system. This system has potential beyond military applications. Firefighters and emergency medical technicians could directly benefit from the capability to triage and administer medical care to trauma victims in low or no light conditions.

  10. Blood bank protocols for large-scale civilian casualty events: experience from terrorist bombing in Israel.

    PubMed

    Dann, E J; Bonstein, L; Arbov, L; Kornberg, A; Rahimi-Levene, N

    2007-04-01

    Terrorist attacks in crowded places cause multiple casualties that are evacuated by quick succession to nearby hospitals. The study goals were to analyse the issues of patient misidentification and excessive blood request and to develop recommendations for the management of such episodes. A retrospective analysis of nine explosion attacks was performed. In nine consecutive events, 450 casualties were reported by the National Ambulance Service, 82 of whom (18%) died on the explosion site and 368 were admitted to nearby trauma centres. Red blood cell units were typed and cross-matched for 70 patients. Seventy-three per cent of the blood supplied over the first 24 h was administered during the first 2 h. The cross-matched/transfused ratio was 2.52 +/- 1.42, reflecting the overestimation of blood requirement in mass casualty episodes. In the mass casualty setup, blood bank personnel should be alert to a potential mistransfusion or a blood collection error. Unidentified patients are subjected to errors due to only one-digit difference in their temporary identification number. Application of the system using an additional sequential four-digit number printed in bold and large size font for patients at admission reduced the possibility of misidentification. Modern technologies, including error-reduction design wristbands, barcode-based system or radiofrequency identification tags may also increase reliability of patient identification in the mass casualty setup. PMID:17430470

  11. Automatic bug triage using text categorization Davor Cubranic

    E-print Network

    Murphy, Gail

    Automatic bug triage using text categorization Davor Cubrani´c Department of Computer Science murphy@cs.ubc.ca Abstract Bug triage, deciding what to do with an incoming bug re- port, is taking up machine learning techniques to assist in bug triage by using text categorization to predict the developer

  12. 46 CFR 4.03-1 - Marine casualty or accident.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ...PROCEDURES APPLICABLE TO THE PUBLIC MARINE CASUALTIES AND INVESTIGATIONS Definitions § 4.03-1 Marine casualty or accident...Collision; (vi) Allision; (vii) Explosion; (viii) Fire; (ix) Reduction or loss of a vessel's electrical...

  13. 46 CFR 4.05-1 - Notice of marine casualty.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ...APPLICABLE TO THE PUBLIC MARINE CASUALTIES AND INVESTIGATIONS Notice of Marine Casualty and Voyage Records...or route, including but not limited to fire, flooding, or failure of or damage to fixed fire-extinguishing systems, lifesaving...

  14. 46 CFR 4.03-1 - Marine casualty or accident.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ...PROCEDURES APPLICABLE TO THE PUBLIC MARINE CASUALTIES AND INVESTIGATIONS Definitions § 4.03-1 Marine casualty or accident...Collision; (vi) Allision; (vii) Explosion; (viii) Fire; (ix) Reduction or loss of a vessel's electrical...

  15. 46 CFR 4.03-1 - Marine casualty or accident.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ...PROCEDURES APPLICABLE TO THE PUBLIC MARINE CASUALTIES AND INVESTIGATIONS Definitions § 4.03-1 Marine casualty or accident...Collision; (vi) Allision; (vii) Explosion; (viii) Fire; (ix) Reduction or loss of a vessel's electrical...

  16. 46 CFR 4.05-1 - Notice of marine casualty.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ...APPLICABLE TO THE PUBLIC MARINE CASUALTIES AND INVESTIGATIONS Notice of Marine Casualty and Voyage Records...or route, including but not limited to fire, flooding, or failure of or damage to fixed fire-extinguishing systems, lifesaving...

  17. 46 CFR 4.05-1 - Notice of marine casualty.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ...APPLICABLE TO THE PUBLIC MARINE CASUALTIES AND INVESTIGATIONS Notice of Marine Casualty and Voyage Records...or route, including but not limited to fire, flooding, or failure of or damage to fixed fire-extinguishing systems, lifesaving...

  18. 46 CFR 4.03-1 - Marine casualty or accident.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ...PROCEDURES APPLICABLE TO THE PUBLIC MARINE CASUALTIES AND INVESTIGATIONS Definitions § 4.03-1 Marine casualty or accident...Collision; (vi) Allision; (vii) Explosion; (viii) Fire; (ix) Reduction or loss of a vessel's electrical...

  19. 46 CFR 4.05-1 - Notice of marine casualty.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ...APPLICABLE TO THE PUBLIC MARINE CASUALTIES AND INVESTIGATIONS Notice of Marine Casualty and Voyage Records...or route, including but not limited to fire, flooding, or failure of or damage to fixed fire-extinguishing systems, lifesaving...

  20. 46 CFR 4.03-1 - Marine casualty or accident.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ...PROCEDURES APPLICABLE TO THE PUBLIC MARINE CASUALTIES AND INVESTIGATIONS Definitions § 4.03-1 Marine casualty or accident...Collision; (vi) Allision; (vii) Explosion; (viii) Fire; (ix) Reduction or loss of a vessel's electrical...

  1. 46 CFR 4.05-1 - Notice of marine casualty.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ...APPLICABLE TO THE PUBLIC MARINE CASUALTIES AND INVESTIGATIONS Notice of Marine Casualty and Voyage Records...or route, including but not limited to fire, flooding, or failure of or damage to fixed fire-extinguishing systems, lifesaving...

  2. 46 CFR 185.260 - Reports of potential vessel casualty.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ...2010-10-01 false Reports of potential vessel casualty. 185.260 Section 185.260 Shipping COAST GUARD, DEPARTMENT OF HOMELAND...OPERATIONS Marine Casualties and Voyage Records § 185.260 Reports of potential vessel...

  3. Machine Learning for Biomedical Literature Triage

    PubMed Central

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

    2014-01-01

    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

  4. 19 CFR 158.27 - Accidental fire or other casualty.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ...2010-04-01 false Accidental fire or other casualty. 158...Custody § 158.27 Accidental fire or other casualty. In the...or destruction by accidental fire or other casualty, the following...vehicle, the proprietor of the warehouse, or other person...

  5. Paramedics and triage: Effect of one training session on triage in the emergency department

    Microsoft Academic Search

    Sezgin Sarikaya; Suna Soysal; Ozgur Karcioglu; Hakan Topacoglu; Ali Tasar

    2004-01-01

    This 3-stage intervention study enrolled all adult patients referred to a universitybased emergency department (ED) during\\u000a randomly assigned 1-week preeducation or posteducation periods. Triage decisions recorded by ED paramedics (n=8) both before\\u000a and after an educational training session were compared to decisions made by emergency physicians (EPs). Triage decisions\\u000a of paramedics and EPs in the preeducation phase showed poor consistency

  6. Is conservation triage just smart decision making?

    E-print Network

    Kark, Salit

    Is conservation triage just smart decision making? Madeleine C. Bottrill1 , Liana N. Joseph1, Townsville, QLD 4811, Australia 4 Landcare Research, Private Bag 1930, Dunedin 9054, New Zealand Conservation efforts and emergency medicine face com- parable problems: how to use scarce resources wisely to conserve

  7. Accountability Incentives: Do Schools Practice Educational Triage?

    ERIC Educational Resources Information Center

    Springer, Matthew G.

    2008-01-01

    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…

  8. Field deployable EEG monitor for nerve agent casualties.

    PubMed

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

    2009-01-01

    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

  9. 49 CFR 850.25 - Coast Guard marine casualty investigation for the Board.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ...2010-10-01 2010-10-01 false Coast Guard marine casualty investigation for...NATIONAL TRANSPORTATION SAFETY BOARD COAST GUARD-NATIONAL TRANSPORTATION SAFETY...CASUALTY INVESTIGATIONS § 850.25 Coast Guard marine casualty investigation...

  10. 33 CFR 174.101 - Applicability of State casualty reporting system.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ...2010-07-01 false Applicability of State casualty reporting system. 174.101 Section 174.101 Navigation...BOATING SAFETY STATE NUMBERING AND CASUALTY REPORTING SYSTEMS Casualty Reporting System Requirements § 174.101...

  11. Web-Based Triage in a College Health Setting

    ERIC Educational Resources Information Center

    Sole, Mary Lou; Stuart, Patricia L.; Deichen, Michael

    2006-01-01

    The authors describe the initiation and use of a Web-based triage system in a college health setting. During the first 4 months of implementation, the system recorded 1,290 encounters. More women accessed the system (70%); the average age was 21.8 years. The Web-based triage system advised the majority of students to seek care within 24 hours;…

  12. Technology Staff Development: Triage Using Three Mastery Levels.

    ERIC Educational Resources Information Center

    Guffey, J. Stephen; Rampp, Lary C.; Bradley, Mary Jane

    The technology triage is a workable paradigm for straightforward school-site/school-district implementation of technology resources. Development of a triage system of participant involvement and in-service staff development can help address the tendency to ineffectively allocate funds within the total picture of the school commitment to…

  13. No Child Overlooked: Mental Health Triage in the Schools

    ERIC Educational Resources Information Center

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

    2009-01-01

    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…

  14. The Casualty Actuarial Society: Helping Universities Train Future Actuaries

    ERIC Educational Resources Information Center

    Boa, J. Michael; Gorvett, Rick

    2014-01-01

    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…

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

    NASA Astrophysics Data System (ADS)

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

    1999-07-01

    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.

  16. [Burns. An epidemiologic casualty ward study].

    PubMed

    Maagaard Mortensen, N H; Poulsen, E U

    1990-05-21

    Four hundred eighty five persons were treated for burns at the casualty ward of Aarhus County Hospital between 1 January and 31 December 1986. Compared to a previous study from the municipality of Copenhagen only minor differences were found concerning the distribution of patient sex and age, and the cause and scene of accident. Small children aged 0-5 years constituted a high risk group, representing more than 18% of all burn injuries. Ninety one per cent of the accidents in this group took place in the home, and the need for further prophylactic measures is evident. Our suggestions include better insulation of oven doors, and protective shields at the front of electric stoves. Further, we emphasize that children should never be left alone in the kitchen without proper supervision. PMID:2360269

  17. Balancing human and system visualization during document triage

    E-print Network

    Bae, Soon Il

    2009-05-15

    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...

  18. Balancing human and system visualization during document triage 

    E-print Network

    Bae, Soon Il

    2009-05-15

    -generated visualization of this dissertation was inspired by the prior studies of document triage [Marshall and Shipman 1997; Shipman, Hsieh et al. 2004; Bae, Badi et al. 2005] . Section 2 describes the problems observed from the prior studies. Section 3 introduces... analysis of user behavior from a prior study of document triage [Bae, Marshall et al. 2006]. Section 5 presents high level approaches to deal with the observed problems, which are primarily based on the implications from the prior studies. The system...

  19. 46 CFR 109.415 - Retention of records after casualty.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ...reports. (4) Bell books. (5) Navigation charts in use at the time of casualty. (6) Navigation work books. (7) Compass deviation cards. (8) Gyrocompass records. (9) Storage plans. (10) Record of drafts. (11) Notices to...

  20. 46 CFR 109.415 - Retention of records after casualty.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ...reports. (4) Bell books. (5) Navigation charts in use at the time of casualty. (6) Navigation work books. (7) Compass deviation cards. (8) Gyrocompass records. (9) Storage plans. (10) Record of drafts. (11) Notices to...

  1. 46 CFR 28.80 - Report of casualty.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... REQUIREMENTS FOR COMMERCIAL FISHING INDUSTRY VESSELS General Provisions...primary insurance for a commercial fishing industry vessel must submit a report...A casualty to a commercial fishing industry vessel must be reported...

  2. 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

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

    2013-01-01

    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

  3. Pharmacotherapy for recently evacuated military casualties.

    PubMed

    Friedman, M J; Charney, D S; Southwick, S M

    1993-07-01

    In late 1990 during the massive Operation Desert Shield/Storm (ODS) deployment of United Nations troops, the VA/DoD Joint Contingency Plan was activated. Worst case scenarios projected tens of thousands of medical evacuees from the Persian Gulf and predicted that U.S. Military Communication Zone and CONUS bed capacity would quickly be saturated. As a result, a massive educational program was rapidly implemented to prepare 80 VA hospitals to receive ODS personnel within 1-3 weeks of their evacuation from battalion aid stations or other front-echelon medical facilities. This article was written as part of this educational effort. Noting that there were no published articles on pharmacotherapy for recently evacuated military casualties, the authors wrote the present manuscript for inclusion in the ODS Clinical Packet prepared by the VA's National Center for PTSD and circulated to VA mental health professionals. Since the published literature still lacks an article on this subject and since we believe that our comments on pharmacotherapy apply to survivors of most acute traumatic events, we present our observations and recommendations with the hope that they may be useful to military, VA, and civilian practitioners. PMID:8351054

  4. Factors Influencing Triage Decisions in Patients Referred for ICU Admission

    PubMed Central

    Orsini, Jose; Butala, Ashvin; Ahmad, Noeen; Llosa, Alfonso; Prajapati, Ramesh; Fishkin, Edward

    2013-01-01

    Background Few data is available on triage of critically ill patients. Because the demand for ICU beds often exceeds their availability, frequently intensivists need to triage these patients in order to equally and efficiently distribute the available resources based on the concept of potential benefit and reasonable chance of recovery. The objective of this study is to evaluate factors influencing triage decisions among patients referred for ICU admission and to assess its impact in outcome. Methods A single-center, prospective, observational study of 165 consecutive triage evaluations was conducted in patients referred for ICU admission that were either accepted, or refused and treated on the medical or surgical wards as well as the step-down and telemetry units. Results Seventy-one patients (43.0%) were accepted for ICU admission. Mean Acute Physiology and Chronic Health Evaluation (APACHE)-II score was 15.3 (0 - 36) and 13.9 (0 - 30) for accepted and refused patients, respectively. Three patients (4.2%) had active advance directives on admission to ICU. Age, gender, and number of ICU beds available at the time of evaluation were not associated with triage decisions. Thirteen patients (18.3%) died in ICU, while the in-hospital mortality for refused patients was 12.8%. Conclusion Refusal of admission to ICU is common, although patients in which ICU admission is granted have higher mortality. Presence of active advance directives seems to play an important role in the triage decision process. Further efforts are needed to define which patients are most likely to benefit from ICU admission. Triage protocols or guidelines to promote efficient critical care beds use are warranted. PMID:23976906

  5. Triage of Elderly Trauma Patients: A Population-Based Perspective

    PubMed Central

    Staudenmayer, Kristan L; Hsia, Renee Y; Mann, N Clay; Spain, David A; Newgard, Craig D

    2013-01-01

    Background Elderly patients are frequently under-triaged. However, the associations between triage patterns and outcomes from a population perspective are unknown. We hypothesized that triage patterns would be associated with differences in outcomes. Study Design This is a population-based, retrospective cohort study of all injured adults aged ?55 years from 3 counties in California and 4 in Utah (2006–2007). Pre-hospital data were linked to trauma registry data, state-level discharge data, emergency department (ED) records, and death files. The primary outcome was 60-day mortality. Patients treated at trauma centers were compared to those treated at non-trauma centers. Under-triage was defined as an injury severity score (ISS)>15 with transport to a non-trauma center. Results There were 6,015 patients in the analysis. Patients who were taken to non-trauma centers were on average older (79.4 vs. 70.7 years, p<0.001), more often female (68.6% vs. 50.2%, p<0.01), and less often had an ISS>15 (2.2% vs. 6.7%, p<0.01). The number of patients with an ISS>15 was 244 and the under-triage rate was 32.8% (N=80). Overall 60-day mortality for patients with an ISS>15 was 17%, with no difference between trauma and non-trauma centers in unadjusted or adjusted analyses. However, the median per-patient costs were $21,000 higher for severely injured patients taken to trauma centers. Conclusions This is the first population-based analysis of triage patterns and outcomes in the elderly. We have shown high rates of under-triage that are not associated with higher mortality, but are associated with higher costs. Future work should focus on determining how to improve outcomes for this population. PMID:24054408

  6. 46 CFR 4.40-25 - Coast Guard marine casualty investigation for the Board.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ...2010-10-01 2010-10-01 false Coast Guard marine casualty investigation for...Section 4.40-25 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY...CASUALTIES AND INVESTIGATIONS Coast Guard-National Transportation...

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

    PubMed Central

    2010-01-01

    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

  8. The nursing triage process: a video review and a proposed audit tool.

    PubMed Central

    Williams, J C; Jones, N L; Richardson, F J; Jones, C; Richmond, P W

    1996-01-01

    OBJECTIVE: To review the activity of the nurse triage process. SETTING: The triage room for adults attending the accident and emergency department of the Cardiff Royal Infirmary. METHODS: 226 triage processes were videotaped over 31 h during July 1994. Activities were subsequently analysed using a specially designed chart. RESULTS: Areas for improvement in staff communication skills and patient privacy were identified. CONCLUSIONS: The use of video in the triage room allows assessment of the triage process and is a valuable aid to training. Additionally, a potential visual audit tool has been identified. PMID:8947797

  9. Mixed Methods Approach for Measuring the Impact of Video Telehealth on Outpatient Clinic Triage Nurse Workflow

    PubMed Central

    Cady, Rhonda G.; Finkelstein, Stanley M.

    2015-01-01

    Nurse-delivered telephone triage is a common component of outpatient clinic settings. Adding new communication technology to clinic triage has the potential to not only transform the triage process, but also alter triage workflow. Evaluating the impact of new technology on an existing workflow is paramount to maximizing efficiency of the delivery system. This study investigated triage nurse workflow before and after the implementation of video telehealth using a sequential mixed methods protocol that combined ethnography and time-motion study to provide a robust analysis of the implementation environment. Outpatient clinic triage using video telehealth required significantly more time than telephone triage, indicating a reduction in nurse efficiency. Despite the increased time needed to conduct video telehealth, nurses consistently rated it useful in providing triage. Interpretive analysis of the qualitative and quantitative data suggests the increased depth and breadth of data available during video triage alters the assessment triage nurses provide physicians. This in turn could impact the time physicians spend formulating a diagnosis and treatment plan. While the immediate impact of video telehealth is a reduction in triage nurse efficiency, what is unknown is the impact of video telehealth on physician and overall clinic efficiency. Future studies should address this area. PMID:24080753

  10. Data Quality for Situational Awareness during Mass-Casualty Events

    PubMed Central

    Demchak, Barry; Griswold, William G.; Lenert, Leslie A.

    2007-01-01

    Incident Command systems often achieve situational awareness through manual paper-tracking systems. Such systems often produce high latencies and incomplete data, resulting in inefficient and ineffective resource deployment. WIISARD (Wireless Internet Information System for Medical Response in Disasters) collects much more data than a paper-based system, dramatically reducing latency while increasing the kinds and quality of information available to incident commanders. Yet, the introduction of IT into a disaster setting is not problem-free. Notably, system component failures can delay the delivery of data. The type and extent of a failure can have varying effects on the usefulness of information displays. We describe a small, coherent set of customizble information overlays to address this problem, and we discuss reactions to these displays by medical commanders. PMID:18693821

  11. Primary Casualty Reception Ship: the hospital within--Operation Granby.

    PubMed

    Dewar, E P

    1992-01-01

    As the build-up of Operation Granby forces developed in the Gulf, casualty estimates indicated the need for a 100-bed hospital facility to care for the possible maritime casualties. RFA Argus, the Air Training Ship, was identified as the potential Primary Casualty Reception Ship (PCRS) and at the end of September 1990 plans were drawn up to convert the forward hangar into a two-storey 100-bed hospital in collective protection (COLPRO). In the three weeks prior to deployment, the hospital was designed, built, equipped and staffed. Argus arrived in the Gulf in mid-November as the PCRS with, all in COLPRO, a 10-bed intensive care unit (ICU), a 14-bed high dependency unit (HDU), a 76-bed low dependency unit (LDU) plus four operating tables in two theatres with full support services. The hospital was staffed by a medical team of 136 personnel and supported by the Air department with four casualty evacuation helicopters, an RN Party and the staff of the RFA. One hundred and five patients were treated of which 78 were returned to duty. Argu as PCRS spent longer in the northern Persian Gulf than any other ship, UK or US. PMID:1460595

  12. Factors Influencing Digital Reference Triage: A Think-Aloud Study

    ERIC Educational Resources Information Center

    Pomerantz, Jeffrey

    2004-01-01

    This article describes a think-aloud study conducted to identify factors that influence the decisions made by digital reference "triagers" when performing triage on questions received by digital reference services. This study follows and expands on a Delphi study that identified factors that triagers agreed on after the fact of their performance…

  13. Investigating Document Triage on Paper and Electronic Media

    Microsoft Academic Search

    George Buchanan; Fernando Loizides

    2007-01-01

    Document triage is the critical point in the information seek- ing process when the user first decides the relevance of a document to their information need. This complex process is not yet well understood, and subsequently we have undertaken a comparison of this task in both electronic and paper media. The results reveal that in each medium hu- man judgement

  14. Navigating triage to meet targets for waiting times.

    PubMed

    Diaz Alonso, Inmaculada

    2013-06-01

    An initial assessment process, called navigation, has been introduced at Medway Maritime Hospital emergency department (ED) to address problems with the triage system and to meet the latest ED quality clinical indicators. This article explains the rationale for introducing the new assessment process, describes the system and discusses the change-management process needed to implement it. - PMID:23888562

  15. Meteorite falls in China and some related human casualty events

    NASA Technical Reports Server (NTRS)

    Yau, Kevin; Weissman, Paul; Yeomans, Donald

    1994-01-01

    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.

  16. Strategies for casualty mitigation programs by using advanced tsunami computation

    NASA Astrophysics Data System (ADS)

    IMAI, K.; Imamura, F.

    2012-12-01

    1. Purpose of the study In this study, based on the scenario of great earthquakes along the Nankai trough, we aim on the estimation of the run up and high accuracy inundation process of tsunami in coastal areas including rivers. Here, using a practical method of tsunami analytical model, and taking into account characteristics of detail topography, land use and climate change in a realistic present and expected future environment, we examined the run up and tsunami inundation process. Using these results we estimated the damage due to tsunami and obtained information for the mitigation of human casualties. Considering the time series from the occurrence of the earthquake and the risk of tsunami damage, in order to mitigate casualties we provide contents of disaster risk information displayed in a tsunami hazard and risk map. 2. Creating a tsunami hazard and risk map From the analytical and practical tsunami model (a long wave approximated model) and the high resolution topography (5 m) including detailed data of shoreline, rivers, building and houses, we present a advanced analysis of tsunami inundation considering the land use. Based on the results of tsunami inundation and its analysis; it is possible to draw a tsunami hazard and risk map with information of human casualty, building damage estimation, drift of vehicles, etc. 3. Contents of disaster prevention information To improve the hazard, risk and evacuation information distribution, it is necessary to follow three steps. (1) Provide basic information such as tsunami attack info, areas and routes for evacuation and location of tsunami evacuation facilities. (2) Provide as additional information the time when inundation starts, the actual results of inundation, location of facilities with hazard materials, presence or absence of public facilities and areas underground that required evacuation. (3) Provide information to support disaster response such as infrastructure and traffic network damage prediction. Finally, compiling all this information on a tsunami hazard and risk map with the tsunami inundation animation, it is possible to create and propose strategies for casualty mitigation programs.

  17. Triaging self-referred patients attending ophthalmic emergency room

    PubMed Central

    AlSamnan, Mazen S.; Mousa, Ahmed; Al-Kuwaileet, Safa; AlSuhaibani, Adel H.

    2015-01-01

    Objectives: To introduce an effective and safe ophthalmic triaging system to be used by non-ophthalmologists. Methods: A modified scoring triage system with more relevant clinical symptoms and signs from a previously published Rome Eye Scoring System for Urgency and Emergency (RESCUE) was evaluated over a 2-month period. The study was conducted following a prospective cohort design between March and September 2014 at King Abdulaziz University Hospital, Riyadh, Saudi Arabia. Only self-referred patients were included. Its reliability in differentiating urgent and semi-urgent conditions from non-urgent conditions, identifying patients who need immediate intervention, and decreasing the waiting time were tested using Mann Whitney U test. Results: A total of 531 patients were included in the validation phase to evaluate the triaging system reliability, and 824 patients were included in the implementation phase (applying the system in the ophthalmology emergency room). The sensitivity to differentiate urgent and semi-urgent conditions from non-urgent conditions improved from 90.7 to 98.7%, while the specificity decreased from 97.2 to 87% compared with RESCUE. The sensitivity in differentiating urgent conditions from semi-urgent and non-urgent conditions was 99%, and the specificity was 90%. Mean waiting time reduced from 58.23 minutes to 46 minutes (p=0.014), and the median waiting time reduced from 46 minutes to 33 minutes (p=0.009). Conclusion: This triage system appears to be safe and effective in recognizing the urgency of different ophthalmic conditions, reducing unnecessary ophthalmic emergency load and waiting time significantly. PMID:25987109

  18. Esophageal ruptures: triage using the systemic inflammatory response syndrome score

    Microsoft Academic Search

    Kouichi Furugaki; Junichi Yoshida; Koji Hokazono; Takuya Emoto; Jo Nakashima; Mayumi Ohyama; Toshiyuki Ishimitsu; Masahiro Shinohara; Kenichi Matsuo

    2011-01-01

    Esophageal rupture is a rare entity. Delay in the diagnosis and treatment may threaten the patient’s life. The decision for\\u000a surgical or nonsurgical treatment, however, remains controversial because advocates of both treatments have reported comparable\\u000a results. To quantify the decision making, we suggest the systemic inflammatory response syndrome (SIRS) score for triage of\\u000a an esophageal rupture. Using this criterion for

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

    Microsoft Academic Search

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

    2008-01-01

    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

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

    PubMed Central

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

    2014-01-01

    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

  1. Selecting samples for Mars sample return: Triage by pyrolysis-FTIR

    NASA Astrophysics Data System (ADS)

    Sephton, Mark A.; Court, Richard W.; Lewis, James M.; Wright, Miriam C.; Gordon, Peter R.

    2013-04-01

    A future Mars Sample Return mission will deliver samples of the red planet to Earth laboratories for detailed analysis. A successful mission will require selection of the best samples that can be used to address the highest priority science objectives including assessment of past habitability and evidence of life. Pyrolysis is a commonly used method for extracting organic information from rocks but is most often coupled with complex analytical steps such as gas chromatography and mass spectrometry. Pyrolysis-Fourier transform infrared spectroscopy is a less resource demanding method that still allows sample characterisation. Here we demonstrate how pyrolysis-Fourier transform infrared spectroscopy could be used to triage samples destined to return to Earth, thereby maximising the scientific return from future sample return missions.

  2. Application of novel hyperspectral imaging technologies in combat casualty care

    NASA Astrophysics Data System (ADS)

    Cancio, Leopoldo C.

    2010-02-01

    Novel hyperspectral imaging (HSI) methods may play several important roles in Combat Casualty Care: (1) HSI of the skin may provide spatial data on hemoglobin saturation of oxygen, as a "window" into perfusion during shock. (2) HSI or similar technology could be incorporated into closed-loop, feedback-controlled resuscitation systems. (3) HSI may provide information about tissue viability and/or wound infection. (4) HSI in the near-infrared range may provide information on the tissue water content--greatly affected, e.g., by fluid resuscitation. Thus, further refinements in the speed and size of HSI systems are sought to make these capabilities available on the battlefield.

  3. Calibrating Urgency: Triage Decision-Making in a Pediatric Emergency Department

    ERIC Educational Resources Information Center

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

    2008-01-01

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

  4. The Social Network and Relationship Finder: Social Sorting for Email Triage

    Microsoft Academic Search

    Carman Neustaedter; A. J. Bernheim Brush; Marc A. Smith; Danyel Fisher

    2005-01-01

    Email triage is the process of going through unhandled email and deciding what to do with it. This process can quickly become a serious problem for users with large volumes of email. Studies have found that people use a variety of approaches to triage their email, many of which have a social component. We believe that email clients can better

  5. IEEE TRANSACTIONS ON JOURNAL NAME, MANUSCRIPT ID 1 Towards Effective Bug Triage with

    E-print Network

    Paris-Sud XI, Université de

    IEEE TRANSACTIONS ON JOURNAL NAME, MANUSCRIPT ID 1 Towards Effective Bug Triage with Software Data with software bugs. An inevitable step of fixing bugs is bug triage, which aims to correctly assign a developer to a new bug. To decrease the time cost in manual work, text classification techniques are applied

  6. Evaluation of symptom checkers for self diagnosis and triage: audit study

    PubMed Central

    Semigran, Hannah L; Linder, Jeffrey A; Gidengil, Courtney

    2015-01-01

    Objective To determine the diagnostic and triage accuracy of online symptom checkers (tools that use computer algorithms to help patients with self diagnosis or self triage). Design Audit study. Setting Publicly available, free symptom checkers. Participants 23 symptom checkers that were in English and provided advice across a range of conditions. 45 standardized patient vignettes were compiled and equally divided into three categories of triage urgency: emergent care required (for example, pulmonary embolism), non-emergent care reasonable (for example, otitis media), and self care reasonable (for example, viral upper respiratory tract infection). Main outcome measures For symptom checkers that provided a diagnosis, our main outcomes were whether the symptom checker listed the correct diagnosis first or within the first 20 potential diagnoses (n=770 standardized patient evaluations). For symptom checkers that provided a triage recommendation, our main outcomes were whether the symptom checker correctly recommended emergent care, non-emergent care, or self care (n=532 standardized patient evaluations). Results The 23 symptom checkers provided the correct diagnosis first in 34% (95% confidence interval 31% to 37%) of standardized patient evaluations, listed the correct diagnosis within the top 20 diagnoses given in 58% (55% to 62%) of standardized patient evaluations, and provided the appropriate triage advice in 57% (52% to 61%) of standardized patient evaluations. Triage performance varied by urgency of condition, with appropriate triage advice provided in 80% (95% confidence interval 75% to 86%) of emergent cases, 55% (47% to 63%) of non-emergent cases, and 33% (26% to 40%) of self care cases (P<0.001). Performance on appropriate triage advice across the 23 individual symptom checkers ranged from 33% (95% confidence interval 19% to 48%) to 78% (64% to 91%) of standardized patient evaluations. Conclusions Symptom checkers had deficits in both triage and diagnosis. Triage advice from symptom checkers is generally risk averse, encouraging users to seek care for conditions where self care is reasonable. PMID:26157077

  7. On the Temporal Distribution of Casualties and Determination of Medical Logistical Requirements

    E-print Network

    Michael Kyle Lauren

    2012-03-31

    It is demonstrated that World War II casualty data display statistical structure that would be expected from multifractal data. Given that the data displayed these properties, it is shown how the existence of power-law tails in the exceedence probability distributions can be used to estimate the likelihood of various casualty levels. Estimates made using this method matched the historical data well.

  8. An investigation into the relationships between area social characteristics and road accident casualties

    Microsoft Academic Search

    Ibrahim M. Abdalla; Robert Raeside; Derek Barker; David R. D. McGuigan

    1997-01-01

    This paper reports on the analysis of a data base created by merging road casualty information and census data for the former Lothian region in Scotland. The data base was established by assigning resident postcodes to each casualty record and relating these postcodes to the census data for the relevant census output area. Initially, consideration was given to the relationship

  9. Mixed-methods approach for measuring the impact of video telehealth on outpatient clinic triage nurse workflow.

    PubMed

    Cady, Rhonda G; Finkelstein, Stanley M

    2013-09-01

    Nurse-delivered telephone triage is a common component of outpatient clinic settings. Adding new communication technology to clinic triage has the potential to not only transform the triage process but also alter triage workflow. Evaluating the impact of new technology on an existing workflow is paramount to maximizing the efficiency of the delivery system. This study investigated triage nurse workflow before and after the implementation of video telehealth using a sequential mixed-methods protocol that combined ethnography and time-motion study to provide a robust analysis of the implementation environment. Outpatient clinic triage using video telehealth required significantly more time than telephone triage did, indicating a reduction in nurse efficiency. Despite the increased time needed to conduct video telehealth, nurses consistently rated it useful in providing triage. Interpretive analysis of the qualitative and quantitative data suggests that the increased depth and breadth of data available during video triage alter the assessment that triage nurses provide physicians. This in turn could affect the time physicians spend formulating a diagnosis and treatment plan. While the immediate impact of video telehealth is a reduction in triage nurse efficiency, what is unknown is the impact of video telehealth on physician and overall clinic efficiency. Future studies should address this area. PMID:24080753

  10. Improving quality through clinical risk management: a triage sentinel event analysis.

    PubMed

    Guzzo, Anna Santa; Marzolini, Leonilde; Diaczenko, Alina Maria; Ruggieri, Maria Pia; Bertazzoni, Giuliano

    2012-06-01

    "Triage" is a useful tool used in emergency departments (EDs) to prioritize the care of patients. Through a methodical process of different sequential steps, the triage nurse assigns a color code which goes from red-critical patient with immediate access to medical examination-to a white code that represents no urgency. Clinical studies have shown that patients can be victims of errors during the process of care, especially in complex systems such as EDs. To reduce errors it is essential to map the risks in order to identify the causes (both individual and organizational); the introduction of corrective changes cannot be postponed. The incorrect assessment at triage represents one of the major errors in EDs. By monitoring this activity, through the analysis of sentinel events we can reduce adverse consequences. Missed recognition of a red code indicates a sentinel event. We used a "root cause analysis" to explain an episode of missed recognition of red code at triage. A nurse without specific training in triage and inexperienced in critical care was identified as the "root cause" of the sentinel event. To make improvements we planned a triage training course (for newly employed nurses and a refresher course for existing staff) and created a team of dedicated triage nurses. PMID:22161317

  11. Percentage of US Emergency Department Patients Seen Within the Recommended Triage Time

    PubMed Central

    Horwitz, Leora I.; Bradley, Elizabeth H.

    2009-01-01

    Background The wait time to see a physician in US emergency departments (EDs) is increasing and may differentially affect patients with varied insurance status and racial/ethnic backgrounds. Methods Using a stratified random sampling of 151 999 visits, representing 539 million ED visits from 1997 to 2006, we examined trends in the percentage of patients seen within the triage target time by triage category (emergent, urgent, semiurgent, and nonurgent), payer type, and race/ethnicity. Results The percentage of patients seen within the triage target time declined a mean of 0.8% per year, from 80.0% in 1997 to 75.9% in 2006 (P<.001). The percentage of patients seen within the triage target time declined 2.3% per year for emergent patients (59.2% to 48.0%; P<.001) compared with 0.7% per year for semiurgent patients (90.6% to 84.7%; P<.001). In 2006, the adjusted odds of being seen within the triage target time were 30% lower than in 1997 (odds ratio, 0.70; 95% confidence interval, 0.55-0.89). The adjusted odds of being seen within the triage target time were 87% lower (odds ratio, 0.13; 95% confidence interval, 0.11-0.15) for emergent patients compared with semiurgent patients. Patients of each payment type experienced similar decreases in the percentage seen within the triage target over time (P for interaction=.24), as did patients of each racial/ethnic group (P=.05). Conclusions The percentage of patients in the ED who are seen by a physician within the time recommended at triage has been steadily declining and is at its lowest point in at least 10 years. Of all patients in the ED, the most emergent are the least likely to be seen within the triage target time. Patients of all racial/ethnic backgrounds and payer types have been similarly affected. PMID:19901137

  12. A Casualty in the Class War: Canada's Medicare

    PubMed Central

    Evans, Robert G.

    2012-01-01

    “There's class warfare, all right, but it's my class, the rich class, that's making war, and we're winning.” (Warren Buffett, five years ago.) Last year's Occupy Wall Street movement suggested that people are finally catching on. Note, making war: Buffett meant that there was deliberate intent and agency behind the huge transfer of wealth, since 1980, from the 99% to the 1%. Nor is the war metaphorical. There are real casualties, even if no body bags. Sadly, much Canadian commentary on inequality is pitiably naïve or deliberately obfuscatory. The 1% have captured national governments. The astronomical cost of American elections excludes the 99%. In Canada, parliamentary government permits one man to rule as a de facto dictator. The 1% don't like medicare. PMID:23372577

  13. Trauma-related Infections in Battlefield Casualties From Iraq

    PubMed Central

    Petersen, Kyle; Riddle, Mark S.; Danko, Janine R.; Blazes, David L.; Hayden, Richard; Tasker, Sybil A.; Dunne, James R.

    2007-01-01

    Objective: To describe risks for, and microbiology and antimicrobial resistance patterns of, war trauma associated infections from Operation Iraqi Freedom. Background: The invasion of Iraq resulted in casualties from high-velocity gunshot, shrapnel, and blunt trauma injuries as well as burns. Infectious complications of these unique war trauma injuries have not been described since the 1970s. Methods: Retrospective record review of all trauma casualties 5 to 65 years of age evacuated from the Iraqi theatre to U.S. Navy hospital ship, USNS Comfort March to May 2003.War trauma-associated infection was defined by positive culture from a wound or sterile body fluid (ie, blood, cerebrospinal fluid) and at least two of the following infection-associated signs/symptoms: fever, dehiscence, foul smell, peri-wound erythema, hypotension, and leukocytosis. A comparison of mechanisms of injury, demographics, and clinical variables was done using multivariate analysis. Results: Of 211 patients, 56 met criteria for infection. Infections were more common in blast injuries, soft tissue injuries, >3 wound sites, loss of limb, abdominal trauma, and higher Injury Severity Score (ISS). Wound infections accounted for 84% of cases, followed by bloodstream infections (38%). Infected were more likely to have had fever prior to arrival, and had higher probability of ICU admission and more surgical procedures. Acinetobacter species (36%) were the predominant organisms followed by Escherichia coli and Pseudomonas species (14% each). Conclusions: Similar to the Vietnam War experience, gram-negative rods, particularly Acinetobacter species, accounted for the majority of wound infections cared for on USNS Comfort during Operation Iraqi Freedom. Multidrug resistance was common, with the exception of the carbapenem class, limiting antibiotic therapy options. PMID:17457175

  14. Building vulnerability and human casualty estimation for a pyroclastic flow: a model and its application to Vesuvius

    NASA Astrophysics Data System (ADS)

    Spence, Robin J. S.; Baxter, Peter J.; Zuccaro, Giulio

    2004-05-01

    Pyroclastic flows clearly present a serious threat to life for the inhabitants of settlements on the slopes of volcanoes with a history of explosive eruptions; but it is increasingly realised that buildings can provide a measure of protection to occupants trapped by such flows. One important example is Vesuvius, whose eruption history includes many events which were lethal for the inhabitants of the neighbouring Vesuvian villages. Recent computational fluid dynamics computer modelling for Vesuvius [Todesco et al., Bull. Volcanol. 64 (2002) 155-177] has enabled a realistic picture of an explosive eruption to be modelled, tracing the time-dependent development of the physical parameters of a simulated flow at a large three-dimensional mesh of points, based on assumed conditions of temperature, mass-flow rate and particle size distribution at the vent. The output includes mapping of temperature, mixture density and mixture velocity over the whole adjacent terrain. But to date this information has not been used to assess the impacts of such flows on buildings and their occupants. In the project reported in this paper, estimates of the near-ground flow parameters were used to assess the impact of a particular simulated pyroclastic flow (modelled roughly on the 1631 eruption) on the buildings and population in four of the Vesuvian villages considered most at risk. The study had five components. First, a survey of buildings and the urban environment was conducted to identify the incidence of characteristics and elements likely to affect human vulnerability, and to classify the building stock. The survey emphasised particularly the number, location and type of openings characteristic of the major classes of the local building stock. In the second part of the study, this survey formed the basis for estimates of the probable impact of the pyroclastic flow on the envelope and internal air conditions of typical buildings. In the third part, a number of distinct ways in which human casualties would occur were identified, and estimates were made of the relationship between casualty rates and environmental conditions for each casualty type. In the fourth part of the study, the assumed casualty rates were used to estimate the proportions of occupants who would be killed or seriously injured for the assumed pyroclastic flow scenario in the Vesuvian villages studied, and their distribution by distance from the vent. It was estimated that in a daytime eruption, 25 min after the start of the eruption, there would be 480 deaths and a further 190 serious injuries, for every 1000 remaining in the area. In a night-time scenario, there would be 360 deaths with a further 230 serious injuries per 1000 after the same time interval. Finally, a set of risk factors for casualties was identified, and factors were discussed and ranked for their mitigation impact in the eruption scenario. The most effective mitigation action would of course be total evacuation before the start of the eruption. But if this were not achieved, barred window openings or sealed openings to slow the ingress of hot gases, together with a reduction of the fire load, could be effective means of reducing casualty levels.

  15. Triage and Referrals for Child Sexual Abuse Medical Examinations from the Sociolegal System.

    ERIC Educational Resources Information Center

    Hibbard, Roberta A.

    1998-01-01

    Examines issues concerning triage and referrals for medical child-sexual-abuse examinations from the sociolegal system. Research recommendations are offered in the areas of structure of care, process of care, and outcomes for evaluation. (DB)

  16. Supporting document triage via annotation-based multi-application visualizations

    Microsoft Academic Search

    Soonil Bae; DoHyoung Kim; Konstantinos A. Meintanis; J. Michael Moore; Anna Zacchi; Frank M. Shipman III; Hao-wei Hsieh; Catherine C. Marshall

    2010-01-01

    For open-ended information tasks, users must sift through many potentially relevant documents, a practice we refer to as document triage. Normally, people perform triage using multiple applications in concert: a search engine interface presents lists of potentially relevant documents; a document reader displays their contents; and a third tool--a text editor or personal information management application--is used to record notes

  17. Prediction of Emergent Heart Failure Death by Semi-Quantitative Triage Risk Stratification

    Microsoft Academic Search

    Harriette G. C. Van Spall; Clare Atzema; Michael J. Schull; Gary E. Newton; Susanna Mak; Alice Chong; Jack V. Tu; Thérèse A. Stukel; Douglas S. Lee

    2011-01-01

    ObjectivesGeneric triage risk assessments are widely used in the emergency department (ED), but have not been validated for prediction of short-term risk among patients with acute heart failure (HF). Our objective was to evaluate the Canadian Triage Acuity Scale (CTAS) for prediction of early death among HF patients.MethodsWe included patients presenting with HF to an ED in Ontario from Apr

  18. 33 CFR 173.81 - Coast Guard forms for numbering and casualty reporting.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ...2010-07-01 2010-07-01 false Coast Guard forms for numbering and casualty...Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY...Certificate of Number § 173.81 Coast Guard forms for numbering and...

  19. Meeting Report--NASA Radiation Biomarker Workshop

    E-print Network

    Straume, Tore

    2008-01-01

    ? -ray doses relevant to medical decisions in a radiologicaldoses as well as to provide effective triage tools for first-responders in mass-casualty radiologicaldose responses, multivariate analysis of gene expression, biomarkers in biodefense, biomarkers in radiation oncology, biomarkers and triage following large-scale radiological

  20. A method for estimating casualties due to the tsunami inundation flow

    Microsoft Academic Search

    Shunichi Koshimura; Toshitaka Katada; Harold O. Mofjeld; Yoshiaki Kawata

    2006-01-01

    This study develops a method for estimating the number of casualties that may occur while people evacuate from an inundation\\u000a zone when a tsunami has inundated an area. The method is based on a simple model of hydrodynamic forces as they affect the\\u000a human body. The method uses a Tsunami casualty index (TCI) computed at each grid point of a

  1. Construct an optimal triage prediction model: a case study of the emergency department of a teaching hospital in Taiwan.

    PubMed

    Wang, Shen-Tsu

    2013-10-01

    The purpose of triage is to prevent the delay of treatment for patients in real emergencies due to excessive numbers of patients in the hospital. This study uses the data of patients of consistent triage to develop the triage prediction model. By integrating Principal Component Analysis (PCA) and Support Vector Machine (SVM), the anomaly detection (overestimate and underestimate) prediction accuracy rate can be 100%, which is better than the accuracy rate of SVM (about 89.2%) or Back- propagation Neural Networks (BPNN) (96.71%); afterwards, this study uses Support Vector Regression (SVR) to adopt Genetic Algorithm (GA) to determine three SVR parameters to predict triage. After using the scroll data predictive values, we calculate the Absolute Percentage Error (APE) of each scroll data. The resulting SVR's Mean Absolute Percentage Error (MAPE) is 3.78%, and BPNN's MAPE is 5.99%; therefore, the proposed triage prediction model of this study can effectively predict anomaly detection and triage. PMID:23990379

  2. Sport associated eye injury: a casualty department survey.

    PubMed Central

    MacEwen, C. J.

    1987-01-01

    A survey was performed of all patients attending the combined Glasgow Eye Infirmary and Western Infirmary Eye Casualty Department with sports injuries. During an 18-month period a total of 246 patients presented with such injuries. Football was responsible for 110 (44.7%), rugby for 24 (9.8%), squash for 19 (7.7%), badminton for 16 (6.5%), and skiing for 9 (3.7%), and 68 (27.6%) were caused by other sports. One hundred and sixty-two patients (65.8%) had superficial or surrounding soft tissue injuries, 54 (22%) had more severe anterior segment damage in the form of hyphaema or traumatic uveitis, 17 (6.9%) had retinal damage manifest as oedema or retinal tear with or without detachment, and two (0.8%) suffered severe disruption of the globe with subsequent loss of the eye in each case. Forty-six (18.7%) required inpatient care and 200 (81.3%) were treated as outpatients, of whom 104 required at least one follow-up appointment (42.3% of the total). I conclude that with increasing time available for leisure activities there has been a parallel increase in sport associated eye trauma. PMID:3663565

  3. Outcomes for Emergency Severity Index Triage Implementation in the Emergency Department

    PubMed Central

    Kooshiar, Hadi; Esmaeili, Habibollah; Ebrahimi, Mohsen

    2015-01-01

    Introduction Hospital triage scale in emergency departments needs to be valid and reliable. Lack of sufficient data exists on triage scale rigor in emergency departments of Iran. This study aimed to determine the impact of the emergency severity index (ESI) triage scale in the emergency department. Materials and Methods A single-center study was conducted. Proportion of triage categories allocated to high-risk patients admitted to high-acuity departments was examined in observational period in June 2012 and May 2013. True triage score was reported based on patients` paper- based scenario questionnaire. Interrater reliability was assessed using unweighted kappa. Concordance among experts, nurses and physicians was examined. The Chi-square test and Kappa statistics was used for statistical analysis. Results Triage decisions regarding high-risk patients before and after implementation period are independent from each other (?2= 22.254; df=1; p<0.05) and more high-risk patients were recognized after implementation of the ESI. Overall agreement and concordance were (79%) and (?=0.54) among nurses; (71%) and (?=0.45) among physicians, (85%) and (?=0.81) among experts, respectively. Correct triage decisions among clinicians were increased after implementation of the ESI. Conclusion The ESI as valid and reliable tool improving desirable outcomes` in the emergency department has been recommended but it may not reveal optimal outcomes in developing countries comparing to what have been achieved in the developed countries. In addition, patient influx in ESI level II could create considerable controversy with clinicians. PMID:26023578

  4. Triaging referrals as part of hematology/oncology fellowship training.

    PubMed

    Kyei, Mark; Lavelle, Ellen; Kyasa, Jameel; Safar, Mazin; Makhoul, Issam; Mehta, Paulette

    2010-09-01

    We developed an integrative component of the consult rotation for fellows training in hematology/oncology. This component consisted of triaging all consults to the hematology/oncology service of the CAVHS during a 1-year period of time. The goals of the rotation were to improve timeliness of response to consultation requests, to gain experience in differential diagnosis of patients with potential hematologic/oncologic disorders through of such patients, review of decisions with attending physicians, and communication of such with the referring physician. The major benefits were that fellows integrated didactic learning into real-life clinical cases, selected patients for their continuity clinic to assure sufficient variety and complexity of cases, honed their communication skills, learned about referring and attending physicians' styles, and gained practice in clinical vignettes representative of cases they would be expected to see in clinical practice. Disadvantages were time involvement (approximately 2 h/day) and risks of over- or under-referrals. Administratively, there was a significant decline in the wait time for patients to be seen in the hematology/oncology service. In all, this elective is a valuable integrative experience of senior fellows, but may have less value for first year fellows. PMID:20339965

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

    PubMed

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

    2013-01-01

    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

  6. On-ground casualty risk reduction by structural design for demise

    NASA Astrophysics Data System (ADS)

    Lemmens, Stijn; Funke, Quirin; Krag, Holger

    2015-06-01

    In recent years, awareness concerning the on-ground risk posed by un-controlled re-entering space systems has increased. On average over the past decade, an object with mass above 800 kg re-enters every week from which only a few, e.g. ESA's GOCE in 2013 and NASA's UARS in 2011, appeared prominent in international media. Space agencies and nations have discussed requirements to limit the on-ground risk for future missions. To meet the requirements, the amount of debris falling back on Earth has to be limited in number, mass and size. Design for demise (D4D) refers to all measures taken in the design of a space object to increase the potential for demise of the object and its components during re-entry. SCARAB (Spacecraft Atmospheric Re-entry and Break-Up) is ESA's high-fidelity tool which analyses the thermal and structural effects of atmospheric re-entry on spacecraft with a finite-element approach. For this study, a model of a representative satellite is developed in SCARAB to serve as test-bed for D4D analyses on a structural level. The model is used as starting point for different D4D approaches based on increasing the exposure of the satellite components to the aero-thermal environment, as a way to speed up the demise. Statistical bootstrapping is applied to the resulting on-ground fragment lists in order to compare the different re-entry scenarios and to determine the uncertainties of the results. Moreover, the bootstrap results can be used to analyse the casualty risk estimator from a theoretical point of view. The risk reductions for the analysed D4D techniques are presented with respect to the reference scenario for the modelled representative satellite.

  7. Triage template pipelines in digital forensic investigations Richard E. Overill a,*, Jantje A.M. Silomon a

    E-print Network

    Overill, Richard E.

    Triage template pipelines in digital forensic investigations Richard E. Overill a,*, Jantje A, UK b Metropolitan Police Service, Digital Electronics & Forensics Service, New Scotland Yard, 8 in revised form 28 February 2013 Accepted 6 March 2013 Keywords: Digital forensics Triage template pipelines

  8. Evolution and challenges in the design of computational systems for triage assistance

    PubMed Central

    Abad-Grau, María M.; Ierache, Jorge; Cervino, Claudio; Sebastiani, Paola

    2008-01-01

    Compared with expert systems for specific disease diagnosis, knowledge-based systems to assist decision making in triage usually try to cover a much wider domain but can use a smaller set of variables due to time restrictions, many of them subjective so that accurate models are difficult to build. In this paper we first study criteria that most affect the performance of systems for triage assistance. Such criteria include whether principled approaches from Machine Learning can be used to increase accuracy and robustness and to represent uncertainty, whether data and model integration can be performed or whether temporal evolution can be modeled to implement retriage or represent medication responses. Following the most important criteria we explore current systems and identify some missing features that, if added, may yield to more accurate triage systems. PMID:18337189

  9. The Value of the Trauma Mechanism in the Triage of Severely Injured Elderly

    Microsoft Academic Search

    Johanna M. M. Nijboer; Corry K. van der Sluis; Pieter U. Dijkstra; Hendrik-Jan ten Duis

    2009-01-01

    \\u000a Abstract\\u000a \\u000a \\u000a Background:\\u000a   The triage of trauma patients is currently based on the trauma mechanism. However, it is known that elderly patients can sustain\\u000a severe injuries due to insignificant trauma mechanisms. As such, triage methods might be questionable.\\u000a \\u000a \\u000a \\u000a \\u000a Objective:\\u000a   To evaluate whether current trauma triage criteria are appropriate in severely injured elderly patients.\\u000a \\u000a \\u000a \\u000a \\u000a Methods:\\u000a   To analyze the effect of the trauma

  10. Safety of telephone triage in out-of-hours care: A systematic review

    PubMed Central

    Huibers, Linda; Smits, Marleen; Renaud, Vera; Giesen, Paul; Wensing, Michel

    2011-01-01

    Objective Telephone triage in patients requesting help may compromise patient safety, particularly if urgency is underestimated and the patient is not seen by a physician. The aim was to assess the research evidence on safety of telephone triage in out-of-hours primary care. Methods A systematic review was performed of published research on telephone triage in out-of-hours care, searching in PubMed and EMBASE up to March 2010. Studies were included if they concerned out-of-hours medical care and focused on telephone triage in patients with a first request for help. Study inclusion and data extraction were performed by two researchers independently. Post-hoc two types of studies were distinguished: observational studies in contacts with real patients (unselected and highly urgent contacts), and prospective observational studies using high-risk simulated patients (with a highly urgent health problem). Results Thirteen observational studies showed that on average triage was safe in 97% (95% CI 96.5–97.4%) of all patients contacting out-of-hours care and in 89% (95% CI 86.7–90.2%) of patients with high urgency. Ten studies that used high-risk simulated patients showed that on average 46% (95% CI 42.7–49.8%) were safe. Adverse events described in the studies included mortality (n = 6 studies), hospitalisations (n = 5), attendance at emergency department (n=1), and medical errors (n = 6). Conclusions There is room for improvement in safety of telephone triage in patients who present symptoms that are high risk. As these have a low incidence, recognition of these calls poses a challenge to health care providers in daily practice. PMID:22126218

  11. [Emergency and disaster response in critical care unit in the Mexican Social Security Institute: triage and evacuation].

    PubMed

    Echevarría-Zuno, Santiago; Cruz-Vega, Felipe; Elizondo-Argueta, Sandra; Martínez Valdés, Everardo; Franco-Bey, Rubén; Méndez-Sánchez, Luis Miguel

    2013-01-01

    Providing medical assistance in emergencies and disaster in advance makes the need to maintain Medical Units functional despite the disturbing phenomenon that confronts the community, but conflict occurs when the Medical Unit needs support and needs to be evacuated, especially when the evacuation of patients in a Critical Care Unit is required. In world literature there is little on this topic, and what is there usually focuses on the conversion of areas and increased ability to care for mass casualties, but not about how to evacuate if necessary, and when a wrong decision can have fatal consequences. That is why the Mexican Social Security Institute gave the task of examining these problems to a working group composed of specialists of the Institute. The purpose was to evaluate and establish a method for performing a protocol in the removal of patients and considering always to safeguard both staff and patients and maintain the quality of care. PMID:23769257

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

    SciTech Connect

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

    1981-10-01

    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.

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

    NASA Astrophysics Data System (ADS)

    So, E.

    2010-12-01

    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.

  14. Comparison of Female and Male Casualty Cohorts from Conflicts in Iraq and Afghanistan.

    PubMed

    Hylden, Christina; Johnson, Anthony E; Rivera, Jessica C

    2015-01-01

    Although there has been interest in the literature regarding the casualties within the recent US military conflicts in Iraq and Afghanistan, very little to date has looked specifically at a difference between the sexes. As the role of the female Soldier has changed over the years, so have the risk and the nature of the female casualty. Combat injuries in women are an important medical consideration that has yet to be studied. For the purposes of this study, the following questions pertained: Do female and male casualties from the US military in recent conflicts differ in age, service, rank, military operation, or other demographic characteristics? Do female and male casualties from the US military in recent conflicts differ in their injury characteristics such as Injury Severity Score (ISS), Abbreviated Injury Score (AIS), injury type (blunt versus penetrating), injury cause (mechanism of injury), and injury date? The Department of Defense Trauma Registry (DoDTR) was queried, returning results for 425 female and 14,982 male subjects who sustained musculoskeletal injuries from October 2003 (beginning of hostilities in Iraq) to December 2012. The female and male cohorts were compared and analyzed for significance in demographics (age, service, rank, and military operation) and injury characteristics (ISS, AIS, injury type, injury cause, and injury date). Female casualties differ from their male counterparts in that they are slightly younger (F=26.11, M=27.83 years; P<.001), proportionally more female casualties were in the Army (F=81.5%, M=72.2%; P<.001), and proportionally more women were injured during Operation Iraqi Freedom (F=75.6%, M=63.2%; P<.001). Female casualties showed on average lower ISS (F=7.49; M=9.68; P<.001) and lower AIS specific to the skeletal anatomic region (F=2.06; M=2.36; P<.001); however when broken down into battle versus nonbattle injury, the difference disappeared. Women were less likely to be injured in battle (F=33.1%; M=70.9%; P<.001) and less likely to be injured due to an explosive device (F=27.7%, M=55.2%; P<.001). Women comprised 2.75% of the DoDTR casualties during the studied time frame and were less likely to be involved in explosions or during battle. The ISS were significantly different when comparing battle and nonbattle injuries for both of the sexes. However, since men were more likely to be injured in battle, their total ISS mean was higher. PMID:26101910

  15. 33 CFR 150.820 - When must a written report of casualty be submitted, and what must it contain?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ...of casualty be submitted, and what must it contain? 150.820 Section 150.820...of casualty be submitted, and what must it contain? (a) In addition to the...Injury, or Death, or in narrative form if it contains all of the applicable...

  16. Their Word against Ours: News Discourse of the 2003 Gulf War Civilian Casualties in CNN and Aljazeera

    Microsoft Academic Search

    Mervat Youssef

    2009-01-01

    In times of war the reporting of casualties becomes one of the most controversial elements. Journalists have to walk the fine line between reporting the suffering of civilians and avoiding accusations of being mouthpieces of the enemy. Textual analysis of news reporting Iraqi casualties on both CNN and Aljazeera suggests that both news outlets disseminated propagandistic messages as they downplayed

  17. Improving Emergency Department Triage Classification with Computerized Clinical Decision Support at a Pediatric Hospital

    ERIC Educational Resources Information Center

    Kunisch, Joseph Martin

    2012-01-01

    Background: The Emergency Severity Index (ESI) is an emergency department (ED) triage classification system based on estimated patient-specific resource utilization. Rules for a computerized clinical decision support (CDS) system based on a patient's chief complaint were developed and tested using a stochastic model for predicting ESI scores.…

  18. Revisiting Bug Triage and Resolution Practices Olga Baysal, Reid Holmes, and Michael W. Godfrey

    E-print Network

    Godfrey, Michael W.

    ]. We would like to revisit bug reporting and fixing practices to find out if bug tracking systems have. However, little qualitative research has been done on the actual use of bug tracking systems, bug triage and fixing process, as well as bug reassignments and reopens. We will study interviews conducted with Mozilla

  19. Postpartum Triage, Services Provided, and Length of Stay for Infants Born At 35 Weeks Gestation.

    PubMed

    Hagadorn, James I; Salikooti, Saritha; Pappagallo, Mariann; Arias-Camison, Jose; Weiner, Scott; Alba, Jorge; Herson, Victor

    2015-07-01

    Objectives?The aim of this article is to (1) compare the care setting to which 35-week infants are initially triaged postpartum to the level of services subsequently provided; and (2) identify factors known at delivery or immediately postpartum associated with services received and length of stay during the birth hospitalization. Study Design?In this multicenter retrospective study of 35-week infants born between 2007 and 2008, service capabilities of the initial postpartum care setting were categorized as level 1 or neonatal intensive care unit (NICU) using American Academy of Pediatrics definitions. Subsequent services actually provided were categorized as routine care, level 1, or >level 1. Results?Over half of 431 studied infants were sent to a level 1 nursery postpartum. Of these, over 90% ultimately received routine care or level 1 services. Of 200 infants triaged to a NICU, the majority received only routine care or level 1 services. The great majority of infants requiring?>?level 1 services were identified promptly postpartum. Initial triage to the NICU was associated with significantly (p?triage of 35-week infants and provides tools for this purpose. Validation of the models presented here is warranted. PMID:25535928

  20. ???Disaster management, triage-based wound care, and patient safety: reflections on practice following an earthquake.

    PubMed

    Ennis, William J

    2010-11-01

    ??Triage is the process of prioritizing patient care based on need and available resources. Clinicians in wound clinics triage daily because time and resources never seem to be sufficient. The triage concept is taken to an extreme when a disaster strikes--the clinical goal of patient care transforms from the individual patient to providing the greatest good for the greatest number of patients. Situational awareness of system resources is of paramount importance in a disaster. Planning for surge capacity while simultaneously attending to patients who require immediate attention is a must. The recent earthquake in Haiti provided an opportunity to test those skill sets. Scores of clinicians volunteered their time and expertise, elevating wound care to the status of a clinical division. The experience of providing quality wound care despite a myriad of situational limitations suggests that busy wound clinics can learn valuable lessons from the realm of disaster management. The rate of under- and over-triage in wound clinics can be reduced by utilizing commonly collected outcomes and operational data. Patient safety improves when the hierarchy is flattened, communication is open, checklists are used, debriefings are held, and teamwork is encouraged. Reflecting on the working conditions in Haiti, it is clear that patients and clinicians benefit when success is measured by patient outcomes instead of individual accomplishments. PMID:21131698

  1. URAC's phone triage standards: a new 'seal of approval' for DM programs?

    PubMed

    1998-11-01

    All telephone triage and health information programs are not alike, and the best ones may soon appear on the public's radar screen. Recently five of these programs were named the first to receive an official "seal of approval" in the form of a full two-year accreditation from URAC. Should you submit your own program to this new accreditation process? PMID:10338760

  2. Comprehensive Strategy for the Evaluation and Triage of the Chest Pain Patient

    Microsoft Academic Search

    James L Tatum; Robert L Jesse; Michael C Kontos; Christopher S Nicholson; Kristin L Schmidt; Charlotte S Roberts; Joseph P Ornato

    1997-01-01

    See related editorial, p 168.Study objective: To evaluate the safety and efficacy of a systematic evaluation and triage strategy including immediate resting myocardial perfusion imaging in patients presenting to the emergency department with chest pain of possible ischemic origin. Methods: We conducted an observational study of 1,187 consecutive patients seen in the ED of an urban tertiary care hospital with

  3. Brush-and-Drag: A Multi-touch Interface For Photo Triaging

    E-print Network

    Winkler, Stefan

    138632 stefan.winkler@adsc.com.sg Peng Song, Chi-Wing Fu School of Computer Engineering NanyangBrush-and-Drag: A Multi-touch Interface For Photo Triaging Seon Joo Kim,1 Hongwei Ng, Stefan Winkler Advanced Digital Sciences Center (ADSC) University of Illinois at Urbana-Champaign Singapore

  4. Assisting bug Triage in Large Open Source Projects Using Approximate String Matching

    E-print Network

    Neumann, Günter

    Assisting bug Triage in Large Open Source Projects Using Approximate String Matching Amir H. Moin a novel approach for assisting human bug triagers in large open source software projects by semi-automating the bug assignment process. Our approach employs a simple and efficient n-gram-based algo- rithm

  5. Point-of-care testing at triage decreases time to lactate level in septic patients.

    PubMed

    Goyal, Munish; Pines, Jesse M; Drumheller, Byron C; Gaieski, David F

    2010-06-01

    Early recognition of elevated lactate levels may hasten the detection of time-sensitive illness. We studied a method to measure lactate levels in septic patients using a point-of-care (POC) device at Emergency Department triage. A convenience sample of adult patients with sepsis was enrolled. Consenting patients received a fingertip lactate measurement using a POC device. Treating clinicians were blinded to study and POC test results. Whole blood lactate levels were drawn at the discretion of the treating physician. A total of 238 patients were eligible; 154 (65%) consented, 5 left without treatment after consenting. Of the remaining 149, 44 (30%) patients received both POC and whole blood lactates. Median time from triage to POC lactate result was 21 min (interquartile range [IQR] 14-25). Median time from triage to whole blood lactate result was 172 min (IQR 119-256). The time difference between POC test result and whole blood lactate result was 151 min (IQR 101-247). Triage POC fingertip lactate is a feasible method for reducing time to identification of lactate levels in patients with sepsis. Larger studies are needed to determine the ability of POC lactate measurement to aid in the risk stratification of septic patients. PMID:18614319

  6. Operational Testing of a Combined Hardware-Software Strategy for Triage of Radiologically-Contaminated Persons.

    PubMed

    Waller, Edward J

    2015-08-01

    After a radiological dispersal device (RDD) event, it is possible for radionuclides to enter the human body through inhalation, ingestion, and skin and wound absorption. The dominant pathway will be through inhalation. From a health physics perspective, it is important to know the magnitude of the intake to perform dosimetric assessments. From a medical perspective, removal of radionuclides leading to dose (hence risk) aversion is of high importance. The efficacy of medical decorporation strategies is extremely dependent upon the time of treatment delivery after intake. The "golden hour," or more realistically 3-4 h, is imperative when attempting to increase removal of radionuclides from extracellular fluids prior to cellular incorporation. To assist medical first response personnel in making timely decisions regarding appropriate treatment delivery modes, a software tool has been developed which compiles existing radionuclide decorporation therapy data and allows a user to perform simple triage leading to potential appropriate decorporation treatment strategies. Three triage algorithms were included: (1) multi-parameter model (MPM), (2) clinical decision guidance (CDG) model, and (3) annual limit on intake (ALI) model. A radiation triage mask (RTM) has simultaneously been developed to provide a simple and rapid hardware solution for first responders to triage internally exposed personnel in the field. The hardware/software strategy was field tested with a military medical unit and was found by end-users to be relatively simple to learn and use. PMID:26102327

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

    ERIC Educational Resources Information Center

    Goode, John C.; Beck, Elaine

    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…

  8. Road Casualties and Enforcement: Distributional Assumptions of Serially Correlated Count Data

    Microsoft Academic Search

    George Yannis; Constantinos Antoniou; Eleonora Papadimitriou

    2007-01-01

    Objective. Road safety data are often in the form of counts and usually temporally correlated. The objective of this research is to investigate the distributional assumptions of road safety data in the presence of temporal correlation.Methods. Using the generalized linear model framework, four distributional assumptions are considered: normal, Poisson, quasi-Poisson and negative binomial, and appropriate models are estimated. Monthly casualty

  9. Rate of British psychiatric combat casualties compared to recent American wars.

    PubMed

    Price, H H

    2007-01-01

    This paper examines factors leading to the low rate of combat psychiatric casualties in the British recapture of the Falklands compared to the American experience in North Africa, Italy, Europe and South Pacific theatres during World War II, the Korean Conflict and Vietnam. The factors compared are those thought to affect rates seen in these past wars. The factors highlighted are psychiatric screening of evacuees, presence of psychiatric personnel in line units, intensity of combat and use of elite units. Factors also mentioned are presence of possible occult psychiatric casualties such as frostbite and malaria, amount of indirect fire and the offensive or defensive nature of the combat. A unique aspect of the Falklands War examined is the exclusive use of hospital ships to treat psychiatric casualties and the impact of the Geneva Convention rules regarding hospital ships on the classic treatment principles of proximity and expectancy. The types and numbers of various diagnoses are also presented. The British Campaign in the Falklands produced a remarkably low rate of psychiatric casualties. When viewed in light of American experience in recent wars, this low rate represents a concentration of optimal factors leading to healthy function in combat. The results of this war should not be used to predict a similar outcome in future combat as this particular constellation of factors may not recur. PMID:18214088

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

    E-print Network

    Maxwell, Bruce D.

    for prehospital and emergency room workers. Fire, Police and EMS personnel must secure the scene, establish-casualty incident (MCI) scenarios that trained hospital and prehospital staff together using Microsoft Visio, images emergency department bed capacity, and trauma victims. The authors also tested participants' knowledge

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

    Microsoft Academic Search

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

    2009-01-01

    Background  Field triage is important for regional trauma systems providing high sensitivity to avoid that severely injured are deprived\\u000a access to trauma team resuscitation (undertriage), yet high specificity to avoid resource over-utilization (overtriage). Previous\\u000a informal trauma team activation (TTA) at Ulleval University Hospital (UUH) caused imprecise triage. We have analyzed triage\\u000a precision after introduction of TTA guidelines.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Retrospective analysis of 7

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

    E-print Network

    Mosher, Katrina N.

    2009-05-15

    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...

  13. Evolutionary triage governs fitness in driver and passenger mutations and suggests targeting never mutations

    PubMed Central

    Gatenby, R A.; Cunningham, J. J.; Brown, J. S.

    2014-01-01

    Genetic and epigenetic changes in cancer cells are typically divided into “drivers” and “passengers”. Drug development strategies target driver mutations, but inter- and intra-tumoral heterogeneity usually results in emergence of resistance. Here we model intratumoral evolution in the context of a fecundity/survivorship trade-off. Simulations demonstrate the fitness value, of any genetic change is not fixed but dependent on evolutionary triage governed by initial cell properties, current selection forces, and prior genotypic/phenotypic trajectories. We demonstrate spatial variations in molecular properties of tumor cells are the result of changes in environmental selection forces such as blood flow. Simulated therapies targeting fitness-increasing (driver) mutations usually decrease the tumor burden but almost inevitably fail due to population heterogeneity. An alternative strategy targets gene mutations that are never observed. Because up or down regulation of these genes unconditionally reduces cellular fitness, they are eliminated by evolutionary triage but can be exploited for targeted therapy. PMID:25407411

  14. Physician response to a prediction rule for the triage of emergency department patients with chest pain

    Microsoft Academic Search

    Steven D. Pearson; Lee Goldman; Tomas B. Garcia; E. Francis Cook; Thomas H. Lee

    1994-01-01

    Objective: To determine the response of physicians to a noncoercive prediction rule for the triage of emergency department patients\\u000a with chest pain.\\u000a \\u000a \\u000a Design: Prospective time-series intervention study.\\u000a \\u000a \\u000a \\u000a \\u000a Setting: A university hospital emergency department.\\u000a \\u000a \\u000a \\u000a \\u000a Participants\\/patients: 68 physicians, all of whom were responsible for the triage of at least one of 252 patients presenting to the emergency department\\u000a with a chief complaint

  15. Dicentric assay: inter-laboratory comparison in Indian laboratories for routine and triage applications.

    PubMed

    Bakkiam, D; Bhavani, M; Anantha Kumar, A Arul; Sonwani, Swetha; Venkatachalam, P; Sivasubramanian, K; Venkatraman, B

    2015-05-01

    An Inter-Laboratory Comparison (ILC) study on Dicentric Chromosome Assay (DCA) was carried out between two Indian biodosimetry labs. Human peripheral blood samples exposed to 10 different doses of X-rays up to 5Gy were shared between the labs to generate calibration data. Validation of calibration curves was done by dose estimation of coded samples exposed to X- or gamma radiation. Reliability of the DCA data for triage application was evaluated by scoring 20, 50 and 100 metaphases in the dose range of 0.5-3.0Gy. No significant difference was observed between labs regarding the established calibration data as well as the DCA triage dose assessments. Scoring of 20 metaphases (MP) was adequate to detect radiation exposure of >2Gy whereas 50 MP were sufficient to determine exposures of 0.5Gy. Both labs performed the DCA in a reliable manner and made the first step in setting up a biodosimetry network in India. PMID:25728004

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

    PubMed Central

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

    2011-01-01

    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

  17. Knowledge of dental trauma first aid (DTFA): the example of avulsed incisors in casualty departments and schools in London

    Microsoft Academic Search

    S. Parekh; D. R. Moles; G. J. Roberts; M. E. Addo

    2007-01-01

    Objective To investigate awareness and practices of dental trauma first aid (DTFA) in hospital emergency settings and in primary and secondary schools in London.Design A cross-sectional study using self-administered questionnaires and semi-structured interviews.Setting Primary and secondary schools and casualty\\/emergency and walk-in casualty centres in London in 2005.Subjects and methods A randomly selected sample of 125 schools and a total of

  18. Logistic regression analysis of pedestrian casualty risk in passenger vehicle collisions in China

    Microsoft Academic Search

    Chunyu Kong; Jikuang Yang

    2010-01-01

    A large number of pedestrian fatalities were reported in China since the 1990s, however the exposure of pedestrians in public traffic has never been measured quantitatively using in-depth accident data. This study aimed to investigate the association between the impact speed and risk of pedestrian casualties in passenger vehicle collisions based on real-world accident cases in China. The cases were

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

    E-print Network

    Johnson, Daniel I.

    2011-08-08

    .? 7 Larson had the benefit of observing both Operation Desert Storm in the Persian Gulf and the American intervention in Somalia ? particularly the subsequent 6 James Burk, ?Public Support... and organization predicated upon a major war with the Soviet Union. The final chapter will address the contributions of operations in the Persian Gulf, Somalia, Haiti, and the Balkans to the debate on casualty aversion. Following the success of the short Desert...

  20. The effect of the London congestion charge on road casualties: an intervention analysis

    Microsoft Academic Search

    Robert B. Noland; Mohammed A. Quddus; Washington Y. Ochieng

    2008-01-01

    The introduction of the congestion charge in central London on the 17th of February, 2003, led to a reduction in congestion.\\u000a One factor that has not been fully analysed is the impact of the congestion charge on traffic casualties in London. Less car\\u000a travel within the charging zone may result in fewer traffic collisions, however, as the number of pedestrians,

  1. Provenancing of unidentified World War II casualties: Application of strontium and oxygen isotope analysis in tooth enamel.

    PubMed

    Font, Laura; Jonker, Geert; van Aalderen, Patric A; Schiltmans, Els F; Davies, Gareth R

    2015-01-01

    In 2010 and 2012 two sets of unidentified human remains of two World War II soldiers were recovered in the area where the 1944-1945 Kapelsche Veer bridgehead battle took place in The Netherlands. Soldiers of four Allied nations: British Royal Marine Commandos, Free Norwegian Commandos, Free Poles and Canadians, fought against the German Army in this battle. The identification of these two casualties could not be achieved using dental record information of DNA analysis. The dental records of Missing in Action soldiers of the Allied nations did not match with the dental records of the two casualties. A DNA profile was determined for the casualty found in 2010, but no match was found. Due to the lack of information on the identification of the casualties provided by routine methods, an isotope study was conducted in teeth from the soldiers to constrain their provenance. The isotope study concluded that the tooth enamel isotope composition for both casualties matched with an origin from the United Kingdom. For one of the casualties a probable origin from the United Kingdom was confirmed, after the isotope study was conducted, by the recognition of a characteristic belt buckle derived from a Royal Marine money belt, only issued to British Royal Marines, found with the remains of the soldier. PMID:25577002

  2. Telephone triage of acute illness by a practice nurse in general practice: outcomes of care.

    PubMed Central

    Gallagher, M; Huddart, T; Henderson, B

    1998-01-01

    BACKGROUND: Telephone working is an increasingly important way of managing general practice workload, particularly out of hours. The role of telephone triage, however, in managing acute consultations during the day has not been adequately researched. AIM: To determine the impact of telephone triage, conducted by a practice nurse, on the management of same day consultations in a general practice. METHOD: A general practice of 11,300 patients in South Tyneside collected prospective telephone and surgery consultation data over three months. Patient satisfaction, for those who had received only telephone advice, was measured using a postal questionnaire. Four outcomes were measured: changes in doctor and nurse workload; repeat consultations with the same problem; prescriptions issued; and patient satisfaction with the service. RESULTS: In three months, 1263 consultations were recorded. Doctor workload fell by 54%, from 1522 to 664 consultations, compared with the previous three months. A total of 325 (26%) telephone requests to see the doctor were managed by the nurse on the telephone without them visiting the surgery. Also, 273 (21%) patients saw the nurse in the surgery, 565 (45%) saw the doctor in the surgery, and 99 (8%) saw the doctor and the nurse in the surgery. The response rate to the postal questionnaire was 192/271 (71%); 154 (88%) were satisfied with nurse telephone advice. CONCLUSIONS: Telephone triage, by a practice nurse, of patients who wish to see the doctor on the same day, reduced doctor workload. This was a service that patients liked. PMID:9667088

  3. From research to the road: the development of EMS specialty triage.

    PubMed

    Domeier, Robert; Scott, Philip; Wagner, Christopher

    2004-01-01

    A recent study in the Journal of Neurosurgery demonstrates decreased mortality rates in patients with subarachnoid hemorrhage (SAH) treated at tertiary care centers with higher volumes of SAH patients.(1) As clinical research in emergency and critical care increases, so will its impact on transport systems. In recent years, advances in cardiology, interventional radiology, surgery, and emergency care all have had major influences in the triage and transport of critically ill and injured patients. The challenge facing modern transport systems is how to integrate research to improve patient care while respecting the logistic, financial, and political issues that are entwined in this process. This article discusses the process undertaken by one medical control zone in the triage and transport of prehospital patients with suspected ischemic stroke. It discusses the transition from initial research and national recommendations for emergent thrombolytic therapy through the development and implementation of prehospital triage protocols. The authors hope it will offer some guidance in dealing with these rapidly emerging and often complicated transport decisions. PMID:15224079

  4. Earthquake casualty models within the USGS Prompt Assessment of Global Earthquakes for Response (PAGER) system

    USGS Publications Warehouse

    Jaiswal, Kishor; Wald, David J.; Earle, Paul S.; Porter, Keith A.; Hearne, Mike

    2011-01-01

    Since the launch of the USGS’s Prompt Assessment of Global Earthquakes for Response (PAGER) system in fall of 2007, the time needed for the U.S. Geological Survey (USGS) to determine and comprehend the scope of any major earthquake disaster anywhere in the world has been dramatically reduced to less than 30 min. PAGER alerts consist of estimated shaking hazard from the ShakeMap system, estimates of population exposure at various shaking intensities, and a list of the most severely shaken cities in the epicentral area. These estimates help government, scientific, and relief agencies to guide their responses in the immediate aftermath of a significant earthquake. To account for wide variability and uncertainty associated with inventory, structural vulnerability and casualty data, PAGER employs three different global earthquake fatality/loss computation models. This article describes the development of the models and demonstrates the loss estimation capability for earthquakes that have occurred since 2007. The empirical model relies on country-specific earthquake loss data from past earthquakes and makes use of calibrated casualty rates for future prediction. The semi-empirical and analytical models are engineering-based and rely on complex datasets including building inventories, time-dependent population distributions within different occupancies, the vulnerability of regional building stocks, and casualty rates given structural collapse.

  5. Aeromedical evacuation of biological warfare casualties: a treatise on infectious diseases on aircraft.

    PubMed

    Withers, M R; Christopher, G W

    2000-11-01

    A basic understanding of the transmission and isolation of infections would be essential to the safe and effective aeromedical evacuation (AE) of biological warfare (BW) casualties. First, the airframe as microbial environment is considered, and relevant preventive and disinfecting measures are discussed. A survey of past infectious disease transmission on civilian aircraft (including tuberculosis, influenza, measles, smallpox, and viral hemorrhagic fevers) is presented, and the communicability and stability of likely BW agents is described. A brief history of U.S. military aeromedical evacuation (as it relates to contagious diseases and U.S. Air Force BW doctrine) is also outlined. Special containment procedures (especially as used by the U.S. Army Aeromedical Isolation Team) are described. Finally, international legal and regulatory aspects of the AE of BW casualties are considered, and some unanswered questions and suggestions for future research are offered. It is concluded that, given adequate foresight, expertise, and resources, the AE of even contagious BW casualties could be safely and effectively accomplished. PMID:11143422

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

    NASA Astrophysics Data System (ADS)

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

    2012-01-01

    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.

  7. Lower cost strategies for triage of human papillomavirus DNA-positive women.

    PubMed

    Qiao, You-Lin; Jeronimo, Jose; Zhao, Fang-Hui; Schweizer, Johannes; Chen, Wen; Valdez, Melissa; Lu, Peter; Zhang, Xun; Kang, Le-Ni; Bansil, Pooja; Paul, Proma; Mahoney, Charles; Berard-Bergery, Marthe; Bai, Ping; Peck, Roger; Li, Jing; Chen, Feng; Stoler, Mark H; Castle, Philip E

    2014-06-15

    Using human papillomavirus (HPV) testing for cervical cancer screening in lower-resource settings (LRS) will result in a significant number of screen-positive women. This analysis compares different triage strategies for detecting cervical precancer and cancer among HPV-positive women in LRS. This was a population-based study of women aged 25-65 years living in China (n?=?7,541). Each woman provided a self-collected and two clinician-collected specimens. The self-collected and one clinician-collected specimen were tested by two HPV DNA tests-careHPV™ and Hybrid Capture 2; the other clinician-collected specimen was tested for HPV16/18/45 E6 protein. CareHPV™-positive specimens were tested for HPV16/18/45 DNA. HPV DNA-positive women underwent visual inspection with acetic acid (VIA) and then colposcopic evaluation with biopsies. The performance for detection of cervical intraepithelial neoplasia grade 3 or cancer (CIN3+) among HPV DNA-positive women was assessed for different triage strategies: HPV16/18/45 E6 or DNA detection, VIA, colposcopic impression, or higher signal strength (?10 relative light units/positive control [rlu/pc]). The percent triage positive ranges were 14.8-17.4% for VIA, 17.8-20.9% for an abnormal colposcopic impression; 7.9-10.5% for HPV16/18/45 E6; 23.4-28.4% for HPV16/18/45 DNA; and 48.0-62.6% for higher signal strength (?10 rlu/pc), depending on the HPV test/specimen combination. The positivity for all triage tests increased with severity of diagnosis. HPV16/18/45 DNA detection was approximately 70% sensitive and had positive predictive values (PPV) of approximately 25% for CIN3+. HPV16/18/45 E6 detection was approximately 50% sensitive with a PPV of nearly 50% for CIN3+. Different triage strategies for HPV DNA-positive women provide important tradeoffs in colposcopy or treatment referral percentages and sensitivity for prevalent CIN3+. PMID:24248915

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

    PubMed Central

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

    2014-01-01

    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

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

    PubMed

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

    2013-01-01

    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

  10. Lower cost strategies for triage of human papillomavirus DNA-positive women

    PubMed Central

    Qiao, You-Lin; Jeronimo, Jose; Zhao, Fang-Hui; Schweizer, Johannes; Chen, Wen; Valdez, Melissa; Lu, Peter; Zhang, Xun; Kang, Le-Ni; Bansil, Pooja; Paul, Proma; Mahoney, Charles; Berard-Bergery, Marthe; Bai, Ping; Peck, Roger; Li, Jing; Chen, Feng; Stoler, Mark H; Castle, Philip E

    2014-01-01

    Using human papillomavirus (HPV) testing for cervical cancer screening in lower-resource settings (LRS) will result in a significant number of screen-positive women. This analysis compares different triage strategies for detecting cervical precancer and cancer among HPV-positive women in LRS. This was a population-based study of women aged 25–65 years living in China (n?=?7,541). Each woman provided a self-collected and two clinician-collected specimens. The self-collected and one clinician-collected specimen were tested by two HPV DNA tests—careHPV™ and Hybrid Capture 2; the other clinician-collected specimen was tested for HPV16/18/45 E6 protein. CareHPV™-positive specimens were tested for HPV16/18/45 DNA. HPV DNA-positive women underwent visual inspection with acetic acid (VIA) and then colposcopic evaluation with biopsies. The performance for detection of cervical intraepithelial neoplasia grade 3 or cancer (CIN3+) among HPV DNA-positive women was assessed for different triage strategies: HPV16/18/45 E6 or DNA detection, VIA, colposcopic impression, or higher signal strength (?10 relative light units/positive control [rlu/pc]). The percent triage positive ranges were 14.8–17.4% for VIA, 17.8–20.9% for an abnormal colposcopic impression; 7.9–10.5% for HPV16/18/45 E6; 23.4–28.4% for HPV16/18/45 DNA; and 48.0–62.6% for higher signal strength (?10 rlu/pc), depending on the HPV test/specimen combination. The positivity for all triage tests increased with severity of diagnosis. HPV16/18/45 DNA detection was approximately 70% sensitive and had positive predictive values (PPV) of approximately 25% for CIN3+. HPV16/18/45 E6 detection was approximately 50% sensitive with a PPV of nearly 50% for CIN3+. Different triage strategies for HPV DNA-positive women provide important tradeoffs in colposcopy or treatment referral percentages and sensitivity for prevalent CIN3+. What's new? The careHPV™ test is a novel technology for primary cervical cancer screening of women from lower-resource settings. However, triage strategies are needed to identify which HPV-positive women are at highest risk of cervical precancer and cancer. Here, multiple viable and affordable strategies to manage HPV-positive women depending on local requirements and resources are identified, based on evaluation of the performance of different triage strategies for developing countries. The different strategies for women who test positive for HPV DNA provide important tradeoffs in colposcopy or treatment referral percentages and sensitivity for cervical intraepithelial neoplasia grade 3 or cancer (CIN3+). PMID:24248915

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

    PubMed Central

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

    2013-01-01

    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

  12. Radiation Injury Treatment Network (RITN): Healthcare professionals preparing for a mass casualty radiological or nuclear incident

    PubMed Central

    ROSS, JOEL R.; CASE, CULLEN; CONFER, DENNIS; WEISDORF, DANIEL J.; WEINSTOCK, DAVID; KRAWISZ, ROBERT; CHUTE, JOHN; WILHAUK, JULIE; NAVARRO, WILLIS; HARTZMAN, ROBERT; COLEMAN, C. NORMAN; HATCHETT, RICHARD; CHAO, NELSON

    2011-01-01

    Purpose To describe the history, composition, and activities of the Radiation Injury Treatment Network (RITN). The Radiation Injury Treatment Network® is a cooperative effort of the National Marrow Donor Program and the American Society for Blood and Marrow Transplantation. The goals of RITN are to educate hematologists, oncologists, and stem cell transplant practitioners about their potential involvement in the response to a radiation incident and provide treatment expertise. Injuries to the marrow system readily occur when a victim is exposed to ionising radiation. This focus therefore leverages the expertise of these specialists who are accustomed to providing the intensive supportive care required by patients with a suppressed marrow function. Following a radiological incident, RITN centres may be asked to: Accept patient transfers to their institutions; provide treatment expertise to practitioners caring for victims at other centres; travel to other centres to provide medical expertise; or provide data on victims treated at their centres. Moving forward, it is crucial that we develop a coordinated interdisciplinary approach in planning for and responding to radiological and nuclear incidents. The ongoing efforts of radiation biologists, radiation oncologists, and health physicists can and should complement the efforts of RITN and government agencies. Conclusion RITN serves as a vital partner in preparedness and response efforts for potential radiological and nuclear incidents. PMID:21801106

  13. Mass casualty in an isolated environment: medical response to a submarine collision.

    PubMed

    Jankosky, Christopher John

    2008-08-01

    On January 8, 2005, the U.S.S. SAN FRANCISCO (SSN 711), a nuclear-powered submarine, collided with a seamount in a remote Pacific Ocean location. The high-speed impact resulted in injuries to 90% of the crew. Subsequent emergency medical response is described as well as the 3-month physical and psychological morbidity. Recommendations for medical training, equipment, and policy for workers in isolated environments are discussed. PMID:18751588

  14. Special report. The Oklahoma City bombing: mass casualties and the local hospital response.

    PubMed

    1995-09-01

    A morning blast at the Alfred P. Murrah Federal Building, Oklahoma City, OK, on April 19, 1995, killed 168 persons and injured more than 500 in the worst terrorist attack in U.S. history. Hospital workers, physicians, and volunteers at nine hospitals there mobilized, put their disaster emergency plans into operation, and treated 466 persons in emergency rooms--many of them later being admitted as patients. To complicate matters, two of the hospitals received bomb threats called in after the disaster. This report will look at the security plans put into force by each of the nine hospitals; the handling of the great influx of persons, including victims, relatives, friends, concerned persons, volunteers, and the news media; and the lessons hospital officials learned from their experiences. PMID:10151262

  15. COSTRIAGE: A Cost-Aware Triage Algorithm for Bug Reporting Systems Jin-woo Park, Mu-Woong Lee, Jinhan Kim, Seung-won Hwang Sunghun Kim

    E-print Network

    Hwang, Seung-won

    COSTRIAGE: A Cost-Aware Triage Algorithm for Bug Reporting Systems Jin-woo Park, Mu-Woong Lee,wlsgks08,swhwang}@postech.edu hunkim@cse.ust.hk Abstract `Who can fix this bug?' is an important question in bug triage to "accurately" assign developers to bug reports. To address this question, recent research

  16. A systematic review of triage-related interventions to improve patient flow in emergency departments

    PubMed Central

    2011-01-01

    Background Overcrowding in emergency departments is a worldwide problem. A systematic literature review was undertaken to scientifically explore which interventions improve patient flow in emergency departments. Methods A systematic literature search for flow processes in emergency departments was followed by assessment of relevance and methodological quality of each individual study fulfilling the inclusion criteria. Studies were excluded if they did not present data on waiting time, length of stay, patients leaving the emergency department without being seen or other flow parameters based on a nonselected material of patients. Only studies with a control group, either in a randomized controlled trial or in an observational study with historical controls, were included. For each intervention, the level of scientific evidence was rated according to the GRADE system, launched by a WHO-supported working group. Results The interventions were grouped into streaming, fast track, team triage, point-of-care testing (performing laboratory analysis in the emergency department), and nurse-requested x-ray. Thirty-three studies, including over 800,000 patients in total, were included. Scientific evidence on the effect of fast track on waiting time, length of stay, and left without being seen was moderately strong. The effect of team triage on left without being seen was relatively strong, but the evidence for all other interventions was limited or insufficient. Conclusions Introducing fast track for patients with less severe symptoms results in shorter waiting time, shorter length of stay, and fewer patients leaving without being seen. Team triage, with a physician in the team, will probably result in shorter waiting time and shorter length of stay and most likely in fewer patients leaving without being seen. There is only limited scientific evidence that streaming of patients into different tracks, performing laboratory analysis in the emergency department or having nurses to request certain x-rays results in shorter waiting time and length of stay. PMID:21771339

  17. Chapter 3 innovations in the en route care of combat casualties.

    PubMed

    Hatzfeld, Jennifer J; Dukes, Susan; Bridges, Elizabeth

    2014-01-01

    The en route care environment is dynamic and requires constant innovation to ensure appropriate nursing care for combat casualties. Building on experiences in Iraq and Afghanistan, there have been tremendous innovations in the process of transporting patients, including the movement of patients with spinal injuries. Advances have also been made in pain management and noninvasive monitoring, particularly for trauma and surgical patients requiring close monitoring of their hemodynamic and perfusion status. In addition to institutionalizing these innovations, future efforts are needed to eliminate secondary insults to patients with traumatic brain injuries and technologies to provide closed-loop sedation and ventilation. PMID:25222537

  18. Triage of Patients Consulted for ICU Admission During Times of ICU-Bed Shortage

    PubMed Central

    Orsini, Jose; Blaak, Christa; Yeh, Angela; Fonseca, Xavier; Helm, Tanya; Butala, Ashvin; Morante, Joaquin

    2014-01-01

    Background The demand for specialized medical services such as critical care often exceeds availability, thus rationing of intensive care unit (ICU) beds commonly leads to difficult triage decisions. Many factors can play a role in the decision to admit a patient to the ICU, including severity of illness and the need for specific treatments limited to these units. Although triage decisions would be based solely on patient and institutional level factors, it is likely that intensivists make different decisions when there are fewer ICU beds available. The objective of this study is to evaluate the characteristics of patients referred for ICU admission during times of limited beds availability. Methods A single center, prospective, observational study was conducted among consecutive patients in whom an evaluation for ICU admission was requested during times of ICU overcrowding, which comprised the months of April and May 2014. Results A total of 95 patients were evaluated for possible ICU admission during the study period. Their mean APACHE-II score was 16.8 (median 16, range 3 - 36). Sixty-four patients (67.4%) were accepted to ICU, 18 patients (18.9%) were triaged to SDU, and 13 patients (13.7%) were admitted to hospital wards. ICU had no beds available 24 times (39.3%) during the study period, and in 39 opportunities (63.9%) only one bed was available. Twenty-four patients (25.3%) were evaluated when there were no available beds, and eight of those patients (33%) were admitted to ICU. A total of 17 patients (17.9%) died in the hospital, and 15 (23.4%) expired in ICU. Conclusion ICU beds are a scarce resource for which demand periodically exceeds supply, raising concerns about mechanisms for resource allocation during times of limited beds availability. At our institution, triage decisions were not related to the number of available beds in ICU, age, or gender. A linear correlation was observed between severity of illness, expressed by APACHE-II scores, and the likelihood of being admitted to ICU. Alternative locations outside the ICU in which care for critically ill patients could be delivered should be considered during times of extreme ICU-bed shortage. PMID:25247021

  19. Healthcare-associated pneumonia among U.S. combat casualties, 2009 to 2010.

    PubMed

    Yun, Heather C; Weintrob, Amy C; Conger, Nicholas G; Li, Ping; Lu, Dan; Tribble, David R; Murray, Clinton K

    2015-01-01

    Although there is literature evaluating infectious complications associated with combat-related injuries from Iraq and Afghanistan, none have evaluated pneumonia specifically. Therefore, we assessed a series of pneumonia cases among wounded military personnel admitted to Landstuhl Regional Medical Center, and then evacuated further to participating U.S. military hospitals. Of the 423 casualties evacuated to the United States, 36 developed pneumonia (8.5%) and 30 of these (83.3%) were ventilator-associated. Restricting to 162 subjects admitted to intensive care, 30 patients had pneumonia (18.5%). The median Injury Severity Score was higher among subjects with pneumonia (23.0 vs. 6.0; p < 0.01). There were 61 first-isolate respiratory specimens recovered from 31 pneumonia subjects, of which 56.1% were gram-negative, 18.2% were gram-positive, and 18.2% were fungal. Staphylococcus aureus and Pseudomonas aeruginosa were most commonly recovered (10.6%, and 9.1%, respectively). Thirteen bacterial isolates (26.5%) were multidrug-resistant. Outcome data were available for 32 patients, of which 26 resolved their infection without progression, 5 resolved after initial progression, and 1 died. Overall, combat-injured casualties suffer a relatively high rate of pneumonia, particularly those requiring mechanical ventilation. Although gram-negative pathogens were common, S. aureus was most frequently isolated. Continued focus on pneumonia prevention strategies is necessary for improving combat care. PMID:25562865

  20. The influence of car registration year on driver casualty rates in Great Britain.

    PubMed

    Broughton, Jeremy

    2012-03-01

    A previous paper analysed data from the British national road accident reporting system to investigate the influence upon car driver casualty rates of the general type of car being driven and its year of first registration. A statistical model was fitted to accident data from 2001 to 2005, and this paper updates the principal results using accident data from 2003 to 2007. Attention focuses upon the role of year of first registration since this allows the influence of developments in car design upon occupant casualty numbers to be evaluated. Three additional topics are also examined with these accident data. Changes over time in frontal and side impacts are compared. Changes in the combined risk for the two drivers involved in a car-car collision are investigated, being the net result of changes in secondary safety and aggressivity. Finally, the results of the new model relating to occupant protection are related to an index that had been developed previously to analyse changes over time in the secondary safety of the car fleet. PMID:22269528

  1. Multi-sources data fusion framework for remote triage prioritization in telehealth.

    PubMed

    Salman, O H; Rasid, M F A; Saripan, M I; Subramaniam, S K

    2014-09-01

    The healthcare industry is streamlining processes to offer more timely and effective services to all patients. Computerized software algorithm and smart devices can streamline the relation between users and doctors by providing more services inside the healthcare telemonitoring systems. This paper proposes a multi-sources framework to support advanced healthcare applications. The proposed framework named Multi Sources Healthcare Architecture (MSHA) considers multi-sources: sensors (ECG, SpO2 and Blood Pressure) and text-based inputs from wireless and pervasive devices of Wireless Body Area Network. The proposed framework is used to improve the healthcare scalability efficiency by enhancing the remote triaging and remote prioritization processes for the patients. The proposed framework is also used to provide intelligent services over telemonitoring healthcare services systems by using data fusion method and prioritization technique. As telemonitoring system consists of three tiers (Sensors/ sources, Base station and Server), the simulation of the MSHA algorithm in the base station is demonstrated in this paper. The achievement of a high level of accuracy in the prioritization and triaging patients remotely, is set to be our main goal. Meanwhile, the role of multi sources data fusion in the telemonitoring healthcare services systems has been demonstrated. In addition to that, we discuss how the proposed framework can be applied in a healthcare telemonitoring scenario. Simulation results, for different symptoms relate to different emergency levels of heart chronic diseases, demonstrate the superiority of our algorithm compared with conventional algorithms in terms of classify and prioritize the patients remotely. PMID:25047520

  2. Detector photon response and absorbed dose and their applications to rapid triage techniques

    NASA Astrophysics Data System (ADS)

    Voss, Shannon Prentice

    As radiation specialists, one of our primary objectives in the Navy is protecting people and the environment from the effects of ionizing and non-ionizing radiation. Focusing on radiological dispersal devices (RDD) will provide increased personnel protection as well as optimize emergency response assets for the general public. An attack involving an RDD has been of particular concern because it is intended to spread contamination over a wide area and cause massive panic within the general population. A rapid method of triage will be necessary to segregate the unexposed and slightly exposed from those needing immediate medical treatment. Because of the aerosol dispersal of the radioactive material, inhalation of the radioactive material may be the primary exposure route. The primary radionuclides likely to be used in a RDD attack are Co-60, Cs-137, Ir-192, Sr-90 and Am-241. Through the use of a MAX phantom along with a few Simulink MATLAB programs, a good anthropomorphic phantom was created for use in MCNPX simulations that would provide organ doses from internally deposited radionuclides. Ludlum model 44-9 and 44-2 detectors were used to verify the simulated dose from the MCNPX code. Based on the results, acute dose rate limits were developed for emergency response personnel that would assist in patient triage.

  3. The essential roles of chemistry in high-throughput screening triage

    PubMed Central

    Dahlin, Jayme L; Walters, Michael A

    2015-01-01

    It is increasingly clear that academic high-throughput screening (HTS) and virtual HTS triage suffers from a lack of scientists trained in the art and science of early drug discovery chemistry. Many recent publications report the discovery of compounds by screening that are most likely artifacts or promiscuous bioactive compounds, and these results are not placed into the context of previous studies. For HTS to be most successful, it is our contention that there must exist an early partnership between biologists and medicinal chemists. Their combined skill sets are necessary to design robust assays and efficient workflows that will weed out assay artifacts, false positives, promiscuous bioactive compounds and intractable screening hits, efforts that ultimately give projects a better chance at identifying truly useful chemical matter. Expertise in medicinal chemistry, cheminformatics and purification sciences (analytical chemistry) can enhance the post-HTS triage process by quickly removing these problematic chemotypes from consideration, while simultaneously prioritizing the more promising chemical matter for follow-up testing. It is only when biologists and chemists collaborate effectively that HTS can manifest its full promise. PMID:25163000

  4. Urine levels of drugs for which Triage DOA screening was positive.

    PubMed

    Moriya, Fumio

    2009-04-01

    The purpose of this study was to investigate the relationship between urine levels of target drugs of abuse for which Triage DOA gave positive results, as well as the cut-off levels for these drugs. Thirty-eight forensic urine samples positive for commonly abused drugs were involved. Of these samples, 12 were positive for barbiturates (BAR), 11 for benzodiazepines (BZO), 8 for opiates (OPI), 7 for amphetamines (AMP), and 4 for tricyclic antidepressants (TCA). In the BAR-positive urine samples, phenobarbital, amobarbital or barbital was detected at concentrations higher than cut-off levels. In the BZO-positive samples, diazepam, nordiazepam, triazolam, nitrazepam and/or midazolam was detected at concentrations lower than cut-off levels; in the triazolam-involved urine, alpha-hydroxytriazolam, a metabolite of triazolam, showed concentrations higher than cut-off level. In the AMP-positive samples, methamphetamine was detected at concentrations higher than cut-off level. Urine samples positive for OPI contained total dihydrocodeine, codeine or morphine at concentrations higher than cut-off levels. In TCA-positive samples, amitriptyline was detected at concentrations higher or lower than cut-off level, and clomipramine was detected at a concentration much lower than cut-off level. Metabolites of BZO and TCA, which are not typically analyzed by instrumental procedures, may cross-react to varying degrees with the antibodies used for Triage DOA. PMID:19261513

  5. The essential roles of chemistry in high-throughput screening triage.

    PubMed

    Dahlin, Jayme L; Walters, Michael A

    2014-07-01

    It is increasingly clear that academic high-throughput screening (HTS) and virtual HTS triage suffers from a lack of scientists trained in the art and science of early drug discovery chemistry. Many recent publications report the discovery of compounds by screening that are most likely artifacts or promiscuous bioactive compounds, and these results are not placed into the context of previous studies. For HTS to be most successful, it is our contention that there must exist an early partnership between biologists and medicinal chemists. Their combined skill sets are necessary to design robust assays and efficient workflows that will weed out assay artifacts, false positives, promiscuous bioactive compounds and intractable screening hits, efforts that ultimately give projects a better chance at identifying truly useful chemical matter. Expertise in medicinal chemistry, cheminformatics and purification sciences (analytical chemistry) can enhance the post-HTS triage process by quickly removing these problematic chemotypes from consideration, while simultaneously prioritizing the more promising chemical matter for follow-up testing. It is only when biologists and chemists collaborate effectively that HTS can manifest its full promise. PMID:25163000

  6. Timing of troponin T measurements in triage of pulmonary embolism patients

    PubMed Central

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

    2013-01-01

    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

  7. A new handbook on triage, monitoring and treatment of people following malevolent use of radiation.

    PubMed

    del Rosario Pérez, Maria; Carr, Zhanat; Rojas-Palma, Carlos; van der Meer, Klaus; Smith, Karen; Rahola, Tua; Muikku, Maarit; Liland, Astrid; Jaworska, Alicja; Jerstad, Anne

    2010-06-01

    Through the Euratom 6 Framework Programme, the European Commission is co-sponsoring the specific targeted research project "Triage, Monitoring and Treatment-Handbook for management of the public in the event of malevolent use of radiation" (TMT Handbook). The main aim of the project is to produce a handbook for the effective and timely triage, monitoring, and treatment of people exposed to radiation following a malevolent act. The World Health Organization contributed to this project with development of guidelines on medical and public health response. A training course based on the TMT Handbook was developed. It will help to enhance national capacity for planning and response to acts involving the malevolent use of radiation. The course will also provide a platform to identify common challenges and discuss opportunities for harmonizing response strategies throughout the European Union. Focusing on its medical and public health response aspects, this paper introduces the TMT Handbook and its potential applicability not only as practical guidance for end-users but also as a useful tool for education and training. PMID:20445402

  8. A Physiotherapy Triage Service for Orthopaedic Surgery: An Effective Strategy for Reducing Wait Times

    PubMed Central

    McCormack, Robert G.; Hunt, Michael A.; Brooks-Hill, Alexandra

    2013-01-01

    ABSTRACT Purpose: To investigate the effectiveness of a physiotherapy triage service for orthopaedic surgery referrals from primary-care physicians. Methods: A prospective, observational design was used with patients referred to an orthopaedic surgeon based out of two small urban centres in British Columbia. The level of agreement between the physiotherapist and surgeon was determined using a weighted kappa statistic (?w) with 95% CI. A patient satisfaction questionnaire was administered, and the surgical conversion rate (SCR) was calculated to assess the level of appropriate referrals. Results: The analysis found substantial agreement (?w=0.77; 95% CI, 0.60–0.94) between surgeon and physiotherapist for surgical management decisions. All patients reported being “satisfied” or “very satisfied” with the overall care they received from the physiotherapist. The SCR of patients referred by the physiotherapist to the surgeon was 91%, versus 22% among patients referred by a general practitioner or emergency physician. Conclusion: More than three-fourths of patients referred by primary-care physicians did not need to see a surgeon and were able to be managed by an experienced orthopaedic physiotherapist. This triage model could have considerable impact on orthopaedic wait times in Canada by minimizing unnecessary referrals; the model could also promote timely and conservative management of non-surgical conditions by physiotherapists. PMID:24396164

  9. The handover process and triage of ambulance-borne patients: the experiences of emergency nurses.

    PubMed

    Bruce, Karin; Suserud, Björn-Ove

    2005-01-01

    One of the most important tasks that a nurse faces in the emergency room, when receiving a patient, is handover and the triage function. The aim of the study was to explore the experiences of nurses receiving patients who were brought into hospital as emergencies by ambulance crews through an analysis of the handover and triage process. A qualitative descriptive interview study inspired by the phenomenological method was used with six emergency nurses. There are three elements to a handover: a verbal report, handing over documented accounts and the final symbolic handover when a patient is transferred from the ambulance stretcher onto the hospital stretcher. The study identified that the verbal communication between ambulance and emergency nurses was often very structured. The ideal handovers often involved patients with very distinct medical problems. The difficult handover or the 'non-ideal' one was characterized by a significantly more complicated care situation. The handover function was pivotal in ensuring that the patient received the correct care and that care was provided at the appropriate level. The most seriously afflicted patients arrived by ambulance; therefore, the interplay between pre-hospital and hospital personnel was vital in conveying this important information. To some extent, this functioned well, but this research has identified areas where this care can be improved. PMID:15997974

  10. The reliability of the Australasian Triage Scale: a meta-analysis

    PubMed Central

    Ebrahimi, Mohsen; Heydari, Abbas; Mazlom, Reza; Mirhaghi, Amir

    2015-01-01

    BACKGROUND: Although the Australasian Triage Scale (ATS) has been developed two decades ago, its reliability has not been defined; therefore, we present a meta-analyis of the reliability of the ATS in order to reveal to what extent the ATS is reliable. DATA SOURCES: Electronic databases were searched to March 2014. The included studies were those that reported samples size, reliability coefficients, and adequate description of the ATS reliability assessment. The guidelines for reporting reliability and agreement studies (GRRAS) were used. Two reviewers independently examined abstracts and extracted data. The effect size was obtained by the z-transformation of reliability coefficients. Data were pooled with random-effects models, and meta-regression was done based on the method of moment’s estimator. RESULTS: Six studies were included in this study at last. Pooled coefficient for the ATS was substantial 0.428 (95%CI 0.340–0.509). The rate of mis-triage was less than fifty percent. The agreement upon the adult version is higher than the pediatric version. CONCLUSION: The ATS has shown an acceptable level of overall reliability in the emergency department, but it needs more development to reach an almost perfect agreement.

  11. Evaluation of the Triage Micro Parasite Panel for Detection of Giardia lamblia, Entamoeba histolytica/Entamoeba dispar, and Cryptosporidium parvum in Patient Stool Specimens

    PubMed Central

    Sharp, Susan E.; Suarez, Clarisa A.; Duran, Yolanda; Poppiti, Robert J.

    2001-01-01

    A study comparing the Triage Micro Parasite Panel (Biosite Diagnostics, Inc., San Diego, Calif.) to conventional O&P examination (O&P) was performed using patient fecal specimens. Five hundred twenty-three stool samples were compared. Nineteen specimens were found to be positive by Triage, and 29 were found to be positive by O&P. Seven specimens were positive for Giardia lamblia, four were positive for Entamoeba histolytica/E. dispar, and three were positive for Cryptosporidium parvum as determined by both methods. There was one false positive by Triage (C. parvum) and four false negatives by O&P (two G. lamblia, one E. histolytica/E. dispar, and one C. parvum). The Triage test accurately detected all 18 specimens that contained one of the three organisms that it was designed to detect. The Triage test is a rapid, easy-to-use enzyme immunoassay for the detection of G. lamblia, E. histolytica/E. dispar, and C. parvum in fresh or fresh-frozen fecal specimens. These data suggest that the Triage test can be used as a screen for the immediate testing of stool specimens for these three pathogenic parasites. If Triage test results are negative, O&P can be performed if parasitic infections other than G. lamblia, E. histolytica/E. dispar, or C. parvum are suspected. PMID:11136793

  12. Cross Validation of the MacNeill-Lichtenberg Decision Tree: Triaging Mental Health Problems in Geriatric Rehabilitation Patients

    Microsoft Academic Search

    Adam L. Bank; Susan E. MacNeill; Peter A. Lichtenberg

    2000-01-01

    Objective: Cross validation of the MacNeill-Lichtenberg Decision Tree (MLDT), a tool for triaging mental health problems in older medical patients. Design: Sensitivity, specificity, and predictive power were calculated for prediction of cognition and depressive symptoms. Correlational analyses were performed to examine the relationship between demographic variables and MLDT measures. Correlational and logistic regression analyses were conducted to examine the utility

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

    E-print Network

    Perry, Dewayne E.

    Understanding the Triaging and Fixing Processes of Long Lived Bugs Ripon K. Saha, Sarfraz Khurshid and Computer Engineering The University of Texas at Austin, USA Abstract Context: Bug fixing is an integral frustrating for user. While there are many studies that investigate factors affecting bug fixing time

  14. Operation GREENHOUSE. Scientific Director's report. Annex 5. 1 - Annex a. Alkali halide and phosphate glass radiological casualty dosimeters

    Microsoft Academic Search

    R. S. Alger; J. P. Dyson; R. A. Levy; D. W. McQuilling

    1951-01-01

    Photochemical reactions induced by ionizing radiations can produce color centers in alkali halide crystals and fluorescent centers in silver-bearing phosphate glasses. These reactions are being investigated as a basis for casualty-badge radiation dosimeters. Potassium bromide and potassium chloride crystals were satisfactorily sensitized by heating in a combined atmosphere of alkali vapor and hydrogen. Doses of 25 r of cobalt 60

  15. [The modern approaches to the principles of medical and surgical casualty estimation. The US and British experience].

    PubMed

    Zhuravlev, V K; Golota, A S; Krassi?, A B; Mironov, V G; Parfenov, V D

    2014-01-01

    The current article is dedicated to the principles of medical and surgical casualty estimation elaborated by the medical services of the US and Great Britain Armed Forces on the basis of their experience obtained during Afghanistan and Iraq operations. PMID:24734435

  16. 19 CFR 158.21 - Allowance in duties for casualty, loss, or theft while in Customs custody.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ...or of the actual injury or destruction, in whole or in part, of any merchandise by accidental fire or other casualty, while in bonded warehouse, or in the public stores, or while in transportation under bond, or while in Customs custody...

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

    PubMed

    Zahran, Sammy; Tavani, Daniele; Weiler, Stephan

    2013-07-01

    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

  18. Biopsychosocial predictors of short-term success among people with low back pain referred to a physiotherapy spinal triage service

    PubMed Central

    Bath, Brenna; Lovo Grona, Stacey

    2015-01-01

    Background A spinal triage assessment service may impact a wide range of patient outcomes. Investigating potential predictors of success or improvement may reveal why some people improve and some do not, as well as help to begin to explain potential mechanisms for improvements. The objective of this study was to determine which factors were associated with improved short-term self-reported pain, function, general health status, and satisfaction in people undergoing a spinal triage assessment performed by physiotherapists. Methods Participants with low back-related complaints were recruited from people referred to a spinal triage assessment program (N=115). Participants completed baseline questionnaires covering a range of sociodemographic, clinical, and psychological features. Self-reported measures of pain, function, quality of life, and satisfaction were completed at 4 weeks following the assessment. Determination of “success” was based on minimal important change scores of select outcome measures. Multivariate logistic regression was used to explore potential predictors of success for each outcome. Results Despite the complex and chronic presentation of most participants, some reported improvements in outcomes at 4 weeks post assessment with the highest proportion of participants demonstrating improvement (according to the minimal important change scores) in the Medical Outcomes Survey 36-item short-form version 2 physical component summary score (48.6%) and the lowest proportion of participants having improvements in the Numeric Pain Rating Scale (11.5%). A variety of different sociodemographic, psychological, clinical, and other variables were associated with success or improvement in each respective outcome. Conclusion There may be a potential mechanism of reassurance that occurs during the spinal triage assessment process as those with higher psychological distress (measured by the Fear Avoidance Beliefs Questionnaire and the Distress and Risk Assessment Measure) were more likely to improve on certain outcomes. The use of an evaluation framework guided by a biopsychosocial model may help determine potential mechanisms of action for a physiotherapy-delivered triage program. PMID:25960675

  19. Orthopedic injuries in U.S. casualties treated on a hospital ship during Operation Iraqi Freedom.

    PubMed

    Enad, Jerome G; Headrick, Jeff D

    2008-10-01

    From March to May 2003, the USNS Comfort was deployed to the Persian Gulf in support of combat operations for Operation Iraqi Freedom. The onboard orthopedic service treated 58 U.S. casualties during that period. Eighty-seven percent of the injuries were to the appendicular skeleton. Twenty-four percent were battle injuries, and 72% were nonbattle injuries. Patients with battle injuries tended to be younger and required more orthopedic operations than did patients with nonbattle injuries. Moreover, all patients with battle injuries were evacuated to higher echelons for further care, whereas 19% of patients with nonbattle injuries returned to duty in the short term. Complications were few, with no infections, amputations, or deaths. A descriptive review of the types of injuries, orthopedic care, and eventual disposition is presented. PMID:19160621

  20. Bilinear common spatial pattern for single-trial ERP-based rapid serial visual presentation triage

    NASA Astrophysics Data System (ADS)

    Yu, K.; Shen, K.; Shao, S.; Ng, W. C.; Li, X.

    2012-08-01

    Common spatial pattern (CSP) analysis is a useful tool for the feature extraction of event-related potentials (ERP). However, CSP is essentially time invariant, and thus unable to exploit the temporal information of ERP. This paper proposes a variant of CSP, namely bilinear common spatial pattern (BCSP), which is capable of accommodating both spatial and temporal information. BCSP generalizes CSP through iteratively optimizing bilinear filters. These bilinear filters constitute a spatio-temporal subspace in which the separation between two conditions is maximized. The method is unique in the sense that it is mathematically intuitive and simple, as all the bilinear filters are obtained by maximizing the power ratio as CSP does. The proposed method was evaluated on 20 subjects’ ERP data collected in rapid serial visual presentation triage experiments. The results show that BCSP achieved significantly higher average test accuracy (12.3% higher, p < 0.001).

  1. Triage, monitoring and dose assessment for people exposed to ionising radiation following a malevolent act.

    PubMed

    Etherington, G; Rothkamm, K; Shutt, A L; Youngman, M J

    2011-03-01

    The part played by individual monitoring within the context of the overall response to incidents involving the malevolent use of radiation or radioactive material is discussed. The main objectives of an individual monitoring programme are outlined, and types of malevolent use scenario briefly described. Some major challenges facing those with responsibilities for planning the monitoring response to such an incident are identified and discussed. These include the need for rapid selection and prioritisation of people for individual monitoring by means of an effective triage system; the need for rapid initiation of individual monitoring; problems associated with monitoring large numbers of people; the particular difficulties associated with incidents involving pure-beta and alpha-emitting radionuclides; the need for techniques that can provide retrospective estimates of external radiation exposures rapidly and the need for rapid interpretation of contamination monitoring data. The paper concludes with a brief review of assistance networks and relevant international projects planned or currently underway. PMID:21147786

  2. DESIGN AND PRELIMINARY VALIDATION OF A RAPID AUTOMATED BIODOSIMETRY TOOL FOR HIGH THROUGPUT RADIOLOGICAL TRIAGE.

    PubMed

    Chen, Youhua; Zhang, Jian; Wang, Hongliang; Garty, Guy; Xu, Yanping; Lyulko, Oleksandra V; Turner, Helen C; Randers-Pehrson, Gerhard; Simaan, Nabil; Yao, Y Lawrence; Brenner, D J

    2009-01-01

    This paper presents design, hardware, software, and parameter optimization for a novel robotic automation system. RABiT is a Rapid Automated Biodosimetry Tool for high throughput radiological triage. The design considerations guiding the hardware and software architecture are presented with focus on methods of communication, ease of implementation, and need for real-time control versus soft time control cycles. The design and parameter determination for a non-contact PVC capillary laser cutting system is presented. A novel approach for lymphocyte concentration estimation based on computer vision is reported. Experimental evaluations of the system components validate the success of our prototype system in achieving a throughput of 6,000 samples in a period of 18 hours. PMID:21258614

  3. DESIGN AND PRELIMINARY VALIDATION OF A RAPID AUTOMATED BIODOSIMETRY TOOL FOR HIGH THROUGPUT RADIOLOGICAL TRIAGE

    PubMed Central

    Chen, Youhua; Zhang, Jian; Wang, Hongliang; Garty, Guy; Xu, Yanping; Lyulko, Oleksandra V.; Turner, Helen C.; Randers-Pehrson, Gerhard; Simaan, Nabil; Yao, Y. Lawrence; Brenner, D. J.

    2010-01-01

    This paper presents design, hardware, software, and parameter optimization for a novel robotic automation system. RABiT is a Rapid Automated Biodosimetry Tool for high throughput radiological triage. The design considerations guiding the hardware and software architecture are presented with focus on methods of communication, ease of implementation, and need for real-time control versus soft time control cycles. The design and parameter determination for a non-contact PVC capillary laser cutting system is presented. A novel approach for lymphocyte concentration estimation based on computer vision is reported. Experimental evaluations of the system components validate the success of our prototype system in achieving a throughput of 6,000 samples in a period of 18 hours. PMID:21258614

  4. Biomarker-enhanced triage in respiratory infections: a proof-of-concept feasibility trial

    PubMed Central

    Albrich, Werner C.; Rüegger, Kristina; Dusemund, Frank; Schuetz, Philipp; Arici, Birsen; Litke, Alexander; Blum, Claudine A.; Bossart, Rita; Regez, Katharina; Schild, Ursula; Guglielmetti, Merih; Conca, Antoinette; Schäfer, Petra; Schubert, Maria; de Geest, Sabina; Reutlinger, Barbara; Irani, Sarosh; Bürgi, Ulrich; Huber, Andreas; Müller, Beat

    2013-01-01

    Concerns about inadequate performance and complexity limit routine use of clinical risk scores in lower respiratory tract infections. Our aim was to study feasibility and effects of adding the biomarker proadrenomedullin (proADM) to the confusion, urea >7 mmol·L?1, respiratory rate ?30 breaths·min?1, blood pressure <90 mmHg (systolic) or ?60 mmHg (diastolic), age ?65 years (CURB-65) score on triage decisions and length of stay. In a randomised controlled proof-of-concept intervention trial, triage and discharge decisions were made for adults with lower respiratory tract infection according to interprofessional assessment using medical and nursing risk scores either without (control group) or with (proADM group) knowledge of proADM values, measured on admission, and on days 3 and 6. An adjusted generalised linear model was calculated to investigate the effect of our intervention. On initial presentation the algorithms were overruled in 123 (39.3%) of the cases. Mean length of stay tended to be shorter in the proADM (n=154, 6.3 days) compared with the control group (n=159, 6.8 days; adjusted regression coefficient -0.19, 95% CI -0.41–0.04; p=0.1). This trend was robust in subgroup analyses and for overall length of stay within 90 days (7.2 versus 7.9 days; adjusted regression coefficient -0.18, 95% CI -0.40–0.05; p=0.13). There were no differences in adverse outcomes or readmission. Logistic obstacles and overruling are major challenges to implement biomarker-enhanced algorithms in clinical settings and need to be addressed to shorten length of stay. PMID:23349444

  5. Telephone triage of cardiac emergency calls by dispatchers: a prospective study of 1386 emergency calls.

    PubMed Central

    Srámek, M.; Post, W.; Koster, R. W.

    1994-01-01

    OBJECTIVES--To evaluate the handling of potential cardiac emergency calls by dispatchers, to determine their final diagnosis and urgency, and to determine the value of the main complaint in predicting urgency and the ability of the dispatchers to recognise non-urgent conditions. DESIGN--Prospective data collection and recording of main complaint of emergency calls placed via the 06-11 alarm telephone number with follow up to hospital when the patients were transported and the general practitioner when they were not. SETTING--Dispatch centres of the emergency medical services in Amsterdam (urban area) and Enschede (rural area). PATIENTS--1386 consecutive adult subjects of emergency calls placed by citizens about chest problems or unconsciousness not caused by injury. MAIN OUTCOME MEASURES--Frequency of characteristics of the calls, outcome in diagnosis, and assessment of urgency. RESULTS--69 (5%) patients were dead when the ambulance arrived. Diagnosis was established in 1071 patients (77%). The disorders most often reported were cardiac, with acute ischaemia in 15% of all subjects. In 28% of cases and for each presenting complaint no organic explanation was found. Overall 39% of all emergency calls were urgent; the urgency rate was lowest for calls for people with abdominal discomfort. Dispatchers correctly identified 90% of the non-urgent calls, but 55% of the calls that they identified as urgent proved to be non-urgent. CONCLUSION--Currently, direct dialling for an ambulance without the intervention of a general practitioner imposes a high work load on emergency systems and hospitals because triage by dispatchers is not sufficiently accurate. It may be possible to increase the accuracy of triage by developing and testing decision algorithms. PMID:8011407

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

    PubMed Central

    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

    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

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

    Microsoft Academic Search

    P. Kruse; C. Rojas-Palma

    2007-01-01

    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,

  8. ACTS OF VIOLENCE ANNEX V ACTS OF VIOLENCE

    E-print Network

    . CONSIDERATIONS FOR SECONDARY EXPLOSIVE DEVICES...................13 R. MEDICAL TRIAGE AND MASS CASUALTY Operations Plan (EOP) and shall be considered an interactive support document to the EOP. APPROVAL an interactive support document to the EOP. The threat associated with acts of violence and most notably

  9. Development and evaluation of a virtual reality patient simulation (VRPS)

    Microsoft Academic Search

    Simon Nestler; Manuel Huber; Florian Echtler; Andreas Dollinger; Gudrun Klinker

    In disasters and mass casualty incidents (MCIs) paramedics initially determine the severeness of all patients' injuries during the so-called triage. In order to enhance disaster preparedness continuous training of all paramedics is indispensable. Due to the fact that large disaster control exercises are laborious and expensive, additional training on a small scale makes sense. Therefore we designed and developed a

  10. Gleaning Data From Disaster: A Hospital-Based Data Mining Method To Studying All-Hazard Triage After A Chemical Disaster

    PubMed Central

    Craig, Jean B.; Culley, Joan M.; Tavakoli, Abbas; Svendsen, Erik R

    2014-01-01

    Objective The objective of this paper is to describe the methods of evaluating currently available triage models for their efficacy in appropriately triaging the surge of patients after an all-hazards disaster. Design We developed a method for evaluating currently available triage models using extracted data from medical records of the victims from the Graniteville chlorine disaster. Setting On January 6, 2005, a freight train carrying three tanker cars of liquid chlorine was inadvertently switched onto an industrial spur in central Graniteville, South Carolina. The train then crashed into a parked locomotive and derailed. This caused one of the chlorine tankers to rupture and immediately release ~60 tons of chlorine. Chlorine gas infiltrated the town with a population of 7,000. Participants This research focuses on the victims who received emergency care in South Carolina. Results With our data mapping and decision tree logic, we were successful in employing the available extracted clinical data to estimate triage categories for use in triage effectiveness research. Conclusions The methodology outlined in this paper can be used to assess the performance of triage models after a disaster. The steps are reliable and repeatable and can easily be extended or applied to other disaster datasets. PMID:24352925

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

    NASA Astrophysics Data System (ADS)

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

    2013-06-01

    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.

  12. Triage and Management of the Injured in World War I: The Diuturnity of Antoine De Page and a Belgian Colleague

    PubMed Central

    Pollock, Richard A.

    2008-01-01

    A system of orderly triage of the injured in World War I and a protocol for early wound management of war injuries were introduced by Antoine De Page in 1914 at the beginning of World War I. The five steps of the De Page protocol (coined by the author as Ordre de Triage) were to be followed in detail by the French and Belgian armies. A younger Belgian colleague, Robert Danis, was recruited to aid in the management of the ambulance corps to transport the injured from dressing (“clearing”) stations to centers of more advanced care, away from the Franco-Belgian front. Danis, also from Brussels, introduced the principles of osteosynthesis of bone a little over a decade later. De Page and Danis, both surgeons, tendered immense carry-forwards for future generations. PMID:22110790

  13. Method comparison of cardiac marker assays on PATHFAST, StratusCS, AxSYM, Immulite 2000, triage, elecsys and cardiac reader.

    PubMed

    Peetz, Dirk; Schweigert, Rosemarie; Jachmann, Nicole; Post, Felix; Schinzel, Helmut; Lackner, Karl J

    2006-01-01

    The purpose of this evaluation was to perform a method comparison of the assays for cardiac troponin I (cTnl), CK-MB, myoglobin, and NT-proBNP on the automated PATHFAST Immuno-Assay Analyzer with respective immunoassays on other commercially available immunoanalyzers. The PATHFAST assays are immunochemiluminescent assays (in single reagent cartridges) employing two mono- or polyclonal antibodies in a sandwich test format. The calibration materials for cTnI and CK-MB are standardized to the reference materials NIST SRM 2921 (troponin CIT complex) and IRMM-IFCC 455 (CK-MB mass). The PATHFAST assays for cTnI, CK-MB, myoglobin, and NT-proBNP on the PATHFAST Analyzer were compared using 118 (NT-proBNP: 90) plasma samples from patients with different cardiovascular diseases with those on the Dade Behring StratusCS Analyzer, on the Abbott AxSYM System, on the DPC IMMMULITE 2000 Analyzer, on the Biosite Triage Meter Plus System, on the Roche Elecsys Immuno Analyzer 2010 and Roche Cardiac Reader System, respectively. The correlation coefficients for the comparison of cTnI methods ranged from 0.953 to 0.982, those for the comparison of myoglobin methods ranged from 0.776 to 0.992, and those for the comparison of CK-MB methods ranged from 0.835 to 0.999, with the Triage System giving in all comparisons the lowest correlation. Also the comparison of PATHFAST NTproBNP against the Roche Elecsys assay yielded a very good correlation (r = 0.992). The slopes of the regression line among methods showed considerable variation indicating that standardization efforts by international groups are indispensable to achieve harmonization of results. In summary, this evaluation study confirms the overall good correlation of the results obtained with assays for cardiac markers developed on the PATHFAST analyzer with those on other immunoassay platforms and thus the analytical reliability of the developed methods. PMID:17175892

  14. Multicenter evaluation of the Roche NT-proBNP assay and comparison to the Biosite Triage BNP assay

    Microsoft Academic Search

    Kiang-Teck J. Yeo; Alan H. B. Wu; Fred S. Apple; Martin H. Kroll; Robert H. Christenson; Kent B. Lewandrowski; Frank A. Sedor; Anthony W. Butch

    2003-01-01

    Background: Brain natriuretic peptides (BNPs) are useful in the assessment of heart failure, left ventricular dysfunction, and acute coronary syndromes. Methods: We performed a multicenter evaluation of the automated Roche NT-proBNP assay and compared its performance to the Biosite Triage BNP assay. Results: The N-terminal (1–76) pro brain natriuretic peptide (NT-proBNP) method is precise (CV?6.1%), has a wide dynamic measuring

  15. The effects of congestion charging on road traffic casualties: a causal analysis using difference-in-difference estimation.

    PubMed

    Li, Haojie; Graham, Daniel J; Majumdar, Arnab

    2012-11-01

    This paper aims to identify the impacts of the London congestion charge on road casualties within the central London charging zone. It develops a full difference-in-difference (DID) model that is integrated with generalized linear models, such as Poisson and Negative Binomial regression models. Covariates are included in the model to adjust for factors that violate the parallel trend assumption, which is critical in the DID model. The lower Bayesian Information Criterion value suggests that the full difference-in-difference model performs well in evaluating the relationship between road accidents and the London congestion charge as well as other socio-economic factors. After adjusting for a time trend and regional effects, the results show that the introduction of the London congestion charge has a significant influence on the incidence of road casualties. The congestion charge reduces the total number of car accidents, but is associated with an increase in two wheeled vehicle accidents. PMID:23036415

  16. Distance from practice moderates the relationship between patient management involving nurse telephone triage consulting and patient satisfaction with care.

    PubMed

    Calitri, Raff; Warren, Fiona C; Wheeler, Benedict; Chaplin, Katherine; Fletcher, Emily; Murdoch, Jamie; Richards, Suzanne; Taylor, Rod S; Varley, Anna; Campbell, John

    2015-07-01

    The ESTEEM trial was a randomised-controlled trial of telephone triage consultations in general practice. We conducted exploratory analyses on data from 9154 patients from 42 UK general practices who returned a questionnaire containing self-reported ratings of satisfaction with care following a request for a same-day consultation. Mode of care was identified through case notes review. There were seven main types: a GP face-to-face consultation, GP or nurse telephone triage consultation with no subsequent same day care, or a GP or nurse telephone triage consultation with a subsequent face-to-face consultation with a GP or a nurse. We investigated the contribution of mode of care to patient satisfaction and distance between the patient?s home and the practice as a potential moderating factor. There was no overall association between patient satisfaction and distance from practice. However, patients managed by a nurse telephone consultation showed lowest levels of satisfaction, and satisfaction for this group of patients increased the further they lived from the practice. There was no association between any of the other modes of management and distance from practice. PMID:25982703

  17. Characteristics of Veterans Accessing the Veterans Affairs Telephone Triage Who Have Depression or Suicidal Ideation: Opportunities for Intervention

    PubMed Central

    Ludwig, Alison; Lucero-Obusan, Cynthia; Schirmer, Patricia; Holodniy, Mark

    2013-01-01

    Objective To characterize Veterans who call telephone triage because of suicidal ideation (SI) or depression and to identify opportunities for suicide prevention efforts among these telephone triage users using a biosurveillance application. Introduction Veterans accessing Veterans Affairs (VA) health care have higher suicide rates and more characteristics associated with suicide risk, including being male, having multiple medical and psychiatric comorbidities, and being an older age, compared with the general U.S. population. The Veterans Crisis Line is a telephone hotline available to Veterans with urgent mental health concerns; however, not all Veterans are aware of this resource. By contrast, telephone triage is a national telephone-based triage system used by the VA to assess and triage all Veterans with acute medical or mental health complaints. Methods The VA Electronic Surveillance System for Early Notification of Community-based Epidemics (ESSENCE) was queried for telephone triage calls during January 1–June 30, 2012. Calls were classified as SI or depression when the triage nurse selected SI or depression as the Veteran’s chief complaint from a set of fixed options. Demographic and recommended follow-up time and location information was reviewed. A random sample of 20 SI calls and 50 depression calls were selected for chart review to determine whether Veterans were examined in a clinic or followed up by a clinician by telephone within 2 weeks of the veteran’s call. Results During January 1–June 30, 2012, 253,573 total calls were placed to telephone triage. Among these calls, 2,460 unique Veterans placed 417 calls for SI and 2,290 calls for depression. This represents 1% (2,707/253,573) of all calls placed during the period. All encounter information is available in the surveillance application within 24 hours of the call being placed. Median age of callers was 55 years (range: 19–94); 86% were male; and 6% placed repeat calls. The median number of repeat calls was 2 (range: 2–10). Among the 2,707 calls for SI or depression, 1,286 (48%) were made after routine business hours (5:00 p.m.–8:00 a.m.), and 646 (24%) were made on weekends. The greatest proportion of calls were from Wisconsin and Northern Illinois (17%) and the Southeastern United States (14%). Among the 2,290 calls for depression, 1,401 callers (61%) were recommended for urgent follow up or within 24 hours. 771 (34%) were assigned a follow up location of an emergency department; 117 (5%) an urgent care; 1,332 (58%) a physician’s office or clinic; 52 (2%) self-care at home; and 18 (1%) were unspecified. Among the 417 calls for SI, callers 410 (98%) were recommended for urgent follow-up or within 24 hours. 330 (79%) were assigned a follow-up location of an emergency department; 38 (9%) an urgent care; 43 (10%) a physician’s office or clinic; 3 (1%) self-care at home; and 3 (1%) unspecified. Among the 20 SI and 50 depression calls for which the charts were reviewed, 1 (5%) SI call and 6 (12%) depression calls had no documented follow-up by telephone or in person with a clinician within 2 weeks of initial call. Conclusions Telephone triage represents an additional data source available to surveillance applications. Although telephone triage is not the traditional method provided by the VA for triage of urgent mental health concerns, >2,000 Veterans called it with acute symptoms of SI or depression during January–June 2012. Training for suicide prevention should be prioritized for operators working during the high-volume periods of off-hours and weekends when approximately half and one-quarter of calls were received, respectively. We recommend standard notification of suicide prevention coordinators regarding calls to telephone triage for SI or depression to prevent loss to follow-up among Veterans at risk for suicide. Further investigation into reasons for increased call burden in identified geographic areas also is recommended.

  18. An Electronic Screen for Triaging Adolescent Substance Use by Risk Levels

    PubMed Central

    Levy, Sharon; Weiss, Roger; Sherritt, Lon; Ziemnik, Rosemary; Spalding, Allegra; Van Hook, Shari; Shrier, Lydia A.

    2014-01-01

    IMPORTANCE Screening adolescents for substance use and intervening immediately can reduce the burden of addiction and substance-related morbidity. Several screening tools have been developed to identify problem substance use for adolescents, but none have been calibrated to triage adolescents into clinically relevant risk categories to guide interventions. OBJECTIVE To describe the psychometric properties of an electronic screen and brief assessment tool that triages adolescents into 4 actionable categories regarding their experience with nontobacco substance use. DESIGN, SETTING, AND PARTICIPANTS Adolescent patients (age range, 12–17 years) arriving for routine medical care at 2 outpatient primary care centers and 1 outpatient center for substance use treatment at a pediatric hospital completed an electronic screening tool from June 1, 2012, through March 31, 2013, that consisted of a question on the frequency of using 8 types of drugs in the past year (Screening to Brief Intervention). Additional questions assessed severity of any past-year substance use. Patients completed a structured diagnostic interview (Composite International Diagnostic Interview–Substance Abuse Module), yielding Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) substance use diagnoses. MAIN OUTCOMES AND MEASURES For the entire screen and the Screening to Brief Intervention, sensitivity and specificity for identifying nontobacco substance use, substance use disorders, severe substance use disorders, and tobacco dependence were calculated using the Composite International Diagnostic Interview–Substance Abuse Module as the criterion standard. RESULTS Of 340 patients invited to participate, 216 (63.5%) enrolled in the study. Sensitivity and specificity were 100% and 84%(95%CI, 76%–89%) for identifying nontobacco substance use, 90% (95%CI, 77%–96%) and 94%(95%CI, 89%–96%) for substance use disorders, 100% and 94%(95%CI, 90%–96%) for severe substance use disorders, and 75% (95%CI, 52%–89%) and 98%(95%CI, 95%–100%) for nicotine dependence. No significant differences were found in sensitivity or specificity between the full tool and the Screening to Brief Intervention. CONCLUSIONS AND RELEVANCE A single screening question assessing past-year frequency use for 8 commonly misused categories of substances appears to be a valid method for discriminating among clinically relevant risk categories of adolescent substance use. PMID:25070067

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

    USGS Publications Warehouse

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

    2012-01-01

    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.

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

    PubMed

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

    2014-06-01

    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

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

    PubMed

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

    2015-02-01

    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

  2. Broadening access to medical care during a severe influenza pandemic: the CDC nurse triage line project.

    PubMed

    Koonin, Lisa M; Hanfling, Dan

    2013-03-01

    The impact of a severe influenza pandemic could be overwhelming to hospital emergency departments, clinics, and medical offices if large numbers of ill people were to simultaneously seek care. While current planning guidance to reduce surge on hospitals and other medical facilities during a pandemic largely focuses on improving the "supply" of medical care services, attention on reducing "demand" for such services is needed by better matching patient needs with alternative types and sites of care. Based on lessons learned during the 2009 H1N1 pandemic, the Centers for Disease Control and Prevention and its partners are currently exploring the acceptability and feasibility of using a coordinated network of nurse triage telephone lines during a pandemic to assess the health status of callers, help callers determine the most appropriate site for care (eg, hospital ED, outpatient center, home), disseminate information, provide clinical advice, and provide access to antiviral medications for ill people, if appropriate. As part of this effort, the integration and coordination of poison control centers, existing nurse advice lines, 2-1-1 information lines, and other hotlines are being investigated. PMID:23458098

  3. HPV-Based Screening, Triage, Treatment, and Followup Strategies in the Management of Cervical Intraepithelial Neoplasia

    PubMed Central

    Peralta-Zaragoza, Oscar; Deas, Jessica; Gómez-Cerón, Claudia; García-Suastegui, Wendy Argelia; Fierros-Zárate, Geny del Socorro; Jacobo-Herrera, Nadia Judith

    2013-01-01

    Cervical cancer is the second most common cause of death from cancer in women worldwide, and the development of new diagnostic, prognostic, and treatment strategies merits special attention. Many efforts have been made to design new drugs and develop immunotherapy and gene therapy strategies to treat cervical cancer. HPV genotyping has potentially valuable applications in triage of low-grade abnormal cervical cytology, assessment of prognosis and followup of cervical intraepithelial neoplasia, and in treatment strategies for invasive cervical cancer. It is known that during the development of cervical cancer associated with HPV infection, a cascade of abnormal events is induced, including disruption of cellular cycle control, alteration of gene expression, and deregulation of microRNA expression. Thus, the identification and subsequent functional evaluation of host proteins associated with HPV E6 and E7 oncoproteins may provide useful information in understanding cervical carcinogenesis, identifying cervical cancer molecular markers, and developing specific targeting strategies against tumor cells. Therefore, in this paper, we discuss the main diagnostic methods, management strategies, and followup of HPV-associated cervical lesions and review clinical trials applying gene therapy strategies against the development of cervical cancer. PMID:23690785

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

    PubMed Central

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

    2014-01-01

    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

  5. Risky business: using necessarily imprecise casualty counts to estimate occupational risks for HIV-1 infection.

    PubMed

    Beekmann, S E; Fahey, B J; Gerberding, J L; Henderson, D K

    1990-07-01

    Although the genesis of healthcare worker anxiety regarding occupational risks of HIV-1 infection is clear, the reasons for continued insistence on a meticulous "casualty count" become less clear with time. One could, in fact, argue that the precise number of such infections has become virtually meaningless, because the routes of occupational/nosocomial transmission of HIV-1 and the magnitude of risk for infection following an adverse exposure in the healthcare setting have been well-characterized. Nevertheless, with the substantial limitations of these data clearly in mind, we have summarized the numbers of healthcare workers reported to have HIV-1 infection in each of the above categories in Table 2. The likelihood that an individual case represents true occupational infection decreases as one moves down the table. Having waded through the depths of this literature, we have reached the conclusion that, of the available data, the magnitude of risk for occupational HIV-1 infection remains the single most useful and instructive statistic available. Longitudinal cohort studies of HCWs involved in the day-to-day care of HIV-1-infected patients and in the handling and processing of specimens from such patients provide the best available evidence regarding the magnitude of risk for transmission of this virus in the healthcare setting. Fourteen prospective studies are currently in progress, with approximately 2,000 HCWs enrolled (Table 4). Six HCWs enrolled in these studies have developed serologic evidence of HIV-1 infection following percutaneous exposures, yielding an infection rate per participant of 0.32% and an infection rate per exposure of 0.31%.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:2165506

  6. Enhanced Influenza Surveillance using Telephone Triage Data in the VA ESSENCE Biosurveillance System

    PubMed Central

    Lucero-Obusan, Cynthia A.; Winston, Carla A.; Schirmer, Patricia L.; Oda, Gina; Mostaghimi, Anoshiravan; Holodniy, Mark

    2013-01-01

    Objective To evaluate the utility and timeliness of telephone triage (TT) for influenza surveillance in the Department of Veterans Affairs (VA). Introduction Telephone triage is a relatively new data source available to biosurveillance systems.1–2 Because early detection and warning is a high priority, many biosurveillance systems have begun to collect and analyze data from non-traditional sources [absenteeism records, over-the-counter drug sales, electronic laboratory reporting, internet searches (e.g. Google Flu Trends) and TT]. These sources may provide disease activity alerts earlier than conventional sources. Little is known about whether VA telephone program influenza data correlates with established influenza biosurveillance. Methods Veterans phoning VA’s TT system, and those admitted or seen at a VA facility with influenza or influenza-like-illness (ILI) diagnosis were included in this analysis. Influenza-specific ICD-9-CM coded emergency department (ED) and urgent care (UC) visits, hospitalizations, TT calls, and ILI outpatient visits were analyzed covering 2010–2011 and 2011–2012 influenza seasons (July 11, 2010–April 14, 2012). Data came from 80 VA Medical Centers and over 500 outpatient clinics with complete reporting data for the time period of interest. We calculated Spearman rank-order coefficients, 95% confidence intervals and p-values using Fisher’s z transformation to describe correlation between TT data and other influenza healthcare measures. For comparison of time trends, we plotted data for hospitalizations, ED/UC visits and outpatient ILI syndrome visits against TT encounters. We applied ESSENCE detection algorithms to identify high-level alerts for influenza activity. ESSENCE aberration detection was restricted to the 2011–2012 season because limited historical TT and outpatient data from 2009–2010 was available to accurately predict aberrancy in the 2010–2011 season. We then calculated the peak measure of healthcare utilization during both influenza seasons (2010–2011 and 2011–2012) for each data source and compared timing of peaks and alerts between TT and other healthcare encounters to assess maximum healthcare system usage and timeliness of surveillance. Results There were 7,044 influenza-coded calls, 564 hospitalizations, 1,849 emergency/urgent visits, and 416,613 ILI-coded outpatient visits. Spearman rank correlation coefficients were calculated for influenza-coded calls with hospitalizations (0.77); ED/UC visits (0.85); and ILI-outpatient visits (0.88), respectively (P< 0.0001 for all correlations). Peak influenza activity occurred on the same week or within 1 week across all settings for both seasons. For the 2011–2012 season, TT alerted with increased influenza activity before all other settings. Conclusions Data from VA telephone care correlates well with other VA data sources for influenza activity. TT may serve to augment these existing clinical data sources and provide earlier alerts of influenza activity. As a national health care system with a large patient population, VA could provide a robust early-warning system for influenza if ongoing biosurveillance activities are combined with TT data. Additional analyses are needed to understand and correlate TT with healthcare utilization and severity of illness.

  7. Natural immune responses against eight oncogenic human papillomaviruses in the ASCUS-LSIL Triage Study.

    PubMed

    Wilson, Lauren E; Pawlita, Michael; Castle, Phillip E; Waterboer, Tim; Sahasrabuddhe, Vikrant; Gravitt, Patti E; Schiffman, Mark; Wentzensen, Nicolas

    2013-11-01

    Only a subset of women with human papillomavirus (HPV) infections will become seropositive, and the factors influencing seroconversion are not well understood. We used a multiplex serology assay in women with mildly abnormal cytology results to examine seroreactivity to oncogenic HPV genotypes. An unbiased subset of women in the atypical squamous cell of undetermined significance /low-grade squamous intraepithelial lesion Triage Study provided blood samples at trial enrollment for serological testing. A Luminex assay based on glutathione s-transferase-L1 fusion proteins as antigens was used to test seroreactivity against eight carcinogenic HPV genotypes (16, 18, 31, 33, 35, 45, 52 and 58). We analyzed the relationship between seroprevalence in women free of precancer (N = 2,464) and HPV DNA status, age, sexual behavior and other HPV-related risk factors. The overall seroprevalence was 24.5% for HPV16 L1 and ?20% for 18L1 and 31L1. Among women free of precancer, seroprevalence peaked in women less than 29 years and decreased with age. Type-specific seroprevalence was associated with baseline DNA detection for HPV16 (OR = 1.36, 95%CI: 1.04-1.79) and HPV18 (OR = 2.31, 95%CI: 1.61-3.32), as well as for HPV52 and HPV58. Correlates of sexual exposure were associated with increased seroprevalence across most genotypes. Women who were current or former smokers were less likely to be seropositive for all eight of the tested oncogenic genotypes. The multiplex assay showed associations between seroprevalence and known risk factors for HPV infection across nearly all tested HPV genotypes but associations between DNA- and serostatus were weak, suggesting possible misclassification of the participants' HPV serostatus. PMID:23588935

  8. Using CT colonography as a triage technique after a positive faecal occult blood test in colorectal cancer screening

    PubMed Central

    Liedenbaum, M H; van Rijn, A F; de Vries, A H; Dekker, H M; Thomeer, M; van Marrewijk, C J; Hol, L; Dijkgraaf, M G W; Fockens, P; Bossuyt, P M M; Dekker, E; Stoker, J

    2009-01-01

    Objective: The purpose of this study was to evaluate the effectiveness of CT colonography (CTC) as a triage technique in faecal occult blood test (FOBT)-positive screening participants. Methods: Consecutive guaiac (G-FOBT) and immunochemical (I-FOBT) FOBT-positive patients scheduled for colonoscopy underwent CTC with iodine tagging bowel preparation. Each CTC was read independently by two experienced observers. Per patient sensitivity, specificity and positive and negative predictive values (PPV and NPV) were calculated based on double reading with different CTC cut-off lesion sizes using segmental unblinded colonoscopy as the reference standard. The acceptability of the technique to patients was evaluated with questionnaires. Results: 302 FOBT-positive patients were included (54 G-FOBT and 248 I-FOBT). 22 FOBT-positive patients (7%) had a colorectal carcinoma and 211 (70%) had a lesion ?6 mm. Participants considered colonoscopy more burdensome than CTC (p<0.05). Using a 6 mm CTC size cut-off, per patient sensitivity for CTC was 91% (95% CI 85% to 91%) and specificity was 69% (95% CI 60% to 89%) for the detection of colonoscopy lesions ?6 mm. The PPV of CTC was 87% (95% CI 80% to 93%) and NPV 77% (95% CI 69% to 85%). Using CTC as a triage technique in 100 FOBT-positive patients would mean that colonoscopy could be prevented in 28 patients while missing ?10 mm lesions in 2 patients. Conclusion: CTC with limited bowel preparation has reasonable predictive values in an FOBT-positive population and a higher acceptability to patients than colonoscopy. However, due to the high prevalence of clinically relevant lesions in FOBT-positive patients, CTC is unlikely to be an efficient triage technique in a first round FOBT population screening programme. PMID:19625276

  9. Visualizing spatio-temporal war casualty data in Google Earth - A case study of Map the Fallen (Invited)

    NASA Astrophysics Data System (ADS)

    Askay, S.

    2009-12-01

    Published on Memorial Day 2009, Map the Fallen is a Google Earth visualization of the 5500+ US and international soldiers that have died in Iraq and Afghanistan since 2001. In addition to providing photos, stories and links for each solider, the time-animated map visually connects hometowns to places of death. This novel way of representing casualty data brings the geographic reach and magnitude of the issue into focus together with the very personal nature of individual stories. Innovative visualizations techniques were used that illustrate the spatio-temporal nature of this information and to show the global reach and interconnectivity of this issue. Several of advanced KML techniques employed to create this engaging and performance-conscious map will be discussed during this session. These include: 1) the use of HTML iframes and javascript to minimize the KML size, and extensive cross-linking throughout content; 2) the creation of a time-animated, on-screen casualty counter; 3) the use of parabolic arcs to connect each hometown to place of death; 4) the use of concentric spirals to represent chronological data; and 5) numerous performance optimizations to ensure the 23K placemarks, 2500 screen overlays and nearly 250k line vertices performed well in Google Earth. This session will include a demonstration of the map, conceptual discussions of the techniques used, and some in-depth technical explanation of the KML code.

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

    PubMed Central

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

    2014-01-01

    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

  11. Decreased length of stay after addition of healthcare provider in emergency department triage: a comparison between computer-simulated and real-world interventions

    PubMed Central

    Al-Roubaie, Abdul Rahim; Goldlust, Eric Jonathan

    2013-01-01

    Objective (1) To determine the effects of adding a provider in triage on average length of stay (LOS) and proportion of patients with >6?h LOS. (2) To assess the accuracy of computer simulation in predicting the magnitude of such effects on these metrics. Methods A group-level quasi-experimental trial comparing the St. Louis Veterans Affairs Medical Center emergency department (1) before intervention, (2) after institution of provider in triage, and discrete event simulation (DES) models of similar (3) ‘before’ and (4) ‘after’ conditions. The outcome measures were daily mean LOS and percentage of patients with LOS >6?h. Results The DES-modelled intervention predicted a decrease in the %6-hour LOS from 19.0% to 13.1%, and a drop in the daily mean LOS from 249 to 200?min (p<0.0001). Following (actual) intervention, the number of patients with LOS >6?h decreased from 19.9% to 14.3% (p<0.0001), with the daily mean LOS decreasing from 247 to 210?min (p<0.0001). Conclusion Physician and mid-level provider coverage at triage significantly reduced emergency department LOS in this setting. DES accurately predicted the magnitude of this effect. These results suggest further work in the generalisability of triage providers and in the utility of DES for predicting quantitative effects of process changes. PMID:22398851

  12. A Randomized Controlled Trial Comparing Health and Quality of Life of Lung Transplant Recipients Following Nurse and Computer-Based Triage Utilizing Home Spirometry Monitoring

    PubMed Central

    Lindgren, Bruce R.; Robiner, William; Lindquist, Ruth; Hertz, Marshall; Carlin, Bradley P.; VanWormer, Arin

    2013-01-01

    Abstract Background: Lung transplantation is now a standard intervention for patients with advanced lung disease. Home monitoring of pulmonary function and symptoms has been used to follow the progress of lung transplant recipients in an effort to improve care and clinical status. The study objective was to determine the relative performance of a computer-based Bayesian algorithm compared with a manual nurse decision process for triaging clinical intervention in lung transplant recipients participating in a home monitoring program. Materials and Methods: This randomized controlled trial had 65 lung transplant recipients assigned to either the Bayesian or nurse triage study arm. Subjects monitored and transmitted spirometry and respiratory symptoms daily to the data center using an electronic spirometer/diary device. Subjects completed the Short Form-36 (SF-36) survey at baseline and after 1 year. End points were change from baseline after 1 year in forced expiratory volume at 1?s (FEV1) and quality of life (SF-36 scales) within and between each study arm. Results: There were no statistically significant differences between groups in FEV1 or SF-36 scales at baseline or after 1 year.: Results were comparable between nurse and Bayesian system for detecting changes in spirometry and symptoms, providing support for using computer-based triage support systems as remote monitoring triage programs become more widely available. Conclusions: The feasibility of monitoring critical patient data with a computer-based decision system is especially important given the likely economic constraints on the growth in the nurse workforce capable of providing these early detection triage services. PMID:24083367

  13. The Real War Will Never Get On Television An Analysis of Casualty Imagery in American Television Coverage of the Iraq War

    Microsoft Academic Search

    Sean Aday

    2004-01-01

    Abstract ,This paper reports the results of an analysis of battle and casualty imagery in television coverage of the 2003 Iraq War. A team of three graduate coders and two professors analyzed 200 hours of coverage aired from March 20 (the beginning of the war) through April 9 (the day the government,of Saddam Hussein was deposed). Ten hours a day

  14. Designing a disaster.

    PubMed

    Fletcher, Linnea; Justice, Stephanie; Rohrig, Lisa

    2015-01-01

    A mass casualty simulation was developed and implemented for senior-level nursing students in a large baccalaureate program. This simulation was developed to introduce students to rapid triage in an interactive and immersive experience. The purpose of the simulation was to provide students with a realistic, hands-on experience in a safe environment. Unlike other similar exercises, all students participated in the health care provider role rather than as observers or victims. Didactic content regarding triage and a short video preceded the surprise simulated "bus crash." The element of surprise was used to create the chaos and confusion that often accompanies these incidents. Fifteen victims were comprised of static manikins, high-fidelity human patient simulators, and live actors with various injuries. The students worked in small groups and assigned each victim an appropriate Simple Triage and Rapid Treatment triage category on the basis of what they learned in lecture. Participating students performed well on their final examinations on questions covering the triage content they learned in this unit and feedback regarding the simulated experience was overwhelmingly positive. This simulation could be adapted for the education of other health care providers who may be involved in a future mass casualty incident. PMID:25584452

  15. Deformations and intrusions of the passenger compartment as indicators of injury severity and triage in head-on collisions of non-airbag-carrying vehicles

    Microsoft Academic Search

    N Stefanopoulos; C Vagianos; M Stavropoulos; E Panagiotopoulos; J Androulakis

    2003-01-01

    In motor vehicle collisions the mechanism of injury is important in determining severity as well as for triage decisions in the pre-hospital phase of patient management. This study correlates deformation of the basic structures of the passenger compartment [windscreen, control panel (dashboard) and steering wheel] with occupants’ injuries in passenger vehicle head-on collisions involving non-airbag-carrying vehicles, with or without compartment

  16. Detection of Giardia lamblia, Entamoeba histolytica/Entamoeba dispar, and Cryptosporidium parvum Antigens in Human Fecal Specimens Using the Triage Parasite Panel Enzyme Immunoassay

    PubMed Central

    Garcia, Lynne S.; Shimizu, Robyn Y.; Bernard, Caroline N.

    2000-01-01

    The Triage parasite panel (BIOSITE Diagnostics, San Diego, Calif.) is a new qualitative enzyme immunoassay (EIA) panel for the detection of Giardia lamblia, Entamoeba histolytica/E. dispar, and Cryptosporidium parvum in fresh or fresh, frozen, unfixed human fecal specimens. By using specific antibodies, antigens specific for these organisms are captured and immobilized on a membrane. Panel performance was evaluated with known positive and negative stool specimens (a total of 444 specimens) that were tested by the standard ova and parasite (O&P) examination as the “gold standard,” including staining with both trichrome and modified acid-fast stains. Specimens with discrepant results between the reference and Triage methods were retested by a different method, either EIA or immunofluorescence. A number of samples with discrepant results with the Triage device were confirmed to be true positives. After resolution of discrepant results, the number of positive specimens and the sensitivity and specificity results were as follows: for G. lamblia, 170, 95.9%, and 97.4%, respectively; for E. histolytica/E. dispar, 99, 96.0%, and 99.1%, respectively; and for C. parvum, 60, 98.3%, and 99.7%, respectively. There was no cross-reactivity with other parasites found in stool specimens, including eight different protozoa (128 challenges) and three different helminths (83 challenges). The ability to perform the complete O&P examination should remain an option for those patients with negative parasite panel results but who are still symptomatic. PMID:10970380

  17. Care of World War II convoy casualties in the Kola area of north Russia. Part 2--The Royal Naval Auxiliary Hospital, Vaenga.

    PubMed

    McMillan, G H

    1996-01-01

    The Royal Naval Auxiliary Hospital at Vaenga, North Russia was operational from October 1942 to July 1945. Care and treatment were provided to 752 male and one female in-patients from Arctic convoy merchant ships and their escorts and Allied personnel who became sick or injured while in the Kola area. One hundred and forty nine of the men were casualties of enemy action. An account is given of the hospital's structure, staff, organisation and work. PMID:8776939

  18. Psychosocial outcomes of three triage methods for the management of borderline abnormal cervical smears: an open randomised trial

    PubMed Central

    2010-01-01

    Objective To assess which of three triage strategies for women with borderline abnormal cervical smear results in the best psychosocial outcomes. Design Pragmatic, non-blinded, multicentre, randomised controlled trial. Setting 18 family planning clinics across Australia, covering both urban and rural areas, between January 2004 and October 2006. Participants Women aged 16-70 years (n=314) who attended routine cervical screening and received a borderline cervical smear. Interventions Patients were randomly assigned to human papillomavirus (HPV) DNA testing (n=104), a repeat smear test at six months (n=106), or the patient’s informed choice of either test supported by a decision aid (n=104). Psychosocial outcomes were assessed at multiple time points over 12 months by postal questionnaire. Main outcome measures We assessed health related quality of life (SF36 mental health subscale), cognitive effects (such as perceived risk of cervical cancer, intrusive thoughts), affective outcomes (general anxiety [state-trait anxiety inventory]), specific anxiety about an abnormal smear (cervical screening questionnaire), and behavioural outcomes (sexual health behaviour and visits to the doctor) over 12 months of follow-up. Results At two weeks, some psychosocial outcomes were worse for women allocated to HPV testing compared with those in the smear testing group (SF36 vitality subscale: t=?1.63, df=131, P=0.10; intrusive thoughts ?2=8.14, df=1, P<0.01). Over 12 months, distress about the abnormal smear was lowest in women allocated to HPV testing and highest in the repeat smear testing group (t=?2.89, df=135, P<0.01). Intrusive thoughts were highest in patients allocated to HPV testing (25%, compared with 13% in the informed choice group; difference=12%, 95% CI ?1.1% to 25.1%). Women in the HPV DNA group and the informed choice group were more satisfied with their care than women allocated to repeat smear testing. Conclusions Although the psychosocial effect was initially worse for women allocated to HPV triage, over the full year of follow-up this intervention was better for women’s psychosocial health than repeat smear testing. Offering informed choice could have a small advantage for cognitive outcomes, but in view of the additional effort and logistical complexity that this intervention requires, HPV testing alone can be justified for most women.Trial Registration actr.org.au Identifier: 12605000111673 PMID:20179125

  19. Cosiesmic slope mass movements and its contribution to the Holocene landscape denudation: geological evidences and numerical estimations from SE Altai (Russia)

    Microsoft Academic Search

    Roman Nepop; Anna Agatova

    2010-01-01

    Strong earthquakes deform Earth's surface and affect the topography of mountain terrains. They can also induce widespread mass wasting which often cause most of the global damage and most of all casualties related to the earthquakes. Their abundant occurrence and large volumes of displaced material also indicate a great influence of seismically induced landslides on landscape denudation. Estimating earthquake magnitudes

  20. Road Casualties and Changes in Risky Driving Behavior in France Between 2001 and 2004 Among Participants in the GAZEL Cohort

    PubMed Central

    Salmi, Louis Rachid; Lafont, Sylviane; Chiron, Mireille; Lagarde, Emmanuel

    2009-01-01

    Objectives. We investigated behavioral changes in a large cohort of drivers to identify underlying causes of the decline in road casualties in France. Methods. In 2001 and 2004, 11 240 participants used self-administered questionnaires to report attitudes toward road safety and driving behaviors. Injury road traffic collisions were recorded from 2001 to 2005 through the cohort's annual questionnaire. Results. Between 2001 and 2004, speeding and cell phone use decreased concomitantly with a decrease in injury road traffic collision rates among participants. Reported driving while sleepy remained unchanged and driving while alcohol intoxicated was reported by a higher proportion in 2004 than in 2001. Decreases in speeding between 2001 and 2004 were strongly linked with positive attitudes toward road safety in 2001. Conclusions. In this cohort, speeding and using a cell phone while driving decreased over the 2001 to 2004 period concomitantly with increases in traffic law enforcement and a dramatic decline in road mortality in France. However, the deterrent effect of traffic enforcement policies may have been reduced by negative attitudes toward traffic safety and having had a history of traffic penalty cancellations. PMID:18923124

  1. The Simple Triage Scoring System (STSS) successfully predicts mortality and critical care resource utilization in H1N1 pandemic flu: a retrospective analysis

    PubMed Central

    2011-01-01

    Introduction Triage protocols are only initiated when it is apparent that resource deficits will occur across a broad geographical area despite efforts to expand or acquire additional capacity. Prior to the pandemic the UK Department of Health (DOH) recommended the use of a staged triage plan incorporating Sepsis-related Organ Failure Assessment (SOFA) developed by the Ontario Ministry of Health to assist in the triage of critical care admissions and discharges during an influenza outbreak in the UK. There are data to suggest that had it been used in the recent H1N1 pandemic it may have led to inappropriate limitation of therapy if surge capacity had been overwhelmed. Methods We retrospectively reviewed the performance of the Simple Triage Scoring System (STSS) as an indicator of the utilization of hospital resources in adult patients with confirmed H1N1 admitted to a university teaching hospital. Our aim was to compare it against the staged initial SOFA score process with regards to mortality, need for intensive care admission and requirement for mechanical ventilation and assess its validity. Results Over an 8 month period, 62 patients with confirmed H1N1 were admitted. Forty (65%) had documented comorbidities and 27 (44%) had pneumonic changes on their admission CXR. Nineteen (31%) were admitted to the intensive care unit where 5 (26%) required mechanical ventilation (MV). There were 3 deaths. The STSS group categorization demonstrated a better discriminating accuracy in predicting critical care resource usage with a receiver operating characteristic area under the curve (95% confidence interval) for ICU admission of 0.88 (0.78-0.98) and need for MV of 0.91 (0.83-0.99). This compared to the staged SOFA score of 0.77 (0.65-0.89) and 0.87 (0.72-1.00) respectively. Low mortality rates limited analysis on survival predictions. Conclusions The STSS accurately risk stratified patients in this cohort according to their risk of death and predicted the likelihood of admission to critical care and the requirement for MV. Its single point in time, accuracy and easily collected component variables commend it as an alternative reproducible system to facilitate the triage and treatment of patients in any future influenza pandemic. PMID:21269458

  2. The World Trade Center Attack: The paramedic response: an insider's view

    PubMed Central

    Cook, Louis

    2001-01-01

    The World Trade Center attack and collapse is the first time an aircraft has been used as a weapon of mass effect. The scale and magnitude of this manmade disaster can only be compared with a natural catastrophe such as the Armenian earthquake of December 1988. The importance of an incident command system and the Simple Triage and Rapid Treatment, and the need for fixed Casualty Collection Points, is explained. PMID:11737911

  3. Mortality among workers exposed to coal tar pitch volatiles and welding emissions: an exercise in epidemiologic triage.

    PubMed Central

    Silverstein, M; Maizlish, N; Park, R; Mirer, F

    1985-01-01

    The United Automobile Workers International Union has established a system of epidemiologic triage to evaluate patterns of mortality among groups of union members. In response to worker concerns, the Union examined mortality at a metal stamping plant, using a method which linked pension records with the State of Michigan computerized death registry. The observed proportion of malignant neoplasms was nearly twice that expected (95% Confidence Limits 1.36, 2.62). Two- to five-fold excess proportional mortality from cancer of the digestive organs, lung cancer, and leukemia accounted for most of the overall excess. Strong associations were found between lung and digestive organ cancer and employment as maintenance welders or millwrights in the plant (odds ratios greater than 10). High levels of six polycyclic aromatic hydrocarbons with mutagenic and carcinogenic properties were found during hot coal tar application to wood block floors, work conducted by the high-risk groups. These levels were substantially reduced following the purchase of new tar pots. The example demonstrates that epidemiologic tools can play a valuable role in occupational health decision making, but care must be taken to avoid mechanical reliance on quantitative testing and to acknowledge the important role of social and political value judgments in the establishment of responsible public policy. PMID:4051064

  4. Optically Stimulated Luminescence (OSL) of Tooth Enamel and its Potential Use in Post-Radiation Exposure Triage

    PubMed Central

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

    2009-01-01

    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 hours after irradiation and slower afterwards, (c) the fading rate of the luminescence signal varied between fragments, (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 to be not 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

  5. Mortality among workers exposed to coal tar pitch volatiles and welding emissions: an exercise in epidemiologic triage.

    PubMed

    Silverstein, M; Maizlish, N; Park, R; Mirer, F

    1985-11-01

    The United Automobile Workers International Union has established a system of epidemiologic triage to evaluate patterns of mortality among groups of union members. In response to worker concerns, the Union examined mortality at a metal stamping plant, using a method which linked pension records with the State of Michigan computerized death registry. The observed proportion of malignant neoplasms was nearly twice that expected (95% Confidence Limits 1.36, 2.62). Two- to five-fold excess proportional mortality from cancer of the digestive organs, lung cancer, and leukemia accounted for most of the overall excess. Strong associations were found between lung and digestive organ cancer and employment as maintenance welders or millwrights in the plant (odds ratios greater than 10). High levels of six polycyclic aromatic hydrocarbons with mutagenic and carcinogenic properties were found during hot coal tar application to wood block floors, work conducted by the high-risk groups. These levels were substantially reduced following the purchase of new tar pots. The example demonstrates that epidemiologic tools can play a valuable role in occupational health decision making, but care must be taken to avoid mechanical reliance on quantitative testing and to acknowledge the important role of social and political value judgments in the establishment of responsible public policy. PMID:4051064

  6. Mortality among workers exposed to coal tar pitch volatiles and welding emissions: an exercise in epidemiologic triage

    SciTech Connect

    Silverstein, M.; Maizlish, N.; Park, R.; Mirer, F.

    1985-11-01

    The United Automobile Workers International Union has established a system of epidemiologic triage to evaluate patterns of mortality among groups of union members. In response to worker concerns, the Union examined mortality at a metal stamping plant, using a method which linked pension records with the State of Michigan computerized death registry. The observed proportion of malignant neoplasms was nearly twice that expected. Two- to five-fold excess proportional mortality from cancer of the digestive organs, lung cancer, and leukemia accounted for most of the overall excess. Strong associations were found between lung and digestive organ cancer and employment as maintenance welders or millwrights in the plant. High levels of six polycyclic aromatic hydrocarbons with mutagenic and carcinogenic properties were found during hot coal tar application to wood block floors, work conducted by the high-risk groups. These levels were substantially reduced following the purchase of new tar pots. The example demonstrates that epidemiologic tools can play a valuable role in occupational health decision making, but care must be taken to avoid mechanical reliance on quantitative testing and to acknowledge the important role of social and political value judgments in the establishment of responsible public policy.

  7. Detecting benzodiazepines: immunoassays compared with negative chemical ionization gas chromatography/mass spectrometry.

    PubMed

    Fitzgerald, R L; Rexin, D A; Herold, D A

    1994-03-01

    We tested 231 urine samples by six immunoassay methods--EMIT d.a.u., EMIT II, Roche Abuscreen Online, Abbott TDx, Diagnostic Products Corp. (DPC) double-antibody radioimmunoassay (RIA), and Biosite Triage--and by negative chemical ionization gas chromatography/mass spectrometry to determine how the immunoassays performed on samples selected for suspected benzodiazepine use (n = 100) and in random urine drug screening (n = 131). In general, all of the assays were successful in detecting oxazepam and related metabolites, even at concentrations below the stated cutoffs. However, the negative predictive value of benzodiazepine immunoassays for samples selected for suspected benzodiazepine use ranged from 86% to 96%. A primary difference between the test kits was the ability of DPC RIA and Triage to detect lorazepam when other assays did not. Contrary to previous reports, pretreatment of specimens with glucuronidase was not necessary to detect oxazepam-related metabolites with these immunoassays. PMID:8131270

  8. Disaster medicine through Google Glass.

    PubMed

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

    2015-06-01

    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

  9. Medical lessons learnt from the US and Canadian experience of treating combat casualties from Afghanistan and Iraq.

    PubMed

    Dharm-Datta, Shreshth; McLenaghan, J

    2013-06-01

    The Winston Churchill Memorial Trust, established in 1965, funds Travelling Fellowships and both authors visited hospitals in Germany, Canada and the USA regarded as centres of excellence with expertise in the early care, reconstruction and rehabilitation of the combat casualties of our NATO Allies, as recipients of these Fellowships. This article presents some of the lessons learnt in the field of musculoskeletal trauma and rehabilitation from the Canadian and US military medical systems. In trauma, there were significant differences in wound debridement policy, use of external fixators for fractures, primary use of circular frames for open tibial fractures and a far more liberal use of bone morphogenetic protein in fracture treatment. Differences in soft tissue reconstruction policy regarding flaps for soft tissue cover over exposed bone, near-universal usage of topical negative pressure dressings and use of Allgöwer-Donati suture pattern to close all wounds were noted. Ertl amputation osteoplasty, a modified form of transtibial amputation, had also been reintroduced. In rehabilitation, the management of heterotopic ossification, in particular with imaging techniques and excision surgery, was identified. For the upper limb, we observed the patient training required to use a myoelectric hand and the future possibility of targeted muscle re-innervation to make controlling these myoelectric prostheses more natural using innate motor patterns. For the lower limb, we found we used identical above knee prostheses. For patients who have had limb reconstruction and have poor function, an energy-storing orthosis was demonstrated to compensate for the loss of range of motion and muscle power. PMID:23720592

  10. Safe management of mass fatalities following chemical, biological, and radiological incidents.

    PubMed

    Baker, David J; Jones, Kelly A; Mobbs, Shelly F; Sepai, Ovnair; Morgan, Dilys; Murray, Virginia S G

    2009-01-01

    Contaminated mass fatalities following the release of chemical, biological, or radiological agents pose a potential major health hazard. A United Kingdom government investigation has identified a number of areas of risk. This paper presents an outline of the findings of the study and describes specific pathways for the management of contaminated and non-contaminated fatalities. Factors determining the choice between cremation and burial are discussed. Effective decontamination remains a neglected area of study for both fatalities and casualties. PMID:19618352

  11. Rapid triage and transport of patients with ST-elevation myocardial infarction for percutaneous coronary intervention in a rural health system.

    PubMed

    Blankenship, James C; Haldis, Thomas A; Wood, G Craig; Skelding, Kimberly A; Scott, Thomas; Menapace, Francis J

    2007-09-15

    This study was conducted to evaluate door-to-treatment times before and after the implementation of a rapid triage and transfer system for patients with ST-elevation myocardial infarction transferred from community hospitals to a rural angioplasty center for primary percutaneous coronary intervention (PCI). The system was developed in late 2004 and implemented at a rural percutaneous coronary intervention center in early 2005. Helicopter transport was available for 97% of requests for transfer from community hospitals. All patients with ST-elevation myocardial infarction transferred during 2004 and 2005 (n=226) were evaluated with respect to presentation and treatment times. Time from community hospital presentation to wire crossing decreased during the study from 205 to 105 minutes (p=0.0001). One fourth of patients were treated <90 minutes after presentation, and 2/3 were treated in <120 minutes. In conclusion, the implementation of a rapid triage, transfer, and treatment protocol can achieve a significant shortening of presentation-to-treatment times. Efficient community hospitals working with an efficient angioplasty center can achieve presentation-to-wire crossing times of <90 minutes for some patients. PMID:17826374

  12. Psychosocial considerations for mass decontamination.

    PubMed

    Lemyre, Louise; Johnson, Colleen; Corneil, Wayne

    2010-11-01

    Mass exposure to explosions, infectious agents, foodborne illnesses, chemicals or radiological materials may require mass decontamination that have critical psychosocial implications for the public and for both traditional and non-traditional responders in terms of impact and of response. Five main issues are common to mass decontamination events: (i) perception, (ii) somatisation, (iii) media role and communication, (iv) information sharing, (v) behavioural guidance and (vi) organisational issues. Empirical evidence is drawn from a number of cases, including Chernobyl; Goiania, Brazil; the sarin gas attack in Tokyo; the anthrax attacks in the USA; Three Mile Island; and by features of the 2003 severe acute respiratory syndrome pandemic. In this paper, a common platform for mass casualty management is explored and suggestions for mass interventions are proposed across the complete event timeline, from pre-event threat and warning stages through to the impact and reconstruction phases. Implication for responders, healthcare and emergency infrastructure, public behaviour, screening processes, risk communication and media management are described. PMID:20924122

  13. Casualties of war: the infection control assessment of civilians transferred from conflict zones to specialist units overseas for treatment.

    PubMed

    Morton, H; Gray, J

    2015-08-01

    The casualties of global conflict attract media attention and sympathy in public, governmental, and non-governmental circles. Hospitals in developed countries offering specialist reconstructive or tertiary services are not infrequently asked to accept civilian patients from overseas conflict for complex surgical procedures or rehabilitation. Concern about the infection prevention and control risks posed by these patients, and the lack of a good evidence base on which to base measured precautions, means that the precautionary principle of accepting zero risk is usually followed. The aim of this article is to highlight infection control considerations that may be required when treating casualties from overseas conflict, based partly on our own experience. Currently there is a lack of published evidence and national consensus on how to manage these patients. The precautionary principle requires that there is an ongoing search for evidence and knowledge that can be used to move towards more traditional risk management. We propose that only by gathering the experiences of the many individual hospitals that have each cared for small numbers of such patients can such evidence and knowledge be assimilated. PMID:26002183

  14. Multicentre prospective validation of use of the Canadian C-Spine Rule by triage nurses in the emergency department

    PubMed Central

    Stiell, Ian G.; Clement, Catherine M.; O’Connor, Annette; Davies, Barbara; Leclair, Christine; Sheehan, Pamela; Clavet, Tamara; Beland, Christine; MacKenzie, Taryn; Wells, George A.

    2010-01-01

    Objectives The Canadian C-Spine Rule for imaging of the cervical spine was developed for use by physicians. We believe that nurses in the emergency department could use this rule to clinically clear the cervical spine. We prospectively evaluated the accuracy, reliability and acceptability of the Canadian C-Spine Rule when used by nurses. Methods We conducted this three-year prospective cohort study in six Canadian emergency departments. The study involved adult trauma patients who were alert and whose condition was stable. We provided two hours of training to 191 triage nurses. The nurses then assessed patients using the Canadian C-Spine Rule, including determination of neck tenderness and range of motion, reapplied immobilization and completed a data form. Results Of the 3633 study patients, 42 (1.2%) had clinically important injuries of the cervical spine. The kappa value for interobserver assessments of 498 patients with the Canadian C-Spine Rule was 0.78. We calculated sensitivity of 100.0% (95% confidence interval [CI] 91.0%–100.0%) and specificity of 43.4% (95% CI 42.0%–45.0%) for the Canadian C-Spine Rule as interpreted by the investigators. The nurses classified patients with a sensitivity of 90.2% (95% CI 76.0%–95.0%) and a specificity of 43.9% (95% CI 42.0%–46.0%). Early in the study, nurses failed to identify four cases of injury, despite the presence of clear high-risk factors. None of these patients suffered sequelae, and after retraining there were no further missed cases. We estimated that for 40.7% of patients, the cervical spine could be cleared clinically by nurses. Nurses reported discomfort in applying the Canadian C-Spine Rule in only 4.8% of cases. Conclusion Use of the Canadian C-Spine Rule by nurses was accurate, reliable and clinically acceptable. Widespread implementation by nurses throughout Canada and elsewhere would diminish patient discomfort and improve patient flow in overcrowded emergency departments. PMID:20457772

  15. Mass illness at an intermediate school: toxic fumes or epidemic hysteria

    SciTech Connect

    Krug, S.E. (Department of Pediatrics, Case Western Reserve University School of Medicine, Rainbow Babies and Childrens Hospital, Cleveland, OH (United States))

    1992-10-01

    The report of an acute illness involving a large number of clustered children will undoubtedly provoke an urgent emergency care response or, in some instances, a mass casualty or disaster response. While responding to the perceived needs of those involved, the professionals caring for these children must consider epidemic hysteria along with the other causes of mass illness. Since the early recognition of epidemic or mass anxiety hysteria can have tremendous impact on the ease of treating this problem, that awareness is quite important.

  16. Mass Burns Disaster in Abule-egba, Lagos, Nigeria from a Petroleum Pipeline Explosion Fire.

    PubMed

    Fadeyibi, I O; Omosebi, D T; Jewo, P I; Ademiluyi, S A

    2009-06-30

    The aim of this paper is to review the basic principles of triage in mass burns disasters and discuss the experience of the Lagos State University Teaching Hospital (LASUTH), Ikeja, Nigeria, in the December 2006 disaster at Abule-Egba, Lagos, Nigeria. It is hoped that the experience gained will help in the planning for and management of similar disasters in the developing countries with limited facilities. Burn injury has been described as the severest form of trauma and its management is very challenging as it is often accompanied by numerous pathophysiological changes. Successful management requires expert management by well-trained personnel in equipped and dedicated centres. In mass disasters the total number of victims may exceed the capability of the facility and its staff and a system for sorting out the patients and caring for those that will benefit from the facilities available needs to be developed. Other patients will either be sent to other medical facilities for further treatment or discharged after initial care for future follow-up. Documented experiences in the management of mass burns disasters from petroleum pipeline explosions from developing countries are rare. However, petroleum pipeline explosions, especially in the Lagos area of Nigeria, are relatively common. These cases have been associated with a variety of factors. The resulting morbidity and mortality have been high. LASUTH has a dedicated burns centre, which has received and managed many burn patients. Triage is the medical process of screening patients according to their need of treatment and the resources available. The aims and objectives of triage are discussed, its various levels described, and the final goals elaborated. All the burn victims involved in the 2006 disaster were studied, together with the triage carried out at different levels and the consequent sorting of the patients. Standard burns management was carried out. A total of 385 patients sustained burns of various degrees from the fire resulting from the explosion. On site, emergency department (ED) and intra-hospital triage were carried out. Ninety patients were brought to the LASUTH ED. Of these, 51 patients (56.67%) received first-aid treatment and were either discharged for out-patient follow-up or referred to secondary health care facilities. Twenty-eight (31.11%) out of the remaining 39 patients with burns in more than 70% total body surface area (TBSA) were categorized as unsalvageable and 11 (12.22%) with less than 70% TBSA as salvageable. All the patients in the unsalvageable group died (i.e. 100% mortality), while one patient died in the salvageable group (mortality rate, 9.09%). The mortality rate for the ruptured petroleum product pipeline incident was 84.16%; the fatality rate for all patients seen at LASUTH was 32.22%. The need for caution in the handling of petroleum products is discussed and the effectiveness of the triage system used is highlighted. In conclusion, burns from flammable petroleum products can be very dangerous and proper triage should therefore be carried out, with salvageable patients being managed by experts in dedicated burns centres. PMID:21991163

  17. First evaluation of the NHS Direct Online Clinical Enquiry Service: A Nurse-led Web Chat Triage Service for the Public

    PubMed Central

    Wyatt, Jeremy C; Tarpey, Aideen M; Murray, Gerard; Ingrams, Grant J

    2004-01-01

    Background NHS Direct is a telephone triage service used by the UK public to contact a nurse for any kind of health problem. NHS Direct Online (NHSDO) extends NHS Direct, allowing the telephone to be replaced by the Internet, and introducing new opportunities for informing patients about their health. One NHSDO service under development is the Clinical Enquiry Service (CES), which uses Web chat as the communication medium. Objective To identify the opportunities and possible risks of such a service by exploring its safety, feasibility, and patient perceptions about using Web chat to contact a nurse. Methods During a six-day pilot performed in an inner-city general practice in Coventry, non-urgent patients attending their GP were asked to test the service. After filling out three Web forms, patients used a simple Web chat application to communicate with trained NHS Direct triage nurses, who responded with appropriate triage advice. All patients were seen by their GP immediately after using the Web chat service. Safety was explored by comparing the nurse triage end point with the GP's recommended end point. In order to check the feasibility of the service, we measured the duration of the chat session. Patient perceptions were measured before and after using the service through a modified Telemedicine Perception Questionnaire (TMPQ) instrument. All patients were observed by a researcher who captured any comments and, if necessary, to assisted with the process. Results A total of 25 patients (mean age 48 years; 57% female) agreed to participate in the study. An exact match between the nurse and the GP end point was found in 45% (10/22) of cases. In two cases, the CES nurse proposed a less urgent end point than the GP. The median duration of Web chat sessions was 30 minutes, twice the median for NHS Direct telephone calls for 360 patients with similar presenting problems. There was a significant improvement in patients' perception of CES after using the service (mean pre-test TMPQ score 44/60, post-test 49/60; p=0.008 (2-tailed)). Patients volunteered several potential advantages of CES, such as the ability to re-read the answers from the nurse. Patients consider CES a useful addition to regular care, but not a replacement for it. Conclusions Based on this pilot, we can conclude that CES was sufficiently safe to continue piloting, but in order to make further judgments about safety, more tests with urgent cases should be performed. The Web chat sessions as conducted were too long and therefore too expensive to be sustainable in the NHS. However, the positive reaction from patients and the potential of CES for specific patient groups (the deaf, shy, or socially isolated) encourage us to continue with piloting such innovative communication methods with the public. PMID:15249266

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

    PubMed Central

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

    2013-01-01

    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

  19. 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

    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

    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

  20. The Ilizarov method for the treatment of complex tibial fractures and non-unions in a mass casualty setting: the 2005 earthquake in Pakistan.

    PubMed

    Tilkeridis, Konstantinos; Chari, Basavraj; Cheema, Nusrat; Tryfonidis, Marios; Khaleel, Arshad

    2015-04-01

    We report our experience in treating victims of the recent earthquake disaster in Pakistan. Our experience was based on two humanitarian missions to Islamabad: one in October 2005, 10 days after the earthquake, and the second in January 2006. The mission consisted of a team of orthopaedic surgeons and a second team of plastic surgeons. The orthopaedic team bought all the equipment for application of Ilizarov external fixators. We treated patients who had already received basic treatment in the region of the disaster and subsequently had been evacuated to Islamabad. During the first visit, we treated 12 injured limbs in 11 patients. Four of these patients were children. All cases consisted of complex multifragmentary fractures associated with severe crush injuries. All fractures involved the tibia, which were treated with Ilizarov external fixators. Nine fractures were type 3b open injuries. Eight were infected requiring debridement of infected bone and acute shortening. During a second visit, we reviewed all patients treated during our first mission. In addition, we treated 13 new patients with complex non-unions. Eight of these patients were deemed to be infected. All patients had previous treatment with monolateral fixators as well as soft tissue coverage procedures, except one patient who had had an IEF applied by another team. All these patients had revision surgery with circular frames. All patients from both groups were allowed to fully weight-bear post-operatively, after a short period of elevation to allow the flaps to take. Overall, all fractures united except one case who eventually had an amputation. Four patients had a corticotomy and lengthening, and three of them had a successful restoration of limb length. The fourth patient was the one with the eventual amputation. PMID:25764152

  1. Plasma Concentrations of Angiogenic/Anti-Angiogenic Factors Have Prognostic Value in Women Presenting With Suspected Preeclampsia to the Obstetrical Triage Area: A Prospective Study

    PubMed Central

    Chaiworapongsa, Tinnakorn; Romero, Roberto; Korzeniewski, Steven J; Cortez, Josef M; Pappas, Athina; Tarca, Adi L; Chaemsaithong, Piya; Dong, Zhong; Yeo, Lami; Hassan, Sonia S

    2014-01-01

    Objective To prospectively determine the prognostic value of maternal plasma concentrations of placental growth factor (PlGF), soluble endoglin (sEng) and soluble vascular endothelial growth factor receptors-1 and ?2 (sVEGFR-1 and ?2) in identifying patients with suspected preeclampsia (PE) who require preterm delivery (PTD) or develop adverse outcomes. Study design This prospective cohort study included 85 consecutive patients who presented to the obstetrical triage area at 20–36 weeks with a diagnosis of ‘rule out PE’. Patients were classified as: 1) those who remained stable until term (n=37); and 2) those who developed severe PE and required PTD (n=48). Plasma concentrations of PlGF, sEng and sVEGFR-1 and ?2 were determined by ELISA. Results Patients with PlGF/sVEGFR-1 ?0.05 multiples of the median (MoM) or PlGF/sEng ?0.07 MoM were more likely to deliver preterm due to PE [adjusted odd ratio (aOR) 7.4 and 8.8], and to develop maternal (aOR 3.7 and 2.4) or neonatal complications (aOR 10.0 and 10.1). Among patients who presented <34 weeks of gestation, PlGF/sVEGFR-1 ? 0.035 MoM or PlGF/sEng ?0.05 MoM had a sensitivity of 89% (16/18), specificity of 96% (24/25) and likelihood ratio for a positive test of 22 to identify patients who delivered within two weeks. The addition of the PlGF/sVEGFR-1 ratio to standard clinical tests improved the sensitivity at a fixed false-positive rate of 3% (p=0.004) for the identification of patients who were delivered due to PE within two weeks. Among patients who had a plasma concentration of PlGF/sVEGFR-1 ratio ? 0.035 MoM, 0.036–0.34 MoM and ? 0.35 MoM, the rates of PTD < 34 weeks were 94%, 27% and 7%, respectively. Conclusions The determination of angiogenic/anti-angiogenic factors has prognostic value in patients presenting to the obstetrical triage area with suspected preeclampsia for the identification of those requiring preterm delivery and at risk for adverse maternal/neonatal outcomes. PMID:23687930

  2. Triaging HPV-positive women with normal cytology by p16/Ki-67 dual-stained cytology testing: baseline and longitudinal data.

    PubMed

    Uijterwaal, Margot H; Polman, Nicole J; Witte, Birgit I; van Kemenade, Folkert J; Rijkaart, Dorien; Berkhof, Johannes; Balfoort-van der Meij, G A M A; Ridder, Ruediger; Snijders, Peter J F; Meijer, Chris J L M

    2015-05-15

    Primary human papillomavirus (HPV)-based screening results in a 2-5% lower specificity for cervical intraepithelial neoplasia Grade 2 or worse (CIN2+) compared to Pap cytology. To identify HPV-positive women with CIN2+, we retrospectively evaluated the cross-sectional and longitudinal performance of p16/Ki-67 dual-stained cytology in HPV-positive women with normal cytology participating in population-based cervical screening. Conventional Pap cytology specimens of 847 of these women derived from the VUSA-Screen study were dual-stained for p16/Ki-67. Cross-sectional clinical performance in detecting CIN3 or worse (CIN3+), and CIN2+ was compared to that of baseline HPV genotyping. Moreover, 5-year cumulative incidence risks (CIR) for CIN3+ (CIN2+) were determined. The sensitivity of p16/Ki-67 dual-stained cytology for CIN3+ (CIN2+) was 73.3% (68.8%) with a specificity of 70.0% (72.8%). HPV16/18 genotyping showed a sensitivity for CIN3+ (CIN2+) of 46.7% (43.8%), with a specificity of 78.3% (79.4%). The 5-year CIR for CIN3+ in HPV-positive women with normal cytology was 6.9%. Testing these women with p16/Ki-67 dual-stained cytology resulted in a significantly lower CIN3+ 5-year CIR of 3.3% (p = 0.017) in case of a negative test result. A negative HPV16/18 genotyping test result also led to a lower 5-year CIN3+ CIR of 3.6%. p16/Ki-67 dual-stained cytology detects more than 70% of underlying CIN3+ lesions in HPV-positive women with normal cytology at baseline and is therefore suitable for triaging these women to colposcopy. Furthermore, the CIN3+ 5-year CIR of 3.3% after a negative dual-stain result is significantly lower compared to the 5-year CIR of 6.9% in women without p16/Ki-67 dual-stained cytology triage. PMID:25345358

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

    PubMed

    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

    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

  4. Burn care in disaster and other austere settings.

    PubMed

    Jeng, James; Gibran, Nicole; Peck, Michael

    2014-08-01

    In some circumstances, burn care must be delivered in a simple manner without the luxury of modern resources. Such circumstances include care in low- and middle-income countries, war zones, and mass casualty incidents. Triage decisions need to be made carefully, allowing the focus of limited personnel and equipment on those most likely to survive. Simple techniques can be used to help many burn victims, such as utilizing oral resuscitation formulas for burn resuscitation. Although even the best attempts at preparation often fall short, there are many benefits from planning and training. PMID:25085095

  5. Towards an immersive virtual environment for medical team training.

    PubMed

    Lee, Chang Ha; Liu, Alan; Del Castillo, Sofia; Bowyer, Mark; Alverson, Dale; Muniz, Gilbert; Caudell, Thomas P

    2007-01-01

    Many computer based medical simulators focus on individual skills training. However, medical care is frequently rendered by teams. In addition, the conditions under which care is provided can be a crucial factor in training. For example, mass-casualty events can involve the management and triage of large numbers of victims under austere environments. Learning to care for the injured warfighter during combat requires realistic simulation of battlefield conditions. Current simulation systems do not adequately address team training requirements within lifelike environments. This paper describes our work toward the development of an immersive virtual environment that meets these needs. PMID:17377284

  6. Triage of Atypical Glandular Cell by SOX1 and POU4F3 Methylation: A Taiwanese Gynecologic Oncology Group (TGOG) Study

    PubMed Central

    Chang, Cheng-Chang; Ou, Yu-Che; Wang, Kung-Liahng; Chang, Ting-Chang; Cheng, Ya-Min; Chen, Chi-Hau; Chu, Tang-Yuan; Hsu, Shih-Tien; Liou, Wen-Shiung; Chang, Yin-Yi; Wu, Hua-Hsi; Chen, Tze-Ho; Lai, Hung-Cheng

    2015-01-01

    Introduction Invasive procedures including loop electrosurgical excision, cervical conization, and endometrial sampling are often recommended when atypical glandular cells (AGC) are detected on Pap smear with unsatisfactory colposcopy. These invasive procedures may result in patient anxiety, increased medical expense, and increasing the risk of preterm delivery in subsequent pregnancies. This study was performed to assess methylation biomarkers in the triage of AGC on Pap smear for invasive procedures. Methods We conducted a multicenter study in 13 medical centers in Taiwan from May 2012 to May 2014. A total of 55 samples diagnosed “AGC not otherwise specified” (AGC-NOS) were included. All patients with AGC underwent colposcopy, cervical biopsy, endometrial sampling, and conization if indicated. Multiplex quantitative methylation-specific polymerase chain reaction (QMSPCR) was performed. Sensitivity, specificity, and accuracy were calculated for detecting CIN3+ and endometrial complex hyperplasia. Results In 55 patients with AGC, the sensitivity for methylated (m) SOX1m, PAX1 m, ZNF582m,PTPRRm, AJAP1m, HS3ST2m, and POU4F3m for detecting CIN3+ and endometrial complex hyperplasia lesions was 100, 86, 71, 86, 86, 57, and 100%; specificity was 67, 79, 85, 50, 52, 96, and 52%, respectively. Testing for high risk-HPV had a sensitivity of 57% and specificity of 75% for CIN3+ and endometrial complex hyperplasia lesions. Conclusion Methylated (m) SOX1m and POU4F3m could be new methylation biomarkers for detection of CIN3+ and endometrial complex hyperplasia in AGC. Women with AGC and positive SOX1m / POU4F3m, colposcopy, cervical conization or endometrial sampling should be considered. PMID:26057869

  7. C-reactive protein and white blood cell count as triage test between urgent and nonurgent conditions in 2961 patients with acute abdominal pain.

    PubMed

    Gans, Sarah L; Atema, Jasper J; Stoker, Jaap; Toorenvliet, Boudewijn R; Laurell, Helena; Boermeester, Marja A

    2015-03-01

    The purpose of this article is to assess the diagnostic accuracy of C-reactive protein (CRP) and white blood cell (WBC) count to discriminate between urgent and nonurgent conditions in patients with acute abdominal pain at the emergency department, thereby guiding the selection of patients for immediate diagnostic imaging.Data from 3 large published prospective cohort studies of patients with acute abdominal pain were combined in an individual patient data meta-analysis. CRP levels and WBC counts were compared between patients with urgent and nonurgent final diagnoses. Parameters of diagnostic accuracy were calculated for clinically applicable cutoff values of CRP levels and WBC count, and for combinations.A total of 2961 patients were included of which 1352 patients (45.6%) had an urgent final diagnosis. The median WBC count and CRP levels were significantly higher in the urgent group than in the nonurgent group (12.8?×10/L; interquartile range [IQR] 9.9-16) versus (9.3?×10/L; IQR 7.2-12.1) and (46? mg/L; IQR 12-100 versus 10 ?mg/L; IQR 7-26) (P?50 ?mg/L and WBC count >15?×10/L were combined; however, 85.3% of urgent cases was missed.A high CRP level (>50? mg/L) combined with a high WBC count (>15?×10/L) leads to the highest PPV. However, this applies only to a small subgroup of patients (8.7%). Overall, CRP levels and WBC count are insufficient markers to be used as a triage test in the selection for diagnostic imaging, even with a longer duration of complaints (>48 ?hours). PMID:25738473

  8. MEDECOR--a medical decorporation tool to assist first responders, receivers, and medical reach-back personnel in triage, treatment, and risk assessment after internalization of radionuclides.

    PubMed

    Waller, Ed; Wilkinson, Diana

    2010-10-01

    After a radiological dispersal device (RDD) event, it is possible for radionuclides to enter the human body through inhalation, ingestion, and skin and wound absorption. From a health physics perspective, it is important to know the magnitude of the intake to perform dosimetric assessments. From a medical perspective, removal of radionuclides leading to dose aversion (hence risk reduction) is of high importance. The efficacy of medical decorporation strategies is extremely dependent upon the time of treatment delivery after intake. The "golden hour," or more realistically 3-4 h, is optimal when attempting to increase removal of radionuclides from extracellular fluids prior to cellular incorporation. To assist medical first response personnel in making timely decisions regarding appropriate treatment delivery modes, it is desirable to have a software tool that compiles existing radionuclide decorporation therapy data and allows a user to perform simple diagnosis leading to optimized decorporation treatment strategies. In its most simple application, the software is a large database of radionuclide decorporation strategies and treatments. The software can also be used in clinical interactive mode, in which the user inputs the radionuclide, estimated activity, route of intake and time since exposure. The software makes suggestions as to the urgency of treatment (i.e., triage) and the suggested therapy. Current developments include risk assessment which impacts the potential risk of delivered therapy and resource allocation of therapeutic agents. The software, developed for the Canadian Department of National Defence (DND), is titled MEDECOR (MEdical DECORporation). The MEDECOR tool was designed for use on both personal digital assistant and laptop computer environments. The tool was designed using HTML/Jscript, to allow for ease of portability amongst different computing platforms. This paper presents the features of MEDECOR, results of testing at a major NATO exercise, and future development of this tool into MEDECOR2. PMID:20838103

  9. [Triage risk screening tool (TRST) in screening elderly patients requiring the intervention of a mobile geriatric team: results of a pilot study].

    PubMed

    Duc, Sophie; Fernandez, Catherine; Moheb, Bahman; Dang, Van Mô; Bloch, Frederic; Floccia, Marie; Videau, Marie-Neige; Tournier Louvel, Sandrine; Ducastaing, Laure; Couturier, Pascal; Salles, Nathalie

    2015-03-01

    Improving care and health course for hospitalized elderly patients is one of the tasks set out in the "Rapport du parcours de santé des PAERPA" (elderly people with or at risk of functional decline). Identification of the needs of a mobile geriatric team (MGT) intervention for the patients remain difficult in emergency department and in medical surgical units. A screening tool is needed and should be simple and fast to use. Its implementation implies that it is efficient and previously validated. The aim of our study was to evaluate the validity and predictive performances of the Triage risk stratification tool (TRST) for identify patients aged over 75 years, requiring the intervention of the MGT. This is a prospective, national, multicenter study including consecutive patients aged 75 years and older, hospitalized in emergency services and medical-surgical units in September and October 2013. The TRST was considered positive when the score was greater than 2 of 5 points. A supplementary question with binary answer (yes/no) was asked to MGT, in order to define if MGT intervention was useful. This issue has served as a "gold standard" for assessing the validity and predictive test performance. In emergency departments, the TRST was performed in 427 patients, 347 were positive. Results showed high sensitivity (79%), and poor specificity (19%) of the test in emergency units, showing that TRST did not permit to identify patients requiring MGT intervention. In contrast, the TRST seems more performant in medical-surgical (n=63 patients) units with good predictive performances (positive predictive value 90% and negative predictive value 87%). The specificity of TRST in emergency services is insufficient to generalize its use. However, performances of the TRST in other units are encouraging to propose a validation as part of a national research project. PMID:25786424

  10. 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

    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

    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

  11. Radiation-induced changes in levels of selected proteins in peripheral blood serum of breast cancer patients as a potential triage biodosimeter for large-scale radiological emergencies.

    PubMed

    Deperas-Kaminska, Marta; Bajinskis, Ainars; Marczyk, Michal; Polanska, Joanna; Wersäll, Peter; Lidbrink, Elisabet; Ainsbury, Elizabeth A; Guipaud, Oliver; Benderitter, Marc; Haghdoost, Siamak; Wojcik, Andrzej

    2014-12-01

    The threat of a large scale radiological emergency, where thousands of people may require fast biological dosimetry for the purpose of triage, makes it necessary to search for new, high throughput biological dosimeters. The authors tested an assay based on the quantitative analysis of selected proteins in peripheral blood serum. They were particularly interested in testing proteins that are specific to irradiation of skin, as these can be used in cases of partial body exposure. Candidate proteins were identified in an earlier study with mice, where skin of the animals was exposed to different doses of radiation and global expression of serum proteins was analyzed. Eight proteins were found, the expression of which showed a consistent dose-response relationship. Human analogues of these proteins were identified, and their expression was measured in peripheral blood serum of 16 breast cancer patients undergoing external beam radiotherapy. The proteins were Apolipoprotein E; Apolipoprotein H; Complement protein 7; Prothrombinase; Pantothenate Kinase 4; Alpha-2-macroglobulin; Fetuin B and Alpha-1-Anti-Chymotrypsin. Measurements were carried out in blood samples collected prior to exposure (control), on the day after one fraction (2 Gy), on the day after five fractions (10 Gy), on the day after 10 fractions (20 Gy), and 1 mo after 23-25 fractions (total dose of 46-50 Gy). Multivariate analysis was carried out, and a multinomial logistic regression model was built. The results indicate that the combined analysis of Apolipoprotein E, Factor X, and Pantothenate Kinase 4 allows discriminating between exposure to 2 Gy and lower and between 10 Gy and higher. The discrimination is possible up to 1 mo after exposure. PMID:25353241

  12. Development of a tool for defining and identifying the dying patient in hospital: Criteria for Screening and Triaging to Appropriate aLternative care (CriSTAL)

    PubMed Central

    Cardona-Morrell, Magnolia; Hillman, Ken

    2015-01-01

    Objective To develop a screening tool to identify elderly patients at the end of life and quantify the risk of death in hospital or soon after discharge for to minimise prognostic uncertainty and avoid potentially harmful and futile treatments. Design Narrative literature review of definitions, tools and measurements that could be combined into a screening tool based on routinely available or obtainable data at the point of care to identify elderly patients who are unavoidably dying at the time of admission or at risk of dying during hospitalisation. Main measurements Variables and thresholds proposed for the Criteria for Screening and Triaging to Appropriate aLternative care (CriSTAL screening tool) were adopted from existing scales and published research findings showing association with either in-hospital, 30-day or 3-month mortality. Results Eighteen predictor instruments and their variants were examined. The final items for the new CriSTAL screening tool included: age ?65; meeting ?2 deterioration criteria; an index of frailty with ?2 criteria; early warning score >4; presence of ?1 selected comorbidities; nursing home placement; evidence of cognitive impairment; prior emergency hospitalisation or intensive care unit readmission in the past year; abnormal ECG; and proteinuria. Conclusions An unambiguous checklist may assist clinicians in reducing uncertainty patients who are likely to die within the next 3?months and help initiate transparent conversations with families and patients about end-of-life care. Retrospective chart review and prospective validation will be undertaken to optimise the number of prognostic items for easy administration and enhanced generalisability. Development of an evidence-based tool for defining and identifying the dying patient in hospital: CriSTAL. PMID:25613983

  13. Earthquakes and the office-based surgeon.

    PubMed Central

    Conover, W A

    1992-01-01

    A major earthquake may strike while a surgeon is performing an operation in an office surgical facility. A sudden major fault disruption will lead to thousands of casualties and widespread destruction. Surgeons who operate in offices can help lessen havoc by careful preparation. These plans should coordinate with other disaster plans for effective triage, evacuation, and the treatment of casualties. PMID:1413756

  14. 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

    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

    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

  15. Tax aspects of casualty losses 

    E-print Network

    Lehmann, August Herman

    1960-01-01

    is 3 Richard A. Dow v. Commissioner, 16 T. C. 1230. 4 Helvering, Commissioner of Internal Revenue v. Owens, 21 A. F. T. R. 1241. 5 Buttram v. Jones, 38 P. F. T. R. 1080. established by the Commissioner and Tax Court. The other follows 6 decisions... insurance claim was settled. P. more detailed discussion of this problem will be considered in Chapter V. There are four primary sources of federal income tax law. The sources are the statutes, regulations, administrative rulings, and court decisions...

  16. California Casualty First Aid America

    E-print Network

    Rose, Michael R.

    Dreamworks Dental & Implant Center Gentle Dental Greater Newport Physicians Health Net, Inc. Hoag Hospital Market Tustin MEDICAL Anaheim Eye Care Anaheim Regional Medical Center Anthem Blue Cross Delta Dental Optometric Center Vitalae Dental Spa VSP (Vision Services Plan) Westcliff Medical Center/Gateway Rehab

  17. Does telephone triage of emergency (999) calls using advanced medical priority dispatch (AMPDS) with Department of Health (DH) call prioritisation effectively identify patients with an acute coronary syndrome? An audit of 42 657 emergency calls to Hampshire Ambulance Service NHS Trust

    Microsoft Academic Search

    C D Deakin; D M Sherwood; A Smith; M Cassidy

    2006-01-01

    Introduction: The National Service Framework for Coronary Heart Disease requires identification of patients with an acute coronary syndrome (ACS) to enable prompt identification of those who may subsequently require pre-hospital thrombolysis. The Advanced Medical Priority Despatch System (AMPDS) with Department of Health (DH) call prioritisation is now the common triage tool for emergency (‘999’) calls in the UK. We retrospectively

  18. Emergency medical services in mass gatherings: the experience of the Formula 1 Grand Prix 'San Marino' in Imola.

    PubMed

    Nardi, R; Bettini, M; Bozzoli, C; Cenni, P; Ferroni, F; Grimaldi, R; Pezzi, A; Vivoli, M; Salcito, D; Gordini, G; Gambarin, R; Lavezzi, E; Lippi, R; Mazzolani, T; Montecuccoli, F; Prati, D; Simonetti, N; Ugolini, A; Zen, C

    1997-12-01

    Mass gatherings are special situations for which mass medical care must be preplanned. Acute emergencies occur at public gatherings and medical coverage on site has proven benefit. Responsibility of general plan, management of specific problems, transport planning, communications system, guidelines and protocols, special situations management, ancillary supports, sources of extra help for unforeseen needs are the most important items to consider. In mass gatherings the whole emergency medical service (EMS) planning and management has to depend on the emergency department direction, with its authority on all aspects of patient care in the EMS system. This report concerns the planning of EMS and of medical care in a situation at risk for mass casualties at the Formula I Grand Prix-Championship Racing 'San Marino' of Imola. PMID:9444507

  19. Triage for Struggling Adolescent Readers

    ERIC Educational Resources Information Center

    Diamond, Linda J.

    2006-01-01

    To improve achievement for struggling readers in particular, secondary schools must design programs and curricula to address students' lack of background knowledge, delayed English language development, and limited success in reading. In this article, the author presents a systems approach that offers intensive care for the most at-risk students…

  20. Data Triage Frederick Ralph Reiss

    E-print Network

    California at Irvine, University of

    tides of grad school. Many thanks to Tim, Meryl, Ally, Roehl, Mark, Helen, Lara, and Susan to make digital or hard copies of all or part of this work for personal or classroom use is granted first year at Berkeley. Joe's support and guidance have been essential in helping me to succeed in grad

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

    PubMed Central

    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

    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

  2. Steps required to inclusion in commercial ECG analysis systems--the new ECG indices for quantitating extent, acuteness and severity of acute myocardial ischemia for facilitating emergency triage decisions.

    PubMed

    Hampton, David R

    2014-01-01

    Clinically useful diagnostic methods for chest pain triage often fail to reach everyday practice where they can improve patient outcomes. One means to bridge the gap is through adoption of ECG interpretive algorithms with enhanced accuracy or expanded features into established commercial products. The transition from innovation to industry can be facilitated if researchers consider three factors aiding a successful handoff to companies. First, they should assess their algorithm to assure that it meets a real market need and can be easily assimilated by commercial partners. Second, their design documentation and databases should support the regulated development processes required of manufacturers. Finally, they should hold appropriate expectations for the structure of commercial partnerships that lead to release of a marketed product. PMID:24891263

  3. Triage of HR-HPV Positive Women with Minor Cytological Abnormalities: A Comparison of mRNA Testing, HPV DNA Testing, and Repeat Cytology Using a 4-Year Follow-Up of a Population-Based Study

    PubMed Central

    Persson, Maria; Elfström, K. Miriam; Brismar Wendel, Sophia; Weiderpass, Elisabete; Andersson, Sonia

    2014-01-01

    Objective Expression of the viral E6/E7 oncogenes of high-risk human papillomaviruses (HR-HPV) is necessary for malignant conversion and maintenance in cervical tissue. In order to determine whether HR-HPV E6/E7 mRNA testing more effectively predicts precancerous lesions and invasive cervical cancer than HR-HPV DNA testing, we aimed to compare triage using HR-HPV E6/E7 mRNA testing by APTIMA HPV Assay (APTIMA) to HPV16 DNA testing, HPV16/18 DNA testing, and repeat cytology. Methods Liquid-based (PreservCyt) cell samples were obtained from HR-HPV-positive women diagnosed with atypical squamous cells of undetermined significance (ASCUS) and low-grade squamous intraepithelial lesions (LSIL) within the framework of the population-based cervical cancer screening program in Stockholm, Sweden. Samples were tested for HR-HPV E6/E7 mRNA by APTIMA (Gene-Probe Inc., San Diego, CA, USA). Women were followed up for 4 years after the index cytology via medical and laboratory records, and the Stockholm Oncology Center. Results Nine of 25 (36%) women in the ASCUS group, and 64 of 180 (36%) women in the LSIL group developed cervical intraepithelial neoplasia (CIN) grade 2 or worse during 4 years of follow-up. 162 (74%) women were APTIMA-positive, and APTIMA had the highest sensitivity to predict CIN2 or worse and CIN3 or worse in the ASCUS (77.8% and 100%) and LSIL (78.1 and 75.8%) groups, although specificity was insufficient (<50%). HPV16 DNA testing and repeat cytology were more specific than APTIMA. Conclusion The results of this population-based study with comprehensive follow-up support the use of APTIMA as a triage test for women with ASCUS. More focused investigation is required for women with LSIL. PMID:24587193

  4. 3 Echo: concept of operations for early care and evacuation of victims of mass violence.

    PubMed

    Autrey, Allen W; Hick, John L; Bramer, Kurtis; Berndt, Jeremy; Bundt, Jonathan

    2014-08-01

    This report describes the successful use of a simple 3-phase approach that guides the initial 30 minutes of a response to blast and active shooter events with casualties: Enter, Evaluate, and Evacuate (3 Echo) in a mass-shooting event occurring in Minneapolis, Minnesota USA, on September 27, 2012. Early coordination between law enforcement (LE) and rescue was emphasized, including establishment of unified command, a common operating picture, determination of evacuation corridors, swift victim evaluation, basic treatment, and rapid evacuation utilizing an approach developed collaboratively over the four years prior to the event. Field implementation of 3 Echo requires multi-disciplinary (Emergency Medical Services (EMS), fire and LE) training to optimize performance. This report details the mass-shooting event, the framework created to support the response, and also describes important aspects of the concepts of operation and curriculum evolved through years of collaboration between multiple disciplines to arrive at unprecedented EMS transport times in response to the event. PMID:24909363

  5. Spatial Mass

    E-print Network

    Benjamin Nachman; Ariel Schwartzman

    2014-07-08

    In analogy to the transverse mass constructed from two objects, we define the spatial mass constructed from the input objects 3-vector momenta. This observable is insensitive to jet mass scale and resolution uncertainties when constructed from small-radius hadronic jets. Thus it improves the effective resolution on multijet masses for searches and measurements in hadronic final states. To illustrate the efficacy of the spatial mass, we consider a top quark mass measurement at the Large Hadron Collider (LHC) in the 3-jet final state. The reduction in uncertainty comes with a negligible cost in sensitivity.

  6. Mass loss

    NASA Technical Reports Server (NTRS)

    Goldberg, Leo

    1987-01-01

    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.

  7. Abdominal mass

    MedlinePLUS

    Mass in the abdomen ... the doctor make a diagnosis. For example, the abdomen is usually divided into four areas: Right-upper ... pain or masses include: Epigastric -- center of the abdomen just below the rib cage Periumbilical -- area around ...

  8. Guidance on the Use of Hand-Held Survey Meters for radiological Triage: Time-Dependent Detector Count Rates Corresponding to 50, 250, and 500 mSv Effective Dose for Adult Males and Adult Females

    SciTech Connect

    Bolch, W.E. [University of Florida; Hurtado, J.L. [University of Florida; Lee, C. [University of Florida; Manger, Ryan P [ORNL; Hertel, Nolan [Georgia Institute of Technology; Burgett, E. [Georgia Institute of Technology; Dickerson, W. [Armed Force Radiobiological Research Institute

    2012-01-01

    In June 2006, the Radiation Studies Branch of the Centers for Disease Control and Prevention held a workshop to explore rapid methods of facilitating radiological triage of large numbers of potentially contaminated individuals following detonation of a radiological dispersal device. Two options were discussed. The first was the use of traditional gamma cameras in nuclear medicine departments operated as makeshift wholebody counters. Guidance on this approach is currently available from the CDC. This approach would be feasible if a manageable number of individuals were involved, transportation to the relevant hospitals was quickly provided, and the medical staff at each facility had been previously trained in this non-traditional use of their radiopharmaceutical imaging devices. If, however, substantially larger numbers of individuals (100 s to 1,000 s) needed radiological screening, other options must be given to first responders, first receivers, and health physicists providing medical management. In this study, the second option of the workshop was investigated by the use of commercially available portable survey meters (either NaI or GM based) for assessing potential ranges of effective dose (G50, 50Y250, 250Y500, and 9500 mSv). Two hybrid computational phantoms were used to model an adult male and an adult female subject internally contaminated with 241Am, 60Cs, 137Cs, 131I, or 192Ir following an acute inhalation or ingestion intake. As a function of time following the exposure, the net count rates corresponding to committed effective doses of 50, 250, and 500 mSv were estimated via Monte Carlo radiation transport simulation for each of four different detector types, positions, and screening distances. Measured net count rates can be compared to these values, and an assignment of one of four possible effective dose ranges could be made. The method implicitly assumes that all external contamination has been removed prior to screening and that the measurements be conducted in a low background, and possibly mobile, facility positioned at the triage location. Net count rate data are provided in both tabular and graphical format within a series of eight handbooks available at the CDC website (http://www.bt.cdc.gov/radiation/clinicians/evaluation).

  9. Quark masses

    Microsoft Academic Search

    J. Gasser; H. Leutwyler

    1982-01-01

    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.

  10. Human Papillomavirus (HPV) DNA Triage of Women with Atypical Squamous Cells of Undetermined Significance with cobas 4800 HPV and Hybrid Capture 2 Tests for Detection of High-Grade Lesions of the Uterine Cervix

    PubMed Central

    Lapierre, Simon Grandjean; Sauthier, Philippe; Mayrand, Marie-Hélène; Dufresne, Simon; Petignat, Patrick; Provencher, Diane; Drouin, Pierre; Gauthier, Philippe; Dupuis, Marie-Josée; Michon, Bertrand; Ouellet, Stéphan; Hadjeres, Rachid; Ferenczy, Alex; Franco, Eduardo L.

    2012-01-01

    The triage of women with high-risk (HR) human papillomavirus (HPV)-positive smears for atypical squamous cells of undetermined significance (ASC-US) to colposcopy is now an integrated option in clinical guidelines. The performance of cobas 4800 HPV and that of Hybrid Capture 2 (HC2) for HR HPV DNA detection in cervical samples in PreservCyt were compared in 396 women referred to colposcopy for ASC-US. Of these, 316 did not have cervical intraepithelial neoplasia (CIN), 47 had CIN1, 29 had CIN2 or CIN3 (CIN2+), and 4 had CIN of unknown grade. HR HPV was detected in 129 (32.6%) and 149 (37.6%) samples with HC2 and cobas 4800 HPV, respectively (P = 0.15). The clinical sensitivities and specificities for detecting CIN2+ were 89.7% (95% confidence interval [CI], 72.8 to 97.2%) and 66.7% (95% CI, 61.7 to 71.3%) with cobas 4800 HPV and 93.1% (95% CI, 77.0 to 99.2%) and 72.2% (95% CI 67.4 to 76.5%) with HC2. The performance of cobas 4800 HPV was similar to that of HC2 for identifying women with ASC-US who would benefit the most from colposcopy. PMID:22301023

  11. 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.

  12. Scrotal masses

    MedlinePLUS

    ... in the scrotum, the sac that contains the testicles. ... Enlarged scrotum Painless or painful testicle lump ... If the scrotal mass is part of the testicle, it has a higher risk of being cancerous. ...

  13. 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.

  14. Mass action

    NSDL National Science Digital Library

    David Liao

    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.

  15. 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).

  16. Masses & Springs

    NSDL National Science Digital Library

    2012-12-27

    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.

  17. 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

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

    2014-10-01

    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

  18. Neutrino mass

    SciTech Connect

    Bowles, T.J.

    1993-04-01

    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.

  19. Neutrino mass

    SciTech Connect

    Bowles, T.J.

    1993-01-01

    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.

  20. Mass Extinction

    NSDL National Science Digital Library

    NOVA scienceNOW

    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.

  1. Mass Spectrometry

    NASA Astrophysics Data System (ADS)

    Smith, J. Scott; Thakur, Rohan A.

    Mass spectrometry (MS) is unique among the various spectroscopy techniques in both theory and instrumentation. As you may recall, spectroscopy involves the interaction of electromagnetic radiation or some form of energy with molecules. The molecules absorb the radiation and produce a spectrum either during the absorption process or as the excited molecules return to the ground state. MS works by placing a charge on a molecule, thereby converting it to an ion in a process called ionization. The generated ions are then resolved according to their mass-to-charge ratio (m/z) by subjecting them to electrostatic fields (mass analyzer) and finally detected. An additional stage of ion fragmentation may be included before detection to elicit structural information in a technique known as tandem MS. The result of ion generation, separation, fragmentation, and detection is manifested as a mass spectrum that can be interpreted to yield molecular weight or structural information. The uniqueness of this process allows the method to be used for both detection and identification of an unknown compound.

  2. Mass Audubon

    NSDL National Science Digital Library

    Founded in 1896 by two women with a passion for the protection of birds, Mass Audubon works to protect the nature of Massachusetts for people and wildlife. Its 100,000 members help care for 35,000 acres of conservation land. On its site, visitors can learn about its advocacy work through reports, policy papers, and educational outreach efforts. In the Our Conservation Network area, visitors can learn about Mass audubon's work in land conservation, ecological management, community reach, and climate change. Moving on, the Learn area features information about the Museum of American Bird Art, resources for young conservationists ("EcoKids"), and resources for school groups hoping to pay a visit to some of their land holdings. It's worth nothing that the News & Events area contains blogs, videos, press releases, and details on fun photo contests.

  3. Mass Disasters

    Microsoft Academic Search

    Cristina Cattneo; Danilo De Angelis; Marco Grandi

    A mass disaster is commonly construed as an event (air, naval, railway, or motorway accident, flooding, earthquake, and so\\u000a on), resulting in a large number of victims that need to be identified and subject to medicolegal investigation. Furthermore,\\u000a depending on which continent one comes from, innumerous protocols and procedures are available, the Interpol Disaster Victim\\u000a Identification form being the most

  4. Mass Sensor

    SciTech Connect

    Adams, B.E.

    2001-01-18

    The purpose of this CRADA was to use Honeywell's experience in low temperature cofire ceramics and traditional ceramics to assemble a relatively low-cost, mass-producible miniature mass analyzer. The specific design, given to us by Mass Sensors, LLC, was used to test for helium. The direct benefit for the participant was to have a prototype unit assembled for the purpose of proof of concept and the ability to secure venture capital investors. From that, the company would begin producing their own product for sale. The consumer/taxpayer benefits come from the wide variety of industries that can utilize this technology to improve quality of life. Medical industry can use this technology to improve diagnostic ability; manufacturing industry can use it for improved air, water, and soil monitoring to minimize pollution; and the law enforcement community can use this technology for identification of substances. These are just a few examples of the benefit of this technology. The benefits to DOE were in the area of process improvement for cofire and ceramic materials. From this project we demonstrated nonlinear thickfilm fine lines and spaces that were 5-mil wide with 5-mil spaces; determined height-to diameter-ratios for punched and filled via holes; demonstrated the ability to punch and fill 5-mil microvias; developed and demonstrated the capability to laser cut difficult geometries in 40-mil ceramic; developed and demonstrated coupling LTCC with standard alumina and achieving hermetic seals; developed and demonstrated three-dimensional electronic packaging concepts; and demonstrated printing variable resistors within 1% of the nominal value and within a tightly defined ratio. The capability of this device makes it invaluable for many industries. The device could be used to monitor air samples around manufacturing plants. It also could be used for monitoring automobile exhaust, for doing blood gas analysis, for sampling gases being emitted by volcanoes, for studying activities of insects, and many other things. The ultimate goal was to build two iterations of the mass sensor. However, due to technical difficulties, only one iteration of the device was manufactured. Initial work to optimize the ion source and build a small ion pump was not successful. Consequently, the ion pump was not incorporated into the analyzer design. Mass Sensors, LLC, is still testing the analyzers that were assembled.

  5. Mass Spectrometry

    NASA Astrophysics Data System (ADS)

    Pflieger, D.; Forest, E.; Vinh, J.

    For twenty years or so now, mass spectrometry has been used to get exact measurements of the mass of biological molecules such as proteins, nucleic acids,oligosaccharides, and so on. Over the past ten years, this technology has followed the trend toward miniaturisation and the samples required can be much smaller. In particular, the nanoelectrospray source (online or by needle) allow one to work at flow rates of a few tens of nanolitres/min. There are many applications, both in the field of proteomics and in the analysis of protein structure, dynamics, and interactions. Combining this source with nanoHPLC, complex mixtures only available in small quantities can be separated and analysed online. There are also some advantages over conventional HPLC, despite a set of constraints related to the small dimensions and low flow rates. Combining capillary electrophoresis with the electrospray source also gives useful results, with its own set of advantages and constraints. Finally, developments are currently underway to combine this source with chips, providing a means of separation and analysis online.

  6. Radiation-induced damage analysed by luminescence methods in retrospective dosimetry and emergency response.

    PubMed

    Woda, Clemens; Bassinet, Céline; Trompier, François; Bortolin, Emanuela; Della Monaca, Sara; Fattibene, Paola

    2009-01-01

    The increasing risk of a mass casualty scenario following a large scale radiological accident or attack necessitates the development of appropriate dosimetric tools for emergency response. Luminescence dosimetry has been reliably applied for dose reconstruction in contaminated settlements for several decades and recent research into new materials carried close to the human body opens the possibility of estimating individual doses for accident and emergency dosimetry using the same technique. This paper reviews the luminescence research into materials useful for accident dosimetry and applications in retrospective dosimetry. The properties of the materials are critically discussed with regard to the requirements for population triage. It is concluded that electronic components found within portable electronic devices, such as e.g. mobile phones, are at present the most promising material to function as a fortuitous dosimeter in an emergency response. PMID:19861735

  7. National road casualties and economic development

    Microsoft Academic Search

    David Bishai; Asma Quresh; Prashant James; Abdul Ghaffar

    2006-01-01

    Objective: This paper explores why traffic fatalities increase with GDP per capita in lower income countries and decrease with GDP per capita in wealthy countries.Methods: Data from 41 countries for the period 1992-1996 were obtained on road transport crashes, injuries, and fatalities as well as numbers of vehicles, kilometers of roadway, oil consumption, population, and GDP. Fixed effects regression was

  8. California Casualty (26) First Aid America (69)

    E-print Network

    Rose, Michael R.

    ) Anaheim Regional Medical Center (39) Anthem Blue Cross (42) Delta Dental (16) Dreamworks Dental & Implant Center (54) Gentle Dental (80) Greater Newport Physicians (12) Health Net, Inc. (32) Hoag Hospital (11) Vitalae Dental Spa (46) VSP (Vision Services Plan) (17) Westcliff Medical Center/Gateway Rehab

  9. War casualties on the home front

    SciTech Connect

    Brenda J. Flinn

    2005-11-01

    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.

  10. Casualties and Injuries Chart Cold Weather

    E-print Network

    Maxwell, Bruce D.

    adequate hydration and ensure nutritional requirements are met * POL - petoleum, oil, lubricants See http in the Cold Weather environment: Chilblain Cause l Repeated exposure of bare skin for prolonged periods from 20°- 60°F with high humidity (for those not acclimated to cold weather). Symptoms l Swollen, red skin

  11. Advanced Technology Applications for Combat Casualty Care

    NASA Technical Reports Server (NTRS)

    Watkins, Sharmila; Baumann, David; Wu, Jimmy

    2010-01-01

    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.

  12. Regenerative medicine applications in combat casualty care.

    PubMed

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

    2014-03-01

    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

  13. Bio-Terrorism Threat and Casualty Prevention

    SciTech Connect

    NOEL,WILLIAM P.

    2000-01-01

    The bio-terrorism threat has become the ''poor man's'' nuclear weapon. The ease of manufacture and dissemination has allowed an organization with only rudimentary skills and equipment to pose a significant threat with high consequences. This report will analyze some of the most likely agents that would be used, the ease of manufacture, the ease of dissemination and what characteristics of the public health response that are particularly important to the successful characterization of a high consequence event to prevent excessive causalities.

  14. Childhood casualties during civil war: Syrian experience.

    PubMed

    Çelikel, Adnan; Karbeyaz, Kenan; Kararslan, Bekir; Arslan, M Mustafa; Zeren, Cem

    2015-08-01

    In war areas a lot of children die as well as adults. According to UNICEF, almost 2 million children have died in the wars took place in the last 10 years. In this study, we aimed to evaluate demographical data and injury characteristics of Syrian children who were wounded in Syria Civil War and died while being treated in Turkey. Postmortem examination and autopsy reports of 985 forensic deaths from Hatay -a Syrian neighborhood city of Turkey-between January 2012 and August 2014 were analyzed retrospectively. Among 763 Syrian people who were wounded in the war and died while being treated in Turkey, 140 cases (18.3%) who were younger than 18 years of age were taken into the scope of this study. Among those cases 77.9% (n = 109) were male and 22.1% were female. Median ages of female cases are 14 (min-max: 2-18) and median age of female cases are 9 (min-max: 1-18). Frequency distribution is highest between 13 and 18 years of age (n: 71, 50.7%). In 70% (n: 98) of cases, cause of death is bombing and shrapnel injuries, 13.6% (19) of them were killed by gunshot wounds. According to injury sites most of the injuries were reported to be on multiple body parts (54.3%, n: 76) and only head and neck injuries (%30). Cause of death was intracranial bleeding and cerebral parenchymal injury in most of the cases (n: 66, %47.1) followed by vascular damage with external bleeding (n: 15, %10.7) and internal organ damage with internal bleeding (n: 15, %10.7). The cases had very high level Abbreviated Injury Scales and Injury Severity Sores. In conclusion, a lot of children have died in the Civil War of Syria. Their average abbreviated injury scale and injury severity score values reported very high. Children that we evaluated were mostly died of head and neck injuries predominantly caused by bombing attacks and Autopsies of them revealed fatal intracranial hemorrhages and parenchymal injuries. PMID:26165650

  15. Mass transfer andMass transfer and Mass transfer andMass transfer and

    E-print Network

    Zevenhoven, Ron

    eknik Mass transfer andMass transfer and arationste Mass transfer andMass transfer and separationSepa Massöverföring och separationsteknikMassöverföring och separationsteknik ("MÖF("MÖF--ST")ST") 4 erföringo 6. Mass transfer and convection6. Mass transfer and convection Massöve Ron Zevenhoven Åbo Akademi Universityy

  16. Mass transfer andMass transfer and Mass transfer andMass transfer and

    E-print Network

    Zevenhoven, Ron

    eknik Mass transfer andMass transfer and arationste Mass transfer andMass transfer and separationSepa Massöverföring och separationsteknikMassöverföring och separationsteknik ("MÖF("MÖF--ST")ST") 4 erföringo 8. Mass transfer8. Mass transfer with chemical reactionwith chemical reaction Massöve with chemical reactionwith

  17. Towards automated requirements prioritization and triage

    Microsoft Academic Search

    Chuan Duan; Paula Laurent; Jane Cleland-huang; Charles Kwiatkowski

    2009-01-01

    Time-to-market deadlines and budgetary restrictions require stakeholders to carefully prioritize requirements and determine\\u000a which ones to implement in a given product release. Unfortunately, existing prioritization techniques do not provide sufficient\\u000a automation for large projects with hundreds of stakeholders and thousands of potentially conflicting requests and requirements.\\u000a This paper therefore describes a new approach for automating a significant part of the

  18. Towards Training Set Reduction for Bug Triage

    Microsoft Academic Search

    Weiqin Zou; Yan Hu; Jifeng Xuan; He Jiang

    2011-01-01

    ? , instance selection algorithm Iterative Case Filter, and their combinations are studied in this paper. We evaluate the training set reduction on the bug data of Eclipse. For the training set, 70% words and 50% bug reports are removed after the training set reduction. The experimental results show that the new and small training sets can provide better accuracy

  19. 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...

  20. Campus Triage: Planning for Comprehensive Change.

    ERIC Educational Resources Information Center

    Gulley, Stuart; Floyd, Jeff

    2003-01-01

    Describes how LaGrange College organized, planned, and implemented several changes occurring within a 2-year period, including semester conversion, a new academic calendar, a new capital plan, and new facilities. Also addresses errors and how they were corrected. (EV)

  1. Computer Forensics Field Triage Process Model

    Microsoft Academic Search

    Marcus K. Rogers; James Goldman; Rick Mislan; Timothy Wedge; Steve Debrota

    2006-01-01

    With the proliferation of digital based evidence, the need for the timely identification, analysis and interpretation of digital evidence is becoming more crucial. In many investigations critical information is required while at the scene or within a short period of time - measured in hours as opposed to days. The traditional cyber forensics approach of seizing a system(s)\\/media, transporting it

  2. Mass shooting in Colorado: practice drills, disaster preparations key to successful emergency response.

    PubMed

    2012-10-01

    While EDs are accustomed to preparing for mass-casualty events, the EDs responsible for caring for the victims of the mass shooting at an Aurora, CO, movie theater on July 20, 2012, say the emotional impact of dealing with such a senseless, horrific event remains challenging. Still, the ED directors from the two hospitals who cared for the most patients that night credit established disaster-response procedures and regular practice drills with helping them to successfully manage the crisis. Within a 30-minute time period, the University of Colorado's Anschutz Medical Campus in Aurora, CO, received 23 critically ill or injured patients, one of which was deceased upon arrival.There were no additional fatalities among the remaining 22 patients. The Medical Center of Aurora received 18 patients, 13 of which where suffering from gun shot wounds; all survived. Hospital administrators say ED providers and staff have responded in different ways to the tragedy, but the emotional impact has been difficult for some. Resources, ranging from spiritual support and grief counselors to psychiatric help, have been made available to help ED personnel access the kind of help they need. PMID:23045762

  3. Advanced Trauma Life Support aboard RFA Argus.

    PubMed

    Greenslade, G L; Taylor, R H

    1992-01-01

    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

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

    Microsoft Academic Search

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

    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

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

    PubMed Central

    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

    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

  6. Does telephone triage of emergency (999) calls using advanced medical priority dispatch (AMPDS) with Department of Health (DH) call prioritisation effectively identify patients with an acute coronary syndrome? An audit of 42?657 emergency calls to Hampshire Ambulance Service NHS Trust

    PubMed Central

    Deakin, C D; Sherwood, D M; Smith, A; Cassidy, M

    2006-01-01

    Introduction The National Service Framework for Coronary Heart Disease requires identification of patients with an acute coronary syndrome (ACS) to enable prompt identification of those who may subsequently require pre?hospital thrombolysis. The Advanced Medical Priority Despatch System (AMPDS) with Department of Health (DH) call prioritisation is now the common triage tool for emergency (‘999') calls in the UK. We retrospectively examined patients with ACS to identify whether this triage tool had been able to allocate an appropriate emergency response. Methods All emergency calls to Hampshire Ambulance Service NHS Trust (HAST) from the Southampton area over an 8?month period (January to August 2004) were analysed. The classification allocated to the patient by AMPDS (version 10.4) was specifically identified. Data from the Myocardial Infarct National Audit Project) were obtained from the receiving hospital in Southampton to identify the actual number of patients with a true ACS. Results In total, 42?657 emergency calls were made to HAST from the Southampton area. Of these, 263 patients were subsequently diagnosed in hospital as having an ACS. Of these 263 patients, 76 presented without chest pain. Sensitivity of AMPDS for detecting ACS in this sample was 71.1% and specificity 92.5%. Positive predictive value was 5.6% (95% confidence interval 4.8 to 6.4%), and 12.5% (33/263) of patients with confirmed ACS were classified as non?life threatening (category B) incidents. Conclusion Only one of approximately every 18 patients with chest pain has an ACS. AMPDS with DH call prioritisation is not a tool designed for clinical diagnosis, and its extension into this field does not enable accurate identification of patients with ACS. PMID:16498168

  7. Healthcare ethics: the experience after the Haitian earthquake.

    PubMed

    Etienne, Mill; Powell, Clydette; Amundson, Dennis

    2010-01-01

    On January 12, 2010, a 7.0 Richter earthquake devastated Haiti and its public health infrastructure leading to a worldwide humanitarian effort. The United States sent forces to Haiti's assistance including the USNS Comfort, a tertiary care medical center on board a ship. Besides setting a transparent triage and medical regulating system, the leadership on the Comfort instituted a multidisciplinary Healthcare Ethics Committee to assist in delivering the highest level efficient care to the largest number of victims. Allocation of resources was based on time-honored ethics principles, the concept of mass casualty triage in the setting of resource constraints, and constructs developed by the host nation's Ministry of Health. In offering aid in austere circumstances, healthcare practitioners must not only adhere to the basic healthcare ethics principles but also practice respect for communities, cultures, and traditions, as well as demonstrate respect for the sovereignty of the host nation. The principles outlined herein should serve as guidance for future disaster relief missions. This work is in accordance with BUMEDINST 6010.25, Establishment of Healthcare Ethics Committees. PMID:20701171

  8. Effective Mass and Energy-Mass Relationship

    E-print Network

    Viktor Ariel

    2012-05-14

    The particle effective mass is often a challenging concept in solid state physics due to the many different definitions of the effective mass that are routinely used. Also, the most commonly used theoretical definition of the effective mass was derived from the assumption of a parabolic energy-momentum relationship, E(p), and therefore should not be applied to non-parabolic materials. In this paper, we use wave-particle duality to derive a definition of the effective mass and the energy-mass approximation suitable for non-parabolic materials. The new energy-mass relationship can be considered a generalization of Einstein's E=mc^2 suitable for arbitrary E(p) and therefore applicable to solid state materials and devices. We show that the resulting definition of the effective mass seems suitable for non-paraboic solid state materials such as HgCdTe, GaAs, and graphene.

  9. A High-Throughput Mass Spectrometry Assay Coupled with Redox Activity Testing Reduces Artifacts and False Positives in Lysine Demethylase Screening.

    PubMed

    Wigle, Tim J; Swinger, Kerren K; Campbell, John E; Scholle, Michael D; Sherrill, John; Admirand, Elizabeth A; Boriack-Sjodin, P Ann; Kuntz, Kevin W; Chesworth, Richard; Moyer, Mikel P; Scott, Margaret Porter; Copeland, Robert A

    2015-07-01

    Demethylation of histones by lysine demethylases (KDMs) plays a critical role in controlling gene transcription. Aberrant demethylation may play a causal role in diseases such as cancer. Despite the biological significance of these enzymes, there are limited assay technologies for study of KDMs and few quality chemical probes available to interrogate their biology. In this report, we demonstrate the utility of self-assembled monolayer desorption/ionization (SAMDI) mass spectrometry for the investigation of quantitative KDM enzyme kinetics and for high-throughput screening for KDM inhibitors. SAMDI can be performed in 384-well format and rapidly allows reaction components to be purified prior to injection into a mass spectrometer, without a throughput-limiting liquid chromatography step. We developed sensitive and robust assays for KDM1A (LSD1, AOF2) and KDM4C (JMJD2C, GASC1) and screened 13,824 compounds against each enzyme. Hits were rapidly triaged using a redox assay to identify compounds that interfered with the catalytic oxidation chemistry used by the KDMs for the demethylation reaction. We find that overall this high-throughput mass spectrometry platform coupled with the elimination of redox active compounds leads to a hit rate that is manageable for follow-up work. PMID:25755264

  10. Disaster management following explosion.

    PubMed

    Sharma, B R

    2008-01-01

    Explosions and bombings remain the most common deliberate cause of disasters involving large numbers of casualties, especially as instruments of terrorism. These attacks are virtually always directed against the untrained and unsuspecting civilian population. Unlike the military, civilians are poorly equipped or prepared to handle the severe emotional, logistical, and medical burdens of a sudden large casualty load, and thus are completely vulnerable to terrorist aims. To address the problem to the maximum benefit of mass disaster victims, we must develop collective forethought and a broad-based consensus on triage and these decisions must reach beyond the hospital emergency department. It needs to be realized that physicians should never be placed in a position of individually deciding to deny treatment to patients without the guidance of a policy or protocol. Emergency physicians, however, may easily find themselves in a situation in which the demand for resources clearly exceeds supply and for this reason, emergency care providers, personnel, hospital administrators, religious leaders, and medical ethics committees need to engage in bioethical decision-making. PMID:18522253

  11. [Disaster medicine].

    PubMed

    Carli, Pierre; Telionri, Caroline

    2015-01-01

    For over 30 years, the French hospital and pre-hospital medical teams are trained in disaster medicine. In fact, they are regularly confronted with the management of multiple casualties in accidents or even terrorist attacks, and more rarely to large-scale disasters. The intervention of physicians of the EMS system (SAMU-SMUR) in the field allows an original healthcare organization: in an advanced medical post, the victims are triaged according to their severity and benefit if needed of initial resuscitation. SAMU medical regulating center then organize their transport and repartition in several hospitals put on alert. To cope with a mass casualty situation, the hospital also has a specific organization, the White Plan. This plan, initiated by the director, assisted by a medico-administrative cell crisis can mobilize all the resources of the institution. Personnel are recalled and the ability of emergency units is increased. Care, less urgent, other patients are postponed. There are many plans for responding to disasters. ORSEC plans of the ministry of Interior articulate with the ORSAN plans of the ministry of Health. This complementarity allows a global mobilization of public services in disasters or exceptional medical situations. PMID:25842432

  12. Towards an evidence-based approach for diagnosis and management of adnexal masses: findings of the International Ovarian Tumour Analysis (IOTA) studies

    PubMed Central

    Kaijser, J.

    2015-01-01

    Whilst the outcomes for patients with ovarian cancer clearly benefit from centralised, comprehensive care in dedicated cancer centres, unfortunately the majority of patients still do not receive appropriate specialist treatment. Any improvement in the accuracy of current triaging and referral pathways whether using new imaging tests or biomarkers would therefore be of value in order to optimise the appropriate selection of patients for such care. An analysis of current evidence shows that such tests are now available, but still await recognition, acceptance and widespread adoption. It is therefore to be hoped that present guidance relating to the classification of ovarian masses will soon become more “evidence-based”. These promising tests include the International Ovarian Tumour Analysis (IOTA) LR2 model and ultrasound-based Simple Rules (SR). Based on a comprehensive recent meta-analysis both currently offer the optimal “evidence-based” approach to discriminating between cancer and benign conditions in women with adnexal tumours needing surgery. LR2 and SR are reliable tests having been shown to maintain a high sensitivity for cancer after independent external and temporal validation by the IOTA group in the hands of examiners with various levels of ultrasound expertise. They also offer more accurate triage compared to the existing Risk of Malignancy Index (RMI). The development of the IOTA ADNEX model represents an important step forward towards more individualised patient care in this area. ADNEX is a novel test that enables the more specific subtyping of adnexal cancers (i.e. borderline, stage 1 invasive, stage II-IV invasive, and secondary metastatic malignant tumours) and shares similar levels of accuracy to IOTA LR2 and SR for basic discrimination between cancer and benign disease. The IOTA study has made significant progress in relation to the classification of adnexal masses, however what is now needed is to see if these or new diagnostic tools can assist clinicians to select patients with adnexal masses that are suitable for expectant management, and that will work in all health care settings (i.e. primary vs secondary vs tertiary care). These important themes will likely control the future agenda of the IOTA project. PMID:25897371

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

    SciTech Connect

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

    2000-06-01

    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.

  14. Mass of the Earth

    NSDL National Science Digital Library

    2012-07-11

    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.

  15. Mass spectrometric immunoassay

    DOEpatents

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

    2005-12-13

    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.

  16. Imaging mass spectrometer with mass tags

    DOEpatents

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

    2010-06-01

    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.

  17. MASS CALC: Z CALCULATE THE Z MASS

    E-print Network

    Quigg, Chris

    Structure and properties of matter o Conservation of energy and increase in disorder o Interactions by measuring their decay products and using conservation laws. · Conservation laws and mass-energy conversion momentum conservation, energy conservation and two-dimensional vector addition to calculate the mass

  18. Mass of He-8

    E-print Network

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

    1977-01-01

    reaction Q value and mass excess. Deduced coefficients of IMME for the A=8 isobaric quintet. INTRODUCTION TABLE I. Summary of previous 8He mass measure- ments. Reaction Mass excess {MeV) Reference 26Mg {4He,SHe)22Mg "Mg{4He sHe)"Mg "O{4He SHe... an accurate 'He mass excess is that it represents the Tz=2 member of the A = 8 isobaric quintet. A = 8 is the only isobaric quintet in which the masses of all five members have been determined. The quadra- tic isobaric multiplet mass equation (IMME...

  19. mass communication advertising &

    E-print Network

    Finzi, Adrien

    mass communication advertising & public relations introduction. Graduate programs in the Department of Mass Communication, Advertising, and Public Relations provide an entry to a wide spectrum of careers the opportunity to create content, campaigns, strategy, and research in public relations, advertising

  20. On Gravity and Mass

    E-print Network

    Athanasios Markou

    2009-03-03

    Motivated mainly by the fact that no charged elementary particles having zero mass have been observed up to now, we investigate the question whether the mass of the elementary particles is connected with their electric charge and whether gravity can be derived from QED. The graviton is considered as a two-photon bound state. A relation between mass and charge of elementary particles is derived. Masses of the light quarks $d$ and $u$ are calculated from the electron mass, assuming that $d$, $u$ and $e$ are all fundamental and not composite. In this picture, the heavier quarks and leptons are considered as not fundamental, the massive neutral gauge bosons (and then their charged partners) are composite. The here calculated $u$ and $d$ quark masses, result in quark-mass ratios which display interesting regularities. The lightest quark mass turns out to be quite small. This may be interesting in connection to the strong CP problem.

  1. Digital Imaging Mass Spectrometry

    Microsoft Academic Search

    Casimir Bamberger; Uwe Renz; Andreas Bamberger

    2011-01-01

    Methods to visualize the two-dimensional (2D) distribution of molecules by mass spectrometric imaging evolve rapidly and yield\\u000a novel applications in biology, medicine, and material surface sciences. Most mass spectrometric imagers acquire high mass\\u000a resolution spectra spot-by-spot and thereby scan the object’s surface. Thus, imaging is slow and image reconstruction remains\\u000a cumbersome. Here we describe an imaging mass spectrometer that exploits

  2. Mass and Heat Recovery 

    E-print Network

    Hindawai, S. M.

    2010-01-01

    uses. Figure (1) showing the mass and heat recovery system (MHRS) layout . This layout can divided to four (4) sections : 1. Mass and heat collection (MHC) . 2. Mass and heat storage unit (MHSU) . 3. Heat recovery unit (HRU) . 4. Mass... recovery unit (MRU) . ESL-IC-10-10-56 Proceedings of the Tenth International Conference for Enhanced Building Operations, Kuwait, October 26-28, 2010 - 2 - ESL-IC-10-10-56 Proceedings of the Tenth International Conference for Enhanced...

  3. On Defining Mass

    ERIC Educational Resources Information Center

    Hecht, Eugene

    2011-01-01

    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…

  4. What is Mass Spectrometry?

    NSDL National Science Digital Library

    Chiu, Chia M.

    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?"

  5. Calculating centres of mass

    E-print Network

    Vickers, James

    Calculating centres of mass 15.2 Introduction In this section we show how the idea of integration as the limit of a sum can be used to find the centre of mass of an object such as a thin plate completing this Section you should be able to . . . calculate the position of the centre of mass

  6. Theories of fermion masses

    SciTech Connect

    Bagger, J.; Dimopoulos, S.; Georgi, H.; Raby, S.

    1984-05-01

    We present grand unified theories in which the quark masses and mixing angles are calculated in terms of the lepton masses through simple group theory. The theories contain no small Yukawa couplings. A favored value of the top quark mass is 35 GeV.

  7. Mass spectrometer mixture calibrations

    Microsoft Academic Search

    Hicks

    1986-01-01

    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.

  8. Fractional conservation of mass

    Microsoft Academic Search

    Stephen W. Wheatcraft; Mark M. Meerschaert

    2008-01-01

    The traditional conservation of mass equation is derived using a first-order Taylor series to represent flux change in a control volume, which is valid strictly for cases of linear changes in flux through the control volume. We show that using higher-order Taylor series approximations for the mass flux results in mass conservation equations that are intractable. We then show that

  9. Proliferation of Mass Destruction

    E-print Network

    Deutch, John

    Combating Proliferation of Weapons of Mass Destruction Report of the Commission to Assess the Organization of the Federal Government to Combat the Proliferation of Weapons of Mass Destruction Pursuant of the Federal Government to Combat the Proliferation of Weapons of Mass Destruction. The Commission

  10. Baryon masses with dynamical twisted mass fermions

    E-print Network

    ETM Collaboration; Constantia Alexandrou; Tomasz Korzec; Giannis Koutsou; Remi Baron; Pierre Guichon; Mariane Brinet; Jaume Carbonell; Vincent Drach; Zhaofeng Liu; Olivier Pène; Carsten Urbach

    2007-10-05

    We present results on the mass of the nucleon and the $\\Delta$ using two dynamical degenerate twisted mass quarks. The evaluation is performed at four quark masses corresponding to a pion mass in the range of 690-300 MeV on lattices of size 2.1 fm and 2.7 fm. We check for cutoff effects by evaluating these baryon masses on lattices of spatial size 2.1 fm with lattice spacings $a(\\beta=3.9)=0.0855(6)$ fm and $a(\\beta=4.05)=0.0666(6)$ fm, determined from the pion sector and find them to be within our statistical errors. Lattice results are extrapolated to the physical limit using continuum chiral perturbation theory. The nucleon mass at the physical point provides a determination of the lattice spacing. Using heavy baryon chiral perturbation theory at ${\\cal O}(p^3)$ we find $a(\\beta=3.9)=0.0879(12)$ fm, with a systematic error due to the chiral extrapolation estimated to be about the same as the statistical error. This value of the lattice spacing is in good agreement with the value determined from the pion sector. We check for isospin breaking in the $\\Delta$-system. We find that $\\Delta^{++,-}$ and $\\Delta^{+,0}$ are almost degenerate pointing to small flavor violating effects.

  11. Fourier transform mass spectrometry.

    PubMed

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

    2011-07-01

    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

  12. Main sequence mass loss

    SciTech Connect

    Brunish, W.M.; Guzik, J.A.; Willson, L.A.; Bowen, G.

    1987-01-01

    It has been hypothesized that variable stars may experience mass loss, driven, at least in part, by oscillations. The class of stars we are discussing here are the delta Scuti variables. These are variable stars with masses between about 1.2 and 2.25 M/sub theta/, lying on or very near the main sequence. According to this theory, high rotation rates enhance the rate of mass loss, so main sequence stars born in this mass range would have a range of mass loss rates, depending on their initial rotation velocity and the amplitude of the oscillations. The stars would evolve rapidly down the main sequence until (at about 1.25 M/sub theta/) a surface convection zone began to form. The presence of this convective region would slow the rotation, perhaps allowing magnetic braking to occur, and thus sharply reduce the mass loss rate. 7 refs.

  13. Mass spectra of copolymers.

    PubMed

    Montaudo, Maurizio S

    2002-01-01

    Recent and older literature (covering the last 12-13 years) in the field of mass spectra of random and block copolymers is reviewed. A detailed description is given of the information on copolymer properties that can be recovered from the analysis of the low-mass region of the spectrum (the region below 500 Da) and the high-mass region. The features of mass spectra of copolymers obtained by different synthetic routes are discussed, such as free radical, condensation, ring-chain equilibration, microbial synthesis, ring-opening, simple anionic, cationic, Ziegler-Natta, and/or metallocene catalysis, along with some random and block copolymers that occur in Nature. The emphasis is on copolymer composition and average molar mass determination, and on the benefits of coupling mass spectrometry (MS) with separation techniques such as size-exclusion chromatography (SEC) and high performance liquid chromatography (HPLC). PMID:12373747

  14. Energy-mass conversion

    NSDL National Science Digital Library

    Lawrence Berkeley National Laboratory. Particle Data Group

    2002-01-01

    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

  15. The critical mass Mup

    NASA Astrophysics Data System (ADS)

    Forieri, Claudio

    The importance of the rate of energy loss due to neutrinos for theoretical calculations of Mup, the upper limit on the mass of intermediate-mass stars (above which nondegenerate C ignition can occur), is investigated. The Mup models of Bertini et al. (1986) are combined with the neutrino-loss formulas of Beaudet et al. (1967) or Munakata et al. (1985), and the results are compared in tables and graphs. The Mup values estimated (5 solar mass for Z = 0.02 and 4.5 solar mass for Z = 0.001) are found to be unaffected by factor-of-two decreases in the neutrino-energy-loss rate.

  16. Atomic mass evaluation

    SciTech Connect

    Wang, M.; Audi, G.; Kondev, F. G.; Xu, X.; Pfeiffer, B. [CSNSM-IN2P3, Batiment108, 91405 Orsay Campus (France) and Max-Planck-Institut fuer Kernphysik, D-69117 Heidelberg (Germany); CSNSM-IN2P3, Batiment108, 91405 Orsay Campus (France); Argonne National Laboratory, 9700 S. Cass Avenue, Argonne, Illinois 60439 (United States); CSNSM-IN2P3, Batiment108, 91405 Orsay Campus (France) and Institute of Modern Physics, Chinese Academy of Sciences, 730000 Lanzhou (China); GSI Helmholtzzentrum fuer Schwerionenforschung, Planckstr. 1, D-64291 Darmstadt (Germany)

    2012-11-12

    The atomic masses are important input parameters for nuclear astrophysics calculations. The Atomic Mass Evaluation (AME) is the most reliable source for comprehensive information related to atomic masses. The latest AME was published in 2003. A new version, which will include the impact of a wealth of new, high-precision experimental data, will be published in December 2012. In this paper we will give the current status of AME2012. The mass surface has been changed significantly compared to AME2003, and the impact on astrophysics calculations is discussed.

  17. Digital Imaging Mass Spectrometry

    E-print Network

    Bamberger, Casimir; Bamberger, Andreas

    2011-01-01

    Methods to visualize the two-dimensional distribution of molecules by mass spectrometric imaging evolve rapidly and yield novel applications in biology, medicine, and material surface sciences. Most mass spectrometric imagers acquire high mass resolution spectra spot-by-spot and thereby scan the object's surface. Thus, imaging is slow and image reconstruction remains cumbersome. Here we describe an imaging mass spectrometer that exploits the true imaging capabilities by ion optical means for the time of flight mass separation. The mass spectrometer is equipped with the ASIC Timepix chip as an array detector to acquire the position, mass, and intensity of ions that are imaged by MALDI directly from the target sample onto the detector. This imaging mass spectrometer has a spatial resolving power at the specimen of (84\\pm35) \\mu m with a mass resolution of 45 and locates atoms or organic compounds on a surface area up to ~2 cm2. Extended laser spots of ~5 mm2 on structured specimens allowed parallel imaging of s...

  18. Urinary tract masses

    Microsoft Academic Search

    Diana L. Farmer

    2000-01-01

    Disorders of the urinary tract account for the majority of abdominal masses in infants. The most common causes of a flank mass in a neonate are a hydronephrotic kidney followed by a multicystic kidney. An increasing number of disorders resulting in hydronephrosis are diagnosed by prenatal ultrasound scan, and their natural history continues to be elucidated. This review will examine

  19. Measurement of Mass.

    ERIC Educational Resources Information Center

    Zimmerer, Robert W.

    1983-01-01

    Various instruments and techniques for measuring mass are discussed, focusing on the physics behind techniques employed. Equal-arm balances, electronic substitution balance (using electromagnetic force), non-gravimetric weighing (intertial-mass measurement) are among the instruments/techniques considered. (JN)

  20. Electromagnetic mass accelerators

    Microsoft Academic Search

    Pavel V. Kasyanenko; Vasily A. Efremov; Sergey A. Kharitonov

    2010-01-01

    The powerful power supplies system (up to 3 - 4 GW in impulse) was developed for the electromagnetic mass accelerator. Unique blocks of repeated switching rated on high currents (up to 1.2MA and voltage up to 5KV) are considered. In this paper various designs of the mass accelerator system and its power supplies are described.

  1. Force, mass and acceleration

    Microsoft Academic Search

    Phil Dalrymple; Richard Griffiths

    2005-01-01

    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

  2. Acceleration and Mass

    NSDL National Science Digital Library

    Michael Horton

    2009-05-30

    Although this lab is not an inquiry activity, it is very important in learning about acceleration and mass. It is a deeply held misconception among students that objects of different masses fall at different rates. Simply explaining that this is not true

  3. Multistage induction mass accelerator

    Microsoft Academic Search

    T. J. Burgess; M. Cowan

    1984-01-01

    The present investigation has the objective to discuss considerations which define the design and performance of a multistage, coaxial induction mass accelerator operating at high magnetic energy density. A review is presented of the magnetohydrodynamic computational model required to design, in detail, a high energy density, coaxial, magnetic induction mass accelerator. Attention is given to the derivation of the accelerator

  4. On the Photon Mass

    E-print Network

    Burra G. Sidharth

    2007-06-22

    We review the case for the photon having a tiny mass compatible with the experimental limits. We go over some possible experimental tests for such a photon mass including the violation of Lorentz symmetry. We point out that such violations may already have been witnessed in tests involving high energy gamma rays from outer space as also ultra high energy cosmic rays.

  5. The Origins of Mass

    SciTech Connect

    Lincoln, Don

    2014-07-30

    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.

  6. Calculating Relative Air Mass

    NSDL National Science Digital Library

    The GLOBE Program, UCAR (University Corporation for Atmospheric Research)

    2003-08-01

    The purpose of this activity is to introduce students to the concept of relative air mass and demonstrate how solar elevation angle affects the intensity of sunlight that reaches an observer on the ground. Students work in teams to calculate air mass using simple geometry. Teacher background materials are included.

  7. Geometry of mass.

    PubMed

    Dietrich, D D

    2015-08-01

    We study the effect of mass on geometric descriptions of gauge field theories. In an approach in which the massless theory resembles general relativity, the introduction of the mass entails non-zero torsion and the generalization to Einstein-Cartan-Sciama-Kibble theories. The relationships to pure torsion formulations (teleparallel gravity) and to higher gauge theories are also discussed. PMID:26124248

  8. Environmental Geomorphology Mass Wasting

    NSDL National Science Digital Library

    Bennington, J. Bret

    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.

  9. Absolute neutrino mass scale

    NASA Astrophysics Data System (ADS)

    Capelli, Silvia; Di Bari, Pasquale

    2013-04-01

    Neutrino oscillation experiments firmly established non-vanishing neutrino masses, a result that can be regarded as a strong motivation to extend the Standard Model. In spite of being the lightest massive particles, neutrinos likely represent an important bridge to new physics at very high energies and offer new opportunities to address some of the current cosmological puzzles, such as the matter-antimatter asymmetry of the Universe and Dark Matter. In this context, the determination of the absolute neutrino mass scale is a key issue within modern High Energy Physics. The talks in this parallel session well describe the current exciting experimental activity aiming to determining the absolute neutrino mass scale and offer an overview of a few models beyond the Standard Model that have been proposed in order to explain the neutrino masses giving a prediction for the absolute neutrino mass scale and solving the cosmological puzzles.

  10. Negative Mass Propulsion

    NASA Astrophysics Data System (ADS)

    Winterberg, F.

    Schrödinger's analysis of the Dirac equation gives a hint for the existence of negative masses hidden behind positive masses. But their use for propulsion by reducing the inertia of matter for example, in the limit of macroscopic bodied with zero rest mass, depends on a technical solution to free them from their imprisonment by positive masses. It appears that there are basically two ways this might be achieved: 1. By the application of strong electromagnetic or gravitational fields or by high particle energies. 2. By searching for places in the universe where nature has already done this separation, and from where the negative masses can be mined. The first of these two possibilities is for all practical means excluded, because if possible at all, it would depend on electromagnetic or gravitational fields with strength beyond what is technically attainable, or on extremely large likewise not attainable particle energies. With regard to the 2nd possibility, it has been observed that non-baryonic cold dark matter tends to accumulate near the center of galaxies, or places in the universe which have a large gravitational potential well. Because of the equivalence principle of general relativity, the attraction towards the center of a gravitational potential well, produced by a positive mass, is for negative masses the same as for positive masses, and large amounts of negative masses might have over billions of years been trapped in these gravitational potential wells. Now it just happens that the center of the moon is a potential well, not too deep that it cannot be reached by making a tunnel through the moon, not possible for the deeper potential well of the earth, where the temperature and pressure are too high. Making a tunnel through the moon, provided there is a good supply of negative mass, could revolutionize interstellar space flight. A sequence of thermonuclear shape charges would make such tunnel technically feasible.

  11. Mass loss at the lowest stellar masses

    E-print Network

    M. Fernandez; F. Comeron

    2005-06-14

    We report the discovery of a jet in a [SII] image of Par-Lup3-4, a remarkable M5-type pre-main sequence object in the Lupus 3 star-forming cloud. The spectrum of this star is dominated by the emission lines commonly interpreted as tracers of accretion and outflows. Par-Lup3-4 is therefore at the very low-mass end of the exciting sources of jets. High resolution spectroscopy shows that the [SII] line profile is double-peaked, implying that the low excitation jet is seen at a small angle (probably larger than 8 degrees) with respect to the plane of the sky. The width of the H_alpha line suggests a dominating contribution from the accretion columns and from the shocks on the stellar surface. Unresolved H_alpha emission coming from an object located at 4.2" from Par-Lup3-4 is detected at a position angle ~30 degrees or ~210 degrees, with no counterpart seen either in visible or infrared images.We also confirm previous evidence of strong mass loss from the very low mass star LS-RCrA 1, with spectral type M6.5 or later. All its forbidden lines are blueshifted with respect to the local standard of rest (LSR) of the molecular cloud at a position very close to the object and the line profile of the [OI] lines is clearly asymmetric. Thus, the receding jet could be hidden by a disk which is not seen edge-on. If an edge-on disk does not surround Par-Lup3-4 or LS-RCrA 1, an alternative explanation, possibly based on the effects of mass accretion, is required to account for their unusually low luminosities.

  12. Absolute neutrino mass measurements

    SciTech Connect

    Wolf, Joachim [Karlsruhe Institute of Technology (KIT), IEKP, Postfach 3640, 76021 Karlsruhe (Germany)

    2011-10-06

    The neutrino mass plays an important role in particle physics, astrophysics and cosmology. In recent years the detection of neutrino flavour oscillations proved that neutrinos carry mass. However, oscillation experiments are only sensitive to the mass-squared difference of the mass eigenvalues. In contrast to cosmological observations and neutrino-less double beta decay (0v2{beta}) searches, single {beta}-decay experiments provide a direct, model-independent way to determine the absolute neutrino mass by measuring the energy spectrum of decay electrons at the endpoint region with high accuracy.Currently the best kinematic upper limits on the neutrino mass of 2.2eV have been set by two experiments in Mainz and Troitsk, using tritium as beta emitter. The next generation tritium {beta}-experiment KATRIN is currently under construction in Karlsruhe/Germany by an international collaboration. KATRIN intends to improve the sensitivity by one order of magnitude to 0.2eV. The investigation of a second isotope ({sup 137}Rh) is being pursued by the international MARE collaboration using micro-calorimeters to measure the beta spectrum. The technology needed to reach 0.2eV sensitivity is still in the R and D phase. This paper reviews the present status of neutrino-mass measurements with cosmological data, 0v2{beta} decay and single {beta}-decay.

  13. Probabilistic Mass Growth Uncertainties

    NASA Technical Reports Server (NTRS)

    Plumer, Eric; Elliott, Darren

    2013-01-01

    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.

  14. Micromechanical Oscillating Mass Balance

    NASA Technical Reports Server (NTRS)

    Altemir, David A. (Inventor)

    1997-01-01

    A micromechanical oscillating mass balance and method adapted for measuring minute quantities of material deposited at a selected location, such as during a vapor deposition process. The invention comprises a vibratory composite beam which includes a dielectric layer sandwiched between two conductive layers. The beam is positioned in a magnetic field. An alternating current passes through one conductive layers, the beam oscillates, inducing an output current in the second conductive layer, which is analyzed to determine the resonant frequency of the beam. As material is deposited on the beam, the mass of the beam increases and the resonant frequency of the beam shifts, and the mass added is determined.

  15. Intraventricular mass lesions

    SciTech Connect

    Morrison, G.; Sobel, D.F.; Kelley, W.M.; Norman, D.

    1984-11-01

    Determining the precise etiology of an intraventricular mass can be a difficult diagnostic problem. CT and angiographic findings were reviewed in a series of 73 patients who had intraventricular masses. The histologic diagnosis can be suggested preoperatively by an analysis of the frequency of lesions occurring at a given ventricular location, lesion density before and after administration of contrast material, age, and sex of the patient, morphologic appearance of the mass, and presence or absence of hydrocephalus. Angiography is useful when meningioma, choroid plexus papilloma and carcinoma, or arteriovenous malformation are considered.

  16. Mass of Cu-57

    E-print Network

    Gagliardi, Carl A.; Semon, D. R.; Tribble, Robert E.; Vanausdeln, L. A.

    1986-01-01

    groups on the counter. In order to minimize deadtime, the b,E and E thresholds were set above the tri- ton group, and a single channel analyzer set to trigger on the mass 6 group in the TOF spectrum was used as a veto. A 28 pm thick Kapton absorber... 4, 6, and 8 groups are indicated. The gap in the mass 6 group was caused by the veto discussed in the text. Data taken without the Kapton absorber between the AE and E counters included an intense group between the mass 6 and 8 peaks due to Li...

  17. Centre of Mass, Moments, Torque Centre of Mass

    E-print Network

    Feldman, Joel

    Centre of Mass, Moments, Torque Centre of Mass If you support a body at its center of mass (in a uniform gravitational field) it balances perfectly. That's the definition of the center of mass of the body. If the body consists of a m1 m2 m3 m4 finite number of masses m1, · · · , mn attached

  18. Mass spectrometry of proteins of known mass Andrew D. Miranker*

    E-print Network

    Miranker, Andrew

    Commentary Mass spectrometry of proteins of known mass Andrew D. Miranker* Department of Molecular measurements in biochemistry are as fundamental as mass. Whereas the mass of a macromolecule is often in- ferred by its migration through polymer gels, direct measure may only be deter- mined by mass

  19. Top Quark Mass Measurements

    E-print Network

    A. P. Heinson; for the CDF Collaboration; D0 Collaboration

    2006-09-18

    First observed in 1995, the top quark is one of a pair of third-generation quarks in the Standard Model of particle physics. It has charge +2/3e and a mass of 171.4 GeV, about 40 times heavier than its partner, the bottom quark. The CDF and D0 collaborations have identified several hundred events containing the decays of top-antitop pairs in the large dataset collected at the Tevatron proton-antiproton collider over the last four years. They have used these events to measure the top quark's mass to nearly 1% precision and to study other top quark properties. The mass of the top quark is a fundamental parameter of the Standard Model, and knowledge of its value with small uncertainty allows us to predict properties of the as-yet-unobserved Higgs boson. This paper presents the status of the measurements of the top quark mass.

  20. [Small renal mass].

    PubMed

    Prokofiev, D; Kreutzer, N; Kress, A; Wissing, F; Pfeifer, H; Stolzenburg, J-U; Dietel, A; Schwalenberg, T; Do, M; Truß, M C

    2012-10-01

    The frequent application of ultrasound and radiological imaging for non-urological indications in recent years has resulted in an increase in the diagnosis of small renal masses. The treatment options for patients with a small renal mass include active surveillance, surgery (both open and minimally invasive) as well as ablative techniques. As there is a risk for metastatic spread even in small renal masses surgical extirpation remains the treatment of choice in most patients. Ablative procedures, such as cryoablation and radiofrequency ablation are appropriate for old and multi-morbid patients who require active treatment of a small renal mass. Active surveillance is an alternative for high-risk patients. Meticulous patient selection by the urologist and patient preference will determine the choice of treatment option in the future. PMID:23053040

  1. Laser probe mass spectrometry

    NASA Astrophysics Data System (ADS)

    Campana, Joseph E.

    1991-04-01

    Fourier transform mass spectrometry (FT/MSR) has been recognized as a powerful analytical technique for the determination of elemental compositions and the molecular structure of materials. The simultaneous measurement of all species, produced in a single event, in a Fourier transform mass spectrometer provides a natural combination with pulsed lasers, where the pulsed laser is used to ablate and ionize a portion of a sample. This unique combination of lasers with FTMS provides elemental and molecular information from inorganic and organic materials and from surface layers and from bulk materials. Microanalysis of materials, allowing spatially-resolved high-resolution mass spectra to be obtained, is possible with small laser spot sizes and optical systems for viewing samples inside the mass spectrometer. The advantages of FTMS are reviewed, and several examples of laser probe FTMS are illustrated to demonstrate applications of the technique to industrial problem solving.

  2. MASS POLITICAL MOBILIZATION

    E-print Network

    -cut manner before voters.1 Unsurprisingly, political parties are a pervasive phenomenon in representative dem ................................................................................................................................................... MASS POLITICAL MOBILIZATION ................................................................................................................................................... Boix & Stokes: The Oxford Handbook of Comparative Politics Boixandstokes-chap21 Revise Proof page 497

  3. Mass Anomalies on Ganymede

    Microsoft Academic Search

    G. Schubert; J. D. Anderson; R. A. Jacobson; E. L. Lau; W. B. Moore; J. Palguta

    2004-01-01

    Analysis of radio Doppler data from the Galileo spacecraft's flybys of Ganymede has detected the existence of mass anomalies on Ganymede that plausibly lie near the interface between the ice and silicate shells and near the surface.

  4. 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.

  5. Evidence for Hidden Mass

    NSDL National Science Digital Library

    2012-08-03

    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.

  6. Direct neutrino mass measurements

    NASA Astrophysics Data System (ADS)

    Thümmler, T.

    2011-07-01

    The determination of the neutrino rest mass plays an important role at the intersections of cosmology, particle physics and astroparticle physics. This topic is currently being addressed by two complementary approaches in laboratory experiments. Neutrinoless double beta decay experiments probe whether neutrinos are Majorana particles and determine an effective neutrino mass value. Single beta decay experiments such as KATRIN and MARE investigate the spectral shape of ?-decay electrons close to their kinematic endpoint in order to determine the neutrino rest mass with a model-independent method. Owing to neutrino flavour mixing, the neutrino mass parameter appears as an average of all neutrino mass eigenstates contributing to the electron neutrino. The KArlsruhe TRItium Neutrino experiment (KATRIN) is currently the experiment in the most advanced status of commissioning. Applying an ultra-luminous molecular windowless gaseous tritium source and an integrating high-resolution spectrometer of MAC-E filter type, it allows ?-spectroscopy close to the T 2 end-point with unprecedented precision and will reach a sensitivity of 200 meV/ c 2 (90% C.L.) on the neutrino rest mass.

  7. Forensic Mass Spectrometry.

    PubMed

    Hoffmann, William D; Jackson, Glen P

    2015-07-22

    Developments in forensic mass spectrometry tend to follow, rather than lead, the developments in other disciplines. Examples of techniques having forensic potential born independently of forensic applications include ambient ionization, imaging mass spectrometry, isotope ratio mass spectrometry, portable mass spectrometers, and hyphenated chromatography-mass spectrometry instruments, to name a few. Forensic science has the potential to benefit enormously from developments that are funded by other means, if only the infrastructure and personnel existed to adopt, validate, and implement the new technologies into casework. Perhaps one unique area in which forensic science is at the cutting edge is in the area of chemometrics and the determination of likelihood ratios for the evaluation of the weight of evidence. Such statistical techniques have been developed most extensively for ignitable-liquid residue analyses and isotope ratio analysis. This review attempts to capture the trends, motivating forces, and likely impact of developing areas of forensic mass spectrometry, with the caveat that none of this research is likely to have any real impact in the forensic community unless: (a) The instruments developed are turned into robust black boxes with red and green lights for positives and negatives, respectively, or (b) there are PhD graduates in the workforce who can help adopt these sophisticated techniques. PMID:26070716

  8. Mass Spectrometers in Space!

    NASA Technical Reports Server (NTRS)

    Brinckerhoff, William B.

    2012-01-01

    Exploration of our solar system over several decades has benefitted greatly from the sensitive chemical analyses offered by spaceflight mass spectrometers. When dealing with an unknown environment, the broadband detection capabilities of mass analyzers have proven extremely valuable in determining the composition and thereby the basic nature of space environments, including the outer reaches of Earth s atmosphere, interplanetary space, the Moon, and the planets and their satellites. Numerous mass analyzer types, including quadrupole, monopole, sector, ion trap, and time-of-flight have been incorporated in flight instruments and delivered robotically to a variety of planetary environments. All such instruments went through a rigorous process of application-specific development, often including significant miniaturization, testing, and qualification for the space environment. Upcoming missions to Mars and opportunities for missions to Venus, Europa, Saturn, Titan, asteroids, and comets provide new challenges for flight mass spectrometers that push to state of the art in fundamental analytical technique. The Sample Analysis at Mars (SAM) investigation on the recently-launch Mars Science Laboratory (MSL) rover mission incorporates a quadrupole analyzer to support direct evolved gas as well as gas chromatograph-based analysis of martian rocks and atmosphere, seeking signs of a past or present habitable environment. A next-generation linear ion trap mass spectrometer, using both electron impact and laser ionization, is being incorporated into the Mars Organic Molecule Analyzer (MOMA) instrument, which will be flown to Mars in 2018. These and other mass spectrometers and mission concepts at various stages of development will be described.

  9. Individual masses of paired galaxies

    Microsoft Academic Search

    I. D. Karachentsev

    1985-01-01

    Individual mass estimates are tabulated for 227 galaxies listed in the author's catalog of isolated pairs. The masses are derived from rotation curves, the 21-cm profile width, or the stellar radial-velocity dispersion in the central part of each galaxy. Comparison of the estimated orbital mass against the combined individual masses in a pair indicates that most of the components' mass

  10. Mass gap from pressure inequalities

    E-print Network

    Tamas S. Biro; Andras Laszlo; Peter Van

    2006-12-07

    We prove that a temperature independent mass distribution is identically zero below a mass threshold (mass gap) value, if the pressure satisfies certain inequalities. This supports the finding of a minimal mass in quark matter equation of state by numerical estimates and by substitution of analytic formulas. We present a few inequalities for the mass distribution based on the Markov inequality.

  11. Mass Spectrometry and Glycomics

    PubMed Central

    2010-01-01

    Abstract Glycosylation defines the adhesive properties of animal cell surfaces and the surrounding extracellular environments. Because cells respond to stimuli by altering glycan expression, glycan structures vary according to spatial location in tissue and temporal factors. These dynamic structural expression patterns, combined with the essential roles glycans play in physiology, drive the need for analytical methods for glycoconjugates. In addition, recombinant glycoprotein drug products represent a multibillion dollar market. Effective analytical methods are needed to speed the identification of new targets and the development of industrial glycoprotein products, both new and biosimilar. Mass spectrometry is an enabling technology in glycomics. This review summarizes mass spectrometry of glycoconjugate glycans. The intent is to summarize appropriate methods for glycans given their chemical properties as distinct from those of proteins, lipids, and small molecule metabolites. Special attention is given to the uses of mass spectral profiling for glycomics with respect to the N-linked, O-linked, ganglioside, and glycosaminoglycan compound classes. Next, the uses of tandem mass spectrometry of glycans are summarized. The review finishes with an update on mass spectral glycoproteomics. PMID:20443730

  12. Galaxy Cosmological Mass Function

    E-print Network

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

    2014-12-03

    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 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.

  13. Medical student disaster medicine education: the development of an educational resource

    PubMed Central

    Domres, Bernd D.; Stahl, Wolfgang; Bauer, Andreas; Houser, Christine M.; Himmelseher, Sabine

    2010-01-01

    Background Disaster medicine education is an enormous challenge, but indispensable for disaster preparedness. Aims We aimed to develop and implement a disaster medicine curriculum for medical student education that can serve as a peer-reviewed, structured educational guide and resource. Additionally, the process of designing, approving and implementing such a curriculum is presented. Methods The six-step approach to curriculum development for medical education was used as a formal process instrument. Recognized experts from professional and governmental bodies involved in disaster health care provided input using disaster-related physician training programs, scientific evidence if available, proposals for education by international disaster medicine organizations and their expertise as the basis for content development. Results The final course consisted of 14 modules composed of 2-h units. The concepts of disaster medicine, including response, medical assistance, law, command, coordination, communication, and mass casualty management, are introduced. Hospital preparedness plans and experiences from worldwide disaster assistance are reviewed. Life-saving emergency and limited individual treatment under disaster conditions are discussed. Specifics of initial management of explosive, war-related, radiological/nuclear, chemical, and biological incidents emphasizing infectious diseases and terrorist attacks are presented. An evacuation exercise is completed, and a mass casualty triage is simulated in collaboration with local disaster response agencies. Decontamination procedures are demonstrated at a nuclear power plant or the local fire department, and personal decontamination practices are exercised. Mannequin resuscitation is practiced while personal protective equipment is utilized. An interactive review of professional ethics, stress disorders, psychosocial interventions, and quality improvement efforts complete the training. Conclusions The curriculum offers medical disaster education in a reasonable time frame, interdisciplinary format, and multi-experiential course. It can serve as a template for basic medical student disaster education. Because of its comprehensive but flexible structure, it should also be helpful for other health-care professional student disaster education programs. PMID:20414376

  14. Sigmoid colon endometriotic mass

    PubMed Central

    Al-Qahtani, Hamad H.; Alfalah, Haitham; Al-Salamah, Reem A.; Elshair, Adel A.

    2015-01-01

    Large bowel obstruction is a rare complication of gastrointestinal endometriosis. A 32-year-old female patient presented to the emergency department with complaints of diffuse abdominal pain and constipation for 10 days with progressive abdominal distention and vomiting. Plain abdominal x-ray showed grossly dilated large bowel up to the sigmoid colon with no gas in the rectum. Abdominal computed tomography revealed hugely dilated large bowel up to the sigmoid colon, with sigmoid soft tissue mass. Flexible sigmoidoscopy showed a non-ulcerating sigmoid mass, with complete obstruction of the sigmoid colon, which impeded the further advancement of the scope. She underwent exploratory laparotomy with provisional diagnosis of complete large bowel obstruction due to sigmoid tumor. Sigmiodectomy with end colostomy was performed. Histopathology revealed endometrial glands with stroma in muscularis properia of the sigmoid colon mass. Endometriosis should be considered in women of reproductive age presenting with symptoms of large bowel obstruction. PMID:25935187

  15. Neutrino mass hierarchy

    NASA Astrophysics Data System (ADS)

    Qian, X.; Vogel, P.

    2015-07-01

    The neutrino mass hierarchy, i.e., whether the ?3 neutrino mass eigenstate is heavier or lighter than the ?1 and ?2 mass eigenstates, is one of the remaining undetermined fundamental features of the neutrino Standard Model. Its determination would represent an important step in the formulation of the generalized model, and would have a profound impact on the quest of the nature of neutrinos (Dirac or Majorana) and the search for a theory of flavor. In this review, we summarize the status of experimental and theoretical work in this field and explore the future opportunities that emerge in light of the recently discovered non-zero and relatively large third neutrino mixing angle ?13.

  16. The Disk Mass Project

    NASA Astrophysics Data System (ADS)

    Verheijen, Marc A. W.; Bershady, Matthew A.; Swaters, Rob A.; Andersen, David R.; Westfall, Kyle B.

    Little is known about the content and distribution of dark matter in spiral galaxies. To break the degeneracy in galaxy rotation curve decompositions, which allows a wide range of dark matter halo density profiles, an independent measure of the mass surface density of stellar disks is needed. Here, we present our ongoing Disk Mass project, using two custom-built Integral Field Units, to measure the vertical velocity dispersion of stars in ~40 spiral galaxies. This will provide a kinematic measurement of the stellar disk mass required to break the degeneracy, enabling us to determine the dark matter properties in spiral galaxies with unprecedented accuracy. Here we present preliminary results for three galaxies with different central disk surface brightness levels.

  17. Mass discrimination during weightlessness

    NASA Technical Reports Server (NTRS)

    Ross, H.

    1981-01-01

    An experiment concerned with the ability of astronauts to discriminate between the mass of objects when both the objects and the astronauts are in weightless states is described. The main object of the experiment is to compare the threshold for weight-discrimination on Earth with that for mass-discrimination in orbit. Tests will be conducted premission and postmission and early and late during the mission while the crew is experiencing weightlessness. A comparison of early and late tests inflight and postflight will reveal the rate of adaptation to zero-gravity and 1-g. The mass discrimination box holds 24 balls which the astronaut will compare to one another in a random routine.

  18. Galaxy cosmological mass function

    NASA Astrophysics Data System (ADS)

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

    2014-12-01

    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

  19. Conservation of Mass

    NSDL National Science Digital Library

    Perkins School for the Blind

    2012-07-11

    This activity was designed for blind learners, but all types of learners can participate to learn about conservation of gas. This is one of the classic experiments using baking soda and vinegar. The expansion of a balloon with gas provides a tactile experience as the gas is captured rather than being released into the air. The evidence of conservation of mass is supported by the collection of data, by weighing the masses of the reactants before and after the experiment. Learners with visual impairments and sighted students can also learn that matter is neither created nor destroyed during a chemical change.

  20. Mass of Cu-57 

    E-print Network

    Gagliardi, Carl A.; Semon, D. R.; Tribble, Robert E.; Vanausdeln, L. A.

    1986-01-01

    with A ~ 56 (Ref. 3) and possibly for the time evolu- tion of cosmic x-ray bursts. Cu has been observed in the Cu~ Ni+e++v, and Ni( Li, He} Cu reactions. The former study found the Cu mass excess to be ?47.34(13) MeV and deter- mined its beta decay... isotopes. In particular, the shell model prediction of Liran and Zeldes and the recur- sive prediction of Janecke and Garvey-Kelson are in ex- cellent agreement vvith the measurements, demonstrating that the 5 Cu mass excess is consistent...

  1. Understanding Chemistry: Mass Spectrometry

    NSDL National Science Digital Library

    Clark, Jim

    This website, which is part of a larger project "ChemGuide" provides a nice introduction to mass spectrometry that is suitable for use by introductory analytical chemistry students. Content includes an introduction to the instrumentation, explanation of fragmentation and how it can be used to identify compound structure, the origin of the M+ and (M+1)+ peaks. Each section is succinct, well written and provides a simple example. As such the site should be useful to faculty introducing mass spectrometry in the analytical classroom and to chemistry students.

  2. The use of mass defect in modern mass spectrometry.

    PubMed

    Sleno, Lekha

    2012-02-01

    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

  3. Mass Resolution and Mass Accuracy: How Much Is Enough?

    PubMed Central

    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

    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

  4. 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.

  5. THE PROTOSTELLAR MASS FUNCTION

    SciTech Connect

    McKee, Christopher F. [Physics Department and Astronomy Department, University of California, Berkeley, CA 94720 (United States); Offner, Stella S. R., E-mail: cmckee@astro.berkeley.ed, E-mail: soffner@cfa.harvard.ed [Harvard-Smithsonian Center for Astrophysics, Cambridge, MA 02138 (United States)

    2010-06-10

    The protostellar mass function (PMF) is the present-day mass function of the protostars in a region of star formation. It is determined by the initial mass function weighted by the accretion time. The PMF thus depends on the accretion history of protostars and in principle provides a powerful tool for observationally distinguishing different protostellar accretion models. We consider three basic models here: the isothermal sphere model, the turbulent core model, and an approximate representation of the competitive accretion model. We also consider modified versions of these accretion models, in which the accretion rate tapers off linearly in time. Finally, we allow for an overall acceleration in the rate of star formation. At present, it is not possible to directly determine the PMF since protostellar masses are not currently measurable. We carry out an approximate comparison of predicted PMFs with observation by using the theory to infer the conditions in the ambient medium in several star-forming regions. Tapered and accelerating models generally agree better with observed star formation times than models without tapering or acceleration, but uncertainties in the accretion models and in the observations do not allow one to rule out any of the proposed models at present. The PMF is essential for the calculation of the protostellar luminosity function, however, and this enables stronger conclusions to be drawn.

  6. Parametric Mass Reliability Study

    NASA Technical Reports Server (NTRS)

    Holt, James P.

    2014-01-01

    The International Space Station (ISS) systems are designed based upon having redundant systems with replaceable orbital replacement units (ORUs). These ORUs are designed to be swapped out fairly quickly, but some are very large, and some are made up of many components. When an ORU fails, it is replaced on orbit with a spare; the failed unit is sometimes returned to Earth to be serviced and re-launched. Such a system is not feasible for a 500+ day long-duration mission beyond low Earth orbit. The components that make up these ORUs have mixed reliabilities. Components that make up the most mass-such as computer housings, pump casings, and the silicon board of PCBs-typically are the most reliable. Meanwhile components that tend to fail the earliest-such as seals or gaskets-typically have a small mass. To better understand the problem, my project is to create a parametric model that relates both the mass of ORUs to reliability, as well as the mass of ORU subcomponents to reliability.

  7. Thesaurus: Mass Communication.

    ERIC Educational Resources Information Center

    Viet, Jean

    Produced for UNESCO on the initiative of the Division of Communication Research and Planning, this thesaurus is a documentation language divised for the purpose of analyzing works, articles, reports, and other documents relating to the problems of mass communication according to the particular medium to which they refer: books, the press, records,…

  8. Residential Thermal Mass Construction 

    E-print Network

    Thieken, J. S.

    1988-01-01

    The southwest has long known the value of building homes with high mass materials. The ancient Pueblo Indians found that by using "adobe" they could capture the energy necessary to survive the harsh desert climate. Our ancestors knew that a heavy...

  9. Engineering rock mass classifications

    Microsoft Academic Search

    Z. T. Bieniawski

    1989-01-01

    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.

  10. Isotope dilution mass spectrometry

    Microsoft Academic Search

    Klaus G. Heumann

    1992-01-01

    In the past isotope dilution mass spectrometry (IDMS) has usually been applied using the formation of positive thermal ions of metals. Especially in calibrating other analytical methods and for the certification of standard reference materials this type of IDMS became a routine method. Today, the progress in this field lies in the determination of ultra trace amounts of elements, e.g.

  11. Center of Mass 1

    NSDL National Science Digital Library

    Michael Horton

    2009-05-30

    This activity will help students see that a low center of mass helps objects balance. This is important engineering in car and motorcycle racing and robotics. This activity is inquiry in that students would probably predict that you could not get one obje

  12. Galileo Probe Mass Spectrometer

    NASA Technical Reports Server (NTRS)

    Owen, Tobias C.

    1998-01-01

    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.

  13. Seismic mass Top electrode

    E-print Network

    Kraft, Michael

    of which provides loop transducer is described. A bulk-micromachined an accurate measure is that the micromachined, capacitive sensing element had only three connections (top and bottom electrodes and seismic mass domains, (Burstein and Kaiser, 1996). Usually, for an analogue, closed loop accelerometer the latter

  14. Media, Minds, and Masses.

    ERIC Educational Resources Information Center

    Baggot, James; Vino, Faith

    This booklet describes the language arts course "Media, Minds, and Masses," written for the Dade County, Fla., public schools. Topics for the course include the workings of contemporary radio, television, newspapers, magazines, and movies; the present status and power of media; the history and development of media; and the influences of the media…

  15. Ambient Ionization Mass Spectrometry

    Microsoft Academic Search

    Min-Zong Huang; Cheng-Hui Yuan; Sy-Chyi Cheng; Yi-Tzu Cho; Jentaie Shiea

    2010-01-01

    Mass spectrometric ionization methods that operate under ambient conditions and require minimal or no sample pretreatment have attracted much attention in such fields as biomedicine, food safety, antiterrorism, pharmaceuticals, and environmental pollution. These technologies usually involve separate ionization and sample-introduction events, allowing independent control over each set of conditions. Ionization is typically performed under ambient conditions through use of existing

  16. Bibliography on Mass Deacidification.

    ERIC Educational Resources Information Center

    Zimmermann, Carole

    This 259-item bibliography is a compilation of books, articles, technical reports, and conference proceedings which deal with the preservation of books and paper materials through mass deacidification. Materials of historical interest from scientific, library science, and "popular" works have been included. The material is arranged in…

  17. STUDENT ORGANIZATION MASS FUNDING

    E-print Network

    Lawrence, Rick L.

    #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

  18. Residential Thermal Mass Construction

    E-print Network

    Thieken, J. S.

    1988-01-01

    The southwest has long known the value of building homes with high mass materials. The ancient Pueblo Indians found that by using "adobe" they could capture the energy necessary to survive the harsh desert climate. Our ancestors knew that a heavy...

  19. Stateline: Critical Mass

    ERIC Educational Resources Information Center

    Christie, Kathy

    2005-01-01

    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…

  20. Analytical mass spectrometry. Abstracts

    SciTech Connect

    Not Available

    1990-12-31

    This 43rd Annual Summer Symposium on Analytical Chemistry was held July 24--27, 1990 at Oak Ridge, TN and contained sessions on the following topics: Fundamentals of Analytical Mass Spectrometry (MS), MS in the National Laboratories, Lasers and Fourier Transform Methods, Future of MS, New Ionization and LC/MS Methods, and an extra session. (WET)

  1. Analytical mass spectrometry

    SciTech Connect

    Not Available

    1990-01-01

    This 43rd Annual Summer Symposium on Analytical Chemistry was held July 24--27, 1990 at Oak Ridge, TN and contained sessions on the following topics: Fundamentals of Analytical Mass Spectrometry (MS), MS in the National Laboratories, Lasers and Fourier Transform Methods, Future of MS, New Ionization and LC/MS Methods, and an extra session. (WET)

  2. Mass extinctions and macroevolution

    Microsoft Academic Search

    David Jablonski

    2005-01-01

    Mass extinctions are important to macroevolution not only because they involve a sharp increase in extinction intensity over ''background'' levels, but also because they bring a change in extinction selectivity, and these quantitative and qualitative shifts set the stage for evolutionary recoveries. The set of extinction intensities for all stratigraphic stages appears to fall into a single right-skewed distribution, but

  3. Transverse Mass Kink

    SciTech Connect

    Cho, W. S.; Choi, K.; Kim, Y. G.; Park, C. B. [Department of Physics, KAIST, Daejeon 305-701 (Korea, Republic of)

    2008-11-23

    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}.

  4. Precision on the top mass

    E-print Network

    Stefan Weinzierl

    2015-05-04

    In this talk I will focus on theoretical issues related to high precision determinations of the top mass. Several mass definitions are reviewed and their respective advantages and disadvantages are discussed. Precision determinations of the top mass will require a short-distance mass definition. I will summarise current work in this direction.

  5. 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.

  6. Automatic scoring of dicentric chromosomes as a tool in large scale radiation accidents.

    PubMed

    Romm, H; Ainsbury, E; Barnard, S; Barrios, L; Barquinero, J F; Beinke, C; Deperas, M; Gregoire, E; Koivistoinen, A; Lindholm, C; Moquet, J; Oestreicher, U; Puig, R; Rothkamm, K; Sommer, S; Thierens, H; Vandersickel, V; Vral, A; Wojcik, A

    2013-08-30

    Mass casualty scenarios of radiation exposure require high throughput biological dosimetry techniques for population triage in order to rapidly identify individuals who require clinical treatment. The manual dicentric assay is a highly suitable technique, but it is also very time consuming and requires well trained scorers. In the framework of the MULTIBIODOSE EU FP7 project, semi-automated dicentric scoring has been established in six European biodosimetry laboratories. Whole blood was irradiated with a Co-60 gamma source resulting in 8 different doses between 0 and 4.5Gy and then shipped to the six participating laboratories. To investigate two different scoring strategies, cell cultures were set up with short term (2-3h) or long term (24h) colcemid treatment. Three classifiers for automatic dicentric detection were applied, two of which were developed specifically for these two different culture techniques. The automation procedure included metaphase finding, capture of cells at high resolution and detection of dicentric candidates. The automatically detected dicentric candidates were then evaluated by a trained human scorer, which led to the term 'semi-automated' being applied to the analysis. The six participating laboratories established at least one semi-automated calibration curve each, using the appropriate classifier for their colcemid treatment time. There was no significant difference between the calibration curves established, regardless of the classifier used. The ratio of false positive to true positive dicentric candidates was dose dependent. The total staff effort required for analysing 150 metaphases using the semi-automated approach was 2 min as opposed to 60 min for manual scoring of 50 metaphases. Semi-automated dicentric scoring is a useful tool in a large scale radiation accident as it enables high throughput screening of samples for fast triage of potentially exposed individuals. Furthermore, the results from the participating laboratories were comparable which supports networking between laboratories for this assay. PMID:23707243

  7. The bio-terrorism threat and casualty prevention.

    SciTech Connect

    Noel, William P.

    1999-10-01

    The bio-terrorism threat has become the 'poor man's' nuclear weapon. The ease of manufacture and dissemination has allowed an organization with only rudimentary skills and equipment to pose a significant threat with high consequences. This report will analyze some of the most likely agents that would be used, the ease of manufacture, the ease of dissemination and what characteristics of the public health response that are particularly important to the successful characterization of a high consequence event to prevent excessive causalities.

  8. The Casualties of the Twenty-First-Century Community College

    ERIC Educational Resources Information Center

    Wilson, David McKay

    2010-01-01

    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…

  9. 46 CFR 169.807 - Notice of casualty.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ...voyage records of the vessel such as both rough and smooth deck and engineroom logs, navigation charts, navigation work books, compass deviation cards, gyrocompass records, record of draft, aids to mariners, radiograms sent and received, the radio...

  10. 46 CFR 169.807 - Notice of casualty.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ...voyage records of the vessel such as both rough and smooth deck and engineroom logs, navigation charts, navigation work books, compass deviation cards, gyrocompass records, record of draft, aids to mariners, radiograms sent and received, the radio...

  11. 46 CFR 169.807 - Notice of casualty.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ...voyage records of the vessel such as both rough and smooth deck and engineroom logs, navigation charts, navigation work books, compass deviation cards, gyrocompass records, record of draft, aids to mariners, radiograms sent and received, the radio...

  12. 46 CFR 169.807 - Notice of casualty.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ...voyage records of the vessel such as both rough and smooth deck and engineroom logs, navigation charts, navigation work books, compass deviation cards, gyrocompass records, record of draft, aids to mariners, radiograms sent and received, the radio...

  13. 46 CFR 169.807 - Notice of casualty.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ...voyage records of the vessel such as both rough and smooth deck and engineroom logs, navigation charts, navigation work books, compass deviation cards, gyrocompass records, record of draft, aids to mariners, radiograms sent and received, the radio...

  14. Treatment of the Stress Casualty during Operation Iraqi Freedom One

    Microsoft Academic Search

    Robert Forsten; Brett Schneider

    2005-01-01

    Introduction: Service members with mental health issues during Operation Iraqi Freedom receive evaluation and treatment at different echelons of care. Mental health teams consist of professionals and paraprofessionals assigned to Combat Stress Control units, Division Mental Health Sections, and Combat Support Hospitals. Methods: Army doctrine for mental health care is delineated and examples describing how mental health personnel must be

  15. A decision support system for managing forest fire casualties.

    PubMed

    Bonazountas, Marc; Kallidromitou, Despina; Kassomenos, Pavlos; Passas, Nikos

    2007-09-01

    Southern Europe is exposed to anthropogenic and natural forest fires. These result in loss of lives, goods and infrastructure, but also deteriorate the natural environment and degrade ecosystems. The early detection and combating of such catastrophes requires the use of a decision support system (DSS) for emergency management. The current literature reports on a series of efforts aimed to deliver DSSs for the management of the forest fires by utilising technologies like remote sensing and geographical information systems (GIS), yet no integrated system exists. This manuscript presents the results of scientific research aiming to the development of a DSS for managing forest fires. The system provides a series of software tools for the assessment of the propagation and combating of forest fires based on Arc/Info, ArcView, Arc Spatial Analyst, Arc Avenue, and Visual C++ technologies. The system integrates GIS technologies under the same data environment and utilises a common user interface to produce an integrated computer system based on semi-automatic satellite image processing (fuel maps), socio-economic risk modelling and probabilistic models that would serve as a useful tool for forest fire prevention, planning and management. Its performance has been demonstrated via real time up-to-date accurate information on the position and evolution of the fire. The system can assist emergency assessment, management and combating of the incident. A site demonstration and validation has been accomplished for the island of Evoia, Greece, an area particularly vulnerable to forest fires due to its ecological characteristics and prevailing wind patterns. PMID:16928418

  16. Estimating Casualties for Large Earthquakes Worldwide Using an Empirical Approach

    USGS Publications Warehouse

    Jaiswal, Kishor; Wald, David J.; Hearne, Mike

    2009-01-01

    We developed an empirical country- and region-specific earthquake vulnerability model to be used as a candidate for post-earthquake fatality estimation by the U.S. Geological Survey's Prompt Assessment of Global Earthquakes for Response (PAGER) system. The earthquake fatality rate is based on past fatal earthquakes (earthquakes causing one or more deaths) in individual countries where at least four fatal earthquakes occurred during the catalog period (since 1973). Because only a few dozen countries have experienced four or more fatal earthquakes since 1973, we propose a new global regionalization scheme based on idealization of countries that are expected to have similar susceptibility to future earthquake losses given the existing building stock, its vulnerability, and other socioeconomic characteristics. The fatality estimates obtained using an empirical country- or region-specific model will be used along with other selected engineering risk-based loss models for generation of automated earthquake alerts. These alerts could potentially benefit the rapid-earthquake-response agencies and governments for better response to reduce earthquake fatalities. Fatality estimates are also useful to stimulate earthquake preparedness planning and disaster mitigation. The proposed model has several advantages as compared with other candidate methods, and the country- or region-specific fatality rates can be readily updated when new data become available.

  17. Complaint Ratios and Property-Casualty Insurer Characteristics

    Microsoft Academic Search

    James M. Carson; Kathleen McCullough; David T. Russell

    2005-01-01

    We extend previous research by Doerpinghaus (1991) and others by examining relationships between private passenger auto insurance complaint ratios and insurer characteristics. Consistent with Doerpinghaus, results indicate that insurers with higher complaint ratios are more likely to write high-risk auto coverage. In addition, this study provides evidence that insurers experiencing relatively fewer complaints spend significantly less on legal and auditing

  18. Nuclear/radiological terrorism: emergency department management of radiation casualties.

    PubMed

    Bushberg, Jerrold T; Kroger, Linda A; Hartman, Marcia B; Leidholdt, Edwin M; Miller, Kenneth L; Derlet, Robert; Wraa, Cheryl

    2007-01-01

    Recent world events have increased concern that hospitals must be prepared for radiological emergencies. Emergency departments (EDs) must be ready to treat patients suffering from injuries in combination with radiation exposure or contamination with radioactive material. Every hospital should have a Radiological Emergency Medical Response Plan, tested through periodic drills, which will allow effective handling of contaminated and injured patients. Treatment of life-threatening or severe traumatic injuries must take priority over radiation-related issues. The risk to ED staff from radioactive contamination is minimal if universal precautions are used. The likelihood of significant radiation exposure to staff under most circumstances is small. Educating medical staff on the magnitude of the radiological hazards allows them to promptly and confidently provide the necessary patient care. Measures must be taken to prevent the "worried well" and uninjured people with radioactive contamination from overwhelming the ED. PMID:17239736

  19. 26 CFR 1.165-7 - Casualty losses.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ...Section 1.165-7 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY...Similarly, if a hurricane causes high waves, all wind and flood damage to a taxpayer's...property caused by the hurricane and the waves results from a single...

  20. 26 CFR 1.165-7 - Casualty losses.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ...Section 1.165-7 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY...Similarly, if a hurricane causes high waves, all wind and flood damage to a taxpayer's...property caused by the hurricane and the waves results from a single...

  1. 26 CFR 1.165-7 - Casualty losses.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ...Section 1.165-7 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY...Similarly, if a hurricane causes high waves, all wind and flood damage to a taxpayer's...property caused by the hurricane and the waves results from a single...

  2. Bridal Laments in the Turkic World: A Casualty of Modernity?

    E-print Network

    Dwyer, Arienne M.

    2008-01-01

    -DAT hand lay-PURP-PERF.DEF 4. ?a??i po?da??? ? ? ?aba laji mu??t?? ? ? Aji boghdaghi aba layi mushti grandmother neck-3POS grandfather ?? 5. ?a?or a?u?? ? x? giji jo ? ? Ahur aghur..., such as ahur ‘now,’ aqa ‘elder sister’ (compare modern Salar quxur, ajie for these lexemes), and ad?ngghan ‘stagnant.’ Furthermore, her grammar reflects archaisms in e.g. the consistent use of the possessive on nouns (e.g. abam ‘my father’) and the use...

  3. First Aid for Female Casualties of the Information Highway

    ERIC Educational Resources Information Center

    Redmond, Petrea

    2006-01-01

    Females are under-represented in education, training and employment in the area of Information Communication Technology (ICT). Research shows that girls are tuning out to ICTs in school and they have a low participation rate in ICT related tertiary study and employment. The Tech Savvy report by the American Association of University Women (2000)…

  4. Mass of Ca-36 

    E-print Network

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

    1977-01-01

    (number of counts) logarithmic. Several particle groups are lndlcated. MASS OF 36Ca 2029 I I l Ca( He He) Ca 4000 ?POSITION SPECTRUM Ca(4He, He) Ca 5000- 0O 2000 Iooo? s.sss 7.800 8e- C C3 Oy. 2- n, nn -58.5 -58& -57.5 Q Value Wf1 -570... I. Properties of the A =36 isobaric quintet members and the IMME coefficients. Nuclide Mass excess (keV) E? (keV) Ref. 36Ca "A.r 36( I 36S -2 0 1 2 -6440 + 40 -19376.3 + 1.6 -25 222.3+ 1.1 -30 666.0 + 1.5 0.0 10 854.2 + 1.6 4299...

  5. A mystifying mass

    PubMed Central

    Sharp, Gary; Railton, Nicholas; Kadirkamanathan, Sritharan

    2014-01-01

    A 57-year-old male was referred by his general practitioner (GP) to hospital with right upper quadrant pain and a palpable mass (10 × 9 cm). He had been assessed by his GP several weeks earlier and represented as initial treatment failed. On his second presentation a mass was evident and thought to represent cholecystitis by the referring GP. However, the correct and prompt use of appropriate radiological imaging enabled swift diagnosis and management of atypical acute appendicitis through microbial specific therapy. Atypical appendicitis delays diagnosis and treatment which represents greater levels of appendiceal ischaemia and heightened perforation risk. This case study highlights the non-surgical management of acute atypical appendicitis and also reinforces the use of appropriate imaging modalities. PMID:24876326

  6. Biological Cluster Mass Spectrometry

    PubMed Central

    Winograd, Nicholas; Garrison, Barbara J.

    2010-01-01

    This article reviews the new physics and new applications of secondary ion mass spectrometry using cluster ion probes. These probes, particularly C60, exhibit enhanced molecular desorption with improved sensitivity owing to the unique nature of the energy-deposition process. In addition, these projectiles are capable of eroding molecular solids while retaining the molecular specificity of mass spectrometry. When the beams are microfocused to a spot on the sample, bioimaging experiments in two and three dimensions are feasible. We describe emerging theoretical models that allow the energy-deposition process to be understood on an atomic and molecular basis. Moreover, experiments on model systems are described that allow protocols for imaging on biological materials to be implemented. Finally, we present recent applications of imaging to biological tissue and single cells to illustrate the future directions of this methodology. PMID:20055679

  7. Neutrino mass: Recent results

    SciTech Connect

    Robertson, R.G.H.

    1989-01-01

    Some recent developments in the experimental search for neutrino mass are discussed. Simpson and Hime report finding new evidence for a 17-keV neutrino in the {beta} decay of {sup 3}H and {sup 35}S. New data from Los Alamos on the electron neutrino mass as measured in tritium beta decay give an upper limit of 13.5 eV at the 95% confidence level. This result is not consistent with the long-standing ITEP result of 26(5) eV within a model-independent'' range of 17 to 40 eV. It now appears that the electron neutrino is not sufficiently massive to close the universe by itself. 38 refs., 1 figs., 2 tabs.

  8. Mass Spectrometry and Glycomics

    Microsoft Academic Search

    Jasna Peter-Katalinic

    Mass spectrometry (MS) in biochemical and biophysical research of complex carbohydrates has to meet a number of challenges\\u000a if compared to other biomacromolecules, like proteins and nucleic acids. MS, as an universal and indispensible tool for analysis\\u000a of biological samples after introduction of soft ionization techniques, like Fast Atom Bombardment (FAB), electrospray (ESI)\\u000a and matrix-assisted laser desorption ionization (MALDI), allows

  9. Electrospray Ionization Mass Spectrometry

    SciTech Connect

    Kelly, Ryan T.; Marginean, Ioan; Tang, Keqi

    2014-06-13

    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.

  10. Critical Mass and Efficiency

    Microsoft Academic Search

    B. Cameron Reed

    \\u000a This chapter forms the heart of this book. After deriving the properties of neutron travel through materials, a detailed analysis\\u000a is presented of how the critical mass of a fissile material, in both “bare” and “tampered” configurations, can be calculated.\\u000a The calculations are applied to both uranium-235 and plutonium-239. Analytic expressions are developed for estimating bomb\\u000a energy yield and efficiency.

  11. Mass Balance Model

    NSDL National Science Digital Library

    Robert MacKay

    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.

  12. Mapping Dirac gaugino masses

    NASA Astrophysics Data System (ADS)

    Abel, Steven; Busbridge, Daniel

    2013-11-01

    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.

  13. Quasiconformality and mass

    SciTech Connect

    Dietrich, Dennis D. [CP3-Origins, Centre for Particle Physics Phenomenology, University of Southern Denmark, Odense (Denmark)

    2010-09-15

    We identify universal quasiconformal (walking) behavior in non-Abelian gauge field theories based on the mass-dependent all-order {beta} function introduced in [D. D. Dietrich, Phys. Rev. D 80, 065032 (2009)]. We find different types of walking behavior in the presence of (partially) massive species. We employ our findings to the construction of candidate theories for dynamical electroweak symmetry breaking by walking technicolor.

  14. Mass spectrometry of oligosaccharides.

    PubMed

    Zaia, Joseph

    2004-01-01

    Glycosylation is a common post-translational modification to cell surface and extracellular matrix (ECM) proteins as well as to lipids. As a result, cells carry a dense coat of carbohydrates on their surfaces that mediates a wide variety of cell-cell and cell-matrix interactions that are crucial to development and function. Because of the historical difficulties with the analysis of complex carbohydrate structures, a detailed understanding of their roles in biology has been slow to develop. Just as mass spectrometry has proven to be the core technology behind proteomics, it stands to play a similar role in the study of functional implications of carbohydrate expression, known as glycomics. This review summarizes the state of knowledge for the mass spectrometric analysis of oligosaccharides with regard to neutral, sialylated, and sulfated compound classes. Mass spectrometric techniques for the ionization and fragmentation of oligosaccharides are discussed so as to give the reader the background to make informed decisions to solve structure-activity relations in glycomics. PMID:14966796

  15. Mass, inertia and gravitation

    E-print Network

    Marc-Thierry Jaekel; Serge Reynaud

    2008-12-22

    We discuss some effects induced by quantum field fluctuations on mass, inertia and gravitation. Recalling the problem raised by vacuum field fluctuations with respect to inertia and gravitation, we show that vacuum energy differences, such as Casimir energy, do contribute to inertia. Mass behaves as a quantum observable and in particular possesses quantum fluctuations. We show that the compatibility of the quantum nature of mass with gravitation can be ensured by conformal symmetries, which allow one to formulate a quantum version of the equivalence principle. Finally, we consider some corrections to the coupling between metric fields and energy-momentum tensors induced by radiative corrections. Newton gravitation constant is replaced by two different running coupling constants in the sectors of traceless and traced tensors. There result metric extensions of general relativity, which can be characterized by modified Ricci curvatures or by two gravitation potentials. The corresponding phenomenological framework extends the usual Parametrized Post-Newtonian one, with the ability to remain compatible with classical tests of gravity while accounting for new features, such as Pioneer like anomalies or anomalous light deflection.

  16. Isotope Ratio Mass Spectrometry.

    PubMed

    Muccio, Zeland; Jackson, Glen P

    2009-02-01

    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

  17. High Precision Dynamical Masses of Very Low Mass Binaries

    E-print Network

    Konopacky, Q M; Barman, T S; Rice, E L; Bailey, J I; White, R J; McLean, I S; Duchene, G

    2010-01-01

    [ABRIDGED] We present the results of a 3 year monitoring program of a sample of very low mass (VLM) field binaries using both astrometric and spectroscopic data obtained in conjunction with the laser guide star adaptive optics system on the W.M. Keck II 10 m telescope. Fifteen systems have undergone sufficient orbital motion, allowing us to derive their relative orbital parameters and hence their total system mass. These measurements triple the number of masses for VLM objects. Among the 11 systems with both astrometric and spectroscopic measurements, six have sufficient radial velocity variations to allow us to obtain individual component masses. This is the first derivation of the component masses for five of these systems. Altogether, the orbital solutions of these low mass systems show a correlation between eccentricity and orbital period, consistent with their higher mass counterparts. In our primary analysis, we find that there are systematic discrepancies between our dynamical mass measurements and the...

  18. Macro-microscopic mass formulae and nuclear mass predictions

    E-print Network

    Boyer, Edmond

    , France 1 Abstract Different mass formulae derived from the liquid drop model and the pairing and shell; 21.60.Ev; 21.60.Cs Keywords: Mass formula, liquid drop model, Wigner term, curvature energy. 1 E performed from mass formulae working well for the known isotopes. Semi-macroscopic liquid drop models

  19. Low-mass dileptons and dropping rho meson mass

    Microsoft Academic Search

    E. L. Bratkovskaya; C. M. Ko

    1999-01-01

    Using the transport model, we have studied dilepton production from heavy-ion collisions at Bevalac energies. It is found that the enhanced production of low-mass dileptons observed in the experiment by the DLS collaboration cannot be explained by the dropping of hadron masses, in particular the ?-meson mass, in dense matter.

  20. Low-mass dileptons and dropping rho meson mass

    E-print Network

    E. L. Bratkovskaya; C. M. Ko

    1998-12-02

    Using the transport model, we have studied dilepton production from heavy-ion collisions at Bevalac energies. It is found that the enhanced production of low-mass dileptons observed in the experiment by the DLS collaboration cannot be explained by the dropping of hadron masses, in particular the $\\rho$-meson mass, in dense matter.

  1. Low-mass dileptons and dropping rho meson mass

    Microsoft Academic Search

    E. L. Bratkovskaya; C. M. Ko

    1999-01-01

    Using the transport model, we have studied dilepton production from heavy-ion collisions at Bevalac energies. It is found that the enhanced production of low-mass dileptons observed in the experiment by the DLS collaboration cannot be explained by the dropping of hadron masses, in particular the rho-meson mass, in dense matter.

  2. Target mass corrections revisited

    SciTech Connect

    Steffens, F.M. [NFC-FCBEE-Universidade Presbiteriana Mackenzie, Rua da Consolacao 930, 01302-907, Sao Paulo, SP, Brazil IFT-UNESP, Rua Pamplona 145, 01405-900, Sao Paulo, SP (Brazil); Melnitchouk, W. [Jefferson Lab, 12000 Jefferson Avenue, Newport News, Virginia 23606 (United States)

    2006-05-15

    We propose a new implementation of target mass corrections to nucleon structure functions which, unlike existing treatments, has the correct kinematic threshold behavior at finite Q{sup 2} in the x{yields}1 limit. We illustrate the differences between the new approach and existing prescriptions by considering specific examples for the F{sub 2} and F{sub L} structure functions, and discuss the broader implications of our results, which call into question the notion of universal parton distribution at finite Q{sup 2}.

  3. Target Mass Corrections Revisited

    SciTech Connect

    W. Melnitchouk; F. Steffens

    2006-03-07

    We propose a new implementation of target mass corrections to nucleon structure functions which, unlike existing treatments, has the correct kinematic threshold behavior at finite Q{sup 2} in the x {yields} 1 limit. We illustrate the differences between the new approach and existing prescriptions by considering specific examples for the F{sub 2} and F{sub L} structure functions, and discuss the broader implications of our results, which call into question the notion of universal parton distribution at finite Q{sup 2}.

  4. Transplanckian masses in inflation

    E-print Network

    Barenboim, G

    2015-01-01

    In this work, we explore the possibility that the transplanckian field values needed to accommodate the experimental results in minimally coupled single-field inflation models are only due to our insistence of imposing a minimal coupling of the inflaton field to gravity. A simple conformal transformation can bring the field values below the Planck mass without changing the physics at the expense of having a richer gravitational sector. Transplanckian field values may be the signal that we are (miss)interpreting phenomena due to gravity as being originated exclusively in the scalar sector.

  5. Quantitative biomedical mass spectrometry

    NASA Astrophysics Data System (ADS)

    de Leenheer, Andrép; Thienpont, Linda M.

    1992-09-01

    The scope of this contribution is an illustration of the capabilities of isotope dilution mass spectrometry (IDMS) for quantification of target substances in the biomedical field. After a brief discussion of the general principles of quantitative MS in biological samples, special attention will be paid to new technological developments or trends in IDMS from selected examples from the literature. The final section will deal with the use of IDMS for accuracy assessment in clinical chemistry. Methodological aspects considered crucial for avoiding sources of error will be discussed.

  6. Schwarzschild mass uncertainty

    NASA Astrophysics Data System (ADS)

    Davidson, Aharon; Yellin, Ben

    2014-02-01

    Applying Dirac's procedure to -dependent constrained systems, we derive a reduced total Hamiltonian, resembling an upside down harmonic oscillator, which generates the Schwarzschild solution in the mini super-spacetime. Associated with the now -dependent Schrodinger equation is a tower of localized Guth-Pi-Barton wave packets, orthonormal and non-singular, admitting equally spaced average-`energy' levels. Our approach is characterized by a universal quantum mechanical uncertainty structure which enters the game already at the flat spacetime level, and accompanies the massive Schwarzschild sector for any arbitrary mean mass. The average black hole horizon surface area is linearly quantized.

  7. VMSL: Virtual Mass Spectrometry Laboratory

    NSDL National Science Digital Library

    2011-07-05

    This site presents a series of case studies that can be explored using modern mass spectrometry methods. The problem-solving nature of the site provides students a virtual laboratory experience that can supplement access to mass spectrometry instrumentation.

  8. The electromagnetic mass analyser EMMA

    NASA Astrophysics Data System (ADS)

    Davids, B.

    2014-01-01

    EMMA is a recoil mass spectrometer for ISAC-II at TRIUMF that will be used to separate the recoils of nuclear reactions from the beam and to disperse them according to their mass-to-charge ratios. EMMA has been designed for both efficiency and selectivity, possessing large acceptances in angle, mass, and energy without sacrificing the necessary beam suppression and mass resolving power.

  9. THE MASS DISTRIBUTION OF STELLAR-MASS BLACK HOLES

    SciTech Connect

    Farr, Will M.; Sravan, Niharika; Kalogera, Vicky [Northwestern University Center for Interdisciplinary Exploration and Research in Astrophysics, 2145 Sheridan Rd., Evanston, IL 60208 (United States); Cantrell, Andrew; Kreidberg, Laura; Bailyn, Charles D. [Department of Astrophysics, Yale University, P. O. Box 208101, New Haven, CT 06520 (United States); Mandel, Ilya, E-mail: w-farr@northwestern.edu, E-mail: niharika.sravan@gmail.com, E-mail: vicky@northwestern.edu, E-mail: andrew.cantrell@yale.edu, E-mail: laura.kreidberg@yale.edu, E-mail: charles.bailyn@yale.edu, E-mail: ilyamandel@chgk.info [Kavli Institute, Massachusetts Institute of Technology, Cambridge, MA 02139 (United States)

    2011-11-10

    We perform a Bayesian analysis of the mass distribution of stellar-mass black holes using the observed masses of 15 low-mass X-ray binary systems undergoing Roche lobe overflow and 5 high-mass, wind-fed X-ray binary systems. Using Markov Chain Monte Carlo calculations, we model the mass distribution both parametrically-as a power law, exponential, Gaussian, combination of two Gaussians, or log-normal distribution-and non-parametrically-as histograms with varying numbers of bins. We provide confidence bounds on the shape of the mass distribution in the context of each model and compare the models with each other by calculating their relative Bayesian evidence as supported by the measurements, taking into account the number of degrees of freedom of each model. The mass distribution of the low-mass systems is best fit by a power law, while the distribution of the combined sample is best fit by the exponential model. This difference indicates that the low-mass subsample is not consistent with being drawn from the distribution of the combined population. We examine the existence of a 'gap' between the most massive neutron stars and the least massive black holes by considering the value, M{sub 1%}, of the 1% quantile from each black hole mass distribution as the lower bound of black hole masses. Our analysis generates posterior distributions for M{sub 1%}; the best model (the power law) fitted to the low-mass systems has a distribution of lower bounds with M{sub 1%}>4.3 M{sub sun} with 90% confidence, while the best model (the exponential) fitted to all 20 systems has M{sub 1%}>4.5 M{sub sun} with 90% confidence. We conclude that our sample of black hole masses provides strong evidence of a gap between the maximum neutron star mass and the lower bound on black hole masses. Our results on the low-mass sample are in qualitative agreement with those of Ozel et al., although our broad model selection analysis more reliably reveals the best-fit quantitative description of the underlying mass distribution. The results on the combined sample of low- and high-mass systems are in qualitative agreement with Fryer and Kalogera, although the presence of a mass gap remains theoretically unexplained.

  10. Mass Spectrometry & Proteomics Services Unit

    E-print Network

    Graham, Nick

    Mass Spectrometry & Proteomics Services Unit Peptide and Protein Submission Form Website: http for analysis is dependent on sample complexity. Normally it takes 1-2 days for mass determination, and 3-5 days for protein identification by in-gel digestion and LC MS/MS analysis. 2. Mass spectrometric analysis Operator

  11. Textures and Lepton Mass Matrices

    E-print Network

    Fakay, Priyanka

    2014-01-01

    In view of the precise measurement of the leptonic mixing angle \\theta_{13}, implications of the latest mixing data have been investigated for lepton mass matrices pertaining to Dirac neutrinos.These texture specific lepton mass matrices have been examined for their compatibility with the latest data in the cases of normal hierarchy, inverted hierarchy and degenerate scenario of neutrino masses.

  12. Mass spectrometry of priority pollutants

    SciTech Connect

    Middleditch, B.S.; Hines, H.B.; Missler, S.R.

    1981-01-01

    This book presents information on the following subjects: anintroduction to gas chromatography; mass spectrometry; review of available methods for comparing spectra; selective ion monitoring; problems associated with the analysis of volatile samples and problems of data processing; use of mass spectrometry in environmental science, cosmo-chemistry, geochemistry, and the pharmaceutical and petrochemical industries; and modern mass spectrometers.

  13. Mass movement in northeast Afghanistan

    Microsoft Academic Search

    John F. Shroder; Brandon J. Weihs; Megan Jensen Schettler

    Mass movements of nearly all types occur in Afghanistan but in the high relief, rugged Pamir and Hindu Kush mountains of northeastern Afghanistan, mass-movement threats to lives and property necessitated study to elucidate problems to development. Twenty-two different mass movements in bedrock in the Badakhshan Province of northeastern Afghanistan were studied for this paper, including large rock falls and rock

  14. Linear electric field mass spectrometry

    DOEpatents

    McComas, D.J.; Nordholt, J.E.

    1992-12-01

    A mass spectrometer and methods for mass spectrometry are described. The apparatus is compact and of low weight and has a low power requirement, making it suitable for use on a space satellite and as a portable detector for the presence of substances. High mass resolution measurements are made by timing ions moving through a gridless cylindrically symmetric linear electric field. 8 figs.

  15. Top quark mass measurements

    SciTech Connect

    L. Cerrito

    2004-07-16

    Preliminary results on the measurement of the top quark mass at the Tevatron Collider are presented. In the dilepton decay channel, the CDF Collaboration measures m{sub t} = 175.0{sub -16.9}{sup +17.4}(stat.){+-}8.4(syst.) GeV/c{sup 2}, using a sample of {approx} 126 pb{sup -1} of proton-antiproton collision data at {radical}s = 1.96 TeV (Run II). In the lepton plus jets channel, the CDF Collaboration measures 177.5{sub -9.4}{sup +12.7}(stat.) {+-} 7.1(syst.) GeV/c{sup 2}, using a sample of {approx} 102 pb{sup -1} at {radical}s = 1.96 TeV. The D0 Collaboration has newly applied a likelihood technique to improve the analysis of {approx} 125 pb{sup -1} of proton-antiproton collisions at {radical}s = 1.8 TeV (Run I), with the result: m{sub t} = 180.1 {+-} 3.6(stat.) {+-}3.9(syst.) GeV/c{sup 2}. The latter is combined with all the measurements based on the data collected in Run I to yield the most recent and comprehensive experimental determination of the top quark mass: m{sub t} = 178.0 {+-} 2.7(stat.) {+-} 3.3(syst.) GeV/c{sup 2}.

  16. A new scoring system for the triage of cardiac tamponade.

    PubMed

    Imazio, Massimo; Adler, Yehuda; Risti?, Arsen D; Charron, Philippe

    2015-03-01

    Prompt recognition of cardiac tamponade is critical since the underlying hemodynamic disorder can lead to death if not resolved by percutaneous or surgical drainage of the pericardium. Nevertheless, the management of cardiac tamponade can be challenging because of the lack of the validated criteria for the risk stratification that should guide clinicians in the decision-making process. The Working Group on Myocardial and Pericardial Diseases issued this position statement in order to reply to specific questions: Which patients need immediate drainage of the pericardial effusion?; Is echocardiography sufficient for guidance of pericardiocentesis or should patient be taken to the cardiac catheterization laboratory?; Who should be transferred to specialized/tertiary institution or surgical service?; What type of medical support is necessary during transportation? Current European guidelines published in 2004 do not cover these issues and no additional guidelines are available from major medical and cardiology societies. PMID:25683169

  17. Emergency ambulance dispatch: is there a case for triage?

    PubMed Central

    Thakore, S; McGugan, E A; Morrison, W

    2002-01-01

    Emergency telephone calls for an ambulance (999 calls) are usually dealt with first-come first-served. We have devised and assessed criteria that ambulance dispatch might use to prioritize responses. Data were collected retrospectively on consecutive patients presenting to an accident and emergency (A&E) department after a 999 call. An unblinded researcher abstracted data including age, date, time, caller, location, reason for call and A&E diagnosis and each case was examined for ten predetermined criteria necessitating an immediate ambulance response—namely, cardiac arrest; chest pain; shortness of breath; altered mental status/seizure; abdominal/loin pain >65 years old; fresh haematemesis; fall >2m; stabbing; major burns. 471 patients were recruited, 55% male, median age 50 years. 406 calls came from bystanders or the patients themselves, 36 from general practitioners, 8 from other hospitals and 21 from the police. 52% of patients were admitted. 44% met at least one of the above criteria. Most patients did not meet the criteria for an immediate ambulance response but might nonetheless be suitable for an urgent response. The criteria used in this study have the advantage of being based on the history provided by the caller. The introduction of a priority-based dispatch system could reduce response times to those who are seriously ill, and also improve road safety. PMID:11872760

  18. Subpopulation triage: how to allocate conservation effort among populations.

    PubMed

    McDonald-Madden, Eve; Baxter, Peter W J; Possingham, Hugh P

    2008-06-01

    Threatened species often exist in a small number of isolated subpopulations. Given limitations on conservation spending, managers must choose from strategies that range from managing just one subpopulation and risking all other subpopulations to managing all subpopulations equally and poorly, thereby risking the loss of all subpopulations. We took an economic approach to this problem in an effort to discover a simple rule of thumb for optimally allocating conservation effort among subpopulations. This rule was derived by maximizing the expected number of extant subpopulations remaining given n subpopulations are actually managed. We also derived a spatiotemporally optimized strategy through stochastic dynamic programming. The rule of thumb suggested that more subpopulations should be managed if the budget increases or if the cost of reducing local extinction probabilities decreases. The rule performed well against the exact optimal strategy that was the result of the stochastic dynamic program and much better than other simple strategies (e.g., always manage one extant subpopulation or half of the remaining subpopulation). We applied our approach to the allocation of funds in 2 contrasting case studies: reduction of poaching of Sumatran tigers (Panthera tigris sumatrae) and habitat acquisition for San Joaquin kit foxes (Vulpes macrotis mutica). For our estimated annual budget for Sumatran tiger management, the mean time to extinction was about 32 years. For our estimated annual management budget for kit foxes in the San Joaquin Valley, the mean time to extinction was approximately 24 years. Our framework allows managers to deal with the important question of how to allocate scarce conservation resources among subpopulations of any threatened species. PMID:18477029

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

    ERIC Educational Resources Information Center

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

    2011-01-01

    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…

  20. Triage and Transport of Infants and Children with Cardiac Disease

    Microsoft Academic Search

    Bradley A. Kuch; Richard A. Orr

    \\u000a Advances in cardiology, intensive care, and surgical techniques have led to the survival of children with previously lethal\\u000a congenital cardiac defects [1–3]. A large number of these children present to local community hospitals, nurseries, and emergency\\u000a for their initial stabilization before being transferred to regional tertiary care centers for more invasive diagnostic, surgical,\\u000a and\\/or critical care intervention. Because of this,